Hospital financing of health coverage improvement program Medicaid waiver expansion -- Hospital share.

  1. Law
  2. Utah Code
  3. Utah Health Code
  4. Inpatient Hospital Assessment Act
  5. Assessment and Collection
  6. Hospital financing of health coverage improvement program Medicaid waiver expansion -- Hospital share.

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Affected by 63I-1-226 on 7/1/2024

Effective 5/12/2020
26-36b-204. Hospital financing of health coverage improvement program Medicaid waiver expansion -- Hospital share.
  • (1) The hospital share is:
    • (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 26-18-411;
    • (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 chapter 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 26-18-3.9(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.




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