reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 6 - FINANCIAL REPORTING PRINCIPLES AND CONCEPTS › Section 10:52-6.62 - Central Supply Services (CSS)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The functions included in the Central Supply Services (CSS) cost center are as follows:
1. Central Supply Services shall prepare and issue medical and surgical supplies and equipment, except pharmaceuticals and intravenous solutions to patients and to other cost centers.
2. The invoice cost of non-charged supplies and equipment issued to other centers shall be transferred to the using centers, preferably on a monthly basis. The invoice cost of charged medical supplies shall be transferred to the Medical and Surgical Supplies Sold Center, preferably on a monthly basis.
3. The cost of non-charged reusable medical supplies and equipment requisitioned from CSS by different centers (for example, respirators) shall be reported in the Central Supply Service Center. Costs associated with non-charged reusable medical supplies and equipment requisitioned from only one center shall be reported in that center.
4. Functions shall include the following: Requisitioning and issuing of appropriate supply items required for patient care; preparing sterile irrigating solutions; collecting, assembling, sterilizing, and redistributing reusable items; and cleaning, assembling, maintaining, and issuing portable apparatus.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 6 - FINANCIAL REPORTING PRINCIPLES AND CONCEPTS › Section 10:52-6.63 - Dietary (DTY)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The functions included in the Dietary (DTY) cost center are as follows:
1. Dietary shall be responsible for the procurement, storage, processing of food, delivery and collection of trays and nourishment to nursing units or outpatient centers. Costs of delivery of trays to the patient once trays have been prepared or have arrived at the nursing unit shall be reported in the appropriate Routine Service center. The cost of preparing meals for cafeterias, residents, students, visitors, or house physicians shall be reported for luxury and guest meals as per 10:52-6.25 through 6.31. Cost and Revenue of food supplements when charged to patients shall be reported in the Drugs Sold to Patients center.
2. Functions shall include the following: Preparing diet manuals; recommending diets; preparing selective menus for various diet requirements; recording diet history; nutrition counseling; determining patient food preferences as to type and method of preparation; food storage and preparations; transportation of food trays to and from nursing units; stocking formula room; cashiering; dishwashing; and maintaining sanitary standards in all facilities.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 6 - FINANCIAL REPORTING PRINCIPLES AND CONCEPTS › Section 10:52-6.64 - Housekeeping (HKP)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The functions included in the Housekeeping (HKP) cost center are as follows:
1. Housekeeping shall be responsible for the maintenance of a clean and sanitary environment in the institution. The cost of routine cleansing of all areas, excluding Dietary (DTY) and Boiler Room (RPM) shall be included in housekeeping. The cost of housekeeping to non-acute care areas, gift and coffee shops, offices rented or maintained for fund raising, or non-approved education and research programs, and for the room and board of employees, students, or others, as well as the expense and revenue of providing housekeeping to entities outside of the hospital shall not be reported here but shall be reported in their appropriate cost center as in N.J.A.C 10:52-6.33 through 6.76. Specialized clean up activities associated with direct care of patients in nursing units and outpatient and ancillary centers shall be reported in those centers (see 10:52-6.33 through 6.77).
2. Functions shall include the following: Maid service; janitorial service; transporting trash to plant staging areas; mopping, stripping and waxing floors; washing of walls, ceilings, partitions and windows (inside and outside); stripping, disinfecting and making beds; and moving furniture and fixtures.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 6 - FINANCIAL REPORTING PRINCIPLES AND CONCEPTS › Section 10:52-6.65 - Laundry and Linen (L and L)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The functions included in the Laundry and Linen (L & L) cost center are as follows: Laundry and Linen is responsible for the requisitioning, laundering, distributing, controlling and mending linen, bedding, wearing apparel and disposable linen substitutes used by the hospital. This cost center shall also include, but not be limited to, the purchased cost and maintenance of all wearing apparel, as well as all linen and bedding. The cost of providing laundry and linen services to non-acute care units and for the room and board of employees, students, and others shall not be included in this center.
(b) Statistics: Pounds of Laundry.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 6 - FINANCIAL REPORTING PRINCIPLES AND CONCEPTS › Section 10:52-6.66 - Medical Records (MRD)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The functions included in the Medical Records (MRD) cost center are as follows:
1. Medical Records shall be responsible for creating and maintaining a medical record for all patients and for maintaining a tumor registry in accordance with Department of Health requirements. (N.J.A.C. 8:43G-21.2(a)). The revenue and costs associated with medical records transcriptions for persons outside of the hospital shall be reported as reconciling items.
2. Functions shall include the following: Coding; typing; abstracting; filing; indexing; accessing; preparing birth and death certificates; processing court and other types of inquiries; maintaining and reporting of data such as patient days, visits, ancillary services and statistics by patient, disease, physician and operation; and coordinating the flow of statistics with certain hospital centers.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 6 - FINANCIAL REPORTING PRINCIPLES AND CONCEPTS › Section 10:52-6.67 - Pharmacy (PHM)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The functions included in the Pharmacy (PHM) cost center are as follows:
1. The Pharmacy procures, preserves, stores, compounds, manufactures, packages, controls, assays, dispenses, and distributes medications (including intravenous solutions) for inpatients and outpatients under the jurisdiction of a licensed pharmacist. Pharmacy services shall include the maintaining of separate stocks of commonly used items in designated areas.
2. The invoice cost of non-charged pharmaceuticals issued to other cost centers shall be transferred to the using cost centers, preferably on a monthly basis. The invoice cost of charged pharmaceuticals and intravenous solutions shall be transferred to the Drugs Sold to Patients center, preferably on a monthly basis.
3. Functions shall include the following: Development and maintenance of formulary(ies) established by the medical staff and consultation and advice to medical and nursing staff on drug therapy; adding drugs to intravenous solutions; determining incompatibility of drug combinations; and stocking floor drugs and dispensing machines.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 6 - FINANCIAL REPORTING PRINCIPLES AND CONCEPTS › Section 10:52-6.68 - Social Services (SOC)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The functions included in the Social Services (SOC) cost center are as follows:
1. Social Services shall obtain, analyze, interpret social and economic information to assist in diagnosis, treatment and rehabilitation of patients. These services shall include: counseling of staff and patients in case units and group units; participation in development of community social and health programs and community education. Revenues received by hospitals shall not be reported here, but shall be reported with the routine or ambulatory revenue centers where social services were provided and billed.
2. Functions shall include the following: Interviewing of patients and relatives to obtain a social history relevant to medical problems and planning; interpreting problems of social situations as they relate to medical condition and/or hospitalization; arranging for post discharge care of chronically ill; collecting and revising information on community health and welfare resources.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 6 - FINANCIAL REPORTING PRINCIPLES AND CONCEPTS › Section 10:52-6.69 - Research (RSH)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The functions included in the Research (RSH) cost center are as follows:
1. This center shall administer, manage, and carry on research projects of the National Institutes of Health or other projects approved by the Commissioner of the Department of Health in approved research. Approved research shall be reported pursuant to N.J.A.C. 10:52-6.25, 6.26, and 6.27. Separate accounting shall be maintained for each research activity in accordance with relevant contracts, grant agreements, or because of restrictions made on donations. Revenue received for research activities such as specific purpose grants shall be recorded as reconciling items. This center shall include expenses related to fellowships.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 6 - FINANCIAL REPORTING PRINCIPLES AND CONCEPTS › Section 10:52-6.70 - Nursing and Allied Health Education (EDU)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The functions of the Nursing and Allied Health Education (EDU) that are included in this cost center are as follows:
1. The Nursing and Allied Health Education Center provides organized programs, approved by an organization which recognizes the professional stature of health services educational programs at the national level, of nursing and medical related clinical education other than for physicians. Hospitals may either operate a school or provide the clinical training activities where a degree is issued by a college or university.
2. Expenses related to the upkeep of student rooms and dormitories.
3. Functions shall include the following: Selecting qualified students; providing education in theory and practice conforming to approved standards; maintaining student personnel records; counseling of students regarding professional, personal and educational problems; selecting faculty personnel; assigning and supervising students in providing medical or nursing care to selected patients; and administering aptitude and other tests for counseling and selection purposes.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 6 - FINANCIAL REPORTING PRINCIPLES AND CONCEPTS › Section 10:52-6.71 - Graduate Medical Education (GME)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The functions included in the Graduate Medical Education (GME) cost center are as follows:
1. Graduate Medical Education shall provide an organized program of graduate medical clinical education to interns and residents. A medical residency training program must be approved by the Liaison Committee on Graduate Medical Education or, in the case of osteopathic residencies, approved by the Committee on Hospitals of the Bureau of Professional Education of the American Osteopathic Association. Residency programs in the field of dentistry in a hospital must have the approval of the Council on Dental Education of the American Dental Association.
2. Included here shall be expenses related to the office of the Director of Medical Education and the housing and board of residents. Expenses associated with fellowships are to be included in the Research (RSH) Center.
3. Functions shall include the following: Selecting qualified students, providing education in theory and practice conforming to approved standards; maintaining student personnel records; counseling of students regarding professional, personal and education problems; and assigning and supervising students.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 6 - FINANCIAL REPORTING PRINCIPLES AND CONCEPTS › Section 10:52-6.72 - General Administrative Services (GAM)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The functions included in the General Administrative Services (GAM) cost center are as follows:
1. General Administrative Services shall be those services associated with the overall direction and administration of the institution at all levels that are not readily distinguishable between inpatient and outpatient services. Expenses and revenues directly associated with services not related to patient care (for example, data processing services sold to outside organizations, administrative personnel responsible for the operation of skilled nursing facilities, and other exclusions) shall be reported as reconciling items. Detailed reporting of certain Administrative Service expenses shall be provided.
2. General Administrative Services include:
i. Governing Board;
ii. Office of Hospital Administrator;
iii. Medical Administration;
iv. Nursing Administration (persons responsible for more than one functional center);
v. Personnel;
vi. Public Relations;
vii. Communications;
viii. Management Engineering;
ix. Health Sciences Library;
x. Auxiliary Groups;
xi. Data Processing;
xii. Purchasing and Stores;
xiii. Internal Audit;
xiv. Postage;
xv. Medical Library;
xvi. Medical Photography and Illustration;
xvii. Licenses and Taxes (other than income taxes and payroll taxes);
xviii. Insurance (other than Malpractice and Employees Fringe Benefits);
xix. Security;
xx. Planning;
xxi. Professional Association Memberships;
xxii. Legal and Audit Fees;
xxiii. Duplicating and Printing;
xxiv. Financial Administration;
xxv. Motor Pool; and
xxvi. Travel.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 6 - FINANCIAL REPORTING PRINCIPLES AND CONCEPTS › Section 10:52-6.73 - Inpatient Administrative Services (IAM)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The functions included in the Inpatient Administrative Services (IAM) cost center are as follows:
1. Inpatient Administrative Services shall be those primarily associated with the overall direction and administration of inpatient services provided in the institution. For example, the hospital admitting office would be assigned to Inpatient Administrative Services, rather than General Administrative Services. Detailed reporting of certain Administrative Services expenses shall be provided per 8:31B-4.61 through 4.67, incorporated herein by reference.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 6 - FINANCIAL REPORTING PRINCIPLES AND CONCEPTS › Section 10:52-6.74 - Malpractice Insurance (MAL)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The functions included in the Malpractice Insurance (MAL) cost center are as follows:
1. Malpractice Insurance shall include the institution's total premium or self-insurance cost for hospital and professional liability coverage. No other type of insurance coverage shall be included here.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 6 - FINANCIAL REPORTING PRINCIPLES AND CONCEPTS › Section 10:52-6.75 - Employee Health Insurance (EHI)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The functions included in the Employee Health Insurance (EHI) cost center are as follows:
1. Employee Health Insurance shall include all premium payments and associated costs with union or group health insurance for employees. Hospitals which are self-insured for employees health insurance shall report no insurance costs in this cost center. However, deductions from operating revenue for personal health programs shall be reported by cost center.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 6 - FINANCIAL REPORTING PRINCIPLES AND CONCEPTS › Section 10:52-6.76 - Repairs and Maintenance (RPM)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The functions included in the Repairs and Maintenance (RPM) cost center are as follows:
1. The Repairs and Maintenance center shall be responsible for maintenance and operation of an institution's buildings and equipment in a state of readiness required to perform hospital operations. Repairs and Maintenance of physical plant not used for services related to patient care (for example, rental of apartments) shall be reported as reconciling items. Renovation of capital assets is to be distinguished from Repairs and Maintenance Expenses and capitalized with the asset according to the criteria described in 10:52-6.19.
2. The maintenance and repair of specialized equipment in areas such as Diagnostic Radiology, Therapeutic Radiology, or Laboratory shall report such costs in those centers. Biomedical engineers' expenses shall be in this cost center.
3. Functions shall include the following: All maintenance of buildings and plant equipment including painting; maintenance of moveable equipment to the extent done by institution employees; and minor improvements and renovation of buildings and plant equipment.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 6 - FINANCIAL REPORTING PRINCIPLES AND CONCEPTS › Section 10:52-6.77 - Utilities Cost (UTC)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The functions included in the Utilities Cost (UTC) cost center are as follows:
1. The center shall be used to account for all utility costs such as electricity, gas, oil, disposal services and water. A breakdown of the cost and source of these utilities shall be provided.
2. Telephones shall not be considered utilities and thus such costs and revenues shall not be reported in this center. Costs associated with utilities provided to buildings and areas not involved in patient care shall be excluded and reported as reconciling items.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 7 - DIAGNOSIS RELATED GROUPS (DRG) › Section 10:52-7.1 - Diagnosis Related Groups (DRG)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Diagnosis Related Groups (DRG) represent categories of hospital inpatients with similar clinical characteristics and, except for outliers, patients in each DRG can be expected to consume similar amounts of hospital resources. Assignment of a patient to a DRG requires the following information:
1. Principal diagnosis;
2. Secondary diagnosis;
3. Principal and other procedures;
4. Age;
5. Sex;
6. Discharge status; and
7. Birthweight (neonate): A newborn under 29 days of age.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 7 - DIAGNOSIS RELATED GROUPS (DRG) › Section 10:52-7.2 - Calculation of payment rates

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Outliers are patients displaying atypical characteristics relative to other patients in a DRG. The three categories of outliers are defined and the methodology for outlier payment is established as follows.
1. High length of stay: Patients assigned to a DRG, but whose Length of Stay (LOS) is longer than the high LOS trim point.
i. The rate is the inlier rate per case plus a per diem for each acute day from the date of admission to the date of discharge.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 7 - DIAGNOSIS RELATED GROUPS (DRG) › Section 10:52-7.3 - List of Diagnosis Related Groups

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following are Major Diagnostic Categories (Organ System Approach):
1. Diseases and Disorders of the Nervous System.
2. Diseases and Disorders of the Eye.
3. Diseases and Disorders of the Ear, Nose, Mouth and Throat.
4. Diseases and Disorders of the Respiratory System.
5. Diseases and Disorders of the Circulatory System.
6. Diseases and Disorders of the Digestive System.
7. Diseases and Disorders of the Hepatobiliary System and Pancreas.
8. Diseases and Disorders of the Musculoskeletal System and Connective Tissue.
9. Diseases and Disorders of the Skin, Subcutaneous Tissue and Breast.
10. Endocrine, Nutritional and Metabolic Diseases and Disorders.
11. Diseases and Disorders of the Kidney and Urinary Tract.
12. Diseases and Disorders of the Male Reproductive System.
13. Diseases and Disorders of the Female Reproductive System.
14. Pregnancy, Childbirth and the Puerperium.
15. Normal Newborns and Other Neonates with Certain Conditions Originating in the Perinatal Period.
16. Diseases and Disorders of Blood and Blood Forming Organs and Immunological Disorders.
17. Myeloproliferative Diseases and Disorders, and Poorly Differentiated Neoplasms.
18. Infectious and Parasitic Diseases (Systemic or Unspecified Sites).
19. Mental Diseases and Disorders.
20. Alcohol/Drug Use and Alcohol/Drug Induced Organic Mental Disorders.
21. Injuries, Poisonings and Toxic Effects of Drugs.
22. Burns.
23. Factors Influencing Health Status and Other Contacts with Health Services.
24. Human Immunodeficiency Virus (HIV) Infections.
25. Multiple Significant Trauma.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 8 - GRADUATE MEDICAL EDUCATION AND INDIRECT MEDICAL EDUCATION › Section 10:52-8.1 - Calculation of the amount of Graduate Medical Education (GME) and Indirect Medical Education (IME) reimbursement to be distributed

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Medicare principles of reimbursement for GME and IME are as follows:
1. Direct GME is calculated based on Medicaid's and NJ FamilyCare-Plan A's fee-for-service share of the major teaching hospitals' intern and resident FTEs multiplied by their specific per resident amounts as reported on the Medicare audited cost report (including subsequent amendments) in Worksheet E-3 Part IV for the year in which payment has been made.
2. IME is calculated based on Medicare's IME formula, at 42 CFR 412.105, incorporated herein by reference. The major teaching hospitals' IME factor, as calculated by the Medicare IME formula, is multiplied by their hospital-specific Medicaid/NJ FamilyCare-Plan A fee-for-service inpatient DRG payments (net of GME and IME) to arrive at the Medicaid/NJ FamilyCare-Plan A fee-for-service IME payment. The components of Medicare's IME formula, IME intern and resident FTEs and maintained beds, are from the audited Medicare cost report (including subsequent amendments) in Worksheet S-3 for the year in which payment has been made.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 8 - GRADUATE MEDICAL EDUCATION AND INDIRECT MEDICAL EDUCATION › Section 10:52-8.5 - Hospital fee-for-service reimbursement for Graduate Medical Education (GME) effective on or after July 6, 1998

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Effective for payments on or after July 6, 1998, the GME payment shall be distributed in 12 monthly lump sum payments during the State Fiscal Year. The amount distributed shall be considered the final GME payment and shall not be reconciled. The GME payment shall not exceed the amount appropriated for GME each State Fiscal Year. This GME payment represents both direct GME and Indirect Medical Education (IME).
(b) The source of the data used to allocate the GME payment is the Medicare/Medicaid submitted cost report that is on file with DMAHS as of October 31 of the current calendar year for GME payments for the State fiscal year commencing July 1 of the subsequent year with corresponding 24-month fee-for-service Medicaid/NJ FamilyCare-Plan A inpatient paid claims data as of February 1 prior to the year of distribution. GME resident full-time-equivalents and total hospital days shall come from the Medicare/Medicaid/NJ FamilyCare submitted cost report. The hospital-specific Medicaid/NJ FamilyCare-Plan A fee-for-service days shall come from the 24-month data fee-for-service Medicaid/NJ FamilyCare-Plan A inpatient paid claims data.
1. For hospitals with psychiatric units included in the Medicare Inpatient Prospective Reimbursement System for Medicare reporting purposes but excluded for Medicaid/NJ FamilyCare reporting purposes, the data from the hospital-submitted worksheets for the Medicaid-excluded psychiatric units shall be used.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 8 - GRADUATE MEDICAL EDUCATION AND INDIRECT MEDICAL EDUCATION › Section 10:52-8.6 - Distribution of Graduate Medical Education (GME) effective on or after July 6, 1998

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Effective for payments on or after July 6, 1998, the amount appropriated for GME shall be distributed to all eligible acute care teaching hospitals. An eligible acute care teaching hospital is defined as an acute care teaching hospital that has a combined Medicaid/NJ FamilyCare-Plan A fee-for-service utilization at or above the median of all New Jersey acute care hospitals. The Medicaid/NJ FamilyCare-Plan A fee-for-service utilization is calculated using the hospital-specific Medicaid/NJ FamilyCare-Plan A fee-for-service days divided by the hospital-specific total days.
(b) The distribution of the GME payment to eligible acute care teaching hospitals is based on the hospital-specific percentage of total weighted GME FTEs, where weighted GME FTEs equals the hospital-specific GME FTEs times the hospital-specific Medicaid/NJ FamilyCare-Plan A fee-for-service days divided by the total Medicaid/NJ FamilyCare-Plan A hospital fee-for-service days for all eligible hospitals.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 9 - REVIEW AND APPEAL OF RATES › Section 10:52-9.1 - Review and appeal of rates

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All hospitals, within 15 working days of receipt of the Proposed Schedule of Rates shall notify the Division of any calculation errors in the rate schedule that relate to adjustments that have been made to the rates since the previously announced schedule of rates. If upon review it is determined by the Division that the error is of substantial value, a revised rate will be issued to the hospital within 10 working days. If the discrepancy is determined to be substantial and a revised Schedule of Rates is not issued by the Division within 10 working days, notification time frames above will not become effective until the hospital receives a revised Schedule of Rates.
(b) Any hospital which seeks an adjustment to its rates shall agree to an operational review at the discretion of the Department.
1. A request for a rate review must be submitted by a hospital in writing to the Department of Human Services, Division of Medical Assistance and Health Services, Office of Hospital Reimbursement, PO Box 712, Mail Code #44, Trenton, New Jersey 08625-0712 within 20 calendar days after publication of the rates by the Department of Human Services (DHS).
i. A hospital shall identify its rate review issues and submit supporting documentation in writing to the Division within 80 calendar days after publication of the rates by the DHS.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 10 - CENTERS FOR MEDICARE & MEDICAID SERVICES HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) FOR HOSPITAL OUTPATIENT LABORATORY SERVICES › Section 10:52-10.1 - Introduction

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The New Jersey Medicaid/FamilyCare fee-for-service program utilizes the Centers for Medicare & Medicaid Services' (CMS's) Healthcare Common Procedure Coding System (HCPCS) for 2009, established and maintained by CMS in accordance with the Health Insurance Portability and Accountability Act of 1996, Pub. L. 104-191, and incorporated herein by reference, as amended and supplemented, and as published by PMIC, 4727 Wilshire Blvd., Suite 300, Los Angeles, CA 90010. Revisions to the Healthcare Common Procedure Coding System made by CMS (code additions, code deletions and replacement codes) will be reflected in this subchapter through publication of a notice of administrative change in the New Jersey Register. Revisions to existing reimbursement amounts specified by the Department and specification of new reimbursement amounts for new codes will be made by rulemaking in accordance with the Administrative Procedure Act, 52:14B-1 et seq. HCPCS follows the American Medical Association's Physicians' Current Procedural Terminology architecture, employing a five position code and as many as two 2-position modifiers. Unlike the CPT numeric design, the CMS assigned codes and modifiers contain alphabetic characters.
1. LEVEL I CODES (Narratives found in CPT)
These codes are adapted from CPT for utilization primarily by Physicians, Podiatrists, Optometrists, Certified Nurse Midwives, Certified Nurse Practitioners, Independent Clinics and Independent Laboratories. CPT is a listing of descriptive terms and numeric identifying codes and modifiers for reporting medical services and procedures performed by physicians.
Copyright restrictions make it impossible to print excerpts from CPT procedure narratives for Level I codes. Thus, in order to determine those narratives it is necessary to refer to CPT, which is incorporated herein by reference, as amended and supplemented. An updated copy of the CPT (Level I) codes may be obtained from the American Medical Association, P.O. Box 10950, Chicago, IL 60610, or by accessing
www.ama-assn.org
.
2. LEVEL II CODES (Narratives found at 10:52-10.3 )
These codes are assigned by CMS for physicians and non-physician services which are not in CPT. An updated copy of the HCPCS (Level II) codes may be obtained by accessing the HCPCS website at
www.cms.gov/TransactionCodeSetsStands/or
by contacting PMIC, 4727 Wilshire Blvd., Suite 300, Los Angeles, CA 90010.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 10 - CENTERS FOR MEDICARE & MEDICAID SERVICES HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) FOR HOSPITAL OUTPATIENT LABORATORY SERVICES › Section 10:52-10.5 - Pathology and Laboratory HCPCS Codes-Modifiers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Services and procedures may be modified under certain circumstances. When applicable, the modifying circumstance has been identified by the addition of alphabetic and/or numeric characters at the end of the code. The New Jersey Medicaid/NJ FamilyCare fee-for-service programs' recognized modifier codes are:
Modifier
Code
Description
22
Unusual Procedural Services: When the service(s) provided
is greater than that usually required for the listed
procedure, it may be identified by adding modifier '22'
to the usual procedure number. A report may also be
appropriate.
26
Professional Component: Certain procedures are a
combination of a physician component and a technical
component. When the physician component is reported
separately, the service may be identified by adding the
modifier '26' to the usual procedure number.
52
Reduced Services: Under certain circumstances a service
or procedure is partially reduced or eliminated at the
physician's election. Under these circumstances the
service provided can be identified by its usual procedure
number and the addition of the modifier '52', signifying
that the service is reduced. This provides a means of
reporting reduced services without disturbing the
identification of the basic service.
90
Reference (Outside) Laboratory: When laboratory
procedures are performed by a party other than the
treating or reporting physician, the procedure may be
identified by adding the modifier '90' to the usual
procedure number.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 11 - CHARITY CARE › Section 10:52-11.1 - Charity care audit functions

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Department of Health shall conduct an audit of disproportionate share hospitals' charity care reported as written-off each calendar year. The Department of Health shall audit charity care at least once, but no more than six times each calendar year.
(b) The Department of Health shall report to the Division of Medical Assistance and Health Services on charity care. This report shall include any adjustments made pursuant to N.J.A.C. 10:52-11.15 or 13.4 or approvals made pursuant to N.J.A.C. 10:52-11.8(c) and (d).
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 11 - CHARITY CARE › Section 10:52-11.2 - Sampling methodology

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Department of Health shall audit charity care claims based on a sample which will be developed from the charity claims submitted for pricing as described in NJ.A.C. 10:52-12.2.
(b) The Department of Health shall require hospitals to make a small number of additional charity care accounts available upon audit.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 11 - CHARITY CARE › Section 10:52-11.3 - Charity care write- off amount

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Department of Health shall value charity care claims at the Medicaid/NJ FamilyCare rate. The Medicaid/NJ FamilyCare rate, for purposes of valuing a given charity care claim, shall be based on the New Jersey Medicaid/NJ FamilyCare program's pricing and program policies pursuant to N.J.A.C. 10:52-12.1 and 12.2. For write-off and billing purposes, the hospital shall use the following procedures:
1. Charity Care Write-Off Amount equals Charity Care Eligibility Percentage, as determined by N.J.A.C. 10:52-11.8(b) and (c) multiplied by the Medicaid/NJ FamilyCare payment rate.
2. In the event that there is a partial payment from a third party, the charity care write-off amount is determined as follows: Charity Care Write-Off Amount equals Medicaid/NJ FamilyCare payment rate minus third party payment multiplied by Charity Care Eligibility Percentage. Beginning July 1, 1995, charity care availability for persons with health insurance shall be subject to all Federal disproportionate share rules, including the Omnibus Budget Reconciliation Act of 1993, Section 13621.
3. If the third-party payment is greater than the Medicaid/NJ FamilyCare payment rate, the charity care write-off amount shall be listed as zero.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 11 - CHARITY CARE › Section 10:52-11.4 - Differing documentation requirements if patient admitted through emergency room

Current through Register Vol. 56, No. 14, July 15, 2024
10:52-11.5 through 11.10 govern documentation requirements for all charity care applications except those for patients admitted through the hospital's emergency room. Documentation requirements for applications of patients admitted through the emergency room are governed by 10:52-11.16.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 11 - CHARITY CARE › Section 10:52-11.6 - Identification

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Applicants for charity care shall provide the hospital with the following proper identification: paragraph (a)3 below represents an alternative measure for documenting identification as described in 10:52-11.11.
1. The applicant shall provide the hospital with one of the following identification documents: driver's license, social security card, alien registry card, birth certificate, baptismal certificate, paycheck stub, passport, visa, death certificate, employee identification, or attestation that the person is homeless and does not possess any of the above mentioned identification documents. If the documents listed above are not available to the applicant, the hospital staff shall document why the applicant was unable to comply, and shall ask for one of the identification documents listed in (a)2 below. If the applicant is unable to comply for medical reasons, such as, if the applicant is deceased, or noncommunicative until discharge for medical reasons, and a person to identify the patient cannot be found, the requirement for identification shall be waived.
2. The applicant shall provide the hospital with one of the following documents containing his or her name and address: a driver's license, a voter registration card, a union membership card, an insurance or welfare plan identification card, a student identification card, a utility bill, a Federal income tax form, a state income tax form, or an unemployment benefits statement. If the documents listed above are not available to the applicant, the hospital staff shall document why the applicant was unable to comply and shall ask for proof of identification as described in (a)3 below.
3. The applicant shall provide proof of identification in one of the following ways: a piece of mail addressed and delivered to the applicant; a signed attestation (which includes the party's name, address and telephone number) from a third party attesting to the applicant's identity; or a signed statement attesting to his or her own identity.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 11 - CHARITY CARE › Section 10:52-11.7 - New Jersey residency

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Applicants for charity care shall provide the hospital with proof of New Jersey residency. An applicant shall provide proof that he or she has been residing in New Jersey since the time of service, has no residency in any other state or country, and has the intent to remain in the State. Paragraph (a)3 below represents an alternative measure for documenting proof of residency.
1. The applicant shall provide the hospital with any of the identification documents listed in 10:52-11.6(a)2  that contains the applicant's current residence address and a date from which the hospital can reasonably infer that the applicant has resided in New Jersey since the time of service, has no residency in any other state or country, and has the intent to remain in the State. The hospital may accept an attestation from the applicant that he or she is homeless. If the applicant is unable to provide one of the documents listed at 10:52-11.6(a)2, the hospital staff shall document why the applicant was unable to comply, and shall ask for proof of residency as described in (a)2 below.
2. If the applicant cannot provide any of the documentation listed in 10:52-11.6(a)2, the applicant shall supply a copy of any undated identification listed in 10:52-11.6(a)1  and this paragraph, or any mail received showing the applicant's name and current residence address. If the applicant is unable to provide these documents, the hospital staff shall document why the applicant was unable to comply and ask for proof of residency as described in (a)3 below.
3. The applicant shall provide a signed attestation stating that he or she has been residing in New Jersey since the time of service, has no residency in any other state or country, and has the intent to remain in the State.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 11 - CHARITY CARE › Section 10:52-11.8 - Income eligibility criteria and documentation

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The hospital shall determine the applicant's family size in accordance with this section. Family size for an adult applicant includes the applicant, spouse, any minor children whom he or she supports, and adults for whom the applicant is legally responsible. The family size for a minor applicant includes both parents, the spouse of a parent, minor siblings and any adults in the family for whom the applicant's parent(s) are legally responsible. If an applicant documents that he or she has been abandoned by a spouse or parent, that spouse or parent shall not be included as a family member. A pregnant female counts as two family members.
(b) The provisions of 42 U.S.C. §
										9902(2), the poverty guidelines revised annually by the United States Department of Health and Human Services (HHS), are hereby incorporated by reference. (For further information on the poverty guidelines, contact the Office of the Assistant Secretary for Planning and Evaluation, Room 415F, Department of Health and Human Services, 200 Independence Avenue, SW Washington, D.C. 20201, Telephone (202) 690-7858; Website:
http://aspe.hhs.gov/
.) A person is eligible for charity care or reduced charge charity care if he or she falls into one of the following categories:
1. A person whose individual or, if applicable, family income, as determined by (e) below, is less than or equal to 200 percent of the HHS Poverty Guidelines shall be eligible for charity care for necessary health services without cost.
2. A person whose individual or, if applicable, family, income as determined by (e) below, is greater than 200 percent of the HHS Poverty Guidelines but not more than 300 percent of these guidelines is eligible for charity care at a reduced rate as described in (c) below.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 11 - CHARITY CARE › Section 10:52-11.9 - Proof of income

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Applicants for charity care shall provide the hospital with proof of income as listed below. Paragraph (a)3 below shall be considered alternative documentation, as described in 10:52-11.11.
1. An applicant shall provide the hospital with proof of income, which includes the following items: Federal or State income tax return; pay check stubs; W-2 forms; a letter from an employer on company letterhead stating the applicant's income; or a statement of the gross benefit amount from any governmental agency providing benefit to the applicant. If an applicant has been employed for at least one month, he or she may document his or her income by providing one paycheck stub immediately prior to the date of service if the paycheck stub indicates a year-to-date income, and if the applicant documents the length of time he or she has been employed by the employer.
i. If an applicant is a recipient of Social Security benefits, he or she may document this income by either providing the annual benefits statement from the Social Security Administration, or copies of bank statements from three months prior which indicate direct deposit of the social security check, or a copy of one social security check.
ii. An applicant with no income or benefits of any type may present the hospital with a signed attestation to this effect. If the applicant is homeless, the hospital may accept a signed attestation which states that the applicant is homeless and receives no support, income or benefits.
iii. If the applicant is unable to provide one of the documents listed above, the hospital staff shall document reasons for the applicant's inability to comply and request the documentation listed in (a)2 below.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 11 - CHARITY CARE › Section 10:52-11.10 - Assets eligibility criteria

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An applicant shall provide proof that:
1. His or her individual assets as of the date of service do not exceed $ 7,500; and
2. His or her family's assets, if applicable, do not exceed $ 15,000 as of the date of service.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 11 - CHARITY CARE › Section 10:52-11.11 - Limit on accounts with alternative documentation

Current through Register Vol. 56, No. 14, July 15, 2024
The total of all sample dollars in which identification, New Jersey residency, income, and assets documented by the alternative procedures described in 10:52-11.6(a)3, 11.7(a)3, 11.9(a)3, or 11.10(d) 3 shall be limited to no more than 10 percent of the total dollars sampled on audit. Sample dollars that exceed 10 percent on the expanded sample shall be adjusted in accordance with 10:52-11.15(b).
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 11 - CHARITY CARE › Section 10:52-11.12 - Additional information to be supplied to facility by applicant

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A hospital shall, as a condition of finding any applicant eligible for charity care or reduced charge charity care, require the applicant to furnish any information that is reasonably necessary to substantiate the applicant's income and assets and that is within the applicant's ability to supply.
(b) An applicant who willfully presents false information will be liable for all hospital charges and subject to civil penalties pursuant to N.J.S.A. 26:2H-18.6 3.