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.
ASSESSED HOSPITALS
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
ASSESSED REVENUES
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.
ASSESSMENT
The assessment imposed and levied upon the assessed hospitals
as defined herein.
ASSESSMENT NOTICE
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.
DIRECTED PAYMENTS
The Medicaid managed care rate increase payments distributed
by DMAHS through the managed care organizations to hospitals as authorized
under the County Option Program.
IMPLEMENTATION DATE
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.
INTERGOVERNMENTAL AGREEMENT
The agreement between the County and DMAHS governing the
transfer of the assessment funds collected from the assessed hospitals.
MANAGED CARE ORGANIZATIONS
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.
PROGRAM YEAR
Each twelve-month period of the County Option Program, beginning
with July 1, 2021, through June 30, 2022.
QUARTERLY ASSESSMENT INVOICE
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.
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.
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
D. The intergovernmental agreement described in §
4.08.11 is terminated by its terms or no longer meets the conditions described in such section.
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.