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Budget committee to look 'very, very closely' at proposed hike in Medicaid rates, chair says

Megan Messerly
Megan Messerly
Health CareLegislature
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Assembly Ways and Means Chair Maggie Carlton indicated Wednesday that discretionary Medicaid rate increases for neonatal and pediatric intensive care unit services proposed by Gov. Steve Sisolak and pushed by Nevada’s largest children’s hospital won’t be rubber stamped by the Legislature.

At a pre-session budget meeting, the Democratic assemblywoman told Medicaid officials that lawmakers will need “a lot of data” as they begin digging into whether to approve the recommended 15 percent increase to the per diem rate for pediatric intensive care unit (PICU) care and 25 percent increase to the per diem rate for neonatal intensive care unit (NICU) care that Sisolak, a Democrat, announced last week during his State of the State address. Sunrise Hospital, which provides care to some of Southern Nevada’s sickest babies in its NICU and PICU, launched a public awareness campaign in November to pressure lawmakers to raise the two rates.

“Our job in Ways and Means and the health care subcommittee is going to be really to dig into the numbers to make sure we have the correct numbers. So I just want you to be prepared for that as we move forward with those discretionary rate increases,” Carlton told Medicaid officials at the meeting. “Just putting everyone on notice that we’re going to go through this very, very closely.”

In an interview, Carlton said she received “mass emails” from the Sunrise campaign and would have preferred a direct conversation about the issue first. But hospital officials said last month that they decided to take their concerns directly to Nevadans in advance of the upcoming legislative session after years of inaction by lawmakers.

The campaign, called Every Baby Counts NV, includes a website that highlights the work the hospital does to care for some of the state’s sickest babies and urges Nevadans to send letters to their lawmakers with the click of a button, as well as a social media campaign on Facebook, Twitter and Instagram.

Sunrise Hospital CEO Todd Sklamberg, speaking in public comment at the Wednesday meeting, said he was grateful for the funding bumps in the budget and asked for lawmakers’ support, too. He told lawmakers that the hospital “simply cannot sustain” $77 million a year in losses on Medicaid patients.

“I am greatly appreciative of the governor’s inclusion of the increased Medicaid reimbursement for neonatal and pediatric intensive care unit services in the executive budget,” Sklamberg said. “I ask not only for your support for this funding but also for your support for higher reimbursement rates for hospitals like Sunrise Hospital so we can continue to provide the best care for everyone in our state.”

Carlton told The Nevada Independent that she applauded the governor’s inclusion of the rate bumps in his budget and that the budget committee will do its due diligence reviewing the proposed rate increases.

“Once you start something like this you can’t stop or say ‘whoa’ because you have people relying on it. You’ve got to make sure that it’s as accurate and complete as possible, and we will have the time in the health care subcommittee to dig deep,” Carlton said. “If it’s discretionary, we’ve got to make sure that we know exactly what we’re funding.”

Part of that review will include comparing Nevada’s rates to those in other states, though Carlton noted that Nevada’s hospital pool differs from that of other states because of a high concentration of for-profit hospitals. Sunrise and its affiliated children's hospital are two of the four hospitals in Las Vegas owned by the for-profit Hospital Corporation of America, or HCA.

“We do have to look at things a little bit differently, but those hospitals serve our constituents. Some of them serve very underserved populations in the city. We need to weigh all of those factors,” Carlton said. “Whether they’re for profit or not, they are serving certain populations and we need to be able to evaluate and address the need of those populations and the impact that they have on the hospital service delivery in those areas.”

She added that the NICU and PICU rates are only a small part of the overall health-care budget conversation. For instance, she said she would like to know how many Medicaid babies in the NICU or PICU didn’t receive prenatal care because their mom didn’t have health insurance because she was undocumented.

“We’ve got to go find those individual pieces and build the corners and the edges of the puzzle,” Carlton said. “That’s what the Legislature does. That’s what Ways and Means does. It’s nothing different than we’ve done before.”

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