Current through Register Vol. 56, No. 24, December 18, 2024
(a) A participating
county must submit a proposed fee and expenditure report to the Department for
review in accordance with instructions specified by the Department. The fee and
expenditure report shall describe the county's plan for imposing fees and
making expenditures from those fees and include such information as may be
required by the Department to determine whether the county's report satisfies
the requirements at N.J.A.C. 10:52B-2.2.
(b) A participating county shall consult with
affected hospitals located in the county to develop its proposed fee and
expenditure report prior to submission to the Department.
(c) A participating county's proposed fee and
expenditure report must include, at a minimum, the following:
1. An overview of the fee and expenditure
plan described in the fee and expenditure report;
2. A list of all the hospitals within the
jurisdiction and their facility type (acute care, psychiatric, rehabilitation,
long-term acute care hospital, etc.);
3. The proposed fee methodology;
4. The proposed expenditure
methodology;
5. Source
documentation for the data used to create the fee and expenditure report (for
example, Medicare or Medicaid/NJ FamilyCare cost report, survey data,
etc.);
6. Any and all facilities
the county requests to exclude from the fee with the rationale for those
exclusions;
7. A delineation of the
percentage of the fee proceeds that the county proposes to:
i. Transfer to the Department to cover State
administrative costs; and
ii.
Transfer to the Department to be used as non-Federal share of Medicaid/NJ
FamilyCare payments to hospitals in the participating county; and
8. A submission of the county's
prospective hospital specific disproportionate share payment limit (DSH limit)
calculation with supporting documentation for each hospital subject to the
hospital fee. The DSH limit is the difference between a hospital's costs for
treating Medicaid and uninsured individuals minus Medicaid payments and minus
any payments received on behalf of the uninsured.
i. The DSH limit must:
(1) Be calculated in a form and in accordance
with instructions specified by the Department;
(2) Be based on the data from the most recent
Federal DSH audit;
(3) Use the
Inpatient Prospective Payment System (IPPS) Hospital Market Basket as published
by CMS to trend costs to the current fiscal year, unless hospital documentation
verifies a different cost inflation for the hospital;
(4) Exclude any proposed payments to be made
under the pilot program;
(5) Adjust
for any changes in Federally matched State subsidy payments since the time of
the finalized DSH audit used in the calculation (that is, Charity Care,
Graduate Medical Education); and
(6) Be approved by the Department. The
Department reserves the right to discount any values included in the
calculation that are not supported by appropriate documentation.
ii. Should the county's fee and
expenditure report include provisions that would result in increased
Medicaid/NJ FamilyCare payments for any hospital that exceed the calculated
value of the hospital's DSH limit, the county's proposed fee and expenditure
report must include an attestation from the specific hospital's chief executive
officer confirming that the hospital is agreeing to a reduction to the
hospital's Medicaid DSH payments, including Charity Care payments, to the
extent necessary to comply with payment limits outlined in Section 1923(g) of
the Social Security Act ( 42 U.S.C. § 1394r-4). The Department reserves
the right to take all appropriate action to comply with Section 1923(g) of the
Social Security Act ( 42 U.S.C. § 1394r-4).
(d) A participating county's
proposed fee and expenditure report must describe the fee methodology that the
county is proposing to adopt. An appropriate fee methodology is any methodology
that is permitted under applicable Federal regulations and that meets the
following criteria:
1. The county must
determine how to apply the fee; the fee may be applied to inpatient hospital
services, outpatient hospital services, or both;
2. The fee must be applied to all hospitals
uniformly, except that the participating county may exempt hospitals within the
county that provide the assessed service from the fee, provided that the
exemption complies with the requirements of
42 CFR
433.68(c) and (d), and the
Department requests and receives approval of the waiver of the broad-based
and/or uniform requirements from CMS; and
3. The fee shall be assessed consistent with
Federal rules, with the basis of the assessment being: net or gross revenues,
discharges, encounters, days, beds, or visits, and may exclude revenue or
utilization attributable to Medicaid/NJ FamilyCare, Medicare, or
both.
