26B-3-511. Outpatient upper payment limit supplemental payments.
| (1) |
Beginning on the effective date of the assessment imposed under this part, and for each subsequent fiscal year, the department shall implement an outpatient upper payment limit program for private hospitals that shall supplement the reimbursement to private hospitals in accordance with Subsection (2). |
Terms Used In Utah Code 26B-3-511
- Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
- Assessment: means the inpatient hospital assessment established by this part. See Utah Code 26B-3-501
- Division: means the Division of Integrated Healthcare within the department. 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
- 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
| (2) |
The division shall ensure that supplemental payment to Utah private hospitals under Subsection (1):
| (a) |
does not exceed the positive upper payment limit gap; and |
| (b) |
is allocated based on the Medicaid state plan. |
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| (3) |
The department shall use the same outpatient data to allocate the payments under Subsection (2) and to calculate the upper payment limit gap. |
| (4) |
The supplemental payments to private hospitals under Subsection (1) are payable for outpatient hospital services provided on or after the later of:
| (b) |
the effective date of the Medicaid state plan amendment necessary to implement the payments under this section; or |
| (c) |
the effective date of the coverage provided through the health coverage improvement program waiver. |
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Renumbered and Amended by Chapter 306, 2023 General Session
