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6 N.J.A.R. 127

Thomas Jefferson University Hospital, Children's Hospital and St. Christopher's Hospital v. Medical Assistance and Health Services, Division of
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Citation: 6 N.J.A.R. 127
Decision Date: 1981
Agency: DIVISION OF MEDICAL ASSISTANCE
Synopsis: Petitioners requested an administrative hearing to contest their Medicaid reimbursement rates established by the New Jersey Division of Medical Assistance and Health Services through its fiscal intermedi- ary, Blue Cross of New Jersey. The petitioners challenged: 1) The propriety of an agency-imposed freeze on Medicaid eimbursement rate increases for inpatient services rendered by an out-of-State hospital on behalf of eligible New Jersey Medicaid patients, and 2) whether the method of calculation in use provides for reasonable rates of reimbursement for the same services. The administrative law judge assigned to the case determined that the attempted freeze was invalid since it had never submitted to be approved by Federal officials. In addition, the judge found that the freeze on rates had not been given the notice required by N.J.A.C. 52:14B-1 et seq., the New Jersey Administrative Procedure Act. Accordingly, the administrative law .judge ordered retroactive reim- bursements to be made to the petitioners. Cynthia Jacob, Esq., for Children's Hospital of Philadelphia and St. Christopher's Hospital for Children (Norris, McLaughlin & Marcus, attorneys) Doris Dabrowski, Esq., for Thomas Jefferson University Hospital (Tabas & Furlong, P.C., attorneys) Ivan Punchatz, Deputy Attorney General, for respondent (James J. Zazzali, Attorney General of New Jersey, attorney)