Outpatient upper payment limit supplemental payments.

1. Law
2. Utah Code
3. Utah Health Code
4. Inpatient Hospital Assessment Act
5. Assessment and Collection
6. Outpatient upper payment limit supplemental payments.

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

Effective 5/8/2018
26-36b-210. Outpatient upper payment limit supplemental payments.

• (1) Beginning on the effective date of the assessment imposed under this chapter, 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).

• (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.

• (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:
  • (a) July 1, 2016;
  • (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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