N.J. Admin. Code § 8:31B-3.16

Current through Register Vol. 56, No. 21, November 4, 2024

Section 8:31B-3.16 - Aggregate Current Cost Data Base

(a) Once the Department has reviewed the hospital's submission in accordance with N.J.A.C. 8:31B-4 and determined it is suitable for entry into an aggregate current cost data base including data for all hospitals, the Department shall issue a notice of its intent to close the aggregate current cost data base. The notice to each hospital shall include a list of the completeness and/or mathematical adjustments the Department has made.

(b) A hospital which disagrees with the Department's completeness and/or mathematical adjustments shall submit, in writing, a complete list of its exceptions to the adjustments made by the Department. This list of exceptions shall be received by the Department within 30 calendar days of the issuance of the notice of intent to close the aggregate current cost data base. If, upon review, the Commissioner determines that there were errors in the completeness and/or mathematical adjustments, a final list of adjustments will be provided to the hospital before the data is entered into the aggregate current cost data base.

(c) A hospital's current cost base submission cannot be substituted or rearranged after the aggregate current cost data base has been closed. Requests to rearrange or substitute current cost base data must be received in writing within 30 calendar days of the issuance of the notice of intent to close the aggregate current cost data base. If, upon review, the Department determines that the revised submission is acceptable, the data entered into the aggregate current cost data base will be based on the revised submission. The Department will advise the hospital of its final list of adjustments.

1. In the event that a hospital which fails to submit the most recent Acute Care Hospital Cost report due on June 30 of each year has not submitted that report prior to August 31 of the same year, the Department shall, in addition to assessing the civil monetary penalties provided for in 8:31B-3.3(c), enter zero dollars as the hospital's total gross revenue in the Aggregate Current Cost Data Base for the purpose of calculating the subsidies provided for in P.L. 2004, c. 113.

(d) If a hospital takes exception to the final list of adjustments provided in accordance with (b) or (c) above, it may appeal the final list of adjustments. A notice by a hospital of an intent to appeal the final list of adjustments entered by the Department into the aggregate current cost data base must be submitted in writing to the Commissioner within 15 calendar days of issuance of the final list. Within 30 calendar days of issuance of the final list of adjustments, the hospital shall submit to the Commissioner two copies of its appeal, describing in detail the basis for its challenge to the final list of adjustments. Appeals shall not include new arrangements or substitutions of current cost submission data that was not previously submitted in accordance with (b) above. The only basis to appeal a decision by the Department to default a hospital to zero for its current cost base elements is a factual challenge of the date of receipt of the hospital's Acute Care Hospital Cost Report by the Department. The appeal document shall list all factual and legal issues, including citation to applicable provisions of the hospital financing rules, and include all written documentation supporting each appeal issue. If the hospital fails to submit the required documentation within the prescribed time frame, it shall have forfeited its right of appeal and the final list of adjustments to the hospital's current cost base submission shall be deemed to have been accepted by the hospital.

1. The Commissioner shall schedule a detailed review to be conducted by the Department with the hospital not more than 45 calendar days following receipt of the appeal document. If the hospital fails to appear on the established date, it shall have forfeited its right of appeal and the final list of adjustments to the hospital's current cost base submission shall be deemed to have been accepted by the hospital.

2. At the detailed review with the hospital, the Department representative shall indicate whether the appeal is supported by sufficient documentation to permit a resolution, and the hospital shall be permitted 10 calendar days after the date of the review in which to submit additional documentation. The Commissioner shall give consideration only to documentation submitted pursuant to the deadlines set forth above in deciding upon any of the hospital's appeal issues.

3. Within 30 calendar days of the review with the hospital, the Commissioner will render detailed findings on the factual and legal issues concerning whether an adjustment to the final list of adjustments to the hospital's current cost base submission is warranted. The Commissioner's decision shall constitute the final agency adjudication.

N.J. Admin. Code § 8:31B-3.16

Amended by R.1982 d.427, eff. 12/6/1982.
See: 14 New Jersey Register 737(a), 14 New Jersey Register 1389(a).
Added (d).
Amended by R.1989 d.383, effective 7/17/1989.
See: 21 New Jersey Register 661(b), 21 New Jersey Register 2087(a).
Added (e).
Amended by R.1989 d.387, effective 7/17/1989.
See: 21 New Jersey Register 135(a), 21 New Jersey Register 2058(a).
Subsection (a) clarified. Base-year cost data base expanded in (b)4, 5 and 6, to include approved reimbursement for waste disposal costs; calculation of economic factor; and calculation of the technology factor. Cost base for 1990 rate year clarified at (b)7.
Amended by R.1990 d.462, effective 9/17/1990.
See: 22 New Jersey Register 1480(a), 22 New Jersey Register 3004(a).
Deletion of (b)4 and (e), on 1986 cost base adjustments.
Amended by R.1991 d.158, effective 3/18/1991.
See: 22 New Jersey Register 3724(a), 23 New Jersey Register 898(a).
Notice to hospitals of data base closing required; no adjustments after closing.
Amended by R.1993 d.593, effective 11/15/1993.
See: 25 New Jersey Register 3117(a), 25 New Jersey Register 5149(a).
Amended by R.2000 d.339, effective 8/21/2000.
See: 32 New Jersey Register 1364(a), 32 New Jersey Register 3059(b).
Amended by R.2003 d.40, effective 1/21/2003.
See: 34 New Jersey Register 2237(a), 34 New Jersey Register 2549(b), 35 New Jersey Register 408(a).
Rewrote the section.
Amended by R.2006 d.27, effective 1/17/2006.
See: 37 New Jersey Register 2165(a), 38 New Jersey Register 667(a).
In (b), added "This list of exceptions shall be received by the Department"; added (c)1; in introductory paragraph (d), added a statement to restrict the basis for appealing a decision by the Department.