New Jersey Administrative Code

Notes N.J. Admin. Code § 10:52-5.21 Recodified to N.J.A.C. 10:52-5.17 by R.2000 d.29, effective 1/18/2000. See: 31 New Jersey Register 3151(a), 32 New Jersey Register 276(a).

Direct and indirect care costs shall be allocated to the inpatient and outpatient services. Direct and indirect costs allocated to inpatient services shall be used to determine inpatient rates per case according to the patient diagnosis. This cost finding process is described in …

Effective for services provided on or after October 1, 1996, the Director shall develop standard reimbursement amounts for each DRG based on the median cost per case for Medicaid/NJ FamilyCare fee-for-service beneficiaries. The standards shall be adjusted to account for significa…

(a) A hospital's Current Cost Base is defined as the actual costs and revenues as identified in the Financial Elements in the base reporting period as recognized by the Division for purposes of rate setting. (b) The Current Cost Base is used to develop the Preliminary Cost Base (…

(a) The aggregate Current Cost Base is developed from Financial Elements reported to the Division and includes:1. Costs related to Medicaid/NJ FamilyCare direct patient care as defined in N.J.A.C. 10:52-6.14; 2. Less net income from specified sources; 3. Capital facilities allowa…

(a) Costs related to Medicaid/NJ FamilyCare fee-for-service patient care as adjusted for price level depreciation as reported to the Division shall be classified as follows: 1. Direct patient costs: i. Routine service costs; ii. Ambulatory service costs; and iii. Ancillary servic…

(a) Hospital case-mix shall be determined as follows: 1. Uniform Bill-Patient Summary (UB-PS) data shall be used for determination of hospital case-mix. The appropriate patient records for the reporting period corresponding with the Financial Elements Report shall be classified i…

(a) The reasonable cost of services related to patient care includes: 1. Current non-physician direct patient care costs per case as adjusted by standard costs per case for Medicaid/NJ FamilyCare fee-for-service inpatients; 2. Current physician patient service costs, as modified …

The reporting principles and concepts adopted by the Department of Health at N.J.A.C. 8:31B-4.1 through 4.25 shall be used for Medicaid/NJ FamilyCare fee-for-service rates. Notes N.J. Admin. Code § 10:52-6.1 Amended by 50 N.J.R. 1261(a), effective 5/21/2018

Notes N.J. Admin. Code § 10:52-6.10 Repealed by R.2005 d.214, effective 7/5/2005. See: 37 New Jersey Register 436(a), 37 New Jersey Register 2506(a). Section was "Timing differences".

Notes N.J. Admin. Code § 10:52-6.11 Repealed by R.2005 d.214, effective 7/5/2005. See: 37 New Jersey Register 436(a), 37 New Jersey Register 2506(a). Section was "Self-insurance".

Notes N.J. Admin. Code § 10:52-6.12 Repealed by R.2005 d.214, effective 7/5/2005. See: 37 New Jersey Register 436(a), 37 New Jersey Register 2506(a). Section was "Related organizations".

The financial elements of the rates shall include the reasonable cost of the following: direct patient care; depreciation expense and interest payments; paid taxes, excluding income taxes; education, research and training programs, not otherwise paid for by the State; and preserv…

(a) Services related to Patient Care include Direct Patient Care; Paid Taxes excluding Income Taxes; and Educational, Research and Training Programs as further defined in N.J.A.C. 10:52-6.15 through 6.17. (b) Services Related to Patient Care include Routine Services, Ambulatory S…

Direct patient care is the provision by a hospital of medically necessary and appropriate health care services to a Medicaid/NJ FamilyCare fee-for-service beneficiary. Notes N.J. Admin. Code § 10:52-6.15 Amended by R.2000 d.29, effective 1/18/2000. See: 31 New Jersey Register 315…

Taxes are monies paid to a governmental unit for conducting business related to direct patient care within its jurisdiction. Taxes are a financial element of the Preliminary Cost Base except for Federal, State, or local income, excess profit, or franchise taxes, taxes on property…

(a) Educational program costs are the costs incurred by a hospital in the provision of a formally organized, planned program of study in a health service profession approved by an organization which recognizes the professional stature of health services education programs at the …

(a) With respect to Buildings and Fixed Equipment, the cost of Capital Facilities used for Services Related to Medicaid Patient Care, except for Major Moveable Equipment as defined in N.J.A.C. 10:52-6.19, are included as financial elements for all hospitals through a Capital Faci…

(a) Major Moveable Equipment includes straight line depreciation costs on owned or capitalized leased Major Moveable Equipment plus a Price Level Depreciation Allowance in excess of this historical depreciation and operating lease/rent payments relative to Major Moveable Equipmen…

Notes N.J. Admin. Code § 10:52-6.2 Repealed by R.2005 d.214, effective 7/5/2005. See: 37 New Jersey Register 436(a), 37 New Jersey Register 2506(a). Section was "Objective evidence".

(a) Salaries and wages, including stipends, payable in cash, for services performed by an employee for a hospital (except a physician, including compensation for time not worked such as on call) vacation, holiday and sickpay or the monetary value assigned to direct services provi…

(a) Medical and Surgical Supplies are medically necessary supplies, appliances and minor moveable equipment furnished by, used at and reported by a hospital for the care and treatment of a patient during a patient's episode of hospital care. Minor moveable equipment includes, but…

Non-Medical and Non-Surgical Supplies include the invoice/inventory cost of supplies, instruments, and minor equipment (other than Medical and Surgical Supplies) required for the operation of a hospital for purposes other than the direct provision of care to a patient are reporte…

Purchased Services include the cost of all services purchased that could be accomplished by a hospital's own employees but for which the hospital elects to contract (not necessarily with a formal contract). All physician services shall be classified as physician compensation. Not…

Major Moveable Equipment expenses are expenses to be included in the costs of each center at historical depreciation costs (for both owned and capitalized leased equipment) plus a price level replacement cost premium and operating lease expenses. Interest expense incurred through…

(a) The financial elements shall take into account a facility's income from all sources, including specific purpose grants and other funds from governmental sources, but excluding income and principal from board or donor restricted funds, gifts and special fund raising projects. …

(a) Non-Acute Care Services provided by a hospital such as skilled nursing care (approved or unapproved), intermediate care, residential care services, long-term psychiatric care and long-term rehabilitation and intermediate care services are not properly acute hospital functions…

(a) Approved Education and Research Income such as grants, or contract payments, tuitions and fees received as direct support for approved educational and research programs (with the exception of those from the Graduate Medical Education Program for primary care residency program…

(a) Provision of General Services to an External Organization: The provision of data processing, laundry, housekeeping, managerial or other general services by a hospital to an organization other than another health care facility shall be excluded and treated as Case A. Costs of …

(a) Television and Radio provided to patients shall be excluded and net gains or losses from such services shall be treated as Case C. (b) Telephone and Telegraph services provided to patients, including the appropriate portion of the hospital's switchboard costs shall be exclude…

Notes N.J. Admin. Code § 10:52-6.3 Repealed by R.2005 d.214, effective 7/5/2005. See: 37 New Jersey Register 436(a), 37 New Jersey Register 2506(a). Section was "Consistency".

(a) Administrative Expense Exclusions, as listed in this section, shall not be included in Costs Related to Patient Care and, as such, shall not be included in expenses defined as General Administrative Services (Case C); 1. Life insurance premiums for employees where the hospita…

(a) Income, net of expenses, or Investment in Rental Property to physicians or others shall be excluded from Revenue Related to Patient Care and treated as Case A. (b) Income or Investment, net of transaction expense, of Operating Fund and/or interest income from financial charge…

Costs and Revenues Related to Patient Care shall be reported in accordance with N.J.A.C. 10:52-6.33 through 6.77. Notes N.J. Admin. Code § 10:52-6.32 Recodified from N.J.A.C. 10:52-6.34 and amended by R.2000 d.29, effective 1/18/2000. See: 31 New Jersey Register 3151(a), 32 New J…

(a) The functions of the Medical-Surgical Acute Care Units (MSA) included in the MSA cost center are as follows:1. Medical-Surgical Acute Care Units provide care to patients on the basis of physicians' orders and approved nursing care plans. Medical-Surgical Acute Care shall incl…

(a) The functions included in the Obstetric Acute Care Unit (OBS) cost center are as follows: 1. The provision of care to the mother before, during, and following delivery on the basis of physicians' orders and approved nursing care plans shall be provided in the Obstetric Acute …

(a) The functions included in the Pediatric Acute Care Units (PED) cost center are as follows: 1. Pediatric Acute Care Units provide care to Pediatric patients (normally children less than 14 years of age and including "boarder patients") in Pediatric nursing units on the basis o…

(a) The functions included in the Psychiatric Acute Care Units (PSA) cost center are as follows: 1. Psychiatric Acute Care Units provide care to patients admitted for diagnosis as well as treatment on the basis of physicians' orders and approved nursing care plans. The units shal…

(a) The functions included in the Burn Care Units (BCU) cost center are as follows: 1. Burn Care Units provide care to severely burned patients that are of a more intensive nature than the usual acute nursing care provided in medical-surgical units. Burn Care Units shall be staff…

(a) The functions included in the Intensive Care Units (ICU) cost center are as follows: 1. Intensive Care Units provide nursing care to patients who, because of surgery, shock, trauma, serious injury or life threatening conditions, require intensified comprehensive observation a…

(a) The functions included in the Coronary Care Units (CCU) cost center are as follows: 1. Coronary Care Units provide the delivery of care of a more specialized nature than that provided to the usual Medical, Surgical, and Pediatric patient. The unit shall contain monitoring and…

Notes N.J. Admin. Code § 10:52-6.4 Repealed by R.2005 d.214, effective 7/5/2005. See: 37 New Jersey Register 436(a), 37 New Jersey Register 2506(a). Section was "Full disclosure".

(a) The functions included in the Neonatal Intensive Care Units (NNI) cost center are as follows: 1. A Neonatal Intensive Care Unit provides care to newborn infants that is of a more intensive nature than care provided in Pediatric Acute or Newborn Nursing Units. Care shall be pr…

(a) The functions included in the Newborn Nursery (NBN) cost center are as follows: 1. A Newborn Nursery shall provide nursing care to newborns on the basis of pediatricians' orders and approved nursing care plans. Newborn Nursery should include all normal care newborns. Bassinet…

(a) The functions included in the Emergency Services (EMR) cost center are as follows: 1. Emergency Services provide emergency treatment to sick and injured patients requiring medical care on an immediate, unscheduled basis. Also included shall be non-emergency type patients who …

(a) The functions included in the Anesthesiology Services (ANS) cost center are as follows: 1. Anesthesiology Services are a hospital based service conducted under the direction of either a qualified physician trained in anesthesiology (that is, an anesthesiologist) or the operat…

(a) The functions included in the Cardiac Catheterization (CCA) cost center are as follows: 1. Cardiac Catheterization includes all invasive cardiac diagnostic procedures performed in dedicated or non-dedicated cardiac catheterization or coronary angiographic laboratories. Cardia…