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8 N.J.A.R. 231

Waterview Nursing Home and Twin Oaks Nursing Home, In the Matter of the Appeal of
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Citation: 8 N.J.A.R. 231
Decision Date: 1981
Agency: DIVISION OF MEDICAL ASSISTANCE
Synopsis: Petitioner contested the long term care facilities review guidelines established for them in the areas of capital facilities--allowance square foot adjustment, inflation factor, mortgage insurance, housekeeping costs and a late filing penalty. The administrative law judge assigned to the case found that under existing CARE guidlines both petitioners had an excessive appraised value due to the established square footage limitation per bed. The judge determined that the square footage requirement as applied to both petitioners was unreasonable since both petitioners had done everything possible to reduce their square footage and any reasonable standard would allow a nursing home to conform its operation to that standard. In addition, the judge concluded that a retroactive reim- bursement for a shortfall in recovery of costs caused by an un- reasonably set inflation factor should be allowed. The judge denied increased reimbursement for mortgage insurance and housekeeping costs since the methods used to arrive at such figures were found to be reasonable. The judge did determine that Waterview Nursing Home should be allowed to recover its late filing fee since an inade- quate review of Waterview's request for an extension had taken place. Upon review, this initial decision was modified by the Division of Medical Assistance and Health Services. The Division noted that federal requirements mandated a procedure to insure that payments for services under the Medicaid Program not be in excess of reason- able charges and in furtherance of that requirement reasonable fee schedules had been adopted. Such schedules had been determined after a comparison of industry-wide costs and like all agency regu- lations were entitled to a presumption of reasonableness. The Division determined that petitioners had failed to overcome this presumption in relation to the square foot adjustment regulation. Petitioners had failed to demonstrate the statistical invalidity of the reimbursement rates in this area since no testimony had been pres- In Re: Waterview Nursing Home ented from experts in nursing home economics or statistics, nor had any evidence been presented to support the invalidity of the inflation factor or on the losses allegedly due to the factor. The Division affirmed the judge's findings as to the mortgage in- surance, housekeeping costs and late filing penalty. James J. Shrager, Esq., for petitioners (Hannoch, Weisman, Stern, Besser, Berkowitz & Kinney, attorneys) Robert J. Haney, Deputy Attorney General, for the Division of Medi- cal Assistance (James R. Zazzali, Attorney General of New Jersey, attorney) Initial Decision
Citation Tracker modified-Div. of Med. Ass't.; affirmed -App. Div., A-3363-86, 6/24/84 (unreported); certification denied-93 N.J. 275 (1983) [Updated through 1991]