reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 2 - NURSING FACILITY SERVICES › Section 8:85-2.10 - Dental services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All facilities shall
				assist Medicaid beneficiaries to obtain dental care though a licensed dentist, who
				shall provide, or make provision for:
1.
				Appropriate consulting services;
2.
				In-service education to the facility;
3.
				Policies concerning oral hygiene; and
4.
				Routine and emergency services.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 2 - NURSING FACILITY SERVICES › Section 8:85-2.11 - Podiatry services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All facilities shall
				assist Medicaid beneficiaries to obtain podiatry care through a licensed podiatrist
				who shall provide, or make provision for:
1.
				Appropriate consulting services;
2.
				In-service education for the facility;
3. Policies concerning foot care; and
4. Routine and emergency services.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 2 - NURSING FACILITY SERVICES › Section 8:85-2.12 - Chiropractic services

Current through Register Vol. 56, No. 14, July 15, 2024
All facilities shall assist Medicaid beneficiaries to obtain
				  chiropractic care through a licensed chiropractor who shall provide, or make
				  provision for, routine and emergency services.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 2 - NURSING FACILITY SERVICES › Section 8:85-2.13 - Vision care services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All facilities shall
				assist Medicaid beneficiaries to obtain vision care through a licensed
				ophthalmologist or optometrist who shall provide, or make provision for, routine and
				emergency services.
(b) Policies and
				procedures regarding the provision of Vision Care services are outlined in the New
				Jersey Medicaid Program's Vision Care Manual (N.J.A.C. 10:62).
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 2 - NURSING FACILITY SERVICES › Section 8:85-2.14 - Laboratory; X-ray, portable X-ray and other diagnostic services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A NF shall have
				written agreements with one or more general hospitals or one or more clinical
				laboratories so that the facility can obtain laboratory services, including
				emergency services promptly. If the facility has its own laboratory capabilities,
				the services may not be billed on a separate fee-for-service basis. A laboratory
				must be:
1. Licensed and/or approved by the New
				Jersey State Department of Health and Senior Services and the State Board of Medical
				Examiners, which includes meeting Certificate of Need and licensure requirements,
				when required, and all applicable laboratory provisions of the New Jersey Sanitary
				Code; and
2. Certified as an independent
				laboratory under the Title XVIII Medicare Program; and
3. Approved for participation as an independent
				laboratory provider by the New Jersey Medicaid program.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 2 - NURSING FACILITY SERVICES › Section 8:85-2.16 - Consultant services; general

Current through Register Vol. 56, No. 14, July 15, 2024
If the NF has significant, unresolved or recurring problems, the
				  NF shall be required to provide appropriate consultation in any service area until
				  the problems are corrected.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 2 - NURSING FACILITY SERVICES › Section 8:85-2.17 - Transportation services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The NF shall assist
				a Medicaid beneficiary in obtaining transportation when the beneficiary requires a
				Medicaid-covered service or care not regularly provided by the NF.
(b) If a transportation service is provided by the
				NF to an inpatient of the NF, no additional reimbursement shall be allowed.
				Reimbursement shall be included in the per diem rate.
(c) Ambulance service shall not require
				authorization from the MDO, but shall be reimbursable to the transportation provider
				only when the use of any other method of transportation is medically
				contraindicated. (See
				10:50-1.3(c)2  for
				specific conditions for ambulance service reimbursement.)
(d) Invalid coach services shall not require prior
				authorization from the MACC.
1. Invalid coach
				services shall be provided by a transportation provider approved in accordance with
				N.J.A.C. 10:50, Transportation Services.
2. An invalid coach may be utilized when a
				Medicaid beneficiary requires transportation from place to place for the purpose of
				obtaining a Medicaid-covered service and when the use of an alternative mode of
				transportation, such as a taxi, bus, livery, or private vehicle, would create a
				serious risk to life or health.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 2 - NURSING FACILITY SERVICES › Section 8:85-2.18 - Bed and board

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Beds are provided in
				rooms licensed by the New Jersey Department of Health and Senior Services. A NF
				providing care to children shall have available protective cribs for infants and
				small children, as well as appropriate furniture, sized and scaled for
				children.
(b) Board shall be provided to
				meet basic nutritional needs and shall include the provision of therapeutic diets as
				prescribed by the attending physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 2 - NURSING FACILITY SERVICES › Section 8:85-2.19 - Housekeeping and maintenance services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Housekeeping and
				maintenance services necessary to maintain a sanitary and comfortable environment
				and laundering of personal clothing (excluding dry cleaning) shall be
				required.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 2 - NURSING FACILITY SERVICES › Section 8:85-2.20 - Non-covered services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Medicaid
				beneficiaries residing in NFs shall not be eligible to receive Medicaid
				reimbursement for the following services:
1.
				Admission or continued care primarily for diet therapy of exogenous obesity, bed
				rest, rest cure, or care of non-medical nature;
2. Private duty nursing;
3. Private attendant services;
4. Services and supplies not related to the care
				of the resident, such as guest meals and accommodations, television, telephone, and
				personal items;
5. Practitioner or
				therapy services furnished on a fee-for-service basis by an owner, partner,
				administrator, stockholder, or others having direct or indirect financial interested
				in the NF;
6. Partial care services in
				independent clinics; or
7.
				Medical/social day care.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 2 - NURSING FACILITY SERVICES › Section 8:85-2.21 - Special care nursing facility (SCNF)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A special care
				nursing facility (SCNF) is a nursing facility or separate and distinct SCNF unit
				within a Medicaid-certified conventional nursing facility which has been approved by
				the Department of Health and Senior Services to provide care to New Jersey Medicaid
				beneficiaries who require intensive nursing facility services beyond the scope of a
				conventional nursing facility as defined in N.J.A.C. 8:85-2. A SCNF or SCNF unit
				shall have a minimum of 24 beds.
1. The minimum
				bed requirement will be waived for SCNFs that were approved by DMAHS prior to
				November 23, 1994. In addition, the requirement will be waived in those instances
				where a SCNF's Certificate of Need stipulates a specific number of beds approved by
				the New Jersey Department of Health and Senior Services.
2. A SCNF receiving reimbursement through the
				Medicaid program shall not increase its total number of licensed beds for which a
				SCNF rate of reimbursement is received except upon approval from the
				Department.
3. A SCNF shall provide
				intensive medical, nursing and psychosocial management to the seriously ill
				individual who has potential for measurable and consistent maturation or
				rehabilitation, or has a technologically and/or therapeutically complex condition
				which requires the delivery of intensive and coordinated health care services on a
				24-hour basis.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 3 - COST REPORT, RATE CALCULATION AND REPORTING SYSTEM FOR LONG-TERM CARE FACILITIES › Section 8:85-3.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) These rules describe
				the methodology to be used by the State of New Jersey, Department of Health and
				Senior Services (Department), to establish prospective per diem rates for the
				provision of nursing facility services to residents under the State's Medicaid
				program.
(b) The Department believes
				that the strict application of these rules will generally produce equitable rates
				for the payment of nursing facilities (NFs) for the reasonable cost of providing
				routine patient care services. The Department recognizes, however, that no rules can
				be developed which might not result in some inequities if applied rigidly and
				indiscriminately in all situations. Inequities could be in the form of rates that
				are unduly low or rates that are unduly high.
(c) Accordingly, in the case where a NF believes
				that, owing to an unusual situation, the application of these rules results in an
				inequity, the Department is prepared to review the particular circumstances with the
				NF. Appeals on the grounds of inequity should be limited to circumstances peculiar
				to the NF affected. They should not address the broader aspects of the rules
				themselves.
(d) On the other hand, these
				rules are not purported to be an exhaustive list of unreasonable costs. Accordingly,
				notwithstanding any inference one may derive from these guidelines, the Department
				reserves the right to question and exclude any unreasonable costs, consistent with
				the provision of
				30:4D-1 et seq.
(e) All rates established pursuant to these rules
				will be subject to onsite audit verification of costs and statistics reported by
				NFs.
(f) The nursing facility rate
				formulae contained in this subchapter have been developed to meet the following
				overall goals:
1. To comply with Federal
				requirements that rates are reasonable and adequate to meet the cost that
				efficiently and economically operated facilities must incur to provide care in
				conformity with applicable State and Federal laws, rules, regulations and quality
				and safety standards;
2. To provide
				rates that are sufficient for facilities to meet the needs of their Medicaid
				beneficiaries through a rate setting system based on the average needs of
				individuals in their care; and
3. To
				control unnecessary costs, avoid duplicative cost reporting requirements and prevent
				fraud and abuse.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 3 - COST REPORT, RATE CALCULATION AND REPORTING SYSTEM FOR LONG-TERM CARE FACILITIES › Section 8:85-3.2 - Cost report preparation and timing of submission

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Nursing facilities
				shall furnish required cost reports to the Department of Health and Senior Services,
				Office of Nursing Facility Rate Setting and Reimbursement, by May 31 following the
				end of each calendar year for a cost reporting period ending December 31.
1. Effective for periods ending on or after
				December 31, 2010, the cost report form shall be the Medicare cost report and
				supplemental Medicaid schedules designated by the Department as N.J.A.C. 8:85
				Appendix U, incorporated herein by reference.
2. A nursing facility shall file separate cost
				reports for each central/home office when costs of the central/home office are
				reported on the facility's cost report.
3. Prospectively determined payment rates will be
				redetermined at least annually by the Department.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 3 - COST REPORT, RATE CALCULATION AND REPORTING SYSTEM FOR LONG-TERM CARE FACILITIES › Section 8:85-3.3 - Rate classes

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For dates of service
				on or after July 1, 2010, Class I and Class II prospective rates will be case mix
				rates for two classes of NFs:
1. Class I
				Proprietary and Voluntary NFs.
2. Class
				II Governmental NFs. To qualify as a Class II Governmental NF, the NF shall meet all
				of the contractual requirements of the Department and be a governmental
				operation.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 3 - COST REPORT, RATE CALCULATION AND REPORTING SYSTEM FOR LONG-TERM CARE FACILITIES › Section 8:85-3.4 - Resident rosters and case mix index calculation

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An NF shall
				electronically transmit MDS assessment information in a complete, accurate and
				timely manner.
1. The Department shall provide a
				Preliminary Resident Roster to an NF based on the NF's transmitted MDS assessment
				information for a calendar quarter, when that information is transmitted by the 20th
				day following the end of the calendar quarter.
2. The Department shall provide a Final Resident
				Roster to an NF based on the NF's transmitted MDS assessment information for a
				calendar quarter, when that information is transmitted by the end of the second
				calendar month following the end of the calendar quarter.
3. The Department shall not consider MDS
				assessment information for the purpose of reimbursement rate calculations under this
				subchapter for a calendar quarter that is not submitted by the end of the second
				calendar month following the end of the calendar quarter, except as provided in (a)4
				below.
4. The Department may only grant
				an exception to the electronic MDS assessment transmission due date for the
				following reasons:
i. A showing by the nursing
				facility that fraud may have occurred;
ii. An intervening natural disaster making timely
				compliance impossible or unsafe;
iii.
				Technical failure of the NF system used to encode and transmit MDS
				information;
iv. Technical failure of
				the central MDS data collection system; or
v. A new NF not previously certified by either the
				Medicare or Medicaid program that can substantiate to the Department circumstances
				that preclude timely electronic transmission.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 3 - COST REPORT, RATE CALCULATION AND REPORTING SYSTEM FOR LONG-TERM CARE FACILITIES › Section 8:85-3.5 - Fringed costs

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In order to
				equitably develop and calculate limits and prices, the following computation will be
				made for all cost reports effective for periods ending before December 31, 2010:
1. General fringe benefits will be allocated to
				function as a percentage of salaries reported to develop total compensation. General
				fringe benefits will include the raw food value of free and subsidized meals to
				employees;
2. The term "fringed costs"
				means the net amount of compensation costs (salary and fringe benefits) plus other
				expenses, less expense recoveries and nonallowable costs; and
3. For NFs that provide residential, sheltered or
				domiciliary care, fringed nursing facility costs will be determined by apportioning
				fringed cost in the same ratio as the apportionment of unfringed net
				expenses.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 3 - COST REPORT, RATE CALCULATION AND REPORTING SYSTEM FOR LONG-TERM CARE FACILITIES › Section 8:85-3.6 - Inflation

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For the purpose of
				calculating the limit and price as set forth in
				8:85-3.9 and for adjusting the operating
				and administrative price between rebasing years as set forth in
				8:85-3.8(c)2, the
				Department shall calculate an index factor using the most recent index factor
				publication.
(b) The Department shall
				calculate the index factor in (a) above by dividing the index associated with the
				quarter ending on the midpoint of the rate year for which the index is being
				established by the index associated with the quarter ending on the midpoint of the
				cost reporting period for purposes of setting the limit and price in
				8:85-3.9 or the midpoint of the prior
				rate year for purposes of adjusting the operating and administrative price in
				8:85-3.8(c)2.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 3 - COST REPORT, RATE CALCULATION AND REPORTING SYSTEM FOR LONG-TERM CARE FACILITIES › Section 8:85-3.7 - Case mix rate components

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Effective for dates
				of service on or after July 1, 2010, for Class I and Class II NFs, each facility's
				rate shall be comprised of:
1. The facility's
				direct care case mix rate component and direct care non-case mix rate
				component;
2. The operating and
				administrative price;
3. The
				facility-specific fair rental value (FRV) allowance; and
4. The provider tax pass-through per diem provided
				by 26:2H-92 et seq. and
				8:85-3.12.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 3 - COST REPORT, RATE CALCULATION AND REPORTING SYSTEM FOR LONG-TERM CARE FACILITIES › Section 8:85-3.8 - Limit and price database

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Department shall
				establish the database used to derive the direct care limit and operating and
				administrative price used in rates for dates of service July 1, 2010 through June
				30, 2011.
1. Each Class I NF and Class II NF in
				operation as a Medicaid certified NF as of May 1, 2010 shall be
				identified.
2. The most recent validated
				cost report for each identified Class I NF and Class II NF, or a prior owner of that
				NF, that is available on May 1, 2010, with a cost reporting period covering at least
				six months ending on or before November 30, 2007, shall be selected as the basis for
				establishing nursing facility rates under this chapter.
i. In the event of a change of ownership after
				November 30, 2007, and the new owner has a more recent validated cost report
				covering at least six months and that validated cost report is available on May 1,
				2010, the more recent validated cost report shall be selected as the basis for
				establishing nursing facility rates under this chapter.
ii. If no validated cost report fitting the
				criteria in (a)2i above is available, the closest validated cost report covering at
				least a six-month period ending after November 30, 2007, shall be selected as the
				basis for establishing nursing facility rates under this chapter.
iii. If no validated cost report covering at least
				a six-month period is available for the identified Class I NF and Class II NF, that
				NF shall be excluded from the limit and price database.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 3 - COST REPORT, RATE CALCULATION AND REPORTING SYSTEM FOR LONG-TERM CARE FACILITIES › Section 8:85-3.9 - Limit and price calculation

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Department shall
				establish the direct care limit for each Class I and Class II nursing facility.
1. For each cost report identified in
				8:85-3.8, the Department shall fringe
				the direct care case mix costs and direct care non-case mix costs, as set forth in
				8:85-3.5, for all cost reports effective
				for periods ending before December 31, 2010.
i.
				For periods ending on or after December 31, 2010, the Department shall select the
				direct care case mix costs and direct care non-case mix costs from the version of
				the cost report form used for the cost reporting period.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 3 - COST REPORT, RATE CALCULATION AND REPORTING SYSTEM FOR LONG-TERM CARE FACILITIES › Section 8:85-3.10 - Direct care and operating and administrative rate component

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For each cost report
				identified in 8:85-3.8, the Department shall establish
				the direct care rate component.
1. A case mix
				portion percentage shall be established by dividing the cost report's normalized
				direct care case mix cost per diem established in
				8:85-3.9(a)5  by the
				total normalized direct care per diem established in
				8:85-3.9(a)6.
i. A non-case mix portion percentage shall be
				calculated as 100 percent minus the case mix portion percentage.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 3 - COST REPORT, RATE CALCULATION AND REPORTING SYSTEM FOR LONG-TERM CARE FACILITIES › Section 8:85-3.12 - Adjustments and pass-throughs

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The provider tax
				pass-through per diem for the rate year shall equal the per diem tax paid by the
				nursing facility for the calendar year preceding the rate year divided by the total
				resident days, including all taxable and non-taxable days, as reported on the
				NHA-100s encompassing that calendar year.
(b) The Department shall approve an NF request for
				an interim adjustment to rates during a prospective rate period for financial
				hardship that is likely to reduce the ability of the facility to provide legally
				required resident care.
1. Interim adjustments, if
				approved by the Department, shall not apply retroactively unless, for reasons beyond
				the control of the NF, costs are affected retroactively.
2. Interim adjustments shall not be in effect for
				a period longer than 12 months.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 3 - COST REPORT, RATE CALCULATION AND REPORTING SYSTEM FOR LONG-TERM CARE FACILITIES › Section 8:85-3.13 - Total adjusted case mix rate

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For each rate year,
				the total adjusted case mix rate for each Class I NF and Class II NF shall be the
				sum of the direct care rate component, the operating and administrative rate
				component, the fair rental value allowance, phase-in provisions identified in
				8:85-3.16 and the provider tax
				pass-through per diem.
1. The Department shall
				compare the Statewide Medicaid day weighted average Class I NF, Class II NF and
				Class III NF July rate to a target rate calculated from the legislative
				appropriations for nursing facility Medicaid reimbursement according to (c)
				below.
2. To the extent that the
				Medicaid day weighted average comparison rate for all Classes exceeds the target
				rate, each Class I NF and Class II NF total adjusted case mix rate and Class III NF
				rate, exclusive of the provider tax pass-through per diem, shall be reduced in
				accordance with (d) below.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 3 - COST REPORT, RATE CALCULATION AND REPORTING SYSTEM FOR LONG-TERM CARE FACILITIES › Section 8:85-3.14 - Full cost rates

Current through Register Vol. 56, No. 14, July 15, 2024
For publicly owned or operated governmental NFs and SCNFs, the
				  Department shall make a full cost rate calculation that is equal to 100 percent of
				  the facility's allowable costs divided by total patient days as determined from the
				  most recent validated cost report identified in
				  8:85-3.8 and inflated pursuant to
				  8:85-3.6.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 3 - COST REPORT, RATE CALCULATION AND REPORTING SYSTEM FOR LONG-TERM CARE FACILITIES › Section 8:85-3.15 - Special Care Nursing Facility (SCNF) rates

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Effective for dates
				of service between July 1, 2010 and June 30, 2011, the rates for a Class III NF,
				Special Care Nursing Facility (SCNF), shall be the facility rate as of June 30
				preceding the rate year adjusted by the percent change allowed for in
				8:85-3.13(c).
1. To qualify as an SCNF, the NF must meet all of
				the Department's contractual requirements and be approved by the Department as an
				SCNF in accordance with the requirements of N.J.A.C. 8:33, 8:33H, 8:39 and this
				chapter.
2. SCNFs shall be grouped by:
i. Ventilator/Respirator;
ii. TBI/Coma;
iii. Pediatric;
iv. HIV;
v. Neurologically Impaired; and
vi. Behavioral Management.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 3 - COST REPORT, RATE CALCULATION AND REPORTING SYSTEM FOR LONG-TERM CARE FACILITIES › Section 8:85-3.16 - Phase in of case mix rates

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For dates of service
				from July 1, 2010 through June 30, 2011, for Class I NFs and Class II NFs, the total
				adjusted case mix rate, exclusive of the provider tax pass-through per diem, shall
				be no more than $ 5.00 above the total reimbursement rate, exclusive of the provider
				tax pass-through per diem, in effect for the NF on June 30, 2010 and no less than $
				5.00 below the total reimbursement rate, exclusive of the provider tax pass-through
				per diem, in effect for the NF on June 30, 2010.
1.
				The Department shall apply the rate change protection in (a) above after any
				reduction in the operating and administrative price and the direct health care limit
				pursuant to 8:85-3.13(d)1  and 2
				before the requirements of
				8:85-3.13(c)  are
				applied.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 3 - COST REPORT, RATE CALCULATION AND REPORTING SYSTEM FOR LONG-TERM CARE FACILITIES › Section 8:85-3.17 - Appeals process

Current through Register Vol. 56, No. 14, July 15, 2024
(a) When an NF believes
				that, owing to an unusual situation, the application of these rules results in an
				inequity (except for the application of
				8:85-3.2(f)  ), two
				levels of appeals are available: a level I appeal heard by representatives of the
				Department; and a Level II appeal heard before an administrative law judge.
1. A request for a Level I appeal should be
				submitted in writing to the Department of Health and Senior Services, Nursing
				Facility Rate Setting and Reimbursement, PO Box 715, Trenton, NJ, 08625-0715.
i. Requests for Level I appeals shall be submitted
				in writing within 60 days of the receipt of notification of the rate by the facility
				and shall include as follows:
(1) A letter
				requesting a Level I appeal from the facility and/or from the facility's designated
				representative;
(2) A specific
				description of each appeal issue; and
(3) Appropriate documentation that will be
				sufficient for the Department to understand the nature of each issue of the appeal.
				No issues other than the specific issues identified in the original Level I appeal
				shall be heard at the Level II hearing.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 3 - COST REPORT, RATE CALCULATION AND REPORTING SYSTEM FOR LONG-TERM CARE FACILITIES › Section 8:85-3.18 - Transfer of ownership and new facilities

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For any facility
				that transfers ownership, the rate, cost reports and case mix indices established
				for the old owner shall pass to the new owner.
(b) New Class I NFs and Class II NFs shall be
				subject to the following:
1. The direct care limit
				for the applicable Class of NF shall be used to establish the direct care rate
				component;
2. The NFs' case mix portion
				percentage shall be the simple average of all Class I NFs' case mix portion
				percentages and the NFs' non-case mix portion percentage shall be 100 percent minus
				the simple average of all Class I NFs' case mix portion percentages;
3. For each rate quarter, the direct care rate
				component shall be the direct care limit for the applicable Class of NF multiplied
				by the simple average case mix portion percentage multiplied by the ratio of the
				facility average Medicaid case mix index to the Statewide average case mix index
				plus the simple average non-case mix portion percentage multiplied by the direct
				care limit.
i. Until the new NF has a final
				resident roster for the quarter, the Department shall use the Statewide average
				Medicaid case mix index for the quarter to establish the direct care rate
				component;
4. The operating
				and administrative rate component shall be the price established for that NF's class
				designation for the rate year; and
5.
				The Department shall calculate the FRV allowance using 40 years of age for the NF
				unless a verifiable FRV Re-age Request is submitted and has the effect of re-aging
				the NF for the purposes of the FRV calculation.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 3 - COST REPORT, RATE CALCULATION AND REPORTING SYSTEM FOR LONG-TERM CARE FACILITIES › Section 8:85-3.19 - Effect of Federal rules incorporated by reference

Current through Register Vol. 56, No. 14, July 15, 2024
Any changes to the Federal MDS required by
				  42 CFR 483.20 and
				  set forth in the Resident Assessment Instrument (RAI) published by CMS, and
				  available at
www.cms.gov
, which are
				  incorporated herein by reference, as amended and supplemented, shall only apply to
				  rate quarters subsequent to the date of amendment and/or supplement.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 3 - COST REPORT, RATE CALCULATION AND REPORTING SYSTEM FOR LONG-TERM CARE FACILITIES › Section 8:85-3.20 - Access to information

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				information maintained by the Department for the purposes of rate-setting or
				administering other duties under this chapter shall not be considered "government
				records" subject to public access or inspection within the meaning of the "Open
				Public Records Act,"
				47:1A-1 et seq.:
1. Any information derived from an NHA-100
				provided by the Division of Taxation in accordance with
				54:50-8;
2. "Information relating to medical . . . history,
				diagnosis, treatment, or evaluation" within the meaning of Executive Order No. 26
				(2002);
3. "Records concerning
				morbidity, mortality and reportable diseases of named individuals required to be
				made, maintained or kept by any State or local government agency" within the meaning
				of Executive Order No. 9 (1963).
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 4 - AUDIT › Section 8:85-4.1 - Audit cycle

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any cost report
				submitted by a Medicaid participating nursing facility (NF) which is selected for
				audit on or after February 7, 1983 may be audited within three years of the due date
				of the cost report or the date it is filed, whichever is later. This requirement
				shall be satisfied if the on-site audit of the NF is initiated within the three-year
				period and completed within a reasonable time thereafter. If a NF audit is not
				initiated within this time limit, the appropriate cost report or cost reports shall
				be excluded from the audit, subject to the conditions set forth in the balance of
				this subsection and the waiver provisions set forth in (b) below. Exclusion is
				subject to the following conditions:
1. Failure to
				initiate a timely audit shall not preclude the Department from collecting
				overpayments, interest or other penalties if the overpayments are identified by an
				agency other than the Department.
2.
				When a timely audit is conducted and additional overpayments are discovered by
				another agency, the Department shall not be precluded from collecting such
				overpayments together with any applicable interest or other penalties.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 4 - AUDIT › Section 8:85-4.2 - Audits

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For the exclusive
				purpose of calculating interest, under
				30:4D-17(f),
				"completion of the field audit" for nursing facility providers shall be defined in
				the following manner:
1. For all such audits and
				audit recovery cases pending on February 7, 1983, it shall mean the date that field
				work is completed, or the date information requested from the provider during the
				course of that field work is received, whichever is later;
2. For all such audits and audit recovery cases
				pending on March 1, 1983, which are, have been or will be referred either to the
				Legal Action Committee, or to the Division of Criminal Justice or other agency for
				criminal investigation, it shall mean the date the Division of Medical Assistance
				and Health Services (DMAHS), Office of Program Integrity Administration (OPIA),
				receives authorization to take administrative action.
3. For all such audits initiated on or after
				February 7, 1983, it shall mean the date the exit conference is completed or the
				date information requested from the provider during the course of the exit
				conference is received, whichever is later.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 4 - AUDIT › Section 8:85-4.3 - Final audited rate calculation

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Department will
				calculate final per diem rates based on audit adjustment reports.
(b) The final per diem rates determined based on
				(a) above cannot exceed the prospective rates previously paid.
(c) Settlement after final rate calculation will
				be for fraud and/or abuse collections or recoveries of payments when the final rate
				is lower than the original rate.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Subchapter 5 - PROVIDER REIMBURSEMENTS › Section 8:85-5.1 - Provider tax reimbursement

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Upon receipt, from
				the Director of the Division of Taxation in the New Jersey Department of the
				Treasury, or the Director's designee, of the total amount of provider tax monies
				available for reimbursement to nursing facilities effective July 1 of each year from
				the Nursing Home Quality of Care Improvement Fund created pursuant to
				26:2H-95, plus the appropriate Federal
				matching funds, the Department shall determine the amount of those monies that are
				necessary to provide funding of the provider tax pass-through per diems in
				accordance with 8:85-3.12(a).
(b) The remaining portion of the provider tax
				monies after determining the portion that shall be reimbursed to NFs as the provider
				tax pass-through per diems as described in (a) above shall be included in the amount
				of total funding available to nursing facilities in accordance with
				8:85-3.13(c)1.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 85 - LONG-TERM CARE SERVICES › Appendix U

Current through Register Vol. 56, No. 14, July 15, 2024
Cost Report Supplemental Schedules
Nursing Facility Rate Setting and Reimbursement
Data in
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New Jersey Administrative Code › Title 8 - HEALTH › Chapter 92 - HIGHER EDUCATION STUDENT HEALTH INSURANCE COVERAGE › Subchapter 1 - GENERAL PROVISIONS › Section 8:92-1.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose
				of this chapter is to implement
				N.J.S.A.
				18A:62-15.
(b) This chapter applies to all
				institutions.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 92 - HIGHER EDUCATION STUDENT HEALTH INSURANCE COVERAGE › Subchapter 1 - GENERAL PROVISIONS › Section 8:92-1.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, as used in this chapter, shall
				  have the following meanings, unless the context clearly indicates
				  otherwise.
"Institution" means a public or independent institution of
				  higher education in New Jersey.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 92 - HIGHER EDUCATION STUDENT HEALTH INSURANCE COVERAGE › Subchapter 1 - GENERAL PROVISIONS › Section 8:92-1.3 - Offer of coverage

Current through Register Vol. 56, No. 14, July 15, 2024
All institutions shall offer health insurance coverage on a
				  group or individual basis for purchase by students who are enrolled full-time
				  at an institution.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 94 - ADMINISTRATION AND OPERATION OF THE NEW JERSEY COMMISSION ON SPINAL CORD RESEARCH, THE NEW JERSEY SPINAL CORD RESEARCH FUND, AND THE NEW JERSEY SPINAL CORD INJURY REGISTRY › Subchapter 1 - GENERAL PROVISIONS › Section 8:94-1.1 - Purpose

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of this
				chapter is to promote scientific research projects that focus on the treatment and
				cure of spinal cord injuries through grants made by the New Jersey Commission on
				Spinal Cord Research, established pursuant to
				52:9E-3 (Commission), from the New
				Jersey Spinal Cord Research Fund.
(b)
				This chapter is intended to assist the Commission in funding scientific and medical
				research and other related activities that may lead to advances in the treatment and
				cure of spinal cord injuries by:
1. Encouraging and
				supporting meritorious spinal cord injury research in New Jersey;
2. Encouraging and supporting collaborations among
				New Jersey researchers and out-of-State researchers engaged in spinal cord injury
				research;
3. Fostering discoveries that
				will benefit New Jersey by reducing the cost of medical services for persons with
				spinal cord injuries;
4. Supporting the
				continued development and enhancement of New Jersey's public and private biomedical
				sector;
5. Establishing New Jersey as a
				leader in the field of spinal cord repair; and
6. Recruiting recognized leaders and promising new
				investigators to New Jersey to engage in spinal cord injury research.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 94 - ADMINISTRATION AND OPERATION OF THE NEW JERSEY COMMISSION ON SPINAL CORD RESEARCH, THE NEW JERSEY SPINAL CORD RESEARCH FUND, AND THE NEW JERSEY SPINAL CORD INJURY REGISTRY › Subchapter 1 - GENERAL PROVISIONS › Section 8:94-1.2 - Scope

Current through Register Vol. 56, No. 14, July 15, 2024
This chapter provides for the administration and operation of the
				  Commission; sets forth procedures for application, review and award of grants made
				  from the New Jersey Spinal Cord Research Fund established pursuant to
				  N.J.S.A.
				  52:9E-4; and sets forth procedures for the
				  creation and operation of the New Jersey Spinal Cord Injury Registry established
				  pursuant to
				  N.J.S.A.
				  52:9E-8. This chapter applies to the Commission,
				  its administrative staff, grant applicants and recipients pursuant to
				  N.J.S.A. 52:9E-1 et seq.,
				  and health care facilities required to report cases of spinal cord injuries pursuant
				  to
				  N.J.S.A.
				  52:9E-8.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 94 - ADMINISTRATION AND OPERATION OF THE NEW JERSEY COMMISSION ON SPINAL CORD RESEARCH, THE NEW JERSEY SPINAL CORD RESEARCH FUND, AND THE NEW JERSEY SPINAL CORD INJURY REGISTRY › Subchapter 2 - OPERATION OF THE COMMISSION › Section 8:94-2.1 - Operations and by-laws

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Commission shall
				operate as a parliamentary body in accordance with Robert's Rules of Order and its
				duly adopted by-laws.
(b) The Commission
				shall issue and adopt by-laws governing its operations that establish and define its
				identity, enumerate its powers and duties, state requirements and terms of
				membership, procedures for meetings, requirements for quorums and voting, election
				and duties of officers and the executive director, conflicts of interest rules and
				code of ethics. Copies of such by-laws may be obtained in printed form from the
				Office of the Commission upon request.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 94 - ADMINISTRATION AND OPERATION OF THE NEW JERSEY COMMISSION ON SPINAL CORD RESEARCH, THE NEW JERSEY SPINAL CORD RESEARCH FUND, AND THE NEW JERSEY SPINAL CORD INJURY REGISTRY › Subchapter 2 - OPERATION OF THE COMMISSION › Section 8:94-2.2 - Office of the Commission

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Commission shall establish and maintain an
				administrative office (the "Office") and may hire such staff as it deems necessary
				to discharge its functions.
(b) The
				Office shall assist the Commission in the administration, operation and execution of
				the work of the Commission, including, but not limited to:
1. Arranging Commission meetings, activities and
				events;
2. Administering the
				Commission's grant solicitation, review and award procedures, grant progress and
				compliance; and
3. Preparing the annual
				report of the Commission, and such other documents required by N.J.S.A. 52:9E-4f and
				8:94-2.1.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 94 - ADMINISTRATION AND OPERATION OF THE NEW JERSEY COMMISSION ON SPINAL CORD RESEARCH, THE NEW JERSEY SPINAL CORD RESEARCH FUND, AND THE NEW JERSEY SPINAL CORD INJURY REGISTRY › Subchapter 2 - OPERATION OF THE COMMISSION › Section 8:94-2.3 - Meetings

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Commission shall
				meet at least once a year for the election of officers or more frequently as
				specified in its by-laws.
(b) All such
				meetings shall be held in accordance with the provisions of the "Open Public
				Meetings Act," P.L. 1975, c. 231 (N.J.S.A 10:4-6 et seq.)
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 94 - ADMINISTRATION AND OPERATION OF THE NEW JERSEY COMMISSION ON SPINAL CORD RESEARCH, THE NEW JERSEY SPINAL CORD RESEARCH FUND, AND THE NEW JERSEY SPINAL CORD INJURY REGISTRY › Subchapter 2 - OPERATION OF THE COMMISSION › Section 8:94-2.4 - Research program guidelines

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Commission may
				from time to time issue, amend and revise research program guidelines (guidelines)
				to provide informational assistance and guidance to prospective applicants and the
				public in general concerning funding priorities, opportunities and parameters. Such
				guidelines shall be advisory only in nature and shall not be binding.
(b) Such guidelines shall be available for viewing
				or download on the Commission's website, and may also be obtained in printed form
				upon request from the Office of the Commission.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 94 - ADMINISTRATION AND OPERATION OF THE NEW JERSEY COMMISSION ON SPINAL CORD RESEARCH, THE NEW JERSEY SPINAL CORD RESEARCH FUND, AND THE NEW JERSEY SPINAL CORD INJURY REGISTRY › Subchapter 3 - COMPETITIVE GRANT AWARDS CYCLE › Section 8:94-3.1 - Notice of grant awards availability

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Commission shall
				initiate and implement a competitive grant awards cycle at least once annually,
				contingent upon availability of funds, by issuing a Notice of Grant Availability
				with respect to such cycle.
(b) Each
				Notice of Grant Availability shall be issued in accordance with and contain the
				information required by
				N.J.S.A.
				52:14-34.4.
(c) Each Notice of Grant Availability shall be
				published in the New Jersey Register and the Department's annual Directory of
				Department of Health Grant Programs. The Notice of Grant Availability shall be
				available for viewing or download on the Commission's website, and in printed form
				from the Office of the Commission upon request. The Commission may take such other
				steps as it determines are necessary to ensure adequate notice to all potentially
				interested persons.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 94 - ADMINISTRATION AND OPERATION OF THE NEW JERSEY COMMISSION ON SPINAL CORD RESEARCH, THE NEW JERSEY SPINAL CORD RESEARCH FUND, AND THE NEW JERSEY SPINAL CORD INJURY REGISTRY › Subchapter 3 - COMPETITIVE GRANT AWARDS CYCLE › Section 8:94-3.2 - Criteria for applicants

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Commission shall
				only consider and approve grant applications for spinal cord research projects made
				by qualifying research institutions, as defined in
				52:9E-2(d).
(b) An institution seeking designation as a
				qualifying research institution shall submit a written request to the Commission
				indicating its intent to apply for research funding and requesting designation as a
				qualifying research institution designation.
1.
				The Commission may designate as a qualifying research institution any public or
				private academic institution, research organization or other entity, other than an
				individual person, established within the State of New Jersey and possessing a
				demonstrable capability to conduct grant-funded research.
2. The Commission may place such pre-conditions on
				the prospective designation of an entity as a qualifying research institution as it
				deems necessary or prudent prior to the award of funds to that
				institution.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 94 - ADMINISTRATION AND OPERATION OF THE NEW JERSEY COMMISSION ON SPINAL CORD RESEARCH, THE NEW JERSEY SPINAL CORD RESEARCH FUND, AND THE NEW JERSEY SPINAL CORD INJURY REGISTRY › Subchapter 3 - COMPETITIVE GRANT AWARDS CYCLE › Section 8:94-3.3 - Types of grants

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Commission may,
				at its discretion, designate specific types or classifications of grants that it has
				determined will best meet the overall purposes of the Commission as set forth in
				8:94-1.1.
(b) The Commission may issue, withdraw or modify
				any grant type at any time, provided such action will not adversely affect any
				current grantee or applicant.