FY 2016 Appropriation

In order to ensure medical appropriateness and/or unit limitations, some items require prior authorization. About half of all medical supplies require a prior authorization. Medicaid maintains a specific list of potentially approvable supplies for use in an emergency. After the emergency providers must submit claims to determine if the supply qualifies for reimbursement. Following are some items approved for possible reimbursement due to a medical emergency:

  • Feeding through tubes via veins or stomachs
  • Hospital bed equipment
  • Respiratory equipment
  • Oxygen
Funding History
Appropriation Overview

During the 2015 General Session, the Legislature appropriated for Fiscal Year 2016, $10,257,400 from all sources for Medical Supplies. This is a 0 percent change from Fiscal Year 2015 revised estimated amounts from all sources. The total includes $3,053,600 from the General/Education Funds, a change of 0 percent from revised Fiscal Year 2015 estimates.

Medicaid pays for supplies based upon the lower amount of billed charges or the Medicaid fee schedule. There are over 250 medical supply companies enrolled to provide services in Utah to Medicaid clients. Reimbursement rates for medical supplies are online at http://health.utah.gov/medicaid/stplan/physician.htm.

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.