TO PROVIDE FOR HOSPITAL ASSESSMENTS TO BE USED TO OBTAIN MATCHING FEDERAL MEDICAID FUNDS TO REDUCE THE LOSSES HOSPITALS SUSTAIN WHEN TREATING MEDICAID AND UNINSURED PATIENTS, TO REDUCE THE INEQUITY IN MEDICAID PAYMENTS BETWEEN PUBLIC AND NONPUBLIC HOSPITALS, AND TO PROVIDE FORTY-THREE MILLION DOLLARS IN ADDITIONAL FUNDING FOR THE STATE OF NORTH CAROLINA.
As the title indicates. Directs the Secretary of Health and Human Services (Secretary) to implement a hospital assessment program for eligible hospitals to improve funding for payments for hospital services provided to Medicaid and uninsured patients.
Requires that the hospital assessment program consist of two different assessments: (1) Equity Assessments and (2) Upper Payment Limit (UPL) Assessments. Details how each assessment is to be levied and calculated. Requires that the assessments be levied on all licensed North Carolina Hospitals; however, exempts the following from all assessments: (1) state-owned and state-operated hospitals, (2) the primary affiliated teaching hospital for each University of North Carolina medical school, (3) Critical Access Hospitals as defined in 42 CFR Section 400.202, (4) long-term care hospitals, (5) freestanding psychiatric hospitals, and (6) freestanding rehabilitation hospitals. Provides additional details regarding assessments and exemptions from those assessments, timelines, and appeal procedures. Allows for a hospital to appeal an assessment determination through a reconsideration review; however, such an appeal does not relieve the hospital from its obligation to pay any assessment due while the appeal is pending.
Provides for quarterly assessments and directs the Secretary to make payments to qualifying hospitals and transfer to the State Controller the quarterly share of $43 million. Provides additional criteria regarding the assessment process, collection of the assessment, and disbursement of the collected funds to qualifying hospitals.
Directs the Department of Health and Human Services (DHHS) to file with the Centers for Medicare and Medicaid Services (CMS) a state plan amendment with the proposed legislation’s provisions for approval, no later than March 31, 2011. Allows the Secretary to levy the initial assessment, as specified, after CMS approval. Details procedures in the event that CMS revokes or modifies approval.
Allows assessments paid under the proposed legislation to be included as allowable hospital costs for a Medicaid reimbursement formula, but they may not be added as a surtax or assessment to a patient’s bill. Prohibits any political subdivision of the state from licensing a hospital or imposing a tax or assessment on a hospital.
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