2001 REGULAR SESSION (71st)                                                                             A SB377 229

Amendment No. 229

 

 

 

 

     Amend section 1, page 1, by deleting lines 10 through 12 and inserting:

          “(1) Paragraph (b) of subsection 2 of NRS 422.387 is located, the county shall transfer [an] :

              (I) Except as otherwise provided in sub-subparagraph (II), an amount equal to 75 percent of the total amount distributed to that hospital pursuant to paragraph (b) of subsection 2 of NRS 422.387 for a fiscal year, less $75,000; or

              (II) An amount established by the legislature for a fiscal year,

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to the division of health care financing and policy.”.

     Amend section 1, page 1, line 13, by deleting “Subsection 4” and inserting:

“Paragraph (c) of subsection 2”.

     Amend section 1, page 1, line 15, by deleting “subsection” and inserting “paragraph”.

     Amend section 1, page 2, by deleting line 4 and inserting:

“paragraph (b) of subsection 2 of NRS 422.387.”.

     Amend the bill as a whole by renumbering sec. 2 as sec. 3 and adding a new section designated sec. 2, following section 1, to read as follows:

     “Sec. 2. NRS 422.385 is hereby amended to read as follows:

     422.385  1.  The allocations and payments required pursuant to subsections 1 and 2 of NRS 422.387 must be made, to the extent allowed by the state plan for Medicaid, from the Medicaid budget account.

     2.  Except as otherwise provided in subsection 3[,] and subsection 3 of NRS 422.387, the money in the intergovernmental transfer account must be transferred from that account to the Medicaid budget account to the extent that money is available from the Federal Government for proposed expenditures, including expenditures for administrative costs. If the amount in the account exceeds the amount authorized for expenditure by the division of health care financing and policy for the purposes specified in NRS 422.387, the division of health care financing and policy is authorized to expend the additional revenue in accordance with the provisions of the state plan for Medicaid.

     3.  If enough money is available to support Medicaid[,] and to make the payments required by subsection 3 of NRS 422.387, money in the intergovernmental transfer account may be transferred [to] :

     (a) To an account established for the provision of health care services to uninsured children pursuant to a federal program in which at least 50 percent of the cost of such services is paid for by the Federal Government, including, without limitation, the children’s health insurance program[, if enough money is available to continue to satisfy existing obligations of the Medicaid program or to] ; or

     (b) To carry out the provisions of NRS 439B.350 [to] and 439B.360.”.

     Amend sec. 2, pages 2 and 3, by deleting lines 21 through 49 on page 2 and lines 1 through 31 on page 3, and inserting:

     “2.  The state plan for Medicaid must provide:

     (a) For the payment of the maximum amount allowable under federal law and regulations after making [a payment, if any,] any payments pursuant to [paragraph (b),] paragraphs (b) and (c), to public hospitals for treating a disproportionate share of Medicaid patients, indigent patients or other low-income patients, unless such payments are subsequently limited by federal law or regulation.

     (b) For a payment in an amount approved by the legislature to the private hospital that provides the largest volume of medical care to Medicaid patients, indigent patients or other low-income patients in a county that does not have a public hospital.

     (c) For a payment to each private hospital whose Medicaid utilization percentage is greater than the average for all the hospitals in this state and which is located in a county that has a public hospital, in an amount of not less than $150 but not more than $200 for each uncompensated day incurred by the hospital.

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The plan must be consistent with the provisions”.

     Amend sec. 2, page 3, by deleting lines 35 through 40 and inserting:

   “3.  [The division of health care financing and policy may, with the approval of the director, amend the state plan for Medicaid to modify the methodology for establishing the rates of payment to public hospitals for inpatient services, except that such amendments must not reduce the total reimbursements to public hospitals for such services.] To the extent that money is available in the intergovernmental transfer account, the division of health care financing and policy shall distribute $50,000 from that account each fiscal year to each public hospital which:

     (a) Is located in a county that does not have any other hospitals; and

     (b) Is not eligible for a payment pursuant to subsection 2.”.

     Amend sec. 2, page 3, line 41, by deleting “7.” and inserting “4.”.

     Amend sec. 2, page 3, by deleting lines 43 and 44 and inserting:

“of treatment of Medicaid patients, including patients who receive their”.

     Amend sec. 2, pages 3 and 4, by deleting line 47 on page 3 and lines 1 through 3 on page 4.

     Amend sec. 2, page 4, line 4, by deleting “(d)” and inserting “(b)”.

     Amend sec. 2, page 4, by deleting lines 9 and 10 and inserting:

“other person or any governmental program.”.

     Amend the bill as a whole by renumbering sections 3 and 4 as sections 6 and 7 and adding new sections designated sections 4 and 5, following sec. 2, to read as follows:

     “Sec. 4. 1.  Except as otherwise provided in subsection 2:

     (a) The state plan for Medicaid must allocate to:

          (1) Any private hospital in a county whose population is 100,000 or more that is qualified to receive a payment pursuant to paragraph (b) of subsection 2 of NRS 422.387, $4,800,000 or the amount of the uncompensated costs of the hospital as defined in the state plan for Medicaid, whichever is less, for the fiscal year 2001-2002 and for the fiscal year 2002-2003.

          (2) Any private hospital in a county whose population is 40,000 or more but less than 100,000 that is qualified to receive a payment pursuant to paragraph (b) of subsection 2 of NRS 422.387, $2,000,000 or the amount of the uncompensated costs of the hospital as defined in the state plan for Medicaid, whichever is less, for the fiscal year 2001-2002 and for the fiscal year 2002-2003.

          (3) Any private hospital in a county whose population is less than 40,000 that is qualified to receive a payment pursuant to paragraph (b) of subsection 2 of NRS 422.387, $1,000,000 or the amount of the uncompensated costs of the hospital as defined in the state plan for Medicaid, whichever is less, for the fiscal year 2001-2002 and for the fiscal year 2002-2003.

     (b) If a private hospital receives a payment pursuant to paragraph (a), the county within which the hospital is located shall transfer to the division of health care financing and policy of the department of human resources:

          (1) If the payment was received pursuant to subparagraph (1) of that paragraph, $1,500,000 for the fiscal year 2001-2002 and for the fiscal year 2002-2003.

          (2) If the payment was received pursuant to subparagraph (2) of that paragraph, $1,500,000 or 75 percent of the amount received by the hospital, whichever is less, for the fiscal year 2001-2002 and for the fiscal year 2002-2003.

          (3) If the payment was received pursuant to subparagraph (3) of that paragraph, $750,000 or 75 percent of the amount received by the hospital, whichever is less, for the fiscal year 2001-2002 and for the fiscal year 2002-2003.

     2.  If federal law changes the amount payable pursuant to paragraph (a) of subsection 2 of NRS 422.387:

     (a) The respective amounts required to be allocated and transferred pursuant to subsection 1 must be reduced proportionally in accordance with the limits of federal law.

     (b) The administrator of the division of health care financing and policy of the department of human resources shall adopt a regulation specifying the amount of the reductions required by paragraph (a).

     Sec. 5. 1.  The department of human resources shall conduct a study of:

     (a) The programs conducted in this state for the provision of medical care to Medicaid patients, indigent patients and other low-income patients; and

     (b) The methodology used in determining the amount and distribution of payments made to public and private hospitals pursuant to NRS 422.387.

     2.  The study must review:

     (a) The sources of funding used for the provision of medical care to Medicaid patients, indigent patients and other low-income patients, including any applicable federal, state and local governmental programs;

     (b) The costs to provide medical care to Medicaid patients, indigent patients and other low-income patients, and the extent to which the sources of funding identified pursuant to paragraph (a) are sufficient to pay those costs;

     (c) Whether the payments received by hospitals based on the volume of medical care provided to Medicaid patients, indigent patients and other low-income patients are equitable;

     (d) The statewide effect of the provisions of NRS 439B.300 to 439B.340, inclusive, on the provision of medical care to Medicaid patients, indigent patients and other low-income patients;

     (e) The policies employed by counties to administer the provisions of NRS 439B.300 to 439B.340, inclusive;

     (f) Whether the amendment of the provisions of NRS 439B.300 to 439B.340, inclusive, to provide for a direct tax would enable the state to increase any revenue from other sources for the provision of medical care to Medicaid patients, indigent patients and other low-income patients;

     (g) Whether it is feasible for the state to provide for the reimbursement of public hospitals for the provision of medical care to Medicaid patients on a cost basis as a means to increase any revenue from other sources for the provision of that care;

     (h) Whether it is feasible to redistribute payments to increase payments to hospitals located in rural counties, including hospitals that are not currently eligible for payments pursuant to NRS 422.387; and

     (i) Alternative methodologies for providing funding for the provision of medical care to Medicaid patients, indigent patients and other low-income patients in Washoe County.

     3.  The department of human resources shall request such relevant information from public and private hospitals, counties and other entities as is necessary to conduct the study. A hospital, county or other entity that receives such a request from the department shall provide the appropriate information. Any such information obtained by the department may be used only for the purpose of conducting the study.

     4.  The department of human resources shall, on or before July 1, 2002, complete the study and submit a report of the activities, findings and recommendations of the study to the governor, the interim finance committee and the legislative committee on health care.”.

     Amend the title of the bill, third line, after “patients;” by inserting:

“providing for the allocation and transfer of certain funding for the treatment of those patients; requiring the department of human resources to conduct a study regarding programs and funding for the treatment of those patients;”.