[HISTORY: Adopted by the Board of County Commissioners of
Mercer County 4-22-2021 by Ord. No. 2021-1. Amendments noted where
applicable.]
The recitals set forth above are hereby incorporated by reference.
As used in this chapter, the following capitalized terms, not
otherwise defined herein, shall have the following meanings, unless
the context hereof otherwise requires.
The hospital facilities located within County’s borders
that provide inpatient hospital services, including: Capital Health
Regional Medical Center; Capital Health Medical Center - Hopewell;
St. Francis Medical Center; Robert Wood Johnson University Hospital
- Hamilton; St. Lawrence Rehabilitation Center; and Princeton House
Behavioral Health
With respect to each assessed hospital, the total amount
of net inpatient hospital service revenues, other than Medicare revenues,
reported on the most recent "Data Form for County Option Hospital
Fee Pilot Program" prepared by the assessed hospital and submitted
to the state prior to the effective date of this chapter. Such non-Medicare
net inpatient hospital service revenues are determined by subtracting
Lines 2, 3, 5 and 7 of Column A from the total net inpatient revenues
reported in Line 1 of Column A of such data form. A blank data form
is included herein for informational purposes.
The assessment imposed and levied upon the assessed hospitals
as defined herein.
The notice distributed to each assessed hospital at the beginning
of each program year specifying the annual assessment owed and the
quarterly assessment amounts owed by each assessed hospital, and any
additional elements specified herein.
The Medicaid managed care rate increase payments distributed
by DMAHS through the managed care organizations to hospitals as authorized
under the County Option Program.
July 1, 2021, provided that the County Option Program has received all necessary federal approvals, but in no case shall the assessment be implemented if the County has not entered into an intergovernmental agreement consistent with § 4.08.11.
The agreement between the County and DMAHS governing the
transfer of the assessment funds collected from the assessed hospitals.
The health plans under contract with DMAHS to provide covered
services to Medicaid beneficiaries through the Medicaid/NJ FamilyCare
program and that will be directed to distribute Medicaid managed care
rate increase payments to hospitals under the County Option Program.
Each twelve-month period of the County Option Program, beginning
with July 1, 2021, through June 30, 2022.
The notice distributed to each assessed hospital prior to
each quarterly assessment due date specifying the quarterly assessment
amount due, any interest incurred, and any additional elements specified
herein.
This chapter is adopted pursuant to P.L. 2018, c. 136, and N.J.S.A.
30:4D-7r et seq., as same may be amended and supplemented from time
to time.
A.
There is hereby imposed on all assessed hospitals an assessment calculated as set forth in § 4.08.05, to take effect on the implementation date.
B.
The County shall use the amounts collected from the assessment only
as follows:
C.
In the event that DMAHS returns all or a portion of the transferred
assessment funds to the County, the County shall refund to each assessed
hospital the pro rata portion of such funds.
D.
In the event that an individual assessed hospital is determined to
have overpaid their assessment or otherwise paid in error, the County
shall refund the overpayment or the amount paid in error to the assessed
hospital within 15 days of the later of:
E.
Assessed hospitals shall not pass on the cost of the fee to any patient,
insurer, self-insured employer program, or other responsible party,
nor list it separately on any invoice or statement sent to a patient,
insurer, self-insured employer program, or other responsible party.
A.
The annual assessment for each assessed hospital shall equal 6.76%
of assessed revenues.
B.
The annual assessment amounts for each assessed hospital, calculated pursuant to Subsection A, above, shall equal the following:
(1)
Capital Health Regional Medical Center: $8,661,359.
(2)
Capital Health Medical Center - Hopewell: $10,691,108.
(3)
St. Francis Medical Center: $1,911,437.
(4)
Robert Wood Johnson University Hospital - Hamilton: $2,942,842.
(5)
St. Lawrence Rehabilitation Center: $214,149.
(6)
Princeton House Behavioral Health: $1,816,610.
C.
The annual assessment shall be payable in four quarterly installments,
each to equal 25% of the annual assessment amount.
A.
At least 30 days' prior to the due date of the first assessment
of each program year, the County shall provide an assessment notice
by certified mail/RRR and first-class mail to the each assessed hospital.
B.
The assessment notice shall include:
(1)
A brief explanation of the assessment;
(2)
A description of the methodology used to determine the assessment
amount;
(3)
The annual assessment amount owed by the assessed hospital for
the upcoming program year;
(4)
The quarterly assessment amounts owed by the assessed hospital
for the program year;
(5)
The acceptable methods of payment;
(6)
The dates on which each quarterly assessment is due;
(7)
The interest rate that will be charged for late payments; and
(8)
A statement of the assessed hospital's appeal right and
the timing and requirements of such appeal.
A.
At least 20 days prior to each quarterly assessment due date, the
County shall provide an assessment invoice by certified mail/RRR and
first-class mail to each assessed hospital.
Should an assessed hospital fail to remit the quarterly assessment
amount by the date specified in the assessment invoice, the County
may require the assessed hospital to pay interest in the amount of
1.5% of the outstanding payment amount per month, to be added to the
following quarter's assessment invoice.
A.
Upon receipt of the County's assessment notice at the beginning
of each program year, assessed hospitals shall have 15 days to file
an appeal of the assessment amount stated in the assessment notice.
B.
Any appeal shall be in writing and shall indicate the specific basis
for the appeal, and shall include all documentation in support thereof.
The appeal shall be made to the County's appeal panel which shall
consist of the County Administrator, County Treasurer, and a designee
from the County's Department of Health & Human Services.
The appeal panel shall review the submission and shall provide the
appealing party with an opportunity to make an oral presentation if
so desired. The appeal panel shall render a written decision within
15 days of receipt of the appeal materials where no oral presentation
is requested; a written decision shall be provided within 15 days
of the conclusion of any oral presentation. The decision of the appeal
panel shall be final and binding upon the parties.
Assessed hospitals shall submit any data forms reasonably related
to the County Option Program requested by the County by the due date
specified by the County.
The County is authorized to enter into an intergovernmental
agreement with DMAHS governing the transfer of assessment funds from
the County to the state, including the following general terms:
A.
Timing requirements for the transfer of assessment funds from the
County to DMAHS, from DMAHS to the managed care organizations, and
from the managed care organizations to the hospitals.
B.
A requirement that DMAHS use 90% of the assessment amount to fund
the nonfederal share of directed payments under the County's
County Option Program, except that DMAHS may permit the managed care
organizations that make the directed payments to retain up to 5% of
the total amount paid to them exclusively to cover their incremental
cost of any state insurance premium tax.
C.
Assurances that the County will not be liable for any unpaid assessment
amounts and will only be responsible for transferring Assessed funds
to the extent received by the assessed hospitals.
D.
A requirement that DMAHS return to the County the nonfederal share
of any Medicaid directed payment funds received by the assessed hospitals
but subsequently recouped by DMAHS.
E.
A statement that any resulting Medicaid/NJ Family Care payments distributed
under the County Option Program shall not supplant or otherwise offset
payments made to hospitals from other state or federal funding mechanisms
or pools, except that payments may be otherwise limited to the hospital's
hospital-specific disproportionate share limit as provided in Section
1923(g) of the Social Security Act (42 U.S.C. § 1396r-4).
F.
A statement describing DMAHS's use of the assessment funds as
the nonfederal share of payments to draw down federal matching funds.
The assessment shall terminate upon expiration of the County
Option Program under state law, unless any of the following conditions
occur earlier:
A.
DMAHS notifies the County that the assessment funds do not qualify
as the state share of Medicaid program expenditures eligible for federal
financial participation;
B.
The assessment is otherwise finally determined to be unlawful under
County, state, or federal law by an agency or Court competent to make
such a final determination;
C.
The County Option Program is terminated by the state, or fails to
obtain required approval or reapproval by the federal Centers for
Medicare and Medicaid Services; or
In the event that the assessment terminates early pursuant to § 4.08.12A through D, the County shall refund to each assessed hospital within 15 days of the effective date of such termination the pro rata portion of:
A.
Any funds that have not been transferred to DMAHS or that DMAHS returns
to the County; and
B.
Any of the portion allocated for the County's use pursuant to § 4.08.04B(2) that has not already been spent or irrevocably allocated for its designated purposes.
