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Measure to enhance Medicaid reimbursements touted as big help for little hospitals 


by Camalot Todd, Nevada Current

A bill for expanding state Medicaid reimbursement for rural hospitals received bipartisan support despite an increase in cost for Nevada at a Senate Finance Committee meeting last week.

The bill, Senate Bill 241, would require Nevada Medicaid to pay the hospitals the cost of the service for outpatient services and administratively flexible “swing beds” for rural hospitals that are designated as Critical Access Hospitals (CAH). Currently, the hospitals are only reimbursed at cost for in-patient services.

There are 13 Critical Access Hospitals in rural Nevada, which serve 250,000 people and cover the bulk of the state’s land mass. CAHs provide health care services to Medicare and Medicaid populations in rural and underserved areas. The facilities must meet certain criteria, like offering 24/7 emergency care services in communities that are 35 miles away from the nearest hospitals and having 25 or fewer beds. 

Swing beds were created in the 1970s after rural hospitals had the wrong number of beds for the wrong level of care. With swing beds, a hospital can offer acute or Skilled Nursing Facility (SNF) care for the same bed, allowing a patient to stay in one place to receive care,  and providers to receive Medicare and Medicaid reimbursement funding at cost for both inpatient and outpatient care.

The federal Centers for Medicare and Medicaid Services (CMS) “does this because they realize it is vital to keep these small, rural hospitals open and provide services to their communities,” said Republican state Sen. Robin Titus, a doctor and one of the bill’s sponsors, during last week’s hearing. Rural hospitals “should not be taking a loss for providing services to our Medicare and Medicaid recipients,” said Titus, who has four of the state’s 13 CAHs in her senate district, which covers Churchill, Douglas, Esmeralda, Lyon, and Mineral counties as well as part of Nye County. 

Annually, all CAHs in the state have a 25% loss for providing care, Titus said.

“This bill will go a long way in ensuring that we don’t have any of our Critical Access Hospitals at risk of closing and that they will remain in our communities,” she said.

The bill for changing the reimbursement rate for swing beds and outpatient services would cost $2.6 million for the fiscal year 2023-2024, over $6 million for the following fiscal year, and an estimated $12.1 million in future bienniums, according to a fiscal note submitted by the Department of Health and Human Services (HHS).  

HHS also estimates use of services will increase by 90% “because of the low reimbursement rates paid by Nevada Medicaid for these services and the associated low usage of these services by CAHs today.”

All members of the Senate Health and Human Services Committee are sponsors of the bill, which is also supported by AARP Nevada and several rural hospitals.

No one testified in opposition to the bill during the hearing. 

Nevada Current
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