NAC: CHAPTER 422 - HEALTH CARE FINANCING AND POLICY

[Rev. 6/10/2016 3:04:38 PM]

[NAC-422 Revised Date: 6-16]

CHAPTER 422 - HEALTH CARE FINANCING AND POLICY

GENERAL PROVISIONS

422.015 Definitions.

422.027 “Disproportionate share payment” defined.

422.035 “Division” defined.

422.055 “Pool of hospitals” defined.

422.065 “Public hospital” defined.

422.075 “Uncompensated care costs” defined.

422.085 Certain hospitals required to submit to Division certain information annually.

PAYMENTS TO CERTAIN HOSPITALS FOR TREATMENT OF INDIGENT PATIENTS

422.105 Intergovernmental transfers of money from certain counties to Division; discharge of duty to provide medical treatment for indigent inpatients in certain circumstances; money remitted to State Controller to be credited toward transfer to Division.

422.115 Designation of pools of hospitals and distribution of disproportionate share payments to each pool; requirements; limitations; calculation of total computable payments.

422.135 Percentage of initial distribution of disproportionate share payments.

422.145 Audit of hospitals required.

422.155 Recalculation after audit; final distribution; notification; recovery and redistribution of payments.

422.165 Transfer of money to certain public hospitals.

GENERAL PROVISIONS

NAC 422.015 Definitions. (NRS 422.390) As used in this chapter, unless the context otherwise requires, the words and terms defined in NAC 422.027 to 422.075, inclusive, have the meanings ascribed to them in those sections.

(Added to NAC by Div. of Health Care Fin. & Policy by R033-10, eff. 6-30-2010; A by R086-13, 12-22-2014)

NAC 422.027 “Disproportionate share payment” defined. (NRS 422.390) “Disproportionate share payment” means a payment made pursuant to 42 U.S.C. § 1396r-4.

(Added to NAC by Div. of Health Care Fin. & Policy by R086-13, eff. 12-22-2014)

NAC 422.035 “Division” defined. (NRS 422.390) “Division” means the Division of Health Care Financing and Policy of the Department of Health and Human Services.

(Added to NAC by Div. of Health Care Fin. & Policy by R033-10, eff. 6-30-2010)

NAC 422.055 “Pool of hospitals” defined. (NRS 422.390) “Pool of hospitals” means a group of hospitals designated in a particular pool pursuant to subsection 1 of NAC 422.115.

(Added to NAC by Div. of Health Care Fin. & Policy by R033-10, eff. 6-30-2010)

NAC 422.065 “Public hospital” defined. (NRS 422.390) “Public hospital” means:

1. A hospital owned or operated by this State or a political subdivision of this State, including, without limitation, a hospital district; or

2. A hospital that is supported in whole or in part by tax revenue collected in this State, other than tax revenue received by a hospital for medical care which is provided to Medicaid patients, indigent patients or other low-income patients.

(Added to NAC by Div. of Health Care Fin. & Policy by R033-10, eff. 6-30-2010; A by R086-13, 12-22-2014)

NAC 422.075 “Uncompensated care costs” defined. (NRS 422.390) “Uncompensated care costs” means the total annual uncompensated care costs as defined in 42 C.F.R. § 447.299(c)(16).

(Added to NAC by Div. of Health Care Fin. & Policy by R033-10, eff. 6-30-2010)

NAC 422.085 Certain hospitals required to submit to Division certain information annually. (NRS 422.390)

1. On or before the dates prescribed by the Division pursuant to subsection 2:

(a) Each hospital that is not solely a psychiatric hospital or other type of mental health facility shall complete and submit to the Division annually:

(1) A survey prescribed by the Division concerning obstetric services provided by the hospital; and

(2) A form prescribed by the Division concerning the Medicaid inpatient utilization rate of the hospital.

(b) Each hospital that qualifies as a disproportionate share hospital pursuant to 42 U.S.C. § 1396r-4 shall complete and submit to the Division annually:

(1) A form prescribed by the Division concerning the low-income utilization rate of the hospital; and

(2) A report of the uncompensated care costs of the hospital.

2. The Division will notify each hospital of the date on which the hospital must submit the documents required pursuant to subsection 1.

3. As used in this section:

(a) “Low-income utilization rate” has the meaning ascribed to it in 42 U.S.C. § 1396r-4(b)(3).

(b) “Medicaid inpatient utilization rate” has the meaning ascribed to it in 42 U.S.C. § 1396r-4(b)(2).

(Added to NAC by Div. of Health Care Fin. & Policy by R086-13, eff. 12-22-2014)

PAYMENTS TO CERTAIN HOSPITALS FOR TREATMENT OF INDIGENT PATIENTS

NAC 422.105 Intergovernmental transfers of money from certain counties to Division; discharge of duty to provide medical treatment for indigent inpatients in certain circumstances; money remitted to State Controller to be credited toward transfer to Division. (NRS 422.390)

1. In a county whose population is 100,000 or more within which a public hospital is located, the State or political subdivision responsible for the public hospital shall transfer to the Division an amount equal to:

(a) Seventy percent of the total amount of disproportionate share payments distributed to all hospitals pursuant to this chapter and NRS 422.380 to 422.390, inclusive, for the current fiscal year, less $1,050,000; or

(b) Sixty-eight and fifty-four one hundredths percent of the total amount of disproportionate share payments distributed to all hospitals pursuant to this chapter and NRS 422.380 to 422.390, inclusive, for the current fiscal year,

Ê whichever is less.

2. In a county whose population is 100,000 or more within which a private hospital which receives a disproportionate share payment pursuant to paragraph (c) of subsection 1 of NAC 422.115 is located, the county shall transfer to the Division 1.95 percent of the total amount of disproportionate share payments distributed to all hospitals pursuant to this chapter and NRS 422.380 to 422.390, inclusive, for the current fiscal year, but not more than $1,500,000.

3. If a county transfers to the Division the amount required pursuant to subsection 2, the county is discharged of the duty and is released from liability for providing medical treatment for indigent inpatients who are treated in the hospital in the county that receives a payment pursuant to paragraph (c) of subsection 1 of NAC 422.115.

4. The amount remitted by the board of county commissioners of a county to the State Controller pursuant to subsection 3 of NRS 428.285 will be credited toward any amount which the State or political subdivision of this State, as applicable, is required to transfer to the Division pursuant to subsection 1 or 2 of this section.

(Added to NAC by Div. of Health Care Fin. & Policy by R033-10, eff. 6-30-2010; A by R086-13, 12-22-2014)

NAC 422.115 Designation of pools of hospitals and distribution of disproportionate share payments to each pool; requirements; limitations; calculation of total computable payments. (NRS 422.390)

1. Except as otherwise provided in subsection 2, the Division will initially distribute for:

(a) Pool A, which consists of all public hospitals in counties whose population is 700,000 or more, total annual disproportionate share payments in the amount of 87.97 percent of the total computable disproportionate share hospital supplemental payments for the fiscal year;

(b) Pool B, which consists of all private hospitals in counties whose population is 700,000 or more, total annual disproportionate share payments in the amount of 1.69 percent of the total computable disproportionate share hospital supplemental payments for the fiscal year;

(c) Pool C, which consists of all private hospitals in counties whose population is 100,000 or more but less than 700,000, total annual disproportionate share payments in the amount of 5.86 percent of the total computable disproportionate share hospital supplemental payments for the fiscal year;

(d) Pool D, which consists of all public hospitals in counties whose population is less than 100,000, total annual disproportionate share payments in the amount of 1.34 percent of the total computable disproportionate share hospital supplemental payments for the fiscal year; and

(e) Pool E, which consists of all private hospitals in counties whose population is less than 100,000, total annual disproportionate share payments in the amount of 3.14 percent of the total computable disproportionate share supplemental payments for the fiscal year.

2. A hospital may not receive a disproportionate share payment unless the hospital meets all the requirements:

(a) Established by federal and state statutes and regulations; and

(b) As prescribed in the State Plan for Medicaid.

3. A hospital is not entitled to receive a disproportionate share payment that is greater than the amount of its uncompensated care costs.

4. The Division will calculate the total computable disproportionate share supplemental payments by dividing the amount allocated to this State pursuant to 42 U.S.C. § 1396r-4(f) by the federal medical assistance percentage for the current year determined pursuant to 42 U.S.C. § 1396d(b).

(Added to NAC by Div. of Health Care Fin. & Policy by R033-10, eff. 6-30-2010; A by R086-13, 12-22-2014)

NAC 422.135 Percentage of initial distribution of disproportionate share payments. (NRS 422.390)

1. The Division will distribute disproportionate share payments as follows:

(a) Fifty percent of the amount allocated to a pool pursuant to NAC 422.115 will be distributed among hospitals in that pool in an amount corresponding to the uncompensated care percentage of the hospital, which is determined by dividing uncompensated care costs of the hospital by the net patient revenues of the hospital. The net patient revenues of a hospital will be determined by subtracting any contracted allowances and discounts reported on the Medicare Cost Report filed by the hospital pursuant to subsection 1 of NAC 439B.230 from the total patient revenues of the hospital.

(b) Fifty percent of the amount allocated to a pool pursuant to NAC 422.115 will be distributed among hospitals in that pool in an amount corresponding to the percentage of total uncompensated care costs of each hospital, which is determined by dividing the uncompensated care costs of a hospital by the aggregate total uncompensated care costs of all hospitals within the pool of hospitals in which the hospital is placed pursuant to NAC 422.115.

2. The Division will make an initial distribution of disproportionate share payments to a hospital in an amount determined in the manner described in subsection 1 and using the data reported on the Medicare Cost Report filed by the hospital pursuant to subsection 1 of NAC 439B.230.

(Added to NAC by Div. of Health Care Fin. & Policy by R033-10, eff. 6-30-2010; A by R086-13, 12-22-2014)

NAC 422.145 Audit of hospitals required. (NRS 422.390) The Division will audit each hospital for each year in which the hospital received a disproportionate share payment pursuant to this chapter and NRS 422.380 to 422.390, inclusive. The audit must be conducted in accordance with the provisions of Title XIX of the Social Security Act, 42 U.S.C. §§ 1396 et seq., and the regulations adopted pursuant to those provisions.

(Added to NAC by Div. of Health Care Fin. & Policy by R033-10, eff. 6-30-2010)

NAC 422.155 Recalculation after audit; final distribution; notification; recovery and redistribution of payments. (NRS 422.390)

1. If the Division determines, based on an audit conducted pursuant to NAC 422.145, that a hospital’s initial disproportionate share payment exceeds the amount that the hospital was entitled to receive, the Division will recalculate, based upon the results of the audit, for each hospital in the affected pool, the:

(a) Uncompensated care costs;

(b) Uncompensated care percentages, determined in the manner described in paragraph (a) of subsection 1 of NAC 422.135; and

(c) Final disproportionate share payments using the amounts recalculated pursuant to paragraphs (a) and (b) and determined in the manner described in NAC 422.135.

2. A hospital may receive as a final distribution of disproportionate share payments for a fiscal year an amount equal to:

(a) The uncompensated care costs calculated pursuant to paragraph (a) of subsection 1; or

(b) The final disproportionate share payment for the hospital calculated pursuant to paragraph (c) of subsection 1,

Ê whichever is less.

3. For each pool that includes a hospital for which the Division has determined pursuant to subsection 1 that the initial disproportionate share payment exceeded the amount that the hospital was entitled to receive, the Division will notify each hospital in the pool whether the final distribution payment calculated pursuant to subsection 2 is less than or greater than the amount of the initial distribution of disproportionate share payments received by the hospital pursuant to NAC 422.135. If the amount of the final distribution payment calculated pursuant to subsection 2 is:

(a) Less than the amount of the initial distribution of disproportionate share payments received by the hospital, the hospital shall return to the Division the difference between the amount of the initial distribution and the amount of the final distribution not later than 90 days after the date on which the hospital receives written notification of the overpayment.

(b) Greater than the amount of the initial distribution of disproportionate share payments received by the hospital, the Division will pay to the hospital the difference between the amount of the final distribution payment and the initial distribution.

4. If each hospital within a pool of hospitals has received the maximum amount of disproportionate share payments allowable by federal and state statutes and regulations, the Division will use the money returned pursuant to paragraph (a) of subsection 3 to pay additional disproportionate share payments as follows:

(a) If the money was returned by a hospital that is a member of Pool A, to hospitals in Pool B;

(b) If the money was returned by a hospital that is a member of Pool B, to hospitals in Pool C;

(d) If the money was returned by a hospital that is a member of Pool D, to hospitals in Pool E; or

(e) If the money was returned by a hospital that is a member of Pool E, to hospitals in Pool D.

(Added to NAC by Div. of Health Care Fin. & Policy by R033-10, eff. 6-30-2010; A by R086-13, 12-22-2014)

NAC 422.165 Transfer of money to certain public hospitals. (NRS 422.390) To the extent that money is available from the amount transferred to the Division pursuant to NAC 422.105, the Division will distribute $50,000 from that amount each fiscal year to each public hospital which:

1. Is located in a county that does not have any other hospital; and

2. Is not eligible for a disproportionate share payment pursuant to this chapter.

(Added to NAC by Div. of Health Care Fin. & Policy by R033-10, eff. 6-30-2010)