ASSEMBLY ACTION Initial and Date |SENATE ACTION Initial and Date
Adopted Lost | Adopted Lost
Concurred In Not
|Concurred In Not
Receded Not | Receded Not
Amend the bill as a whole by renumbering sections 1 and 2 as sections 2 and 3 and adding a new section designated section 1, following the enacting clause, to read as follows:
“Section 1. The Legislature hereby finds and declares that:
1. Federal law concerning payments made pursuant to 42 U.S.C. § 1396r-4, otherwise known as “disproportionate share payments,” are a critical source of income for hospitals, particularly public hospitals.
2. To ensure that certain hospitals can depend upon the revenue from this source, the Legislature has periodically established base payments to the hospitals in a fiscal year.
3. Because of the unique geographic, financial and organizational characteristics of these hospitals, a general law establishing base disproportionate share payments cannot be made applicable.”.
Amend sec. 2, page 2, line 14, by deleting “Sixty-seven” and inserting:
“Sixty-eight and fifty-four one hundredths”.
Amend sec. 2, page 2, line 21, by deleting “(c)” and inserting “(d)”.
Amend sec. 2, page 3, line 1, by deleting “(c)” and inserting “(d)”.
Amend the bill as a whole by renumbering sections 3 and 4 as sections 5 and 6 and adding a new section designated sec. 4, following sec. 2, to read as follows:
“Sec. 4. NRS 422.382 is hereby amended to read as follows:
NEW
PARALLEL SECTION
422.382 1. In
a county whose population is 100,000 or more within which:
(a) A public hospital is located, the state or local government or other entity responsible for the public hospital shall transfer an amount equal to:
(1) Seventypercent of the total amount of disproportionate share paymentsdistributed to all hospitalspursuant to NRS 422.387 for a fiscal year, less $1,050,000; or
(2) Sixty-eight and fifty-four one hundredths percent of the total amount of disproportionate share payments distributed to all hospitals pursuant to NRS 422.387 for a fiscal year,
whichever is less,to the Division of Health Care Financing and Policy.
(b) A private hospital which receives a disproportionate share payment pursuant to paragraph [(d)] (c) of subsection 2 of NRS 422.387 is located, the county shall transfer1.95 percent of the total amount of disproportionate share payments distributed to all hospitals pursuant to NRS 422.387 for a fiscal year, but not more than $1,500,000,to the Division of Health Care Financing and Policy.
2. A county that transfers the amount required pursuant to paragraph (b) of subsection 1 to the Division of Health Care Financing and Policy 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 [(d)] (c) of subsection 2 of NRS 422.387.
3. The money transferred to the Division of Health Care Financing and Policy pursuant to subsection 1 must not come from any source of funding that could result in any reduction in revenue to the State pursuant to 42 U.S.C. § 1396b(w).
4. Any money collected pursuant to subsection 1, including any interest or penalties imposed for a delinquent payment, must be deposited in the State Treasury for credit to the Intergovernmental Transfer Account in the State General Fund to be administered by the Division of Health Care Financing and Policy.
5. The interest and income earned on money in the Intergovernmental Transfer Account, after deducting any applicable charges, must be credited to the Account.”.
Amend sec. 3, page 3, line 17, by deleting “4,” and inserting “5,”.
Amend sec. 3, page 3, line 21, by deleting “5” and inserting “6”.
Amend sec. 3, page 3, line 32, by deleting “5” and inserting “6”.
Amend sec. 4, page 4, by deleting lines 32 through 36 and inserting:
“(b) The private hospital with the highest uncompensated care percentage in each county whose population is 400,000 or more, the total annual disproportionate share payments are $1,000,000 plus 2.1 percent of the total amount of disproportionate share payments distributed by the State in that fiscal year that exceeds $76,000,000;
(c) All private hospitals in counties whose population is 400,000 or more other than the hospitals described in paragraph (b), the total annual disproportionate share payments are $200,000 plus 0.4 percent of the total amount of disproportionate share payments distributed by the State in that fiscal year that exceeds $76,000,000;”.
Amend sec. 4, page 4, line 37, by deleting “(c)” and inserting “(d)”.
Amend sec. 4, page 4, line 42, by deleting “(d)” and inserting “(e)”.
Amend sec. 4, page 5, line 3, by deleting “(e)” and inserting “(f)”.
Amend sec. 4, page 5, by deleting lines 9 and 10 and inserting:
“payment in an amount determined pursuant to subsections 4 and 5. Any amount set forth in each”.
Amend sec. 4, page 5, line 31, after “4.” by inserting:
“Except as otherwise provided in subsection 5, the base payments for the purposes of subsection 3 are:
(a) For the University Medical Center of Southern Nevada, $66,531,729;
(b) For Washoe Medical Center, $4,800,000;
(c) For Carson-Tahoe Hospital, $1,000,000;
(d) For Northeastern Nevada Regional Hospital, $500,000;
(e) For Churchill Community Hospital, $500,000;
(f) For Humboldt General Hospital, $215,109;
(g) For William Bee Ririe Hospital, $204,001;
(h) For Mt. Grant General Hospital, $195,838;
(i) For South Lyon Medical Center, $174,417;
(j) For Nye Regional Medical Center, $115,000; and
(k) For Sunrise Hospital and Medical Center, $200,000,
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or the successors in
interest to such hospitals.
5.”.
Amend sec. 4, page 5, line 39, by deleting “law; and” and inserting:
“law. If the amount available to hospitals in a group described in a paragraph of subsection 2 is less than the total amount of base payments specified in subsection 4, the Administrator shall reduce the base payments proportionally in accordance with the limits of federal law.”.
Amend sec. 4, page 5, line 42, by deleting “5.” and inserting “6.”.
Amend sec. 4, page 6, line 4, by deleting:
“2 and 3.” and inserting:
“2, 3 and 4.”.
Amend sec. 4, page 6, line 5, by deleting “6.” and inserting “7.”.
Amend the bill as a whole by renumbering sections 5 through 7 as sections 8 through 10 and adding a new section designated sec. 7, following sec. 4, to read as follows:
“Sec. 7. NRS 422.387 is hereby amended to read as follows:
NEW PARALLEL SECTION
422.387 1. Before making the payments required or authorized by this section,
the Division of Health Care Financing and Policy shall allocate money for the
administrative costs necessary to carry out the provisions of NRS 422.380 to
422.390, inclusive. The amount allocated for administrative costs must not
exceed the amount authorized for expenditure by the Legislature for this
purpose in a fiscal year. The Interim Finance Committee may adjust the amount
allowed for administrative costs.
2. The State Plan for Medicaid must provide for the payment of the maximum amount of disproportionate share payments allowable under federal law and regulations. The State Plan for Medicaid must provide that for:
(a) All public hospitals in counties whose population is 400,000 or more, the total annual disproportionate share payments are $66,650,000 plus 90 percent of the total amount of disproportionate share payments distributed by the State in that fiscal year that exceeds $76,000,000;
(b) [The private hospital with the highest uncompensated care percentage in each county whose population is 400,000 or more, the total annual disproportionate share payments are $1,000,000 plus 2.1 percent of the total amount of disproportionate share payments distributed by the State in that fiscal year that exceeds $76,000,000;
(c)] All private hospitals in counties whose population is 400,000 or more , [other than the hospitals described in paragraph (b),] the total annual disproportionate share payments are [$200,000 plus 0.4] $1,200,000 plus 2.5 percent of the total amount of disproportionate share payments distributed by the State in that fiscal year that exceeds $76,000,000;
[(d)] (c) All private hospitals in counties whose population is 100,000 or more but less than 400,000, the total annual disproportionate share payments are $4,800,000 plus 2.5 percent of the total amount of disproportionate share payments distributed by the State in that fiscal year that exceeds $76,000,000;
[(e)] (d) All public hospitals in counties whose population is less than 100,000, the total annual disproportionate share payments are $900,000 plus 2.5 percent of the total amount of disproportionate share payments distributed by the State in that fiscal year that exceeds $76,000,000; and
[(f)] (e) All private hospitals in counties whose population is less than 100,000, the total annual disproportionate share payments are $2,450,000 plus 2.5 percent of the total amount of disproportionate share payments distributed by the State in that fiscal year that exceeds $76,000,000.
3. The State Plan for Medicaid must provide for a base payment in an amount determined pursuant to subsections 4 and 5. Any amount set forth in each paragraph of subsection 2 that remains after all base payments have been distributed must be distributed to the hospital within that paragraph with the highest uncompensated care percentage in an amount equal to either the amount remaining after all base payments have been distributed or the amount necessary to reduce the uncompensated care percentage of that hospital to the uncompensated care percentage of the hospital in that paragraph with the second highest uncompensated care percentage, whichever is less. Any amount set forth in subsection 2 that remains after the uncompensated care percentage of the hospital with the highest uncompensated care percentage in a paragraph has been reduced to equal the uncompensated care percentage of the hospital in that paragraph with the second highest uncompensated care percentage must be distributed equally to the two hospitals with the highest uncompensated care percentage in that paragraph until their uncompensated care percentages are equal to the uncompensated care percentage of the hospital with the third highest uncompensated care percentage in that paragraph. This process must be repeated until all available funds set forth in a paragraph of subsection 2 have been distributed.
4. Except as otherwise provided in subsection 5, the base payments for the purposes of subsection 3 are:
(a) For the University Medical Center of Southern Nevada, $66,531,729;
(b) For Washoe Medical Center, $4,800,000;
(c) For Carson-Tahoe Hospital, $1,000,000;
(d) For Northeastern Nevada Regional Hospital, $500,000;
(e) For Churchill Community Hospital, $500,000;
(f) For Humboldt General Hospital, $215,109;
(g) For William Bee Ririe Hospital, $204,001;
(h) For Mt. Grant General Hospital, $195,838;
(i) For South Lyon Medical Center, $174,417;
(j) For Nye Regional Medical Center, $115,000; and
(k) For Sunrise Hospital and Medical Center, [$200,000,] one-sixth of the total amount distributed in the respective fiscal year to the group described in the paragraph of subsection 2 of which Sunrise Hospital and Medical Center is a member,
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or the successors in interest to such hospitals.
5. The Plan must be consistent with the provisions of NRS 422.380 to 422.390, inclusive, and Title XIX of the Social Security Act, 42 U.S.C. §§ 1396 et seq., and the regulations adopted pursuant to those provisions. If the total amount available to the State for making disproportionate share payments is less than $76,000,000, the Administrator:
(a) Shall adjust the amounts for each group of hospitals described in a paragraph of subsection 2 proportionally in accordance with the limits of federal law. If the amount available to hospitals in a group described in a paragraph of subsection 2 is less than the total amount of base payments specified in subsection 4, the Administrator shall reduce the base payments proportionally in accordance with the limits of federal law.
(b) Shall adopt a regulation specifying the amount of the reductions required by paragraph (a).
6. To the extent that money is available in the Intergovernmental Transfer Account, the Division of Health Care Financing and Policy shall distribute $50,000 from that Account each fiscal year to each public hospital which:
(a) Is located in a county that does not have any other hospitals; and
(b) Is not eligible for a payment pursuant to subsections 2, 3 and 4.
7. As used in this section:
(a) “Total revenue” is the amount of revenue a hospital receives for patient care and other services, net of any contractual allowances or bad debts.
(b) “Uncompensated care costs” means the total costs of a hospital incurred in providing care to uninsured patients, including, without limitation, patients covered by Medicaid or another governmental program for indigent patients, less any payments received by the hospital for that care.
(c) “Uncompensated care percentage” means the uncompensated care costs of a hospital divided by the total revenue for the hospital.”.
Amend sec. 6, page 7, by deleting lines 1 through 30 and inserting:
“Sec. 9. 1. There is hereby appropriated from the State General Fund to the Medicaid Budget Account in the State General Fund:
For the Fiscal Year 2003-2004........................................................................................ $350,000
For the Fiscal Year 2004-2005........................................................................................ $350,000
2. Any balance of the appropriation made by subsection 1 remaining at the end of the respective fiscal years must not be committed for expenditure after June 30 of the respective fiscal years and reverts to the State General Fund as soon as all payments of money committed have been made.
3. The Division of Health Care Financing and Policy of the Department of Human Resources shall distribute $350,000 during Fiscal Year 2003-2004 and $350,000 during Fiscal Year 2004-2005, proportionally to each hospital described in paragraph (c) of subsection 2 of NRS 422.387 whose annual disproportionate share payment was reduced by at least 40 percent between Fiscal Year 2002-2003 and Fiscal Year 2003-2004.”.
Amend sec. 7, page 7, line 31, by deleting:
“This act becomes” and inserting:
“1. This section and sections 1, 2, 3, 5, 6, 8 and 9 of this act become”.
Amend sec. 7, page 7, after line 33, by inserting:
“2. Sections 4 and 7 of this act become effective on July 1, 2005.”.
Amend the title of the bill, fifth line, after “patients;” by inserting:
“making an appropriation;”.