Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-506

Hospital Provider Assessments

Notice of Proposed Rule

(Amendment)

DAR File No.: 36101
Filed: 04/27/2012 11:30:34 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to implement the Hospital Provider Assessment Act in accordance with S.B. 179 of the 2012 General Session of the Utah Legislature and to update the rule to allow new providers.

Summary of the rule or change:

This rule change removes the wording that limits which facilities are subject to the assessment or payments as of a specific date. It also corrects a citation in the rule.

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:

The impact of this change is unknown as the assessment amounts collected from providers is limited to the annual upper payment limit gap of which changes each year and will also change based on new hospitals entering the program. The change in payments made to providers as a result of this assessment will change also. The impact of that change is unknown until such time as new providers are added to the upper payment limit gap calculation and the assessment then determined.

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

The impact of this change is unknown as the assessment amounts collected from providers is limited to the annual upper payment limit gap of which changes each year and will also change based on new hospitals entering the program. The change in payments made to providers as a result of this assessment will change also. The impact of that change is unknown until such time as new providers are added to the upper payment limit gap calculation and the assessment then determined.

Compliance costs for affected persons:

Hospitals that are new to this program will realize assessment costs, but will likely also see revenues generated from the payments made as a result of the overall provider assessment. The impact of that change is unknown until such time as new providers are added to the upper payment limit gap calculation and the assessment then determined.

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

These changes reflect appropriation actions of the Utah Legislature for funding of the Medicaid program and will permit continued reimbursement levels to providers subject to the assessment at agreed upon levels.

David Patton, PhD, 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
CANNON HEALTH BLDG
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:

06/14/2012

This rule may become effective on:

07/01/2012

Authorized by:

David Patton, Executive Director

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

R414-506. Hospital Provider Assessments.

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-20[4]3 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.]For State Fiscal Year 2013 and subsequent years, prior to the beginning of each state fiscal year, the Department shall determine if new providers are eligible to receive Medicaid hospital inpatient access payments. The new providers will also be subject to the assessment beginning that same state fiscal year as they become eligible to receive the Medicaid hospital inpatient access payments. New providers identified will be added prospectively beginning with that new state fiscal year (e.g., a May 2012 evaluation identifying new providers will result in those new providers being added July 2012).

 

[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]6. 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]7. Retrospective Operation.

This rule has retrospective operation for taxable years beginning on or after January 1, 2010, as authorized under Section 26-36a-209 of the Hospital Provider Assessment Act.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [October 13, 2010]2012

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