NV
Nevada Senate Bill SB435

Nevada 2023 Regular Session

Nevada Senate Bill SB435 Compare Versions

OldNewDifferences
1+ EXEMPT
2+ (Reprinted with amendments adopted on June 1, 2023)
3+ SECOND REPRINT S.B. 435
14
2-
3-- 82nd Session (2023)
5+- *SB435_R2*
46
57 SENATE BILL NO. 435–COMMITTEE ON
68 HEALTH AND HUMAN SERVICES
79
8-CHAPTER..........
10+(ON BEHALF OF THE OFFICE OF FINANCE
11+IN THE OFFICE OF THE GOVERNOR)
12+
13+MARCH 27, 2023
14+____________
15+
16+Referred to Committee on Health and Human Services
17+
18+SUMMARY—Revises provisions relating to Medicaid.
19+(BDR 38-1069)
20+
21+FISCAL NOTE: Effect on Local Government: No.
22+ Effect on the State: Yes.
23+
24+~
25+
26+EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.
27+
928
1029 AN ACT relating to Medicaid; requiring the provision of certain
1130 information to the operator of a hospital or rural hospital
12-concerning the use of revenue generated by certain proposed
13-assessments; prohibiting the continued imposition of such an
14-assessment under certain circumstances; revising the
15-authorized uses of the revenue generated from an assessment
16-authorized to be imposed on operators of certain agencies and
17-facilities; and providing other matters properly relating
18-thereto.
31+concerning the use of revenue generated by certain
32+proposed assessments; prohibiting the continued
33+imposition of such an assessment under certain
34+circumstances; revising the authorized uses of the revenue
35+generated from an assessment authorized to be imposed
36+on operators of certain agencies and facilities; and
37+providing other matters properly relating thereto.
1938 Legislative Counsel’s Digest:
20- Existing law authorizes the Division of Health Care Financing and Policy of the
21-Department of Health and Human Services to impose an assessment on each
22-operator of an agency to provide personal care services in the home and each
23-operator of a medical facility that is required to obtain a license if, after polling the
24-operators, at least 67 percent of those operators vote in favor of the assessment.
25-(NRS 422.3794) Existing law authorizes the expenditure of the money generated
26-from such an assessment only to: (1) provide supplemental payments or enhanced
27-rates of reimbursement under Medicaid to operators upon whom the assessment is
28-imposed; and (2) administer provisions of law governing such assessments. (NRS
29-422.37945) Section 2 of this bill authorizes the money to also be used to provide
30-supplemental payments or enhanced rates of reimbursement to operators that are
31-not subject to the assessment if such expenditure was identified as a potential use of
32-the assessment in the polling of operators which received an affirmative vote from
33-at least 67 percent of the operators on whom the assessment was to be imposed.
34-Section 2 additionally authorizes the Division to use money generated from an
35-assessment imposed on private hospitals or rural hospitals to provide additional
36-supports and services under Medicaid for recipients of Medicaid with serious
37-behavioral health conditions. Section 2 provides that not more than 15 percent of
38-the total amount of money generated each year by such an assessment may be used
39-for administrative costs and to fund such supports and services. Section 1.8 of this
40-bill requires the Division to provide each operator of a hospital or rural hospital
41-who is polled concerning the imposition of such an assessment of the amount of the
42-assessment that will be used for those purposes. Section 1.8 also prohibits the
43-continued imposition of such an assessment where state or federal law or
44-regulations prohibit or alter the authorized uses of the revenue generated by the
45-assessment. Sections 1.2 and 1.4 of this bill define the terms “hospital” and “rural
46-hospital,” respectively. Section 1.6 of this bill makes conforming changes to
47-indicate the proper placement of sections 1.2 and 1.4 in the Nevada Revised
48-Statutes.
49-
50-
51-
52-
53-
54-
39+ Existing law authorizes the Division of Health Care Financing and Policy of the 1
40+Department of Health and Human Services to impose an assessment on each 2
41+operator of an agency to provide personal care services in the home and each 3
42+operator of a medical facility that is required to obtain a license if, after polling the 4
43+operators, at least 67 percent of those operators vote in favor of the assessment. 5
44+(NRS 422.3794) Existing law authorizes the expenditure of the money generated 6
45+from such an assessment only to: (1) provide supplemental payments or enhanced 7
46+rates of reimbursement under Medicaid to operators upon whom the assessment is 8
47+imposed; and (2) administer provisions of law governing such assessments. (NRS 9
48+422.37945) Section 2 of this bill authorizes the money to also be used to provide 10
49+supplemental payments or enhanced rates of reimbursement to operators that are 11
50+not subject to the assessment if such expenditure was identified as a potential use of 12
51+the assessment in the polling of operators which received an affirmative vote from 13
52+at least 67 percent of the operators on whom the assessment was to be imposed. 14
5553 – 2 –
5654
5755
58-- 82nd Session (2023)
59-EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.
56+- *SB435_R2*
57+Section 2 additionally authorizes the Division to use money generated from an 15
58+assessment imposed on private hospitals or rural hospitals to provide additional 16
59+supports and services under Medicaid for recipients of Medicaid with serious 17
60+behavioral health conditions. Section 2 provides that not more than 15 percent of 18
61+the total amount of money generated each year by such an assessment may be used 19
62+for administrative costs and to fund such supports and services. Section 1.8 of this 20
63+bill requires the Division to provide each operator of a hospital or rural hospital 21
64+who is polled concerning the imposition of such an assessment of the amount of the 22
65+assessment that will be used for those purposes. Section 1.8 also prohibits the 23
66+continued imposition of such an assessment where state or federal law or 24
67+regulations prohibit or alter the authorized uses of the revenue generated by the 25
68+assessment. Sections 1.2 and 1.4 of this bill define the terms “hospital” and “rural 26
69+hospital,” respectively. Section 1.6 of this bill makes conforming changes to 27
70+indicate the proper placement of sections 1.2 and 1.4 in the Nevada Revised 28
71+Statutes. 29
6072
6173
6274 THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
6375 SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
6476
65- Section 1. Chapter 422 of NRS is hereby amended by adding
66-thereto the provisions set forth as sections 1.2 and 1.4 of this act.
67- Sec. 1.2. “Hospital” has the meaning ascribed to it in
68-NRS 449.012.
69- Sec. 1.4. “Rural hospital” has the meaning ascribed to it in
70-NRS 449.0177.
71- Sec. 1.6. NRS 422.3791 is hereby amended to read as follows:
72- 422.3791 As used in NRS 422.3791 to 422.3795, inclusive,
73-and section 1.2 and 1.4 of this act, unless the context otherwise
74-requires, the words and terms defined in NRS 422.37915 to
75-422.37935, inclusive, and sections 1.2 and 1.4 of this act have the
76-meanings ascribed to them in those sections.
77- Sec. 1.8. NRS 422.3794 is hereby amended to read as follows:
78- 422.3794 1. Except as otherwise provided in this section,
79-after polling the operators in an operator group and receiving an
80-affirmative vote from at least 67 percent of the operators in that
81-operator group, the Division may impose by regulation, against each
82-operator in the operator group, an assessment in an amount equal to
83-a percentage of the net revenue generated by the agency to provide
84-personal care services in the home or medical facility, as applicable,
85-from providing care in this State during a calendar or fiscal year.
86-The Division shall adopt:
87- (a) Regulations prescribing the percentage that must be used to
88-calculate the amount of the assessment, the date on which the
89-assessment is due and the manner in which the assessment must be
90-paid; and
91- (b) Any other regulations necessary or convenient to carry out
92-the provisions of this section.
93- 2. Before polling the operator of a hospital or a rural hospital
94-pursuant to subsection 1, the Division shall provide the operator a
95-statement of the amount of the revenue generated by the proposed
96-assessment that will be used for the purposes prescribed by
97-paragraphs (c) and (d) of subsection 3 of NRS 422.37945.
98- 3. The revenue from an assessment imposed pursuant to
99-subsection 1 must be deposited in the Account.
100- [3.] 4. An assessment imposed pursuant to subsection 1 must
101-comply with the provisions of 42 C.F.R. § 433.68. The revenue
102-generated by such an assessment must be used only for the
77+ Section 1. Chapter 422 of NRS is hereby amended by adding 1
78+thereto the provisions set forth as sections 1.2 and 1.4 of this act. 2
79+ Sec. 1.2. “Hospital” has the meaning ascribed to it in 3
80+NRS 449.012. 4
81+ Sec. 1.4. “Rural hospital” has the meaning ascribed to it in 5
82+NRS 449.0177. 6
83+ Sec. 1.6. NRS 422.3791 is hereby amended to read as follows: 7
84+ 422.3791 As used in NRS 422.3791 to 422.3795, inclusive, 8
85+and section 1.2 and 1.4 of this act, unless the context otherwise 9
86+requires, the words and terms defined in NRS 422.37915 to 10
87+422.37935, inclusive, and sections 1.2 and 1.4 of this act have the 11
88+meanings ascribed to them in those sections. 12
89+ Sec. 1.8. NRS 422.3794 is hereby amended to read as follows: 13
90+ 422.3794 1. Except as otherwise provided in this section, 14
91+after polling the operators in an operator group and receiving an 15
92+affirmative vote from at least 67 percent of the operators in that 16
93+operator group, the Division may impose by regulation, against each 17
94+operator in the operator group, an assessment in an amount equal to 18
95+a percentage of the net revenue generated by the agency to provide 19
96+personal care services in the home or medical facility, as applicable, 20
97+from providing care in this State during a calendar or fiscal year. 21
98+The Division shall adopt: 22
99+ (a) Regulations prescribing the percentage that must be used to 23
100+calculate the amount of the assessment, the date on which the 24
101+assessment is due and the manner in which the assessment must be 25
102+paid; and 26
103+ (b) Any other regulations necessary or convenient to carry out 27
104+the provisions of this section. 28
103105 – 3 –
104106
105107
106-- 82nd Session (2023)
107-purposes authorized by NRS 422.37945. An assessment must not
108-be imposed pursuant to subsection 1 if state or federal law or
109-regulations prohibit [using] or alter the use of the revenue generated
110-by the assessment for the purposes prescribed in NRS 422.37945. If
111-new state or federal law or regulations imposing such a prohibition
112-or making such an alteration are enacted or adopted, as applicable:
113- (a) An assessment must not be collected after the effective date
114-of the law or regulations; and
115- (b) Any money collected during the calendar or fiscal year, as
116-applicable, in which the [federal] law or regulations become
117-effective must be returned to the operators from whom it was
118-collected.
119- [4.] 5. An operator shall submit to the Division any
120-information requested by the Division for the purposes of carrying
121-out the provisions of this section.
122- Sec. 2. NRS 422.37945 is hereby amended to read as follows:
123- 422.37945 1. The Account to Improve Health Care Quality
124-and Access is hereby created in the State General Fund. The
125-Division shall administer the Account. The revenue from
126-assessments and penalties imposed on the operators in each operator
127-group must be accounted for separately in the Account.
128- 2. The interest and income on the money in the Account, after
129-deducting any applicable charges, must be credited to the Account.
130- 3. [The] Subject to the provisions of subsections 4 and 5,
131-money in the Account must be expended to:
132- (a) Provide supplemental payments or enhanced rates of
133-reimbursement to operators [in the operator group upon whom an
134-assessment was imposed] pursuant to an upper payment limit
135-program established under the provisions of 42 C.F.R. § 447.272 or
136-447.321;
137- (b) Provide supplemental payments to operators [in the operator
138-group upon whom an assessment was imposed] who provide care to
139-recipients of Medicaid in addition to the reimbursements those
140-operators would otherwise receive for providing such care; [and]
141- (c) Administer the provisions of NRS 422.3791 to 422.3795,
142-inclusive [.
143- 4.] ; and
144- (d) For money generated by an assessment imposed against
145-the operators of private hospitals or private rural hospitals, fund
146-additional supports and services under Medicaid, as approved by
147-the Director, to improve access to behavioral health care for
148-recipients of Medicaid with serious behavioral health conditions,
149-including, without limitation, psychiatric disorders, in order to
108+- *SB435_R2*
109+ 2. Before polling the operator of a hospital or a rural hospital 1
110+pursuant to subsection 1, the Division shall provide the operator a 2
111+statement of the amount of the revenue generated by the proposed 3
112+assessment that will be used for the purposes prescribed by 4
113+paragraphs (c) and (d) of subsection 3 of NRS 422.37945. 5
114+ 3. The revenue from an assessment imposed pursuant to 6
115+subsection 1 must be deposited in the Account. 7
116+ [3.] 4. An assessment imposed pursuant to subsection 1 must 8
117+comply with the provisions of 42 C.F.R. § 433.68. The revenue 9
118+generated by such an assessment must be used only for the 10
119+purposes authorized by NRS 422.37945. An assessment must not 11
120+be imposed pursuant to subsection 1 if state or federal law or 12
121+regulations prohibit [using] or alter the use of the revenue generated 13
122+by the assessment for the purposes prescribed in NRS 422.37945. If 14
123+new state or federal law or regulations imposing such a prohibition 15
124+or making such an alteration are enacted or adopted, as applicable: 16
125+ (a) An assessment must not be collected after the effective date 17
126+of the law or regulations; and 18
127+ (b) Any money collected during the calendar or fiscal year, as 19
128+applicable, in which the [federal] law or regulations become 20
129+effective must be returned to the operators from whom it was 21
130+collected. 22
131+ [4.] 5. An operator shall submit to the Division any 23
132+information requested by the Division for the purposes of carrying 24
133+out the provisions of this section. 25
134+ Sec. 2. NRS 422.37945 is hereby amended to read as follows: 26
135+ 422.37945 1. The Account to Improve Health Care Quality 27
136+and Access is hereby created in the State General Fund. The 28
137+Division shall administer the Account. The revenue from 29
138+assessments and penalties imposed on the operators in each operator 30
139+group must be accounted for separately in the Account. 31
140+ 2. The interest and income on the money in the Account, after 32
141+deducting any applicable charges, must be credited to the Account. 33
142+ 3. [The] Subject to the provisions of subsections 4 and 5, 34
143+money in the Account must be expended to: 35
144+ (a) Provide supplemental payments or enhanced rates of 36
145+reimbursement to operators [in the operator group upon whom an 37
146+assessment was imposed] pursuant to an upper payment limit 38
147+program established under the provisions of 42 C.F.R. § 447.272 or 39
148+447.321; 40
149+ (b) Provide supplemental payments to operators [in the operator 41
150+group upon whom an assessment was imposed] who provide care to 42
151+recipients of Medicaid in addition to the reimbursements those 43
152+operators would otherwise receive for providing such care; [and] 44
150153 – 4 –
151154
152155
153-- 82nd Session (2023)
154-reduce the burden imposed by such recipients on the emergency
155-medical services and inpatient services of the hospitals in this
156-State.
157- 4. Not more than 15 percent of the total amount of money
158-generated each year by assessments against the operators of
159-private hospitals or private rural hospitals may be expended for
160-the purposes described in paragraphs (c) and (d) of subsection 3.
161-Money allocated for such expenditures must be used first for the
162-purpose described in paragraph (c) of subsection 3. If money
163-allocated for such expenditures remains after all necessary
164-expenditures are made for that purpose, the Division shall expend
165-the remaining money for the purpose described in paragraph (d)
166-of subsection 3.
167- 5. Money in the Account that was generated by a specific
168-assessment must not be expended to provide supplemental
169-payments or enhanced rates of reimbursement pursuant to
170-subsection 3 to operators in an operator group that is not subject
171-to the assessment unless such expenditure was identified as a
172-potential use of revenue when the assessment received an
173-affirmative vote of at least 67 percent of the operators in the
174-operator group subject to the assessment pursuant to subsection 1
175-of NRS 422.3794.
176- 6. Any money remaining in the Account at the end of a fiscal
177-year does not revert to the State General Fund, and the balance of
178-the Account must be carried forward to the next fiscal year.
179- 7. The Director shall seek all necessary federal authority to
180-capture all available federal financial participation to provide
181-additional supports and services as described in paragraph (d) of
182-subsection 3.
183- Sec. 3. This act becomes effective upon passage and approval.
156+- *SB435_R2*
157+ (c) Administer the provisions of NRS 422.3791 to 422.3795, 1
158+inclusive [. 2
159+ 4.] ; and 3
160+ (d) For money generated by an assessment imposed against 4
161+the operators of private hospitals or private rural hospitals, fund 5
162+additional supports and services under Medicaid, as approved by 6
163+the Director, to improve access to behavioral health care for 7
164+recipients of Medicaid with serious behavioral health conditions, 8
165+including, without limitation, psychiatric disorders, in order to 9
166+reduce the burden imposed by such recipients on the emergency 10
167+medical services and inpatient services of the hospitals in this 11
168+State. 12
169+ 4. Not more than 15 percent of the total amount of money 13
170+generated each year by assessments against the operators of 14
171+private hospitals or private rural hospitals may be expended for 15
172+the purposes described in paragraphs (c) and (d) of subsection 3. 16
173+Money allocated for such expenditures must be used first for the 17
174+purpose described in paragraph (c) of subsection 3. If money 18
175+allocated for such expenditures remains after all necessary 19
176+expenditures are made for that purpose, the Division shall expend 20
177+the remaining money for the purpose described in paragraph (d) 21
178+of subsection 3. 22
179+ 5. Money in the Account that was generated by a specific 23
180+assessment must not be expended to provide supplemental 24
181+payments or enhanced rates of reimbursement pursuant to 25
182+subsection 3 to operators in an operator group that is not subject 26
183+to the assessment unless such expenditure was identified as a 27
184+potential use of revenue when the assessment received an 28
185+affirmative vote of at least 67 percent of the operators in the 29
186+operator group subject to the assessment pursuant to subsection 1 30
187+of NRS 422.3794. 31
188+ 6. Any money remaining in the Account at the end of a fiscal 32
189+year does not revert to the State General Fund, and the balance of 33
190+the Account must be carried forward to the next fiscal year. 34
191+ 7. The Director shall seek all necessary federal authority to 35
192+capture all available federal financial participation to provide 36
193+additional supports and services as described in paragraph (d) of 37
194+subsection 3. 38
195+ Sec. 3. This act becomes effective upon passage and approval. 39
184196
185-20 ~~~~~ 23
197+H