N.J. Admin. Code § 8:85-3.2

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

Section 8:85-3.2 - Cost report preparation and timing of submission

(a) Nursing facilities shall furnish required cost reports to the Department of Health and Senior Services, Office of Nursing Facility Rate Setting and Reimbursement, by May 31 following the end of each calendar year for a cost reporting period ending December 31.

1. Effective for periods ending on or after December 31, 2010, the cost report form shall be the Medicare cost report and supplemental Medicaid schedules designated by the Department as N.J.A.C. 8:85 Appendix U, incorporated herein by reference.

2. A nursing facility shall file separate cost reports for each central/home office when costs of the central/home office are reported on the facility's cost report.

3. Prospectively determined payment rates will be redetermined at least annually by the Department.

(b) Where a properly completed cost report, and other required documents, are received beyond the filing requirements of (a) above, the following schedule of penalties will be applied to current and/or subsequent reimbursement rates as the particular circumstances dictate:

Number of days after due date	Amount of penalty	Month(s)of penalty
1-15	.25 percent of the NF's rate	1st month
per patient day
16-30	.50 percent of the NF's rate	1st month
per patient day
31-60	.50 percent of the NF's rate	1st month
per patient day
1 percent of the NF's rate per	2nd month
patient day
61-90	.50 percent of the NF's rate	1st month
per patient day
1 percent of the NF's rate per	2nd month
patient day
2 percent of the NF's rate per	3rd month
patient day
91 and thereafter	.50 percent of the NF's rate	1st month
per patient day
1 percent of the NF's rate per	2nd month
patient day
2 percent of the NF's rate per	3rd month
patient day
3 percent of the NF's rate per	4th and subsequent
patient day	months

(c) Penalties will remain in force until such time that a properly completed cost report and all other required documents have been received. Penalties are not recoverable and are not allowable costs.

(d) The Assistant Commissioner, Division of Senior Benefits and Utilization Management, or a designee of the Assistant Commissioner, may mitigate or waive the penalties specified in (b) above, for "good cause" shown:

1. "Good cause" shall include but shall not be limited to, circumstances beyond the control of the nursing care facility, such as fire, flood or other natural disaster;

2. Acts of omission and/or negligence by the nursing facility, its employees, or its agents, shall not constitute "good cause" for waiving the penalty provisions;

3. All requests for mitigation and/or waiver of the penalty provisions must be submitted in writing, and accompanied by such documentation and/or supporting affidavits as the Assistant Commissioner may require.

(e) The penalty rates indicated in (b) above will be applied to cost reports commencing with the reporting periods ending December 31, 2010.

(f) A nursing facility cost report cannot be substituted or revised by an NF except if such substitution or revision would prevent an overpayment to the NF.

(g) Nursing facilities shall report allowable costs for cost report periods ending on or after December 31, 2010, using allowable cost criteria contained within the Medicare Provider Reimbursement Manual.

N.J. Admin. Code § 8:85-3.2

As amended, R.1979 d.482, effective 1/1/1980.
See: 11 N.J.R. 552(a), 12 N.J.R. 42(b).
As amended, R.1980 d.211, effective 5/14/1980.
See: 12 N.J.R. 84(b), 12 N.J.R. 323(b).
As amended, R.1982 d.87, effective 3/9/1981.
See: 12 N.J.R. 702(a), 13 N.J.R. 227(a).
(a) Deleted "to be in effect for one full year" after "per diem reimbursement rates."
As amended, R.1984 d.573, effective 12/16/1984.
See: 16 N.J.R. 2484(a), 16 N.J.R. 3437(a).
Added in (a): "As required .. at least annually".
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. 10:63-3.2 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).
Section was "Timing"; rewrote the section.
Amended by R.2011 d.121, effective 4/18/2011.
See: 42 N.J.R. 1793(a), 43 N.J.R. 961(c).
Rewrote (a); in (b), inserted "a properly completed" and "of (a) above", substituted "report" for "studies", and deleted "90 day" preceding "filing"; rewrote the table in (b); in (c), inserted "properly completed" and "all", and deleted ", completed in accordance with 'Care' guidelines"; in (e), substituted "December 31, 2010" for "May 31, 1980", rewrote (f); and added (g).