SB 435 — Revises provisions relating to Medicaid. (BDR 38-1069)

EXEMPTSenate (ReprintedBill withNo. amendments adopted on April 24, 2023) FIRST REPRINT S.B.

435435–Committee SENATEon BHealth ILLNand O.Human Services CHAPTER..........

435–COMMITTEE ON H EALTH AND H UMAN SERVICES (O NB EHALF OF THE OFFICE OF FINANCE IN THE OFFICE OF THE G OVERNOR ) M ARCH 27, 2023 ____________ Referred to Committee on Health and Human Services SUMMARY—Revises provisions relating to Medicaid.

(BDR 38-1069) FISCAL NOTE:

Effect on Local Government:

No.

Effect on the State:

Yes.

~ EXPLANATION – Matter in bolded italics is new;

matter between brackets [omitted material] is material to be omitted.

prohibiting the continued imposition of such an assessment under certain circumstances;

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 422.37945)imposed; 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 supports and services(2) underadminister Medicaidprovisions for recipients of Medicaidlaw withgoverning seriousonalsuch -assessments. *SB435_R1* – 2 – behavioral health conditions.

(NRS 422.37945) Section 2 providesof thatthis notbill moreauthorizes thanthe 15money percentto ofalso thebe totalused amountto ofprovide moneysupplemental generatedpayments eachor yearenhanced byrates suchof anreimbursement assessmentto mayoperators bethat usedare billnot requiressubject to the Divisionassessment toif providesuch eachexpenditure operatorwas ofidentified as a hospitalpotential oruse ruralof hospitalsat wholeast is67 polledpercent concerningof the impositionoperators ofon suchwhom anthe assessment ofwas theto amountbe ofimposed.from Section 2 additionally authorizes the Division to use money generated from an assessment thatimposed willon beprivate usedhospitals or rural hospitals to provide additional supports and services under Medicaid for thoserecipients purposes.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 who is polled concerning the imposition of such an assessment of the amount of thel 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.

- 82nd Session (2023) – 2 – EXPLANATION – Matter in bolded italics is new;

matter between brackets [omitted material] is material to be omitted.

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 meaningsmeaSec. ascribed to them in those sections.

Sec.

- *SB435_R1* – 3 – 3.

The revenue from an assessment imposed pursuant to subsectionsub[3.] 14. must be deposited in the Account.

[3.]1An 4.assessment imposed pursuant to subsection 1 must comply with the provisions of 42 C.F.R.

An assessment imposed pursuant to subsection 1 must comply with the provisions of 42 C.F.R.

AnThe revenue generated by such an assessment must notbe used only for the - 82nd Session (2023) – 3 – be imposed pursuant to subsection 1 if state or federal law or regulations prohibit using[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:

and (b) Any money collected during the calendar or fiscal year, as applicable, in which the federal[federal] law or regulations become effective must be returned to the operators from whom it was collected.

The Account to Improve Health Care Quality andDivision Accessshall isadminister hereby created in the StateAccount. General Fund.

The Divisionrevenue shallfrom administerThe assessments and penalties imposed on the operators in each operator group must be accounted for separately in the Account.

The revenue from assessments and penalties imposed on the operators in each operator group must be accounted for separately in the Account.

(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 operatorsope(c) wouldAdminister otherwisethe receiveprovisions forof providingNRS such422.3791 care;to 422.3795,nd] inclusive [.

[and] (c) Administer the provisions of NRS 422.3791 to 422.3795, inclusive [.

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 - *SB435_R1*82nd Session (2023) – 4 – reduce the burden imposed by such recipients on the emergency medical services and inpatient services of the hospitals in this State.

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.

If money allocated for such expenditures remains after all necessary expenditures are made for that purpose, the Division shall expend ofthe subsectionremaining 3.neymoney for the purpose described in paragraph (d) 5.of subsection 3.

5.

The Director shall seek all necessary federal authority to capture all available federal financial participation to provide additionalsubsection supports3.pports and services as described in paragraph (d) of subsectionSec. 3.