FY 2016 Appropriation

Outpatient hospital services provided must be medically necessary and appropriate to diagnose or treat illness, disability or pain. Medicaid covers outpatient visits at a hospital for most services without a prior authorization. Some surgeries may require a prior authorization. Some examples of outpatient hospital services include blood transfusions, casts, emergency room visits, and outpatient surgeries.

Funding History
Appropriation Overview

During the 2015 General Session, the Legislature appropriated for Fiscal Year 2016, $59,896,900 from all sources for Outpatient Hospital. This is a 0 percent change from Fiscal Year 2015 revised estimated amounts from all sources. The total includes $17,953,800 from the General/Education Funds, a change of 0 percent from revised Fiscal Year 2015 estimates.

Medicaid clients subject to co-pay requirements have a $3 co-payment for outpatient hospital services. Medicaid clients subject to co-pay requirements have a $6 co-payment for non-emergency use of the emergency room. Medicaid staff contact clients, who use the emergency room for non-emergency reasons, to connect them with a primary care provider and educate them on proper emergency room usage.

Medicare's Outpatient Prospective Payment System is the basis for outpatient hospital services reimbursement rates.

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.