Current through Register Vol. 56, No. 18, September 16, 2024
(a) The Department of Human Services may authorize a county to become a participating county by approving its implementation of a pilot program imposing a fee on hospitals located within the county. Approval is subject to the following procedures:
1. The county shall submit a proposed fee and expenditure report to the Department for review and approval as specified in N.J.A.C. 10:52B-3.1;
2. The Department will make a participating county's proposed fee and expenditure report available for review and comment by affected hospitals and other interested parties for a period of 21 days and will consider the comments received in its review of the proposed report; and
3. The Department may request that a participating county amend its proposed fee and expenditure report if the Department determines that the county's proposal does not meet Federal or State requirements or address comments received during the comment period.
(b) As part of the Department's process to decide whether to approve the proposed fee and expenditure report, the Department shall determine whether the report meets the following requirements, whether:
1. The county's proposed fee and expenditure report will increase financial resources through the Medicaid/NJ FamilyCare program to support local hospitals and to ensure that they continue to provide the necessary services to residents with low-income;
2. The county's proposed fee complies with 42 U.S.C. §
1396b(w)(3)(A);
3. The county's proposed fee and expenditure plan described in the fee and expenditure report will not create a direct or indirect guarantee to hold affected hospitals harmless, consistent with 42 CFR 433.68(f);
4. The county's proposed fee will not exceed the aggregate amount specified in 42 CFR 433.68(f)(3) minus three and one-half percent of total net patient revenues, as defined therein;
5. The revenues collected from the fee will qualify as the non-Federal share of Medicaid/NJ FamilyCare program expenditures;
6. The financial impact of the county's proposed fee and expenditure report will reduce access to Medicaid/NJ FamilyCare services, reduce services to the uninsured, or otherwise threaten critical health care services at any hospital within the county, as determined by the Commissioner; and
7. The county's proposed plan described in the fee and expenditure report demonstrates that all good faith efforts will be made by the county to ensure that payments to be made under its proposal will not result in any hospital in the county exceeding its hospital-specific disproportionate share (DSH) limit as outlined in 42 U.S.C. §
1396r-4.
(c) After review of each county's proposed fee and expenditure report and consideration of any comments received during the 21-day public review period, the Department shall make a determination regarding approval for each county's proposed fee and expenditure report.
(d) Once a county's fee and expenditure report is approved, the board of chosen freeholders of the participating county may enact an ordinance or resolution, as appropriate to the county's form of government, imposing the fee and containing the elements specified at N.J.A.C. 10:52B-2.2.
(e) If a waiver is required pursuant to 42 CFR 433.68(e) to implement the county's approved fee and expenditure report, the Department will notify the county when the approval of such waiver is received from CMS.
(f) If revenue collected from the fee will be used as the non-Federal share of expenditures for new Medicaid/NJ FamilyCare provider payments, the Department will notify the county that it has received CMS approval for new Medicaid/NJ FamilyCare provider payments.
(g) A fee may only be collected from assessed hospitals to the extent, and for the period that, the Department determines that the fee proceeds qualify as the non-Federal share of Medicaid/NJ FamilyCare program expenditures pursuant to 42 CFR 433.68.
(h) A fee shall be collected and the proceeds from the fee shall be used in accordance with a participating county's approved fee and expenditure report.
1. A participating county may propose to amend its approved fee and expenditure report annually by submitting a proposed amendment to its fee and expenditure report to the Commissioner for review and approval. Any amendments must be approved by the Commissioner and have received any required Federal approvals before any changes are implemented.
2. Any amendment to a participating county's approved fee and expenditure report shall be subject to the requirements and process specified in this chapter.
3. Revenues from the imposition of a fee must be used as specified at N.J.A.C. 10:52B-3.3.
