Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-5

Reduction in Hospital Payments

Notice of Proposed Rule

(Repeal)

DAR File No.: 33215
Filed: 11/24/2009 03:03:55 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

This repeal is necessary because the uniform reduction of hospital payments as stated in the rule has been incorporated into the ongoing base rates.

Summary of the rule or change:

This rule is repealed in its entirety.

State statutory or constitutional authorization for this rule:

• Section 26-18-3
• Section 26-1-5

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget because the uniform reduction of hospital payments as stated in the rule has simply been incorporated into the ongoing base rates.

local governments:

There is no impact to local governments because they do not reimburse hospitals for their services.

small businesses:

There is no impact to small businesses because the uniform reduction of hospital payments as stated in the rule has simply been incorporated into the ongoing base rates.

persons other than small businesses, businesses, or local governmental entities:

There is no impact to persons other than small businesses, businesses, or local government entities because the uniform reduction of hospital payments as stated in the rule has simply been incorporated into the ongoing base rates.

Compliance costs for affected persons:

There are no compliance costs because the uniform reduction of hospital payments as stated in the rule has simply been incorporated into the ongoing base rates.

Comments by the department head on the fiscal impact the rule may have on businesses:

This rule is obsolete and its repeal is expected to have no impact on regulated business. Public input will be carefully evaluated.

David N. Sundwall, MD Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Health Care Financing, Coverage and Reimbursement Policy
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at cdevashrayee@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

01/14/2010

This rule may become effective on:

01/21/2010

Authorized by:

David Sundwall, Executive Director

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

[R414-5. Reduction in Hospital Payments.

R414-5-1. Introduction and Authority.

This rule describes the Utah Medicaid Program's uniform reduction in hospital inpatient payments. This rule is authorized by Title 26, Chapter 18, Section 7, UCA.

 

R414-5-2. Hospital Reimbursements.

The Utah Medicaid Program reimburses hospital services based upon diagnosis for urban hospitals and based upon a percent-of-charges for rural hospitals as described in the UTAH STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM attachment 4:19A, Section 190.

 

R414-5-3. Inpatient Hospital Payments Reduced.

For payment claims related to discharges occurring after January 15, 2003, the following reductions will be applied:

(1) For state fiscal year 2003, which ends June 30, 2003, a pro-rata reduction shall be applied to all claims at a percentage that will generate a $4.6 million reduction in the amount that would otherwise be paid to hospitals for claims that apply during the state fiscal year 2003.

(2) For subsequent state fiscal years, the pro-rata reduction will be reduced to a level that will generate a $4.6 million reduction for claims that apply during the subsequent state fiscal year.

(3) The executive director, after consultation with hospital providers, shall set the percentage at the level that is predicted to generate the requisite savings. The executive director may adjust the percentage as necessary, after consultation with hospital providers.

 

KEY: Medicaid, hospital

Date of Enactment or Last Substantive Amendment: May 13, 2003

Notice of Continuation: May 13, 2008

Authorizing, and Implemented or Interpreted Law: 26-18]