REQUIRES TWO-THIRDS MAJORITY VOTE (§ 1)
(REPRINTED WITH ADOPTED AMENDMENTS)
THIRD REPRINT S.B. 377
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.
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.
Green numbers along left margin indicate location on the printed bill (e.g., 5-15 indicates page 5, line 15).
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:
2-8 (I) An amount equal to 75 percent of the total amount distributed
2-9 to that hospital pursuant to that paragraph for a fiscal year, less $75,000;
2-10 or
2-11 (II) Any maximum amount established by the legislature for a
2-12 fiscal year,
2-13 whichever is less, to the division of health care financing and policy.
2-14 2. A county that transfers the amount required pursuant to
2-15 subparagraph (1) of paragraph (b) of subsection 1 to the division of health
2-16 care financing and policy is discharged of the duty and is released from
2-17 liability for providing medical treatment for indigent inpatients who are
2-18 treated in the hospital in the county that receives a payment pursuant to
2-19 paragraph (b) of subsection 2 of NRS 422.387.
2-20 3. The money transferred to the division of health care financing and
2-21 policy pursuant to subsection 1 must not come from any source of
2-22 funding that could result in any reduction in revenue to the state
2-23 pursuant to 42 U.S.C. § 1396b(w).
2-24 4. Any money collected pursuant to subsection 1, including any
2-25 interest or penalties imposed for a delinquent payment, must be deposited
2-26 in the state treasury for credit to the intergovernmental transfer account in
2-27 the state general fund to be administered by the division of health care
2-28 financing and policy.
2-29 [4.] 5. The interest and income earned on money in the
2-30 intergovernmental transfer account, after deducting any applicable charges,
2-31 must be credited to the account.
2-32 Sec. 2. NRS 422.385 is hereby amended to read as follows:
2-33 422.385 1. The allocations and payments required pursuant to
2-34 subsections 1 and 2 of NRS 422.387 must be made, to the extent allowed
2-35 by the state plan for Medicaid, from the Medicaid budget account.
2-36 2. Except as otherwise provided in subsection 3[,] and subsection 3 of
2-37 NRS 422.387, the money in the intergovernmental transfer account must be
2-38 transferred from that account to the Medicaid budget account to the extent
2-39 that money is available from the Federal Government for proposed
2-40 expenditures, including expenditures for administrative costs. If the amount
2-41 in the account exceeds the amount authorized for expenditure by the
2-42 division of health care financing and policy for the purposes specified in
2-43 NRS 422.387, the division of health care financing and policy is authorized
2-44 to expend the additional revenue in accordance with the provisions of the
2-45 state plan for Medicaid.
2-46 3. If enough money is available to support Medicaid[,] and to make
2-47 the payments required by subsection 3 of NRS 422.387, money in the
2-48 intergovernmental transfer account may be transferred [to] :
3-1 (a) To an account established for the provision of health care services to
3-2 uninsured children pursuant to a federal program in which at least 50
3-3 percent of the cost of such services is paid for by the Federal Government,
3-4 including, without limitation, the children’s health insurance program[, if
3-5 enough money is available to continue to satisfy existing obligations of the
3-6 Medicaid program or to] ; or
3-7 (b) To carry out the provisions of NRS 439B.350 [to] and 439B.360.
3-8 Sec. 3. NRS 422.387 is hereby amended to read as follows:
3-9 422.387 1. Before making the payments required or authorized by
3-10 this section, the division of health care financing and policy shall allocate
3-11 money for the administrative costs necessary to carry out the provisions of
3-12 NRS 422.380 to 422.390, inclusive. The amount allocated for
3-13 administrative costs must not exceed the amount authorized for
3-14 expenditure by the legislature for this purpose in a fiscal year. The interim
3-15 finance committee may adjust the amount allowed for administrative costs.
3-16 2. The state plan for Medicaid must provide:
3-17 (a) For the payment of the maximum amount allowable under federal
3-18 law and regulations after making [a payment, if any,] any payments
3-19 pursuant to [paragraph (b),] paragraphs (b) and (c), to public hospitals for
3-20 treating a disproportionate share of Medicaid patients, indigent patients or
3-21 other low-income patients, unless such payments are subsequently limited
3-22 by federal law or regulation.
3-23 (b) For a payment in an amount approved by the legislature to the
3-24 private hospital that provides the largest volume of medical care to
3-25 Medicaid patients, indigent patients or other low-income patients in a
3-26 county that does not have a public hospital.
3-27 (c) For a payment to each private hospital whose Medicaid utilization
3-28 percentage is greater than the average for all the hospitals in this state
3-29 and which is located in a county that has a public hospital, in an amount
3-30 equal to:
3-31 (1) If the Medicaid utilization percentage of the hospital is greater
3-32 than 20 percent, $200 for each uncompensated day incurred by the
3-33 hospital; and
3-34 (2) If the Medicaid utilization percentage of the hospital is 20
3-35 percent or less, $100 for each uncompensated day incurred by the
3-36 hospital.
3-37 The plan must be consistent with the provisions of NRS 422.380 to
3-38 422.390, inclusive, and Title XIX of the Social Security Act , [(]42 U.S.C.
3-39 §§ 1396 et seq. , [.),] and the regulations adopted pursuant to those
3-40 provisions.
3-41 3. [The division of health care financing and policy may, with the
3-42 approval of the director, amend the state plan for Medicaid to modify the
3-43 methodology for establishing the rates of payment to public hospitals for
3-44 inpatient services, except that such amendments must not reduce the total
3-45 reimbursements to public hospitals for such services.] To the extent that
3-46 money is available in the intergovernmental transfer account, the
3-47 division of health care financing and policy shall distribute $50,000 from
3-48 that account each fiscal year to each public hospital which:
4-1 (a) Is located in a county that does not have any other hospitals; and
4-2 (b) Is not eligible for a payment pursuant to subsection 2.
4-3 4. As used in this section:
4-4 (a) “Medicaid utilization percentage” means the total number of days
4-5 of treatment of Medicaid patients, including patients who receive their
4-6 Medicaid benefits through a health maintenance organization, divided by
4-7 the total number of days of treatment of all patients during a fiscal year.
4-8 (b) “Uncompensated day” means a day in which medical care is
4-9 provided to an inpatient for which a hospital receives:
4-10 (1) Not more than 25 percent of the cost of providing that care from
4-11 the patient; and
4-12 (2) No compensation for the cost of providing that care from any
4-13 other person or any governmental program.
4-14 Sec. 4. 1. Except as otherwise provided in subsection 2:
4-15 (a) The state plan for Medicaid must allocate to:
4-16 (1) Any private hospital in a county whose population is 100,000 or
4-17 more that is qualified to receive a payment pursuant to paragraph (b) of
4-18 subsection 2 of NRS 422.387, $4,800,000 or the amount of the
4-19 uncompensated costs of the hospital as defined in the state plan for
4-20 Medicaid, whichever is less, for the fiscal year 2001-2002 and for the fiscal
4-21 year 2002-2003.
4-22 (2) Any private hospital in a county whose population is 50,000 or
4-23 more but less than 100,000 that is qualified to receive a payment pursuant
4-24 to paragraph (b) of subsection 2 of NRS 422.387, $4,000,000 or the
4-25 amount of the uncompensated costs of the hospital as defined in the state
4-26 plan for Medicaid, whichever is less, for the fiscal year 2001-2002 and for
4-27 the fiscal year 2002-2003.
4-28 (3) Any private hospital in a county whose population is 40,000 or
4-29 more but less than 50,000 that is qualified to receive a payment pursuant to
4-30 paragraph (b) of subsection 2 of NRS 422.387, $2,000,000 or the amount
4-31 of the uncompensated costs of the hospital as defined in the state plan for
4-32 Medicaid, whichever is less, for the fiscal year 2001-2002 and for the fiscal
4-33 year 2002-2003.
4-34 (4) Any private hospital in a county whose population is less than
4-35 40,000 that is qualified to receive a payment pursuant to paragraph (b) of
4-36 subsection 2 of NRS 422.387, $1,000,000 or the amount of the
4-37 uncompensated costs of the hospital as defined in the state plan for
4-38 Medicaid, whichever is less, for the fiscal year 2001-2002 and for the fiscal
4-39 year 2002-2003.
4-40 (b) If a private hospital receives a payment pursuant to paragraph (a),
4-41 the county within which the hospital is located shall transfer to the division
4-42 of health care financing and policy of the department of human resources:
4-43 (1) If the payment was received pursuant to subparagraph (1) of that
4-44 paragraph, $1,500,000 for the fiscal year 2001-2002 and for the fiscal year
4-45 2002-2003.
4-46 (2) If the payment was received pursuant to subparagraph (2) of that
4-47 paragraph, $3,000,000 or 75 percent of the amount received by the
4-48 hospital, whichever is less, for the fiscal year 2001-2002 and for the fiscal
4-49 year 2002-2003.
5-1 (3) If the payment was received pursuant to subparagraph (3) of that
5-2 paragraph, $1,500,000 or 75 percent of the amount received by the
5-3 hospital, whichever is less, for the fiscal year 2001-2002 and for the fiscal
5-4 year 2002-2003.
5-5 (4) If the payment was received pursuant to subparagraph (4) of that
5-6 paragraph, $750,000 or 75 percent of the amount received by the hospital,
5-7 whichever is less, for the fiscal year 2001-2002 and for the fiscal year
5-8 2002-2003.
5-9 2. If federal law changes the amount payable pursuant to paragraph (a)
5-10 of subsection 2 of NRS 422.387:
5-11 (a) The respective amounts required to be allocated and transferred
5-12 pursuant to subsection 1 must be reduced proportionally in accordance with
5-13 the limits of federal law.
5-14 (b) The administrator of the division of health care financing and policy
5-15 of the department of human resources shall adopt a regulation specifying
5-16 the amount of the reductions required by paragraph (a).
5-17 Sec. 5. The maximum amount a county is required to transfer to the
5-18 division of health care financing and policy of the department of human
5-19 resources pursuant to subparagraph (2) of paragraph (b) of subsection 1 of
5-20 NRS 422.382 for:
5-21 1. The fiscal year 2001-2002 is $900,000; and
5-22 2. The fiscal year 2002-2003 is $950,000.
5-23 Sec. 6. 1. The board of county commissioners of a county within
5-24 which is located only one private hospital or one group of affiliated
5-25 hospitals and which makes a transfer of money pursuant to paragraph (b) of
5-26 subsection 1 of NRS 422.382 may impose a tax on the revenue of those
5-27 hospitals during the fiscal years 2001-2002 and 2002-2003 at a rate that
5-28 does not exceed 6 percent of that revenue, to pay for indigent care.
5-29 2. The proceeds of the tax imposed pursuant to this section are exempt
5-30 from the limitations imposed by NRS 354.59811 and must be excluded in
5-31 determining the allowed revenue from taxes ad valorem for the county.
5-32 Sec. 7. 1. The legislative committee on health care shall conduct a
5-33 study of:
5-34 (a) The programs conducted in this state for the provision of medical
5-35 care to Medicaid patients, indigent patients and other low-income patients;
5-36 and
5-37 (b) The methodology used in determining the amount and distribution
5-38 of payments made to public and private hospitals pursuant to
5-39 NRS 422.387.
5-40 2. The study must review:
5-41 (a) The sources of funding used for the provision of medical care to
5-42 Medicaid patients, indigent patients and other low-income patients,
5-43 including any applicable federal, state and local governmental programs;
5-44 (b) The costs to provide medical care to Medicaid patients, indigent
5-45 patients and other low-income patients, and the extent to which the sources
5-46 of funding identified pursuant to paragraph (a) are sufficient to pay those
5-47 costs;
6-1 (c) Whether the payments received by hospitals based on the volume of
6-2 medical care provided to Medicaid patients, indigent patients and other
6-3 low-income patients are equitable;
6-4 (d) The statewide effect of the provisions of NRS 439B.300 to
6-5 439B.340, inclusive, on the provision of medical care to Medicaid patients,
6-6 indigent patients and other low-income patients;
6-7 (e) The policies employed by counties to administer the provisions of
6-8 NRS 439B.300 to 439B.340, inclusive;
6-9 (f) Whether the amendment of the provisions of NRS 439B.300 to
6-10 439B.340, inclusive, to provide for a direct tax would enable the state to
6-11 increase any revenue from other sources for the provision of medical care
6-12 to Medicaid patients, indigent patients and other low-income patients;
6-13 (g) Whether it is feasible for the state to provide for the reimbursement
6-14 of public hospitals for the provision of medical care to Medicaid patients
6-15 on a cost basis as a means to increase any revenue from other sources for
6-16 the provision of that care;
6-17 (h) Whether it is feasible to redistribute payments to increase payments
6-18 to hospitals located in rural counties, including hospitals that are not
6-19 currently eligible for payments pursuant to NRS 422.387; and
6-20 (i) Alternative methodologies for providing funding for the provision of
6-21 medical care to Medicaid patients, indigent patients and other low-income
6-22 patients in Washoe County.
6-23 3. The legislative committee on health care shall request such relevant
6-24 information from public and private hospitals, counties and other entities as
6-25 is necessary to conduct the study. A hospital, county or other entity that
6-26 receives such a request from the committee shall provide the appropriate
6-27 information. Any such information obtained by the committee may be used
6-28 only for the purpose of conducting the study.
6-29 Sec. 8. The provisions of subsection 1 of NRS 354.599 do not apply
6-30 to any additional expenses of a local government that are related to the
6-31 provisions of this act.
6-32 Sec. 9. This act becomes effective on July 1, 2001.
6-33 H