N.J. Admin. Code § 10:7-4.1

Current through Register Vol. 56, No. 12, June 17, 2024

Section 10:7-4.1 - County adjuster's responsibilities for preparing court orders of settlement and support for clients/LRRs of DMHAS and/or county psychiatric facilities

(a) The county adjuster, at the discretion of the court, shall act as referee to conduct investigations to determine each client's legal settlement and the client's/LRR's financial ability to pay for the cost of care and maintenance. This investigation shall be a thorough and systematic attempt to learn the facts about the client's/LRR's financial circumstances and residence(s), and shall be conducted as follows:

1. The county adjuster shall utilize his or her subpoena powers to conduct such investigation, when necessary.

2. The investigation shall be completed within six to eight weeks but no later than 60 days after receipt of notification of admission/commitment of the client.

3. The county adjuster's investigatory testimony, in the form of findings, conclusions and recommendations, are subject to the approval of the court and shall be based on factual evidence.

4. For clients 18 years of age or older, the county adjuster shall utilize the eligibility criteria of the Charity Care Fee Scale, as described at 10:7-4.2. For the LRR(s) of clients under 18 years of age, the "Methodology and Formula for Determination of Financial Ability to Pay of Clients and Legally Responsible Relatives--The Treasury Formula" procedures manual shall be utilized if the calculations produce a lesser LRR obligation. Published or updated annually, in accordance with 30:4-60, this manual assists in identifying those areas to be addressed by these investigations.

5. The county adjuster of the county of admission shall refer all cases when an investigation indicates settlement is in another county. The county adjuster of the county to which the client's case is referred shall review the information provided by the county of admission, conduct its investigation as required and respond in writing to the referring county. If accepted, the county of admission shall obtain an order transferring venue to the county of legal settlement and the county of legal settlement will then proceed with the petition.

(b) The formal investigation of support regarding the county of legal settlement shall, as necessary, take into consideration each of the following listed items. However, it need not be limited to just those items. The county adjuster shall:

1. Obtain client residency data from screening, admissions and commitment documents;

2. Contact facilities from previous admissions of the client to obtain residency data and to inquire as to the county of admission and the classification of the admission (including private hospitals, county facilities, other counties and their facilities, and State agencies);

3. Interview the client for residency data, when possible;

4. Interview the client's spouse, relatives, friends and neighbors for residency data;

5. Obtain residency data from Federal, State, and county agencies supplying the client with benefits or assistance (SSA, SSI, SSD, RR, VA Pensions, Medicare, Medicaid, DCF, DFD, General Assistance, etc.);

6. Contact county, State and Federal correctional facilities for residency data (including county probation offices), if applicable;

7. Review local municipal records to verify residency data, such as property tax records, police records, occupancy permits/inspections, etc.;

8. Obtain written verification of residency data, whenever possible;

9. Obtain oral verification of residency data when written data is not obtainable; and

10. Keep a record of the client's settlement investigation, including date, time, data obtained, method data obtained and the source of the data.

(c) The formal investigation of support to determine financial ability of the client and/or LRR(s) to pay shall, as necessary, take into consideration each of the following listed items. However, it need not be limited to just those items. The county adjuster shall:

1. Obtain client financial data from admissions documents;

2. Contact facilities from previous admissions of the client to obtain financial data (including private hospitals, county facilities, other counties and their facilities, and State agencies);

3. Interview the client for financial data, when possible;

4. Interview the client's spouse, relatives, friends and neighbors for financial data;

5. Provide an LRR claiming crime victim exemption from financial assessment status, with the DHS approved form to complete and submit with appropriate proof to the county adjuster. The county adjuster shall review the completed form and proofs and determine if the exemption meets the criteria of P.L. 2001, c. 208.

i. It is the responsibility of the person claiming the exemption to supply copies of documents that will substantiate his or her claim for exemption from financial assessment. Some examples of documents that may be submitted to the county adjuster are police reports (identifying victim), indictment, judgment or conviction, court order finding the defendant IST or NGRI, and/or a restraining order. These examples are not all inclusive; other forms of proof may be submitted.

ii. A person determined by the county adjuster to have crime victim exemption status from financial assessment as an LRR shall only retain the exemption for the commitment(s) that resulted from that crime against the LRR. Should the client have future commitments, the exemption does not carry forward. If a new crime is committed against the LRR the person must submit a new exemption request and proofs directly related to the new commitment.

6. Obtain financial data from Federal, State, and county agencies supplying the client with benefits or assistance (SSA, SSI, SSD, RR, VA Pensions, Medicare, Medicaid, DCF, DFD, General Assistance, etc.);

7. Obtain client's/LRR's employment financial data, when possible;

8. Review client/LRR's tax records, pay stubs, banking/savings institution's records, employment retirement records, insurance records, etc., for financial data;

9. Contact county, State and Federal correctional facilities for financial data, if applicable;

10. Review local municipal records to verify financial data, such as property tax records;

11. Obtain written verification of financial data, whenever possible;

12. Obtain oral verification of financial data when written data is not obtainable;

13. Keep a record of the client's/LRR's financial investigation, including date, time, data obtained, method data obtained and the source of the data; and

14. Complete the appropriate Charity Care Fee Scale and, in the case of a legally responsible relative (LRR), the Treasury Formula worksheets.

(d) The county adjuster shall utilize the eligibility criteria of the Charity Care Fee Scale (as described at 10:7-4.2) for clients 18 years of age or older and/or the procedures found in the "Methodology and Formula for Determination of Financial Ability to Pay of Clients and Legally Responsible Relatives -- The Treasury Formula" procedures manual, developed in accordance with 30:4-60, for the LRR(s) of clients under 18 years of age to calculate the amount of charges to clients/LRR(s) for each hospitalization.

1. The county adjuster shall utilize the appropriate Charity Care Fee Scale or Treasury Formula worksheets. The county adjuster shall complete the appropriate worksheet to the maximum extent possible. The county adjuster shall complete the "Charity Care Determination of Eligibility" form or "Summary of Total Charges" form for each client/LRR, as appropriate.

2. For clients 18 years of age or older, the county adjuster shall utilize the Charity Care Fee Scale eligibility criteria as described at N.J.A.C. 10:7-4.2, plus the annual update of income and asset standards for the current calendar year, which is distributed in April of each year by DHS.

3. For the LRR(s) of clients under 18 years of age, in order to determine the lesser obligation between the Charity Care Fee Scale and the Treasury Formula, the county adjuster shall utilize, in addition to the Charity Care Fee Scale, the last manual published, plus the current calendar year's update for the "Methodology and Formula for Determination of Financial Ability to Pay of Clients and Legally Responsible Relatives -- The Treasury Formula." Treasury Formula manual updates are distributed in December of each year with an effective date of January 1st of the next year. Copies can be obtained from the:

Department of Human Services

Office of Finance

222 South Warren Street, 5th Floor

PO Box 700

Trenton, New Jersey 08625-0700

(e) In the case of a person who is married, the county adjuster shall take into account a spousal share of the combined assets of the couple that shall be preserved for the non-institutionalized spouse and immune from execution to satisfy the person's liability to contribute toward the cost of treatment, maintenance and all necessary and related expenses of the person's hospitalization. In determining the amount of the spousal share, the county adjuster shall employ the same methodology used by the State Medicaid program, in accordance with 10:71-4.8(a)1.

(f) The county adjuster shall review the settlement and support court orders prior to submission to make sure that they are in compliance with all appropriate Federal and State laws and regulations. Specifically, the county adjuster shall ensure that said orders do not contain Federal benefit funds consisting of Social Security benefits, Veterans Administration benefits, Railroad Retirement benefits and/or Federal Civil Service Pension benefits.

(g) Settlement orders shall not be submitted to the court making Medicaid, Medicare, or private insurance responsible for the cost of care and maintenance. Settlement orders shall only indicate that the client has county, State, or no settlement in the State or county. Support orders shall indicate whether the client and/or the LRRs are chargeable for paying all or a portion of the cost of care and maintenance pursuant to the Charity Care Fee Scale or Treasury Formula and whether the county or State is responsible for the support of the individual.

1. The only exception shall be clients who meet the requirements of 30:4C-30.1. Settlement and support orders for these clients shall indicate the county of settlement, if any, that the county is relieved of the financial responsibility for these clients under 30:4C-30.1. The orders shall indicate that the client and his or her estate remain liable for the full cost of care and maintenance allocated to them.

(h) Inmates/detainees of county and municipal corrections systems transferred to State or county psychiatric facilities shall be the financial responsibility, for the cost of care and maintenance, of the county in which they were incarcerated. Inmates of the State correctional system, whether housed in a county or State correctional facility, shall be the financial responsibility of the State when transferred to a State or county psychiatric facility. The county adjuster shall include for State correctional inmates the State prisoner identification number in the investigation accompanying the order of settlement and support.

(i) The county adjuster shall submit a petition for the court to determine the client's legal settlement and provision for payment of expenses of the client's care and maintenance, in accordance with Civil Practice Rules 4:74-7 and 4:74-7A, or as otherwise directed by the AOC. The county adjuster shall attach a report to the petition that includes the investigative findings and/or testimony, the Charity Care Fee Scale and/or Treasury Formula worksheet(s), the results of the investigation, and the recommendations for an order of settlement and support. The county adjuster shall schedule a hearing, with proper notice, for settlement and support, only if there are objections to the proposed court order. The county adjuster shall distribute a copy of the petition and report:

1. Directly to the client or the client's guardian or guardian ad litem, if any, by certified mail, return receipt requested, or as directed by the court;

2. To the client's counsel, by regular mail, as required;

3. To the supervisor of patients accounts of the State agency where the client is located, by regular mail;

4. To the CEO or his or her designee of the county psychiatric facility where the client is located, by regular mail;

5. To the DMHAS for State and no settlement clients in county psychiatric facilities, by regular mail; and

6. To the legally responsible relative(s) (LRRs), where applicable, by certified mail, return receipt requested, or as directed by the court.

(j) The county adjuster shall file the completed Orders of Settlement and Support in the county adjuster's office of the county of settlement.

(k) The county adjuster shall reevaluate the client's and/or LRR's financial circumstances annually or sooner when information is obtained that their financial circumstances have changed. The county adjuster shall take the appropriate action to initiate an amendment to the client's and/or LRR's Order of Settlement and Support.

(l) The county adjuster shall distribute copies of the following documentation to the appropriate agency's supervisor of patients' accounts, or equivalent, no later than 90 days after receipt of notification that the client is admitted/committed:

1. An appropriate Order of Settlement and Support;

2. An amended Order of Settlement and Support, if applicable;

3. Investigative findings and/or testimony;

4. Charity Care Fee Scale worksheets and/or Treasury Formula worksheets;

5. Charity Care Determination of Eligibility form and/or Summary of Total Charges form(s); and

6. Outside representative payee voluntary agreement(s), if applicable.

(m) Upon receipt of the Order of Settlement and Support from the county adjuster, the hospital supervisor of patient accounts will:

1. In cases where the financial responsibility of the client, or the LRR of a client under 18 years of age, was established through the Charity Care Fee Scale, apply the calculated percentage of responsibility to the net amount due for the specific hospitalization.

2. In cases where the financial responsibility of the LRR of a client under 18 years of age was established through the Treasury Formula, apply the dollar amount from the Summary of Total Charges form as the amount due for the specific hospitalization.

(n) Initial contact with the client, or the LRR of a client under 18 years of age, regarding the net dollar amount due for the specific hospitalization will be through correspondence generated by the hospital supervisor of patient accounts with a copy to the appropriate county adjuster.

N.J. Admin. Code § 10:7-4.1

Amended by R.2003 d.96, effective 3/3/2003.
See: 34 N.J.R. 3181(a), 35 N.J.R. 1276(a).
In (c), added a new 5 and recodified former 5 through 13 as 6 through 14; in (i), substituted "adjuster's" for "clerk's".
Amended by R.2007 d.71, effective 3/5/2007.
See: 38 N.J.R. 1978(a), 39 N.J.R. 772(b).
Rewrote (a)4; in (a)5, inserted "legal" two times and "the" preceding "petition"; in the introductory paragraph of (b), substituted "regarding the county of" for "to determine"; rewrote (c)14; rewrote (d); added new (e); recodified former (e) through (k) as (f) through ( l); in the introductory paragraph of (g), inserted "Charity Care Fee Scale or"; in (g)1, inserted "allocated to them"; in (i), substituted "Charity Care Fee Scale and/or Treasury Formula" for "treasury formula"; rewrote ( l)4 and ( l)5; and added (m) and (n).

Amended by 54 N.J.R. 1817(b), effective 9/19/2022