N.J. Admin. Code § 10:52-6.26 - Excluded health care services

(a) Non-Acute Care Services provided by a hospital such as skilled nursing care (approved or unapproved), intermediate care, residential care services, long-term psychiatric care and long-term rehabilitation and intermediate care services are not properly acute hospital functions, and hence shall be excluded and treated as Case C. Sufficient accounting records shall be maintained to account for the costs of such operations and such costs shall be excluded from Costs Related to Patient Care by cost center per N.J.A.C. 10:52-5.9 and 5.13.

(b) 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 shall not be included in the service definitions. The acquisition costs incurred shall be accounted for in accordance with the definition of the Organ Acquisition cost center but not reported therein. However, costs of such donated organs shall be applied as increases to Costs Related to Patient Care and Revenues and shall be applied as offsets (Case B).

(c) 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 shall be excluded and treated as Case C.

(d) When a hospital utilizes the laboratory, data processing, physical therapy department, or other services of a hospital, such costs shall not be included in the Costs Related to Patient Care of the hospital providing the services. The associated costs (including overhead) and revenue shall be excluded from the definitions of those centers in the providing hospital and treated as Case B.

(e) When 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 shall not be included in Revenue Related to Patient Care and are treated as Case B.

(f) The cost and revenue related to excluded ambulatory services outpatient renal and home dialysis shall be treated as Case C. Revenues and expenses are netted, and neither gains nor losses shall be added to the Preliminary Cost Base. Sufficient accounting records shall 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.

(g) Concerning the following excluded ambulatory services:

1. The revenues and expenses associated with the provision of HealthStart Maternity Care Health Support Services shall be treated as Case C, netted against each other, with neither gains nor losses added to the Preliminary Cost Base.

2. As to HealthStart Pediatric Continuity of Care, in hospitals with salaried pediatricians, revenues and expenses associated with the non-institutional Medicaid capitated fee shall be treated as Case C and netted against each other. Gains and losses shall be excluded from the Preliminary Cost Base.

Notes

N.J. Admin. Code § 10:52-6.26

Recodified from N.J.A.C. 10:52-6.28 and amended by R.2000 d.29, effective 1/18/2000.
See: 31 New Jersey Register 3151(a), 32 New Jersey Register 276(a).
In (a), changed N.J.A.C. reference. Former N.J.A.C. 10:52-6.26, Major Moveable Equipment, recodified to N.J.A.C. 10:52-6.24.