N.J. Admin. Code § 10:52-8.1

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

Section 10:52-8.1 - Calculation of the amount of Graduate Medical Education (GME) and Indirect Medical Education (IME) reimbursement to be distributed

(a) Medicare principles of reimbursement for GME and IME are as follows:

1. Direct GME is calculated based on Medicaid's and NJ FamilyCare-Plan A's fee-for-service share of the major teaching hospitals' intern and resident FTEs multiplied by their specific per resident amounts as reported on the Medicare audited cost report (including subsequent amendments) in Worksheet E-3 Part IV for the year in which payment has been made.

2. IME is calculated based on Medicare's IME formula, at 42 CFR 412.105, incorporated herein by reference. The major teaching hospitals' IME factor, as calculated by the Medicare IME formula, is multiplied by their hospital-specific Medicaid/NJ FamilyCare-Plan A fee-for-service inpatient DRG payments (net of GME and IME) to arrive at the Medicaid/NJ FamilyCare-Plan A fee-for-service IME payment. The components of Medicare's IME formula, IME intern and resident FTEs and maintained beds, are from the audited Medicare cost report (including subsequent amendments) in Worksheet S-3 for the year in which payment has been made.

N.J. Admin. Code § 10:52-8.1

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