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S.B. 273 Enrolled
7 LONG TITLE
8 General Description:
9 This bill enacts the Hospital Provider Assessment Act in the health code.
10 Highlighted Provisions:
11 This bill:
12 . makes legislative findings;
13 . defines terms;
14 . clarifies the application of the chapter;
15 . establishes the assessment and payment of the hospital provider assessment;
16 . establishes the calculation of the assessment;
17 . provides for quarterly assessment and payment;
18 . establishes a Medicaid inpatient hospital access payment from the division to a
20 . provides for penalties if the hospital provider assessment is not paid;
21 . creates a restricted special revenue fund;
22 . repeals the assessment if certain events occur;
23 . creates a Hospital Policy Review Board to review Medicaid state plan amendments
24 that effect hospital reimbursements;
25 . requires the division to seek approval from the Center for Medicare and Medicaid
26 Services for federal matching based on the hospital provider assessment; and
27 . repeals the hospital provider assessment on July 1, 2013.
28 Monies Appropriated in this Bill:
30 Other Special Clauses:
31 This bill has retrospective operation for taxable years beginning on or after January 1,
33 Utah Code Sections Affected:
35 63I-1-226, as last amended by Laws of Utah 2009, Chapter 334
37 26-36a-101, Utah Code Annotated 1953
38 26-36a-102, Utah Code Annotated 1953
39 26-36a-103, Utah Code Annotated 1953
40 26-36a-201, Utah Code Annotated 1953
41 26-36a-202, Utah Code Annotated 1953
42 26-36a-203, Utah Code Annotated 1953
43 26-36a-204, Utah Code Annotated 1953
44 26-36a-205, Utah Code Annotated 1953
45 26-36a-206, Utah Code Annotated 1953
46 26-36a-207, Utah Code Annotated 1953
47 26-36a-208, Utah Code Annotated 1953
48 26-36a-209, Utah Code Annotated 1953
50 Be it enacted by the Legislature of the state of Utah:
51 Section 1. Section 26-36a-101 is enacted to read:
54 26-36a-101. Title.
55 This chapter is known as the "Hospital Provider Assessment Act."
56 Section 2. Section 26-36a-102 is enacted to read:
57 26-36a-102. Legislative findings.
58 (1) The Legislature finds that there is an important state purpose to improve the access
59 of Medicaid patients to quality care in Utah hospitals because of continuous decreases in state
60 revenues and increases in enrollment under the Utah Medicaid program.
61 (2) The Legislature finds that in order to improve this access to those persons
62 described in Subsection (1):
63 (a) the rates paid to Utah hospitals must be adequate to encourage and support
64 improved access; and
65 (b) adequate funding must be provided to increase the rates paid to Utah hospitals
66 providing services pursuant to the Utah Medicaid program.
67 Section 3. Section 26-36a-103 is enacted to read:
68 26-36a-103. Definitions.
69 As used in this chapter:
70 (1) "Assessment" means the Medicaid hospital provider assessment established by this
72 (2) "Discharges" means the number of total hospital discharges reported on worksheet
73 S-3, column 15, lines 12, 14, and 14.01 of the Medicare Cost Report for the applicable
74 assessment year.
75 (3) "Division" means the Division of Health Care Financing of the department.
76 (4) "Hospital":
77 (a) means a privately owned:
78 (i) general acute hospital operating in the state as defined in Section 26-21-2 ; and
79 (ii) specialty hospital operating in the state, which shall include a privately owned
80 hospital whose inpatient admissions are predominantly:
81 (A) rehabilitation;
82 (B) psychiatric;
83 (C) chemical dependency; or
84 (D) long-term acute care services; and
85 (b) does not include:
86 (i) a residential care or treatment facility as defined in Section 62A-2-101 ;
87 (ii) a hospital owned by the federal government, including the Veterans
88 Administration Hospital;
89 (iii) a Shriners hospital that does not charge for its services; or
90 (iv) a hospital that is owned by the state government, a state agency, or a political
91 subdivision of the state, including:
92 (A) a state-owned teaching hospital; and
93 (B) the Utah State Hospital.
94 (5) "Low volume select access hospital" means a hospital that furnished inpatient
95 hospital services during fiscal year 2008 to less than 300 Medicaid cases under the select
96 access program.
97 (6) "Medicare cost report" means CMS-2552-96, the cost report for electronic filing of
99 (7) "Select access cases" means the number of hospital inpatient cases related to
100 individuals enrolled in the state's select access program for 2008.
101 (8) "State plan amendment" means a change or update to the state Medicaid plan.
102 (9) "Upper payment limit" means the maximum ceiling imposed by federal regulation
103 on a hospital Medicaid reimbursement for inpatient services under 42 C.F.R. Sec. 447.272.
104 (10) "Upper payment limit gap":
105 (a) means the difference between:
106 (i) the inpatient hospital upper payment limit for hospitals; and
107 (ii) Medicaid payments for inpatient hospital services not financed using hospital
108 assessments paid by all hospitals;
109 (b) shall be calculated separately for hospital inpatient services; and
110 (c) does not include Medicaid disproportionate share payments as part of the
111 calculation for the upper payment limit gap.
112 Section 4. Section 26-36a-201 is enacted to read:
114 26-36a-201. Application of chapter.
115 (1) Other than for the imposition of the assessment described in this chapter, nothing
116 in this chapter shall affect the nonprofit or tax exempt status of any nonprofit charitable,
117 religious, or educational health care provider under:
118 (a) Section 501(c), as amended, of the Internal Revenue Code;
119 (b) other applicable federal law;
120 (c) any state law;
121 (d) any ad valorem property taxes;
122 (e) any sales or use taxes; or
123 (f) any other taxes, fees, or assessments, whether imposed or sought to be imposed by
124 the state or any political subdivision, county, municipality, district, authority, or any agency or
125 department thereof.
126 (2) All assessments paid under this chapter may be included as an allowable cost of a
127 hospital for purposes of any applicable Medicaid reimbursement formula.
128 (3) This chapter does not authorize a political subdivision of the state to:
129 (a) license a hospital for revenue;
130 (b) impose a tax or assessment upon hospitals; or
131 (c) impose a tax or assessment measured by the income or earnings of a hospital.
132 Section 5. Section 26-36a-202 is enacted to read:
133 26-36a-202. Assessment, collection, and payment of hospital provider assessment.
134 (1) A uniform, broad based, assessment is imposed on each hospital as defined in
135 Subsection 26-36a-103 (4)(a):
136 (a) in the amount designated in Section 26-36a-203 ; and
137 (b) in accordance with Section 26-36a-204 , beginning when the division has obtained
138 approval from the Center for Medicare and Medicaid Services and provided notice of the
139 assessment to the hospital.
140 (2) (a) The assessment imposed by this chapter is due and payable on a quarterly basis
141 in accordance with Section 26-36a-204 .
142 (b) The collecting agent for this assessment is the department which is vested with the
143 administration and enforcement of this chapter, including the right to adopt administrative
144 rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act,
145 necessary to:
146 (i) implement and enforce the provisions of this act; and
147 (ii) audit records of a facility:
148 (A) that is subject to the assessment imposed by this chapter; and
149 (B) does not file a Medicare cost report.
150 (c) The department shall forward proceeds from the assessment imposed by this
151 chapter to the state treasurer for deposit in the restricted special revenue fund as specified in
152 Section 26-36a-207 .
153 (3) The department may, by rule, extend the time for paying the assessment.
154 Section 6. Section 26-36a-203 is enacted to read:
155 26-36a-203. Calculation of assessment.
156 (1) The division shall calculate the inpatient upper payment limit gap for hospitals for
157 each state fiscal year.
158 (2) (a) An annual assessment is payable on a quarterly basis for each hospital in an
159 amount calculated at a uniform assessment rate for each hospital discharge, in accordance with
160 this section.
161 (b) The uniform assessment rate shall be determined using the total number of hospital
162 discharges for assessed hospitals divided into the total non-federal portion of the upper
163 payment limit gap.
164 (c) Any quarterly changes to the uniform assessment rate must be applied uniformly to
165 all assessed hospitals.
166 (d) (i) Except as provided in Subsection (2)(d)(ii), the annual uniform assessment rate
167 may not generate more than the non-federal share of the annual upper payment limit gap for
168 the fiscal year.
169 (ii) (A) For fiscal year 2010 the assessment may not generate more than the
170 non-federal share of the annual upper payment limit gap for the fiscal year.
171 (B) For fiscal year 2010-11 the department may generate an additional amount from
172 the assessment imposed under Subsection (2)(d)(i) in the amount of $2,000,000 which shall be
173 used by the department and the division as follows:
174 (I) $1,000,000 to offset Medicaid mandatory expenditures; and
175 (II) $1,000,000 to offset the reduction in hospital outpatient fees in the state program.
176 (C) For fiscal years 2011-12 and 2012-13 the department may generate an additional
177 amount from the assessment imposed under Subsection (2)(d)(i) in the amount of $1,000,000
178 to offset Medicaid mandatory expenditures.
179 (3) (a) For state fiscal years 2010 and 2011, discharges shall be determined using the
180 data from each hospital's Medicare Cost Report contained in the Centers for Medicare and
181 Medicaid Services' Healthcare Cost Report Information System file as of April 1, 2009 for
182 hospital fiscal years ending between October 1, 2007, and September 30, 2008.
183 (b) If a hospital's fiscal year Medicare Cost Report is not contained in the Centers for
184 Medicare and Medicaid Services' Healthcare Cost Report Information System file dated March
185 31, 2009:
186 (i) the hospital shall submit to the division a copy of the hospital's Medicare Cost
187 Report with a fiscal year end between October 1, 2007, and September 30, 2008; and
188 (ii) the division shall determine the hospital's discharges from the information
189 submitted under Subsection (3)(b)(i).
190 (c) If a hospital started operations after the due date for a 2007 Medicare Cost Report:
191 (i) the hospital shall submit to the division a copy of the hospital's most recent
192 complete year Medicare Cost Report; and
193 (ii) the division shall determine the hospital's discharges from the information
194 submitted under Subsection (3)(c)(i).
195 (d) If a hospital is not certified by the Medicare program and is not required to file a
196 Medicare Cost Report:
197 (i) the hospital shall submit to the division its applicable fiscal year discharges with
198 supporting documentation;
199 (ii) the division shall determine the hospital's discharges from the information
200 submitted under Subsection (3)(d)(i); and
201 (iii) the failure to submit discharge information under Subsections (3)(d)(i) and (ii)
202 shall result in an audit of the hospital's records by the department and the imposition of a
203 penalty equal to 5% of the calculated assessment.
204 (4) (a) For state fiscal year 2012 and 2013, discharges shall be determined using the
205 data from each hospital's Medicare Cost Report contained in the Centers for Medicare and
206 Medicaid Services' Healthcare Cost Report Information System file as of:
207 (i) for state fiscal year 2012, September 30, 2010, for hospital fiscal years ending
208 between October 1, 2008, and September 30, 2009; and
209 (ii) for state fiscal year 2013, September 30, 2011, for hospital fiscal years ending
210 between October 1, 2009, and September 30, 2010.
211 (b) If a hospital's fiscal year Medicare Cost Report is not contained in the Centers for
212 Medicare and Medicaid Services' Healthcare Cost Report Information System file:
213 (i) the hospital shall submit to the division a copy of the hospital's Medicare Cost
214 Report applicable to the assessment year; and
215 (ii) the division shall determine the hospital's discharges.
216 (c) If a hospital is not certified by the Medicare program and is not required to file a
217 Medicare Cost Report:
218 (i) the hospital shall submit to the division its applicable fiscal year discharges with
219 supporting documentation;
220 (ii) the division shall determine the hospital's discharges from the information
221 submitted under Subsection (4)(c)(i); and
222 (iii) the failure to submit discharge information shall result in an audit of the hospital's
223 records and a penalty equal to 5% of the calculated assessment.
224 (5) Except as provided in Subsection (6), if a hospital is owned by an organization that
225 owns more than one hospital in the state:
226 (a) the assessment for each hospital shall be separately calculated by the department;
228 (b) each separate hospital shall pay the assessment imposed by this chapter.
229 (6) Notwithstanding the requirement of Subsection (5), if multiple hospitals use the
230 same Medicaid provider number:
231 (a) the department shall calculate the assessment in the aggregate for the hospitals
232 using the same Medicaid provider number; and
233 (b) the hospitals may pay the assessment in the aggregate.
234 (7) (a) The assessment formula imposed by this section, and the inpatient access
235 payments under Section 26-36a-205 , shall be adjusted in accordance with Subsection (7)(b) if
236 a hospital, for any reason, does not meet the definition of a hospital subject to the assessment
237 under Section 26-36a-103 for the entire fiscal year.
238 (b) The department shall adjust the assessment payable to the department under this
239 chapter for a hospital that is not subject to the assessment for an entire fiscal year by
240 multiplying the annual assessment calculated under Subsection (3) or (4) by a fraction, the
241 numerator of which is the number of days during the year that the hospital operated, and the
242 denominator of which is 365.
243 (c) A hospital described in Subsection (7)(a):
244 (i) that is ceasing to operate in the state, shall pay any assessment owed to the
245 department immediately upon ceasing to operate in the state; and
246 (ii) shall receive Medicaid inpatient hospital access payments under Section
247 26-36a-205 for the state fiscal year, adjusted using the same formula described in Subsection
249 (8) A hospital that is subject to payment of the assessment at the beginning of a state
250 fiscal year, but during the state fiscal year experiences a change in status so that it no longer
251 falls under the definition of a hospital subject to the assessment in Section 26-36a-204 , shall:
252 (a) not be required to pay the hospital assessment beginning on the date established by
253 the department by administrative rule; and
254 (b) not be entitled to Medicaid inpatient hospital access payments under Section
255 26-36a-205 on the date established by the department by administrative rule.
256 Section 7. Section 26-36a-204 is enacted to read:
257 26-36a-204. Quarterly notice -- Collection.
258 (1) (a) The division shall submit to the Center for Medicare and Medicaid Services:
259 (i) the payment methodology for the assessment imposed by this chapter; and
260 (ii) if necessary, a waiver under 42 C.F.R. Sec. 433.68.
261 (b) When the division receives notice of approval of the assessment and access
262 payments under this chapter from the Center for Medicare and Medicaid Services, the division
263 shall, within 45 days of the notice from the Center for Medicare and Medicaid Services,
264 provide a hospital that is subject to the assessment notice of:
265 (i) the approval of the assessment methodology from the Center for Medicare and
266 Medicaid Services;
267 (ii) the assessment rate;
268 (iii) the hospital's discharges subject to the assessment; and
269 (iv) the assessment amount owed by the hospital for the applicable fiscal year.
270 (2) The initial quarterly installments of the assessment imposed by this chapter are due
271 and payable if:
272 (a) the division has provided notice of the annual assessment under Subsection (1);
274 (b) the division has made all the quarterly installments of the Medicaid inpatient
275 hospital access payments that were otherwise due under Section 26-36a-205 , consistent with
276 the effective date of the approved state plan amendment.
277 (3) After the initial quarterly installments of the Medicaid inpatient hospital access
278 payments are made by the division, a hospital shall pay to the division the initial quarterly
279 assessments imposed by this chapter within 10 business days. Subsequent quarterly
280 assessments imposed by this chapter shall be paid to the division within 10 business days after
281 the hospital receives its Medicaid inpatient hospital access payment due for the applicable
282 quarter under Section 26-36a-205 .
283 Section 8. Section 26-36a-205 is enacted to read:
284 26-36a-205. Medicaid hospital inpatient access payments.
285 (1) To preserve and improve access to hospitals, the division shall make Medicaid
286 inpatient hospital access payments to hospitals in accordance with this section, Section
287 26-36a-204 , and Subsection 26-36a-203 (7).
288 (2) (a) The Medicaid inpatient hospital access payment amount to a particular hospital
289 shall be established by the division.
290 (b) The aggregate of all hospital's Medicaid inpatient hospital access payments shall
292 (i) equal to the upper payment limit gap for inpatient services for all hospitals; and
293 (ii) designated as the Medicaid inpatient hospital access payment pool.
294 (3) In addition to any other funds paid to hospitals during fiscal years 2010 and 2011
295 for inpatient hospital services to Medicaid patients, a Medicaid hospital inpatient access
296 payment shall be made:
297 (a) for state fiscal years 2010 and 2011:
298 (i) the amount of $825 per Medicaid fee for service day, to a hospital that:
299 (A) was not a specialty hospital; and
300 (B) had less than 300 select access inpatient cases during state fiscal year 2008; and
301 (ii) inpatient hospital access payments as determined by dividing the remaining
302 spending room available in the current year UPL, after offsetting the payments authorized
303 under Subsection (3)(a)(i) by the total 2008 Medicaid inpatient hospital payments, multiplied
304 by the hospital's Medicaid inpatient payments for state fiscal year 2008, exclusive of medical
305 education and Medicaid disproportionate share payments;
306 (b) for state fiscal year 2012, using state fiscal year 2009 paid Medicaid inpatient
307 claims data; and
308 (c) for state fiscal year 2013, using state fiscal year 2010 paid Medicaid inpatient
309 claims data.
310 (4) For both state fiscal years 2012 and 2013, the division shall submit adjustments to
311 the payment rates in Subsection (3)(a) to the Hospital Policy Review Board for their review.
312 (5) Medicaid inpatient hospital access payments shall be made:
313 (a) on a quarterly basis for inpatient hospital services furnished to Medicaid
314 individuals during each quarter; and
315 (b) within 15 days after the end of each quarter.
316 (6) A hospital's Medicaid inpatient access payment shall not be used to offset any
317 other payment by Medicaid for hospital inpatient or outpatient services to Medicaid
318 beneficiaries, including a:
319 (a) fee-for-service payment;
320 (b) per diem payment;
321 (c) hospital inpatient adjustment; or
322 (d) cost settlement payment.
323 (7) A hospital shall not be guaranteed that the hospital's Medicaid inpatient hospital
324 access payments will equal or exceed the amount of the hospital's assessment.
325 Section 9. Section 26-36a-206 is enacted to read:
326 26-36a-206. Penalties and interest.
327 (1) A facility that fails to pay any assessment or file a return as required under this
328 chapter, within the time required by this chapter, shall pay, in addition to the assessment,
329 penalties and interest established by the department.
330 (2) (a) Consistent with Subsection (2)(b), the department shall adopt rules in
331 accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, which establish
332 reasonable penalties and interest for the violations described in Subsection (1).
333 (b) If a hospital fails to timely pay the full amount of a quarterly assessment, the
334 department shall add to the assessment:
335 (i) a penalty equal to 5% of the quarterly amount not paid on or before the due date;
337 (ii) on the last day of each quarter after the due date until the assessed amount and the
338 penalty imposed under Subsection (2)(b)(i) are paid in full, an additional 5% penalty on:
339 (A) any unpaid quarterly assessment; and
340 (B) any unpaid penalty assessment.
341 (c) The division may waive, reduce, or compromise the penalties and interest provided
342 for in this section in the same manner as provided in Subsection 59-1-401 (8).
343 Section 10. Section 26-36a-207 is enacted to read:
344 26-36a-207. Restricted Special Revenue Fund -- Creation -- Deposits.
345 (1) There is created a restricted special revenue fund known as the "Hospital Provider
346 Assessment Special Revenue Fund."
347 (2) The fund shall consist of:
348 (a) the assessments collected by the department under this chapter;
349 (b) any interest and penalties levied with the administration of this chapter; and
350 (c) any other funds received as donations for the restricted fund and appropriations
351 from other sources.
352 (3) Money in the fund shall be used:
353 (a) to make inpatient hospital access payments under Section 26-36a-205 ; and
354 (b) to reimburse money collected by the division from a hospital through a mistake
355 made under this chapter.
356 Section 11. Section 26-36a-208 is enacted to read:
357 26-36a-208. Repeal of assessment.
358 (1) The repeal of the assessment imposed by this chapter shall occur upon the
359 certification by the executive director of the department that the sooner of the following has
361 (a) the effective date of any action by Congress that would disqualify the assessment
362 imposed by this chapter from counting towards state Medicaid funds available to be used to
363 determine the federal financial participation;
364 (b) the effective date of any decision, enactment, or other determination by the
365 Legislature or by any court, officer, department, or agency of the state, or of the federal
366 government that has the effect of:
367 (i) disqualifying the assessment from counting towards state Medicaid funds available
368 to be used to determine federal financial participation for Medicaid matching funds; or
369 (ii) creating for any reason a failure of the state to use the assessments for the
370 Medicaid program as described in this chapter; and
371 (c) the effective date of:
372 (i) an appropriation for any state fiscal year from the General Fund for hospital
373 payments under the state Medicaid program that is less than the amount appropriated for state
374 fiscal year 2011;
375 (ii) the annual revenues of the state General Fund budget return to the level that was
376 appropriated for fiscal year 2008;
377 (iii) approval of any change in the state Medicaid plan that requires a greater
378 percentage of Medicaid patients to enroll in Medicaid managed care plans than what is
379 required on January 1, 2010;
380 (iv) a division change in rules that reduces any of the following below July 1, 2010
382 (A) aggregate hospital inpatient payments;
383 (B) adjustment payment rates; or
384 (C) any cost settlement protocol; or
385 (v) a division change in rules that reduces the aggregate outpatient payments below
386 July 1, 2011 payments.
387 (2) If the assessment is repealed under Subsection (1), money in the fund that was
388 derived from assessments imposed by this chapter, before the determination made under
389 Subsection (1), shall be disbursed under Section 26-36a-205 to the extent federal matching is
390 not reduced due to the impermissibility of the assessments. Any funds remaining in the
391 special revenue fund shall be refunded to the hospitals in proportion to the amount paid by
392 each hospital.
393 Section 12. Section 26-36a-209 is enacted to read:
394 26-36a-209. State plan amendment -- Hospital Policy Review Board.
395 (1) The division shall file with the Center for Medicare and Medicaid Services a state
396 plan amendment to implement the requirements of this chapter, including the payment of
397 hospital access payments under Section 26-36a-205 no later than 45 days after the effective
398 date of this chapter.
399 (2) If the state plan amendment is not approved by the Center for Medicare and
400 Medicaid Services, the division shall:
401 (a) not implement the assessment imposed under this chapter; and
402 (b) return any assessment fees to the hospitals that paid the fees if assessment fees
403 have been collected.
404 (3) (a) The department shall establish an advisory board that is the Hospital Policy
405 Review Board.
406 (b) The board shall have five members selected as follows:
407 (i) one member appointed by the governor from a list of names submitted by the Utah
408 Hospitals and Health Systems Association;
409 (ii) two members appointed by the president of the Senate from a list of names
410 submitted by the Utah Hospitals and Health Systems Association; and
411 (iii) two members appointed by the speaker of the House from a list of names
412 submitted by the Utah Hospitals and Health Systems Association.
413 (c) Members of the board may not be compensated for their services on the board or
414 receive reimbursement for costs or per diem expenses.
415 (d) If a selection is not made by the governor, the speaker of the House, or the
416 president of the Senate within 60 days after the names are submitted by the Utah Hospitals and
417 Health Systems Association, the member shall be appointed by the Utah Hospitals and Health
418 Systems Association.
419 (e) (i) The board shall review state Medicaid plan amendments or waivers affecting
420 hospital reimbursement between the date of enactment of this chapter and the end of state
421 fiscal year 2013.
422 (ii) A majority of the board is a quorum.
423 (f) The department may not amend the state Medicaid plan or any waiver affecting
424 hospital reimbursement without submitting the amendment or waiver to the board for review.
425 Section 13. Section 63I-1-226 is amended to read:
426 63I-1-226. Repeal dates, Title 26.
427 (1) Title 26, Chapter 9f, Utah Digital Health Service Commission Act, is repealed July
428 1, 2015.
429 (2) Section 26-18-12 , Expansion of 340B drug pricing programs, is repealed July 1,
431 (3) Title 26, Chapter 33a, Utah Health Data Authority Act, is repealed July 1, 2014.
432 (4) Section 26-21-23 , Licensing of non-Medicaid nursing care facility beds, is
433 repealed July 1, 2011.
434 (5) Title 26, Chapter 36a, Hospital Provider and Assessment Act, is repealed July 1,
436 Section 14. Retrospective operation.
437 This bill has retrospective operation for taxable years beginning on or after January 1,
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