Existing law prescribes a procedure to determine the amount that a third party which provides health coverage to a person is required to pay to an out-of-network hospital, independent center for emergency medical care or other provider of health care for medically necessary emergency services rendered to that person. (NRS 439B.700-439B.760) Existing law also requires certain major hospitals to reduce the total billed charge by at least 30 percent for hospital services provided to certain patients who have no insurance or other contractual agreement for the payment of the charges by a third party that provides health coverage. (NRS 439B.260) Sections 2-13 of this bill establish procedures to fix rates charged by hospitals, independent centers for emergency medical care and surgical centers for ambulatory patients for goods and services that are reimbursable through Medicare when provided to a patient who is covered by the Public Employees' Benefits Program. Section 27.5 of this bill additionally applies those fixed rates to such goods and services when provided to a patient who is covered by the Public Option, when the Public Option begins operating on January 1, 2026. Sections 3-5 of this bill define necessary terms. Section 6 of this bill creates the Independent Commission on Rates for Health Care Services, which consists of members who are representatives of various health care and business entities. Section 7 of this bill establishes procedures governing the meetings and operations of the Independent Commission. Section 8 of this bill generally prohibits hospitals, independent centers for emergency medical care and surgical centers for ambulatory patients from charging rates different from those fixed under sections 2-13 for services provided to patients to whom such fixed rates apply. Section 9 of this bill requires the Independent Commission to fix rates to ensure that each health care facility is able to cover reasonable costs, earn a fair and reasonable profit and provide fair and adequate compensation to its employees. Section 9 requires the Independent Commission to generally: (1) presume that the rates paid by Medicare allow a health care facility to cover reasonable costs, earn a fair and reasonable profit and provide fair and adequate compensation to employees; and (2) fix rates at that amount. However, section 9 authorizes a health care facility to request a different rate if the health care facility determines the rates paid by Medicare do not allow the health care facility to cover reasonable costs, earn a fair and reasonable profit and provide fair and adequate compensation to employees. Section 10 of this bill: (1) requires the Division of Health Care Financing and Policy of the Department of Health and Human Services to evaluate such requests; and (2) prescribes the procedure for evaluating such a request and the criteria that the Division is required to consider during the evaluation. Section 11 of this bill: (1) requires the Division to make a recommendation on the request to the Independent Commission; (2) requires the Independent Commission to review that recommendation and issue an order fixing rates for the health care facility that requested a different rate; and (3) prescribes the procedure and requirements concerning such a recommendation and order relating to such a request. Section 11 provides that such an order is valid for 1 year and authorizes a health care facility to request to renew a rate. Section 11.5 of this bill requires the Independent Commission to annually submit to the Legislature a report concerning the impacts of rate fixing in accordance with sections 2-13. Section 12 of this bill requires the Division to adopt certain regulations governing rate fixing, including regulations establishing civil penalties to be imposed against a health care facility that violates provisions governing rate fixing. Sections 13 and 21 of this bill provide for the imposition of disciplinary action against a health care facility for such a violation. Section 13 also authorizes: (1) the Division or Attorney General to maintain a suit for an injunction against such a violation; and (2) any person or entity injured by such a violation to maintain a suit for damages. Sections 15, 17 and 22-27.4 of this bill make conforming changes to clarify the application of or remove existing provisions concerning the rates that a health care facility may charge for certain services.

Statutes affected:
As Introduced: 439B.260, 439B.400, 439B.727, 439B.742, 439B.745, 439B.751, 439B.754, 449.160, 449A.118, 450.420, 689A.041, 689B.0375, 695B.191, 695C.171
Reprint 1: 439B.400, 439B.742, 449.160, 449A.118, 450.420, 287.0434, 695K.200, 695K.240
BDR: 439B.260, 439B.400, 439B.727, 439B.742, 439B.745, 439B.751, 439B.754, 449.160, 449A.118, 450.420, 689A.041, 689B.0375, 695B.191, 695C.171