Return to Browsing

8 N.J.A.R. 389

Preakness Hospital, In the Matter of
Formats: PDF | DjVu— Help viewing DjVu Files
Citation: 8 N.J.A.R. 389
Decision Date: 1982
Agency: DIVISION OF MEDICAL ASSISTANCE
Synopsis: Preakness Hospital, a long term care facility run by Passaic County, requested a change in its system of rate reimbursement to more accurately reflect nursing costs. The administrative law judge assigned to the case found that Preak- ness had asked the Department of Health to review staffing patterns to help determine a minimal standard of care for the facility. The end result was the development of a report setting forth minimum staffing requirements. This report was not designed to support an upward revision of Medicaid reimbursement rates but to bolster arguments to prevent budget cutbacks. Preakness, however, utilized this report in a direct appeal for a review of rates. The Division of Medical Assistance and Health Services originally denied the sought-after extra hours of care as being not only above the required hours of nursing care given the patient population, but above the required hours per unit staffing as well. The administrative law judge concluded that DMAHS' action in rejecting the request for reimbursement of additional hours of nursing care was not unreasonable. The judge determined that DMAHS should not be bound by a determination of the Department of Health to recommend revised rates of reimbursement to Preakness based on the hours generated by a staffing report, since the statutory role of the Department of Health is limited to assisting DMAHS with the development of rates for reimbursement for long-term care facilities. It is DMAHS which has the authority to render a final agency decision on the validity of Medicaid rates. DMAHS was only required to ensure that minimum standards of nursing care were maintained, and no authority existed for the Department of Health to establish mini- mum staffing patterns. Thus, DMAHS could not be required to accept as minimum staffing patterns the results of a survey which ignored minimum standards promulgated by regulation. Accordingly, Preakness' request for additional reimbursement was denied. In Re: Preakness Hospital Upon review this initial decision was adopted by the Division of Medical Assistance and Health Services. Peter T. Bongiorno, Esq., for petitioner Michael H. Glovin, Esq., for intervenor, County of Passaic Ivan J. Punchatz, Deputy Attorney General, for respondent (Irwin I. Kimmelman, Attorney General of New Jersey, attorney) Initial Decision