HB 636-FN-A – AS INTRODUCED

2011 SESSION

11-0839

09/01

HOUSE BILL 636-FN-A

AN ACT increasing the rate of the Medicaid enhancement tax, the nursing facility quality assessment fee, and the ICF quality assessment fee.

SPONSORS: Rep. Kurk, Hills 7

COMMITTEE: Ways and Means

ANALYSIS

This bill increases the rate of the Medicaid enhancement tax, the nursing facility quality assessment fee, and the ICF (intermediate care facility for the intellectually disabled) quality assessment fee.

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Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [in brackets and struckthrough.]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

11-0839

09/01

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Eleven

AN ACT increasing the rate of the Medicaid enhancement tax, the nursing facility quality assessment fee, and the ICF quality assessment fee.

Be it Enacted by the Senate and House of Representatives in General Court convened:

1 Medicaid Enhancement Tax. Amend RSA 84-A:2 to read as follows:

84-A:2 Imposition of Tax. A tax is imposed at a rate of [5.5] 6 percent upon the net patient services revenue of every hospital for the hospital's fiscal year ending during the first full calendar year preceding the taxable period.

2 Nursing Facility Quality Assessment Fee. Amend RSA 84-C:2 to read as follows:

84-C:2 Imposition of Fee. An assessment of [5.5] 6 percent of net patient services revenues is hereby imposed on all nursing facilities on the basis of patient days in each nursing facility. The fee shall be implemented in accordance with the provisions of 42 C.F.R. part 433.

3 ICF Quality Assessment Fee. Amend RSA 84-D:2 to read as follows:

84-D:2 Imposition of Fee. An assessment of [5.5] 6 percent of net patient services revenues is hereby imposed on all ICFs on the basis of patient days in each ICF. The fee shall be implemented in accordance with the provisions of 42 C.F.R. part 433.

4 Effective Date. This act shall take effect July 1, 2011.

LBAO

11-0839

Revised 02/14/11

HB 636 FISCAL NOTE

AN ACT increasing the rate of the Medicaid enhancement tax, the nursing facility quality assessment fee, and the ICF quality assessment fee.

FISCAL IMPACT:

The Departments of Health and Human Services and Revenue Administration state this bill will increase state restricted revenue and expenditures by $22,217,538 in FY 2012, $25,186,800 in FY 2013, $26,736,601 in FY 2014, and $28,410,387 in FY 2015. State unrestricted revenue will increase by $8,968,758 in FY 2012, $9,686,259 in FY 2013, $10,461,160 in FY 2014, and $11,298,052 in FY 2015. County revenue and expenditures will increase by $632,825 in FY 2012, and $860,638 in FY 2013 and each year thereafter. There will be no fiscal impact on local revenue and expenditures.

METHODOLOGY:

The Department of Health and Human Services states this bill increases the Medicaid provider tax rate from 5.5% to 6%. The Department assumes the increases in the Nursing Facility Quality Assessment, the ICF Quality Assessment, and the Medicaid Enhancement Tax will be effective on October 1, 2011 in order to comply with federal laws. The Department assumed a partial year for the Nursing Facility and ICF Quality Assessments in FY 2012 and projected future years at a level annual amount. Approximately 30% of the Nursing Facility Quality Assessment and 30% of the Medicaid Quality Incentive Payments (MQIP) will apply to the county nursing homes. The Department indicates that a $1 increase in the MQIP payment to county nursing homes results in a corresponding $0.50 decrease in the Proportionate Share payments to county nursing homes. The increase in the Medicaid Enhancement Tax would apply to all of FY 2012, and the Department assumed an 8% growth in the following years. Based on these assumptions, the Department estimates the fiscal impact will be as follows:

State Impact
Nursing Facility Quality Assessment	FY 2012	FY 2013	FY 2014	FY 2015
Federal Revenue 50%	$2,109,416	$2,868,794	$2,868,794	$2,868,794
Nursing Home Assessment Revenue	$2,109,416	$2,868,794	$2,868,794	$2,868,794
State Expenditures - MQIP Payments	($4,218,832)	($5,737,588)	($5,737,588)	($5,737,588)
Net Impact:	$0	$0	$0	$0
ICF Quality Assessment
Federal Revenue - 50%	$30,595	$38,347	$38,347	$38,347
ICF Assessment Revenue	$30,595	$38,347	$38,347	$38,347
State Expenditures - ICF Payments	($61,190)	($76,694)	($76,694)	($76,694)
Net Impact:	$0	$0	$0	$0
Medicaid Enhancement Tax
Federal Revenue - 50%	$8,968,758	$9,686,259	$10,461,160	$11,298,052
Hospital Tax Revenue	$17,937,516	$19,372,518	$20,922,319	$22,596,105
State Expenditures - Uncompensated Care	($17,937,516)	($19,372,518)	($20,922,319)	($22,596,105)
Net Impact:	$8,968,758	$9,686,259	$10,461,160	$11,298,052
Total State Impact
Total Federal Revenue - 50%	$11,108,769	$12,593,400	$13,368,301	$14,205,193
Total Assessment / Tax Revenue	$20,077,527	$22,279,659	$23,829,460	$25,503,246
State Expenditures to Hospitals, Nursing Facilities and ICFs	($22,217,538)	($25,186,800)	($26,736,601)	($28,410,387)
Total State Impact:	$8,968,758	$9,686,259	$10,461,160	$11,298,052

County Impact
Revenue receipt of MQIP payment	$1,265,650	$1,721,276	$1,721,276	$1,721,276
Reduction in ProShare Revenue	($632,825)	($860,638)	($860,638)	($860,638)
Expense for additional 1/2% Assessment	($632,825)	($860,638)	($860,638)	($860,638)
Net County Impact:	$0	$0	$0	$0

The Intermediate Care Facilities that are subject to the ICF Quality Assessment are non-profit organizations not operated by state, county or local governments, therefore, the ICF Quality Assessment and payments will have no fiscal impact on state, county or local revenue or expenditures.

The Department of Revenue Administration states this bill could be administered by the Department with existing resources. The Department estimated the increase in provider taxes from 5.5% to 6% would generate an additional $19,960,555 in state revenue. The Department is not able to determine the impact beyond FY 2012.