Bill Text: NJ A1974 | 2010-2011 | Regular Session | Introduced
Bill Title: Extends charity care payments to physicians providing hospital-based charity care.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Introduced - Dead) 2010-02-08 - Introduced, Referred to Assembly Health and Senior Services Committee [A1974 Detail]
Download: New_Jersey-2010-A1974-Introduced.html
Sponsored by:
Assemblyman HERB CONAWAY, JR.
District 7 (Burlington and Camden)
SYNOPSIS
Extends charity care payments to physicians providing hospital-based charity care.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning hospital charity care payments and amending P.L.1992, c.160 and P.L.2004, c.113.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 8 of P.L.1992, c.160 (C.26:2H-18.58) is amended to read as follows:
8. There is established the Health Care Subsidy Fund in the Department of Health and Senior Services.
a. The fund shall be comprised of revenues from employee and employer contributions made pursuant to section 29 of P.L.1992, c.160 (C.43:21-7b), revenues from the hospital assessment made pursuant to section 12 of P.L.1992, c.160 (C.26:2H-18.62), revenues pursuant to section 11 of P.L.1996, c.28 (C.26:2H-18.58c), revenues from interest and penalties collected pursuant to this act and revenues from such other sources as the Legislature shall determine. Interest earned on the monies in the fund shall be credited to the fund. The fund shall be a nonlapsing fund dedicated for use by the State to: (1) distribute charity care and other uncompensated care disproportionate share payments to hospitals and physicians providing hospital-based charity care, and other eligible providers pursuant to section 8 of P.L.1996, c.28 (C.26:2H-18.59f), provide subsidies for the Health Access New Jersey program established pursuant to section 15 of P.L.1992, c.160 (C.26:2H-18.65), and provide funding for children's health care coverage pursuant to P.L.1997, c.272 (C.30:4I-1 et seq.); (2) provide funding for federally qualified health centers pursuant to section 12 of P.L.1992, c.160 (C.26:2H-18.62); and (3) provide for the payment in State fiscal year 2002 of appropriate Medicaid expenses, subject to the approval of the Director of the Division of Budget and Accounting.
b. The fund shall be administered by a person appointed by the commissioner.
The administrator of the fund is responsible for overseeing and coordinating the collection and reimbursement of fund monies. The administrator is responsible for promptly informing the commissioner if monies are not or are not reasonably expected to be collected or disbursed.
c. The commissioner shall adopt rules and regulations to ensure the integrity of the fund, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.).
d. The administrator shall
establish separate accounts for the charity care component of the
disproportionate share hospital subsidy, other uncompensated care component of
the
disproportionate share hospital subsidy, federally qualified health centers
funding and the payments for subsidies for insurance premiums to provide care
in disproportionate share hospitals, known as the Health Access New Jersey
subsidy account, respectively.
e. In the event that the charity care component of the disproportionate share hospital subsidy account has a surplus in a given year after payments are distributed pursuant to the methodology established in section 13 of P.L.1995, c.133 (C.26:2H-18.59b) and section 7 of P.L.1996, c.28 (C.26:2H-18.59e) and within the limitations provided in subsection e. of section 9 of P.L.1992, c.160 (C.26:2H-18.59), the surplus monies in calendar years 2002, 2003 and 2004 shall lapse to the unemployment compensation fund established pursuant to R.S.43:21-9, and each year thereafter shall lapse to the charity care component of the disproportionate share hospital subsidy account for distribution in subsequent years.
(cf: P.L.2005, c.237, s.1)
2. Section 3 of P.L.2004, c.113 (C.26:2H-18.59i) is amended to read as follows:
3. a. Beginning July 1, 2004 and each year thereafter:
(1) Reimbursed documented charity care shall be equal to the Medicaid-priced amounts of charity care claims submitted to the Department of Health and Senior Services for the most recent calendar year, adjusted, as necessary, to reflect the annual audit results. These amounts shall be augmented to reflect payments to hospitals by the Medicaid program for Graduate Medical Education and Indirect Medical Education based on the most recent Graduate Medical Education and Indirect Medical Education formulas utilized by the federal Medicare program.
(2) Hospital-specific reimbursed documented charity care shall be equal to the Medicaid-priced dollar amount of charity care provided by a hospital as submitted to the Department of Health and Senior Services for the most recent calendar year. A sample of the claims submitted by the hospital to the department shall be subject to an annual audit conducted pursuant to applicable charity care eligibility criteria.
b. Beginning July 1, 2004 and each year thereafter, the charity care subsidy shall be determined according to the following methodology:
(1) Each hospital shall be ranked in order of its hospital-specific, relative charity care percentage, or RCCP, by dividing the amount of hospital-specific gross revenue for charity care patients by the hospital's total gross revenue for all patients.
(2) The nine hospitals with the highest RCCPs shall receive a charity care payment equal to 96% of each hospital's hospital-specific reimbursed documented charity care. The hospital ranked number 10 shall receive a charity care payment equal to 94% of its hospital-specific reimbursed documented charity care, and each hospital ranked number 11 and below shall receive two percentage points less than the hospital ranked immediately above that hospital. The provisions of this paragraph are subject to the provisions of subsection e. of this section.
(3) Notwithstanding the provisions of paragraph (2) of this subsection to the contrary, each of the hospitals located in the 10 municipalities in the State with the lowest median annual household income according to the most recent census data, shall be ranked from the hospital with the highest hospital-specific reimbursed documented charity care to the hospital with the lowest hospital-specific reimbursed documented charity care. The hospital in each of the 10 municipalities, if any, with the highest documented hospital-specific charity care shall receive a charity care payment equal to 96% of its hospital-specific reimbursed documented charity care, subject to the provisions of subsection e. of this section.
(4) Notwithstanding the provisions of this subsection to the contrary but subject to the provisions of subsection e. of this section, no hospital shall receive reimbursement for less than 43% of its hospital-specific reimbursed documented charity care.
c. To ensure that charity care subsidy payments remain viable and appropriate, the State shall maintain the charity care subsidy at an amount not less than 75% of the Medicaid-priced amounts of charity care provided by hospitals in the State. In addition, these amounts shall be augmented to reflect payments to hospitals by the Medicaid program for Graduate Medical Education and Indirect Medical Education based on the most recent Graduate Medical Education and Indirect Medical Education formulas utilized by the federal Medicare program.
d. Notwithstanding any other provisions of this section to the contrary, in the event that the change from the charity care subsidy formula in effect for fiscal year 2004 to the formula established pursuant to this section in effect for fiscal year 2005, reduces, for any reason, the amount of the charity care subsidy payment to a hospital below the amount that the hospital received under the formula in effect in fiscal year 2004, the hospital shall receive a payment equal to the amount it would have received under the formula in effect for fiscal year 2004.
e. (1) Beginning July 1, 2010, the amount of the charity care subsidy payment to a hospital pursuant to this section shall be reduced by an amount which shall be allocated among each of its physicians who provides documented charity care at that hospital so that each such physician receives an amount in the same proportion as that received by the hospital for its hospital-specific reimbursed documented charity care.
(2) The documented charity care provided by physicians at a hospital shall be equal to the Medicaid-priced dollar amount of charity care provided by those physicians as submitted to the Department of Health and Senior Services for the most recent calendar year. A sample of the claims submitted by physicians to the department shall be subject to an annual audit conducted pursuant to applicable charity care eligibility criteria.
(cf: P.L.2004, c.113, s.3)
3. The Commissioner of Health and Senior Services shall adopt regulations, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), to effectuate the purposes of this act.
4. This act shall take effect July 1, 2010.
STATEMENT
This bill extends charity care payments to physicians providing hospital-based charity care.
Specifically, the bill provides that:
C Beginning July 1, 2010, the amount of the charity care subsidy payment to a hospital pursuant to N.J.S.A.26:2H-18.59i will be reduced by an amount which is to be allocated among each of its physicians who provides documented charity care at that hospital so that each such physician receives an amount in the same proportion as that received by the hospital for its hospital-specific reimbursed documented charity care.
C The documented charity care provided by physicians at a hospital is to be equal to the Medicaid-priced dollar amount of charity care provided by those physicians as submitted to the Department of Health and Senior Services for the most recent calendar year. A sample of the claims submitted by physicians to the department will be subject to an annual audit conducted pursuant to applicable charity care eligibility criteria.
