File No. 36101
This rule was published in the May 15, 2012, issue (Vol. 2012, No. 10) of the Utah State Bulletin.
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:
HealthHealth 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 [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:
06/14/2012
This rule may become effective on:
07/01/2012
Authorized by:
David Patton, Executive Director
RULE TEXT
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
Additional Information
The Portable Document Format (PDF) version of the Bulletin is the official version. The PDF version of this issue is available at https://rules.utah.gov/publicat/bull-pdf/2012/b20120515.pdf. The HTML edition of the Bulletin is a convenience copy. Any discrepancy between the PDF version and HTML version is resolved in favor of the PDF version.
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For questions regarding the content or application of this rule, please contact 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].