New Jersey § 26:2h-18

§ 26:2h-18.

a. Effective January 1, 1994, the Department of Health shall assess each hospital

a per adjusted admission charge of $10. Of the revenues raised by the hospital per adjusted admission charge, $5 per adjusted

admission shall be used by the department to carry out its duties pursuant to P.L.1992, c. 160 ( C.26:2H-18.51 et al.) and $5 per adjusted admission shall be used by the department for administrative

costs related to health planning. Effective July 1, 2018, the assessment shall apply to all general acute care hospitals,

rehabilitation hospitals, and long term acute care hospitals. Any General Fund savings resulting from the assessment meeting the permissibility

standards set forth in 42 C.F.R. s.433.68 shall be used to create a supplemental funding pool, known as Safety Net Graduate

Medical Education, for the State's graduate medical education subsidy. Notwithstanding the provisions of any law or regulation to the contrary, and except

as otherwise provided and subject to such modifications as may be required by the

Centers for Medicare and Medicaid Services in order to achieve any required federal

approval and full federal financial participation, $24,285,714 is appropriated from

the General Fund for Safety Net Graduate Medical Education, and conditioned upon the

following: Funds from the Safety Net Graduate Medical Education pool shall be available to eligible

hospitals that meet the following eligibility criteria: An eligible hospital has

a Relative Medicaid Percentage (RMP) that is in the top third of all acute care hospitals

that have a residency program. The RMP is a ratio calculated using the 2016 Audited C.160 SHARE Cost Reports. The numerator of the RMP equals a hospital's gross revenue from patient care for

Medicaid and Medicaid HMO as reported on Line 1, Col. D & Col. H of Forms E5 and E6. The denominator of the RMP equals a hospital's gross revenue from patient care as

reported on Line 1, Col. E of Form E4. For instances where hospitals that have a single Medicare identification number

submit a separate cost report for each campus, the values referenced above shall be

consolidated. Payments to eligible hospitals shall be made in the following manner: (1) the subsidy payment shall be split into a Direct Medical Education (DME) allocation,

which is calculated by multiplying the total subsidy amount by the ratio of 2016 total

median Medicaid managed care DME costs to total 2016 median Medicaid managed care

GME costs; and an Indirect Medical Education (IME) allocation, which is calculated

by multiplying the total subsidy amount by the ratio of 2016 total Medicaid managed

care IME costs to total 2016 Medicaid managed care GME costs. (2) Each hospital's percentage of total 2016 Medicaid managed care DME costs shall

be multiplied by the DME allocation to calculate its DME payment. Each hospital's percentage of total 2016 Medicaid managed care IME costs shall be

multiplied by the IME allocation to calculate its IME payment. (3) Source data used shall come from the Medicaid cost report for calendar year (CY)

2016 submitted by each acute care hospital by November 30, 2017 and Medicaid Managed

Care encounter payments for Medicaid and NJ FamilyCare clients as reported by insurers

to the State for the following reporting period: services dates between January 1,

2016 and December 31, 2016; payment dates between January 1, 2016 and December 31,

2017; and a run date of not later than January 31, 2018. (4) In the event that a hospital reported less than 12 months of 2016 Medicaid costs,

the number of reported months of data regarding days, costs, or payments shall be

annualized. In the event the hospital completed a merger, acquisition, or business combination

or a supplemental cost report for the calendar year 2016 submitted by the affected

acute care hospital by November 30, 2017 shall be used. In the event that a hospital did not report its Medicaid managed care days on the

cost report utilized in this calculation, the Department of Health (DOH) shall ascertain

Medicaid managed care encounter days for Medicaid and NJ FamilyCare clients as reported

by insurers to the State. (5) Medicaid managed care DME cost is defined as the approved intern and residency

program costs using the 2016 Medicaid cost report total residency costs, reported

on Worksheet B Pt I Column 21 line 21 plus Worksheet B Pt I Column 22 Line 22 divided

by 2016 resident full time equivalent employees (FTE), reported on Worksheet S--3

Pt 1 Column 9 line 14 to develop an average cost per FTE for each hospital used to

calculate the overall median cost per FTE. (6) The median cost per FTE is multiplied by the 2016 resident FTEs reported on Worksheet

S--3 Pt 1 Column 9 line 14 to develop approved total residency program costs. (7) The approved residency costs are multiplied by the quotient of Medicaid managed

care days, reported on Worksheet S--3 Column 7 line 2, divided by the quantity of

total days, on Worksheet S--3 Column 8 line 14, less nursery days, on Worksheet S--3

Column 8 line 13. (8) Medicaid managed care IME cost is defined as the Medicare IME factor multiplied

by Medicaid managed care encounter payments for Medicaid and NJ FamilyCare clients

as reported by insurers to the State. (9) The IME factor is calculated using the Medicare IME formula as follows: 1.35

* [(1+x) ^0.405 - 1], in which “x” is the quotient of submitted IME resident full--time

equivalencies reported on Worksheet S--3 Pt 1 Column 9 line 14 divided by the quantity

of total available beds less nursery beds reported on Worksheet S--3 Column 2 line

14. (10) In the event that a hospital believes that there are mathematical errors in the

calculations, or data not matching the actual source documents used to calculate the

subsidy as defined above, hospitals shall be permitted to file calculation appeals

within 15 working days of receipt of the subsidy allocation letter. If upon review it is determined by the department that the error has occurred and

would constitute at least a five percent change in the hospital's allocation amount,

a revised industry--wide allocation shall be issued. b. Effective July 1, 2004, the department shall assess each licensed ambulatory care

facility that is licensed to provide one or more of the following ambulatory care

services: ambulatory surgery, computerized axial tomography, comprehensive outpatient

rehabilitation, extracorporeal shock wave lithotripsy, magnetic resonance imaging,

megavoltage radiation oncology, positron emission tomography, orthotripsy, and sleep

disorder services. The Commissioner of Health may, by regulation, add additional categories of ambulatory

care services that shall be subject to the assessment if such services are added to

the list of services provided in N.J.A.C.8:43A-2.2(b) after the effective date of P.L.2004, c. 54 . The assessment established in this subsection shall not apply to an ambulatory care

facility that is licensed to a hospital in this State as an off-site ambulatory care

service facility. (1) For Fiscal Year 2005, the assessment on an ambulatory care facility providing

one or more of the services listed in this subsection shall be based on gross receipts

for the 2003 tax year as follows: (a) a facility with less than $300,000 in gross receipts shall not pay an assessment;

and (b) a facility with at least $300,000 in gross receipts shall pay an assessment equal

to 3.5 percent of its gross receipts or $200,000, whichever amount is less. The commissioner shall provide notice no later than August 15, 2004 to all facilities

that are subject to the assessment that the first payment of the assessment is due

October 1, 2004 and that proof of gross receipts for the facility's tax year ending

in calendar year 2003 shall be provided by the facility to the commissioner no later

than September 15, 2004. If a facility fails to provide proof of gross receipts by September 15, 2004, the

facility shall be assessed the maximum rate of $200,000 for Fiscal Year 2005. The Fiscal Year 2005 assessment shall be payable to the department in four installments,

with payments due October 1, 2004, January 1, 2005, March 15, 2005 , and June 15, 2005. (2) For Fiscal Year 2006, the commissioner shall use the calendar year 2004 data submitted

in accordance with subsection c. of this section to calculate a uniform gross receipts

assessment rate for each facility with gross receipts over $300,000 that is subject

to the assessment, except that no facility shall pay an assessment greater than $200,000. The rate shall be calculated so as to raise the same amount in the aggregate as

was assessed in Fiscal Year 2005. A facility shall pay its assessment to the department in four payments in accordance

with a timetable prescribed by the commissioner. (3) Beginning in Fiscal Year 2007 and for each fiscal year thereafter through Fiscal

Year 2010, the uniform gross receipts assessment rate calculated in accordance with

paragraph (2) of this subsection shall be applied to each facility subject to the

assessment with gross receipts over $300,000, as those gross receipts are documented

in the facility's most recent annual report to the department, except that no facility

shall pay an assessment greater than $200,000. A facility shall pay its annual assessment to the department in four payments in

accordance with a timetable prescribed by the commissioner. (4) Beginning in Fiscal Year 2011 and for each fiscal year thereafter, the uniform

gross receipts assessment shall be applied at the rate of 2.95 percent to each facility subject to the assessment with gross receipts over $300,000, as

those gross receipts are documented in the facility's most recent annual report submitted

to the department pursuant to subsection c. of this section, except that no facility

shall pay an assessment greater than $350,000. A facility shall pay its annual assessment to the department in four payments in

accordance with a timetable prescribed by the commissioner. c. Each ambulatory care facility that is subject to the assessment provided in subsection

b. of this section shall submit an annual report including, at a minimum, data on

volume of patient visits, charges, and gross revenues, by payer type, for patient

services, beginning with calendar year 2004 data. The annual report shall be submitted to the department according to a timetable

and in a form and manner prescribed by the commissioner. The department may audit selected annual reports in order to determine their accuracy. d. (1) If, upon audit as provided for in subsection c. of this section, it is determined

that an ambulatory care facility understated its gross receipts in its annual report

to the department, the facility's assessment for the fiscal year that was based on

the defective report shall be retroactively increased to the appropriate amount and

the facility shall be liable for a penalty in the amount of the difference between

the original and corrected assessment. (2) A facility that fails to provide the information required pursuant to subsection

c. of this section shall be liable for a civil penalty not to exceed $500 for each

day in which the facility is not in compliance. (3) A facility that is operating one or more of the ambulatory care services listed

in subsection b. of this section without a license from the department, on or after

July 1, 2004, shall be liable for double the amount of the assessment provided for

in subsection b. of this section, in addition to such other penalties as the department

may impose for operating an ambulatory care facility without a license. (4) The commissioner shall recover any penalties provided for in this subsection in

an administrative proceeding in accordance with the “Administrative Procedure Act,”

P.L.1968, c. 410 ( C.52:14B-1 et seq. ). e. The revenues raised by the ambulatory care facility assessment pursuant to this

section shall be deposited in the Health Care Subsidy Fund established pursuant to

section 8 of P.L.1992, c. 160 ( C.26:2H-18.58 ).