requires two-thirds majority vote (§ 1)                                                   

                                                                                                  

 

Senate Bill No. 377–Committee on Human
Resources and Facilities

 

March 19, 2001

____________

 

Referred to Committee on Human Resources and Facilities

 

SUMMARY—Revises provisions governing payment of hospitals for treating disproportionate share of Medicaid patients, indigent patients or other low-income patients. (BDR 38‑316)

 

FISCAL NOTE:            Effect on Local Government: Yes.

                                    Effect on the State: Yes.

 

CONTAINS UNFUNDED MANDATE (§ 1)

(Not Requested by Affected Local Government)

 

~

 

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

AN ACT relating to welfare; revising the provisions governing the payment of hospitals for treating a disproportionate share of Medicaid patients, indigent patients or other low-income 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 422.382 is hereby amended to read as follows:

1-2    422.382  1.  In a county within which:

1-3    (a) A public hospital is located, the state or local government or other

1-4  entity responsible for the public hospital shall transfer an amount equal to

1-5  75 percent of the total amount [of the payment made to the public]

1-6  distributed to that hospital pursuant to NRS 422.387 [less $50,000] for a

1-7  fiscal year, less $75,000, to the division of health care financing and

1-8  policy.

1-9    (b) A private hospital which receives a payment pursuant to :

1-10      (1) Subsection 3 of NRS 422.387 is located, the county shall transfer

1-11  an amount established by the legislature for each fiscal year to the division

1-12  of health care financing and policy.

1-13      (2) Subsection 4 of NRS 422.387 is located, the county shall

1-14  transfer an amount equal to 75 percent of the total amount distributed to

1-15  that hospital pursuant to that subsection for a fiscal year, less $75,000, to

1-16  the division of health care financing and policy.

1-17    2.  A county that transfers the amount required pursuant to

1-18  subparagraph (1) of paragraph (b) of subsection 1 to the division of health

2-1  care financing and policy is discharged of the duty and is released from

2-2  liability for providing medical treatment for indigent inpatients who are

2-3  treated in the hospital in the county that receives a payment pursuant to

2-4  paragraph [(b)] (a) of subsection [2] 3 of NRS 422.387.

2-5    3.  Any money collected pursuant to subsection 1, including any

2-6  interest or penalties imposed for a delinquent payment, must be deposited

2-7  in the state treasury for credit to the intergovernmental transfer account in

2-8  the state general fund to be administered by the division of health care

2-9  financing and policy.

2-10    4.  The interest and income earned on money in the intergovernmental

2-11  transfer account, after deducting any applicable charges, must be credited

2-12  to the account.

2-13    Sec. 2.  NRS 422.387 is hereby amended to read as follows:

2-14    422.387  1.  Before making the payments required or authorized by

2-15  this section, the division of health care financing and policy shall allocate

2-16  money for the administrative costs necessary to carry out the provisions of

2-17  NRS 422.380 to 422.390, inclusive. The amount allocated for

2-18  administrative costs must not exceed the amount authorized for

2-19  expenditure by the legislature for this purpose in a fiscal year. The interim

2-20  finance committee may adjust the amount allowed for administrative costs.

2-21    2.  The state plan for Medicaid must provide[:

2-22    (a) For] for the payment of the maximum aggregate amount allowable

2-23  under federal law and regulations [after making a payment, if any, pursuant

2-24  to paragraph (b), to public] to the hospitals in this state for treating a

2-25  disproportionate share of Medicaid patients, indigent patients or other low-

2-26  income patients . [, unless such payments are subsequently limited by

2-27  federal law or regulation.

2-28    (b) For a payment in an amount approved by the legislature to the] This

2-29  amount must initially be allocated each fiscal year for distribution to:

2-30    (a) Hospitals in counties whose populations are less than 400,000;

2-31  and

2-32    (b) Hospitals in counties whose populations are 400,000 or
more,

2-33  in the same proportion as payments were distributed to hospitals in those

2-34  categories of counties pursuant to this section for the fiscal year ending

2-35  on June 30, 2001. If the maximum amount allowable under federal law

2-36  and regulations for distribution to the hospitals described in either

2-37  paragraph (a) or (b) for treating a disproportionate share of Medicaid

2-38  patients, indigent patients or other low-income patients for a fiscal year

2-39  is less than the amount initially allocated for distribution to those

2-40  hospitals pursuant to this subsection, the additional amount initially

2-41  allocated for distribution to those hospitals must be reallocated for

2-42  distribution to the hospitals described in the other paragraph.

2-43    3.  To the greatest extent allowable under federal law and

2-44  regulations, the final allocation established for a fiscal year pursuant to

2-45  subsection 2 for hospitals in counties whose populations are less than

2-46  400,000 must be distributed in the following manner:

2-47    (a) The private hospital that provides the largest volume of medical care

2-48  to Medicaid patients, indigent patients or other low-income patients in [a

3-1  county] each of those counties that does not have a public hospital[.] must

3-2  receive a payment in an amount approved by the legislature which is not

3-3  less than the amount distributed to a private hospital pursuant to this

3-4  section for the fiscal year ending on June 30, 2001.

3-5    (b) After making any distributions required by paragraph (a), each of

3-6  the public hospitals in those counties must receive a payment in an

3-7  amount equal to the uncompensated costs incurred by the hospital

3-8  during that fiscal year or $500,000, whichever is less.

3-9    (c) After making any distributions required by paragraphs (a) and (b),

3-10  each of the public hospitals in those counties that incurred

3-11  uncompensated costs during that fiscal year in excess of $500,000 must

3-12  receive a portion of any remaining amount of the allocation based upon

3-13  its pro rata share of the cumulative amount by which all those hospitals

3-14  respectively incurred uncompensated costs during that fiscal year in

3-15  excess of $500,000.

3-16    4.  To the greatest extent allowable under federal law and

3-17  regulations, the final allocation established for a fiscal year pursuant to

3-18  subsection 2 for hospitals in counties whose populations are 400,000 or

3-19  more must be distributed in the following manner:

3-20    (a) The public hospital that provides the largest volume of medical

3-21  care to Medicaid patients and indigent patients in each of those counties

3-22  during that fiscal year must receive a payment of $45,000,000.

3-23    (b) After making any distributions required by paragraph (a), each

3-24  hospital in those counties whose Medicaid utilization percentage is

3-25  greater than the average for all the hospitals in this state for that fiscal

3-26  year must receive a portion of any remaining amount of the allocation

3-27  based upon its pro rata share of the cumulative number of

3-28  uncompensated days respectively incurred during that fiscal year by all

3-29  the hospitals in the same county whose Medicaid utilization percentage is

3-30  greater than the average for all the hospitals in this state.

3-31    5.  The state plan for Medicaid must be consistent with the provisions

3-32  of NRS 422.380 to 422.390, inclusive, and Title XIX of the Social Security

3-33  Act , [(]42 U.S.C. §§ 1396 et seq. , [.),] and the regulations adopted

3-34  pursuant to those provisions.

3-35    [3.] 6.  The division of health care financing and policy may, with the

3-36  approval of the director, amend the state plan for Medicaid to modify the

3-37  methodology for establishing the rates of payment to public hospitals for

3-38  inpatient services . [, except that such] Except as otherwise required to

3-39  carry out subsection 4, those amendments must not reduce the total

3-40  reimbursements to public hospitals for such services.

3-41    7.  As used in this section:

3-42    (a) “Medicaid utilization percentage” means the total number of days

3-43  of treatment of Medicaid patients, including, without limitation, newborn

3-44  infants who qualify for Medicaid benefits and patients who receive their

3-45  Medicaid benefits through a health maintenance organization, divided by

3-46  the total number of days of treatment of all patients during a fiscal year.

3-47    (b) “Medicare” has the meaning ascribed to it in NRS 439B.130.

4-1    (c) “Uncompensated costs” means the costs to provide medical care to

4-2  inpatients for which a hospital receives no compensation from any

4-3  source.

4-4    (d) “Uncompensated day” means a day in which medical care is

4-5  provided to an inpatient for which a hospital receives:

4-6       (1) Not more than 25 percent of the cost of providing that care from

4-7  the patient; and

4-8       (2) No compensation for the cost of providing that care from any

4-9  other person or any governmental program, including, without

4-10  limitation, a private insurer, Medicaid or Medicare.

4-11    Sec. 3.  The provisions of subsection 1 of NRS 354.599 do not apply

4-12  to any additional expenses of a local government that are related to the

4-13  provisions of this act.

4-14    Sec. 4.  This act becomes effective on July 1, 2001.

 

4-15  H