Upper payment limit program-private hospitals.

ORIGINAL
House
Bill No
.
HB0057

ENROLLED
ACT NO. 24,

HOUSE OF REPRESENTATIVES

SIXTY-THIRD LEGISLATURE OF THE STATE OF WYOMING
2016 Budget Session

AN ACT relating to public welfare; establishing a private hospital assessment as specified; providing for the use of assessments to obtain federal matching funds; providing for payments to private hospitals as specified; establishing an account; providing definitions; providing regulatory authority; providing penalties; and providing for an effective date.

Be It Enacted by the Legislature of the State of Wyoming:

Section 1
.

W.S. 42
‑
9
‑
101 through 42
‑
9
‑
1
09
are
created to read:

CHAPTER 9
PRIVATE HOSPITAL ASSESSMENT ACT

42
‑
9
‑
1
01
.

Short title
.

This
chapter
shall be known and may be cited as the "Wyoming
Private Hospital
Assessment Act."

42
‑
9
‑
1
02
.

Definitions
.

(a)

As used in this chapter
:

(i)

"Account" means the
private hospital
assessment a
ccount created
by
W.S. 42
‑
9
‑
1
03;

(ii)

"Department" means the department of health;

(iii)

"Fiscal year" means the twelve (12) month period beginning October 1 and ending September 30;

(iv)

"Medicaid" means
the medical assistance program established by title XIX of the federal Social Security Act and administered in this state by the department pursuant to the Wyoming Medical Assistance and Services Act;

(v)

"Medica
re
cost report" means
the annual hospital cost report
as
determined by the centers for medicare and medicaid services and as reported to the health

care cost report information system;

(v
i
)

"
Net hospital patient revenue" means gross hospital revenue as reported on the
most recent
ly filed

m
edicare cost report, excluding estimated nonhospital ancillary revenue, multiplied by the hospital’s ratio of total net to gross revenue
.
The department shall establish a procedure to reconcile filed cost report information with information from the settled cost report. If a hospital does not file a medicaid cost report, the department shall establish a procedure to determine what the hospital would have reported as net patient hospital revenue if the hospital had filed a medicaid cost report
;

(
vi
i
)

"
Private h
ospital" means
those institutions licensed by the department as hospitals
which are not owned or operated by the state or any city, town, county
, special district
or other political subdivision of the state or local government
;

(viii)

"Quarterly adjustment payment" means the payment made to private hos
pitals pursuant to W.S. 42
‑
9
‑
106
;

(ix
)

"U
pper payment limit" means the
applicable
limitation established pursuant to 42 C.F.R. 447.272
,
42 C.F.R. 447.321
or as otherwise established by the centers for medicare and medicaid services
;

(
x
)

"Upper payment limit gap" means
the amount calculated annually by the department constituting
the difference betwe
en the
applicable
upper payment limit and m
edicaid payments
made
subject to that limit
in a fiscal year, excluding any quarterly adjustment payments authorized by this
chapter.

42
‑
9
‑
1
03
.

Private h
ospital
assessment account
.

(a)

The
private hospital
assessment account is created.

(b)

The state treasurer shall invest amounts deposited within the
account in accordance with law
and all investment earnings shall be credited back to the account.
Funds in the account are continuously appropriated to the department for the purposes specified in this
section
.

(c)

The account shall consist of:

(i)

Amounts collected or received by the department from
private hospital
assessments under this chapter
;

(ii)

All federal matching funds received by the department as a result of expenditures made by the department
pursuant to this chapter
.

(d)

The account
shall be used exclusively for the following purposes:

(i)

To pay administrative expenses incurred by the department or its agent in performing the activities authorized by this
chapter
, provided that
these
expenses shall not exceed a total of one percent (1%) of the aggregate assessment funds collected in the fiscal year;

(ii)

To secure federal matching fun
ds available through the state m
edicaid plan
as approved pursuant to W.S. 42
‑
9
‑
108
, which shall be used to make quarterly adjustment payments as provided by this chapter
;

(iii)

To repay
to
the federal government any excess payments
received or
made to
private hospitals
if the state plan, after appro
val by the centers for medicare and m
edicaid services, is subsequently disapproved for any reason and after the state has
exhausted all appeals
.
Private hospitals
shall refund any
excess payments to the assessment account.

If a
private hospital
is unable to refund payments as provided in this paragraph, the department shall develop a payment plan
to recoup deficient payments
and
accordingly
deduct amounts from future m
edicaid payments. The department shall refund the federal government for the federal p
ortion of those overpayments;

(iv)

To refund assessments paid by private hospitals for quarterly adjustment payments which were earned but not
paid by the department
, but only after the payments authorized by paragraphs (i) and (iii) of this section have been made.

42
‑
9
‑
1
04
.

Assessments
.

(a)

Each
private hospital
shall pay a

private hospital
assessment to the department

in accordance with this
section
.
Hospitals owned or

operated by the state or any city, town, county
, special district
or other political subdivision of the state or local government

shall not be required to pay the ass
essment required by this section
.

(b)

The assessment due under this section shall be imposed each fiscal year in an amount calculated as a uniform percentage of each hospital's net patient revenue.
The assessment rate shall be determined by the department on a prospective basis and shall be based on the percentage of net hospital patient revenue needed to generate an amount not to exceed the nonfederal portion of the upper payment limit gap plus the fee authorized by W.S. 42
‑
9
‑
103(
d)(i). In no event shall the assessment rate
:

(i)

E
xceed the indirect guarantee threshold amount established by 42 C.F.R. 433.6
8(f
)(
3)(i) or other federal law;

(ii)

Exceed two percent (2%) of a hospital's net patient revenue for the first fiscal year in which the hospital is assessed;

(iii)

Increase by more than one
‑
half of one percent (.5%) of a hospital's net patient revenue for each fiscal year following the first fiscal year in which the hospital is assessed without further approval by the legislature.

(
c
)

Unless otherwise determined by the department, the department shall collect
and each
private hospital
shall pay
the assessment
required by this
section on a quarterly basis
, each payment constituting twenty
‑
five percent (25%) of the annual assessment determined by the department
. The initial payment shall be due not later than forty
‑
five (45) days after the state plan has been appro
ved by the centers for medicare and m
edicaid services unless a later date is set by the department. Subsequent payments are due not later than forty
‑
five (45) days after the end of each calendar quarter
unless a later
date is set by the department
.

(
d
)

If a
private hospital ceases to operate as a hospital or for any reason ceases to be subject to the assessment imposed under this
chapter
, the assessment for
the fiscal year in which the cessation occurs shall be adjusted by multiplying the annual assessment by a fraction, the numerator of which is the number of days in the year during which the hospital is subject to the assessment and the denominator of which is
three hundred sixty
‑
five

(
365
)
. Immediately upon ceasing to operate as a hospital, or otherwise ceasi
ng to be subject to this chapter
, the hospital shall
pay the assessment for each quarter
as adjusted, to the extent not previously paid.

42
‑
9
‑
105
.

Penalties for failure to pay assessment
.

(a)

If a private hospital fails to pay an assessment due under this chapter, there shall be added to the assessment a penalty equal to five percent (5%) of the amount of the assessment that was not paid when due. The penalty under this section may be waived by the department for good cause. Any payments
made
after a penalty is assessed under this section shall be credited first to unpaid assessment amounts rather than to penalty amounts, beginning with the most delinquent installment.

(b)

In addition to the penalty under subsection (a) of this section, the department may implement any of the following remedies for failure of a private hospital to pay its assess
ment when due under this chapter
:

(i)

Withhold any m
edicaid payments, including any quarterly adjustment payments, until the assessment is paid;
or

(ii)

Develop a plan that requires the private hospital to pay any delinquent assessment in installments.

42
‑
9
‑
106
.

Quarterly adjustment payments
.

(a)

To preserve the quality and improve access to hospital services for private hospital inpatient and outpatient services rendered on or after
July 1, 2016, the d
epartment shall make quarterly adjustment payments as set forth in this section.

(b)

Each private hospital that
pays

assessments

under this chapter
and is eligible to receive medicaid
payments
shall
be eligible to receive quarterly adjustment payments as provided in this section. The department shall
distribute
quarterly adjustment payments in an amount up to but not to exceed the
applicable
upper payment limit gap.
The department shall establish a uniform methodology by which to distribute quarterly adjustment payments in compl
iance with applicable federal and
state medicaid laws and regulations.

(c
)

Quarterly adjustment payments shall not be used
to offset any other payment by m
edicaid for hospital inpat
ient or outpatient services to m
edicaid beneficiaries, including without limitation any fee
‑
for
‑
service, per diem, private hospital inpatient adjustment or cost

settlement payment.

(d
)

No private hospital shall be guaranteed, expressly or otherwise, that any quarterly adjustment payment will equal or exceed the amount of the private hospital assessments due under this chapter.

(e
)

Monies
made available by
this
chapter
shall not be used to replace other general revenues appropriated and funded by the legislature or
other revenues used to support m
edicaid.

42
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9
‑
107
.

Discontinuation of the assessment and quarterly adjustment payments
.

(a)

The assessment imposed by this
chapter
shall be discontinued if:

(i)

The state plan amendment reflecting the quarterly adjustment payments authorized by this chapter is not appro
ved by the centers for m
edica
re and m
edicaid services. The department may modify the quarterly adjustment payment provisions as necessary to
obtain the centers for medicare and m
edicaid services approval if
the
changes do not exceed the authority and purposes of this chapter;

(ii)

F
ederal financial participation to match assessments under this chapter becomes unavailable under federal law. In
this event
, the department shall terminate the imposition of assessments beginning on the date the federal statutory, regulatory or interpretive change takes effect.

(b)

If collection of the assessment is discontinued as provided in this section, quarterly adjustment payments shall be discontinued and, after payment of all amounts under W.S. 42
‑
9
‑
103(
d)(i) and (iii),
any assessments remaining
in the account shall be returned to the private hospital
s
from which the assessment
s were
c
ollected on the same basis as they were
collected.

42
‑
9
‑
1
08
.

Approval of state plan; rulemaking.

(a)

The department shall seek necessary federal approval in the form of state plan amendments in order to
continue to
implement the provisions of this
chapter
.

(b)

The department shall adopt rules and regulations necessary to implement the provisions of this
chapter and to
obtain approval of the state plan amendments.

42
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9
‑
1
09
.

Multiple facilities
.

If a person conducts, operates or maintains more than one (1)
private hospital
licensed by the department, the person shall pay the assessment for ea
ch
private hospital
separately.

Section
2
.

This
act is effective July 1,
201
6
.

(END)

Speaker of the House

President of the Senate

Governor

TIME APPROVED: _________

DATE APPROVED: _________

I hereby certify that this act originated in the
House
.

Chief Clerk

1