N.J. Admin. Code § 10:52-5.13

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

Section 10:52-5.13 - Update factors

(a) The economic factor is the measure of the change in prices of goods and services used by New Jersey hospitals. The economic factor will be the factor recognized under the TEFRA target limitations.

1. The hospital-specific economic factor is the weighted average of the recorded and projected change in the value of its components. The weight given to each component is its share of that hospital's total expenditure. The projection of individual components shall be based, where appropriate, on legal or regulatory changes which fix the future value of a proxy. Components which are of particular importance may be projected through the use of time series analysis or other relevant indicators.

(b) The technology factor takes into account the costs of adopting quality enhancing technologies.

(c) Base-year direct patient care and indirect rates shall be multiplied in succeeding years by a technology factor to provide prospective funds to support hospital adoption of quality-enhancing technologies. The technology factor shall be based on the Scientific and Technological Advancement Allowance recommended annually to the Secretary of the United States Department of Health and Human Services by the Medicare Payment Advisory Commission (MedPAC). The factor shall be composed of the proportion of incremental operating costs associated with MedPAC's identified cost-increasing technologies, and MedPAC's allowance for technologies not included in the technology-specific projections, less the proportion of incremental operating costs of cost-decreasing technologies identified by MedPAC.

(d) In addition, the following payment rates will be in effect for these special procedures:

1. Liver Transplants: payment for DRG 480 will be $ 72,139 in 1988 dollars.

2. Heart Transplants: payment for DRG 103 will be $ 72,438 in 1988 dollars.

3. Cochlear Implants: payment for DRG 759 will be $ 21,608 in 1988 dollars.

4. Bone Marrow Transplants: payment for DRG 481 will be $ 46,599 in 1988 dollars.

5. Neonate rates: payment for neonatal DRGs as defined by New Jersey Grouper 8.0 will be based on 1989 actual New Jersey patient volume.

(e) For determination of the payment rates, direct patient care is increased for the following components:

1. Indirect patient care for items other than listed in 10:52-5.7;

2. Health Planning fees;

3. Capital facilities allowance;

4. Physician fee for service;

5. Child psychiatric hospital direct and indirect;

6. Resident count correction (only for services provided prior to October 1, 1996).

7. Special perinatal expense adjustment;

8. Trauma center adjustment;

9. GME reversal (only for services provided prior to October 1, 1996);

10. Hemophilia adjustment;

11. Regional perinatal adjustment;

12. Personnel health allowance;

13. Pediatric rate adjustment;

14. Sickle cell adjustment;

15. Continuous adjustments;

16. Outlier reversal adjustment; and

17. Poison Control Costs.

(f) No Statewide transition adjustment not otherwise specified in this chapter will be included in the rate.

N.J. Admin. Code § 10:52-5.13

Amended by R.1995 d.141, effective 3/6/1995.
See: 27 N.J.R. 34(a), 27 N.J.R. 908(a).
Amended by R.1997 d.43, effective 1/21/1997.
See: 28 N.J.R. 4022(a), 29 N.J.R. 350(b).
In (a)6 and (a)9, added text "(only for services provided prior to October 1, 1996)".
Recodified from N.J.A.C. 10:52-5.17 and amended by R.2000 d.29, effective 1/18/2000.
See: 31 N.J.R. 3151(a), 32 N.J.R. 276(a).
In (e)1, changed N.J.A.C. reference. Former N.J.A.C. 10:52-5.13, Reasonable cost of services related to patient care, recodified to N.J.A.C. 10:52-5.9.
Amended by R.2005 d.214, effective 7/5/2005.
See: 37 N.J.R. 436(a), 37 N.J.R. 2506(a).
In (a), added 1; in (b), deleted 1; in (c), substituted references to the Medicare Payment Advisory Commission (MedPAC) for references to the Prospective Payment Assessment Commission (ProPAC) throughout.