- 82nd Session (2023)
Senate Bill No. 435–Committee on
Health and Human Services
CHAPTER..........
AN ACT relating to Medicaid; requiring the provision of certain
information to the operator of a hospital or rural hospital
concerning the use of revenue generated by certain proposed
assessments; prohibiting the continued imposition of such an
assessment under certain circumstances; revising the
authorized uses of the revenue generated from an assessment
authorized to be imposed on operators of certain agencies and
facilities; and providing other matters properly relating
thereto.
Legislative Counsel’s Digest:
Existing law authorizes the Division of Health Care Financing and Policy of the
Department of Health and Human Services to impose an assessment on each
operator of an agency to provide personal care services in the home and each
operator of a medical facility that is required to obtain a license if, after polling the
operators, at least 67 percent of those operators vote in favor of the assessment.
(NRS 422.3794) Existing law authorizes the expenditure of the money generated
from such an assessment only to: (1) provide supplemental payments or enhanced
rates of reimbursement under Medicaid to operators upon whom the assessment is
imposed; and (2) administer provisions of law governing such assessments. (NRS
422.37945) Section 2 of this bill authorizes the money to also be used to provide
supplemental payments or enhanced rates of reimbursement to operators that are
not subject to the assessment if such expenditure was identified as a potential use of
the assessment in the polling of operators which received an affirmative vote from
at least 67 percent of the operators on whom the assessment was to be imposed.
Section 2 additionally authorizes the Division to use money generated from an
assessment imposed on private hospitals or rural hospitals to provide additional
supports and services under Medicaid for recipients of Medicaid with serious
behavioral health conditions. Section 2 provides that not more than 15 percent of
the total amount of money generated each year by such an assessment may be used
for administrative costs and to fund such supports and services. Section 1.8 of this
bill requires the Division to provide each operator of a hospital or rural hospital
who is polled concerning the imposition of such an assessment of the amount of the
assessment that will be used for those purposes. Section 1.8 also prohibits the
continued imposition of such an assessment where state or federal law or
regulations prohibit or alter the authorized uses of the revenue generated by the
assessment. Sections 1.2 and 1.4 of this bill define the terms “hospital” and “rural
hospital,” respectively. Section 1.6 of this bill makes conforming changes to
indicate the proper placement of sections 1.2 and 1.4 in the Nevada Revised
Statutes.
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- 82nd Session (2023)
EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. Chapter 422 of NRS is hereby amended by adding
thereto the provisions set forth as sections 1.2 and 1.4 of this act.
Sec. 1.2. “Hospital” has the meaning ascribed to it in
NRS 449.012.
Sec. 1.4. “Rural hospital” has the meaning ascribed to it in
NRS 449.0177.
Sec. 1.6. NRS 422.3791 is hereby amended to read as follows:
422.3791 As used in NRS 422.3791 to 422.3795, inclusive,
and section 1.2 and 1.4 of this act, unless the context otherwise
requires, the words and terms defined in NRS 422.37915 to
422.37935, inclusive, and sections 1.2 and 1.4 of this act have the
meanings ascribed to them in those sections.
Sec. 1.8. NRS 422.3794 is hereby amended to read as follows:
422.3794 1. Except as otherwise provided in this section,
after polling the operators in an operator group and receiving an
affirmative vote from at least 67 percent of the operators in that
operator group, the Division may impose by regulation, against each
operator in the operator group, an assessment in an amount equal to
a percentage of the net revenue generated by the agency to provide
personal care services in the home or medical facility, as applicable,
from providing care in this State during a calendar or fiscal year.
The Division shall adopt:
(a) Regulations prescribing the percentage that must be used to
calculate the amount of the assessment, the date on which the
assessment is due and the manner in which the assessment must be
paid; and
(b) Any other regulations necessary or convenient to carry out
the provisions of this section.
2. Before polling the operator of a hospital or a rural hospital
pursuant to subsection 1, the Division shall provide the operator a
statement of the amount of the revenue generated by the proposed
assessment that will be used for the purposes prescribed by
paragraphs (c) and (d) of subsection 3 of NRS 422.37945.
3. The revenue from an assessment imposed pursuant to
subsection 1 must be deposited in the Account.
[3.] 4. An assessment imposed pursuant to subsection 1 must
comply with the provisions of 42 C.F.R. § 433.68. The revenue
generated by such an assessment must be used only for the
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- 82nd Session (2023)
purposes authorized by NRS 422.37945. An assessment must not
be imposed pursuant to subsection 1 if state or federal law or
regulations prohibit [using] or alter the use of the revenue generated
by the assessment for the purposes prescribed in NRS 422.37945. If
new state or federal law or regulations imposing such a prohibition
or making such an alteration are enacted or adopted, as applicable:
(a) An assessment must not be collected after the effective date
of the law or regulations; and
(b) Any money collected during the calendar or fiscal year, as
applicable, in which the [federal] law or regulations become
effective must be returned to the operators from whom it was
collected.
[4.] 5. An operator shall submit to the Division any
information requested by the Division for the purposes of carrying
out the provisions of this section.
Sec. 2. NRS 422.37945 is hereby amended to read as follows:
422.37945 1. The Account to Improve Health Care Quality
and Access is hereby created in the State General Fund. The
Division shall administer the Account. The revenue from
assessments and penalties imposed on the operators in each operator
group must be accounted for separately in the Account.
2. The interest and income on the money in the Account, after
deducting any applicable charges, must be credited to the Account.
3. [The] Subject to the provisions of subsections 4 and 5,
money in the Account must be expended to:
(a) Provide supplemental payments or enhanced rates of
reimbursement to operators [in the operator group upon whom an
assessment was imposed] pursuant to an upper payment limit
program established under the provisions of 42 C.F.R. § 447.272 or
447.321;
(b) Provide supplemental payments to operators [in the operator
group upon whom an assessment was imposed] who provide care to
recipients of Medicaid in addition to the reimbursements those
operators would otherwise receive for providing such care; [and]
(c) Administer the provisions of NRS 422.3791 to 422.3795,
inclusive [.
4.] ; and
(d) For money generated by an assessment imposed against
the operators of private hospitals or private rural hospitals, fund
additional supports and services under Medicaid, as approved by
the Director, to improve access to behavioral health care for
recipients of Medicaid with serious behavioral health conditions,
including, without limitation, psychiatric disorders, in order to
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- 82nd Session (2023)
reduce the burden imposed by such recipients on the emergency
medical services and inpatient services of the hospitals in this
State.
4. Not more than 15 percent of the total amount of money
generated each year by assessments against the operators of
private hospitals or private rural hospitals may be expended for
the purposes described in paragraphs (c) and (d) of subsection 3.
Money allocated for such expenditures must be used first for the
purpose described in paragraph (c) of subsection 3. If money
allocated for such expenditures remains after all necessary
expenditures are made for that purpose, the Division shall expend
the remaining money for the purpose described in paragraph (d)
of subsection 3.
5. Money in the Account that was generated by a specific
assessment must not be expended to provide supplemental
payments or enhanced rates of reimbursement pursuant to
subsection 3 to operators in an operator group that is not subject
to the assessment unless such expenditure was identified as a
potential use of revenue when the assessment received an
affirmative vote of at least 67 percent of the operators in the
operator group subject to the assessment pursuant to subsection 1
of NRS 422.3794.
6. Any money remaining in the Account at the end of a fiscal
year does not revert to the State General Fund, and the balance of
the Account must be carried forward to the next fiscal year.
7. The Director shall seek all necessary federal authority to
capture all available federal financial participation to provide
additional supports and services as described in paragraph (d) of
subsection 3.
Sec. 3. This act becomes effective upon passage and approval.
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