N.J. Admin. Code § 8:85-3.8

Current through Register Vol. 56, No. 21, November 4, 2024

Section 8:85-3.8 - Limit and price database

(a) The Department shall establish the database used to derive the direct care limit and operating and administrative price used in rates for dates of service July 1, 2010 through June 30, 2011.

1. Each Class I NF and Class II NF in operation as a Medicaid certified NF as of May 1, 2010 shall be identified.

2. The most recent validated cost report for each identified Class I NF and Class II NF, or a prior owner of that NF, that is available on May 1, 2010, with a cost reporting period covering at least six months ending on or before November 30, 2007, shall be selected as the basis for establishing nursing facility rates under this chapter.

i. In the event of a change of ownership after November 30, 2007, and the new owner has a more recent validated cost report covering at least six months and that validated cost report is available on May 1, 2010, the more recent validated cost report shall be selected as the basis for establishing nursing facility rates under this chapter.

ii. If no validated cost report fitting the criteria in (a)2i above is available, the closest validated cost report covering at least a six-month period ending after November 30, 2007, shall be selected as the basis for establishing nursing facility rates under this chapter.

iii. If no validated cost report covering at least a six-month period is available for the identified Class I NF and Class II NF, that NF shall be excluded from the limit and price database.

(b) On an annual basis beginning for rates for dates of service after June 30, 2011, the Department shall establish the direct care limit using the most recent validated cost report as of May 1 preceding the rate year covering at least a six-month period for each Class I NF and Class II NF in operation as a Medicaid certified NF.

1. If no validated cost report is available for a Class I NF and Class II NF, that NF shall be excluded from the limit database.

(c) Every third year, beginning for rates for dates of service after June 30, 2013, the Department shall establish the operating and administrative price using the most recent validated cost report as of May 1 preceding the rate year covering at least a six-month period for each Class I NF in operation as a Medicaid certified NF.

1. If no validated cost report is available for a Class I NF, that NF shall be excluded from the price database.

2. For the second and third year between periods when the operating and administrative price is reestablished, the Department shall adjust by one year the operating and administrative price used for the prior rate year, prior to making any adjustments pursuant to 8:85-3.13(d)1, using the index factor developed from the most recent index factor publication as of May 1 preceding the rate year, as identified in 8:85-3.6, from the midpoint of the prior rate year to the midpoint of the rate year for which the price is used to establish rates.

N.J. Admin. Code § 8:85-3.8

Recodified from 10:63-3.1 and amended by R.1994 d.624, effective 1/3/1995.
See: 26 N.J.R. 3614(a), 27 N.J.R. 156(a).
Amended by R.1995 d.174, effective 3/20/1995 (operative April 1, 1995).
See: 27 N.J.R. 281(a), 27 N.J.R. 1307(a).
Recodified from N.J.A.C. 10:63-3.8 and amended by R.2005 d.389, effective 1/17/2006.
See: 36 N.J.R. 4700(a), 37 N.J.R. 1185(a), 38 N.J.R. 674(a).
In (a) and (b), substituted "Department" for "departments".
Repeal and New Rule, R.2011 d.121, effective 4/18/2011.
See: 42 N.J.R. 1793(a), 43 N.J.R. 961(c).
Section was "Special amortization".