26B-3-506. Hospital financing of health coverage improvement programMedicaid waiver expansion — Hospital share.
(1)
The hospital share is:
Terms Used In Utah Code 26B-3-506
Assessment: means the inpatient hospital assessment established by this part. See Utah Code 26B-3-501
Dependent: A person dependent for support upon another.
Discharges: means the number of total hospital discharges reported on:
(a)
Worksheet S-3 Part I, column 15, lines 14, 16, and 17 of the 2552-10 Medicare cost report for the applicable assessment year; or
(b)
a similar report adopted by the department by administrative rule, if the report under Subsection (3)(a) is no longer available. See Utah Code 26B-3-501
Enhancement waiver program: means the program established by the Primary Care Network enhancement waiver program described in Section 26B-3-211. See Utah Code 26B-3-501
Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
Health coverage improvement program: means the health coverage improvement program described in Section 26B-3-207. See Utah Code 26B-3-501
State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
State teaching hospital: means a state owned teaching hospital that is part of an institution of higher education. See Utah Code 26B-3-501
Upper payment limit gap: means the difference between the private hospital outpatient upper payment limit and the private hospital Medicaid outpatient payments, as determined in accordance with 42 C. See Utah Code 26B-3-501
(a)
45% of the state‘s net cost of the health coverage improvement program, including Medicaid coverage for individuals with dependent children up to the federal poverty level designated under Section 26B-3-207;
(b)
45% of the state’s net cost of the enhancement waiver program;
(c)
if the waiver for the Medicaid waiver expansion is approved, $11,900,000; and
(d)
45% of the state’s net cost of the upper payment limit gap.
(2)
(a)
The hospital share is capped at no more than $13,600,000 annually, consisting of:
(i)
an $11,900,000 cap for the programs specified in Subsections (1)(a) through (c); and
(ii)
a $1,700,000 cap for the program specified in Subsection (1)(d).
(b)
The department shall prorate the cap described in Subsection (2)(a) in any year in which the programs specified in Subsections (1)(a) and (d) are not in effect for the full fiscal year.
(3)
Private hospitals shall be assessed under this part for:
(a)
69% of the portion of the hospital share for the programs specified in Subsections (1)(a) through (c); and
(b)
100% of the portion of the hospital share specified in Subsection (1)(d).
(4)
(a)
In the report described in Subsection 26B-3-113(8), the department shall calculate the state’s net cost of each of the programs described in Subsections (1)(a) through (c) that are in effect for that year.
(b)
If the assessment collected in the previous fiscal year is above or below the hospital share for private hospitals for the previous fiscal year, the underpayment or overpayment of the assessment by the private hospitals shall be applied to the fiscal year in which the report is issued.
(5)
A Medicaid accountable care organization shall, on or before October 15 of each year, report to the department the following data from the prior state fiscal year for each private hospital, state teaching hospital, and non-state government hospital provider that the Medicaid accountable care organization contracts with:
(a)
for the traditional Medicaid population:
(i)
hospital inpatient payments;
(ii)
hospital inpatient discharges;
(iii)
hospital inpatient days; and
(iv)
hospital outpatient payments; and
(b)
if the Medicaid accountable care organization enrolls any individuals in the health coverage improvement program, the enhancement waiver program, or the Medicaid waiver expansion, for the population newly eligible for any of those programs:
(i)
hospital inpatient payments;
(ii)
hospital inpatient discharges;
(iii)
hospital inpatient days; and
(iv)
hospital outpatient payments.
(6)
The department shall, by rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, provide details surrounding specific content and format for the reporting by the Medicaid accountable care organization.
Renumbered and Amended by Chapter 306, 2023 General Session
