New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 52 - HOSPITAL SERVICES MANUAL
Subchapter 14 - METHODOLOGY FOR ESTABLISHING DRG PAYMENT RATES FOR INPATIENT SERVICES AT GENERAL ACUTE CARE HOSPITALS BASED ON DRG WEIGHTS AND A STATEWIDE BASE RATE
Section 10:52-14.6 - Determination of the Statewide base rate
Current through Register Vol. 56, No. 18, September 16, 2024
(a) The Division established an initial Statewide base rate, which applies to all hospitals. Those hospitals meeting the criteria for add-on amounts in accordance with N.J.A.C. 10:52-14.7have rates higher than the Statewide base rate. The initial Statewide base rate is established as follows:
(b) The Statewide base rate is increased by the hospital specific add-on amounts to determine a final rate for each hospital. The final rate for new hospitals and hospitals that had no Medicaid/NJ FamilyCare discharges in the base year are set at the Statewide base rate.
(c) The Statewide base rate will be updated annually by the excluded hospital inflation factor, also referred to as the economic factor recognized under the CMS TEFRA target limitations, which is published in the Federal Register by CMS.
(d) The initial Statewide base rate calculated in this section is $ 4,479. The Statewide base rate will not be changed, except for annual inflation as noted in (c) above, unless rebasing occurs as described in (e) below.
(e) Rebasing, which is setting the Statewide base rate using a more current year's claim payment data, will be done at the discretion of the Division with the approval of the Commissioner of DHS. Rebasing may or may not include recalibrating the DRG weights as described in 10:52-14.3(g).