N.J. Admin. Code § 8:31B-4.38

Current through Register Vol. 56, No. 24, December 18, 2024

Section 8:31B-4.38 - Charity care and reduced charge charity care

(a) Charity care includes only the reasonable cost of the following:

1. Charity care for services, provided the patient is qualified as eligible pursuant to N.J.A.C. 10:52-11;

2. Advanced life support (ALS) services provided pursuant to P.L. 1984, c. 146 (N.J.S.A. 26:2K-7 et seq.), provided the patient is qualified as eligible for charity care pursuant to N.J.A.C. 10:52-11;

3. Charity care as defined by following N.J.A.C. 10:52-11 for outpatient dialysis services provided after September 1, 1987 to patients ineligible for Medicare coverage. The amount reported by the hospital as charity care shall not include Medicare co-insurance amounts, since Medicare will reimburse providers for the amount, provided the patient is eligible for charity care pursuant to N.J.A.C. 10:52-11.

(b) Charity care excludes the cost of the following:

1. Medical denials, which are services that are denied for lack of medical necessity by a utilization review organization (URO) or peer review organization, unless the denial is for days within the trim points;

2. Courtesy adjustments as defined in N.J.A.C. 8:31B-4.15(a)4;

3. Discounts provided to health maintenance organizations or other payers;

4. Patient Convenience Items as defined in N.J.A.C. 8:31B-4.65;

5. Excluded Health Services as defined in N.J.A.C. 8:31B-4.62;

6. Cosmetic surgery except where medically necessary;

7. Cost associated with procuring organs sent to foreign countries; and

8. Non-health services provided by a hospital.

N.J. Admin. Code § 8:31B-4.38

Amended by R.1985 d.550, effective 11/4/1985.
See: 17 New Jersey Register 2004(a), 17 New Jersey Register 2637(a).
(a)1 substantially amended.
Amended by R.1988 d.276, effective 6/20/1988.
See: 19 New Jersey Register 2092(c), 20 New Jersey Register 1430(a).
Added (a)4.
Amended by R.1989 d.620, effective 12/18/1989.
See: 21 New Jersey Register 2449(a), 21 New Jersey Register 3953(a).
Provisions for advanced life support, exclusions from uncompensated care and specification regarding Chapter 83 service eligibility added.
Amended by R.1993 d.668, effective 12/20/1993.
See: 25 New Jersey Register 3125(a), 25 New Jersey Register 6016(a).
Amended by R.1995 d.507, effective 9/5/1995.
See: 27 New Jersey Register 2148(a), 27 New Jersey Register 3481(a).
Amended by R.2006 d.27, effective 1/17/2006.
See: 37 New Jersey Register 2165(a), 38 New Jersey Register 667(a).
In (a), corrected references to the rules from N.J.A.C. 10:52-10 to N.J.A.C. 10:52-11 throughout.