10:69-6.1 Definitions
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. 10:69-6.3
"Adverse action" means any action by a CBOSS 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 county board of social services.
"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 (DMAES) 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 which 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. 10:69-1.2.)
"Administrative review official" is a representative of the State, Department of Human Services assigned to conduct an administrative review.
"C.F.R." 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 a AFDC-related Medicaid client may protest an adverse action or decision of the county board of social services (CBOSS) regarding eligibility or manner of granting AFDC-related Medicaid. Fair hearing is a general term which 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.
New Rule R. 1999 d. 233, effective July 19, 1999. See: The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) Public Law 104-193; the Balanced Budget Act of 1997 (Public Law 105-33), Section 1902(a)8, 1902(a)10, 1902(e) and Section 1931(a) of the Social Security Act (42 U.S.C. § 1396a(a)(10), 1396a(a)(8), 1396a(a)(e), and 1396u-1a) respectively); 42 C.F.R. § 435.2 — 42 C.F.R. § 435.170
and 436.100-128; N.J.S.A. 30:4D-1 et seq.; N.J.S.A.44:10-3, P.L. 1997, c. 13, 14, 37 and 38, and 352.