Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-506

Hospital Provider Assessments

Notice of Proposed Rule

(New Rule)

DAR File No.: 33871
Filed: 07/29/2010 02:23:33 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this new rule is to implement the Hospital Provider Assessment Act in accordance with S.B. 273 of the 2010 General Session of the Utah Legislature. (DAR NOTE: S.B. 273 (2010) is found at Chapter 179, Laws of Utah 2010, and was effective 05/11/2010.)

Summary of the rule or change:

This new rule outlines hospital provider assessments that include hospital audit procedures, notice requirements, payment requirements, and penalties for non-compliance. It also lists the duties of the Hospital Policy Review Board, specifies rule repeal based on the repeal of the assessment, and specifies that the rule is retrospective to 01/01/2010.

State statutory or constitutional authorization for this rule:

• Section 26-18-3

Anticipated cost or savings to:

the state budget:

The Department does not anticipate any impact to the General Fund because this change only implements a hospital provider assessment that will provide necessary matching funds.

local governments:

There is no impact to local governments because they do not fund or provide hospital assessments for the Medicaid program.

small businesses:

Inpatient hospitals may see a total increase of approximately $56,000,000 in revenue.

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

Inpatient hospitals may see a total increase of approximately $56,000,000 in revenue.

Compliance costs for affected persons:

Compliance costs should be minimal for those participating in this program and insignificant compared to the revenue. Great effort was made to implement a streamlined simple program for providers.

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

Net fiscal impact of program should be positive for providers by increasing reimbursement rates.

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 [email protected]

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:

09/14/2010

This rule may become effective on:

09/21/2010

Authorized by:

David Sundwall, Executive Director

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

R414-506. Hospital Provider Assessments.

R414-506-1. Introduction and Authority.

This rule defines the scope of hospital provider assessment. This rule is authorized under Title 26, Chapter36a and governs the services allowed under 42 CFR 447.272.

 

R414-504-2. Definitions.

The definitions in Section 26-36a-103 apply to this rule.

 

R414-506-3. Audit of Hospitals.

(1) For hospitals that do not file a Medicare cost report for the time frames outlined in Subsection 26-36a-203(3) and (4), the Department of Health shall audit the hospital's records to determine the correct discharges for the assessment.

(2) Hospitals subject to the assessment shall make their records available for reasonable inspection upon written request from the Department. Failure to make the records available shall be considered non-compliance and subject the hospital to penalties set forth in Section R414-506-5.

 

R414-506-4. Change in Hospital Status.

(1) If a hospital's status changes during any given year and it no longer falls under the definition of a hospital that is subject to the assessment outlined in Section 26-36a-204 or is no longer entitled to Medicaid hospital access payments under Section 26-36a-205, the hospital must submit in writing to the Division of Medicaid and Health Financing (DMHF) a notice of the status change and the effective date of that change. The notice must be mailed to the correct address, as follows, and is only effective upon receipt by the Reimbursement Unit:

Via United States Postal Service:

Utah Department of Health

DMHF, BCRP

Attn: Reimbursement Unit

P.O. Box 143102

Salt Lake City, UT 84114-3102

Via United Parcel Service, Federal Express, and similar:

Utah Department of Health

DMHF, BCRP

Attn: Reimbursement Unit

288 North 1460 West

Salt Lake City, UT 84116-3231

(2) For any period where a hospital is no longer subject to the assessment and notice has been given under Subsection R414-506-4 (1):

(a) the Department shall require payment of the assessment from that hospital for the full quarter in which the status change occurred and the hospital will receive full payment for the applicable quarter; and

(b) the hospital is exempt from future assessment and not eligible for payment under this rule.

(3) Facilities not subject to the assessment or payments outlined in this rule as of January 1, 2010, are not eligible to receive Medicaid hospital inpatient access payments.

 

R414-506-5. Penalties and Interest.

(1) If DMHF audits a hospital's records to determine the correct discharges for the assessment for a hospital that is required to file a Medicare cost report but failed to provide its Medicare cost report within the timeline required, DMHF shall fine the hospital five percent of its annual calculated assessment. The fine is payable within 30 days of invoice.

(2) If DMHF audits a hospital's records to determine the correct discharges for the assessment because the hospital does not file a Medicare cost report and did not submit its discharges and supporting documentation within the timeline required, DMHF shall fine the hospital five percent of its annual calculated assessment. The fine is payable within 30 days of invoice.

(3) If a hospital fails to fully pay its assessment on or before the due date, DMHF shall fine the hospital five percent of its quarterly calculated assessment. The fine is payable within 30 days of invoice.

(4) On the last day of each quarter, if a hospital has any unpaid assessment or penalty, DMHF shall fine the hospital five percent of the unpaid amount. The fine is payable within 30 days of invoice.

 

R414-506-6. State Plan Amendment -- Hospital Policy Review Board.

(1) The Hospital Policy Review Board is established under Subsection 26-36a-209(3). It shall serve as an advisory board to DMHF.

(2) The Division Director shall act on behalf of the Executive Director of the Utah Department of Health regarding all Hospital Policy Review Board issues.

(3) DMHF shall appoint a non-voting board member who will manage the Hospital Policy Review Board.

(4) Other individuals of DMHF, as appointed by the Division Director, are non-voting ex-officio advisory members of the Hospital Policy Review Board.

(5) The board shall:

(a) review State Plan Amendments or waivers affecting hospital reimbursement between the date of enactment of this chapter and the end of State Fiscal Year 2013; and

(b) review adjustments to the payment rates for State Fiscal Years 2012 and 2013.

(6) If a board member is unable to serve, DMHF shall fill the vacancy using the same method that it originally used to appoint the board position.

 

R414-506-7. Rule Repeal.

The Department shall repeal this rule in conjunction with the repeal of the Hospital Provider Assessment Act outlined in Section 26-36a-208.

 

R414-506-8. Retrospective Operation.

This rule has retrospective operation for taxable years beginning on or after January 1, 2010, as authorized under Section 14 of the 2010 Hospital Provider Assessment Act.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: 2010

Authorizing, and Implemented or Interpreted Law: 26-1-5; 26-18-3; 26-36a