N.J. Admin. Code § 10:52B-3.1

Current through Register Vol. 56, No. 24, December 18, 2024

Section 10:52B-3.1 - Fee and expenditure report; appropriate fee methodology

(a) A participating county must submit a proposed fee and expenditure report to the Department for review in accordance with instructions specified by the Department. The fee and expenditure report shall describe the county's plan for imposing fees and making expenditures from those fees and include such information as may be required by the Department to determine whether the county's report satisfies the requirements at N.J.A.C. 10:52B-2.2.

(b) A participating county shall consult with affected hospitals located in the county to develop its proposed fee and expenditure report prior to submission to the Department.

(c) A participating county's proposed fee and expenditure report must include, at a minimum, the following:

1. An overview of the fee and expenditure plan described in the fee and expenditure report;

2. A list of all the hospitals within the jurisdiction and their facility type (acute care, psychiatric, rehabilitation, long-term acute care hospital, etc.);

3. The proposed fee methodology;

4. The proposed expenditure methodology;

5. Source documentation for the data used to create the fee and expenditure report (for example, Medicare or Medicaid/NJ FamilyCare cost report, survey data, etc.);

6. Any and all facilities the county requests to exclude from the fee with the rationale for those exclusions;

7. A delineation of the percentage of the fee proceeds that the county proposes to:

i. Transfer to the Department to cover State administrative costs; and

ii. Transfer to the Department to be used as non-Federal share of Medicaid/NJ FamilyCare payments to hospitals in the participating county; and

8. A submission of the county's prospective hospital specific disproportionate share payment limit (DSH limit) calculation with supporting documentation for each hospital subject to the hospital fee. The DSH limit is the difference between a hospital's costs for treating Medicaid and uninsured individuals minus Medicaid payments and minus any payments received on behalf of the uninsured.

i. The DSH limit must:

(1) Be calculated in a form and in accordance with instructions specified by the Department;

(2) Be based on the data from the most recent Federal DSH audit;

(3) Use the Inpatient Prospective Payment System (IPPS) Hospital Market Basket as published by CMS to trend costs to the current fiscal year, unless hospital documentation verifies a different cost inflation for the hospital;

(4) Exclude any proposed payments to be made under the pilot program;

(5) Adjust for any changes in Federally matched State subsidy payments since the time of the finalized DSH audit used in the calculation (that is, Charity Care, Graduate Medical Education); and

(6) Be approved by the Department. The Department reserves the right to discount any values included in the calculation that are not supported by appropriate documentation.

ii. Should the county's fee and expenditure report include provisions that would result in increased Medicaid/NJ FamilyCare payments for any hospital that exceed the calculated value of the hospital's DSH limit, the county's proposed fee and expenditure report must include an attestation from the specific hospital's chief executive officer confirming that the hospital is agreeing to a reduction to the hospital's Medicaid DSH payments, including Charity Care payments, to the extent necessary to comply with payment limits outlined in Section 1923(g) of the Social Security Act ( 42 U.S.C. § 1394r-4). The Department reserves the right to take all appropriate action to comply with Section 1923(g) of the Social Security Act ( 42 U.S.C. § 1394r-4).

(d) A participating county's proposed fee and expenditure report must describe the fee methodology that the county is proposing to adopt. An appropriate fee methodology is any methodology that is permitted under applicable Federal regulations and that meets the following criteria:

1. The county must determine how to apply the fee; the fee may be applied to inpatient hospital services, outpatient hospital services, or both;

2. The fee must be applied to all hospitals uniformly, except that the participating county may exempt hospitals within the county that provide the assessed service from the fee, provided that the exemption complies with the requirements of 42 CFR 433.68(c) and (d), and the Department requests and receives approval of the waiver of the broad-based and/or uniform requirements from CMS; and

3. The fee shall be assessed consistent with Federal rules, with the basis of the assessment being: net or gross revenues, discharges, encounters, days, beds, or visits, and may exclude revenue or utilization attributable to Medicaid/NJ FamilyCare, Medicare, or both.

N.J. Admin. Code § 10:52B-3.1

Adopted by 52 N.J.R. 520(a), effective 3/16/2020