(REPRINTED WITH ADOPTED AMENDMENTS)
FIRST REPRINT S.B. 302
Senate Bill No. 302–Committee on Human
Resources and Facilities
March 8, 2001
____________
Referred to Committee on Human Resources and Facilities
SUMMARY—Revises provisions governing payment of hospitals for serving indigent patients. (BDR 40‑962)
FISCAL NOTE: Effect on Local Government: Yes.
CONTAINS UNFUNDED MANDATE (§§ 4, 11)
(Not Requested by Affected Local Government)
~
EXPLANATION
– Matter in bolded italics is new; matter
between brackets [omitted material] is material to be omitted.
Green numbers along left margin indicate location on the printed bill (e.g., 5-15 indicates page 5, line 15).
AN ACT relating to the provision of health care; repealing the requirement for certain hospitals to provide a certain amount of uncompensated care to indigent patients; providing a minimum amount certain counties must pay to certain hospitals for serving indigent patients; and providing other matters properly relating thereto.
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
1-1 Section 1. NRS 439B.300 is hereby amended to read as follows:
1-2 439B.300 1. [The legislature finds and declares that:
1-3 (a) The practice of refusing to treat an indigent patient if another
1-4 hospital can provide the treatment endangers the health and well-being of
1-5 such patients.
1-6 (b) Counties in which more than one hospital is located may lack
1-7 available resources to compensate for all indigent care provided at their
1-8 hospitals. Refusal by a hospital to treat indigent patients in such counties
1-9 results in a burden upon hospitals which treat large numbers of indigent
1-10 patients.
1-11 (c) A requirement that hospitals in such counties provide a designated
1-12 amount of uncompensated care for indigent patients would:
1-13 (1) Equalize the burden on such hospitals of treating indigent
1-14 patients; and
1-15 (2) Aid the counties in meeting their obligation to compensate
1-16 hospitals for such care.
2-1 (d) Hospitals with 100 or fewer beds have been meeting the needs of
2-2 their communities with regard to care of indigents, and have a minimal
2-3 effect on the provision of such care.
2-4 2.] Except as otherwise provided in this subsection, the provisions of
2-5 NRS [439B.300 to 439B.340, inclusive,] 439B.310 and 439B.330 apply to
2-6 each hospital in this state which is located in a county in which there are
2-7 two or more licensed hospitals. The provisions of NRS [439B.300 to
2-8 439B.340, inclusive,] 439B.310 and 439B.330 do not apply to a hospital
2-9 which has 100 or fewer beds.
2-10 [3.] 2. The provisions of NRS [439B.300 to 439B.340, inclusive,]
2-11 439B.310 and 439B.330 do not prohibit a county from:
2-12 (a) Entering into an agreement for medical care or otherwise contracting
2-13 with any hospital located within that county; or
2-14 (b) Using a definition of “indigent” which would include more persons
2-15 than the definition in NRS 439B.310.
2-16 Sec. 2. NRS 439B.310 is hereby amended to read as follows:
2-17 439B.310 For the purposes of NRS [439B.300 to 439B.340, inclusive,]
2-18 439B.330, “indigent” means those persons:
2-19 1. Who are not covered by any policy of health insurance;
2-20 2. Who are ineligible for Medicare, Medicaid, the children’s health
2-21 insurance program, the benefits provided pursuant to NRS 428.115 to
2-22 428.255, inclusive, or any other federal or state program of public
2-23 assistance covering the provision of health care;
2-24 3. Who meet the limitations imposed by the county upon assets and
2-25 other resources or potential resources; and
2-26 4. Whose income is less than:
2-27 (a) For one person living without another member of a household, $438.
2-28 (b) For two persons, $588.
2-29 (c) For three or more persons, $588 plus $150 for each person in the
2-30 family in excess of two.
2-31 For the purposes of this subsection, “income” includes the entire income of
2-32 a household and the amount which the county projects a person or
2-33 household is able to earn. “Household” is limited to a person and his
2-34 spouse, parents, children, brothers and sisters residing with him.
2-35 Sec. 3. NRS 439B.330 is hereby amended to read as follows:
2-36 439B.330 1. Except as otherwise provided in NRS 439B.300 and
2-37 subsection [2] 5 of this section, each county shall use the definition of
2-38 “indigent” in NRS 439B.310 to determine a person’s eligibility for medical
2-39 assistance pursuant to chapter 428 of NRS, other than assistance provided
2-40 pursuant to NRS 428.115 to 428.255, inclusive.
2-41 2. [A board of county commissioners may, if it determines that a
2-42 hospital within the county is serving a disproportionately large share of
2-43 low-income patients:
2-44 (a) Pay a higher rate to the hospital for treatment of indigent inpatients;
2-45 (b) Pay the hospital for treatment of indigent inpatients whom the
2-46 hospital would otherwise be required to treat without receiving
2-47 compensation from the county; or
2-48 (c) Both pay at a higher rate and pay for inpatients for whom the
2-49 hospital would otherwise be uncompensated.
3-1 3.] Each hospital which treats an indigent inpatient shall submit to the
3-2 board of county commissioners of the county of residence of the patient a
3-3 discharge form identifying the patient as a possible indigent and containing
3-4 the information required by the department and the county to be included
3-5 in all such forms.
3-6 [4.] 3. The county which receives a discharge form from a hospital for
3-7 an indigent inpatient shall verify the status of the patient and the amount
3-8 which the hospital is entitled to receive. A hospital aggrieved by a
3-9 determination of a county regarding the indigent status of an inpatient may
3-10 appeal the determination to the director or a person designated by the
3-11 director to hear such an appeal. The decision of the director or the person
3-12 he designates must be mailed by registered or certified mail to the county
3-13 and the hospital. The decision of the director or the person he designates
3-14 may be appealed to a court having general jurisdiction in the county within
3-15 15 days after the date of the postmark on the envelope in which the
3-16 decision was mailed.
3-17 [5.] 4. Except as otherwise provided in subsection [2 of this section
3-18 and subsection 3 of NRS 439B.320,] 5, if the county is the county of
3-19 residence of the patient and the patient is indigent, the county shall , [pay to
3-20 the hospital the amount required,] within the limits of money which may
3-21 lawfully be appropriated for this purpose pursuant to NRS 428.050,
3-22 428.285 and 450.425[.] , pay to the hospital the amount required.
3-23 5. A board of county commissioners may, if it determines that a
3-24 hospital within the county is serving a disproportionately large share of
3-25 low-income patients:
3-26 (a) Pay a higher rate to the hospital for the treatment of indigent
3-27 inpatients;
3-28 (b) Pay the hospital for the treatment of indigent inpatients whom the
3-29 hospital would otherwise be required to treat without receiving
3-30 compensation from the county; or
3-31 (c) Both pay at a higher rate and pay for inpatients for whom the
3-32 hospital would otherwise be uncompensated.
3-33 6. For the purposes of this section, the county of residence of the
3-34 patient is the county of residence of that person before he was admitted to
3-35 the hospital.
3-36 Sec. 4. NRS 439B.330 is hereby amended to read as follows:
3-37 439B.330 1. Except as otherwise provided in NRS 439B.300 and
3-38 subsection 5 of this section, each county shall use the definition of
3-39 “indigent” in NRS 439B.310 to determine a person’s eligibility for medical
3-40 assistance pursuant to chapter 428 of NRS, other than assistance provided
3-41 pursuant to NRS 428.115 to 428.255, inclusive.
3-42 2. Each hospital which treats an indigent inpatient shall submit to the
3-43 board of county commissioners of the county of residence of the patient a
3-44 discharge form identifying the patient as a possible indigent and containing
3-45 the information required by the department and the county to be included
3-46 in all such forms.
3-47 3. The county which receives a discharge form from a hospital for an
3-48 indigent inpatient shall verify the status of the patient and the amount
3-49 which the hospital is entitled to receive. A hospital aggrieved by a
4-1 determination of a county regarding the indigent status of an inpatient may
4-2 appeal the determination to the director or a person designated by the
4-3 director to hear such an appeal. The decision of the director or the person
4-4 he designates must be mailed by registered or certified mail to the county
4-5 and the hospital. The decision of the director or the person he designates
4-6 may be appealed to a court having general jurisdiction in the county within
4-7 15 days after the date of the postmark on the envelope in which the
4-8 decision was mailed.
4-9 4. Except as otherwise provided in subsection 5, if the county is the
4-10 county of residence of the patient and the patient is indigent, the county
4-11 shall, within the limits of money which may lawfully be appropriated for
4-12 this purpose pursuant to NRS 428.050, 428.285 and 450.425, pay to the
4-13 hospital [the amount required.] an amount that is not less than the
4-14 payment required for providing the same treatment to patients pursuant
4-15 to the state plan for Medicaid.
4-16 5. A board of county commissioners may, if it determines that a
4-17 hospital within the county is serving a disproportionately large share of
4-18 low-income patients:
4-19 (a) Pay a higher rate to the hospital for the treatment of indigent
4-20 inpatients;
4-21 (b) Pay the hospital for the treatment of indigent inpatients whom the
4-22 hospital would otherwise be required to treat without receiving
4-23 compensation from the county; or
4-24 (c) Both pay at a higher rate and pay for inpatients for whom the
4-25 hospital would otherwise be uncompensated.
4-26 6. For the purposes of this section, the county of residence of the
4-27 patient is the county of residence of that person before he was admitted to
4-28 the hospital.
4-29 Sec. 5. NRS 450.420 is hereby amended to read as follows:
4-30 450.420 1. The board of county commissioners of the county in
4-31 which a public hospital is located may determine whether patients
4-32 presented to the public hospital for treatment are subjects of charity. Except
4-33 as otherwise provided in NRS 439B.330, the board of county
4-34 commissioners shall establish , by ordinance , criteria and procedures to be
4-35 used in the determination of eligibility for medical care as medical
4-36 indigents or subjects of charity.
4-37 2. The board of hospital trustees shall fix the charges for treatment of
4-38 those persons able to pay for the charges, as the board deems just and
4-39 proper. The board of hospital trustees may impose an interest charge of not
4-40 more than 12 percent per annum on unpaid accounts. The receipts must be
4-41 paid to the county treasurer and credited by him to the hospital fund. In
4-42 fixing charges pursuant to this subsection , the board of hospital trustees
4-43 shall not include, or seek to recover from paying patients, any portion of
4-44 the expense of the hospital which is properly attributable to the care of
4-45 indigent patients.
4-46 3. Except as otherwise provided in subsection 4 , [of this section and
4-47 subsection 3 of NRS 439B.320,] the county is chargeable with the entire
4-48 cost of services rendered by the hospital and any salaried staff physician or
4-49 employee to any person admitted for emergency treatment, including ,
5-1 without limitation, all reasonably necessary recovery, convalescent and
5-2 follow-up inpatient care required for any such person as determined by the
5-3 board of trustees of the hospital, but the hospital shall use reasonable
5-4 diligence to collect the charges from the emergency patient or any other
5-5 person responsible for his support. Any amount collected must be
5-6 reimbursed or credited to the county.
5-7 4. The county is not chargeable with the cost of services rendered by
5-8 the hospital or any attending staff physician or surgeon to the extent the
5-9 hospital is reimbursed for those services pursuant to NRS 428.115 to
5-10 428.255, inclusive.
5-11 Sec. 6. NRS 450.490 is hereby amended to read as follows:
5-12 450.490 1. The board of county commissioners of any county for
5-13 which a public hospital has been established or is administered pursuant to
5-14 NRS 450.010 to 450.510, inclusive, and whose public hospital is the only
5-15 hospital in the county, may convey the hospital for an amount not less than
5-16 its appraised value or lease it for a term of not more than 50 years to any
5-17 corporation if all of the following conditions are met:
5-18 (a) The corporation must provide in its articles of incorporation for an
5-19 advisory board for the hospital. The advisory board must consist of persons
5-20 who represent a broad section of the people to be served by the hospital.
5-21 (b) The corporation must contract to:
5-22 (1) Care for indigent patients at a charge to the county which does not
5-23 exceed the actual cost of providing that care, or in accordance with NRS
5-24 439B.300 [to 439B.340, inclusive,] , 439B.310 and 439B.330, if
5-25 applicable; and
5-26 (2) Receive any person falling sick or maimed within the county.
5-27 (c) The corporation must agree to accept all the current assets, including
5-28 accounts receivable, to assume all the current liabilities, and to take over
5-29 and maintain the records of the existing public hospital.
5-30 (d) The agreement must provide for the transfer of patients, staff and
5-31 employees, and for the continuing administration of any trusts or bequests
5-32 pertaining to the existing public hospital.
5-33 (e) The agreement must provide for the assumption by the corporation
5-34 of all indebtedness of the county which is attributable to the hospital, and:
5-35 (1) If the hospital is conveyed, for payment to the county of an
5-36 amount which is not less than the appraised value of the hospital, after
5-37 deducting any indebtedness so assumed, immediately or by deferred
5-38 installments over a period of not more than 30 years.
5-39 (2) If the hospital is leased, for a rental which will, over the term of
5-40 the lease, reimburse the county for its actual capital investment in the
5-41 hospital, after deducting depreciation and any indebtedness so assumed.
5-42 The lease may provide a credit against the rental so required for the value
5-43 of any capital improvements made by the corporation.
5-44 2. If any hospital which has been conveyed pursuant to this section
5-45 ceases to be used as a hospital, unless the premises so conveyed are sold
5-46 and the proceeds used to erect or enlarge another hospital for the county,
5-47 the hospital so conveyed reverts to the ownership of the county. If any
5-48 hospital which has been leased pursuant to this section ceases to be used as
5-49 a hospital, the lease is terminated.
6-1 Sec. 7. NRS 450.500 is hereby amended to read as follows:
6-2 450.500 1. Except as otherwise provided in NRS 450.490, the board
6-3 of county commissioners of any county for which a public hospital has
6-4 been established pursuant to NRS 450.010 to 450.510, inclusive, or
6-5 established otherwise but administered pursuant to NRS 450.010 to
6-6 450.510, inclusive, may convey the hospital, or lease it for a term of not
6-7 more than 50 years, to a nonprofit corporation if all of the following
6-8 conditions are met:
6-9 (a) The governing body of the nonprofit corporation must be composed
6-10 initially of the incumbent members of the board of hospital trustees, as
6-11 individuals. The articles of incorporation must provide for:
6-12 (1) A membership of the corporation which is broadly representative
6-13 of the public and includes residents of each incorporated city in the county
6-14 and of the unincorporated area of the county or a single member which is a
6-15 nonprofit corporation whose articles of incorporation provide for a
6-16 membership which is broadly representative of the public and includes
6-17 residents of each incorporated city in the county and of the unincorporated
6-18 area of the county;
6-19 (2) The selection of the governing body by the membership of the
6-20 corporation or, if the corporation has a single member, by the single
6-21 member;
6-22 (3) The governing body to select its members only to fill a vacancy
6-23 for an unexpired term; and
6-24 (4) The terms of office of members of the governing body, not to
6-25 exceed 6 years.
6-26 (b) The nonprofit corporation must contract to:
6-27 (1) Care for indigent patients at a charge to the county which does not
6-28 exceed the actual cost of providing such care, or in accordance with NRS
6-29 439B.300 [to 439B.340, inclusive,] , 439B.310 and 439B.330, if
6-30 applicable; and
6-31 (2) Receive any person falling sick or maimed within the county.
6-32 (c) The nonprofit corporation must agree to accept all the current assets,
6-33 including accounts receivable, to assume all the current liabilities, and to
6-34 take over and maintain the records of the existing public hospital.
6-35 (d) The agreement must provide for the transfer of patients, staff and
6-36 employees, and for the continuing administration of any trusts or bequests
6-37 pertaining to the existing public hospital.
6-38 (e) The agreement must provide for the assumption by the corporation
6-39 of all indebtedness of the county which is attributable to the hospital, and:
6-40 (1) If the hospital is conveyed, for payment to the county of its actual
6-41 capital investment in the hospital, after deducting depreciation and any
6-42 indebtedness so assumed, immediately or by deferred installments over a
6-43 period of not more than 30 years.
6-44 (2) If the hospital is leased, for a rental which will , over the term of
6-45 the lease , reimburse the county for its actual capital investment in the
6-46 hospital, after deducting depreciation and any indebtedness so assumed.
6-47 The lease may provide a credit against the rental so required for the value
6-48 of any capital improvements made by the corporation.
7-1 2. Boards of county commissioners which have joint responsibility for
7-2 a public hospital may jointly exercise the power conferred by subsection 1,
7-3 and are subject jointly to the related duties.
7-4 3. If any hospital which has been conveyed pursuant to this section
7-5 ceases to be used as a nonprofit hospital, unless the premises so conveyed
7-6 are sold and the proceeds used to erect or enlarge another nonprofit
7-7 hospital for the county, the hospital so conveyed reverts to the ownership
7-8 of the county. If any hospital which has been leased pursuant to this section
7-9 ceases to be used as a nonprofit hospital, the lease is terminated.
7-10 Sec. 8. NRS 450.510 is hereby amended to read as follows:
7-11 450.510 1. The board of county commissioners of any county whose
7-12 population is less than 100,000 may contract with any nonprofit
7-13 corporation to which a public hospital has been conveyed or leased, for the
7-14 care of indigent patients from the contracting county and the receiving of
7-15 other persons falling sick or being maimed or injured within the
7-16 contracting county. The contract must be consistent with the provisions of
7-17 NRS 439B.300 [to 439B.340, inclusive,] , 439B.310 and 439B.330, if
7-18 applicable.
7-19 2. The contracting county may participate in the enlargement or
7-20 alteration of the hospital.
7-21 Sec. 9. 1. Before September 30, 2002, each county in which
7-22 hospitals subject to the provisions of NRS 439B.300, 439B.310 and
7-23 439B.330 are located shall provide to the department a report showing:
7-24 (a) The total number of inpatients treated during the fiscal year ending
7-25 on June 30, 2002, by each such hospital who are claimed by the hospital to
7-26 be indigent;
7-27 (b) The number of such patients for whom no reimbursement was
7-28 provided by the county because of the limitation imposed by subsection 3
7-29 of NRS 439B.320;
7-30 (c) The total amount paid to each such hospital for treatment of such
7-31 patients; and
7-32 (d) The amount the hospital would have received for patients for whom
7-33 no reimbursement was provided.
7-34 2. The director shall verify the amount of treatment provided to
7-35 indigent inpatients during the fiscal year ending on June 30, 2002, by each
7-36 hospital to which no reimbursement was provided by:
7-37 (a) Determining the number of indigent inpatients who received
7-38 treatment. For a hospital that has contracted with the department pursuant
7-39 to subsection 4 of NRS 428.030, the director shall determine the number
7-40 based upon the evaluations of eligibility made by the employee assigned to
7-41 the hospital pursuant to the contract. For all other hospitals, the director
7-42 shall determine the number based upon the report submitted pursuant to
7-43 subsection 1 of this section.
7-44 (b) Multiplying the number of indigent inpatients who received each
7-45 type of treatment by the highest amount paid by the county for that
7-46 treatment.
7-47 (c) Adding the products of the calculations made pursuant to paragraphs
7-48 (a) and (b) for all treatment provided.
8-1 If the total amount of treatment provided by the hospital to indigent
8-2 inpatients during the fiscal year ending on June 30, 2002, was less than its
8-3 minimum obligation for the year, the director shall assess the hospital for
8-4 the amount of the difference between the minimum obligation and the
8-5 actual amount of treatment provided by the hospital to indigent inpatients.
8-6 If a decision of a county regarding the indigent status of one or more
8-7 inpatients is pending appeal before the director or upon receiving
8-8 satisfactory proof from a hospital that the decision is pending appeal before
8-9 a court having general jurisdiction in the county pursuant to NRS
8-10 439B.330, the director shall defer assessing the hospital the amount that
8-11 may be offset by the determination on appeal until a final determination of
8-12 the matter is made.
8-13 3. If the director determines that a hospital has met its obligation to
8-14 provide treatment to indigent inpatients during the fiscal year ending on
8-15 June 30, 2002, he shall certify to the county in which the hospital is located
8-16 that the hospital has met its obligation. The county is not required to pay
8-17 the hospital for the costs of treating indigent inpatients for that fiscal year
8-18 until the certification is received from the director. The county shall pay
8-19 the hospital for such treatment within 30 days after receipt of the
8-20 certification to the extent that money was available for payment pursuant to
8-21 NRS 428.050, 428.285 and 450.425 at the time the treatment was provided.
8-22 4. The director shall determine the amount of the assessment which a
8-23 hospital must pay pursuant to this section and shall notify the hospital in
8-24 writing of that amount on or before November 1, 2002. The notice must
8-25 include, but is not limited to, a written statement for each claim that is
8-26 denied indicating why the claim was denied. Payment is due 30 days after
8-27 receipt of the notice, except for assessments deferred pursuant to
8-28 subsection 2 that, if required, must be paid within 30 days after the court
8-29 hearing the appeal renders its decision. If a hospital fails to pay the
8-30 assessment when it is due, the hospital shall pay, in addition to the
8-31 assessment:
8-32 (a) Interest at a rate of 1 percent per month for each month after the
8-33 assessment is due in which it remains unpaid; and
8-34 (b) Any court costs and fees required by the director to obtain payment
8-35 of the assessment and interest from the hospital.
8-36 5. Any money collected pursuant to this section must be paid to the
8-37 county in which the hospital paying the assessment is located for use in
8-38 paying other hospitals in the county for the treatment of indigent inpatients
8-39 by those hospitals. The money received by a county from assessments
8-40 made pursuant to this section does not constitute revenue from taxes ad
8-41 valorem for the purposes of NRS 354.59811, 428.050, 428.285 and
8-42 450.425, and must be excluded in determining the maximum rate of tax
8-43 authorized by those sections.
8-44 6. For the purposes of this section:
8-45 (a) “Department” means the department of human resources;
8-46 (b) “Director” means the director of the department; and
8-47 (c) “Indigent” has the meaning ascribed to it in NRS 439B.310.
9-1 Sec. 10. The provisions of subsection 1 of NRS 354.599 do not apply
9-2 to any additional expenses of a local government that are related to the
9-3 provisions of this act.
9-4 Sec. 11. NRS 439B.320 and 439B.340 are hereby repealed.
9-5 Sec. 12. 1. This section and sections 1, 2, 3 and 5 to 11, inclusive, of
9-6 this act become effective on July 1, 2002.
9-7 2. Section 4 of this act becomes effective on July 1, 2003.
9-8 TEXT OF REPEALED SECTIONS
9-9 439B.320 Hospital required to provide care for proportionate
9-10 share of indigent patients; duties of department and board of count
9-11 commissioners; reimbursement for care.
9-12 1. A hospital shall provide, without charge, in each fiscal year, care for
9-13 indigent inpatients in an amount which represents 0.6 percent of its net
9-14 revenue for the hospital’s preceding fiscal year.
9-15 2. The department shall compute the obligation of each hospital for
9-16 care of indigent inpatients for each fiscal year based upon the net revenue
9-17 of the hospital in its preceding fiscal year and shall provide this
9-18 information to the board of county commissioners of the county in which
9-19 the hospital is located.
9-20 3. The board of county commissioners shall maintain a record of
9-21 discharge forms submitted by each hospital located within the county,
9-22 together with the amount accruing to the hospital. The amount accruing to
9-23 the hospital for the care, until the hospital has met its obligation pursuant
9-24 to this section, is the highest amount the county is paying to any hospital
9-25 in the county for that care. Except as otherwise provided in subsection 2 of
9-26 NRS 439B.330, no payment for indigent care may be made to the hospital
9-27 until the total amount so accruing to the hospital exceeds the minimum
9-28 obligation of the hospital for the fiscal year, and a hospital may only
9-29 receive payment from the county for indigent care provided in excess of
9-30 its obligation pursuant to this section. After a hospital has met its
9-31 obligation pursuant to this section, the county may reimburse the hospital
9-32 for care of indigent inpatients at any rate otherwise authorized by law.
9-33 439B.340 Report on indigent patients treated; verification by
9-34 director; compensation for treatment provided in excess of obligation;
9-35 assessment for failure to fulfill minimum obligation.
9-36 1. Before September 30 of each year, each county in which hospitals
9-37 subject to the provisions of NRS 439B.300 to 439B.340, inclusive, are
9-38 located shall provide to the department a report showing:
9-39 (a) The total number of inpatients treated by each such hospital who are
9-40 claimed by the hospital to be indigent;
10-1 (b) The number of such patients for whom no reimbursement was
10-2 provided by the county because of the limitation imposed by subsection 3
10-3 of NRS 439B.320;
10-4 (c) The total amount paid to each such hospital for treatment of such
10-5 patients; and
10-6 (d) The amount the hospital would have received for patients for whom
10-7 no reimbursement was provided.
10-8 2. The director shall verify the amount of treatment provided to
10-9 indigent inpatients by each hospital to which no reimbursement was
10-10 provided by:
10-11 (a) Determining the number of indigent inpatients who received
10-12 treatment. For a hospital that has contracted with the department of human
10-13 resources pursuant to subsection 4 of NRS 428.030, the director shall
10-14 determine the number based upon the evaluations of eligibility made by
10-15 the employee assigned to the hospital pursuant to the contract. For all
10-16 other hospitals, the director shall determine the number based upon the
10-17 report submitted pursuant to subsection 1 of this section.
10-18 (b) Multiplying the number of indigent inpatients who received each
10-19 type of treatment by the highest amount paid by the county for that
10-20 treatment.
10-21 (c) Adding the products of the calculations made pursuant to paragraphs
10-22 (a) and (b) for all treatment provided.
10-23 If the total amount of treatment provided to indigent inpatients in the
10-24 previous fiscal year by the hospital was less than its minimum obligation
10-25 for the year, the director shall assess the hospital for the amount of the
10-26 difference between the minimum obligation and the actual amount of
10-27 treatment provided by the hospital to indigent inpatients. If a decision of a
10-28 county regarding the indigent status of one or more inpatients is pending
10-29 appeal before the director or upon receiving satisfactory proof from a
10-30 hospital that the decision is pending appeal before a court having general
10-31 jurisdiction in the county pursuant to subsection 4 of NRS 439B.330, the
10-32 director shall defer assessing the hospital the amount that may be offset by
10-33 the determination on appeal until a final determination of the matter is
10-34 made.
10-35 3. If the director determines that a hospital has met its obligation to
10-36 provide treatment to indigent inpatients, he shall certify to the county in
10-37 which the hospital is located that the hospital has met its obligation. The
10-38 county is not required to pay the hospital for the costs of treating indigent
10-39 inpatients until the certification is received from the director. The county
10-40 shall pay the hospital for such treatment within 30 days after receipt of the
10-41 certification to the extent that money was available for payment pursuant
10-42 to NRS 428.050, 428.285 and 450.425 at the time the treatment was
10-43 provided.
10-44 4. The director shall determine the amount of the assessment which a
10-45 hospital must pay pursuant to this section and shall notify the hospital in
10-46 writing of that amount on or before November 1 of each year. The notice
10-47 must include, but is not limited to, a written statement for each claim
10-48 which is denied indicating why the claim was denied. Payment is due 30
10-49 days after receipt of the notice, except for assessments deferred pursuant
10-50 to subsection 2 which, if required, must be paid within 30 days after the
10-51 court
11-1 hearing the appeal renders its decision. If a hospital fails to pay the
11-2 assessment when it is due the hospital shall pay, in addition to the
11-3 assessment:
11-4 (a) Interest at a rate of 1 percent per month for each month after the
11-5 assessment is due in which it remains unpaid; and
11-6 (b) Any court costs and fees required by the director to obtain payment
11-7 of the assessment and interest from the hospital.
11-8 5. Any money collected pursuant to this section must be paid to the
11-9 county in which the hospital paying the assessment is located for use in
11-10 paying other hospitals in the county for the treatment of indigent inpatients
11-11 by those hospitals. The money received by a county from assessments
11-12 made pursuant to this section does not constitute revenue from taxes ad
11-13 valorem for the purposes of NRS 354.59811, 428.050, 428.285 and
11-14 450.425, and must be excluded in determining the maximum rate of tax
11-15 authorized by those sections.
11-16 H