26B-3-510. Hospital reimbursement.
| (1) |
If the health coverage improvement program, the enhancement waiver program, or the Medicaid waiver expansion is implemented by contracting with a Medicaid accountable care organization, the department shall, to the extent allowed by law, include, in a contract to provide benefits under the health coverage improvement program, the enhancement waiver program, or the Medicaid waiver expansion, a requirement that the Medicaid accountable care organization reimburse hospitals in the accountable care organization’s provider network at no less than the Medicaid fee-for-service rate. |
Terms Used In Utah Code 26B-3-510
- Contract: A legal written agreement that becomes binding when signed.
- 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
- Health coverage improvement program: means the health coverage improvement program described in Section 26B-3-207. See Utah Code 26B-3-501
- Medicaid accountable care organization: means a managed care organization, as defined in 42 C. See Utah Code 26B-3-501
- Medicaid waiver expansion: means a Medicaid expansion in accordance with Section 26B-3-113 or 26B-3-210. See Utah Code 26B-3-501
| (2) |
If the health coverage improvement program, the enhancement waiver program, or the Medicaid waiver expansion is implemented by the department as a fee-for-service program, the department shall reimburse hospitals at no less than the Medicaid fee-for-service rate. |
| (3) |
Nothing in this section prohibits a Medicaid accountable care organization from paying a rate that exceeds the Medicaid fee-for-service rate. |
Renumbered and Amended by Chapter 306, 2023 General Session
