12/20/16 – Provider Fee Workshop
Dear NVOS Members,
On Monday, Dec 19, the Nevada DHHS Division of Health Care Financing and Policy held a workshop to begin a discussion of extending the “provider fee”, currently levied on nursing facilities, to all (or at least more) providers. Presentation found here: provider taxes.DHHS presentation Dec 19-1
This is how the program currently works: http://dhcfp.nv.gov/Resources/Rates/RAPProviderTax/
This is what we learned at the meeting:
With the uncertainties surrounding the new administration relative to federal funding for healthcare, DHCFP is looking for ways to maximize the amount of federal match available to the state for Medicaid. Provider fee revenues create opportunities for NV Medicaid to make supplemental payments in various formats, such as reimbursement rate enhancements. The theory is that, as the State receives higher federal match, the additional revenues will be returned to participating providers to offset the cost of the “fee”.
DHCFP is working on concepts/language to present to the legislature and held Monday’s meeting to determine interest in the concept and willingness to participate.
The tax could range from 1% to a federal maximum of 6%; the rate may be variable among provider groups.
The Nevada Hospital Association raised the many challenges associated with the implementation of the current program and the constant need to make adjustments so that the nursing facilities are not harmed. The CEO opined that NHA might become a willing partner in this program, with a few stipulations:
· the groups involved will have on-going input into drafting the legislative language;
· the new revenues collected will be restricted, meaning that they may not be shifted to solve gaps in the state budget; and
· the new revenues will not be pooled, meaning that they will be distributed back to the group that paid the fee.
There will likely be carve outs and exceptions. For instance, the rural hospitals already receive maximum reimbursement from the feds, so participation in this program would not be a net positive. Certain physician specialties would reap no benefit from paying the fee and may seek a carve out.
DHCFP has hired a consultant to analyze the numbers; attendees asked how they can access the data being used by the consultants to assure accuracy and pointed out that transparency in this process is vital. Staff provided this link to the data that the state uses: http://dhcfp.nv.gov/Resources/Rates/RatesSupplementalPymtMain/
Per the handout, staff explained the following:
· The tax has to be broad based and apply to all providers in a group, not just those who are Medicaid providers.
· Provider groups that don’t participate will not be eligible to receive any of the return.
· If the fee is approved by the legislature, the state Medicaid plan will need to be amended and approved by the feds before the fee can be levied.
There will obviously be much more to come on this topic, but I wanted to put it on your radar screen now. Please let me know if any of you have experiences with provider taxes in other states.