Revision: May 9, 2024, 4:23 p.m.
Sen. Bradley, Dist 3
May 9, 2024
2024-1885s
05/08
Amendment to HB 1593-FN
Amend the title of the bill by replacing it with the following:
AN ACT making an appropriation to the department of health and human services to support recreational activities for individuals with developmental disabilities and relative to the uncompensated care and Medicaid fund.
Amend the bill by replacing all after section 1 with the following:
2 Uncompensated Care and Medicaid Fund; Definition of Hospital. RSA 167:63, IV is repealed and reenacted to read as follows:
IV. "Hospitals" mean general acute care hospitals licensed under RSA 151 that provide inpatient and outpatient hospital services, but shall not include government facilities or special hospitals for rehabilitation.
3 Hospital Medicaid Payments and Medicaid Payment Fund. RSA 167:64 is repealed and reenacted to read as follows:
167:64 Hospital Medicaid Payments and Medicaid Payment Fund; Disproportionate Share Hospital Fund.
I. There is hereby established in the state treasury a Medicaid payment fund, which shall consist of the moneys collected pursuant to RSA 84-A. Moneys paid into the fund shall be exempt from any state budget reductions, and the commissioner of the department of health and human services is authorized to expend these funds, together with matching federal funds, as authorized by this section. Investment earnings of the fund shall be credited to the fund. The moneys in the fund shall be nonlapsing and continually appropriated to the department of health and human services for the purpose of making hospital payments and provider payments and to support Medicaid services and programs administered by the department of health and human services in accordance with this section.
II. Beginning in state fiscal year 2025 and continuing every state fiscal year thereafter, the commissioner of the department of health and human services shall provide Medicaid payments, subject to the directed payment conditions set forth in paragraph V, to the hospitals in an amount equal to 91 percent of the money collected pursuant to RSA 84-A in the prior state fiscal year. Payments to the hospitals shall be made in accordance with this section.
III. The commissioner of the department of health and human services shall have the sole and absolute discretion to determine which payment method or methods are used to make the hospital payments subject to this section through Medicaid reimbursement for inpatient or outpatient hospital services, Medicaid supplemental payments, managed care directed payments, disproportionate share hospital payment adjustments, or any other Medicaid payment method allowed by the Centers for Medicare and Medicaid Services (CMS).
IV. All payments made pursuant to this section shall be subject to approval by CMS, and the department shall secure all necessary waivers or approvals to state plan amendments from CMS.
V. Any payments made under this section through directed payments shall comply with 42 CFR 438.6 or any other applicable federal regulation or guidance. The commissioner shall consult with and consider feedback from the hospitals prior to submission of a directed payment plan to CMS for approval. If CMS does not approve a hospital directed payment plan, the commissioner shall seek to provide payments through increased hospital rates, disproportionate share hospital payments, supplemental Medicaid payments, or any other allowable Medicaid payment method that provides for federal fund matching. For purposes of determining the portion of the payments to the hospitals that are attributable to CMS approved directed payments, the amount shall be the total amount available for the hospitals to earn under any directed payment, including, but not limited to, any amount of a directed payment that is at risk, value-based, or subject to performance conditions. In no event shall the state be liable for any payments the hospitals fail to earn under any CMS approved directed payments. The commissioner shall have sole authority to determine the parameters of any hospital directed payment or any alternative payment methods.
VI. In the event the commissioner of the department of health and human services determines there has been a change in federal law, regulations, or CMS guidance that materially impacts payments to the hospitals in accordance with this section or a material change in the amount of money collected pursuant to RSA 84-A, the hospitals and commissioner of the department of health and human services shall collaborate on adjustments, and subject to the commissioner’s final discretion, to the payment method or methods that are used to make the hospital payments subject to this section.
VII.(a) Disproportionate share hospital payments shall only be made to a hospital that is:
(1) A "deemed disproportionate share hospital” as defined by criteria set forth under 42 U.S.C. section 1396r-4 and is not otherwise receiving a disproportionate share hospital payment; or
(2) Meets the minimum criteria for disproportionate share eligibility under relevant federal statutory changes at 42 U.S.C. 1396r-4(d).
(b) For purposes of this paragraph, a hospital’s uncompensated care costs, for purposes of calculating a disproportionate share hospital payment, shall include any charity care cost, and any portion of Medicaid-covered patient care costs unreimbursed by Medicaid payments, that the commissioner determines would meet the criteria under 42 U.S.C. section 1396r-4(g) governing hospital-specific limits on disproportionate share hospital payments under Title XIX of the Social Security Act and the provisions of all federal regulations promulgated thereunder.
VIII. Payment of the federal share of any amount payable under this section to the hospitals is contingent upon New Hampshire receiving those federal funds and any necessary CMS approvals that the department is required to secure pursuant to paragraph IV. In no event shall the state be liable for any payments in excess of such available federal appropriated funds. In the event of a reduction or termination of appropriated federal funds by any federal legislative or executive action that reduces, eliminates, or otherwise modifies the federal appropriation or availability of funding for the federal share, in whole or in part, the state shall have the right to withhold the federal share payment until such federal funds become available, if ever, and shall have the right to reduce or terminate the state’s payment obligations of the federal share to the hospitals. The state shall not be required to transfer funds from any other account or source in the event federal funds are reduced or unavailable.
IX. The remaining funds available under this section shall be used to make provider payments and to support Medicaid services and programs administered by the department in amounts directed by the budget in each year of the biennium, and from this an amount of at least 9 percent of the money collected pursuant to RSA 84-A in the prior state fiscal year shall be used to support Medicaid services and programs administered by the department of health and human services with first priority to funding Medicaid service provider payments to community mental health centers, federally qualified health centers, substance use disorder providers, and other Medicaid service providers as determined by the commissioner of the department of health and human services.
X. One percent of the funds made available for hospital Medicaid payments shall be placed in a separate class line for purposes of the department administering this section.
XI. No hospital shall be entitled to receive any reimbursement under this section unless it meets the definition of a hospital, as defined in RSA 167:63, IV.
XII. For the purpose of making disproportionate share hospital payments only, there is hereby established in the state treasury the disproportionate share hospital fund, which shall be kept separate and distinct from all other funds. All disproportionate share hospital revenue received by the department of health and human services shall be credited to the fund. The moneys in the fund shall be nonlapsing and continually appropriated to the department of health and human services for the purpose of redistributing disproportionate share hospital funds between and among hospitals for compliance with the federally required disproportionate share hospital examinations.
4 Dedicated Funds; Reference Changed. Amend RSA 6:12, I(b)(338) to read as follows:
(338) Moneys deposited in the [uncompensated care and] Medicaid payment fund and the disproportionate share hospital fund established in RSA 167:64.
5 Medicaid Enhancement Tax; Definitions; Reference Change. Amend RSA 84-A:1, VI to read as follows:
VI. "[Uncompensated care and] Medicaid payment fund" [means the fund] and "disproportionate share hospital fund" mean the funds established in RSA 167:64 to reimburse hospitals for costs associated with uncompensated care and shortfalls in publicly funded programs.
6 Medicaid Enhancement Tax; Method of Payment and Deposit of Tax. Amend RSA 84-A:5, I to read as follows:
I. The payments required by RSA 84-A:3 shall be made by electronic transfer of moneys to the state treasurer and deposited to the [uncompensated care and Medicaid fund] Medicaid payment fund and disproportionate share hospital fund established by RSA 167:64.
I. Section 1 of this act shall take effect upon its passage.
II. The remainder of this act shall take effect July 1, 2024.
2024-1885s
AMENDED ANALYSIS
This bill:
I. Makes an appropriation to the department of health and human services to fund recreational activities for individuals with developmental disabilities.
II. Restructures the uncompensated care and Medicaid fund under RSA 167:64 as the Medicaid payment fund and disproportionate share hospital fund, administered by the department of health and human services.