N.J. Admin. Code § 10:52-13.1

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

Section 10:52-13.1 - Disproportionate share adjustment-general eligibility

(a) A disproportionate share hospital (DSH) shall be a hospital designated as such by the Commissioner of the Department of Human Services. At a minimum, each hospital with a Medicaid/NJ FamilyCare inpatient hospital utilization rate that is one standard deviation above the mean Medicaid/NJ FamilyCare utilization rate for hospitals receiving Medicaid/NJ FamilyCare payments in the State, and every hospital with a low-income utilization rate above 25 percent will be treated as a disproportionate share hospital.

(b) The Commissioner of the Department of Human Services may designate additional hospitals as disproportionate share hospitals if it is determined they serve a large number of low-income mentally ill or developmentally disabled clients.

(c) The Commissioner of the Department of Human Services may make additional disproportionate share payments to facilities operating under 18A:64G-1 et. seq. providing a high level of charity and uncompensated care to low-income persons and persons with special needs.

(d) The Commissioner of the Department of Human Services may also designate a hospital as eligible for additional disproportionate share payments if it is determined that the hospital provides a high percentage of care (as defined in N.J.A.C. 10:52-13.5) in proportion to total operating revenue to patients with HIV, mental illness, tuberculosis, substance abuse and addiction, complex neonates, HIV as a secondary diagnosis, and mothers with substance abuse. In addition, to be designated as eligible for this additional disproportionate share payment, the facility shall have a high Charity Care plus Medicaid/NJ FamilyCare utilization rate (as defined in N.J.A.C. 10:52-13.5).

N.J. Admin. Code § 10:52-13.1

Amended by 50 N.J.R. 1261(a), effective 5/21/2018