26B-3-707. Medicaid hospital adjustment under accountable care organization rates.
| (1) |
To preserve and improve access to hospital services, the division shall incorporate into the accountable care organization rate structure calculation consistent with the certified actuarial rate range:
Terms Used In Utah Code 26B-3-707- Accountable care organization: means a managed care organization, as defined in 42 C. See Utah Code 26B-3-701
- CMS: means the Centers for Medicare and Medicaid Services within the United States Department of Health and Human Services. See Utah Code 26B-3-101
- Division: means the Division of Integrated Healthcare of the department. See Utah Code 26B-3-701
| (a) |
$154,000,000 to be allocated toward the hospital inpatient directed payments for the Medicaid eligibility categories covered in Utah before January 1, 2019; and |
| (b) |
an amount equal to the difference between payments made to hospitals by accountable care organizations for the Medicaid eligibility categories covered in Utah, based on submitted encounter data and the maximum amount that could be paid for those services to be used for directed payments to hospitals for inpatient and outpatient services. |
|
| (2) |
| (a) |
To preserve and improve the quality of inpatient and outpatient hospital services authorized under Subsection (1)(b), the division shall amend its quality strategies required by 42 C.F.R. § 438.340 to include quality measures selected from the CMS hospital quality improvement programs. |
| (b) |
To better address the unique needs of rural and specialty hospitals, the division may adopt different quality standards for rural and specialty hospitals. |
| (d) |
The division shall apply the same quality measures and penalties under this Subsection (2) to new directed payments made to the University of Utah Hospital and Clinics. |
|
Renumbered and Amended by Chapter 306, 2023 General Session
Amended by Chapter 495, 2023 General Session
