10:71-8.2 Redetermination of medical eligibility
(a) Redetermination of disability and blindness factors shall be done for every Medicaid
Only beneficiary at intervals set by the Division of Medical Assistance and Health Services,
Medical Review Team (MRT), except those beneficiaries who are currently receiving SSA
Disability Insurance Benefits. The redetermination review date is designated on Form PA-8,
Record of Action: Medical Eligibility Factor (see N.J.A.C. 10:71-3.13(g)).
(b) An individual who has been determined to be disabled or statutorily blind shall, if
requested with reasonable notice, present himself or herself for and submit to examinations
or tests, and shall submit medical and other evidence necessary for the purpose of
determining whether he or she continues to be disabled or statutorily blind.
(c) In Medicaid Only cases, the CBOSS shall take into account the redetermination review
date on Form PA-8 in scheduling both the annual review and interim visits. The CBOSS
may adjust the date for case submittal to the Medical Review Team (MRT), to coincide as
closely as is practical with either the annual review or with an interim visit, but such
adjustment shall assure that the case will be submitted not more than two months earlier
and in no event later than the date originally set on Form PA-8.
(d) The Medical Review Team (MRT) will maintain a control file in order to ensure
appropriate and timely reevaluation by the medical review team (MRT). The Medical Review
Team (MRT) will notify county board of social services one month in advance of cases
scheduled for such review by means of Form PA-655, Cases for Medical Review Team
Reevaluation Due During the Month.
(e) The eligibility worker shall organize his or her caseload controls (notebooks, index, and
other related materials or equipment) so that he or she will be alerted sufficiently in advance
of redetermination review dates to enable him or her to obtain any specific medical
information or reports requested on the last Form PA-8. The data and reports so submitted
must be "current."
(f) When a case is to be submitted to the Medical Review Team (MRT) for redetermination
review, the eligibility worker shall prepare Form PA-6A, Interim Medical Social Report in
detail. Form PA-6A shall be placed on top of all forms, reports and related data previously
submitted.
(g) Medicaid coverage shall be continued, if financial and resource eligibility continues to exist, unless and until the CBOSS is advised by the Medical Review Team (MRT) that the
individual no longer meets the disability and blindness requirements or the individual
withdraws voluntarily.
(h) Upon receipt of records from the Medical Review Team (MRT), the CBOSS shall follow
the procedures as outlined in N.J.A.C. 10:71-3.13(g)