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; authorizing the imposition in certain counties of a temporary tax on the revenue of hospitals; requiring the legislative committee on health care 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

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

2-2  fiscal year; or

2-3         (II) An amount established by the legislature for a fiscal

2-4  year,

2-5  to the division of health care financing and policy.

2-6       (2) Paragraph (c) of subsection 2 of NRS 422.387 is located, the

2-7  county shall transfer an amount equal to 75 percent of the total amount

2-8  distributed to that hospital pursuant to that paragraph for a fiscal year,

2-9  less $75,000, to the division of health care financing and policy.

2-10    2.  A county that transfers the amount required pursuant to

2-11  subparagraph (1) of paragraph (b) of subsection 1 to the division of health

2-12  care financing and policy is discharged of the duty and is released from

2-13  liability for providing medical treatment for indigent inpatients who are

2-14  treated in the hospital in the county that receives a payment pursuant to

2-15  paragraph (b) of subsection 2 of NRS 422.387.

2-16    3.  The money transferred to the division of health care financing and

2-17  policy pursuant to subsection 1 must not come from any source of

2-18  funding that could result in any reduction in revenue to the state

2-19  pursuant to 42 U.S.C. § 1396b(w).

2-20    4.  Any money collected pursuant to subsection 1, including any

2-21  interest or penalties imposed for a delinquent payment, must be deposited

2-22  in the state treasury for credit to the intergovernmental transfer account in

2-23  the state general fund to be administered by the division of health care

2-24  financing and policy.

2-25    [4.] 5. The interest and income earned on money in the

2-26  intergovernmental transfer account, after deducting any applicable charges,

2-27  must be credited to the account.

2-28    Sec. 2.  NRS 422.385 is hereby amended to read as follows:

2-29    422.385  1.  The allocations and payments required pursuant to

2-30  subsections 1 and 2 of NRS 422.387 must be made, to the extent allowed

2-31  by the state plan for Medicaid, from the Medicaid budget account.

2-32    2.  Except as otherwise provided in subsection 3[,] and subsection 3 of

2-33  NRS 422.387, the money in the intergovernmental transfer account must be

2-34  transferred from that account to the Medicaid budget account to the extent

2-35  that money is available from the Federal Government for proposed

2-36  expenditures, including expenditures for administrative costs. If the amount

2-37  in the account exceeds the amount authorized for expenditure by the

2-38  division of health care financing and policy for the purposes specified in

2-39  NRS 422.387, the division of health care financing and policy is authorized

2-40  to expend the additional revenue in accordance with the provisions of the

2-41  state plan for Medicaid.

2-42    3.  If enough money is available to support Medicaid[,] and to make

2-43  the payments required by subsection 3 of NRS 422.387, money in the

2-44  intergovernmental transfer account may be transferred [to] :

2-45    (a) To an account established for the provision of health care services to

2-46  uninsured children pursuant to a federal program in which at least 50

2-47  percent of the cost of such services is paid for by the Federal Government,

2-48  including, without limitation, the children’s health insurance program[, if

3-1  enough money is available to continue to satisfy existing obligations of the

3-2  Medicaid program or to] ; or

3-3    (b) To carry out the provisions of NRS 439B.350 [to] and 439B.360.

3-4    Sec. 3.  NRS 422.387 is hereby amended to read as follows:

3-5    422.387  1.  Before making the payments required or authorized by

3-6  this section, the division of health care financing and policy shall allocate

3-7  money for the administrative costs necessary to carry out the provisions of

3-8  NRS 422.380 to 422.390, inclusive. The amount allocated for

3-9  administrative costs must not exceed the amount authorized for

3-10  expenditure by the legislature for this purpose in a fiscal year. The interim

3-11  finance committee may adjust the amount allowed for administrative costs.

3-12    2.  The state plan for Medicaid must provide:

3-13    (a) For the payment of the maximum amount allowable under federal

3-14  law and regulations after making [a payment, if any,] any payments

3-15  pursuant to [paragraph (b),] paragraphs (b) and (c), to public hospitals for

3-16  treating a disproportionate share of Medicaid patients, indigent patients or

3-17  other low-income patients, unless such payments are subsequently limited

3-18  by federal law or regulation.

3-19    (b) For a payment in an amount approved by the legislature to the

3-20  private hospital that provides the largest volume of medical care to

3-21  Medicaid patients, indigent patients or other low-income patients in a

3-22  county that does not have a public hospital.

3-23    (c) For a payment to each private hospital:

3-24      (1) Which provides acute care and is located in a county that has a

3-25  public hospital; and

3-26      (2) Whose Medicaid utilization percentage is greater than 20

3-27  percent,

3-28  in an amount of not less than $150 for each Medicaid day incurred by

3-29  the hospital.

3-30  The plan must be consistent with the provisions of NRS 422.380 to

3-31  422.390, inclusive, and Title XIX of the Social Security Act , [(]42 U.S.C.

3-32  §§ 1396 et seq. , [.),] and the regulations adopted pursuant to those

3-33  provisions.

3-34    3.  [The division of health care financing and policy may, with the

3-35  approval of the director, amend the state plan for Medicaid to modify the

3-36  methodology for establishing the rates of payment to public hospitals for

3-37  inpatient services, except that such amendments must not reduce the total

3-38  reimbursements to public hospitals for such services.] To the extent that

3-39  money is available in the intergovernmental transfer account, the

3-40  division of health care financing and policy shall distribute $50,000 from

3-41  that account each fiscal year to each public hospital which:

3-42    (a) Is located in a county that does not have any other hospitals; and

3-43    (b) Is not eligible for a payment pursuant to subsection 2.

3-44    4.  As used in this section:

3-45    (a) “Medicaid day” means a day in which medical care is provided to

3-46  a Medicaid patient, including a patient who receives his Medicaid

3-47  benefits through a health maintenance organization.

3-48    (b) “Medicaid utilization percentage” means the total number of days

3-49  of treatment of Medicaid patients, including patients who receive their

4-1  Medicaid benefits through a health maintenance organization, divided by

4-2  the total number of days of treatment of all patients during a fiscal year.

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

4-4    (a) The state plan for Medicaid must allocate to:

4-5       (1) Any private hospital in a county whose population is 100,000 or

4-6  more that is qualified to receive a payment pursuant to paragraph (b) of

4-7  subsection 2 of NRS 422.387, $4,800,000 or the amount of the

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

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

4-10  year 2002-2003.

4-11      (2) Any private hospital in a county whose population is 50,000 or

4-12  more but less than 100,000 that is qualified to receive a payment pursuant

4-13  to paragraph (b) of subsection 2 of NRS 422.387, $4,000,000 or the

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

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

4-16  the fiscal year 2002-2003.

4-17      (3) Any private hospital in a county whose population is 40,000 or

4-18  more but less than 50,000 that is qualified to receive a payment pursuant to

4-19  paragraph (b) of subsection 2 of NRS 422.387, $2,000,000 or the amount

4-20  of the uncompensated costs of the hospital as defined in the state plan for

4-21  Medicaid, whichever is less, for the fiscal year 2001-2002 and for the fiscal

4-22  year 2002-2003.

4-23      (4) Any private hospital in a county whose population is less than

4-24  40,000 that is qualified to receive a payment pursuant to paragraph (b) of

4-25  subsection 2 of NRS 422.387, $1,000,000 or the amount of the

4-26  uncompensated costs of the hospital as defined in the state plan for

4-27  Medicaid, whichever is less, for the fiscal year 2001-2002 and for the fiscal

4-28  year 2002-2003.

4-29    (b) If a private hospital receives a payment pursuant to paragraph (a),

4-30  the county within which the hospital is located shall transfer to the division

4-31  of health care financing and policy of the department of human resources:

4-32      (1) If the payment was received pursuant to subparagraph (1) of that

4-33  paragraph, $1,500,000 for the fiscal year 2001-2002 and for the fiscal year

4-34  2002-2003.

4-35      (2) If the payment was received pursuant to subparagraph (2) of that

4-36  paragraph, $3,000,000 or 75 percent of the amount received by the

4-37  hospital, whichever is less, for the fiscal year 2001-2002 and for the fiscal

4-38  year 2002-2003.

4-39      (3) If the payment was received pursuant to subparagraph (3) of that

4-40  paragraph, $1,500,000 or 75 percent of the amount received by the

4-41  hospital, whichever is less, for the fiscal year 2001-2002 and for the fiscal

4-42  year 2002-2003.

4-43      (4) If the payment was received pursuant to subparagraph (4) of that

4-44  paragraph, $750,000 or 75 percent of the amount received by the hospital,

4-45  whichever is less, for the fiscal year 2001-2002 and for the fiscal year

4-46  2002-2003.

4-47    2.  If federal law changes the amount payable pursuant to paragraph (a)

4-48  of subsection 2 of NRS 422.387:

5-1    (a) The respective amounts required to be allocated and transferred

5-2  pursuant to subsection 1 must be reduced proportionally in accordance with

5-3  the limits of federal law.

5-4    (b) The administrator of the division of health care financing and policy

5-5  of the department of human resources shall adopt a regulation specifying

5-6  the amount of the reductions required by paragraph (a).

5-7    Sec. 5.  1.  The board of county commissioners of a county within

5-8  which is located only one private hospital or one group of affiliated

5-9  hospitals and which makes a transfer of money pursuant to paragraph (b) of

5-10  subsection 1 of NRS 422.382 may obtain the money for that transfer by

5-11  imposing a tax on the revenue of those hospitals during the fiscal years

5-12  2001-2002 and 2002-2003 at a rate that does not exceed 6 percent of that

5-13  revenue.

5-14    2.  The proceeds of the tax imposed pursuant to this section are exempt

5-15  from the limitations imposed by NRS 354.59811 and must be excluded in

5-16  determining the allowed revenue from taxes ad valorem for the county.

5-17    Sec. 6.  1.  The legislative committee on health care shall conduct a

5-18  study of:

5-19    (a) The programs conducted in this state for the provision of medical

5-20  care to Medicaid patients, indigent patients and other low-income patients;

5-21  and

5-22    (b) The methodology used in determining the amount and distribution

5-23  of payments made to public and private hospitals pursuant to NRS

5-24  422.387.

5-25    2.  The study must review:

5-26    (a) The sources of funding used for the provision of medical care to

5-27  Medicaid patients, indigent patients and other low-income patients,

5-28  including any applicable federal, state and local governmental programs;

5-29    (b) The costs to provide medical care to Medicaid patients, indigent

5-30  patients and other low-income patients, and the extent to which the sources

5-31  of funding identified pursuant to paragraph (a) are sufficient to pay those

5-32  costs;

5-33    (c) Whether the payments received by hospitals based on the volume of

5-34  medical care provided to Medicaid patients, indigent patients and other

5-35  low-income patients are equitable;

5-36    (d) The statewide effect of the provisions of NRS 439B.300 to

5-37  439B.340, inclusive, on the provision of medical care to Medicaid patients,

5-38  indigent patients and other low-income patients;

5-39    (e) The policies employed by counties to administer the provisions of

5-40  NRS 439B.300 to 439B.340, inclusive;

5-41    (f) Whether the amendment of the provisions of NRS 439B.300 to

5-42  439B.340, inclusive, to provide for a direct tax would enable the state to

5-43  increase any revenue from other sources for the provision of medical care

5-44  to Medicaid patients, indigent patients and other low-income patients;

5-45    (g) Whether it is feasible for the state to provide for the reimbursement

5-46  of public hospitals for the provision of medical care to Medicaid patients

5-47  on a cost basis as a means to increase any revenue from other sources for

5-48  the provision of that care;

6-1    (h) Whether it is feasible to redistribute payments to increase payments

6-2  to hospitals located in rural counties, including hospitals that are not

6-3  currently eligible for payments pursuant to NRS 422.387; and

6-4    (i) Alternative methodologies for providing funding for the provision of

6-5  medical care to Medicaid patients, indigent patients and other low-income

6-6  patients in Washoe County.

6-7    3.  The legislative committee on health care shall request such relevant

6-8  information from public and private hospitals, counties and other entities as

6-9  is necessary to conduct the study. A hospital, county or other entity that

6-10  receives such a request from the committee shall provide the appropriate

6-11  information. Any such information obtained by the committee may be used

6-12  only for the purpose of conducting the study.

6-13    Sec. 7.  The provisions of subsection 1 of NRS 354.599 do not apply

6-14  to any additional expenses of a local government that are related to the

6-15  provisions of this act.

6-16    Sec. 8.  This act becomes effective on July 1, 2001.

 

6-17  H