MINUTES OF THE
HEALTH CARE ADMINISTRATION BOARD MEETING
Thursday, September 25, 2008
MEMBERS PRESENT:
Ruth Charbonneau
Christine Stearns
Mary Kay Roberts
Gregory Marks (via teleconference)
Judith Persichilli (via teleconference)
Ellsworth Havens (via teleconference)
EXCUSED:
Michael Malloy
Anastasius Efstratiades
Mary Wachter
Michael Baker
STAFF:
Rachana Munshi, DAG
CALL TO ORDER
Mary Kay Roberts, Chair opened the meeting on Thursday, September 25, 2008 at 9:26
a.m. located at the New Jersey Department of Health and Senior Services, Health and
Agriculture Building, Boardroom, 1
stFloor, Trenton New Jersey.
1. Approval of the Specially Adopted and Concurrently Proposed New Rules at New
N.J.A.C. 8:32, Healthcare Stabilization Fund Grants
Motion – Ms. Stearns, Second – Mr. Marks
2. Adjournment (voice vote)
SEPTEMBER 25, 2008 HEALTH CARE ADMINISTRATION BOARD
VOTING RECORD
VOTING BOARD MEMBER
ROLL
1
2
Ms. Charbonneau
X Y Y
Mr. Malloy
- - -
Mr. Baker
- - -
Ms. Roberts
X Y Y
Mr. Havens
X Y Y
Mr. Efstratiades
- - -
Mr. Marks
X Y Y
Ms. Persichilli
X Y Y
Mr. Roth
- - -
Ms. Stearns
X Y Y
Ms. Wachter
- - -
TOTAL
TOTAL Absent
6
5-(-)
6-Y
0-A
0-N
5-(-)
6-Y
1-A
0-N
4-(-)
KEY:
Y=YES
N=NO
A=ABSTAIN
( - )=ABSENT
DETAILED MINUTES TAKEN FROM TRANSCRIPT OF
SEPTEMBER 25, 2008 ATTACHED
MS. ROBERTS: We'll get started. I apologize for being late. Do you have everybody on the phone?
MS. STARK: Yes. This is a formal meeting of the Healthcare Administration Board. Adequate notice of this meeting has been published in accordance with the provisions of Chapter 231, Public Law 1975 C-10:4.10 of the State of New Jersey entitled, "Open Public Meetings Act." Notice was sent to the Secretary of State, who posted the notice in a public place. Notices were forwarded to 17 New Jersey newspapers, 2 New York newspapers, 2 wire services, 2
Philadelphia newspapers and the New Jersey Public Broadcasting Television Station. I'll call roll.
Ms. Charbonneau?
MS. CHARBONNEAU: Yes.
MS. STARK: Mr. Malloy is excused. Mr. Marks?
MR. MARKS: Here.
MS. STARK: Ms. Persichilli is excused. Mr. Havens?
CHAIRMAN HAVENS: Yes. MS. STARK: Mr. Roth? MR. ROTH: Yes.
MS. STARK: Mr. Efstratiades is excused. Ms. Stearns?
MS. STEARNS: Yes.
MS. STARK: Ms. Wachter is excused. Ms. Roberts?
MS. ROBERTS: Yes.
MS. STARK: Mr. Baker is excused. Six members of the Board are present, which does constitute a quorum.
MS. ROBERTS: We'll move to Ruth on the Healthcare Stabilization Programs.
MS. CHARBONNEAU: Thank you. This is a request for approval to submit a Notice of Proposal for new rules at New Jersey Administrative Code, Chapter 8:32, Healthcare
Stabilization Fund Grants. This special adoption and proposal for new rules is based on Public Law 2008, Chapter 33, which created the Healthcare Stabilization Fund.
The Fund was established with the purpose of providing emergency grants to general hospitals and other licensed healthcare facilities to ensure continuation of access and
availability of necessary healthcare services to residents in a community served by a hospital facing closure or significantly reducing services due to financial distress.
This specially adopted and concurrently proposed new rule would implement the requirements of the Act.
In response to the final report of the New Jersey Commission on Rationalizing Healthcare Resources, the Act established the Healthcare Stabilization Fund as a revolving fund in the Department of Health and Senior Services to be administered by the Department in consultation of the Department of Treasury.
In summary, I am going to just list the primary areas and chapters of the special adoption and proposed new rules.
N.J.A.C. 8:32-1.2 establishes definitions.
N.J.A.C. 8:32-1.3 provides for the adoption and concurrent proposal that any New Jersey healthcare facility could apply for the grant, if the facility is facing closure or a decrease in healthcare services due to financial distress that would jeopardize the
availability of necessary services for community residents.
N.J.A.C. 8:32-1.4 articulates and concurrently proposes that the Department shall only disperse the funds in the forms of grants for qualifying healthcare facilities. The Department would consult with the State Treasurer and the New Jersey Healthcare
Facilities Financing Authority prior to dispersing funds for grants.
N.J.A.C. 8:32-2.1 establishes and concurrently proposes the grant application process. N.J.A.C. 8:32-3 provides and concurrently proposes the Department's Selection
will review all grant applications, and identify and qualify healthcare facilities based on the factors as set forth at the rule at N.J.A.C. 8:32-3.2.
3.2 articulates and concurrently proposes the factors to be using and identifying
qualifying healthcare facilities. These qualified healthcare facilities and factors are identified in the statute and re-articulated in the rule. Specifically, they would need to demonstrate an application that due to extraordinary circumstances, a grant is necessary to maintain access to essential healthcare services.
The Selection Committee would be required to identify qualifying healthcare facilities based on those extraordinary circumstances that threaten access to essential healthcare services, that persons in a community will be without access to essential healthcare services.
In the absence of an award of a grant, the funding is unavailable from other sources to preserve or provide essential healthcare services. The grant is likely to stabilize access to essential healthcare services.
There is reasonable likelihood that the healthcare facilities will sustain essential
healthcare services upon termination of the grant. The healthcare facilities' services will have a significant number of uninsured and underinsured persons in the target community. The
healthcare facility must agree to the conditions for the receipt of the grant.
N.J.A.C. 8:32-3.3 establishes and concurrently proposes the conditions for the award of the grant. And again, this tracks the statutory language.
Prior to the award of the grant, each qualifying facility would agree to the following: To use the grant only for the purposes set forth in the Act and the Chapter; to provide essential healthcare services to the community, as determined by the Selection Committee, based on the contents of the application; to facilitate the enrollment of individuals and appropriate government insurance programs; and to provide the Department with quality of care, utilization, and financial information in accordance with the rule.
In the case of a facility whose financial condition created or contributed to the extraordinary circumstances, they should take corrective action with the management and business operation that the Commissioner deems appropriate.
The Department would be required to notify a healthcare facility, in writing, of any required conditions prior to the award of grant.
N.J.A.C. 8:32-4 allows and concurrently proposes that the Selection Committee require other conditions for the award of a grant, based on the particular circumstances of the facility. Subchapter 4 sets forth auditing and record keeping requirements. Those are identified based on the statutory language and standard grant-making processes.
We would, in consultation with the State Comptroller, require each qualifying healthcare facility to complete an audit within one year of the award. The statutory language itself allows for this to be a special adoption, which allows it to be adopted upon filing.
It also set forth an effective period not to exceed 270 days following enactment of the Act, which would bring us to a January 26, 2009 lapse, so that's why we are submitting this as a concurrent proposal as well.
The Department has made a preliminary release of the Request for Application. The application form is available on the web and distributed electronically to various facilities.
The grants will be reviewed as a competitive grant selection. The grant itself must be for at least $1 million. The grant application is consistent with the grant process that is used by what is called HIPER, which is the Health Infrastructure Preparedness and Emergency
Preparedness Division, as well as our Family Health Services Unit, which provides grants to our federally qualified health centers.
We believe that the grant process is one that is known to facilities and will ensure the necessary monitoring that is required under any award of a grant.
With that, I'm open to any questions in terms of the special adoption or concurrent proposal, as well as the requests for application and the application process.
MS. ROBERTS: Have any institutions reached out and expressed an interest in what we're doing?
MS. CHARBONNEAU: We've had numerous inquiries; however, at this point, we haven't had any specifics in terms of the type of application or the services that would be requested.
We've had a number of hospitals that have inquired as to the grant process. A Notice of Grant Award or a Notice of Grant Availability has been submitted to the New Jersey Register; it will be published October 6.
The reason we have provided an early notice to facilities is applications will be due October 8, and so in order to allow facilities to prepare for the grant-making process, we have distributed the application through a general list to all at least general hospitals. It also is available on the Healthcare Administration Board's website for the
meeting materials.
MS. ROBERTS: You said grants must be at least $1 million?
MS. CHARBONNEAU: At least $1 million. Ultimately, the Commissioner can condition what the final award will be. But because we do not know the number of facilities that will be applying for the types of services, we didn't want to put an outside range. We're hoping facilities use discretion in terms of the application. $44 million was allocated in the fiscal year '09 budget for the Stabilization Fund. It obviously does not all have to be awarded if we don't receive grants, but we anticipate we will receive multiple applications.
MS. STEARNS: With all that's happening on Wall Street, do you anticipate that the hospitals will be facing difficulty accessing capital? Would that play into this grant process, or how is the Department reviewing that situation?
MS. CHARBONNEAU: The Stabilization – the intent of the Stabilization Fund is really to address closure issues and access. Although we recognize that the financial conditions may generally impact all facilities, the Fund is targeted specifically towards
closure, not purely capital costs.
There's an intention that the Fund is in a transition to carry forward, to allow facilities to plan on fund -- continued funding through other means.
MS. ROBERTS: Is the closure -- is it prior to a CN being filed? What triggers it?
MS. CHARBONNEAU: It does not necessarily have to be a formal closure, but there has to be a closure of the facility or a potential closure of essential services.
MS. ROBERTS: Does anyone else on the Board or anyone else on the phone have any questions for the Department?
(No response.)
MS. ROBERTS: Anyone in the audience?
MS. SQUIERS: Jill Squiers, S-Q-U-I-E-R-S. I'm with the New Jersey Hospital Association. I don't have prepared remarks. We're planning to submit extensive comments during the public comment period, but you just mentioned something that
raised a question for me.
What is the deadline for applications? Because we're not aware that the Department had already published the availability of grants.
Certainly, with the October 8 deadline coming up very shortly, if there is a way that we can get that notice out to hospitals through the New Jersey Hospital Association, because the materials just showed up two days ago. We haven't had a lot of notice to alert hospitals that they can start applying.
And is the October 8 deadline just for this year? And then, after these rules are adopted, will there be another grant process?
MS. CHARBONNEAU: Yes, the rules themselves set out a process.
MR. HAVENS: I couldn't hear the question. Can someone repeat the question?
MS. ROBERTS: Essentially, the Hospital Association asked about this upcoming October 8 deadline and whether or not materials could be submitted out through the New Jersey Hospital Association so they can get them out to their members, in terms of the Notice of Grant process. And then, also, whether or not that October 8 date applies for going forward for future grant years that Ruth was about to answer.
MS. CHARBONNEAU: The October 8 date is only for this cycle. The rule itself is intended to follow the same schedule of any rulemaking, so it will be in effect for five years.
We've set out a mechanism for going forward, if the funds are placed into the Stabilization Fund, that we will continue to have a Notice of Grant on a yearly basis. This process -- I'm glad to share that information with the New Jersey Hospital Association.
The Grant Notice or the grant application -- the request for applications was forwarded to each CEO of the hospitals by the Deputy Commissioner two weeks ago. There has been notice to the hospitals themselves.
They have been aware of the application and the requirements in terms of the grant-making process.
I'll be glad to send you out a separate notice as well.
MS. ROBERTS: I heard a buzz. Did someone just join, or did someone have to leave?
MS. PERSICHILLI: It's Judy Persichilli. I've just joined. I apologize for being late.
MS. ROBERTS: Ruth has finished a summary, and the Hospital Association just asked a question.
I don't know if you have any questions with respect to this notice? MS. PERSICHILLI: No.
MS. ROBERTS: Seeing none, we'll entertain a motion. MS. STEARNS: I approve the proposal --
MS. CHARBONNEAU: Special Adoption Notice.
MS. STEARNS: Special Adoption Notice of the Healthcare Stabilization Fund Grant, especially adopting concurrently proposed at N.J.A.C. 8:32.
MR. MARKS: I second.
MS. STARK: Ms. Charbonneau? MS. CHARBONNEAU: Yes.
MS. STARK: Mr. Marks? MR. MARKS: Yes. MS. STARK: Ms. Persichilli? MS. PERSICHILLI: Yes. MS. STARK: Mr. Havens? CHAIRMAN HAVENS: Yes. MS. STARK: Mr. Roth? MR. ROTH: Yes. MS. STARK: Ms. Stearns? MS. STEARNS: Yes. MS. STARK: Ms. Roberts? MS. ROBERTS: Yes.
MS. STARK: Seven yes, motion carries.
MS. ROBERTS: Does anyone have any other business for the Board? (No response.)
MS. ROBERTS: Seeing none, we'll adjourn.
MS. CHARBONNEAU: Thank you for making yourselves available today, we appreciate it.
MS. ROBERTS: Thank you.
(Whereupon, the proceeding concluded at approximately 9:41 a.m.)
