Statutes, codes, and regulations
New Jersey Administrative Code
Title 8 - HEALTHChapter 85 - LONG-TERM CARE SERVICES
Subchapter 3 - COST REPORT, RATE CALCULATION AND REPORTING SYSTEM FOR LONG-TERM CARE FACILITIES
Section 8:85-3.17 - Appeals process

N.J. Admin. Code § 8:85-3.17

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Current through Register Vol. 56, No. 21, November 4, 2024
Section 8:85-3.17 - Appeals process
(a) When an NF believes that, owing to an unusual situation, the application of these rules results in an inequity (except for the application of 8:85-3.2(f) ) , two levels of appeals are available: a level I appeal heard by representatives of the Department; and a Level II appeal heard before an administrative law judge.
1. A request for a Level I appeal should be submitted in writing to the Department of Health and Senior Services, Nursing Facility Rate Setting and Reimbursement, PO Box 715, Trenton, NJ, 08625-0715.
i. Requests for Level I appeals shall be submitted in writing within 60 days of the receipt of notification of the rate by the facility and shall include as follows:
(1) A letter requesting a Level I appeal from the facility and/or from the facility's designated representative;
(2) A specific description of each appeal issue; and
(3) Appropriate documentation that will be sufficient for the Department to understand the nature of each issue of the appeal. No issues other than the specific issues identified in the original Level I appeal shall be heard at the Level II hearing.
ii. Adjustments resulting from the Level I appeal submitted in accordance with (a)1i above shall be effective as follows:
(1) At the beginning of the prospective reimbursement period if either an error in computation was made by the Department or the appeal was submitted within the specified period.
(2) On the first day of the month following the date of appeal for non-computational matters if the appeal is submitted after the specified period.
iii. The date of submission shall be defined as the date received by the Department of Health and Senior Services.
2. If the NF is not satisfied with the results of the Level I appeal, the NF may request a hearing before an administrative law judge. No issues other than the specific issues identified in the original Level I appeal shall be heard at the Level II hearing.
i. Request for an administrative hearing must be submitted in writing to the Department of Health and Senior Services, Nursing Facility Rate Setting and Reimbursement, PO Box 715, Trenton, NJ 08625-0715.
ii. Requests for an Administrative hearing will be considered timely filed if they are submitted within 20 days from the mailing of the ruling in the Level 1 appeal.
iii. The Administrative hearing will be scheduled by the Office of Administrative Law and the facility will be notified accordingly.
iv. At the Level II hearing, the burden is upon the NF to demonstrate entitlement to cost adjustments under this chapter.

N.J. Admin. Code § 8:85-3.17

The following annotations apply to N.J.A.C. 8:85-3.17 prior to its repeal by R.2011 d.121:
Recodified from 10:63-3.16 and amended by R.1994 d.624, effective 1/3/1995.
See: 26 N.J.R. 3614(a), 27 N.J.R. 156(a).
Recodified from N.J.A.C. 10:63-3.17 by R.2005 d.389, effective 1/17/2006.
See: 36 N.J.R. 4700(a), 37 N.J.R. 1185(a), 38 N.J.R. 674(a).
The following annotations apply to N.J.A.C. 8:85-3.17 subsequent to its recodification from N.J.A.C. 8:85-3.21 by R.2011 d.121:
As amended, R.1983 d.11, effective 2/7/1983, operative March 1, 1983.
See: 14 N.J.R. 269(a), 15 N.J.R. 156(a).
Language added concerning Level II hearing being an Administrative Law hearing.
Recodified from 10:63-3.20 and amended by R.1994 d.624, effective 1/3/1995.
See: 26 N.J.R. 3614(a), 27 N.J.R. 156(a).
Prior text at 10:63-3.21, Medicaid Occupancy Initiative, repealed by R.1994 d.213, effective 5/2/1994. See: 26 N.J.R. 1840(a).
Amended by R.1995 d.174, effective 3/20/1995 (operative April 1, 1995).
See: 27 N.J.R. 281(a), 27 N.J.R. 1307(a).
Recodified from N.J.A.C. 10:63-3.21 and amended by R.2005 d.389, effective 1/17/2006.
See: 36 N.J.R. 4700(a), 37 N.J.R. 1185(a), 38 N.J.R. 674(a).
Rewrote the section.
Recodified from N.J.A.C. 8:85-3.21 and amended by R.2011 d.121, effective 4/18/2011.
See: 42 N.J.R. 1793(a), 43 N.J.R. 961(c).
In the introductory paragraph of (a), substituted "an" for "a" preceding "NF"; in the introductory paragraph of (a) and of (a)2, substituted "administrative law judge" for "Administrative Law Judge"; and rewrote (a)2iv. Former N.J.A.C. 8:85-3.17, Restricted funds, repealed.