Existing law creates the Public Employees' Benefits Program to provide group life, accident or health insurance to certain public employees, state officers and members of the Legislature in this State. (NRS 287.043) Existing law also prescribes a procedure to determine the amount that a third party which provides health coverage to a person, including the Public Employees' Benefits Program, 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) Section 5 of this bill establishes maximum rates that hospitals, independent centers for emergency medical care and surgical centers for ambulatory patients may charge for goods and services when provided to a patient who is covered by the Program or a local government employer that elects to be subject to those maximum rates. Those maximum rates differ depending on whether the facility is an in-network facility or an out-of-network facility. Section 5 authorizes the Division of Health Care Financing and Policy of the Department of Health and Human Services to increase those maximum rates if: (1) the Division determines that health care facilities in this State are experiencing financial hardship due to a decrease in the rates of reimbursement provided under Medicaid; and (2) the Interim Finance Committee approves the increase. Section 11 of this bill authorizes the Interim Finance Committee to consider such an increase during a regular or special session of the Legislature. Section 9 of this bill prescribes the manner in which a local government employer may opt in to the provisions of section 5. Section 19 of this bill requires the Board and each participating local government employer to consider the change in rates as a result of implementing section 5 when assessing the cost of premiums of contributions for the Program. Sections 3 and 4 of this bill define necessary terms, and section 2 of this bill establishes the applicability of those definitions. Section 6 of this bill requires the Division to annually submit to the Legislature a report concerning the impacts of the maximum rates established by section 5. Section 7 of this bill requires the Division to adopt certain regulations to implement sections 2-8 of this bill, including regulations prescribing civil penalties to be imposed against a health care facility that charges the Program or a participating local government employer an amount that exceeds the maximum rates prescribed by section 5. Sections 8 and 14 of this bill provide for the imposition of disciplinary action against a health care facility for such a violation. Section 8 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 and attorney's fees and costs. Section 10 of this bill applies the definitions in existing law relating to the Program to the provisions of sections 2-8. Sections 13 and 16 of this bill make conforming changes to clarify the application of existing provisions concerning the rates that a health care facility, including a county hospital, may charge for certain services. Sections 17 and 18 of this bill make conforming changes to clarify the applicability of certain provisions of existing law relating to the Program. (NRS 687B.409, 689B.065) Existing federal regulations require a hospital to publish: (1) a list of standard charges for all items and services provided by the hospital; and (2) a consumer-friendly list of standard charges for a limited set of shoppable services, which are services provided by a hospital that can be scheduled by a consumer in advance. (45 C.F.R. §§ 180.20, 180.40-180.60) Section 12 of this bill requires each hospital in this State to comply with those federal requirements, and sections 12, 14 and 15 authorize the imposition of disciplinary action against a hospital that fails to comply with those requirements.

Statutes affected:
As Introduced: 287.012, 287.0402, 218E.405, 439B.400, 439B.742, 449.160, 449.163, 450.410, 687B.409, 689B.065
BDR: 287.012, 287.0402, 218E.405, 439B.400, 439B.742, 449.160, 449.163, 450.410, 687B.409, 689B.065