Inpatient Hospital means services that a hospital provides for the care and treatment of inpatients with disorders other than mental illness, under the direction of a physician. Medicaid covers inpatient visits at a hospital for most services without a prior authorization. Some services may require a prior authorization. Some imaging services require manual review for medical necessity after the service.
During the 2015 General Session, the Legislature appropriated for Fiscal Year 2016, $162,311,500 from all sources for Inpatient Hospital. This is a 0 percent change from Fiscal Year 2015 revised estimated amounts from all sources. The total includes $40,522,100 from the General/Education Funds, an increase of 105.1 percent from revised Fiscal Year 2015 estimates.
In addition to statewide compensation and internal service fund cost increases, the following appropriation adjustments were made during the 2015 General Session:
A hospital which accepts a Medicaid patient for treatment accepts the responsibility to make sure that the patient receives all medically necessary services from Medicaid providers. In reviewing claims for readmissions within 30 days for the same or similar principal diagnosis, the State may deny or combine the claim with the first admission.
Non-pregnant Medicaid adult clients have a $220 co-insurance payment for non-emergency inpatient hospital services. The most frequent claims for inpatient hospital service for Medicaid usually are for the care of newborns, delivery of babies, respiratory flu treatments, and tracheotomies.
Reimbursement rates for inpatient hospital services are online at http://health.utah.gov/medicaid/stplan/inpatient.htm.
The monthly caseload is the number of clients served in the Medicaid program.
COBI contains unaudited data as presented to the Legislature by state agencies at the time of publication. For audited financial data see the State of Utah's Comprehensive Annual Financial Reports.