N.J. Admin. Code § 10:52-12.3

Current through Register Vol. 56, No. 11, June 3, 2024

Section 10:52-12.3 - Basis of pricing for charity care claims

(a) All hospital outpatient and inpatient charity care claims shall be priced based on the New Jersey Medicaid/NJ FamilyCare program's pricing and program policies for hospital outpatient and inpatient hospital services. (See this chapter, and, specifically, NJ.A.C. 10:52-1.6, Covered services (inpatient and outpatient services), and 10:52-4, Basis of Payment.)

1. Exception: Although the New Jersey Medicaid/NJ FamilyCare program reimburses dental services on a fee-for-service schedule for outpatient hospital charity care claims, dental services shall be priced based on hospital outpatient cost to charge ratio as described in N.J.A.C. 10:52-4.3. All other hospital outpatient services for charity care shall also be priced according to the Medicaid/NJ FamilyCare hospital outpatient methodology. (See N.J.A.C. 10:52-4.3.)

(b) All hospital outpatient and inpatient charity care claims pricing results shall be considered final and not subject to cost settlements or adjustments resulting from subsequent rate appeal changes when evaluating total charity care amounts.

N.J. Admin. Code § 10:52-12.3

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