N.J. Admin. Code § 10:69-7.7 - Retention and destruction of case records

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

(a) Each CWA shall retain all material normally kept in the "case folder" for the time periods indicated in (b) below. At the expiration of such time period the CWA may, at its option, destroy records in accordance with (c) and (d) below, continuing to retain those portions indicated. In permanent available archives, the CWA shall retain information showing the date and manner of destruction of each "case folder" destroyed.
1. "Case folder" shall be construed to mean the entire set of financial eligibility records related to eligibility determinations for one person or household. Each such case folder may be reviewed as a single unit without reference to the fact that the person(s) involved may have received Medicaid or may be receiving Medicaid under another program.
(b) Retention periods are as follows:
1. In destroying records in this category, the agency shall provide for the permanent retention of information by which to assure itself in the future of the absence of a claim and the reason(s) therefor.

Case Folders Retention Period
a. Cases denied or rejected without Three years after the last
providing Medicaid coverage official agency action or court
action that influences the
granting or recovery of
b. Cases in which all incorrectly Medicaid coverage or the receipt
provided Medicaid coverage has of the final recovery payment,
been repaid in full whichever is later.
c. Cases in which no repayment was
ever due
d. Cases in which no further
repayment is due (repaid fraud
restitution, and other
incorrectly paid benefits in all
programs, repaid "suits and
claims")
e. Cases in which a specific agency
decision has resulted in
abandonment of a claim(s)
2. The following concern records of cases in which reimbursement is owing:
i. In all instances of unresolved fraud or other incorrectly paid benefit matters, unresolved "suits and claims" matters, all records in each case shall be retained until the matter(s) in question is resolved and the case falls into one of the groups listed below or in (b)1 above; then retain accordingly.
ii. In destroying records of cases in which reimbursement is owing, the agency shall retain enough information in permanent archives to provide clear identification of debtors, to document the amounts, and to allow the taking of any legal or administrative action which may become necessary in the future by either the agency or by DMAHS.
iii. Records in cases in which reimbursement is owing shall be retained as follows:

Case Folders Retention Period
AFDC-related Medicaid, New Jersey Care... Special Medicaid Programs, Medically Needy, NJ FamilyCare -- Children's Program, MAA, and Medicaid Only

a. Beneficiary still living Indefinite
b. Beneficiary deceased (see note below)

(1) Probable recovery pending Indefinite
(2) All known or probable recoveries Three years after death or last
completed or none possible official action, is later
whichever
iv. In accordance with actuarial practice, persons not known to be deceased may be presumed dead at age 100 unless information to the contrary exists.
(c) Requests for destruction of case records shall be submitted on State Form ED-6, Request and Authorization for Records Disposal, which may be obtained from the Office of Eligibility Policy, Division of Medical Assistance and Health Services. Form ED-6 will be completed as follows:
1. Request Number and Date: Each CWA shall assign its own number to each request and the date upon which it was submitted;
2. Authorization Number and Date: For use of the Bureau of Archives and History;
3. From: Provide complete address of CWA;
i. Item: Number the items in sequence beginning with No. 1;
ii. Records Title and Description: Indicate the number of case records by categorical program and provide sufficient information to show where they are in the Record Retention Schedule;
iii. Inclusive Dates: Indicate the inclusive dates to which the material applies (for example, the earliest application was taken and the most recent year a case was closed);
iv. Volume: Volume is to be measured in cubic feet (one file drawer equals two cubic feet). Measurements should be rounded to the nearest cubic foot; do not use a measurement less than one cubic foot;
v. Retention Period: Complete in accordance with (b) above;
vi. Requested By: Signature of CWA director or authorized agent; and
vii. The appropriate State agency shall complete all other items;
4. All copies of the completed Form ED-6 shall be forwarded to Disposal Requests, Department of the Treasury, Division of Revenue and Enterprise Services, PO Box 661, Trenton, NJ 08625-0661, for approval. The CWA shall not destroy any records until such approval has been received by the CWA in writing.
5. Additional information regarding records management and disposal can be found on the RMS website: http://www.nj.gov/treasury/revenue/rms/index.shtml.
(d) When disposal is authorized, records shall be destroyed in fact and shall not be allowed to fall into unauthorized hands. Nonconfidential records may be sold for waste, providing that they will eventually be processed to destroy their identity. Confidential records shall be destroyed by burning, shredding or pulping, and a responsible official shall supervise such disposal or accompany the records, if they have to be transported, to see that they are in fact totally destroyed.

Notes

N.J. Admin. Code § 10:69-7.7
Amended by 49 N.J.R. 3729(a), effective 12/4/2017

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