N.J. Admin. Code § 10:7-5.1

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

Section 10:7-5.1 - County adjuster accounting procedures

(a) The county adjuster is responsible for accounting activities regarding clients/LRRs of DMHAS and the county psychiatric facilities with respect to the State billing for clients with county settlement, the county billing for clients with State or no settlement, and billing and collection of client and/or LRR maintenance contributions and recoveries for clients with county settlement. The county adjuster is also responsible for accounting activities regarding DDD clients/LRRs with respect to the State billing for clients with county settlement, and the reporting of all maintenance collections and all recoveries received by the county from the client and/or LRR or a third party on behalf of the client. Payment from DDD clients and their LRRs shall be made in accordance with N.J.S.A. 30:4-60b and N.J.A.C. 10:46-2.3(f). The State and counties' settlement agreement pursuant to County of Union v. Gibbs (Docket No. 38428, New Jersey Supreme Court, stipulation of dismissal, February 17, 1995) case does not preclude the county from reporting all the maintenance collections and all recoveries received by the county. Under terms of the settlement agreements, the counties are required to submit documentation and remit certain recoveries immediately to the State.

(b) The county adjuster shall review and reconcile the monthly State billing to the county for clients with county settlement. The county adjuster shall determine that those clients charged to the county have appropriate county settlement, and that the number of days charged are accurate to the extent possible. The county adjuster shall certify to the county administration that the State billing is correct and is authorized for payment.

1. The county adjuster shall notify the DHS, Office of Finance, in writing within 25 workdays from the date of receipt of the State billing of any adjustments required.

2. The county adjuster shall review all credits issued by the State to determine if appropriate for clients charged to the county. The county adjuster shall notify the State within 25 workdays of receipt of the credits of any discrepancies, additional information and/or adjustments required.

(c) The county adjuster shall review the county billing to the State and certify to the State that clients billed by the county psychiatric facility have appropriate State or county settlement and that the clients were resident in the facility for the number of days charged.

1. The DHS, DMHAS shall notify the county adjuster in writing, if necessary, within 25 workdays from the receipt of the county billing of any adjustments required.

2. The county adjuster shall review all credits issued by the county to the State to determine if the clients were properly charged to the State. The DMHAS will review the accuracy of the credit(s) information submitted to the State and notify the county adjuster within 25 workdays of receipt of any adjustments required.

3. The county adjuster shall file a report with the DMHAS on all revenue received by the county psychiatric facility. The report shall be on a cash basis by revenue source for the calendar year. The report is due to DMHAS by June 30 of the year following the end of the calendar year.

(d) The county adjuster shall actively pursue court-ordered and voluntary contributions due from county chargeable clients and/or LRRs of DMHAS and/or the county psychiatric facilities, pursuant to billing by the facility supervisor of patient accounts. A monthly statement shall be issued to contributing clients and/or LRRs of DMHAS and/or the county psychiatric facilities indicating the amount of contribution expected (court ordered or voluntary) for the month as well as any open balances from previous months. Court ordered contribution amounts based on assessments completed prior to September 20, 2005, the effective date of P.L. 2005, c. 55, for clients in a DMHAS or county psychiatric facility on September 20, 2005, shall be the amount resulting from the original calculation or the amount resulting from utilizing the Charity Care Fee Scale, whichever is less.

(e) The county adjuster shall maintain a ledger account for each client with county settlement. This ledger shall reflect the amounts of county charges incurred on the clients' behalf for services in State agencies and county psychiatric facilities. The ledger shall also reflect the amounts of offsetting client/LRR contributions, State maintenance recoveries, retroactive recoveries (compromises, settlements, etc.), and credits from county and/or State facilities for Medicare and/or commercial insurance recoveries.

(f) The county adjuster shall issue a monthly report to the DHS, Office of Finance, indicating the amounts of client/LRR court ordered and/or voluntary contributions received by client, service period, and nature of contribution. This report shall be issued no later than 25 days after the end of each month on forms developed by the State.

1. The county adjuster shall report LRR contributions for Medicaid eligible county chargeable clients in DDD Intermediate Care Facility/Mental Retardation (ICF/MR) facilities to the Division of Medical Assistance and Health Services (DMAHS).

2. The county adjuster may maintain an aged statement of court ordered accounts receivable. This statement shall reflect the amounts outstanding at the end of each quarter resulting from the county contributor billing. The statement shall reflect the age of the amounts due from each client. The statement shall also segregate all balances for litigation, which has been initiated or is pending for collection, and write-offs.

i. The county adjuster shall not consider voluntary contributions as receivables.

ii. For court ordered contributions, the county adjuster shall initiate individual collection efforts for those balances outstanding for more than six months.

iii. For court ordered contributions, the county adjuster shall refer to the court for collection, those balances outstanding for more than one year.

iv. For court ordered contributions, the county adjuster shall prepare justification to support balances outstanding for more than two years. The justification shall document previous collection efforts taken in accordance with (f)2ii and iii above.

v. For court ordered contributions, the county adjuster shall prepare a request to remove from the receivables, those balances determined to be uncollectible. The removal of the receivable, an accounting transaction, must be reported to the DHS, Office of Finance. For court ordered contributions, the county adjuster shall prepare an amended order for removal of those balances determined to be uncollectible. The amended order shall direct that the client has State or county settlement, the revised contribution amount, and that the client and his or her estate continues to be responsible for the full cost of care and maintenance.

(g) Any payments due the State for State psychiatric facility clients and DDD clients shall be incorporated into the reconciliation of the mental health billings for the State psychiatric facilities. The payments due shall be considered as adjustments.

(h) The county adjuster is responsible for reconciling with the DHS the county charges on behalf of clients with county settlement in State agencies net of subsequent contributions and recoveries, as deemed appropriate by DHS.

N.J. Admin. Code § 10:7-5.1

Amended by R.2007 d.71, effective 3/5/2007.
See: 38 N.J.R. 1978(a), 39 N.J.R. 772(b).
Rewrote (d).

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