N.J. Admin. Code § 8:31B-4.62

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

Section 8:31B-4.62 - Separately Reported Health Care Services

(a) Non-Acute Care Services provided by a hospital such as skilled nursing facilities (approved or unapproved); intermediate care facilities, residential care, psychiatric care, and comprehensive rehabilitation services are not properly acute hospital functions, and hence are separately reported and treated as Case C. Sufficient accounting records should be maintained to account for the costs of such operations and such costs should be excluded from Costs Related to Patient Care by cost center per N.J.A.C. 8:31B-3.24.

(b) Organ Donations: Organs acquired by a hospital and donated to a pool or patient at another hospital are not properly service related to care of patients at the donating hospital, and hence costs and revenues are not included in the service definitions. Costs of such donated organs are applied as increases to Costs Related to Patient Care and Revenues are applied as offsets (Case B).

(c) Blood: In order to encourage hospital solicitation of blood donations, the purchase cost of whole blood or the equivalent units of blood extender and/or plasma are separately reported and treated as Case C.

(d) Provisions of Health Care Services to Another Health Care Facility or Shared Services: Where a hospital care facility utilizes the laboratory, data processing, physical therapy department, or other services of a hospital, such costs are not included in the Costs Related to Patient Care of the hospital providing the services. The associated costs (including overhead) and revenue should be excluded from the definitions of those centers in the providing hospital and are treated as Case B.

(e) Physician Fees Remunerated to a Hospital: Where a physician's compensation arrangement with a hospital requires some or all of the physician's fees received directly from patients to be turned over to the hospital, such fees are not included in Revenue Related to Patient Care and are treated as Case B.

(f) Separately reported Ambulatory Services: Outpatient Renal and Home Dialysis. The cost and revenue related to these services are to be treated as Case C. Sufficient accounting records should be maintained to account for the costs of such operations and such direct and indirect costs shall be excluded from Costs Related to Patient Care.

(g) Separately reported Ambulatory Services: HealthStart Maternal Care Health Support Services. The revenues and expenses associated with the provision of these services shall be treated as Case C, netted against each other.

(h) Separately reported Ambulatory Services: HealthStart Pediatric Continuity of Care. In Hospitals with salaried pediatricians, revenues and expenses associated with non-institutional Medicaid capitated fee shall be treated as Case C and netted against each other.

(i) Mobile Intensive Care Unit (MICU) Services provided after November 1, 1987: The cost and revenue related to these services are to be treated as Case C, revenues and expenses are netted. Sufficient accounting records should be maintained to account for the costs of such operations and such direct and indirect cost shall be excluded from Costs Related to Patient Care.

N.J. Admin. Code § 8:31B-4.62

Amended by R.1981 d.10, effective 1/9/1981.
See: 12 New Jersey Register 643(d), 13 New Jersey Register 92(a).
(a)1 and 2 added.
Amended by R.1987 d.338, effective 8/17/1987.
See: 19 New Jersey Register 840(a), 19 New Jersey Register 1545(a).
(f) added.
Amended by R.1988 d.213, effective 5/16/1988.
See: 19 New Jersey Register 2365(a), 20 New Jersey Register 1082(a).
Added (g) and (h).
Amended by R.1989 d.604, effective 12/18/1989.
See: 21 New Jersey Register 2453(a), 21 New Jersey Register 3970(a).
MICU services provided after November 1, 1987 excluded at (g).
Amended by R.1993 d.593, effective 11/15/1993.
See: 25 New Jersey Register 3117(a), 25 New Jersey Register 5149(a).
Amended by R.2006 d.27, effective 1/17/2006.
See: 37 New Jersey Register 2165(a), 38 New Jersey Register 667(a).
Section was "Excluded Health Care Services"; rewrote the section.