N.J. Admin. Code § 10:69-6.1 - Definitions

Current through Register Vol. 54, No. 7, April 4, 2022

The following words and terms, when used in this subchapter, shall have the following meanings unless the context clearly indicates otherwise.

"Adequate notice" means a written notice that meets the requirements of N.J.A.C. 10:69-6.2(d).

"Administrative hearings" are hearings concerning either contested cases or non-contested cases, which have been determined by the Director of the Division of Medical Assistance and Health Services (DMAHS) in accordance with N.J.A.C. 1:1-1, to be appropriately heard in the Office of Administrative Law (see N.J.A.C. 10:6).

"Administrative law judge" (ALJ) means the person from the Office of Administrative Law (OAL) who conducts the hearing and who writes an initial decision which may be reviewed by the Director of the Division of Medical Assistance and Health Services.

"Administrative review" means a review of a disputed matter that has been determined by the Director of the Division of Medical Assistance and Health Services not to constitute a contested case and therefore remains in the Division for review. At the discretion of the Director, an administrative review may be conducted as a procedure at which parties appear and are heard or it may be a paper review (see N.J.A.C. 10:69-6.6 ).

"Administrative review official" is a representative of the State, Department of Human Services assigned to conduct an administrative review.

"Adverse action" means any action by a CWA resulting in denial of application for AFDC-related Medicaid. An adverse action is an action to deny an application for Medicaid, or to terminate Medicaid (including service, vendor payments, or Medicaid entitlement) or to deny payment to a vendor for medical services required to be reimbursed by the CWA.

"CFR" is the acronym for Code of Federal Regulations.

"Contested case" means a dispute that is heard by an Administrative Law Judge.

"Fair hearing" means a formal or informal procedure through which an AFDC-related Medicaid client may protest an adverse action or decision of the CWA regarding eligibility or manner of granting AFDC-related Medicaid. Fair hearing is a general term that includes administrative hearing and administrative review.

"Initial decision" means the decision of an administrative law judge that is sent to the Director of the Division of Medical Assistance and Health Services, who may accept, reject or modify it within 45 days.

"Timely notice" means that the notice is mailed at least 10 days before the effective date of agency action.

Notes

N.J. Admin. Code § 10:69-6.1
Amended by 49 N.J.R. 3729(a), effective 12/4/2017

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