Nevada Administrative Code Chapter 428 - Hospital Care for Indigent Persons
Overview of NAC Chapter 428
Chapter 428 governs the provision of hospital care to indigent persons in Nevada, with the purpose of:
Ensuring that low-income individuals have access to necessary medical services.
Setting eligibility criteria for indigent care.
Establishing hospital responsibilities for billing, reporting, and treatment.
Defining penalties or corrective measures for noncompliance.
Hospitals that receive public funds or operate within certain jurisdictions must follow these rules.
Case 1: Eligibility Misclassification
Scenario
A 45-year-old patient applies for indigent care after losing their job. The hospital staff initially denies coverage, stating the patient earns too much, without reviewing detailed income documentation.
NAC 428 Requirement
Hospitals must verify income and financial resources according to NAC guidelines.
Denial cannot be arbitrary and must be based on actual documented eligibility.
What Happens
The patient appeals the decision.
The hospital reviews tax returns, bank statements, and household size.
Result
The patient qualifies for partial coverage.
Hospital provides necessary treatment and adjusts billing.
Hospital staff receive retraining on proper eligibility assessment.
Key Principle
Eligibility must be fair, documented, and verifiable; hospitals cannot deny care without proper review.
Case 2: Emergency Treatment Before Verification
Scenario
A homeless individual arrives with severe chest pain. Staff begin treatment but have no documentation of indigent status.
NAC 428 Requirement
Hospitals cannot delay emergency care pending eligibility verification.
Initial stabilization must be provided immediately.
What Happens
The patient receives life-saving care.
After stabilization, the hospital begins indigent care verification.
Result
Treatment is covered under indigent care provisions.
Hospital documents compliance with emergency treatment rules.
Key Principle
NAC 428 prioritizes immediate patient care over paperwork in emergencies.
Case 3: Improper Billing Practices
Scenario
A hospital bills an indigent patient for 50% of a covered procedure, claiming administrative costs, even though NAC 428 caps patient responsibility at a lower percentage.
NAC 428 Requirement
Hospitals must adhere to the cost-sharing and billing limits defined in NAC 428.
Overcharging or ignoring the maximum allowed patient contribution is prohibited.
What Happens
Patient files a complaint with the Nevada Division of Health and Human Services.
Audit confirms the billing error.
Result
Hospital must refund the overcharged amount.
Administrative penalty may be applied.
Hospital updates billing procedures to comply with NAC rules.
Key Principle
Hospitals are legally responsible for accurate billing under indigent care regulations.
Case 4: Denial of Specialty Services
Scenario
An indigent patient requires a specialist consultation, but the hospital refuses because it claims the service is “non-essential.”
NAC 428 Requirement
Hospitals must provide medically necessary care, including specialty services, if the condition is serious or urgent.
Refusal is allowed only if care is not medically necessary or unavailable locally.
What Happens
Patient appeals through state channels.
A medical review board determines the consultation is essential for proper treatment.
Result
Hospital arranges specialist care under indigent coverage.
Policy revised to ensure specialty care requests are properly evaluated.
Key Principle
NAC 428 ensures all necessary medical services are available to eligible patients.
Case 5: Failure to Maintain Records
Scenario
A hospital provides indigent care but fails to maintain documentation of patient eligibility, treatment, and costs.
NAC 428 Requirement
Hospitals must keep detailed records of all indigent care provided for audits and compliance purposes.
What Happens
During a routine audit, the hospital cannot verify several claims for reimbursement or compliance.
Result
Hospital is fined and ordered to implement proper record-keeping systems.
Staff training is required to prevent future violations.
Key Principle
Accurate record-keeping is essential for transparency, auditing, and accountability.
Case 6: Delayed Approval Leading to Complications
Scenario
A patient applies for indigent care for urgent surgery. Hospital delays approval for two weeks while waiting for paperwork, resulting in worsening of the patient’s condition.
NAC 428 Requirement
Hospitals must process applications promptly.
Delay cannot endanger the patient’s health.
What Happens
The state investigates the delay.
Hospital acknowledges procedural flaws.
Result
Patient receives full coverage for surgery.
Hospital implements a fast-track process for urgent cases.
Administrative penalties applied for failure to follow timely procedures.
Key Principle
NAC 428 emphasizes timeliness in processing applications, especially when delays threaten health.
Case 7: Misuse of Funds Allocated for Indigent Care
Scenario
A hospital receives state funds to cover indigent care but uses them to renovate administrative offices.
NAC 428 Requirement
Funds must be used exclusively for providing care to eligible patients.
What Happens
Audit reveals misuse of funds.
State imposes corrective action and requires repayment.
Result
Hospital returns misallocated funds.
Staff receive ethics and compliance training.
Future funding contingent on proper financial management.
Key Principle
NAC 428 ensures that public resources are used appropriately to serve vulnerable populations.
Summary of Core Themes in NAC Chapter 428 Cases
Eligibility verification – fair, documented, non-discriminatory.
Immediate care in emergencies – cannot delay for paperwork.
Accurate billing and cost-sharing – overcharging is prohibited.
Provision of medically necessary services – specialty care included.
Record-keeping and compliance – critical for audits and accountability.
Timely application processing – delays should not harm patients.
Proper use of allocated funds – financial accountability is mandatory.
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