SB 13

Abstract

Healthcare facility assessments are currently the second largest source of funding for states’ shares of Medicaid costs, behind general funds. Today, 49 states have at least one facility assessment in place, including Delaware, while 34 states and Washington D.C. have 3 or more provider taxes. Delaware is one of only 6 states without a facility assessment on hospitals, causing the state to miss out on critical Medicaid funding that most states are already able to access. This Act is a substitute for Senate Bill No. 13. Like Senate Bill No. 13, this Act creates the Hospital Quality Assessment, which places a 3.58% assessment on Delaware hospitals’ net patient revenues. Funds generated by the Hospital Quality Assessment must be utilized in one of two ways: (1) To increase the inpatient and outpatient payments to hospitals. (2) To develop or enhance funding for Medicaid initiatives, unlocking federal matching dollars. Funds may not be used to supplant or replace appropriations for programs in existence on the effective date of this Act, except for 25% of these funds, which may be used to support the general operations of the Medicaid program. Like Senate Bill No. 13, this Act also creates the Hospital Quality and Health Equity Assessment Commission (“Commission”), which includes state agency and hospital representation. The Commission is required to meet at least annually to monitor the implementation of the assessment. If the Centers for Medicare & Medicaid Services (CMS) determines that either the assessment or the expenditure of money does not satisfy eligibility requirements for federal financial participation or that modifications are necessary to assure continued eligibility for federal financial participation, the Commission shall develop and approve modifications to Subchapters II and III of Chapter 10 of Tile 16 of the Delaware Code and submit the modifications to the General Assembly. This Act differs from Senate Bill No. 13 as follows: (1) By directing the Department of Health and Social Services (“Department”) to administer the Hospital Quality Assessment. (2) By establishing a different method of calculating the assessment for a hospital that begins or ceases hospital operations or does not conduct hospital operations through a calendar year or fiscal year. (3) By prohibiting a hospital subject to the Hospital Quality Assessment from passing on the cost of the assessment to any patient, insurer, self-insured program, or other responsible party. (4) By requiring a hospital subject to the Hospital Quality Assessment to attest in writing to the Department that an oral or written, formal or informal agreement or arrangement does not exist to share, redirect, or redistribute Medicaid payments which would result in violation of federal or state law. (5) By updating the split in percentages of the funds collected from the Hospital Quality Assessment to reflect the wide range of federal match levels for services. The expected amount to be collected by the Assessment does not change as the result of the update. (6) By requiring the Registrar of Regulations to publish in the Register of Regulations a certification by the Commission under § 1034(d) and (e) of Title 16 of the Delaware Code, as contained in this Act. (7) By providing that appointments of members of the Minority Caucus of the House of Representatives and Senate are to be made by the Speaker of the House of Representatives and President Pro Tempore of the Senate, respectively. (8) By making modifications to the requirements for meetings of the Commission. (9) By providing that modifications to Subchapters II and III of Chapter 10 of Tile 16 of the Delaware Code recommended by the Commission take effect as of July 1 of the ensuing fiscal year unless rejected in full by an act of the General Assembly before that ensuing fiscal year. This Act requires a greater than majority vote for passage because § 11 of Article VIII of the Delaware Constitution requires the affirmative vote of three-fifths of the members elected to each house of the General Assembly to impose or levy a tax or license fee. This Act may be cited as the “Protect Medicaid Act of 2024”.