DAR File No. 42353

Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-517

Inpatient Hospital Provider Assessments

Notice of Proposed Rule

(Amendment)

DAR File No.: 42353
Filed: 12/01/2017 11:26:28 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to implement provisions of the Inpatient Hospital Assessment Act (IHAA) set forth in Title 26, Chapter 36b.

Summary of the rule or change:

In accordance with Title 26, Chapter 36b, this amendment designates the rate methodology for non-state government hospital-intergovernmental transfers.

Statutory or constitutional authorization for this rule:

• Section 26-1-5
• Title 26, Chapter 36b
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget because the Legislature has already appropriated funds to implement the IHAA. This amendment only designates rate methodology and does not create further costs or savings.

local governments:

There is no impact to local governments because the Legislature has already appropriated funds to implement the IHAA. This amendment only designates rate methodology and does not create further costs or savings.

small businesses:

There is no impact to small businesses because the Legislature has already appropriated funds to implement the IHAA. This amendment only designates rate methodology, and neither creates further costs nor affects potential revenue.

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

There is no impact to Medicaid providers and to Medicaid members because the Legislature has already appropriated funds to implement the IHAA. This amendment only designates rate methodology, and does not affect costs, savings, or potential revenue.

Compliance costs for affected persons:

There are no compliance costs to a single Medicaid provider or to a Medicaid member because the Legislature has already appropriated funds to implement the IHAA. This amendment only designates rate methodology, and does not affect costs, savings, or potential revenue.

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

After conducting a thorough analysis, it was determined that this proposed rule amendment will not result in a fiscal impact to businesses.

Joseph K. Miner, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office 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 [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:

01/16/2018

This rule may become effective on:

01/23/2018

Authorized by:

Joseph Miner, Executive Director

Appendix 1: Regulatory Impact Summary Table*

Fiscal Costs	FY 2018	FY 2019	FY 2020
State Government	$0	$0	$0
Local Government	$0	$0	$0
Small Businesses	$0	$0	$0
Non-Small Businesses	$0	$0	$0
Other Person	$0	$0	$0
Total Fiscal Costs:	$0	$0	$0
Fiscal Benefits
State Government	$0	$0	$0
Local Government	$0	$0	$0
Small Businesses	$0	$0	$0
Non-Small Businesses	$0	$0	$0
Other Persons	$0	$0	$0
Total Fiscal Benefits:	$0	$0	$0
Net Fiscal Benefits:	$0	$0	$0

*This table only includes fiscal impacts that could be measured. If there are inestimable fiscal impacts, they will not be included in this table. Inestimable impacts for State Government, Local Government, Small Businesses and Other Persons are described above. Inestimable impacts for Non - Small Businesses are described below.

 

Appendix 2: Regulatory Impact to Non - Small Businesses

 

None of the six non-state government-owned hospitals will see a fiscal impact in regard to this amendment because the Legislature has already allocated funds to implement this provision of the Inpatient Hospital Assessment Act, which requires designation of rate methodology and does not affect potential revenue or cost.

 

 

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

R414-517. Inpatient Hospital Provider Assessments.

R414-517-1. Introduction and Authority.

This rule defines the scope of hospital provider assessment. This rule is authorized under Title 26, Chapter 36b.

 

R414-517-2. Definitions.

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

 

R414-517-3. Audit of Hospitals.

(1) For hospitals that do not file a Medicare cost report for the time frames outlined in Section 26-36b-205, 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 R414-517-[5]6.

 

R414-517-4. 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 26-36b-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 R414-517-4(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, as outlined in Section 26-36b-210, for the applicable quarter; and

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

(3) For State Fiscal Year 2018 and subsequent years, the Department shall determine if new providers are eligible to receive payments as allowed under Section 26-36b-210. The new providers will also be subject to the assessment beginning that same state fiscal year as they become eligible to receive the payments as allowed under Section 26-36b-210. New providers identified will be added prospectively beginning with that new state fiscal year.

 

R414-517-5. Intergovernmental Transfer Calculation and Schedule.

The non-state government hospital-intergovernmental transfer, as specified in Title 26, Chapter 36b, shall be calculated at a uniform rate for each hospital discharge. The uniform rate shall be determined using the total number of hospital discharges for non-state government hospitals. Any quarterly changes to the uniform rate shall be applied uniformly to all non-state government hospitals.

 

R414-517-[5]6. 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.

 

R414-517-[6]7. Rule Repeal.

The Department shall repeal this rule in conjunction with the repeal of the Hospital Provider Assessment Act outlined in Section 26-36b-211.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [November 1, 2017]2018

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