Nev. Admin. Code § 422.155 - Recalculation after audit; final distribution; recovery and redistribution of payments

1. If the Division determines, based on an audit conducted pursuant to NAC 422.145, that a hospital's initial disproportionate share payment exceeds the amount that the hospital was entitled to receive, the Division will recalculate, based upon the results of the audit, for each hospital in the affected pool, the:

(a) Uncompensated care costs;

(b) Uncompensated care percentages, determined in the manner described in paragraph (a) of subsection 1 of NAC 422.135; and

(c) Final disproportionate share payments using the amounts recalculated pursuant to paragraphs (a) and (b) and determined in the manner described in NAC 422.135.

2. A hospital may receive as a final distribution of disproportionate share payments for a fiscal year an amount equal to:

(a) The uncompensated care costs calculated pursuant to paragraph (a) of subsection 1; or

(b) The final disproportionate share payment for the hospital calculated pursuant to paragraph (c) of subsection 1,

whichever is less.

3. For each pool that includes a hospital for which the Division has determined pursuant to subsection 1 that the initial disproportionate share payment exceeded the amount that the hospital was entitled to receive, the Division will notify each hospital in the pool whether the final distribution payment calculated pursuant to subsection 2 is less than or greater than the amount of the initial distribution of disproportionate share payments received by the hospital pursuant to NAC 422.135. If the amount of the final distribution payment calculated pursuant to subsection 2 is:

(a) Less than the amount of the initial distribution of disproportionate share payments received by the hospital , the hospital shall return to the Division the difference between the amount of the initial distribution and the amount of the final distribution not later than 90 days after the date on which the hospital receives written notification of the overpayment.

(b) Greater than the amount of the initial distribution of disproportionate share payments received by the hospital, the Division will pay to the hospital the difference between the amount of the final distribution payment and the initial distribution.

4. If each hospital within a pool of hospitals has received the maximum amount of disproportionate share payments allowable by federal and state statutes and regulations, the Division will use the money returned pursuant to paragraph (a) of subsection 3 to pay additional disproportionate share payments as follows:

(a) If the money was returned by a hospital that is a member of Pool A, to hospitals in Pool B;

(b) If the money was returned by a hospital that is a member of Pool B, to hospitals in Pool C;

(c) If the money was returned by a hospital that is a member of Pool C, to hospitals in Pool D;

(d) If the money was returned by a hospital that is a member of Pool D, to hospitals in Pool E; or

(e) If the money was returned by a hospital that is a member of Pool E, to hospitals in Pool D.

Notes

Nev. Admin. Code § 422.155

Added to NAC by Div. of Health Care Fin. & Policy by R033-10, eff. 6-30-2010; A by R086-13, eff. 12/22/2014

NRS 422.390