Bill Text: HI SB1228 | 2020 | Regular Session | Introduced
Bill Title: Relating To The Hospital Sustainability Program.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2019-12-01 - Carried over to 2020 Regular Session. [SB1228 Detail]
Download: Hawaii-2020-SB1228-Introduced.html
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THE SENATE |
S.B. NO. |
1228 |
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THIRTIETH LEGISLATURE, 2019 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
RELATING TO THE HOSPITAL SUSTAINABILITY PROGRAM.
BE IT
ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION
1. The legislature finds that the hospital
sustainability program that was established in 2012 has
served a critical role in strengthening the health care system in Hawaii.
In the seven years since its inception, the hospital sustainability program has
helped acute care facilities treat the most vulnerable patients in the State,
especially low-income individuals who require hospital services. The program has been carried out in a
public-private partnership to ensure that patients in Hawaii can access quality,
affordable care.
The
legislature further finds that even with this program, hospitals in the State
face financial challenges. These
challenges are due in part to inadequate payments
from the medicaid program that do not cover the actual costs of care. Medicaid is jointly financed by the federal
and state governments by statutory formula.
The federal government pays between fifty per cent and seventy-four per
cent, with assistance levels determined by each state's per capita income. States with the lowest per capita income
receive higher federal matching rates.
Under federal rules, the state share must be paid from public funds that
are not federal funds. The legislature
finds that public funding to help financially sustain Hawaii's hospitals may be
accessed through a provider fee.
The legislature further finds that provider fees exist in
forty-nine states and the District of Columbia as a means of drawing down
federal funds to sustain medicaid programs due to rising state budget deficits,
increasing health care costs, and expanding medicaid enrollment. Provider fees, which are collected from
specific categories of health care providers that agree to the fee, may be
imposed on nineteen different classes of health care services, including inpatient
and outpatient hospital and nursing facility services.
The legislature additionally finds that, in Hawaii, a provider
fee on hospitals has resulted in substantial increases in
medicaid payments at a time when there are
constraints on the State's budget. The
additional federal funds obtained via the fee program authorized by the
hospital sustainability program have helped to reduce the amount of losses
incurred by hospitals and maintain access to care for medicaid recipients. This allows
hospitals in the state to continue to serve uninsured or under-insured patients
in a timely, effective manner, and helps to ensure the overall sustainability
of the healthcare system in the State.
The purpose of this Act is to preserve access to health care for
medicaid recipients by extending the hospital sustainability program.
SECTION 2. Section
346G-3, Hawaii Revised Statutes, is amended by amending the definition of
"private hospital", adding a definition of medicaid cost report, and
repealing the definition of "section 1115 waiver":
"Private hospital" means [those
non-public hospitals named in attachment A of the medicaid section 1115
demonstration waiver that were in operation in calendar year 2016 and are
currently operating or any hospitals not named in attachment A of the medicaid
section 1115 demonstration waiver that became private hospitals in calendar
year 2017 or 2018 and are] all currently operating[.]hospitals except for hospitals that are:
(1) Operated
by the Hawaii health systems corporation; or
(2) Charitable
hospitals funded primarily through donations or other non-insurance sources of
funding, and whose net patient revenue is less than forty per cent of operating
expenses, per the medicaid cost report.
["Section
1115 waiver" means the medicaid section 1115 demonstration waiver under
which the state medicaid program is operating.]"
SECTION
3. Section 346G-5, Hawaii Revised
Statutes, is amended by amending subsection (d) to read as follows:
"(d) The department shall exempt children's
hospitals, federal hospitals, public hospitals, and psychiatric hospitals from
the hospital sustainability fees on inpatient services. In addition, the department shall exempt from
the hospital sustainability fee on outpatient care services children's
hospitals, public hospitals, [rehabilitation hospitals, psychiatric
hospitals, and any hospitals with net outpatient revenues of less than
$57,000,000 per year based upon the hospital's medicare cost report for the
fiscal year ending three years prior to the state fiscal year for which the
hospital's net patient service revenue is calculated] and federal
hospitals; provided that the department may exclude any facility from the
hospital sustainability fee [on outpatient care services] if it is
determined that its exclusion is required to meet federal standards of
approval."
SECTION
4. Section 346G-10, Hawaii Revised
Statutes, is amended by amending subsection (b) to read as follows:
"(b) In accordance with title 42 Code of Federal
Regulations part 438, the department shall use revenues from the hospital
sustainability fee and federal matching funds to enhance the capitated rates
paid to medicaid managed care health plans for state fiscal years [2017-2018
and 2018-2019,] 2019-2020 and 2020-2021, consistent with the
following objectives:
(1) The rate enhancement shall be used exclusively
for increasing reimbursements to private hospitals to support the availability
of services and to ensure access to care to the medicaid managed care health
plan enrollees;
(2) The rate enhancement shall be made part of the
monthly capitated rates by the department to medicaid managed care health
plans, which shall provide documentation to the department and the hospital
trade association located in Hawaii certifying that the revenues received under
paragraph (1) are used in accordance with this section;
(3) The rate enhancement shall be actuarially
sound and approved by the federal government for federal fund participation;
(4) The rate enhancements shall be retroactive to
July 1, 2012, or the effective date approved by the federal government,
whichever is later. Retroactive rate
enhancements shall be paid within thirty days of notification by the Centers
for Medicare and Medicaid Services to the department of all necessary
approvals; and
(5) Payments made by the medicaid managed care
health plans shall be made within thirty business days upon receipt of
monthly capitation rates from the department."
SECTION
5. Section 346G-12, Hawaii Revised
Statutes, is amended by amending subsection (a) to read as follows:
"(a) Collection of the hospital sustainability fee
established by section 346G-5 shall be discontinued if:
1) The required federal approvals specified in section
346G‑7
are not granted or are revoked by the Centers for Medicare and Medicaid
Services;
(2) The department reduces funding for hospital
services below the state appropriation in effect as of July 1, [2012;] 2020;
(3) The department or any other state agency uses
the money in the hospital sustainability program special fund for any use other
than the uses permitted by this chapter; or
(4) Federal financial participation to match the
revenue from the hospital sustainability fee becomes unavailable under federal
law; provided that the department shall terminate the imposition of the
hospital sustainability fee beginning on the date the federal statutory,
regulatory, or interpretive change takes effect."
SECTION
6. Act 217, Session Laws of Hawaii 2012,
as amended by section 2 of Act 141, Session Laws of Hawaii 2013, as amended by
section 2 of Act 123, Session Laws of Hawaii 2014, as amended by section 2 of
Act 70, Session Laws of Hawaii 2015, as amended by section 3 of Act 60, Session
Laws of Hawaii 2016, and as amended by section 5 of Act 59, Sessions Laws of
Hawaii 2017, is amended by amending section 5 to read as follows:
"SECTION
5. This Act shall take effect on July 1,
2012, and shall be repealed on June 30, [2019;] 2021; provided
that section ‑4, Hawaii Revised Statutes, in section 2
of this Act, and the amendment to section 36-30(a), Hawaii Revised [Statues,]
Statutes, in section 3 of this Act, shall be repealed on December 31, [2019.]
2021."
SECTION
7. Act 123, Session Laws of Hawaii 2014,
as amended by section 3 of Act 70, Session Laws of Hawaii 2015, as amended by
section 4 of Act 60, Session Laws of Hawaii 2016, and as amended by section 6
of Act 59, Session Laws of Hawaii 2017, is amended by amending section 7 to
read as follows:
"SECTION
7. This Act shall take effect on June
29, 2014; provided that:
(1) Section 5 shall take effect on July 1, 2014;
and
(2) The amendments made to sections 36-27(a) and
36-30(a), Hawaii Revised [Statues,] Statutes, in sections 3 and 4
of this Act shall be repealed on December 31, [2019.] 2021."
SECTION
8. There is appropriated out of the
hospital sustainability program special fund the sum of $75,000,000 or so much
thereof as may be necessary for fiscal year 2019-2020 and the same sum or so
much thereof as may be necessary for fiscal year 2020-2021 for the purposes of
the hospital sustainability program special fund.
The
sums appropriated shall be expended by the department of human services for the
purposes of this Act.
SECTION
9. Statutory material to be repealed is
bracketed and stricken. New statutory
material is underscored.
SECTION
10. This Act, upon its approval, shall
take effect on June 29, 2019; provided that section 7 of this Act shall take
effect on July 1, 2019.
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INTRODUCED BY: |
_____________________________ |
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BY REQUEST |
Report Title:
Hospital Sustainability Program; Appropriation
Description:
Continues the Hospital Sustainability Program for two years. Appropriates funds out of the Hospital Sustainability Program Special Fund for fiscal years 2019-2020 and 2020-2021.
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.
