This document includes House Committee Amendments incorporated into the bill on Fri, Mar 2, 2018 at 5:00 PM by bbryner.
1 2
3
4
5
6
7 LONG TITLE
8 General Description:
9 This bill amends the state Medicaid program to permit an expansion of Medicaid
10 eligibility under certain conditions.
11 Highlighted Provisions:
12 This bill:
13 ▸ requires the Department of Health to submit a waiver request to the federal
14 government by January 1, 2019, to:
15 • provide Medicaid benefits to eligible individuals who are below 95% of the
16 federal poverty level;
17 • offer services to Medicaid enrollees through the Medicaid managed care
18 organizations;
19 • obtain maximum federal financial participation for the new Medicaid enrollees;
20 • require certain qualified adults to meet a work activity requirement; and
21 • obtain options for flexibility on enrollment;
22 ▸ makes changes to the inpatient hospital assessment;
23 ▸ creates a new Medicaid expansion hospital assessment;
24 ▸ amends the sunset date for the inpatient hospital assessment and creates a sunset
25 date for the Medicaid expansion hospital assessment; and
26 ▸ makes technical changes.
27 Money Appropriated in this Bill:
28 None
29 Other Special Clauses:
30 Ĥ→ [
31 Utah Code Sections Affected:
32 AMENDS:
33 26-18-18, as last amended by Laws of Utah 2017, Chapter 247
34 26-36b-103, as enacted by Laws of Utah 2016, Chapter 279
35 26-36b-201, as enacted by Laws of Utah 2016, Chapter 279
36 26-36b-202, as enacted by Laws of Utah 2016, Chapter 279
37 26-36b-203, as enacted by Laws of Utah 2016, Chapter 279
38 26-36b-204, as enacted by Laws of Utah 2016, Chapter 279
39 26-36b-205, as enacted by Laws of Utah 2016, Chapter 279
40 26-36b-206, as enacted by Laws of Utah 2016, Chapter 279
41 26-36b-207, as enacted by Laws of Utah 2016, Chapter 279
42 26-36b-208, as enacted by Laws of Utah 2016, Chapter 279
43 26-36b-209, as enacted by Laws of Utah 2016, Chapter 279
44 26-36b-210, as enacted by Laws of Utah 2016, Chapter 279
45 26-36b-211, as enacted by Laws of Utah 2016, Chapter 279
46 63I-1-226, as last amended by Laws of Utah 2017, Chapters 177 and 443
47 ENACTS:
48 26-18-415, Utah Code Annotated 1953
49 26-36c-101, Utah Code Annotated 1953
50 26-36c-102, Utah Code Annotated 1953
51 26-36c-103, Utah Code Annotated 1953
52 26-36c-201, Utah Code Annotated 1953
53 26-36c-202, Utah Code Annotated 1953
54 26-36c-203, Utah Code Annotated 1953
55 26-36c-204, Utah Code Annotated 1953
56 26-36c-205, Utah Code Annotated 1953
57 26-36c-206, Utah Code Annotated 1953
58 26-36c-207, Utah Code Annotated 1953
59 26-36c-208, Utah Code Annotated 1953
60 26-36c-209, Utah Code Annotated 1953
61 26-36c-210, Utah Code Annotated 1953
61a Ĥ→ Utah Code Sections Affected by Coordination Clause:
61b 26-36b-103, as enacted by Laws of Utah 2016, Chapter 279 ←Ĥ
62
63 Be it enacted by the Legislature of the state of Utah:
64 Section 1. Section 26-18-18 is amended to read:
65 26-18-18. Optional Medicaid expansion.
66 (1) For purposes of this section[
67 (a) "CMS" means the Centers for Medicare and Medicaid Services within the United
68 States Department of Health and Human Services.
69 (b) "PPACA" means the same as that term is defined in Section 31A-1-301.
70 (2) The department and the governor [
71 program [
72 (a) the department expands Medicaid in accordance with Section 26-18-415; or
73 [
74 the state Medicaid program under PPACA to the Legislature in compliance with the legislative
75 review process in Sections 63N-11-106 and 26-18-3; and
76 [
77 optional populations to the Legislature under the high impact federal funds request process
78 required by Section 63J-5-204[
79
80 (3) (a) The department shall request approval from [
81
82 for waivers from federal statutory and regulatory law necessary to implement the health
83 coverage improvement program under Section 26-18-411.
84 (b) The health coverage improvement program under Section 26-18-411 is not
85 [
86 Section 2. Section 26-18-415 is enacted to read:
87 26-18-415. Medicaid waiver expansion.
88 (1) As used in this section:
89 (a) "CMS" means the Centers for Medicare and Medicaid Services within the United
90 States Department of Health and Human Services.
91 (b) "Expansion population" means individuals:
92 (i) whose household income is less than 95% of the federal poverty level; and
93 (ii) who are not eligible for enrollment in the Medicaid program Ĥ→ , with the exception
93a of the Primary Care Network program, ←Ĥ on May 8, 2018.
94 (c) "Federal poverty level" means the same as that term is defined in Section
95 26-18-411.
96 (d) "Medicaid waiver expansion" means a Medicaid expansion in accordance with this
97 section.
98 (2) (a) Before January 1, 2019, the department shall apply to CMS for approval of a
99 waiver or state plan amendment to implement the Medicaid waiver expansion.
100 (b) The Medicaid waiver expansion shall:
101 (i) expand Medicaid coverage to eligible individuals whose income is below 95% of
102 the federal poverty level;
103 (ii) obtain maximum federal financial participation under 42 U.S.C. Sec. 1396d(y) for
104 enrolling an individual in the Medicaid program;
105 (iii) provide Medicaid benefits through the state's Medicaid accountable care
106 organizations in areas where a Medicaid accountable care organization is implemented;
107 (iv) integrate the delivery of behavioral health services and physical health services
108 with Medicaid accountable care organizations in select geographic areas of the state that
109 choose an integrated model;
110 (v) include a path to self-sufficiency, including work activities as defined in 42 U.S.C.
111 Sec. 607(d), for qualified adults;
112 (vi) require an individual who is offered a private health benefit plan by an employer to
113 enroll in the employer's health plan;
114 (vii) sunset in accordance with Subsection (5)(a); and
115 (viii) permit the state to close enrollment in the Medicaid waiver expansion if the
116 department has insufficient funding to provide services to additional eligible individuals.
117 (3) If the Medicaid waiver described in Subsection (1) is approved, the department may
118 only pay the state portion of costs for the Medicaid waiver expansion with appropriations from:
119 (a) the Medicaid Expansion Fund, created in Section 26-36b-208;
120 (b) county contributions to the non-federal share of Medicaid expenditures; and
121 (c) any other contributions, funds, or transfers from a non-state agency for Medicaid
122 expenditures.
123 (4) Medicaid accountable care organizations and counties that elect to integrate care
124 under Subsection (2)(b)(iv) shall collaborate on enrollment, engagement of patients, and
125 coordination of services.
126 (5) (a) If federal financial participation for the Medicaid waiver expansion is reduced
127 below 90%, the authority of the department to implement the Medicaid waiver expansion shall
128 sunset no later than the next July 1 after the date on which the federal financial participation is
129 reduced.
130 (b) The department shall close the program to new enrollment if the cost of the
131 Medicaid waiver expansion is projected to exceed the appropriations for the fiscal year that are
132 authorized by the Legislature through an appropriations act adopted in accordance with Title
133 63J, Chapter 1, Budgetary Procedures Act.
134 (6) If the Medicaid waiver expansion is approved by CMS, the department shall report
135 to the Social Services Appropriations Subcommittee on or before November 1 of each year that
136 the Medicaid waiver expansion is operational:
137 (a) the number of individuals who enrolled in the Medicaid waiver program;
138 (b) costs to the state for the Medicaid waiver program;
139 (c) estimated costs for the current and following state fiscal year; and
140 (d) recommendations to control costs of the Medicaid waiver expansion.
141 Section 3. Section 26-36b-103 is amended to read:
142 26-36b-103. Definitions.
143 As used in this chapter:
144 (1) "Assessment" means the inpatient hospital assessment established by this chapter.
145 (2) "CMS" means the [
146 Medicare and Medicaid Services within the United States Department of Health and Human
147 Services.
148 (3) "Discharges" means the number of total hospital discharges reported on:
149 (a) Worksheet S-3 Part I, column 15, lines 14, 16, and 17 of the 2552-10 Medicare cost
150 report for the applicable assessment year; or
151 (b) a similar report adopted by the department by administrative rule, if the report
152 under Subsection (3)(a) is no longer available.
153 (4) "Division" means the Division of Health Care Financing within the department.
154 (5) "Health coverage improvement program" means the health coverage improvement
155 program described in Section 26-18-411.
156 (6) "Hospital share" means the hospital share described in Section 26-36b-203.
157 (7) "Medicaid accountable care organization" means a managed care organization, as
158 defined in 42 C.F.R. Sec. 438, that contracts with the department under the provisions of
159 Section 26-18-405.
160 (8) "Medicaid waiver expansion" means a Medicaid expansion in accordance with
161 Section 26-18-415.
162 [
163 filing of hospitals.
164 [
165 non-state government entity[
166 (b) "Non-state government hospital" does not include:
167 (i) the Utah State Hospital; or
168 (ii) a hospital owned by the federal government, including the Veterans Administration
169 Hospital.
170 [
171 (i) a [
172 Section 26-21-2, that is privately owned and operating in the state; and
173 (ii) a privately owned specialty hospital operating in the state, [
174 including a privately owned hospital whose inpatient admissions are predominantly Ĥ→ for ←Ĥ :
175 (A) rehabilitation;
176 (B) psychiatric care;
177 (C) chemical dependency services; or
178 (D) long-term acute care services[
179 (b) "Private hospital" does not include a facility for residential [
180 [
181 [
182 an institution of higher education.
183 (13) "Upper payment limit gap" means the difference between the private hospital
184 outpatient upper payment limit and the private hospital Medicaid outpatient payments, as
185 determined in accordance with 42 C.F.R. Sec. 447.321.
186 Section 4. Section 26-36b-201 is amended to read:
187 26-36b-201. Assessment.
188 (1) An assessment is imposed on each private hospital:
189 (a) beginning upon the later of CMS approval of:
190 (i) the health coverage improvement program waiver under Section 26-18-411; and
191 (ii) the assessment under this chapter;
192 (b) in the amount designated in Sections 26-36b-204 and 26-36b-205; and
193 (c) in accordance with Section 26-36b-202.
194 (2) Subject to Section 26-36b-203, the assessment imposed by this chapter is due and
195 payable on a quarterly basis, after payment of the outpatient upper payment limit supplemental
196 payments under Section 26-36b-210 have been paid.
197 (3) The first quarterly payment [
198 the Ĥ→ earlier of the ←Ĥ effective Ĥ→ [
199 (a) the health coverage improvement program [
200 (b) the Medicaid waiver expansion.
201 Section 5. Section 26-36b-202 is amended to read:
202 26-36b-202. Collection of assessment -- Deposit of revenue -- Rulemaking.
203 (1) The collecting agent for the assessment imposed under Section 26-36b-201 is the
204 department.
205 (2) The department is vested with the administration and enforcement of this chapter,
206 [
207 Chapter 3, Utah Administrative Rulemaking Act, necessary to:
208 [
209 (a) collect the assessment, intergovernmental transfers, and penalties imposed under
210 this chapter;
211 (b) audit records of a facility that:
212 (i) is subject to the assessment imposed by this chapter; and
213 (ii) does not file a Medicare cost report; and
214 (c) select a report similar to the Medicare cost report if Medicare no longer uses a
215 Medicare cost report.
216 (2) The department shall:
217 (a) administer the assessment in this [
218 assessment in Chapter 36a, Hospital Provider Assessment Act; and
219 (b) deposit assessments collected under this chapter into the Medicaid Expansion Fund
220 created by Section 26-36b-208.
221 Section 6. Section 26-36b-203 is amended to read:
222 26-36b-203. Quarterly notice.
223 (1) Quarterly assessments imposed by this chapter shall be paid to the division within
224 15 business days after the original invoice date that appears on the invoice issued by the
225 division.
226 (2) The department may, by rule, extend the time for paying the assessment.
227 Section 7. Section 26-36b-204 is amended to read:
228 26-36b-204. Hospital financing of health coverage improvement program
229 Medicaid waiver expansion-- Hospital share.
230 [
231 (1) The hospital share is:
232 (a) [
233 program [
234 individuals with dependent children up to the federal poverty level designated under Section
235 26-18-411; [
236 [
237 [
238 (b) if the waiver for the Medicaid waiver expansion is approved, $11,900,000; and
239 (c) 45% of the state's net cost of the upper payment limit gap.
240 (2) (a) The hospital share is capped at no more than $13,600,000 annually, consisting
241 of:
242 (i) an $11,900,000 cap Ĥ→ [
242a Subsections
243 (1)(a)[
244 (ii) a $1,700,000 cap for the program specified in Subsection (1)[
245 [
246 (b) The department shall prorate the cap described in Subsection (2)(a) in any year in
247 which at least one of the programs specified in Subsection (1) Ĥ→ [
247a full
248 fiscal year[
249 [
250
251
252 [
253 (3) Private hospitals shall be assessed under this chapter for:
254 (a) 69% of the portion of the hospital share specified in Subsections (1)(a)[
255 and (b); and
256 (b) 100% of the portion of the hospital share specified in Subsection (1)[
257 [
258 October 15 of each subsequent year [
259 cost of the programs described in Subsections (1)(a)[
260 that year.
261 (b) If the assessment collected in the previous fiscal year is above or below the [
262
263 hospitals for the previous fiscal year, the underpayment or overpayment of the assessment by
264 the private hospitals shall be applied to the fiscal year in which the report [
265 [
266 each year, report to the department the following data from the prior state fiscal year for each
267 private hospital, state teaching hospital, and non-state government hospital provider that the
268 Medicaid accountable care organization contracts with:
269 (a) for the traditional Medicaid population[
270
271 (i) hospital inpatient payments;
272 (ii) hospital inpatient discharges;
273 (iii) hospital inpatient days; and
274 (iv) hospital outpatient payments; and
275 [
276
277 (b) if the Medicaid accountable care organization enrolls any individuals in the health
278 coverage improvement program or the Medicaid waiver expansion, for the population newly
279 eligible for either program:
280 (i) hospital inpatient payments;
281 (ii) hospital inpatient discharges;
282 (iii) hospital inpatient days; and
283 (iv) hospital outpatient payments.
284 (6) The department shall, by rule made in accordance with Title 63G, Chapter 3, Utah
285 Administrative Rulemaking Act, provide details surrounding specific content and format for
286 the reporting by the Medicaid accountable care organization.
287 Section 8. Section 26-36b-205 is amended to read:
288 26-36b-205. Calculation of assessment.
289 (1) (a) Except as provided in Subsection (1)(b), an annual assessment is payable on a
290 quarterly basis for each private hospital in an amount calculated by the division at a uniform
291 assessment rate for each hospital discharge, in accordance with this section.
292 (b) A private teaching hospital with more than 425 beds and 60 residents shall pay an
293 assessment rate [
294 (c) The division shall calculate the uniform assessment rate [
295
296
297 by dividing the hospital share for assessed private hospitals, described in Subsection
298 26-36b-204(1), by the sum of:
299 (i) the total number of discharges for assessed private hospitals that are not a private
300 teaching hospital; and
301 (ii) 2.5 times the number of discharges for a private teaching hospital, described in
302 Subsection (1)(b).
302a Ĥ→ (d) The division may, by rule made in accordance with Title 63G, Chapter 3, Utah
302b Administrative Rulemaking Act, adjust the formula described in Subsection (1)(c) to address
302c unforeseen circumstances in the administration of the assessment under this chapter.
303 [
303a uniformly to
304 all assessed private hospitals.
305 [
306
307
308
309 (2) Except as provided in Subsection (3), for each state fiscal year, the division shall
310 determine a hospital's discharges as follows:
311 [
312 year ending between July 1, 2013, and June 30, 2014; and
313 [
314 hospital's fiscal year that ended in the state fiscal year two years before the assessment fiscal
315 year.
316 [
317 [
318 System file:
319 (i) the hospital shall submit to the division a copy of the hospital's Medicare cost report
320 applicable to the assessment year; and
321 (ii) the division shall determine the hospital's discharges.
322 [
323 a Medicare cost report:
324 (i) the hospital shall submit to the division the hospital's applicable fiscal year
325 discharges with supporting documentation;
326 (ii) the division shall determine the hospital's discharges from the information
327 submitted under Subsection [
328 (iii) [
329 hospital's records and a penalty equal to 5% of the calculated assessment.
330 [
331 organization that owns more than one hospital in the state:
332 (a) the assessment for each hospital shall be separately calculated by the department;
333 and
334 (b) each separate hospital shall pay the assessment imposed by this chapter.
335 [
336 (5) If multiple hospitals use the same Medicaid provider number:
337 (a) the department shall calculate the assessment in the aggregate for the hospitals
338 using the same Medicaid provider number; and
339 (b) the hospitals may pay the assessment in the aggregate.
340 Section 9. Section 26-36b-206 is amended to read:
341 26-36b-206. State teaching hospital and non-state government hospital
342 mandatory intergovernmental transfer.
343 (1) [
344 intergovernmental transfer to the Medicaid Expansion Fund created in Section 26-36b-208, in
345 accordance with this section.
346 (2) The [
347 shall pay the intergovernmental transfer beginning on the later of CMS approval of:
348 (a) the health improvement program waiver under Section 26-18-411; or
349 (b) the assessment for private hospitals in this chapter[
350 [
351 (3) The intergovernmental transfer [
352 as follows:
353 (a) the state teaching hospital is responsible for:
354 (i) 30% of the portion of the hospital share specified in Subsections
355 26-36b-204(1)(a)[
356 (ii) 0% of the hospital share specified in Subsection 26-36b-204(1)[
357 (b) non-state government hospitals are responsible for:
358 (i) 1% of the portion of the hospital share specified in Subsections 26-36b-204(1)(a)[
359
360 (ii) 0% of the hospital share specified in Subsection 26-36b-204(1)[
361 (4) The department shall, by rule made in accordance with Title 63G, Chapter 3, Utah
362 Administrative Rulemaking Act, designate:
363 (a) the method of calculating the Ĥ→ [
363a (3); and
364 (b) the schedule for the intergovernmental transfers.
365 Section 10. Section 26-36b-207 is amended to read:
366 26-36b-207. Penalties and interest.
367 (1) A hospital that fails to pay [
368 intergovernmental transfer, or file a return as required under this chapter, within the time
369 required by this chapter, shall pay penalties described in this section, in addition to the
370 assessment or intergovernmental transfer[
371 [
372
373
374 [
375 mandated intergovernmental transfer, the department shall add to the assessment or
376 intergovernmental transfer:
377 [
378 date; and
379 [
380 the penalty imposed under Subsection (2)[
381 on:
382 [
383 [
384 [
385 shown, the division may waive, reduce, or compromise any of the penalties imposed under this
386 chapter.
387 Section 11. Section 26-36b-208 is amended to read:
388 26-36b-208. Medicaid Expansion Fund.
389 (1) There is created an expendable special revenue fund known as the Medicaid
390 Expansion Fund.
391 (2) The fund consists of:
392 (a) assessments collected under this chapter;
393 (b) intergovernmental transfers under Section 26-36b-206;
394 (c) savings attributable to the health coverage improvement program [
395
396 (d) savings attributable to the Medicaid waiver expansion as determined by the
397 department;
398 [
399 drug list under Subsection 26-18-2.4(3) as determined by the department;
400 [
401 Plan under Subsection 49-20-401(1)(u);
402 [
403 the fund from private sources; [
404 (h) interest earned on money in the fund; and
405 [
406 (3) (a) The fund shall earn interest.
407 (b) All interest earned on fund money shall be deposited into the fund.
408 (4) (a) A state agency administering the provisions of this chapter may use money from
409 the fund to pay the costs [
410 sources, of:
411 (i) the health coverage improvement [
412 program;
413 (ii) the Medicaid waiver expansion; and
414 (iii) the outpatient [
415 26-36b-210[
416
417 (b) A state agency administering the provisions of this chapter may not use:
418 (i) funds described in Subsection (2)(b) [
419 outpatient [
420 [
421 not described in Subsection (4)(a).
422 Section 12. Section 26-36b-209 is amended to read:
423 26-36b-209. Hospital reimbursement.
424 (1) [
425 expansion is implemented by contracting with a Medicaid accountable care organization, the
426 department shall, to the extent allowed by law, include, in a contract [
427
428 program or the Medicaid waiver expansion, a requirement that the Medicaid accountable care
429 organization reimburse hospitals in the accountable care organization's provider network[
430 no less than the Medicaid fee-for-service rate.
431 (2) If the health coverage improvement program or the Medicaid waiver expansion is
432 implemented by the department as a fee-for-service program, the department shall reimburse
433 hospitals at no less than the Medicaid fee-for-service rate.
434 (3) Nothing in this section prohibits a Medicaid accountable care organization from
435 paying a rate that exceeds the Medicaid fee-for-service [
436 Section 13. Section 26-36b-210 is amended to read:
437 26-36b-210. Outpatient upper payment limit supplemental payments.
438 [
439
440
441 [
442 and for each subsequent fiscal year [
443 upper payment limit program for private hospitals that shall supplement the reimbursement to
444 private hospitals in accordance with Subsection [
445 [
446 under Subsection [
447 (a) does not exceed the positive [
448 (b) [
449 [
450
451 Subsection [
452 [
453
454 (a) July 1, 2016;
455 (b) the effective date of the Medicaid state plan amendment necessary to implement the
456 payments under this section; or
457 (c) the effective date of the coverage provided through the health coverage
458 improvement program waiver [
459 Section 14. Section 26-36b-211 is amended to read:
460 26-36b-211. Suspension of assessment.
461 (1) The [
462 chapter [
463
464 [
465 (a) action by Congress is in effect that disqualifies the assessment imposed by this
466 chapter from counting toward state Medicaid funds available to be used to determine the
467 amount of federal financial participation;
468 (b) [
469 Legislature or by any court, officer, department, or agency of the state, or of the federal
470 government, [
471 (i) [
472 funds available to be used to determine federal financial participation for Medicaid matching
473 funds; or
474 (ii) [
475 least one of the Medicaid [
476 (c) [
477 inpatient and outpatient payment rate below the aggregate hospital inpatient and outpatient
478 payment rate for July 1, 2015[
479 [
480 [
481
482
483
484
485
486 (2) If the assessment is suspended under Subsection (1):
487 (a) the division may not collect any assessment or intergovernmental transfer under this
488 chapter;
489 (b) the division shall disburse money in the Ĥ→ [
489a Expansion Fund ←Ĥ in accordance with
490 the requirements in Subsection 26-36b-208(4), to the extent federal matching is not reduced by
491 CMS due to the repeal of the assessment;
492 (c) the division shall refund any money remaining in the Ĥ→ [
492a Medicaid Expansion Fund ←Ĥ after the
493 disbursement described in Subsection (2)(b) that was derived from assessments imposed by
494 this chapter to the hospitals in proportion to the amount paid by each hospital for the last three
495 fiscal years; and
496 (d) the division shall deposit any money remaining in the Ĥ→ [
496a Medicaid Expansion Fund ←Ĥ after the
497 disbursements described in Subsections (2)(b) and (c) into the General Fund Ĥ→ by the end of the
497a fiscal year that the assessment is suspended ←Ĥ .
498 Section 15. Section 26-36c-101 is enacted to read:
499
500
501 26-36c-101. Title.
502 This chapter is known as the "Medicaid Expansion Hospital Assessment Act."
503 Section 16. Section 26-36c-102 is enacted to read:
504 26-36c-102. Definitions.
505 As used in this chapter:
506 (1) "Assessment" means the Medicaid expansion hospital assessment established by
507 this chapter.
508 (2) "CMS" means the Centers for Medicare and Medicaid Services within the United
509 States Department of Health and Human Services.
510 (3) "Discharges" means the number of total hospital discharges reported on:
511 (a) Worksheet S-3 Part I, column 15, lines 14, 16, and 17 of the 2552-10 Medicare cost
512 report for the applicable assessment year; or
513 (b) a similar report adopted by the department by administrative rule, if the report
514 under Subsection (3)(a) is no longer available.
515 (4) "Division" means the Division of Health Care Financing within the department.
516 (5) "Hospital share" means the hospital share described in Section 26-36c-203.
517 (6) "Medicaid accountable care organization" means a managed care organization, as
518 defined in 42 C.F.R. Sec. 438, that contracts with the department under the provisions of
519 Section 26-18-405.
520 (7) "Medicaid Expansion Fund" means the Medicaid Expansion Fund created in
521 Section 26-36b-208.
522 (8) "Medicaid waiver expansion" means the same as that term is defined in Section
523 26-18-415.
524 (9) "Medicare cost report" means CMS-2552-10, the cost report for electronic filing of
525 hospitals.
526 (10) (a) "Non-state government hospital" means a hospital owned by a non-state
527 government entity.
528 (b) "Non-state government hospital" does not include:
529 (i) the Utah State Hospital; or
530 (ii) a hospital owned by the federal government, including the Veterans Administration
531 Hospital.
532 (11) (a) "Private hospital" means:
533 (i) a privately owned general acute hospital operating in the state as defined in Section
534 26-21-2; or
535 (ii) a privately owned specialty hospital operating in the state, including a privately
536 owned hospital for which inpatient admissions are predominantly:
537 (A) rehabilitation;
538 (B) psychiatric;
539 (C) chemical dependency; or
540 (D) long-term acute care services.
541 (b) "Private hospital" does not include a facility for residential treatment as defined in
542 Section 62A-2-101.
543 (12) "State teaching hospital" means a state owned teaching hospital that is part of an
544 institution of higher education.
545 Section 17. Section 26-36c-103 is enacted to read:
546 26-36c-103. Application.
547 (1) Other than for the imposition of the assessment described in this chapter, nothing in
548 this chapter shall affect the nonprofit or tax exempt status of any nonprofit charitable, religious,
549 or educational health care provider under any:
550 (a) state law;
551 (b) ad valorem property tax requirement;
552 (c) sales or use tax requirement; or
553 (d) other requirements imposed by taxes, fees, or assessments, whether imposed or
554 sought to be imposed, by the state or any political subdivision of the state.
555 (2) A hospital paying an assessment under this chapter may include the assessment as
556 an allowable cost of a hospital for purposes of any applicable Medicaid reimbursement
557 formula.
558 (3) This chapter does not authorize a political subdivision of the state to:
559 (a) license a hospital for revenue;
560 (b) impose a tax or assessment upon a hospital; or
561 (c) impose a tax or assessment measured by the income or earnings of a hospital.
562 Section 18. Section 26-36c-201 is enacted to read:
563
564 26-36c-201. Assessment.
565 (1) An assessment is imposed on each private hospital:
566 (a) beginning upon the later of CMS approval of:
567 (i) the waiver for the Medicaid waiver expansion; and
568 (ii) the assessment under this chapter;
569 (b) in the amount designated in Sections 26-36c-204 and 26-36c-205; and
570 (c) in accordance with Section 26-36c-202.
571 (2) Subject to Subsection 26-36c-202(4), the assessment imposed by this chapter is due
572 and payable on the last day of each quarter.
573 (3) The first quarterly payment is not due until at least three months after the effective
574 date of the coverage provided through the Medicaid waiver expansion.
575 Section 19. Section 26-36c-202 is enacted to read:
576 26-36c-202. Collection of assessment -- Deposit of revenue -- Rulemaking.
577 (1) The department shall act as the collecting agent for the assessment imposed under
578 Section 26-36c-201.
579 (2) The department shall administer and enforce the provisions of this chapter, and may
580 make rules, in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act,
581 necessary to:
582 (a) collect the assessment, intergovernmental transfers, and penalties imposed under
583 this chapter;
584 (b) audit records of a facility that:
585 (i) is subject to the assessment imposed under this chapter; and
586 (ii) does not file a Medicare cost report; and
587 (c) select a report similar to the Medicare cost report if Medicare no longer uses a
588 Medicare cost report.
589 (3) The department shall:
590 (a) administer the assessment in this part separately from the assessments in Chapter
591 36a, Hospital Provider Assessment Act, and Chapter 36b, Inpatient Hospital Assessment Act;
592 and
593 (b) deposit assessments collected under this chapter into the Medicaid Expansion Fund.
594 (4) (a) Hospitals shall pay the quarterly assessments imposed by this chapter to the
595 division within 15 business days after the original invoice date that appears on the invoice
596 issued by the division.
597 (b) The department may make rules creating requirements to allow the time for paying
598 the assessment to be extended.
599 Section 20. Section 26-36c-203 is enacted to read:
600 26-36c-203. Hospital share.
601 (1) The hospital share is 100% of the state's net cost of the Medicaid waiver expansion,
602 after deducting appropriate offsets and savings expected as a result of implementing the
603 Medicaid waiver expansion, including savings from:
604 (a) the Primary Care Network program;
605 (b) the health coverage improvement program, as defined in Section 26-18-411;
606 (c) the state portion of inpatient prison medical coverage;
607 (d) behavioral health coverage; and
608 (e) county contributions to the non-federal share of Medicaid expenditures.
609 (2) (a) The hospital share is capped at no more than $25,000,000 annually.
610 (b) The division shall prorate the cap specified in Subsection (2)(a) in any year in
611 which the Medicaid waiver expansion is not in effect for the full fiscal year.
612 Section 21. Section 26-36c-204 is enacted to read:
613 26-36c-204. Hospital financing of Medicaid waiver expansion.
614 (1) Private hospitals shall be assessed under this chapter for the portion of the hospital
615 share described in Section 26-36c-209.
616 (2) The department shall, on or before October 15, 2019, and on or before October 15
617 of each subsequent year, produce a report that calculates the state's net cost of the Medicaid
618 waiver expansion.
619 (3) If the assessment collected in the previous fiscal year is above or below the hospital
620 share for private hospitals for the previous fiscal year, the division shall apply the
621 underpayment or overpayment of the assessment by the private hospitals to the fiscal year in
622 which the report is issued.
623 Section 22. Section 26-36c-205 is enacted to read:
624 26-36c-205. Calculation of assessment.
625 (1) (a) Except as provided in Subsection (1)(b), each private hospital shall pay an
626 annual assessment due on the last day of each quarter in an amount calculated by the division at
627 a uniform assessment rate for each hospital discharge, in accordance with this section.
628 (b) A private teaching hospital with more than 425 beds and more than 60 residents
629 shall pay an assessment rate 2.5 times the uniform rate established under Subsection (1)(c).
630 (c) The division shall calculate the uniform assessment rate described in Subsection
631 (1)(a) by dividing the hospital share for assessed private hospitals, as described in Subsection
632 26-36c-204(1), by the sum of:
633 (i) the total number of discharges for assessed private hospitals that are not a private
634 teaching hospital; and
635 (ii) 2.5 times the number of discharges for a private teaching hospital, described in
636 Subsection (1)(b).
637 (d) The division may make rules in accordance with Title 63G, Chapter 3, Utah
638 Administrative Rulemaking Act, to adjust the formula described in Subsection (1)(c) to address
639 unforeseen circumstances in the administration of the assessment under this chapter.
640 (e) The division shall apply any quarterly changes to the uniform assessment rate
641 uniformly to all assessed private hospitals.
642 (2) Except as provided in Subsection (3), for each state fiscal year, the division shall
643 determine a hospital's discharges as follows:
644 (a) for state fiscal year 2019, the hospital's cost report data for the hospital's fiscal year
645 ending between July 1, 2015, and June 30, 2016; and
646 (b) for each subsequent state fiscal year, the hospital's cost report data for the hospital's
647 fiscal year that ended in the state fiscal year two years before the assessment fiscal year.
648 (3) (a) If a hospital's fiscal year Medicare cost report is not contained in the Centers for
649 Medicare and Medicaid Services' Healthcare Cost Report Information System file:
650 (i) the hospital shall submit to the division a copy of the hospital's Medicare cost report
651 applicable to the assessment year; and
652 (ii) the division shall determine the hospital's discharges.
653 (b) If a hospital is not certified by the Medicare program and is not required to file a
654 Medicare cost report:
655 (i) the hospital shall submit to the division the hospital's applicable fiscal year
656 discharges with supporting documentation;
657 (ii) the division shall determine the hospital's discharges from the information
658 submitted under Subsection (3)(c)(i); and
659 (iii) if the hospital fails to submit discharge information, the division shall audit the
660 hospital's records and may impose a penalty equal to 5% of the calculated assessment.
661 (4) Except as provided in Subsection (5), if a hospital is owned by an organization that
662 owns more than one hospital in the state:
663 (a) the division shall calculate the assessment for each hospital separately; and
664 (b) each separate hospital shall pay the assessment imposed by this chapter.
665 (5) If multiple hospitals use the same Medicaid provider number:
666 (a) the department shall calculate the assessment in the aggregate for the hospitals
667 using the same Medicaid provider number; and
668 (b) the hospitals may pay the assessment in the aggregate.
669 Section 23. Section 26-36c-206 is enacted to read:
670 26-36c-206. State teaching hospital and non-state government hospital mandatory
671 intergovernmental transfer.
672 (1) A state teaching hospital and a non-state government hospital shall make an
673 intergovernmental transfer to the Medicaid Expansion Fund, in accordance with this section.
674 (2) The hospitals described in Subsection (1) shall pay the intergovernmental transfer
675 beginning on the later of CMS approval of:
676 (a) the waiver for the Medicaid waiver expansion; or
677 (b) the assessment for private hospitals in this chapter.
678 (3) The intergovernmental transfer is apportioned between the non-state government
679 hospitals as follows:
680 (a) the state teaching hospital shall pay for the portion of the hospital share described in
681 Section 26-36c-209; and
682 (b) non-state government hospitals shall pay for the portion of the hospital share
683 described in Section 26-36c-209.
684 (4) The department shall, by rule made in accordance with Title 63G, Chapter 3, Utah
685 Administrative Rulemaking Act, designate:
686 (a) the method of calculating the amounts designated in Subsection (3); and
687 (b) the schedule for the intergovernmental transfers.
688 Section 24. Section 26-36c-207 is enacted to read:
689 26-36c-207. Penalties.
690 (1) A hospital that fails to pay a quarterly assessment, make the mandated
691 intergovernmental transfer, or file a return as required under this chapter, within the time
692 required by this chapter, shall pay penalties described in this section, in addition to the
693 assessment or intergovernmental transfer.
694 (2) If a hospital fails to timely pay the full amount of a quarterly assessment or the
695 mandated intergovernmental transfer, the department shall add to the assessment or
696 intergovernmental transfer:
697 (a) a penalty equal to 5% of the quarterly amount not paid on or before the due date;
698 and
699 (b) on the last day of each quarter after the due date until the assessed amount and the
700 penalty imposed under Subsection (2)(a) are paid in full, an additional 5% penalty on:
701 (i) any unpaid quarterly assessment or intergovernmental transfer; and
702 (ii) any unpaid penalty assessment.
703 (3) Upon making a record of the division's actions, and upon reasonable cause shown,
704 the division may waive or reduce any of the penalties imposed under this chapter.
705 Section 25. Section 26-36c-208 is enacted to read:
706 26-36c-208. Hospital reimbursement.
707 (1) If the Medicaid waiver expansion is implemented by contracting with a Medicaid
708 accountable care organization, the department shall, to the extent allowed by law, include in a
709 contract to provide benefits under the Medicaid waiver expansion a requirement that the
710 accountable care organization reimburse hospitals in the accountable care organization's
711 provider network at no less than the Medicaid fee-for-service rate.
712 (2) If the Medicaid waiver expansion is implemented by the department as a
713 fee-for-service program, the department shall reimburse hospitals at no less than the Medicaid
714 fee-for-service rate.
715 (3) Nothing in this section prohibits the department or a Medicaid accountable care
716 organization from paying a rate that exceeds the Medicaid fee-for-service rate.
717 Section 26. Section 26-36c-209 is enacted to read:
718 26-36c-209. Hospital financing of the hospital share.
719 (1) For the first two full fiscal years that the assessment is in effect, the department
720 shall:
721 (a) assess private hospitals under this chapter for 69% of the hospital share for the
722 Medicaid waiver expansion;
723 (b) require the state teaching hospital to make an intergovernmental transfer under this
724 chapter for 30% of the hospital share for the Medicaid waiver expansion; and
725 (c) require non-state government hospitals to make an intergovernmental transfer under
726 this chapter for 1% of the hospital share for the Medicaid waiver expansion.
727 (2) (a) At the beginning of the third full fiscal year that the assessment is in effect, and
728 at the beginning of each subsequent fiscal year, the department may set a different percentage
729 share for private hospitals, the state teaching hospital, and non-state government hospitals by
730 rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, with
731 input from private hospitals and private teaching hospitals.
732 (b) If the department does not set a different percentage share under Subsection (2)(a),
733 the percentage shares in Subsection (1) shall apply.
734 Section 27. Section 26-36c-210 is enacted to read:
735 26-36c-210. Suspension of assessment.
736 (1) The department shall suspend the assessment imposed by this chapter when the
737 executive director certifies that:
738 (a) action by Congress is in effect that disqualifies the assessment imposed by this
739 chapter from counting toward state Medicaid funds available to be used to determine the
740 amount of federal financial participation;
741 (b) a decision, enactment, or other determination by the Legislature or by any court,
742 officer, department, or agency of the state, or of the federal government, is in effect that:
743 (i) disqualifies the assessment from counting toward state Medicaid funds available to
744 be used to determine federal financial participation for Medicaid matching funds; or
745 (ii) creates for any reason a failure of the state to use the assessments for at least one of
746 the Medicaid programs described in this chapter; or
747 (c) a change is in effect that reduces the aggregate hospital inpatient and outpatient
748 payment rate below the aggregate hospital inpatient and outpatient payment rate for July 1,
749 2015.
750 (2) If the assessment is suspended under Subsection (1):
751 (a) the division may not collect any assessment or intergovernmental transfer under this
752 chapter;
753 (b) the division shall disburse money in the Ĥ→ [
753a Expansion Fund ←Ĥ that was derived from
754 assessments imposed by this chapter in accordance with the requirements in Subsection
755 26-36b-208(4), to the extent federal matching is not reduced by CMS due to the repeal of the
756 assessment;
757 (c) the division shall refund any money remaining in the Ĥ→ [
757a Medicaid Expansion Fund ←Ĥ after the
758 disbursement described in Subsection (2)(b) that was derived from assessments imposed by
759 this chapter to the hospitals in proportion to the amount paid by each hospital for the last three
760 fiscal years Ĥ→ [
761 [
762 disbursements described in Subsections (2)(b) and (c) into the General Fund.
763 Section 28. Section 63I-1-226 is amended to read:
764 63I-1-226. Repeal dates, Title 26.
765 (1) Section 26-1-40 is repealed July 1, 2019.
766 (2) Title 26, Chapter 9f, Utah Digital Health Service Commission Act, is repealed July
767 1, 2025.
768 (3) Section 26-10-11 is repealed July 1, 2020.
769 (4) Title 26, Chapter 33a, Utah Health Data Authority Act, is repealed July 1, 2024.
770 (5) Title 26, Chapter 36a, Hospital Provider Assessment Act, is repealed July 1, 2019.
771 (6) Title 26, Chapter 36b, Inpatient Hospital Assessment Act, is repealed July 1, [
772 2024.
773 [
774 [
775 (7) Title 26, Chapter 36c, Medicaid Expansion Hospital Assessment Act, is repealed
776 July 1, 2024.
777 [
777a Ĥ→ Section 29. Coordinating H.B. 472 with H.B. 14 -- Superseding technical and substantive
777b amendments.
777c If this H.B. 472 and H.B. 14, Substance Abuse Treatment Facility Patient Brokering, both pass
777d and become law, it is the intent of the Legislature that the amendments to Section 26-36b-103
777e in this bill supersede the amendments to Section 26-36b-103 in H.B. 14, when the Office of
777f Legislative Research and General Counsel prepares the Utah Code database for
777g publication.
777h Section 30. Coordinating H.B. 472 with S.B. 125 -- Superseding technical and substantive
777i amendments.
777j If this H.B. 472 and S.B. 125, Child Welfare Amendments, both pass and become law, it is the
777k intent of the Legislature that the amendments to Section 26-36b-103 in this bill supersede the
777l amendments to Section 26-36b-103 in S.B. 125, when the Office of Legislative Research and
777m General Counsel prepares the Utah Code database for publication. ←Ĥ
Legislative Review Note
Office of Legislative Research and General Counsel