1     
PRIMARY CARE NETWORK AMENDMENTS

2     
2018 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Steve Eliason

5     
Senate Sponsor: Brian Zehnder

6     

7     LONG TITLE
8     General Description:
9          This bill creates a new waiver program to provide enhanced benefits for certain
10     individuals in the Medicaid program, and provides funding for the enhancement waiver
11     program through an existing hospital assessment and a portion of the growth in alcohol
12     and tobacco tax revenues.
13     Highlighted Provisions:
14          This bill:
15          ▸     directs the Department of Health to apply for a new waiver or an amendment to an
16     existing waiver to implement the Primary Care Network enhancement waiver
17     program described in this bill; and
18          ▸     amends the Inpatient Hospital Assessment Act to pay for the cost of the
19     enhancement waiver program.
20     Money Appropriated in this Bill:
21          None
22     Other Special Clauses:
23          This bill provides coordination clauses.
24     Utah Code Sections Affected:
25     AMENDS:
26          26-18-411, as enacted by Laws of Utah 2016, Chapter 279
27          26-36b-102, as enacted by Laws of Utah 2016, Chapter 279
28          26-36b-103, as enacted by Laws of Utah 2016, Chapter 279
29          26-36b-201, as enacted by Laws of Utah 2016, Chapter 279
30          26-36b-202, as enacted by Laws of Utah 2016, Chapter 279
31          26-36b-203, as enacted by Laws of Utah 2016, Chapter 279
32          26-36b-204, as enacted by Laws of Utah 2016, Chapter 279
33          26-36b-205, as enacted by Laws of Utah 2016, Chapter 279
34          26-36b-206, as enacted by Laws of Utah 2016, Chapter 279
35          26-36b-207, as enacted by Laws of Utah 2016, Chapter 279
36          26-36b-208, as enacted by Laws of Utah 2016, Chapter 279
37          26-36b-209, as enacted by Laws of Utah 2016, Chapter 279
38          26-36b-210, as enacted by Laws of Utah 2016, Chapter 279
39          26-36b-211, as enacted by Laws of Utah 2016, Chapter 279
40          63I-1-226, as last amended by Laws of Utah 2017, Chapters 177 and 443
41     ENACTS:
42          26-18-415, Utah Code Annotated 1953
43     Utah Code Sections Affected by Coordination Clause:
44          26-18-415, Utah Code Annotated 1953
45          26-36b-103, as enacted by Laws of Utah 2016, Chapter 279
46          26-36b-201, as enacted by Laws of Utah 2016, Chapter 279
47          26-36b-204, as enacted by Laws of Utah 2016, Chapter 279
48          26-36b-206, as enacted by Laws of Utah 2016, Chapter 279
49          26-36b-208, as enacted by Laws of Utah 2016, Chapter 279
50          26-36b-209, as enacted by Laws of Utah 2016, Chapter 279
51          26-36b-211, as enacted by Laws of Utah 2016, Chapter 279
52     

53     Be it enacted by the Legislature of the state of Utah:
54          Section 1. Section 26-18-411 is amended to read:
55          26-18-411. Health coverage improvement program -- Eligibility -- Annual report
56     -- Expansion of eligibility for adults with dependent children.
57          (1) For purposes of this section:
58          (a) "Adult in the expansion population" means an individual who:
59          (i) is described in 42 U.S.C. Sec. 1396a(10)(A)(i)(VIII); and
60          (ii) is not otherwise eligible for Medicaid as a mandatory categorically needy
61     individual.
62          (b) "CMS" means the Centers for Medicare and Medicaid Services within the United
63     States Department of Health and Human Services.
64          (c) "Enhancement waiver program" means the Primary Care Network enhancement
65     waiver program described in Section 26-18-415.
66          [(c)] (d) "Federal poverty level" means the poverty guidelines established by the
67     Secretary of the United States Department of Health and Human Services under 42 U.S.C. Sec.
68     9909(2).
69          (e) "Health coverage improvement program" means the health coverage improvement
70     program described in Subsections (3) through (10).
71          [(d)] (f) "Homeless":
72          (i) means an individual who is chronically homeless, as determined by the department;
73     and
74          (ii) includes someone who was chronically homeless and is currently living in
75     supported housing for the chronically homeless.
76          [(e)] (g) "Income eligibility ceiling" means the percent of federal poverty level:
77          (i) established by the state in an appropriations act adopted pursuant to Title 63J,
78     Chapter 1, Budgetary Procedures Act; and
79          (ii) under which an individual may qualify for Medicaid coverage in accordance with
80     this section.
81          (2) Beginning July 1, 2016, the department shall amend the state Medicaid plan to
82     allow temporary residential treatment for substance abuse, for the traditional Medicaid
83     population, in a short term, non-institutional, 24-hour facility, without a bed capacity limit that
84     provides rehabilitation services that are medically necessary and in accordance with an
85     individualized treatment plan, as approved by CMS and as long as the county makes the
86     required match under Section 17-43-201.
87          (3) Beginning July 1, 2016, the department shall amend the state Medicaid plan to
88     increase the income eligibility ceiling to a percentage of the federal poverty level designated by
89     the department, based on appropriations for the program, for an individual with a dependent
90     child.
91          [(2) (a) No later than]
92          (4) Before July 1, 2016, the division shall submit to CMS a request for waivers, or an
93     amendment of existing waivers, from federal statutory and regulatory law necessary for the
94     state to implement the health coverage improvement program in the Medicaid program in
95     accordance with this section.
96          [(b)] (5) (a) An adult in the expansion population is eligible for Medicaid if the adult
97     meets the income eligibility and other criteria established under Subsection [(3)] (6).
98          [(c)] (b) An adult who qualifies under Subsection [(3)] (6) shall receive Medicaid
99     coverage:
100          (i) through[: (A)] the traditional fee for service Medicaid model in counties without
101     Medicaid accountable care organizations or the state's Medicaid accountable care organization
102     delivery system, where implemented; [and]
103          [(B)] (ii) except as provided in Subsection [(2)(c)(ii)] (5)(b)(iii), for behavioral health,
104     through the counties in accordance with Sections 17-43-201 and 17-43-301;
105          [(ii)] (iii) that integrates behavioral health services and physical health services with
106     Medicaid accountable care organizations in select geographic areas of the state that choose an
107     integrated model; and
108          [(iii)] (iv) that permits temporary residential treatment for substance abuse in a short
109     term, non-institutional, 24-hour facility, without a bed capacity limit, as approved by CMS, that
110     provides rehabilitation services that are medically necessary and in accordance with an
111     individualized treatment plan.
112          [(d)] (c) Medicaid accountable care organizations and counties that elect to integrate
113     care under Subsection [(2)(c)(ii)] (5)(b)(iii) shall collaborate on enrollment, engagement of
114     patients, and coordination of services.
115          [(3)] (6) (a) An individual is eligible for the health coverage improvement program
116     under Subsection [(2)(b)] (5) if:
117          (i) at the time of enrollment, the individual's annual income is below the income
118     eligibility ceiling established by the state under Subsection (1)[(e)](g); and
119          (ii) the individual meets the eligibility criteria established by the department under
120     Subsection [(3)] (6)(b).
121          (b) Based on available funding and approval from CMS, the department shall select the
122     criteria for an individual to qualify for the Medicaid program under Subsection [(3)] (6)(a)(ii),
123     based on the following priority:
124          (i) a chronically homeless individual;
125          (ii) if funding is available, an individual:
126          (A) involved in the justice system through probation, parole, or court ordered
127     treatment; and
128          (B) in need of substance abuse treatment or mental health treatment, as determined by
129     the department; or
130          (iii) if funding is available, an individual in need of substance abuse treatment or
131     mental health treatment, as determined by the department.
132          (c) An individual who qualifies for Medicaid coverage under Subsections [(3)] (6)(a)
133     and (b) may remain on the Medicaid program for a 12-month certification period as defined by
134     the department. Eligibility changes made by the department under Subsection (1)[(e)](g) or
135     [(3)] (6)(b) shall not apply to an individual during the 12-month certification period.
136          [(4)] (7) The state may request a modification of the income eligibility ceiling and
137     other eligibility criteria under Subsection [(3)] (6) each fiscal year based on enrollment in the
138     health coverage improvement program, projected enrollment, costs to the state, and the state
139     budget.
140          [(5) On or before September 30, 2017, and on or before]
141          (8) Before September 30 of each year [thereafter], the department shall report to the
142     [Legislature's] Health and Human Services Interim Committee and to the [Legislature's]
143     Executive Appropriations Committee:
144          (a) the number of individuals who enrolled in Medicaid under Subsection [(3)] (6);
145          (b) the state cost of providing Medicaid to individuals enrolled under Subsection [(3)]
146     (6); and
147          (c) recommendations for adjusting the income eligibility ceiling under Subsection [(4)]
148     (7), and other eligibility criteria under Subsection [(3)] (6), for the upcoming fiscal year.
149          [(6) In addition to the waiver under Subsection (2), beginning July 1, 2016, the
150     department shall amend the state Medicaid plan:]
151          [(a) for an individual with a dependent child, to increase the income eligibility ceiling
152     to a percent of the federal poverty level designated by the department, based on appropriations
153     for the program; and]
154          [(b) to allow temporary residential treatment for substance abuse, for the traditional
155     Medicaid population, in a short term, non-institutional, 24-hour facility, without a bed capacity
156     limit that provides rehabilitation services that are medically necessary and in accordance with
157     an individualized treatment plan, as approved by CMS and as long as the county makes the
158     required match under Section 17-43-201.]
159          [(7)] (9) The current Medicaid program and the health coverage improvement program,
160     when implemented, shall coordinate with a state prison or county jail to expedite Medicaid
161     enrollment for an individual who is released from custody and was eligible for or enrolled in
162     Medicaid before incarceration.
163          [(8)] (10) Notwithstanding Sections 17-43-201 and 17-43-301, a county does not have
164     to provide matching funds to the state for the cost of providing Medicaid services to newly
165     enrolled individuals who qualify for Medicaid coverage under the health coverage
166     improvement program under Subsection [(3)] (6).
167          [(9) The department shall:]
168          [(a) study, in consultation with health care providers, employers, uninsured families,
169     and community stakeholders:]
170          [(i) options to maximize use of employer sponsored coverage for current Medicaid
171     enrollees; and]
172          [(ii) strategies to increase participation of currently Medicaid eligible, and uninsured,
173     children; and]
174          [(b) report the findings of the study to the Legislature's Health Reform Task Force
175     before November 30, 2016.]
176          (11) If the enhancement waiver program is implemented, the department:
177          (a) may not accept any new enrollees into the health coverage improvement program
178     after the day on which the enhancement waiver program is implemented;
179          (b) shall transition all individuals who are enrolled in the health coverage improvement
180     program into the enhancement waiver program;
181          (c) shall suspend the health coverage improvement program within one year after the
182     day on which the enhancement waiver program is implemented;
183          (d) shall, within one year after the day on which the enhancement waiver program is
184     implemented, use all appropriations for the health coverage improvement program to
185     implement the enhancement waiver program; and
186          (e) shall work with CMS to maintain any waiver for the health coverage improvement
187     program while the health coverage improvement program is suspended under Subsection
188     (11)(c).
189          (12) If, after the enhancement waiver program takes effect, the enhancement waiver
190     program is repealed or suspended by either the state or federal government, the department
191     shall reinstate the health coverage improvement program and continue to accept new enrollees
192     into the health coverage improvement program in accordance with the provisions of this
193     section.
194          Section 2. Section 26-18-415 is enacted to read:
195          26-18-415. Primary Care Network enhancement waiver program.
196          (1) As used in this section:
197          (a) "CMS" means the Centers for Medicare and Medicaid Services within the United
198     States Department of Health and Human Services.
199          (b) "Enhancement waiver program" means the Primary Care Network enhancement
200     waiver program described in this section.
201          (c) "Federal poverty level" means the poverty guidelines established by the secretary of
202     the United States Department of Health and Human Services under 42 U.S.C. Sec. 9902(2).
203          (d) "Health coverage improvement program" means the same as that term is defined in
204     Section 26-18-411.
205          (e) "Income eligibility ceiling" means the percentage of federal poverty level:
206          (i) established by the Legislature in an appropriations act adopted pursuant to Title 63J,
207     Chapter 1, Budgetary Procedures Act; and
208          (ii) under which an individual may qualify for coverage in the enhancement waiver
209     program in accordance with this section.
210          (f) "Optional population" means the optional expansion population under PPACA if
211     the expansion provides coverage for individuals at or above 95% of the federal poverty level.
212          (g) "PPACA" means the same as that term is defined in Section 31A-1-301.
213          (h) "Primary Care Network" means the state Primary Care Network program created by
214     the Medicaid primary care network demonstration waiver obtained under Section 26-18-3.
215          (2) The department shall continue to implement the Primary Care Network program for
216     qualified individuals under the Primary Care Network program.
217          (3) Before July 1, 2018, the division shall apply for a Medicaid waiver or a state plan
218     amendment with CMS to implement, within the state Medicaid program, the enhancement
219     waiver program described in this section.
220          (4) An individual who is eligible for the enhancement waiver program may receive the
221     following benefits under the enhancement waiver program:
222          (a) the benefits offered under the Primary Care Network program;
223          (b) diagnostic testing and procedures;
224          (c) medical specialty care;
225          (d) inpatient hospital services;
226          (e) outpatient hospital services;
227          (f) outpatient behavioral health care, including outpatient substance abuse care; and
228          (g) for an individual who qualifies for the health coverage improvement program, as
229     approved by CMS, temporary residential treatment for substance abuse in a short term,
230     non-institutional, 24-hour facility, without a bed capacity limit, that provides rehabilitation
231     services that are medically necessary and in accordance with an individualized treatment plan.
232          (5) An individual is eligible for the enhancement waiver program if, at the time of
233     enrollment:
234          (a) the individual is qualified to enroll in the Primary Care Network or the health
235     coverage improvement program;
236          (b) the individual's annual income is below the income eligibility ceiling established by
237     the Legislature under Subsection (1)(e); and
238          (c) the individual meets the eligibility criteria established by the department under
239     Subsection (6).
240          (6) (a) Based on available funding and approval from CMS and subject to Subsection
241     (6)(d), the department shall determine the criteria for an individual to qualify for the
242     enhancement waiver program, based on the following priority:
243          (i) adults in the expansion population, as defined in Section 26-18-411, who qualify for
244     the health coverage improvement program;
245          (ii) adults with dependent children who qualify for the health coverage improvement
246     program under Subsection 26-18-411(3) ;
247          (iii) adults with dependent children who do not qualify for the health coverage
248     improvement program; and
249          (iv) if funding is available, adults without dependent children.
250          (b) The number of individuals enrolled in the enhancement waiver program may not
251     exceed 105% of the number of individuals who were enrolled in the Primary Care Network on
252     December 31, 2017.
253          (c) The department may only use appropriations from the Medicaid Expansion Fund
254     created in Section 26-36b-208 to fund the state portion of the enhancement waiver program.
255          (d) The money deposited into the Medicaid Expansion Fund under Subsections
256     26-36b-208(g) and (h) may only be used to pay the cost of enrolling individuals who qualify for
257     the enhancement waiver program under Subsections (6)(a)(iii) and (iv).
258          (7) The department may request a modification of the income eligibility ceiling and the
259     eligibility criteria under Subsection (6) from CMS each fiscal year based on enrollment in the
260     enhancement waiver program, projected enrollment in the enhancement waiver program, costs
261     to the state, and the state budget.
262          (8) The department may implement the enhancement waiver program by contracting
263     with Medicaid accountable care organizations to administer the enhancement waiver program.
264          (9) In accordance with Subsections 26-18-411(11) and (12), the department may use
265     funds that have been appropriated for the health coverage improvement program to implement
266     the enhancement waiver program.
267          (10) If the department expands the state Medicaid program to the optional population,
268     the department:
269          (a) except as provided in Subsection (11), may not accept any new enrollees into the
270     enhancement waiver program after the day on which the expansion to the optional population
271     is effective;
272          (b) shall suspend the enhancement waiver program within one year after the day on
273     which the expansion to the optional population is effective; and
274          (c) shall work with CMS to maintain the waiver for the enhancement waiver program
275     submitted under Subsection (3) while the enhancement waiver program is suspended under
276     Subsection (10)(b).
277          (11) If, after the expansion to the optional population described in Subsection (10)
278     takes effect, the expansion to the optional population is repealed by either the state or the
279     federal government, the department shall reinstate the enhancement waiver program and
280     continue to accept new enrollees into the enhancement waiver program in accordance with the
281     provisions of this section.
282          Section 3. Section 26-36b-102 is amended to read:
283          26-36b-102. Application.
284          (1) Other than for the imposition of the assessment described in this chapter, nothing in
285     this chapter shall affect the nonprofit or tax exempt status of any nonprofit charitable, religious,
286     or educational health care provider under any:
287          [(a) Section 501(c), as amended, of the Internal Revenue Code;]
288          [(b) other applicable federal law;]
289          [(c)] (a) [any] state law;
290          [(d)] (b) [any] ad valorem property taxes;
291          [(e)] (c) [any] sales or use taxes; or
292          [(f)] (d) [any] other taxes, fees, or assessments, whether imposed or sought to be
293     imposed, by the state or any political subdivision[, county, municipality, district, authority, or
294     any agency or department thereof] of the state.
295          (2) All assessments paid under this chapter may be included as an allowable cost of a
296     hospital for purposes of any applicable Medicaid reimbursement formula.
297          (3) This chapter does not authorize a political subdivision of the state to:
298          (a) license a hospital for revenue;
299          (b) impose a tax or assessment upon a hospital; or
300          (c) impose a tax or assessment measured by the income or earnings of a hospital.
301          Section 4. Section 26-36b-103 is amended to read:
302          26-36b-103. Definitions.
303          As used in this chapter:
304          (1) "Assessment" means the inpatient hospital assessment established by this chapter.
305          (2) "CMS" means the [same as that term is defined in Section 26-18-411] Centers for
306     Medicare and Medicaid Services within the United States Department of Health and Human
307     Services.
308          (3) "Discharges" means the number of total hospital discharges reported on:
309          (a) Worksheet S-3 Part I, column 15, lines 14, 16, and 17 of the 2552-10 Medicare cost
310     report for the applicable assessment year; or
311          (b) a similar report adopted by the department by administrative rule, if the report
312     under Subsection (3)(a) is no longer available.
313          (4) "Division" means the Division of Health Care Financing within the department.
314          (5) "Enhancement waiver program" means the program established by the Primary
315     Care Network enhancement waiver program described in Section 26-18-415.
316          (6) "Health coverage improvement program" means the health coverage improvement
317     program described in Section 26-18-411.
318          (7) "Hospital share" means the hospital share described in Section 26-36b-203.
319          (8) "Medicaid accountable care organization" means a managed care organization, as
320     defined in 42 C.F.R. Sec. 438, that contracts with the department under the provisions of
321     Section 26-18-405.
322          [(5)] (9) "Medicare cost report" means CMS-2552-10, the cost report for electronic
323     filing of hospitals.
324          [(6)] (10) (a) "Non-state government hospital"[:(a)] means a hospital owned by a
325     non-state government entity[; and].
326          (b) "Non-state government hospital" does not include:
327          (i) the Utah State Hospital; or
328          (ii) a hospital owned by the federal government, including the Veterans Administration
329     Hospital.
330          [(7)] (11) (a) "Private hospital"[:(a)] means:
331          (i) a [privately owned] general acute hospital [operating in the state], as defined in
332     Section 26-21-2, that is privately owned and operating in the state; and
333          (ii) a privately owned specialty hospital operating in the state, [which shall include]
334     including a privately owned hospital whose inpatient admissions are predominantly for:
335          (A) rehabilitation;
336          (B) psychiatric care;
337          (C) chemical dependency services; or
338          (D) long-term acute care services[; and].
339          (b) "Private hospital" does not include a facility for residential [care or] treatment
340     [facility] as defined in Section 62A-2-101.
341          [(8)] (12) "State teaching hospital" means a state owned teaching hospital that is part of
342     an institution of higher education.
343          (13) "Upper payment limit gap" means the difference between the private hospital
344     outpatient upper payment limit and the private hospital Medicaid outpatient payments, as
345     determined in accordance with 42 C.F.R. Sec. 447.321.
346          Section 5. Section 26-36b-201 is amended to read:
347          26-36b-201. Assessment.
348          (1) An assessment is imposed on each private hospital:
349          (a) beginning upon the later of CMS approval of:
350          (i) the health coverage improvement program waiver under Section 26-18-411; and
351          (ii) the assessment under this chapter;
352          (b) in the amount designated in Sections 26-36b-204 and 26-36b-205; and
353          (c) in accordance with Section 26-36b-202.
354          (2) Subject to Section 26-36b-203, the assessment imposed by this chapter is due and
355     payable on a quarterly basis, after payment of the outpatient upper payment limit supplemental
356     payments under Section 26-36b-210 have been paid.
357          (3) The first quarterly payment [shall not be] is not due until at least three months after
358     the earlier of the effective [date] dates of the coverage provided through:
359          (a) the health coverage improvement program [waiver under Section 26-18-411.]; or
360          (b) the enhancement waiver program.
361          Section 6. Section 26-36b-202 is amended to read:
362          26-36b-202. Collection of assessment -- Deposit of revenue -- Rulemaking.
363          (1) The collecting agent for the assessment imposed under Section 26-36b-201 is the
364     department.
365          (2) The department is vested with the administration and enforcement of this chapter,
366     [including the right to adopt administrative] and may make rules in accordance with Title 63G,
367     Chapter 3, Utah Administrative Rulemaking Act, necessary to:
368          [(a) implement and enforce the provisions of this chapter;]
369          (a) collect the assessment, intergovernmental transfers, and penalties imposed under
370     this chapter;
371          (b) audit records of a facility that:
372          (i) is subject to the assessment imposed by this chapter; and
373          (ii) does not file a Medicare cost report; and
374          (c) select a report similar to the Medicare cost report if Medicare no longer uses a
375     Medicare cost report.
376          (2) The department shall:
377          (a) administer the assessment in this [part separate] chapter separately from the
378     assessment in Chapter 36a, Hospital Provider Assessment Act; and
379          (b) deposit assessments collected under this chapter into the Medicaid Expansion Fund
380     created by Section 26-36b-208.
381          Section 7. Section 26-36b-203 is amended to read:
382          26-36b-203. Quarterly notice.
383          (1) Quarterly assessments imposed by this chapter shall be paid to the division within
384     15 business days after the original invoice date that appears on the invoice issued by the
385     division.
386          (2) The department may, by rule, extend the time for paying the assessment.
387          Section 8. Section 26-36b-204 is amended to read:
388          26-36b-204. Hospital financing of health coverage improvement program
389     Medicaid waiver -- Hospital share.
390          [(1) For purposes of this section, "hospital share":(a) means]
391          (1) The hospital share is:
392          (a) 45% of the state's net cost of[: (i)] the health coverage improvement program
393     [Medicaid waiver under Section 26-18-411; (ii)], including Medicaid coverage for individuals
394     with dependent children up to the federal poverty level designated under Section 26-18-411;
395     [and]
396          [(iii) the UPL gap, as that term is defined in Section 26-36b-210;]
397          (b) 45% of the state's net cost of the enhancement waiver program; and
398          (c) 45% of the state's net cost of the upper payment limit gap.
399          [(b) for the hospital share of the additional coverage under Section 26-18-411,]
400          (2) (a) The hospital share is capped at no more than $13,600,000 annually, consisting
401     of:
402          (i) an $11,900,000 cap [on the hospital's share] for the programs specified in
403     Subsections (1)(a)[(i) and (ii)] and (b); and
404          (ii) a $1,700,000 cap for the program specified in Subsection [(1)(a)(iii);] (1)(c).
405          [(c) for the cap specified in Subsection (1)(b), shall be prorated]
406          (b) The department shall prorate the cap described in Subsection (2)(a) in any year in
407     which the programs specified in [Subsection] Subsections (1)(a) and (c) are not in effect for the
408     full fiscal year[; and].
409          [(d)] (c) [if] If the Medicaid program expands in a manner that is greater than the
410     expansion described in Section 26-18-411[,] and the enhancement described in Section
411     26-18-415, the hospital share is capped at 33% of the state's share of the cost of the expansion
412     or enhancement that is in addition to the [program] programs described in Section 26-18-411 or
413     26-18-415.
414          [(2) The assessment for the private hospital share under Subsection (1) shall be:]
415          (3) Private hospitals shall be assessed under this chapter for:
416          (a) 69% of the portion of the hospital share specified in Subsections (1)(a)[(i) and (ii)]
417     and (b); and
418          (b) 100% of the portion of the hospital share specified in Subsection (1)[(a)(iii)](c).
419          [(3)] (4) (a) The department shall, on or before October 15, 2017, and on or before
420     October 15 of each subsequent year [thereafter], produce a report that calculates the state's net
421     cost of the programs described in Subsections (1)(a)[(i) and (ii)] and (b) that are in effect for
422     that year .
423          (b) If the assessment collected in the previous fiscal year is above or below the [private
424     hospital's share of the state's net cost as specified in Subsection (2),] hospital share for private
425     hospitals for the previous fiscal year, the underpayment or overpayment of the assessment by
426     the private hospitals shall be applied to the fiscal year in which the report [was] is issued.
427          [(4)] (5) A Medicaid accountable care organization shall, on or before October 15 of
428     each year, report to the department the following data from the prior state fiscal year for each
429     private hospital, state teaching hospital, and non-state government hospital provider that the
430     Medicaid accountable care organization contracts with:
431          (a) for the traditional Medicaid population[, for each private hospital, state teaching
432     hospital, and non-state government hospital provider]:
433          (i) hospital inpatient payments;
434          (ii) hospital inpatient discharges;
435          (iii) hospital inpatient days; and
436          (iv) hospital outpatient payments; and
437          [(b) for the Medicaid population newly eligible under Subsection 26-18-411, for each
438     private hospital, state teaching hospital, and non-state government hospital provider:]
439          (b) if the Medicaid accountable care organization enrolls any individuals in the health
440     coverage improvement program or the enhancement waiver program, for the population newly
441     eligible for either program:
442          (i) hospital inpatient payments;
443          (ii) hospital inpatient discharges;
444          (iii) hospital inpatient days; and
445          (iv) hospital outpatient payments.
446          (6) The department shall, by rule made in accordance with Title 63G, Chapter 3, Utah
447     Administrative Rulemaking Act, provide details surrounding specific content and format for
448     the reporting by the Medicaid accountable care organization.
449          Section 9. Section 26-36b-205 is amended to read:
450          26-36b-205. Calculation of assessment.
451          (1) (a) Except as provided in Subsection (1)(b), an annual assessment is payable on a
452     quarterly basis for each private hospital in an amount calculated by the division at a uniform
453     assessment rate for each hospital discharge, in accordance with this section.
454          (b) A private teaching hospital with more than 425 beds and 60 residents shall pay an
455     assessment rate [2.50] 2.5 times the uniform rate established under Subsection (1)(c).
456          (c) The division shall calculate the uniform assessment rate [shall be determined using
457     the total number of hospital discharges for assessed private hospitals, the percentages in
458     Subsection 26-36b-204(2), and rule adopted by the department.] described in Subsection (1)(a)
459     by dividing the hospital share for assessed private hospitals, described in Subsection
460     26-36b-204(1), by the sum of:
461          (i) the total number of discharges for assessed private hospitals that are not a private
462     teaching hospital; and
463          (ii) 2.5 times the number of discharges for a private teaching hospital, described in
464     Subsection (1)(b).
465          (d) The division may, by rule made in accordance with Title 63G, Chapter 3, Utah
466     Administrative Rulemaking Act, adjust the formula described in Subsection (1)(c) to address
467     unforeseen circumstances in the administration of the assessment under this chapter.
468          [(d)] (e) Any quarterly changes to the uniform assessment rate shall be applied
469     uniformly to all assessed private hospitals.
470          [(2) (a) For each state fiscal year, discharges shall be determined using the data from
471     each hospital's Medicare cost report contained in the Centers for Medicare and Medicaid
472     Services' Healthcare Cost Report Information System file. The hospital's discharge data will be
473     derived as follows:]
474          (2) Except as provided in Subsection (3), for each state fiscal year, the division shall
475     determine a hospital's discharges as follows:
476          [(i)] (a) for state fiscal year 2017, the hospital's cost report data for the hospital's fiscal
477     year ending between July 1, 2013, and June 30, 2014; and
478          [(ii)] (b) for each subsequent state fiscal year, the hospital's cost report data for the
479     hospital's fiscal year that ended in the state fiscal year two years before the assessment fiscal
480     year.
481          [(b)] (3) (a) If a hospital's fiscal year Medicare cost report is not contained in the
482     [Centers for Medicare and Medicaid Services'] CMS Healthcare Cost Report Information
483     System file:
484          (i) the hospital shall submit to the division a copy of the hospital's Medicare cost report
485     applicable to the assessment year; and
486          (ii) the division shall determine the hospital's discharges.
487          [(c)] (b) If a hospital is not certified by the Medicare program and is not required to file
488     a Medicare cost report:
489          (i) the hospital shall submit to the division the hospital's applicable fiscal year
490     discharges with supporting documentation;
491          (ii) the division shall determine the hospital's discharges from the information
492     submitted under Subsection [(2)(c)(i)] (3)(b)(i); and
493          (iii) [the] failure to submit discharge information shall result in an audit of the
494     hospital's records and a penalty equal to 5% of the calculated assessment.
495          [(3)] (4) Except as provided in Subsection [(4)] (5), if a hospital is owned by an
496     organization that owns more than one hospital in the state:
497          (a) the assessment for each hospital shall be separately calculated by the department;
498     and
499          (b) each separate hospital shall pay the assessment imposed by this chapter.
500          [(4) Notwithstanding the requirement of Subsection (3), if]
501          (5) If multiple hospitals use the same Medicaid provider number:
502          (a) the department shall calculate the assessment in the aggregate for the hospitals
503     using the same Medicaid provider number; and
504          (b) the hospitals may pay the assessment in the aggregate.
505          Section 10. Section 26-36b-206 is amended to read:
506          26-36b-206. State teaching hospital and non-state government hospital
507     mandatory intergovernmental transfer.
508          (1) [A] The state teaching hospital and a non-state government hospital shall make an
509     intergovernmental transfer to the Medicaid Expansion Fund created in Section 26-36b-208, in
510     accordance with this section.
511          (2) The [intergovernmental transfer shall be paid] hospitals described in Subsection (1)
512     shall pay the intergovernmental transfer beginning on the later of CMS approval of:
513          (a) the health improvement program waiver under Section 26-18-411; or
514          (b) the assessment for private hospitals in this chapter[; and].
515          [(c) the intergovernmental transfer in this section.]
516          (3) The intergovernmental transfer [shall be paid in an amount divided] is apportioned
517     as follows:
518          (a) the state teaching hospital is responsible for:
519          (i) 30% of the portion of the hospital share specified in Subsections
520     26-36b-204(1)(a)[(i) and (ii)] and (b); and
521          (ii) 0% of the hospital share specified in Subsection 26-36b-204(1)[(a)(iii)](c); and
522          (b) non-state government hospitals are responsible for:
523          (i) 1% of the portion of the hospital share specified in Subsections 26-36b-204(1)(a)[(i)
524     and (ii)] and (b); and
525          (ii) 0% of the hospital share specified in Subsection 26-36b-204(1)[(a)(iii)](c).
526          (4) The department shall, by rule made in accordance with Title 63G, Chapter 3, Utah
527     Administrative Rulemaking Act, designate:
528          (a) the method of calculating the [percentages] amounts designated in Subsection (3);
529     and
530          (b) the schedule for the intergovernmental transfers.
531          Section 11. Section 26-36b-207 is amended to read:
532          26-36b-207. Penalties.
533          (1) A hospital that fails to pay [any] a quarterly assessment, make the mandated
534     intergovernmental transfer, or file a return as required under this chapter, within the time
535     required by this chapter, shall pay penalties described in this section, in addition to the
536     assessment or intergovernmental transfer[, and interest established by the department].
537          [(2) (a) Consistent with Subsection (2)(b), the department shall adopt rules in
538     accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, that establish
539     reasonable penalties and interest for the violations described in Subsection (1).]
540          [(b)] (2) If a hospital fails to timely pay the full amount of a quarterly assessment or the
541     mandated intergovernmental transfer, the department shall add to the assessment or
542     intergovernmental transfer:
543          [(i)] (a) a penalty equal to 5% of the quarterly amount not paid on or before the due
544     date; and
545          [(ii)] (b) on the last day of each quarter after the due date until the assessed amount and
546     the penalty imposed under Subsection (2)[(b)(i)](a) are paid in full, an additional 5% penalty
547     on:
548          [(A)] (i) any unpaid quarterly assessment or intergovernmental transfer; and
549          [(B)] (ii) any unpaid penalty assessment.
550          [(c)] (3) Upon making a record of the division's actions, and upon reasonable cause
551     shown, the division may waive, reduce, or compromise any of the penalties imposed under this
552     chapter.
553          Section 12. Section 26-36b-208 is amended to read:
554          26-36b-208. Medicaid Expansion Fund.
555          (1) There is created an expendable special revenue fund known as the Medicaid
556     Expansion Fund.
557          (2) The fund consists of:
558          (a) assessments collected under this chapter;
559          (b) intergovernmental transfers under Section 26-36b-206;
560          (c) savings attributable to the health coverage improvement program [under Section
561     26-18-411] as determined by the department;
562          (d) savings attributable to the enhancement waiver program as determined by the
563     department;
564          [(d)] (e) savings attributable to the inclusion of psychotropic drugs on the preferred
565     drug list under Subsection 26-18-2.4(3) as determined by the department;
566          [(e)] (f) savings attributable to the services provided by the Public Employees' Health
567     Plan under Subsection 49-20-401(1)(u);
568          [(f)] (g) gifts, grants, donations, or any other conveyance of money that may be made to
569     the fund from private sources; [and]
570          (h) interest earned on money in the fund; and
571          [(g)] (i) additional amounts as appropriated by the Legislature.
572          (3) (a) The fund shall earn interest.
573          (b) All interest earned on fund money shall be deposited into the fund.
574          (4) (a) A state agency administering the provisions of this chapter may use money from
575     the fund to pay the costs [of], not otherwise paid for with federal funds or other revenue
576     sources, of:
577          (i) the health coverage improvement [Medicaid waiver under Section 26-18-411, and]
578     program;
579          (ii) the enhancement waiver program; and
580          (iii) the outpatient [UPL] upper payment limit supplemental payments under Section
581     26-36b-210[, not otherwise paid for with federal funds or other revenue sources, except that
582     no].
583          (b) A state agency administering the provisions of this chapter may not use:
584          (i) funds described in Subsection (2)(b) [may be used] to pay the cost of private
585     outpatient [UPL] upper payment limit supplemental payments[.]; or
586          [(b)] (ii) [Money] money in the fund [may not be used] for any [other] purpose not
587     described in Subsection (4)(a).
588          Section 13. Section 26-36b-209 is amended to read:
589          26-36b-209. Hospital reimbursement.
590          (1) [The] If the health coverage improvement program or the enhancement waiver
591     program is implemented by contracting with a Medicaid accountable care organization, the
592     department shall, to the extent allowed by law, include, in a contract [with a Medicaid
593     accountable care organization] to provide benefits under the health coverage improvement
594     program or the enhancement waiver program, a requirement that the Medicaid accountable care
595     organization reimburse hospitals in the accountable care organization's provider network[,] at
596     no less than the Medicaid fee-for-service rate.
597          (2) If the health coverage improvement program or the enhancement waiver program is
598     implemented by the department as a fee-for-service program, the department shall reimburse
599     hospitals at no less than the Medicaid fee-for-service rate.
600          (3) Nothing in this section prohibits a Medicaid accountable care organization from
601     paying a rate that exceeds the Medicaid fee-for-service [rates] rate.
602          Section 14. Section 26-36b-210 is amended to read:
603          26-36b-210. Outpatient upper payment limit supplemental payments.
604          [(1) For purposes of this section, "UPL gap" means the difference between the private
605     hospital outpatient upper payment limit and the private hospital Medicaid outpatient payments,
606     as determined in accordance with 42 C.F.R. 447.321.]
607          [(2)] (1) Beginning on the effective date of the assessment imposed under this chapter,
608     and for each subsequent fiscal year [thereafter], the department shall implement an outpatient
609     upper payment limit program for private hospitals that shall supplement the reimbursement to
610     private hospitals in accordance with Subsection [(3)] (2).
611          [(3)] (2) The division shall ensure that supplemental payment to Utah private hospitals
612     under Subsection [(2) shall] (1):
613          (a) does not exceed the positive [UPL] upper payment limit gap; and
614          (b) [be] is allocated based on the Medicaid state plan.
615          [(4)] (3) The department shall use the same outpatient data [used to calculate the UPL
616     gap under Subsection (1) shall be the same outpatient data used] to allocate the payments under
617     Subsection [(3)] (2) and to calculate the upper payment limit gap.
618          [(5)] (4) The supplemental payments to private hospitals under Subsection [(2) shall
619     be] (1) are payable for outpatient hospital services provided on or after the later of:
620          (a) July 1, 2016;
621          (b) the effective date of the Medicaid state plan amendment necessary to implement the
622     payments under this section; or
623          (c) the effective date of the coverage provided through the health coverage
624     improvement program [waiver under Section 26-18-411].
625          Section 15. Section 26-36b-211 is amended to read:
626          26-36b-211. Repeal of assessment.
627          (1) The [repeal of the] assessment imposed by this chapter shall [occur upon the
628     certification by the executive director of the department that the sooner of the following has
629     occurred] be repealed when:
630          [(a) the effective date of any]
631          (a) the executive director certifies that:
632          (i) action by Congress [that would disqualify] is in effect that disqualifies the
633     assessment imposed by this chapter from counting toward state Medicaid funds available to be
634     used to determine the amount of federal financial participation;
635          [(b) the effective date of any]
636          (ii) a decision, enactment, or other determination by the Legislature or by any court,
637     officer, department, or agency of the state, or of the federal government, [that has the effect of]
638     is in effect that:
639          [(i) disqualifying] (A) disqualifies the assessment from counting toward state
640     Medicaid funds available to be used to determine federal financial participation for Medicaid
641     matching funds; or
642          [(ii) creating] (B) creates for any reason a failure of the state to use the assessments for
643     at least one of the Medicaid [program as] programs described in this chapter; or
644          [(c) the effective date of]
645          (iii) a change is in effect that reduces the aggregate hospital inpatient and outpatient
646     payment rate below the aggregate hospital inpatient and outpatient payment rate for July 1,
647     2015; [and] or
648          [(d) the sunset of] (b) this chapter is repealed in accordance with Section 63I-1-226.
649          [(2) If the assessment is repealed under Subsection (1), money in the fund that was
650     derived from assessments imposed by this chapter, before the determination made under
651     Subsection (1), shall be disbursed under Section 26-36b-207 to the extent federal matching is
652     not reduced due to the impermissibility of the assessments. Any funds remaining in the special
653     revenue fund shall be refunded to the hospitals in proportion to the amount paid by each
654     hospital.]
655          (2) If the assessment is repealed under Subsection (1):
656          (a) the division may not collect any assessment or intergovernmental transfer under this
657     chapter;
658          (b) the department shall disburse money in the special Medicaid Expansion Fund in
659     accordance with the requirements in Subsection 26-36b-208(4), to the extent federal matching
660     is not reduced by CMS due to the repeal of the assessment;
661          (c) any money remaining in the Medicaid Expansion Fund after the disbursement
662     described in Subsection (2)(b) that was derived from assessments imposed by this chapter shall
663     be refunded to the hospitals in proportion to the amount paid by each hospital for the last three
664     fiscal years; and
665          (d) any money remaining in the Medicaid Expansion Fund after the disbursements
666     described in Subsections (2)(b) and (c) shall be deposited into the General Fund by the end of
667     the fiscal year that the assessment is suspended.
668          Section 16. Section 63I-1-226 is amended to read:
669          63I-1-226. Repeal dates, Title 26.
670          (1) Section 26-1-40 is repealed July 1, 2019.
671          (2) Title 26, Chapter 9f, Utah Digital Health Service Commission Act, is repealed July
672     1, 2025.
673          (3) Section 26-10-11 is repealed July 1, 2020.
674          (4) Title 26, Chapter 33a, Utah Health Data Authority Act, is repealed July 1, 2024.
675          (5) Title 26, Chapter 36a, Hospital Provider Assessment Act, is repealed July 1, 2019.
676          (6) Title 26, Chapter 36b, Inpatient Hospital Assessment Act, is repealed July 1, 2021.
677          [(7) Section 26-38-2.5 is repealed July 1, 2017.]
678          [(8) Section 26-38-2.6 is repealed July 1, 2017.]
679          [(9)] (7) Title 26, Chapter 56, Hemp Extract Registration Act, is repealed July 1, 2021.
680          Section 17. Coordinating H.B. 325 with H.B. 14 -- Superseding substantive and
681     technical amendments.
682           If this H.B. 325 and H.B. 14, Substance Abuse Treatment Facility Patient Brokering,
683     both pass and become law, it is the intent of the Legislature that the amendments to Section
684     26-36b-103 in this bill supersede the amendments to Section 26-36b-103 in H.B. 14, when the
685     Office of Legislative Research and General Counsel prepares the Utah Code database for
686     publication.
687          Section 18. Coordinating H.B. 325 with H.B. 472 -- Substantive and technical
688     amendments.
689          If this H.B. 325 and H.B. 472, Medicaid Expansion Revisions, both pass and become
690     law, it is the intent of the Legislature that the Office of Legislative Research and General
691     Counsel shall prepare the Utah Code database for publication by making the following
692     changes:
693          (1) modifying Subsection 26-18-415(3) to read:
694          "(3) (a) The division shall apply for a Medicaid waiver or a state plan amendment with
695     CMS to implement, within the state Medicaid program, the enhancement waiver program
696     described in this section within six months after the day on which:
697          (i) the division receives a notice from CMS that the waiver for the Medicaid waiver
698     expansion submitted under Section 26-18-415, Medicaid waiver expansion, will not be
699     approved; or
700          (ii) the division withdraws the waiver for the Medicaid waiver expansion submitted
701     under Section 26-18-415, Medicaid waiver expansion.
702          (b) The division may not apply for a waiver under Subsection (3)(a) while a waiver
703     request under Section 26-18-415, Medicaid waiver expansion, is pending with CMS.";
704          (2) modifying Subsection 26-36b-201(3) to read:
705          "(3) The first quarterly payment [shall not be] is not due until at least three months
706     after the earlier of the effective [date] dates of the coverage provided through:
707          (a) the health coverage improvement program [waiver under Section 26-18-411.];
708          (b) the enhancement waiver program; or
709          (c) the Medicaid waiver expansion.";
710          (3) modifying Section 26-36b-204 to read:
711          "26-36b-204.     Hospital financing of health coverage improvement program
712     Medicaid waiver -- Hospital share.
713          [(1) For purposes of this section, "hospital share":(a) means]
714          (1) The hospital share is:
715          (a) 45% of the state's net cost of[:(i)] the health coverage improvement program
716     [Medicaid waiver under Section 26-18-411;(ii)], including Medicaid coverage for individuals
717     with dependent children up to the federal poverty level designated under Section 26-18-411;
718     [and]
719          [(iii) the UPL gap, as that term is defined in Section 26-36b-210;]
720          (b) 45% of the state's net cost of the enhancement waiver program;
721          (c) if the waiver for the Medicaid waiver expansion is approved, $11,900,000; and
722          (d) 45% of the state's net cost of the upper payment limit gap.
723          [(b) for the hospital share of the additional coverage under Section 26-18-411,]
724          (2) (a) The hospital share is capped at no more than $13,600,000 annually, consisting
725     of:
726          (i) an $11,900,000 cap [on the hospital's share] for the programs specified in
727     Subsections (1)(a)[(i) and (ii)] through (c); and
728          (ii) a $1,700,000 cap for the program specified in Subsection [(1)(a)(iii);] (1)(d).
729          [(c) for the cap specified in Subsection (1)(b), shall be prorated]
730          (b) The department shall prorate the cap described in Subsection (2)(a) in any year in
731     which the programs specified in [Subsection] Subsections (1)(a) and (d) are not in effect for the
732     full fiscal year[; and].
733          [(d) if the Medicaid program expands in a manner that is greater than the expansion
734     described in Section 26-18-411, is capped at 33% of the state's share of the cost of the
735     expansion that is in addition to the program described in Section 26-18-411.]
736          [(2) The assessment for the private hospital share under Subsection (1) shall be:]
737          (3) Private hospitals shall be assessed under this chapter for:
738          (a) 69% of the portion of the hospital share for the programs specified in Subsections
739     (1)(a)[(i) and (ii)] through (c); and
740          (b) 100% of the portion of the hospital share specified in Subsection [(1)(a)(iii)] (1)(d).
741          [(3)] (4) (a) The department shall, on or before October 15, 2017, and on or before
742     October 15 of each subsequent year [thereafter], produce a report that calculates the state's net
743     cost of each of the programs described in Subsections (1)(a)[(i) and (ii)] through (c) that are in
744     effect for that year.
745          (b) If the assessment collected in the previous fiscal year is above or below the [private
746     hospital's share of the state's net cost as specified in Subsection (2),] hospital share for private
747     hospitals for the previous fiscal year, the underpayment or overpayment of the assessment by
748     the private hospitals shall be applied to the fiscal year in which the report [was] is issued.
749          [(4)] (5) A Medicaid accountable care organization shall, on or before October 15 of
750     each year, report to the department the following data from the prior state fiscal year for each
751     private hospital, state teaching hospital, and non-state government hospital provider that the
752     Medicaid accountable care organization contracts with:
753          (a) for the traditional Medicaid population[, for each private hospital, state teaching
754     hospital, and non-state government hospital provider]:
755          (i) hospital inpatient payments;
756          (ii) hospital inpatient discharges;
757          (iii) hospital inpatient days; and
758          (iv) hospital outpatient payments; and
759          [(b) for the Medicaid population newly eligible under Subsection 26-18-411, for each
760     private hospital, state teaching hospital, and non-state government hospital provider:]
761          (b) if the Medicaid accountable care organization enrolls any individuals in the health
762     coverage improvement program, the enhancement waiver program, or the Medicaid waiver
763     expansion, for the population newly eligible for any of those programs:
764          (i) hospital inpatient payments;
765          (ii) hospital inpatient discharges;
766          (iii) hospital inpatient days; and
767          (iv) hospital outpatient payments.
768          (6) The department shall, by rule made in accordance with Title 63G, Chapter 3, Utah
769     Administrative Rulemaking Act, provide details surrounding specific content and format for
770     the reporting by the Medicaid accountable care organization.";
771          (4) modifying Subsection 26-36b-206(3) to read:
772          "(3) The intergovernmental transfer [shall be paid in an amount divided] is apportioned
773     as follows:
774          (a) the state teaching hospital is responsible for:
775          (i) 30% of the portion of the hospital share specified in Subsections
776     26-36b-204(1)(a)[(i) and (ii)] through (c); and
777          (ii) 0% of the hospital share specified in Subsection 26-36b-204(1)[(a)(iii)](d); and
778          (b) non-state government hospitals are responsible for:
779          (i) 1% of the portion of the hospital share specified in Subsections 26-36b-204(1)(a)[(i)
780     and (ii)] through (c); and
781          (ii) 0% of the hospital share specified in Subsection 26-36b-204(1)[(a)(iii)](d).";
782          (5) modifying Section 26-36b-208 to read:
783          "26-36b-208.     Medicaid Expansion Fund.
784          (1) There is created an expendable special revenue fund known as the Medicaid
785     Expansion Fund.
786          (2) The fund consists of:
787          (a) assessments collected under this chapter;
788          (b) intergovernmental transfers under Section 26-36b-206;
789          (c) savings attributable to the health coverage improvement program [under Section
790     26-18-411] as determined by the department;
791          (d) savings attributable to the enhancement waiver program as determined by the
792     department;
793          (e) savings attributable to the Medicaid waiver expansion as determined by the
794     department;
795          [(d)] (f) savings attributable to the inclusion of psychotropic drugs on the preferred
796     drug list under Subsection 26-18-2.4(3) as determined by the department;
797          [(e)] (g) savings attributable to the services provided by the Public Employees' Health
798     Plan under Subsection 49-20-401(1)(u);
799          [(f)] (h) gifts, grants, donations, or any other conveyance of money that may be made to
800     the fund from private sources; [and]
801          (i) interest earned on money in the fund; and
802          [(g)] (j) additional amounts as appropriated by the Legislature.
803          (3) (a) The fund shall earn interest.
804          (b) All interest earned on fund money shall be deposited into the fund.
805          (4) (a) A state agency administering the provisions of this chapter may use money from
806     the fund to pay the costs [of], not otherwise paid for with federal funds or other revenue
807     sources, of:
808          (i) the health coverage improvement [Medicaid waiver under Section 26-18-411, and]
809     program;
810          (ii) the enhancement waiver program;
811          (iii) the Medicaid waiver expansion; and
812          (iv) the outpatient [UPL] upper payment limit supplemental payments under Section
813     26-36b-210[, not otherwise paid for with federal funds or other revenue sources, except that
814     no].
815          (b) A state agency administering the provisions of this chapter may not use:
816          (i) funds described in Subsection (2)(b) may be used to pay the cost of private
817     outpatient [UPL] upper payment limit supplemental payments[.]; or
818          [(b)] (ii) [Money] money in the fund [may not be used for any other] for any purpose
819     not described in Subsection (4)(a).";
820          (6) modifying Section 26-36b-209 to read:
821          "26-36b-209.     Hospital reimbursement.
822          (1) [The] If the health coverage improvement program, the enhancement waiver
823     program, or the Medicaid waiver expansion is implemented by contracting with a Medicaid
824     accountable care organization, the department shall, to the extent allowed by law, include, in a
825     contract [with a Medicaid accountable care organization] to provide benefits under the health
826     coverage improvement program, the enhancement waiver program, or the Medicaid waiver
827     expansion, a requirement that the Medicaid accountable care organization reimburse hospitals
828     in the accountable care organization's provider network[,] at no less than the Medicaid
829     fee-for-service rate.
830          (2) If the health coverage improvement program, the enhancement waiver program, or
831     the Medicaid waiver expansion is implemented by the department as a fee-for-service program,
832     the department shall reimburse hospitals at no less than the Medicaid fee-for-service rate.
833          (3) Nothing in this section prohibits a Medicaid accountable care organization from
834     paying a rate that exceeds the Medicaid fee-for-service [rates] rate."; and
835          (7) Section 26-36b-211 in this H.B. 325 supersedes Section 26-36b-211 in H.B. 472.
836          Section 19. Coordinating H.B. 325 with S.B. 125 -- Superseding substantive and
837     technical amendments.
838           If this H.B. 325 and S.B. 125, Child Welfare Amendments, both pass and become law,
839     it is the intent of the Legislature that the amendments to Section 26-36b-103 in this bill
840     supersede the amendments to Section 26-36b-103 in S.B. 125, when the Office of Legislative
841     Research and General Counsel prepares the Utah Code database for publication.
842