N.J. Admin. Code § 10:52-8.5

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

Section 10:52-8.5 - Hospital fee-for-service reimbursement for Graduate Medical Education (GME) effective on or after July 6, 1998

(a) Effective for payments on or after July 6, 1998, the GME payment shall be distributed in 12 monthly lump sum payments during the State Fiscal Year. The amount distributed shall be considered the final GME payment and shall not be reconciled. The GME payment shall not exceed the amount appropriated for GME each State Fiscal Year. This GME payment represents both direct GME and Indirect Medical Education (IME).

(b) The source of the data used to allocate the GME payment is the Medicare/Medicaid submitted cost report that is on file with DMAHS as of October 31 of the current calendar year for GME payments for the State fiscal year commencing July 1 of the subsequent year with corresponding 24-month fee-for-service Medicaid/NJ FamilyCare-Plan A inpatient paid claims data as of February 1 prior to the year of distribution. GME resident full-time-equivalents and total hospital days shall come from the Medicare/Medicaid/NJ FamilyCare submitted cost report. The hospital-specific Medicaid/NJ FamilyCare-Plan A fee-for-service days shall come from the 24-month data fee-for-service Medicaid/NJ FamilyCare-Plan A inpatient paid claims data.

1. For hospitals with psychiatric units included in the Medicare Inpatient Prospective Reimbursement System for Medicare reporting purposes but excluded for Medicaid/NJ FamilyCare reporting purposes, the data from the hospital-submitted worksheets for the Medicaid-excluded psychiatric units shall be used.

(c) The intern and resident full-time equivalents (FTEs) as reported on the Medicare submitted cost report may be audited by the Division or its agent prior to payment. An adjustment, if necessary, to the submitted intern and resident FTEs shall be made in accordance with the audit.

N.J. Admin. Code § 10:52-8.5

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