N.J. Admin. Code § 10:52-11.3

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:52-11.3 - Charity care write- off amount

(a) The Department of Health shall value charity care claims at the Medicaid/NJ FamilyCare rate. The Medicaid/NJ FamilyCare rate, for purposes of valuing a given charity care claim, shall be based on the New Jersey Medicaid/NJ FamilyCare program's pricing and program policies pursuant to N.J.A.C. 10:52-12.1 and 12.2. For write-off and billing purposes, the hospital shall use the following procedures:

1. Charity Care Write-Off Amount equals Charity Care Eligibility Percentage, as determined by N.J.A.C. 10:52-11.8(b) and (c) multiplied by the Medicaid/NJ FamilyCare payment rate.

2. In the event that there is a partial payment from a third party, the charity care write-off amount is determined as follows: Charity Care Write-Off Amount equals Medicaid/NJ FamilyCare payment rate minus third party payment multiplied by Charity Care Eligibility Percentage. Beginning July 1, 1995, charity care availability for persons with health insurance shall be subject to all Federal disproportionate share rules, including the Omnibus Budget Reconciliation Act of 1993, Section 13621.

3. If the third-party payment is greater than the Medicaid/NJ FamilyCare payment rate, the charity care write-off amount shall be listed as zero.

(b) Applicants eligible for charity care at 100 percent shall not be billed. Any difference between hospital charges and the Medicaid/NJ FamilyCare rate shall be recorded as a contractual allowance.

(c) Applicants eligible for charity care at less than 100 percent shall be billed as follows:

1. Applicant Responsibility equals 100 percent minus Charity Care Eligibility Percentage multiplied by Hospital Charges minus any third party payment.

2. Contractual allowance equals Hospital Charges minus any third party payment minus Charity Care Write Off plus Applicant Responsibility.

(d) The Department of Health will calculate the cost of charity care services at the rate that would have been paid by the New Jersey Medicaid/NJ FamilyCare program.

N.J. Admin. Code § 10:52-11.3

Amended by 50 N.J.R. 1261(a), effective 5/21/2018