FY 2016 Appropriation

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.

Funding History
Appropriation Overview

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.

Appropriation Adjustments

The following appropriation adjustments were made during the 2015 General Session:

DescriptionOngoingOne-Time

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.

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.

The monthly caseload is the number of clients served in the Medicaid program.

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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.