[Rev. 11/21/2013 4:27:45 PM--2013]

[NAC-422 Revised Date: 7-11]

CHAPTER 422 - HEALTH CARE FINANCING AND POLICY

GENERAL PROVISIONS

422.015            Definitions.

422.025            “Distribution factor” defined.

422.035            “Division” defined.

422.045            “Pool distribution factor” defined.

422.055            “Pool of hospitals” defined.

422.065            “Public hospital” defined.

422.075            “Uncompensated care costs” defined.

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.

422.115            Designation of pools of hospitals and distribution of disproportionate share payments to each pool.

422.125            Formula for Division to calculate distribution factor for hospitals.

422.135            Formula for initial distribution of disproportionate share payments; adjustment.

422.145            Audit of hospitals required.

422.155            Recalculation after audit; final distribution; 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 422.025 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)

      NAC 422.025  “Distribution factor” defined. (NRS 422.390)  “Distribution factor” means the value of the formula set forth in NAC 422.125 calculated for a hospital.

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

      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 422.045  “Pool distribution factor” defined. (NRS 422.390)  “Pool distribution factor” means the sum of each distribution factor for each hospital that is a member of the pool of hospitals for which a disproportionate share payment is being calculated.

     (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 by a state or local government, including, without limitation, a hospital district; or

     2.  A hospital that is supported in whole or in part by tax revenue, other than tax revenue received 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)

      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)

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. (NRS 422.390)

     1.  In a county whose population is 100,000 or more within which a public hospital is located, the state or local government or other entity 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,

Ę 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.

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

      NAC 422.115  Designation of pools of hospitals and distribution of disproportionate share payments to each pool. (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 400,000 or more, total annual disproportionate share payments in the amount of $66,650,000 plus 90 percent of the total amount of disproportionate share payments distributed by the State in that fiscal year which exceeds $76,000,000;

     (b) Pool B, which consists of all private hospitals in counties whose population is 400,000 or more, total annual disproportionate share payments in the amount of $1,200,000 plus 2.5 percent of the total amount of disproportionate share payments distributed by the State in that fiscal year which exceeds $76,000,000;

     (c) Pool C, which consists of all private hospitals in counties whose population is 100,000 or more but less than 400,000, total annual disproportionate share payments in the amount of $4,800,000 plus 2.5 percent of the total amount of disproportionate share payments distributed by the State in that fiscal year which exceeds $76,000,000;

     (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 $900,000 plus 2.5 percent of the total amount of disproportionate share payments distributed by the State in that fiscal year which exceeds $76,000,000; 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 $2,450,000 plus 2.5 percent of the total amount of disproportionate share payments distributed by the State in that fiscal year which exceeds $76,000,000.

     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.

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

      NAC 422.125  Formula for Division to calculate distribution factor for hospitals. (NRS 422.390)

     1.  The Division will use the following formula to calculate the distribution factor for a hospital:

 

DF=UCC x

(

UCPH

)

4

 

UCPP

 

 

where:

     DF is the distribution factor.

     UCC is the uncompensated care costs of the hospital.

     UCPH is the uncompensated care percentage of the hospital.

     UCPP is the uncompensated care percentage of the pool of hospitals of which the hospital is a designated member.

 

     2.  As used in this section:

     (a) “Uncompensated care percentage of the hospital” means the uncompensated care costs of a hospital divided by the net patient revenues of the hospital, as reported on the report filed pursuant to subsection 1 of NAC 439B.230.

     (b) “Uncompensated care percentage of the pool of hospitals” means the sum of the uncompensated care costs for all hospitals in the pool divided by the sum of the net patient revenues of all hospitals in the pool, as reported on the reports filed pursuant to subsection 1 of NAC 439B.230 for each such hospital.

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

      NAC 422.135  Formula for initial distribution of disproportionate share payments; adjustment. (NRS 422.390)

     1.  Except as otherwise provided in subsection 2, the Division will make an initial distribution of disproportionate share payments to a hospital by dividing the distribution factor for that hospital by the pool distribution factor and multiplying the result by the total amount of money available for initial distribution to the pool of hospitals pursuant to NAC 422.115.

     2.  The Division will adjust the initial distribution for each hospital in a pool of hospitals to ensure that each hospital which is eligible to receive a disproportionate share payment receives not less than $10,000.

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

      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; recovery and redistribution of payments. (NRS 422.390)

     1.  After conducting an audit pursuant to NAC 422.145, the Division will recalculate, based upon the results of the audit, the:

     (a) Uncompensated care costs for each hospital in this State;

     (b) Distribution factor for each hospital and each pool of hospitals; and

     (c) Disproportionate share payments for each hospital by dividing the recalculated distribution factor for that hospital by the pool distribution factor and multiplying the result by the total amount of money available for final distribution to the pool of hospitals pursuant to NAC 422.115.

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

Ę whichever is less.

     3.  If the amount of the final distribution payment calculated pursuant to subsection 2 is less than the amount of the initial distribution of disproportionate share payments received by the hospital pursuant to NAC 422.135, the hospital shall return to the Division the difference between the amount of the initial distribution and the amount of the final distribution.

     4.  Except as otherwise provided in subsection 5, the Division will, for each pool of hospitals, redistribute among the hospitals within the pool the money returned to the Division pursuant to subsection 3 by the hospitals within that pool.

     5.  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 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;

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

     (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,

Ę or, if each hospital in a pool of hospitals to which additional payments would have been paid pursuant to this subsection has received the maximum allowable disproportionate share payments, to such other pool of hospitals as the Division determines appropriate.

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

      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)