Nebraska § 68-2106 - Hospital Quality Assurance and Access Assessment Fund; created; use; investment; department; duties; medicaid managed care organizations; hospitals; prohibited acts.

§ 68-2106. Hospital Quality Assurance and Access Assessment Fund; created; use; investment; department; duties; medicaid managed care organizations; hospitals; prohibited acts.

(1) The Hospital Quality Assurance and Access Assessment Fund is created. Interest earned on the fund shall be credited to the fund. Any money in the fund available for investment shall be invested by the state investment officer pursuant to the Nebraska Capital Expansion Act and the Nebraska State Funds Investment Act.

(2) The department shall use the Hospital Quality Assurance and Access Assessment Fund, including the matching federal financial participation, for the purpose of enhancing rates paid to hospitals under the medical assistance program except as allowed by subsection (3) of this section. Money in the fund shall not be used to replace or offset existing state funds paid to hospitals for providing services under the medical assistance program.

(3) The Hospital Quality Assurance and Access Assessment Fund shall also be used to:

(a) Reimburse the General Fund the amount of the first quarterly payment on or before June 30 of each fiscal year;

(b) Reimburse the department an administrative fee of three percent of the assessment, not to exceed fifteen million dollars per year, to collect assessments and administer directed-payment programs established by the Hospital Quality Assurance and Access Assessment Act;

(c) Provide the Nebraska Center for Nursing Board one-half of one percent of the assessment, not to exceed two million five hundred thousand dollars per year, for the expansion of clinical nursing training sites as authorized in subsection (3) of section 71-1798; and

(d) Provide funding of three and one-half percent of the assessment, not to exceed seventeen million five hundred thousand dollars per year, for rates for nonhospital providers in the medical assistance program, continuous eligibility for children, or the designated health information exchange authorized in section 81-6,125.

(4) In calculating rates, the proceeds from assessments and federal match not utilized under subsection (3) of this section shall be used to enhance rates for hospital inpatient and outpatient services in addition to any funds appropriated by the Legislature.

(5) The department shall collect data for revenue, discharge, and inpatient days from a hospital that does not file an annual medicare cost report. At the request of the department, a hospital that does not file an annual medicare cost report shall submit such requested data to the department.

(6) The department shall prohibit a medicaid managed care organization from (a) setting, establishing, or negotiating reimbursement rates with a hospital in a manner that takes into account, directly or indirectly, a directed payment that a hospital receives under the Hospital Quality Assurance and Access Assessment Act, (b) unnecessarily delaying a directed payment to a hospital, or (c) recouping or offsetting a directed payment for any reason.

(7)(a) A hospital shall not:

(i) Set, establish, or negotiate reimbursement rates with a managed care organization in a manner that directly or indirectly takes into account a directed payment that a hospital receives under the Hospital Quality Assurance and Access Assessment Act; or

(ii) Directly pass on the cost of an assessment to patients or nonmedicaid payors, including as a fee or rate increase.

(b) A hospital that violates this subsection shall not receive a directed payment for the remainder of the rate year. This subsection shall not be construed to prohibit a hospital from negotiating with a payor for a rate increase.