Current through Register Vol. 56, No. 18, September 16, 2024
(a) The county adjuster, at the discretion of
the court, shall act as referee to conduct investigations to determine each
client's legal settlement and the client's/LRR's financial ability to pay for
the cost of care and maintenance. This investigation shall be a thorough and
systematic attempt to learn the facts about the client's/LRR's financial
circumstances and residence(s), and shall be conducted as follows:
1. The county adjuster shall utilize his or
her subpoena powers to conduct such investigation, when necessary.
2. The investigation shall be completed
within six to eight weeks but no later than 60 days after receipt of
notification of admission/commitment of the client.
3. The county adjuster's investigatory
testimony, in the form of findings, conclusions and recommendations, are
subject to the approval of the court and shall be based on factual
evidence.
4. For clients 18 years
of age or older, the county adjuster shall utilize the eligibility criteria of
the Charity Care Fee Scale, as described at
10:7-4.2.
For the LRR(s) of clients under 18 years of age, the "Methodology and Formula
for Determination of Financial Ability to Pay of Clients and Legally
Responsible Relatives--The Treasury Formula" procedures manual shall be
utilized if the calculations produce a lesser LRR obligation. Published or
updated annually, in accordance with
30:4-60,
this manual assists in identifying those areas to be addressed by these
investigations.
5. The county
adjuster of the county of admission shall refer all cases when an investigation
indicates settlement is in another county. The county adjuster of the county to
which the client's case is referred shall review the information provided by
the county of admission, conduct its investigation as required and respond in
writing to the referring county. If accepted, the county of admission shall
obtain an order transferring venue to the county of legal settlement and the
county of legal settlement will then proceed with the petition.
(b) The formal investigation of
support regarding the county of legal settlement shall, as necessary, take into
consideration each of the following listed items. However, it need not be
limited to just those items. The county adjuster shall:
1. Obtain client residency data from
screening, admissions and commitment documents;
2. Contact facilities from previous
admissions of the client to obtain residency data and to inquire as to the
county of admission and the classification of the admission (including private
hospitals, county facilities, other counties and their facilities, and State
agencies);
3. Interview the client
for residency data, when possible;
4. Interview the client's spouse, relatives,
friends and neighbors for residency data;
5. Obtain residency data from Federal, State,
and county agencies supplying the client with benefits or assistance (SSA, SSI,
SSD, RR, VA Pensions, Medicare, Medicaid, DCF, DFD, General Assistance,
etc.);
6. Contact county, State and
Federal correctional facilities for residency data (including county probation
offices), if applicable;
7. Review
local municipal records to verify residency data, such as property tax records,
police records, occupancy permits/inspections, etc.;
8. Obtain written verification of residency
data, whenever possible;
9. Obtain
oral verification of residency data when written data is not obtainable;
and
10. Keep a record of the
client's settlement investigation, including date, time, data obtained, method
data obtained and the source of the data.
(c) The formal investigation of support to
determine financial ability of the client and/or LRR(s) to pay shall, as
necessary, take into consideration each of the following listed items. However,
it need not be limited to just those items. The county adjuster shall:
1. Obtain client financial data from
admissions documents;
2. Contact
facilities from previous admissions of the client to obtain financial data
(including private hospitals, county facilities, other counties and their
facilities, and State agencies);
3.
Interview the client for financial data, when possible;
4. Interview the client's spouse, relatives,
friends and neighbors for financial data;
5. Provide an LRR claiming crime victim
exemption from financial assessment status, with the DHS approved form to
complete and submit with appropriate proof to the county adjuster. The county
adjuster shall review the completed form and proofs and determine if the
exemption meets the criteria of
P.L.
2001, c. 208.
i. It is the responsibility of the person
claiming the exemption to supply copies of documents that will substantiate his
or her claim for exemption from financial assessment. Some examples of
documents that may be submitted to the county adjuster are police reports
(identifying victim), indictment, judgment or conviction, court order finding
the defendant IST or NGRI, and/or a restraining order. These examples are not
all inclusive; other forms of proof may be submitted.
ii. A person determined by the county
adjuster to have crime victim exemption status from financial assessment as an
LRR shall only retain the exemption for the commitment(s) that resulted from
that crime against the LRR. Should the client have future commitments, the
exemption does not carry forward. If a new crime is committed against the LRR
the person must submit a new exemption request and proofs directly related to
the new commitment.
6.
Obtain financial data from Federal, State, and county agencies supplying the
client with benefits or assistance (SSA, SSI, SSD, RR, VA Pensions, Medicare,
Medicaid, DCF, DFD, General Assistance, etc.);
7. Obtain client's/LRR's employment financial
data, when possible;
8. Review
client/LRR's tax records, pay stubs, banking/savings institution's records,
employment retirement records, insurance records, etc., for financial
data;
9. Contact county, State and
Federal correctional facilities for financial data, if applicable;
10. Review local municipal records to verify
financial data, such as property tax records;
11. Obtain written verification of financial
data, whenever possible;
12. Obtain
oral verification of financial data when written data is not
obtainable;
13. Keep a record of
the client's/LRR's financial investigation, including date, time, data
obtained, method data obtained and the source of the data; and
14. Complete the appropriate Charity Care Fee
Scale and, in the case of a legally responsible relative (LRR), the Treasury
Formula worksheets.
(d)
The county adjuster shall utilize the eligibility criteria of the Charity Care
Fee Scale (as described at
10:7-4.2)
for clients 18 years of age or older and/or the procedures found in the
"Methodology and Formula for Determination of Financial Ability to Pay of
Clients and Legally Responsible Relatives -- The Treasury Formula" procedures
manual, developed in accordance with
30:4-60,
for the LRR(s) of clients under 18 years of age to calculate the amount of
charges to clients/LRR(s) for each hospitalization.
1. The county adjuster shall utilize the
appropriate Charity Care Fee Scale or Treasury Formula worksheets. The county
adjuster shall complete the appropriate worksheet to the maximum extent
possible. The county adjuster shall complete the "Charity Care Determination of
Eligibility" form or "Summary of Total Charges" form for each client/LRR, as
appropriate.
2. For clients 18
years of age or older, the county adjuster shall utilize the Charity Care Fee
Scale eligibility criteria as described at
N.J.A.C.
10:7-4.2, plus the annual update of income
and asset standards for the current calendar year, which is distributed in
April of each year by DHS.
3. For
the LRR(s) of clients under 18 years of age, in order to determine the lesser
obligation between the Charity Care Fee Scale and the Treasury Formula, the
county adjuster shall utilize, in addition to the Charity Care Fee Scale, the
last manual published, plus the current calendar year's update for the
"Methodology and Formula for Determination of Financial Ability to Pay of
Clients and Legally Responsible Relatives -- The Treasury Formula." Treasury
Formula manual updates are distributed in December of each year with an
effective date of January 1st of the next year. Copies can be obtained from
the:
Department of Human Services
Office of Finance
222 South Warren Street, 5th Floor
PO Box 700
Trenton, New Jersey 08625-0700
(e) In the case of a person who is married,
the county adjuster shall take into account a spousal share of the combined
assets of the couple that shall be preserved for the non-institutionalized
spouse and immune from execution to satisfy the person's liability to
contribute toward the cost of treatment, maintenance and all necessary and
related expenses of the person's hospitalization. In determining the amount of
the spousal share, the county adjuster shall employ the same methodology used
by the State Medicaid program, in accordance with
10:71-4.8(a)1.
(f) The county adjuster shall review the
settlement and support court orders prior to submission to make sure that they
are in compliance with all appropriate Federal and State laws and regulations.
Specifically, the county adjuster shall ensure that said orders do not contain
Federal benefit funds consisting of Social Security benefits, Veterans
Administration benefits, Railroad Retirement benefits and/or Federal Civil
Service Pension benefits.
(g)
Settlement orders shall not be submitted to the court making Medicaid,
Medicare, or private insurance responsible for the cost of care and
maintenance. Settlement orders shall only indicate that the client has county,
State, or no settlement in the State or county. Support orders shall indicate
whether the client and/or the LRRs are chargeable for paying all or a portion
of the cost of care and maintenance pursuant to the Charity Care Fee Scale or
Treasury Formula and whether the county or State is responsible for the support
of the individual.
1. The only exception shall
be clients who meet the requirements of
30:4C-30.1.
Settlement and support orders for these clients shall indicate the county of
settlement, if any, that the county is relieved of the financial responsibility
for these clients under
30:4C-30.1.
The orders shall indicate that the client and his or her estate remain liable
for the full cost of care and maintenance allocated to them.
(h) Inmates/detainees of county
and municipal corrections systems transferred to State or county psychiatric
facilities shall be the financial responsibility, for the cost of care and
maintenance, of the county in which they were incarcerated. Inmates of the
State correctional system, whether housed in a county or State correctional
facility, shall be the financial responsibility of the State when transferred
to a State or county psychiatric facility. The county adjuster shall include
for State correctional inmates the State prisoner identification number in the
investigation accompanying the order of settlement and support.
(i) The county adjuster shall submit a
petition for the court to determine the client's legal settlement and provision
for payment of expenses of the client's care and maintenance, in accordance
with Civil Practice Rules 4:74-7 and 4:74-7A, or as otherwise directed by the
AOC. The county adjuster shall attach a report to the petition that includes
the investigative findings and/or testimony, the Charity Care Fee Scale and/or
Treasury Formula worksheet(s), the results of the investigation, and the
recommendations for an order of settlement and support. The county adjuster
shall schedule a hearing, with proper notice, for settlement and support, only
if there are objections to the proposed court order. The county adjuster shall
distribute a copy of the petition and report:
1. Directly to the client or the client's
guardian or guardian ad litem, if any, by certified mail, return receipt
requested, or as directed by the court;
2. To the client's counsel, by regular mail,
as required;
3. To the supervisor
of patients accounts of the State agency where the client is located, by
regular mail;
4. To the CEO or his
or her designee of the county psychiatric facility where the client is located,
by regular mail;
5. To the DMHAS
for State and no settlement clients in county psychiatric facilities, by
regular mail; and
6. To the legally
responsible relative(s) (LRRs), where applicable, by certified mail, return
receipt requested, or as directed by the court.
(j) The county adjuster shall file the
completed Orders of Settlement and Support in the county adjuster's office of
the county of settlement.
(k) The
county adjuster shall reevaluate the client's and/or LRR's financial
circumstances annually or sooner when information is obtained that their
financial circumstances have changed. The county adjuster shall take the
appropriate action to initiate an amendment to the client's and/or LRR's Order
of Settlement and Support.
(l) The
county adjuster shall distribute copies of the following documentation to the
appropriate agency's supervisor of patients' accounts, or equivalent, no later
than 90 days after receipt of notification that the client is
admitted/committed:
1. An appropriate Order
of Settlement and Support;
2. An
amended Order of Settlement and Support, if applicable;
3. Investigative findings and/or
testimony;
4. Charity Care Fee
Scale worksheets and/or Treasury Formula worksheets;
5. Charity Care Determination of Eligibility
form and/or Summary of Total Charges form(s); and
6. Outside representative payee voluntary
agreement(s), if applicable.
(m) Upon receipt of the Order of Settlement
and Support from the county adjuster, the hospital supervisor of patient
accounts will:
1. In cases where the
financial responsibility of the client, or the LRR of a client under 18 years
of age, was established through the Charity Care Fee Scale, apply the
calculated percentage of responsibility to the net amount due for the specific
hospitalization.
2. In cases where
the financial responsibility of the LRR of a client under 18 years of age was
established through the Treasury Formula, apply the dollar amount from the
Summary of Total Charges form as the amount due for the specific
hospitalization.
(n)
Initial contact with the client, or the LRR of a client under 18 years of age,
regarding the net dollar amount due for the specific hospitalization will be
through correspondence generated by the hospital supervisor of patient accounts
with a copy to the appropriate county adjuster.
