REQUIRES TWO THIRDS MAJORITY VOTE (§ 1)                 

                                            (REPRINTED WITH ADOPTED AMENDMENTS)

 

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; 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; 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) Paragraph (b) of subsection 2 of NRS 422.387 is located, the

1-11  county shall transfer [an] :

1-12         (I) Except as otherwise provided in sub-subparagraph (II), an

1-13  amount equal to 75 percent of the total amount distributed to that

1-14  hospital pursuant to paragraph (b) of subsection 2 of NRS 422.387 for a

1-15  fiscal year, less $75,000; or

2-1          (II) An amount established by the legislature for a fiscal

2-2  year,

2-3  to the division of health care financing and policy.

2-4       (2) Paragraph (c) of subsection 2 of NRS 422.387 is located, the

2-5  county shall transfer an amount equal to 75 percent of the total amount

2-6  distributed to that hospital pursuant to that paragraph for a fiscal year,

2-7  less $75,000, to the division of health care financing and policy.

2-8    2.  A county that transfers the amount required pursuant to

2-9  subparagraph (1) of paragraph (b) of subsection 1 to the division of health

2-10  care financing and policy is discharged of the duty and is released from

2-11  liability for providing medical treatment for indigent inpatients who are

2-12  treated in the hospital in the county that receives a payment pursuant to

2-13  paragraph (b) of subsection 2 of NRS 422.387.

2-14    3.  Any money collected pursuant to subsection 1, including any

2-15  interest or penalties imposed for a delinquent payment, must be deposited

2-16  in the state treasury for credit to the intergovernmental transfer account in

2-17  the state general fund to be administered by the division of health care

2-18  financing and policy.

2-19    4.  The interest and income earned on money in the intergovernmental

2-20  transfer account, after deducting any applicable charges, must be credited

2-21  to the account.

2-22    Sec. 2.  NRS 422.385 is hereby amended to read as follows:

2-23    422.385  1.  The allocations and payments required pursuant to

2-24  subsections 1 and 2 of NRS 422.387 must be made, to the extent allowed

2-25  by the state plan for Medicaid, from the Medicaid budget account.

2-26    2.  Except as otherwise provided in subsection 3[,] and subsection 3 of

2-27  NRS 422.387, the money in the intergovernmental transfer account must be

2-28  transferred from that account to the Medicaid budget account to the extent

2-29  that money is available from the Federal Government for proposed

2-30  expenditures, including expenditures for administrative costs. If the amount

2-31  in the account exceeds the amount authorized for expenditure by the

2-32  division of health care financing and policy for the purposes specified in

2-33  NRS 422.387, the division of health care financing and policy is authorized

2-34  to expend the additional revenue in accordance with the provisions of the

2-35  state plan for Medicaid.

2-36    3.  If enough money is available to support Medicaid[,] and to make

2-37  the payments required by subsection 3 of NRS 422.387, money in the

2-38  intergovernmental transfer account may be transferred [to] :

2-39    (a) To an account established for the provision of health care services to

2-40  uninsured children pursuant to a federal program in which at least 50

2-41  percent of the cost of such services is paid for by the Federal Government,

2-42  including, without limitation, the children’s health insurance program[, if

2-43  enough money is available to continue to satisfy existing obligations of the

2-44  Medicaid program or to] ; or

2-45    (b) To carry out the provisions of NRS 439B.350 [to] and 439B.360.

2-46    Sec. 3.  NRS 422.387 is hereby amended to read as follows:

2-47    422.387  1.  Before making the payments required or authorized by

2-48  this section, the division of health care financing and policy shall allocate

2-49  money for the administrative costs necessary to carry out the provisions of

3-1  NRS 422.380 to 422.390, inclusive. The amount allocated for

3-2  administrative costs must not exceed the amount authorized for

3-3  expenditure by the legislature for this purpose in a fiscal year. The interim

3-4  finance committee may adjust the amount allowed for administrative costs.

3-5    2.  The state plan for Medicaid must provide:

3-6    (a) For the payment of the maximum amount allowable under federal

3-7  law and regulations after making [a payment, if any,] any payments

3-8  pursuant to [paragraph (b),] paragraphs (b) and (c), to public hospitals for

3-9  treating a disproportionate share of Medicaid patients, indigent patients or

3-10  other low-income patients, unless such payments are subsequently limited

3-11  by federal law or regulation.

3-12    (b) For a payment in an amount approved by the legislature to the

3-13  private hospital that provides the largest volume of medical care to

3-14  Medicaid patients, indigent patients or other low-income patients in a

3-15  county that does not have a public hospital.

3-16    (c) For a payment to each private hospital whose Medicaid utilization

3-17  percentage is greater than the average for all the hospitals in this state

3-18  and which is located in a county that has a public hospital, in an amount

3-19  of not less than $150 but not more than $200 for each uncompensated

3-20  day incurred by the hospital.

3-21  The plan must be consistent with the provisions of NRS 422.380 to

3-22  422.390, inclusive, and Title XIX of the Social Security Act , [(]42 U.S.C.

3-23  §§ 1396 et seq. , [.),] and the regulations adopted pursuant to those

3-24  provisions.

3-25    3.  [The division of health care financing and policy may, with the

3-26  approval of the director, amend the state plan for Medicaid to modify the

3-27  methodology for establishing the rates of payment to public hospitals for

3-28  inpatient services, except that such amendments must not reduce the total

3-29  reimbursements to public hospitals for such services.] To the extent that

3-30  money is available in the intergovernmental transfer account, the

3-31  division of health care financing and policy shall distribute $50,000 from

3-32  that account each fiscal year to each public hospital which:

3-33    (a) Is located in a county that does not have any other hospitals; and

3-34    (b) Is not eligible for a payment pursuant to subsection 2.

3-35    4.  As used in this section:

3-36    (a) “Medicaid utilization percentage” means the total number of days

3-37  of treatment of Medicaid patients, including patients who receive their

3-38  Medicaid benefits through a health maintenance organization, divided by

3-39  the total number of days of treatment of all patients during a fiscal year.

3-40    (b) “Uncompensated day” means a day in which medical care is

3-41  provided to an inpatient for which a hospital receives:

3-42      (1) Not more than 25 percent of the cost of providing that care from

3-43  the patient; and

3-44      (2) No compensation for the cost of providing that care from any

3-45  other person or any governmental program.

3-46    Sec. 4.  1.  Except as otherwise provided in subsection 2:

3-47    (a) The state plan for Medicaid must allocate to:

3-48      (1) Any private hospital in a county whose population is 100,000 or

3-49  more that is qualified to receive a payment pursuant to paragraph (b) of

4-1  subsection 2 of NRS 422.387, $4,800,000 or the amount of the

4-2  uncompensated costs of the hospital as defined in the state plan for

4-3  Medicaid, whichever is less, for the fiscal year 2001-2002 and for the fiscal

4-4  year 2002-2003.

4-5       (2) Any private hospital in a county whose population is 40,000 or

4-6  more but less than 100,000 that is qualified to receive a payment pursuant

4-7  to paragraph (b) of subsection 2 of NRS 422.387, $2,000,000 or the

4-8  amount of the uncompensated costs of the hospital as defined in the state

4-9  plan for Medicaid, whichever is less, for the fiscal year 2001-2002 and for

4-10  the fiscal year 2002-2003.

4-11      (3) Any private hospital in a county whose population is less than

4-12  40,000 that is qualified to receive a payment pursuant to paragraph (b) of

4-13  subsection 2 of NRS 422.387, $1,000,000 or the amount of the

4-14  uncompensated costs of the hospital as defined in the state plan for

4-15  Medicaid, whichever is less, for the fiscal year 2001-2002 and for the fiscal

4-16  year 2002-2003.

4-17    (b) If a private hospital receives a payment pursuant to paragraph (a),

4-18  the county within which the hospital is located shall transfer to the division

4-19  of health care financing and policy of the department of human resources:

4-20      (1) If the payment was received pursuant to subparagraph (1) of that

4-21  paragraph, $1,500,000 for the fiscal year 2001-2002 and for the fiscal year

4-22  2002-2003.

4-23      (2) If the payment was received pursuant to subparagraph (2) of that

4-24  paragraph, $1,500,000 or 75 percent of the amount received by the

4-25  hospital, whichever is less, for the fiscal year 2001-2002 and for the fiscal

4-26  year 2002-2003.

4-27      (3) If the payment was received pursuant to subparagraph (3) of that

4-28  paragraph, $750,000 or 75 percent of the amount received by the hospital,

4-29  whichever is less, for the fiscal year 2001-2002 and for the fiscal year

4-30  2002-2003.

4-31    2.  If federal law changes the amount payable pursuant to paragraph (a)

4-32  of subsection 2 of NRS 422.387:

4-33    (a) The respective amounts required to be allocated and transferred

4-34  pursuant to subsection 1 must be reduced proportionally in accordance with

4-35  the limits of federal law.

4-36    (b) The administrator of the division of health care financing and policy

4-37  of the department of human resources shall adopt a regulation specifying

4-38  the amount of the reductions required by paragraph (a).

4-39    Sec. 5.  1.  The department of human resources shall conduct a study

4-40  of:

4-41    (a) The programs conducted in this state for the provision of medical

4-42  care to Medicaid patients, indigent patients and other low-income patients;

4-43  and

4-44    (b) The methodology used in determining the amount and distribution

4-45  of payments made to public and private hospitals pursuant to NRS

4-46  422.387.

4-47    2.  The study must review:

5-1    (a) The sources of funding used for the provision of medical care to

5-2  Medicaid patients, indigent patients and other low-income patients,

5-3  including any applicable federal, state and local governmental programs;

5-4    (b) The costs to provide medical care to Medicaid patients, indigent

5-5  patients and other low-income patients, and the extent to which the sources

5-6  of funding identified pursuant to paragraph (a) are sufficient to pay those

5-7  costs;

5-8    (c) Whether the payments received by hospitals based on the volume of

5-9  medical care provided to Medicaid patients, indigent patients and other

5-10  low-income patients are equitable;

5-11    (d) The statewide effect of the provisions of NRS 439B.300 to

5-12  439B.340, inclusive, on the provision of medical care to Medicaid patients,

5-13  indigent patients and other low-income patients;

5-14    (e) The policies employed by counties to administer the provisions of

5-15  NRS 439B.300 to 439B.340, inclusive;

5-16    (f) Whether the amendment of the provisions of NRS 439B.300 to

5-17  439B.340, inclusive, to provide for a direct tax would enable the state to

5-18  increase any revenue from other sources for the provision of medical care

5-19  to Medicaid patients, indigent patients and other low-income patients;

5-20    (g) Whether it is feasible for the state to provide for the reimbursement

5-21  of public hospitals for the provision of medical care to Medicaid patients

5-22  on a cost basis as a means to increase any revenue from other sources for

5-23  the provision of that care;

5-24    (h) Whether it is feasible to redistribute payments to increase payments

5-25  to hospitals located in rural counties, including hospitals that are not

5-26  currently eligible for payments pursuant to NRS 422.387; and

5-27    (i) Alternative methodologies for providing funding for the provision of

5-28  medical care to Medicaid patients, indigent patients and other low-income

5-29  patients in Washoe County.

5-30    3.  The department of human resources shall request such relevant

5-31  information from public and private hospitals, counties and other entities as

5-32  is necessary to conduct the study. A hospital, county or other entity that

5-33  receives such a request from the department shall provide the appropriate

5-34  information. Any such information obtained by the department may be

5-35  used only for the purpose of conducting the study.

5-36    4.  The department of human resources shall, on or before July 1, 2002,

5-37  complete the study and submit a report of the activities, findings and

5-38  recommendations of the study to the governor, the interim finance

5-39  committee and the legislative committee on health care.

5-40    Sec. 6.  The provisions of subsection 1 of NRS 354.599 do not apply

5-41  to any additional expenses of a local government that are related to the

5-42  provisions of this act.

5-43    Sec. 7.  This act becomes effective on July 1, 2001.

 

5-44  H