FY 2016 Appropriation

Medicaid clients, who are not in a managed care plan (about one third of clients), may visit any willing physician provider to receive services. This includes any specialist physician. Medicaid clients must have a medical need for seeking physician services as Medicaid does not pay for annual wellness or preventive health visits. Most non-pregnant adults have a $3 co-pay per doctor's visit. Reimbursement rates for physician services are online at http://health.utah.gov/medicaid/stplan/physician.htm.

Licensed nurse practitioners may bill Medicaid directly for approved procedure codes. Payment for approved services will be made at the lower of the usual and customary charge or the established physician's fee schedule.

Funding History
Appropriation Overview

During the 2015 General Session, the Legislature appropriated for Fiscal Year 2016, $79,455,400 from all sources for Physician Services. This is a 26.9 percent increase from Fiscal Year 2015 revised estimated amounts from all sources. The total includes $21,210,100 from the General/Education Funds, an increase of 30.8 percent from revised Fiscal Year 2015 estimates.

Appropriation Adjustments

In addition to statewide compensation and internal service fund cost increases, the following appropriation adjustments were made during the 2015 General Session:

DescriptionOngoingOne-Time Medicaid Physician Reimbursement Rates$8,423,200$8,423,200
OngoingOne-TimeFinancing Source
$2,500,000$0General Fund
$0$2,500,000General Fund, One-time
$5,923,200$5,923,200Federal Funds
Utah Medical Association: "Description is that funding flows through the DOH to the Medicaid insurance plans to the physicians to keep reimbursement rates at Medicaid reimbursement rates at for Primary care providers at Medicare rates which are still less than 70% of commercial rates but much higher than Medicaid rates were before the federal government bumped primary care rates up for two years." Health: "The $6 million figure would increase rates about 22% and be about 1.5% short of Medicare rates...$6.3 million in [General Fund] is needed to get the entire way there."

Intent Language

HB0003: Item 81

Under Section 63J-1-603 of the Utah Code, the Legislature intends up to $3,500,000 provided for the Department of Health's Medicaid Management Information System Replacement in Item 72 of Chapter 282, Laws of Utah 2014 shall not lapse at the close of Fiscal Year 2015. The use of any nonlapsing funds is limited to the redesign and replacement of the Medicaid Management Information System.

SB0003: Item 121

The Legislature intends that the Medicaid Accountable Care Organizations receive a scheduled two percent increase effective January 1, 2016 consistent with the intent of S.B. 180, 2011 General Session.

SB0007S01: Item 5

The Legislature intends that the Department of Health report quarterly to the Office of the Legislative Fiscal Analyst on the status of replacing the Medicaid Management Information System replacement beginning September 30, 2015. The reports should include, where applicable, the responses to any requests for proposals. At least one report during FY 2016 should include the first estimate of net ongoing impacts to the State from the new system.

SB0007S01: Item 5

The Legislature intends that the Department of Health report on the following performance measures for the Medicaid Mandatory Services line item: (1) percent of adults age 45-64 with ambulatory or preventive care visits (Target = 88% or more), (2) percent of deliveries that had a post partum visit between 21 and 56 days after delivery (Target = 60% or more), and (3) percent of customers satisfied with their managed care plan (Target = 85% or more) by January 1, 2016 to the Social Services Appropriations Subcommittee.

SB0007S01: Item 17

The Legislature intends that the Department of Health report quarterly to the Office of the Legislative Fiscal Analyst on the status of replacing the Medicaid Management Information System replacement beginning September 30, 2015. The reports should include, where applicable, the responses to any requests for proposals. At least one report during FY 2016 should include the first estimate of net ongoing impacts to the State from the new system.

SB0007S01: Item 17

The Legislature intends that the Department of Health report on the following performance measures for the Medicaid Mandatory Services line item: (1) percent of adults age 45-64 with ambulatory or preventive care visits (Target = 88% or more), (2) percent of deliveries that had a post partum visit between 21 and 56 days after delivery (Target = 60% or more), and (3) percent of customers satisfied with their managed care plan (Target = 85% or more) by January 1, 2016 to the Social Services Appropriations Subcommittee.

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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.