Representative Steve Eliason proposes the following substitute bill:


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;
18          ▸     amends the Inpatient Hospital Assessment Act to pay for the cost of the
19     enhancement waiver program; and
20          ▸     dedicates a portion of the growth in the state's revenue from alcohol and tobacco
21     taxes to pay for the cost of the enhancement waiver program.
22     Money Appropriated in this Bill:
23          None
24     Other Special Clauses:
25          This bill provides a special effective date.
26          This bill provides coordination clauses.
27     Utah Code Sections Affected:
28     AMENDS:
29          26-18-411, as enacted by Laws of Utah 2016, Chapter 279
30          26-36b-102, as enacted by Laws of Utah 2016, Chapter 279
31          26-36b-103, as enacted by Laws of Utah 2016, Chapter 279
32          26-36b-201, as enacted by Laws of Utah 2016, Chapter 279
33          26-36b-202, as enacted by Laws of Utah 2016, Chapter 279
34          26-36b-203, as enacted by Laws of Utah 2016, Chapter 279
35          26-36b-204, as enacted by Laws of Utah 2016, Chapter 279
36          26-36b-205, as enacted by Laws of Utah 2016, Chapter 279
37          26-36b-206, as enacted by Laws of Utah 2016, Chapter 279
38          26-36b-207, as enacted by Laws of Utah 2016, Chapter 279
39          26-36b-208, as enacted by Laws of Utah 2016, Chapter 279
40          26-36b-209, as enacted by Laws of Utah 2016, Chapter 279
41          26-36b-210, as enacted by Laws of Utah 2016, Chapter 279
42          26-36b-211, as enacted by Laws of Utah 2016, Chapter 279
43          32B-2-301, as last amended by Laws of Utah 2017, Chapter 159
44          59-14-204, as last amended by Laws of Utah 2016, Chapter 168
45          63I-1-226, as last amended by Laws of Utah 2017, Chapters 177 and 443
46     ENACTS:
47          26-18-415, Utah Code Annotated 1953
48     Utah Code Sections Affected by Coordination Clause:
49          26-18-415, Utah Code Annotated 1953
50          26-36b-103, as enacted by Laws of Utah 2016, Chapter 279
51          26-36b-201, as enacted by Laws of Utah 2016, Chapter 279
52          26-36b-204, as enacted by Laws of Utah 2016, Chapter 279
53          26-36b-206, as enacted by Laws of Utah 2016, Chapter 279
54          26-36b-208, as enacted by Laws of Utah 2016, Chapter 279
55          26-36b-209, as enacted by Laws of Utah 2016, Chapter 279
56          26-36b-211, as enacted by Laws of Utah 2016, Chapter 279
57     

58     Be it enacted by the Legislature of the state of Utah:
59          Section 1. Section 26-18-411 is amended to read:
60          26-18-411. Health coverage improvement program -- Eligibility -- Annual report
61     -- Expansion of eligibility for adults with dependent children.
62          (1) For purposes of this section:
63          (a) "Adult in the expansion population" means an individual who:
64          (i) is described in 42 U.S.C. Sec. 1396a(10)(A)(i)(VIII); and
65          (ii) is not otherwise eligible for Medicaid as a mandatory categorically needy
66     individual.
67          (b) "CMS" means the Centers for Medicare and Medicaid Services within the United
68     States Department of Health and Human Services.
69          (c) "Enhancement waiver program" means the Primary Care Network enhancement
70     waiver program described in Section 26-18-415.
71          [(c)] (d) "Federal poverty level" means the poverty guidelines established by the
72     Secretary of the United States Department of Health and Human Services under 42 U.S.C. Sec.
73     9909(2).
74          (e) "Health coverage improvement program" means the health coverage improvement
75     program described in Subsections (3) through (10).
76          [(d)] (f) "Homeless":
77          (i) means an individual who is chronically homeless, as determined by the department;
78     and
79          (ii) includes someone who was chronically homeless and is currently living in
80     supported housing for the chronically homeless.
81          [(e)] (g) "Income eligibility ceiling" means the percent of federal poverty level:
82          (i) established by the state in an appropriations act adopted pursuant to Title 63J,
83     Chapter 1, Budgetary Procedures Act; and
84          (ii) under which an individual may qualify for Medicaid coverage in accordance with
85     this section.
86          (2) Beginning July 1, 2016, the department shall amend the state Medicaid plan to
87     allow temporary residential treatment for substance abuse, for the traditional Medicaid
88     population, in a short term, non-institutional, 24-hour facility, without a bed capacity limit that
89     provides rehabilitation services that are medically necessary and in accordance with an
90     individualized treatment plan, as approved by CMS and as long as the county makes the
91     required match under Section 17-43-201.
92          (3) Beginning July 1, 2016, the department shall amend the state Medicaid plan to
93     increase the income eligibility ceiling to a percentage of the federal poverty level designated by
94     the department, based on appropriations for the program, for an individual with a dependent
95     child.
96          [(2) (a) No later than]
97          (4) Before July 1, 2016, the division shall submit to CMS a request for waivers, or an
98     amendment of existing waivers, from federal statutory and regulatory law necessary for the
99     state to implement the health coverage improvement program in the Medicaid program in
100     accordance with this section.
101          [(b)] (5) (a) An adult in the expansion population is eligible for Medicaid if the adult
102     meets the income eligibility and other criteria established under Subsection [(3)] (6).
103          [(c)] (b) An adult who qualifies under Subsection [(3)] (6) shall receive Medicaid
104     coverage:
105          (i) through[: (A)] the traditional fee for service Medicaid model in counties without
106     Medicaid accountable care organizations or the state's Medicaid accountable care organization
107     delivery system, where implemented; [and]
108          [(B)] (ii) except as provided in Subsection [(2)(c)(ii)] (5)(b)(iii), for behavioral health,
109     through the counties in accordance with Sections 17-43-201 and 17-43-301;
110          [(ii)] (iii) that integrates behavioral health services and physical health services with
111     Medicaid accountable care organizations in select geographic areas of the state that choose an
112     integrated model; and
113          [(iii)] (iv) that permits temporary residential treatment for substance abuse in a short
114     term, non-institutional, 24-hour facility, without a bed capacity limit, as approved by CMS, that
115     provides rehabilitation services that are medically necessary and in accordance with an
116     individualized treatment plan.
117          [(d)] (c) Medicaid accountable care organizations and counties that elect to integrate
118     care under Subsection [(2)(c)(ii)] (5)(b)(iii) shall collaborate on enrollment, engagement of
119     patients, and coordination of services.
120          [(3)] (6) (a) An individual is eligible for the health coverage improvement program
121     under Subsection [(2)(b)] (5) if:
122          (i) at the time of enrollment, the individual's annual income is below the income
123     eligibility ceiling established by the state under Subsection (1)[(e)](g); and
124          (ii) the individual meets the eligibility criteria established by the department under
125     Subsection [(3)] (6)(b).
126          (b) Based on available funding and approval from CMS, the department shall select the
127     criteria for an individual to qualify for the Medicaid program under Subsection [(3)] (6)(a)(ii),
128     based on the following priority:
129          (i) a chronically homeless individual;
130          (ii) if funding is available, an individual:
131          (A) involved in the justice system through probation, parole, or court ordered
132     treatment; and
133          (B) in need of substance abuse treatment or mental health treatment, as determined by
134     the department; or
135          (iii) if funding is available, an individual in need of substance abuse treatment or
136     mental health treatment, as determined by the department.
137          (c) An individual who qualifies for Medicaid coverage under Subsections [(3)] (6)(a)
138     and (b) may remain on the Medicaid program for a 12-month certification period as defined by
139     the department. Eligibility changes made by the department under Subsection (1)[(e)](g) or
140     [(3)] (6)(b) shall not apply to an individual during the 12-month certification period.
141          [(4)] (7) The state may request a modification of the income eligibility ceiling and
142     other eligibility criteria under Subsection [(3)] (6) each fiscal year based on enrollment in the
143     health coverage improvement program, projected enrollment, costs to the state, and the state
144     budget.
145          [(5) On or before September 30, 2017, and on or before]
146          (8) Before September 30 of each year [thereafter], the department shall report to the
147     [Legislature's] Health and Human Services Interim Committee and to the [Legislature's]
148     Executive Appropriations Committee:
149          (a) the number of individuals who enrolled in Medicaid under Subsection [(3)] (6);
150          (b) the state cost of providing Medicaid to individuals enrolled under Subsection [(3)]
151     (6); and
152          (c) recommendations for adjusting the income eligibility ceiling under Subsection [(4)]
153     (7), and other eligibility criteria under Subsection [(3)] (6), for the upcoming fiscal year.
154          [(6) In addition to the waiver under Subsection (2), beginning July 1, 2016, the
155     department shall amend the state Medicaid plan:]
156          [(a) for an individual with a dependent child, to increase the income eligibility ceiling
157     to a percent of the federal poverty level designated by the department, based on appropriations
158     for the program; and]
159          [(b) to allow temporary residential treatment for substance abuse, for the traditional
160     Medicaid population, in a short term, non-institutional, 24-hour facility, without a bed capacity
161     limit that provides rehabilitation services that are medically necessary and in accordance with
162     an individualized treatment plan, as approved by CMS and as long as the county makes the
163     required match under Section 17-43-201.]
164          [(7)] (9) The current Medicaid program and the health coverage improvement program,
165     when implemented, shall coordinate with a state prison or county jail to expedite Medicaid
166     enrollment for an individual who is released from custody and was eligible for or enrolled in
167     Medicaid before incarceration.
168          [(8)] (10) Notwithstanding Sections 17-43-201 and 17-43-301, a county does not have
169     to provide matching funds to the state for the cost of providing Medicaid services to newly
170     enrolled individuals who qualify for Medicaid coverage under the health coverage
171     improvement program under Subsection [(3)] (6).
172          [(9) The department shall:]
173          [(a) study, in consultation with health care providers, employers, uninsured families,
174     and community stakeholders:]
175          [(i) options to maximize use of employer sponsored coverage for current Medicaid
176     enrollees; and]
177          [(ii) strategies to increase participation of currently Medicaid eligible, and uninsured,
178     children; and]
179          [(b) report the findings of the study to the Legislature's Health Reform Task Force
180     before November 30, 2016.]
181          (11) If the enhancement waiver program is implemented, the department:
182          (a) may not accept any new enrollees into the health coverage improvement program
183     after the day on which the enhancement waiver program is implemented;
184          (b) shall transition all individuals who are enrolled in the health coverage improvement
185     program into the enhancement waiver program;
186          (c) shall suspend the health coverage improvement program within one year after the
187     day on which the enhancement waiver program is implemented;
188          (d) shall, within one year after the day on which the enhancement waiver program is
189     implemented, use all appropriations for the health coverage improvement program to
190     implement the enhancement waiver program; and
191          (e) shall work with CMS to maintain any waiver for the health coverage improvement
192     program while the health coverage improvement program is suspended under Subsection
193     (11)(c).
194          (12) If, after the enhancement waiver program takes effect, the enhancement waiver
195     program is repealed or suspended by either the state or federal government, the department
196     shall reinstate the health coverage improvement program and continue to accept new enrollees
197     into the health coverage improvement program in accordance with the provisions of this
198     section.
199          Section 2. Section 26-18-415 is enacted to read:
200          26-18-415. Primary Care Network enhancement waiver program.
201          (1) As used in this section:
202          (a) "CMS" means the Centers for Medicare and Medicaid Services within the United
203     States Department of Health and Human Services.
204          (b) "Enhancement waiver program" means the Primary Care Network enhancement
205     waiver program described in this section.
206          (c) "Federal poverty level" means the poverty guidelines established by the secretary of
207     the United States Department of Health and Human Services under 42 U.S.C. Sec. 9902(2).
208          (d) "Health coverage improvement program" means the same as that term is defined in
209     Section 26-18-411.
210          (e) "Income eligibility ceiling" means the percentage of federal poverty level:
211          (i) established by the Legislature in an appropriations act adopted pursuant to Title 63J,
212     Chapter 1, Budgetary Procedures Act; and
213          (ii) under which an individual may qualify for coverage in the enhancement waiver
214     program in accordance with this section.
215          (f) "Optional population" means the optional expansion population under PPACA if
216     the expansion provides coverage for individuals at or above 95% of the federal poverty level.
217          (g) "PPACA" means the same as that term is defined in Section 31A-1-301.
218          (h) "Primary Care Network" means the state Primary Care Network program created by
219     the Medicaid primary care network demonstration waiver obtained under Section 26-18-3.
220          (2) The department shall continue to implement the Primary Care Network program for
221     qualified individuals under the Primary Care Network program.
222          (3) Before July 1, 2018, the division shall apply for a Medicaid waiver or a state plan
223     amendment with CMS to implement, within the state Medicaid program, the enhancement
224     waiver program described in this section.
225          (4) An individual who is eligible for the enhancement waiver program may receive the
226     following benefits under the enhancement waiver program:
227          (a) the benefits offered under the Primary Care Network program;
228          (b) diagnostic testing and procedures;
229          (c) medical specialty care;
230          (d) inpatient hospital services;
231          (e) outpatient hospital services;
232          (f) outpatient behavioral health care, including outpatient substance abuse care; and
233          (g) for an individual who qualifies for the health coverage improvement program, as
234     approved by CMS, temporary residential treatment for substance abuse in a short term,
235     non-institutional, 24-hour facility, without a bed capacity limit, that provides rehabilitation
236     services that are medically necessary and in accordance with an individualized treatment plan.
237          (5) An individual is eligible for the enhancement waiver program if, at the time of
238     enrollment:
239          (a) the individual is qualified to enroll in the Primary Care Network or the health
240     coverage improvement program;
241          (b) the individual's annual income is below the income eligibility ceiling established by
242     the Legislature under Subsection (1)(e); and
243          (c) the individual meets the eligibility criteria established by the department under
244     Subsection (6).
245          (6) (a) Based on available funding and approval from CMS and subject to Subsection
246     (6)(d), the department shall determine the criteria for an individual to qualify for the
247     enhancement waiver program, based on the following priority:
248          (i) adults in the expansion population, as defined in Section 26-18-411, who qualify for
249     the health coverage improvement program;
250          (ii) adults with dependent children who qualify for the health coverage improvement
251     program under Subsection 26-18-411(3) ;
252          (iii) adults with dependent children who do not qualify for the health coverage
253     improvement program; and
254          (iv) if funding is available, adults without dependent children.
255          (b) The number of individuals enrolled in the enhancement waiver program may not
256     exceed 105% of the number of individuals who were enrolled in the Primary Care Network on
257     December 31, 2017.
258          (c) The department may only use appropriations from the Medicaid Expansion Fund
259     created in Section 26-36b-208 to fund the state portion of the enhancement waiver program.
260          (d) The money deposited into the Medicaid Expansion Fund under Subsections
261     26-36b-208(g) and (h) may only be used to pay the cost of enrolling individuals who qualify for
262     the enhancement waiver program under Subsections (6)(a)(iii) and (iv).
263          (7) The department may request a modification of the income eligibility ceiling and the
264     eligibility criteria under Subsection (6) from CMS each fiscal year based on enrollment in the
265     enhancement waiver program, projected enrollment in the enhancement waiver program, costs
266     to the state, and the state budget.
267          (8) The department may implement the enhancement waiver program by contracting
268     with Medicaid accountable care organizations to administer the enhancement waiver program.
269          (9) In accordance with Subsections 26-18-411(11) and (12), the department may use
270     funds that have been appropriated for the health coverage improvement program to implement
271     the enhancement waiver program.
272          (10) If the department expands the state Medicaid program to the optional population,
273     the department:
274          (a) except as provided in Subsection (11), may not accept any new enrollees into the
275     enhancement waiver program after the day on which the expansion to the optional population
276     is effective;
277          (b) shall suspend the enhancement waiver program within one year after the day on
278     which the expansion to the optional population is effective; and
279          (c) shall work with CMS to maintain the waiver for the enhancement waiver program
280     submitted under Subsection (3) while the enhancement waiver program is suspended under
281     Subsection (10)(b).
282          (11) If, after the expansion to the optional population described in Subsection (10)
283     takes effect, the expansion to the optional population is repealed by either the state or the
284     federal government, the department shall reinstate the enhancement waiver program and
285     continue to accept new enrollees into the enhancement waiver program in accordance with the
286     provisions of this section.
287          Section 3. Section 26-36b-102 is amended to read:
288          26-36b-102. Application.
289          (1) Other than for the imposition of the assessment described in this chapter, nothing in
290     this chapter shall affect the nonprofit or tax exempt status of any nonprofit charitable, religious,
291     or educational health care provider under any:
292          [(a) Section 501(c), as amended, of the Internal Revenue Code;]
293          [(b) other applicable federal law;]
294          [(c)] (a) [any] state law;
295          [(d)] (b) [any] ad valorem property taxes;
296          [(e)] (c) [any] sales or use taxes; or
297          [(f)] (d) [any] other taxes, fees, or assessments, whether imposed or sought to be
298     imposed, by the state or any political subdivision[, county, municipality, district, authority, or
299     any agency or department thereof] of the state.
300          (2) All assessments paid under this chapter may be included as an allowable cost of a
301     hospital for purposes of any applicable Medicaid reimbursement formula.
302          (3) This chapter does not authorize a political subdivision of the state to:
303          (a) license a hospital for revenue;
304          (b) impose a tax or assessment upon a hospital; or
305          (c) impose a tax or assessment measured by the income or earnings of a hospital.
306          Section 4. Section 26-36b-103 is amended to read:
307          26-36b-103. Definitions.
308          As used in this chapter:
309          (1) "Assessment" means the inpatient hospital assessment established by this chapter.
310          (2) "CMS" means the [same as that term is defined in Section 26-18-411] Centers for
311     Medicare and Medicaid Services within the United States Department of Health and Human
312     Services.
313          (3) "Discharges" means the number of total hospital discharges reported on:
314          (a) Worksheet S-3 Part I, column 15, lines 14, 16, and 17 of the 2552-10 Medicare cost
315     report for the applicable assessment year; or
316          (b) a similar report adopted by the department by administrative rule, if the report
317     under Subsection (3)(a) is no longer available.
318          (4) "Division" means the Division of Health Care Financing within the department.
319          (5) "Enhancement waiver program" means the program established by the Primary
320     Care Network enhancement waiver program described in Section 26-18-415.
321          (6) "Health coverage improvement program" means the health coverage improvement
322     program described in Section 26-18-411.
323          (7) "Hospital share" means the hospital share described in Section 26-36b-203.
324          (8) "Medicaid accountable care organization" means a managed care organization, as
325     defined in 42 C.F.R. Sec. 438, that contracts with the department under the provisions of
326     Section 26-18-405.
327          [(5)] (9) "Medicare cost report" means CMS-2552-10, the cost report for electronic
328     filing of hospitals.
329          [(6)] (10) (a) "Non-state government hospital"[:(a)] means a hospital owned by a
330     non-state government entity[; and].
331          (b) "Non-state government hospital" does not include:
332          (i) the Utah State Hospital; or
333          (ii) a hospital owned by the federal government, including the Veterans Administration
334     Hospital.
335          [(7)] (11) (a) "Private hospital"[:(a)] means:
336          (i) a [privately owned] general acute hospital [operating in the state], as defined in
337     Section 26-21-2, that is privately owned and operating in the state; and
338          (ii) a privately owned specialty hospital operating in the state, [which shall include]
339     including a privately owned hospital whose inpatient admissions are predominantly for:
340          (A) rehabilitation;
341          (B) psychiatric care;
342          (C) chemical dependency services; or
343          (D) long-term acute care services[; and].
344          (b) "Private hospital" does not include a facility for residential [care or] treatment
345     [facility] as defined in Section 62A-2-101.
346          [(8)] (12) "State teaching hospital" means a state owned teaching hospital that is part of
347     an institution of higher education.
348          (13) "Upper payment limit gap" means the difference between the private hospital
349     outpatient upper payment limit and the private hospital Medicaid outpatient payments, as
350     determined in accordance with 42 C.F.R. Sec. 447.321.
351          Section 5. Section 26-36b-201 is amended to read:
352          26-36b-201. Assessment.
353          (1) An assessment is imposed on each private hospital:
354          (a) beginning upon the later of CMS approval of:
355          (i) the health coverage improvement program waiver under Section 26-18-411; and
356          (ii) the assessment under this chapter;
357          (b) in the amount designated in Sections 26-36b-204 and 26-36b-205; and
358          (c) in accordance with Section 26-36b-202.
359          (2) Subject to Section 26-36b-203, the assessment imposed by this chapter is due and
360     payable on a quarterly basis, after payment of the outpatient upper payment limit supplemental
361     payments under Section 26-36b-210 have been paid.
362          (3) The first quarterly payment [shall not be] is not due until at least three months after
363     the earlier of the effective [date] dates of the coverage provided through:
364          (a) the health coverage improvement program [waiver under Section 26-18-411.]; or
365          (b) the enhancement waiver program.
366          Section 6. Section 26-36b-202 is amended to read:
367          26-36b-202. Collection of assessment -- Deposit of revenue -- Rulemaking.
368          (1) The collecting agent for the assessment imposed under Section 26-36b-201 is the
369     department.
370          (2) The department is vested with the administration and enforcement of this chapter,
371     [including the right to adopt administrative] and may make rules in accordance with Title 63G,
372     Chapter 3, Utah Administrative Rulemaking Act, necessary to:
373          [(a) implement and enforce the provisions of this chapter;]
374          (a) collect the assessment, intergovernmental transfers, and penalties imposed under
375     this chapter;
376          (b) audit records of a facility that:
377          (i) is subject to the assessment imposed by this chapter; and
378          (ii) does not file a Medicare cost report; and
379          (c) select a report similar to the Medicare cost report if Medicare no longer uses a
380     Medicare cost report.
381          (2) The department shall:
382          (a) administer the assessment in this [part separate] chapter separately from the
383     assessment in Chapter 36a, Hospital Provider Assessment Act; and
384          (b) deposit assessments collected under this chapter into the Medicaid Expansion Fund
385     created by Section 26-36b-208.
386          Section 7. Section 26-36b-203 is amended to read:
387          26-36b-203. Quarterly notice.
388          (1) Quarterly assessments imposed by this chapter shall be paid to the division within
389     15 business days after the original invoice date that appears on the invoice issued by the
390     division.
391          (2) The department may, by rule, extend the time for paying the assessment.
392          Section 8. Section 26-36b-204 is amended to read:
393          26-36b-204. Hospital financing of health coverage improvement program
394     Medicaid waiver -- Hospital share.
395          [(1) For purposes of this section, "hospital share":(a) means]
396          (1) The hospital share is:
397          (a) 45% of the state's net cost of[: (i)] the health coverage improvement program
398     [Medicaid waiver under Section 26-18-411; (ii)], including Medicaid coverage for individuals
399     with dependent children up to the federal poverty level designated under Section 26-18-411;
400     [and]
401          [(iii) the UPL gap, as that term is defined in Section 26-36b-210;]
402          (b) 45% of the state's net cost of the enhancement waiver program; and
403          (c) 45% of the state's net cost of the upper payment limit gap.
404          [(b) for the hospital share of the additional coverage under Section 26-18-411,]
405          (2) (a) The hospital share is capped at no more than $13,600,000 annually, consisting
406     of:
407          (i) an $11,900,000 cap [on the hospital's share] for the programs specified in
408     Subsections (1)(a)[(i) and (ii)] and (b); and
409          (ii) a $1,700,000 cap for the program specified in Subsection [(1)(a)(iii);] (1)(c).
410          [(c) for the cap specified in Subsection (1)(b), shall be prorated]
411          (b) The department shall prorate the cap described in Subsection (2)(a) in any year in
412     which the programs specified in Subsection (1)(a) and (c) are not in effect for the full fiscal
413     year[; and].
414          [(d)] (c) [if] If the Medicaid program expands in a manner that is greater than the
415     expansion described in Section 26-18-411[,] and the enhancement described in Section
416     26-18-415, the hospital share is capped at 33% of the state's share of the cost of the expansion
417     or enhancement that is in addition to the [program] programs described in Section 26-18-411 or
418     26-18-415.
419          [(2) The assessment for the private hospital share under Subsection (1) shall be:]
420          (3) Private hospitals shall be assessed under this chapter for:
421          (a) 69% of the portion of the hospital share specified in Subsections (1)(a)[(i) and (ii)]
422     and (b); and
423          (b) 100% of the portion of the hospital share specified in Subsection (1)[(a)(iii)](c).
424          [(3)] (4) (a) The department shall, on or before October 15, 2017, and on or before
425     October 15 of each subsequent year [thereafter], produce a report that calculates the state's net
426     cost of the programs described in Subsections (1)(a)[(i) and (ii)] and (b) that are in effect for
427     that year .
428          (b) If the assessment collected in the previous fiscal year is above or below the [private
429     hospital's share of the state's net cost as specified in Subsection (2),] hospital share for private
430     hospitals for the previous fiscal year, the underpayment or overpayment of the assessment by
431     the private hospitals shall be applied to the fiscal year in which the report [was] is issued.
432          [(4)] (5) A Medicaid accountable care organization shall, on or before October 15 of
433     each year, report to the department the following data from the prior state fiscal year for each
434     private hospital, state teaching hospital, and non-state government hospital provider that the
435     Medicaid accountable care organization contracts with:
436          (a) for the traditional Medicaid population[, for each private hospital, state teaching
437     hospital, and non-state government hospital provider]:
438          (i) hospital inpatient payments;
439          (ii) hospital inpatient discharges;
440          (iii) hospital inpatient days; and
441          (iv) hospital outpatient payments; and
442          [(b) for the Medicaid population newly eligible under Subsection 26-18-411, for each
443     private hospital, state teaching hospital, and non-state government hospital provider:]
444          (b) if the Medicaid accountable care organization enrolls any individuals in the health
445     coverage improvement program or the enhancement waiver program, for the population newly
446     eligible for either program:
447          (i) hospital inpatient payments;
448          (ii) hospital inpatient discharges;
449          (iii) hospital inpatient days; and
450          (iv) hospital outpatient payments.
451          (6) The department shall, by rule made in accordance with Title 63G, Chapter 3, Utah
452     Administrative Rulemaking Act, provide details surrounding specific content and format for
453     the reporting by the Medicaid accountable care organization.
454          Section 9. Section 26-36b-205 is amended to read:
455          26-36b-205. Calculation of assessment.
456          (1) (a) Except as provided in Subsection (1)(b), an annual assessment is payable on a
457     quarterly basis for each private hospital in an amount calculated by the division at a uniform
458     assessment rate for each hospital discharge, in accordance with this section.
459          (b) A private teaching hospital with more than 425 beds and 60 residents shall pay an
460     assessment rate [2.50] 2.5 times the uniform rate established under Subsection (1)(c).
461          (c) The division shall calculate the uniform assessment rate [shall be determined using
462     the total number of hospital discharges for assessed private hospitals, the percentages in
463     Subsection 26-36b-204(2), and rule adopted by the department.] described in Subsection (1)(a)
464     by dividing the hospital share for assessed private hospitals, described in Subsection
465     26-36b-204(1), by the sum of:
466          (i) the total number of discharges for assessed private hospitals that are not a private
467     teaching hospital; and
468          (ii) 2.5 times the number of discharges for a private teaching hospital, described in
469     Subsection (1)(b).
470          (d) The division may, by rule made in accordance with Title 63G, Chapter 3, Utah
471     Administrative Rulemaking Act, adjust the formula described in Subsection (1)(c) to address
472     unforeseen circumstances in the administration of the assessment under this chapter.
473          [(d)] (e) Any quarterly changes to the uniform assessment rate shall be applied
474     uniformly to all assessed private hospitals.
475          [(2) (a) For each state fiscal year, discharges shall be determined using the data from
476     each hospital's Medicare cost report contained in the Centers for Medicare and Medicaid
477     Services' Healthcare Cost Report Information System file. The hospital's discharge data will be
478     derived as follows:]
479          (2) Except as provided in Subsection (3), for each state fiscal year, the division shall
480     determine a hospital's discharges as follows:
481          [(i)] (a) for state fiscal year 2017, the hospital's cost report data for the hospital's fiscal
482     year ending between July 1, 2013, and June 30, 2014; and
483          [(ii)] (b) for each subsequent state fiscal year, the hospital's cost report data for the
484     hospital's fiscal year that ended in the state fiscal year two years before the assessment fiscal
485     year.
486          [(b)] (3) (a) If a hospital's fiscal year Medicare cost report is not contained in the
487     [Centers for Medicare and Medicaid Services'] CMS Healthcare Cost Report Information
488     System file:
489          (i) the hospital shall submit to the division a copy of the hospital's Medicare cost report
490     applicable to the assessment year; and
491          (ii) the division shall determine the hospital's discharges.
492          [(c)] (b) If a hospital is not certified by the Medicare program and is not required to file
493     a Medicare cost report:
494          (i) the hospital shall submit to the division the hospital's applicable fiscal year
495     discharges with supporting documentation;
496          (ii) the division shall determine the hospital's discharges from the information
497     submitted under Subsection [(2)(c)(i)] (3)(b)(i); and
498          (iii) [the] failure to submit discharge information shall result in an audit of the
499     hospital's records and a penalty equal to 5% of the calculated assessment.
500          [(3)] (4) Except as provided in Subsection [(4)] (5), if a hospital is owned by an
501     organization that owns more than one hospital in the state:
502          (a) the assessment for each hospital shall be separately calculated by the department;
503     and
504          (b) each separate hospital shall pay the assessment imposed by this chapter.
505          [(4) Notwithstanding the requirement of Subsection (3), if]
506          (5) If multiple hospitals use the same Medicaid provider number:
507          (a) the department shall calculate the assessment in the aggregate for the hospitals
508     using the same Medicaid provider number; and
509          (b) the hospitals may pay the assessment in the aggregate.
510          Section 10. Section 26-36b-206 is amended to read:
511          26-36b-206. State teaching hospital and non-state government hospital
512     mandatory intergovernmental transfer.
513          (1) [A] The state teaching hospital and a non-state government hospital shall make an
514     intergovernmental transfer to the Medicaid Expansion Fund created in Section 26-36b-208, in
515     accordance with this section.
516          (2) The [intergovernmental transfer shall be paid] hospitals described in Subsection (1)
517     shall pay the intergovernmental transfer beginning on the later of CMS approval of:
518          (a) the health improvement program waiver under Section 26-18-411; or
519          (b) the assessment for private hospitals in this chapter[; and].
520          [(c) the intergovernmental transfer in this section.]
521          (3) The intergovernmental transfer [shall be paid in an amount divided] is apportioned
522     as follows:
523          (a) the state teaching hospital is responsible for:
524          (i) 30% of the portion of the hospital share specified in Subsections
525     26-36b-204(1)(a)[(i) and (ii)] and (b); and
526          (ii) 0% of the hospital share specified in Subsection 26-36b-204(1)[(a)(iii)](c); and
527          (b) non-state government hospitals are responsible for:
528          (i) 1% of the portion of the hospital share specified in Subsections 26-36b-204(1)(a)[(i)
529     and (ii)] and (b); and
530          (ii) 0% of the hospital share specified in Subsection 26-36b-204(1)[(a)(iii)](c).
531          (4) The department shall, by rule made in accordance with Title 63G, Chapter 3, Utah
532     Administrative Rulemaking Act, designate:
533          (a) the method of calculating the [percentages] amounts designated in Subsection (3);
534     and
535          (b) the schedule for the intergovernmental transfers.
536          Section 11. Section 26-36b-207 is amended to read:
537          26-36b-207. Penalties.
538          (1) A hospital that fails to pay [any] a quarterly assessment, make the mandated
539     intergovernmental transfer, or file a return as required under this chapter, within the time
540     required by this chapter, shall pay penalties described in this section, in addition to the
541     assessment or intergovernmental transfer[, and interest established by the department].
542          [(2) (a) Consistent with Subsection (2)(b), the department shall adopt rules in
543     accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, that establish
544     reasonable penalties and interest for the violations described in Subsection (1).]
545          [(b)] (2) If a hospital fails to timely pay the full amount of a quarterly assessment or the
546     mandated intergovernmental transfer, the department shall add to the assessment or
547     intergovernmental transfer:
548          [(i)] (a) a penalty equal to 5% of the quarterly amount not paid on or before the due
549     date; and
550          [(ii)] (b) on the last day of each quarter after the due date until the assessed amount and
551     the penalty imposed under Subsection (2)[(b)(i)](a) are paid in full, an additional 5% penalty
552     on:
553          [(A)] (i) any unpaid quarterly assessment or intergovernmental transfer; and
554          [(B)] (ii) any unpaid penalty assessment.
555          [(c)] (3) Upon making a record of the division's actions, and upon reasonable cause
556     shown, the division may waive, reduce, or compromise any of the penalties imposed under this
557     chapter.
558          Section 12. Section 26-36b-208 is amended to read:
559          26-36b-208. Medicaid Expansion Fund.
560          (1) There is created an expendable special revenue fund known as the Medicaid
561     Expansion Fund.
562          (2) The fund consists of:
563          (a) assessments collected under this chapter;
564          (b) intergovernmental transfers under Section 26-36b-206;
565          (c) savings attributable to the health coverage improvement program [under Section
566     26-18-411] as determined by the department;
567          (d) savings attributable to the enhancement waiver program as determined by the
568     department;
569          [(d)] (e) savings attributable to the inclusion of psychotropic drugs on the preferred
570     drug list under Subsection 26-18-2.4(3) as determined by the department;
571          [(e)] (f) savings attributable to the services provided by the Public Employees' Health
572     Plan under Subsection 49-20-401(1)(u);
573          (g) the amount transferred under Subsection 32B-2-301(7);
574          (h) the amount transferred under Subsection 59-14-204(6);
575          [(f)] (i) gifts, grants, donations, or any other conveyance of money that may be made to
576     the fund from private sources; [and]
577          (j) interest earned on money in the fund; and
578          [(g)] (k) additional amounts as appropriated by the Legislature.
579          (3) (a) The fund shall earn interest.
580          (b) All interest earned on fund money shall be deposited into the fund.
581          (4) (a) A state agency administering the provisions of this chapter may use money from
582     the fund to pay the costs [of], not otherwise paid for with federal funds or other revenue
583     sources, of:
584          (i) the health coverage improvement [Medicaid waiver under Section 26-18-411, and]
585     program;
586          (ii) the enhancement waiver program; and
587          (iii) the outpatient [UPL] upper payment limit supplemental payments under Section
588     26-36b-210[, not otherwise paid for with federal funds or other revenue sources, except that
589     no].
590          (b) A state agency administering the provisions of this chapter may not use:
591          (i) funds described in Subsection (2)(b) [may be used] to pay the cost of private
592     outpatient [UPL] upper payment limit supplemental payments[.]; or
593          [(b)] (ii) [Money] money in the fund [may not be used] for any [other] purpose not
594     described in Subsection (4)(a).
595          Section 13. Section 26-36b-209 is amended to read:
596          26-36b-209. Hospital reimbursement.
597          (1) [The] If the health coverage improvement program or the enhancement waiver
598     program is implemented by contracting with a Medicaid accountable care organization, the
599     department shall, to the extent allowed by law, include, in a contract [with a Medicaid
600     accountable care organization] to provide benefits under the health coverage improvement
601     program or the enhancement waiver program, a requirement that the Medicaid accountable care
602     organization reimburse hospitals in the accountable care organization's provider network[,] at
603     no less than the Medicaid fee-for-service rate.
604          (2) If the health coverage improvement program or the enhancement waiver program is
605     implemented by the department as a fee-for-service program, the department shall reimburse
606     hospitals at no less than the Medicaid fee-for-service rate.
607          (3) Nothing in this section prohibits a Medicaid accountable care organization from
608     paying a rate that exceeds the Medicaid fee-for-service [rates] rate.
609          Section 14. Section 26-36b-210 is amended to read:
610          26-36b-210. Outpatient upper payment limit supplemental payments.
611          [(1) For purposes of this section, "UPL gap" means the difference between the private
612     hospital outpatient upper payment limit and the private hospital Medicaid outpatient payments,
613     as determined in accordance with 42 C.F.R. 447.321.]
614          [(2)] (1) Beginning on the effective date of the assessment imposed under this chapter,
615     and for each subsequent fiscal year [thereafter], the department shall implement an outpatient
616     upper payment limit program for private hospitals that shall supplement the reimbursement to
617     private hospitals in accordance with Subsection [(3)] (2).
618          [(3)] (2) The division shall ensure that supplemental payment to Utah private hospitals
619     under Subsection [(2) shall] (1):
620          (a) does not exceed the positive [UPL] upper payment limit gap; and
621          (b) [be] is allocated based on the Medicaid state plan.
622          [(4)] (3) The department shall use the same outpatient data [used to calculate the UPL
623     gap under Subsection (1) shall be the same outpatient data used] to allocate the payments under
624     Subsection [(3)] (2) and to calculate the upper payment limit gap.
625          [(5)] (4) The supplemental payments to private hospitals under Subsection [(2) shall
626     be] (1) are payable for outpatient hospital services provided on or after the later of:
627          (a) July 1, 2016;
628          (b) the effective date of the Medicaid state plan amendment necessary to implement the
629     payments under this section; or
630          (c) the effective date of the coverage provided through the health coverage
631     improvement program [waiver under Section 26-18-411].
632          Section 15. Section 26-36b-211 is amended to read:
633          26-36b-211. Repeal of assessment.
634          (1) The [repeal of the] assessment imposed by this chapter shall [occur upon the
635     certification by the executive director of the department that the sooner of the following has
636     occurred] be repealed when:
637          [(a) the effective date of any]
638          (a) the executive director certifies that:
639          (i) action by Congress [that would disqualify] is in effect that disqualifies the
640     assessment imposed by this chapter from counting toward state Medicaid funds available to be
641     used to determine the amount of federal financial participation;
642          [(b) the effective date of any]
643          (ii) a decision, enactment, or other determination by the Legislature or by any court,
644     officer, department, or agency of the state, or of the federal government, [that has the effect of]
645     is in effect that:
646          [(i) disqualifying] (A) disqualifies the assessment from counting toward state
647     Medicaid funds available to be used to determine federal financial participation for Medicaid
648     matching funds; or
649          [(ii) creating] (B) creates for any reason a failure of the state to use the assessments for
650     at least one of the Medicaid [program as] programs described in this chapter; or
651          [(c) the effective date of]
652          (iii) a change is in effect that reduces the aggregate hospital inpatient and outpatient
653     payment rate below the aggregate hospital inpatient and outpatient payment rate for July 1,
654     2015; [and] or
655          [(d) the sunset of] (b) this chapter is repealed in accordance with Section 63I-1-226.
656          [(2) If the assessment is repealed under Subsection (1), money in the fund that was
657     derived from assessments imposed by this chapter, before the determination made under
658     Subsection (1), shall be disbursed under Section 26-36b-207 to the extent federal matching is
659     not reduced due to the impermissibility of the assessments. Any funds remaining in the special
660     revenue fund shall be refunded to the hospitals in proportion to the amount paid by each
661     hospital.]
662          (2) If the assessment is repealed under Subsection (1):
663          (a) the division may not collect any assessment or intergovernmental transfer under this
664     chapter;
665          (b) the department shall disburse money in the special Medicaid Expansion Fund in
666     accordance with the requirements in Subsection 26-36b-208(4), to the extent federal matching
667     is not reduced by CMS due to the repeal of the assessment;
668          (c) any money remaining in the Medicaid Expansion Fund after the disbursement
669     described in Subsection (2)(b) that was derived from assessments imposed by this chapter shall
670     be refunded to the hospitals in proportion to the amount paid by each hospital for the last three
671     fiscal years; and
672          (d) any money remaining in the Medicaid Expansion Fund after the disbursements
673     described in Subsection (2)(b) and (c) shall be deposited into the General Fund by the end of
674     the fiscal year that the assessment is suspended.
675          Section 16. Section 32B-2-301 is amended to read:
676          32B-2-301. State property -- Liquor Control Fund -- Markup Holding Fund.
677          (1) The following are property of the state:
678          (a) the money received in the administration of this title, except as otherwise provided;
679     and
680          (b) property acquired, administered, possessed, or received by the department.
681          (2) (a) There is created an enterprise fund known as the "Liquor Control Fund."
682          (b) Except as provided in Sections 32B-3-205 and 32B-2-304, money received in the
683     administration of this title shall be transferred to the Liquor Control Fund.
684          (3) (a) There is created an enterprise fund known as the "Markup Holding Fund."
685          (b) In accordance with Section 32B-2-304, the State Tax Commission shall deposit
686     revenue remitted to the State Tax Commission from the markup imposed under Section
687     32B-2-304 into the Markup Holding Fund.
688          (c) Money deposited into the Markup Holding Fund may be expended:
689          (i) to the extent appropriated by the Legislature; and
690          (ii) to fund the deposits required by Subsection 32B-2-304(4) and Subsection
691     32B-2-305(4).
692          (4) The department may draw from the Liquor Control Fund only to the extent
693     appropriated by the Legislature or provided for by statute, except that the department may draw
694     by warrant without an appropriation from the Liquor Control Fund for an expenditure that is
695     directly incurred by the department:
696          (a) to purchase an alcoholic product;
697          (b) to transport an alcoholic product from the supplier to a warehouse of the
698     department; and
699          (c) for variances related to an alcoholic product.
700          (5) (a) As used in this Subsection (5), "base budget" means the same as that term is
701     defined in legislative rule.
702          (b) The department's base budget shall include as an appropriation from the Liquor
703     Control Fund:
704          (i) credit card related fees paid by the department;
705          (ii) package agency compensation; and
706          (iii) the department's costs of shipping and warehousing alcoholic products.
707          (6) Before the transfer required by Subsection (7), the department may retain each
708     fiscal year from the Liquor Control Fund $1,000,000 that the department may use for:
709          (a) capital equipment purchases;
710          (b) salary increases for department employees;
711          (c) performance awards for department employees; or
712          (d) information technology enhancements because of changes or trends in technology.
713          (7) [The] (a) Except as provided in Subsection (7)(b), the department shall transfer
714     annually from the Liquor Control Fund and the State Tax Commission shall transfer annually
715     from the Markup Holding Fund to the General Fund a sum equal to the amount of net profit
716     earned from the sale of liquor since the preceding transfer of money under this Subsection (7).
717     The transfers shall be calculated by no later than September 1 and made by no later than
718     September 30 after a fiscal year. The Division of Finance may make year-end closing entries in
719     the Liquor Control Fund and the Markup Holding Fund in order to comply with Subsection
720     51-5-6(2).
721          (b) Subject to Subsection (7)(c), and in accordance with Subsection 26-36b-208(2)(f),
722     for each fiscal year beginning in fiscal year 2019, the department and the Division of Finance
723     shall transfer to the Medicaid Expansion Fund, created in Section 26-36b-208, any amount
724     described in Subsection (7)(a) in excess of the amount transferred by the department or the
725     Division of Finance in fiscal year 2018.
726          (c) The annual transfer to the Medicaid Expansion Fund, described in Subsection
727     (7)(b), shall be capped at:
728          (i) for fiscal year 2019, $1,150,000; and
729          (ii) for a fiscal year beginning after fiscal year 2019, $2,400,000.
730          (8) (a) By the end of each day, the department shall:
731          (i) make a deposit to a qualified depository, as defined in Section 51-7-3; and
732          (ii) report the deposit to the state treasurer.
733          (b) A commissioner or department employee is not personally liable for a loss caused
734     by the default or failure of a qualified depository.
735          (c) Money deposited in a qualified depository is entitled to the same priority of
736     payment as other public funds of the state.
737          (9) If the cash balance of the Liquor Control Fund is not adequate to cover a warrant
738     drawn against the Liquor Control Fund by the department, the cash resources of the General
739     Fund may be used to the extent necessary. At no time may the fund equity of the Liquor
740     Control Fund fall below zero.
741          Section 17. Section 59-14-204 is amended to read:
742          59-14-204. Tax basis -- Rate -- Future increase -- Cigarette Tax Restricted
743     Account -- Appropriation and expenditure of revenues.
744          (1) Except for cigarettes described under Subsection 59-14-210(3), there is levied a tax
745     upon the sale, use, storage, or distribution of cigarettes in the state.
746          (2) The rates of the tax levied under Subsection (1) are, beginning on July 1, 2010:
747          (a) 8.5 cents on each cigarette, for all cigarettes weighing not more than three pounds
748     per thousand cigarettes; and
749          (b) 9.963 cents on each cigarette, for all cigarettes weighing in excess of three pounds
750     per thousand cigarettes.
751          (3) Except as otherwise provided under this chapter, the tax levied under Subsection
752     (1) shall be paid by any person who is the manufacturer, jobber, importer, distributor,
753     wholesaler, retailer, user, or consumer.
754          (4) The tax rates specified in this section shall be increased by the commission by the
755     same amount as any future reduction in the federal excise tax on cigarettes.
756          (5) (a) There is created within the General Fund a restricted account known as the
757     "Cigarette Tax Restricted Account."
758          (b) The Cigarette Tax Restricted Account consists of:
759          (i) the first $7,950,000 of the revenues collected from a tax under this section; and
760          (ii) any other appropriations the Legislature makes to the Cigarette Tax Restricted
761     Account.
762          (c) For each fiscal year beginning with fiscal year 2011-12 and subject to appropriation
763     by the Legislature, the Division of Finance shall distribute money from the Cigarette Tax
764     Restricted Account as follows:
765          (i) $250,000 to the Department of Health to be expended for a tobacco prevention and
766     control media campaign targeted towards children;
767          (ii) $2,900,000 to the Department of Health to be expended for tobacco prevention,
768     reduction, cessation, and control programs;
769          (iii) $2,000,000 to the University of Utah Health Sciences Center for the Huntsman
770     Cancer Institute to be expended for cancer research; and
771          (iv) $2,800,000 to the University of Utah Health Sciences Center to be expended for
772     medical education at the University of Utah School of Medicine.
773          (d) In determining how to appropriate revenue deposited into the Cigarette Tax
774     Restricted Account that is not otherwise appropriated under Subsection (5)(c), the Legislature
775     shall give particular consideration to enhancing Medicaid provider reimbursement rates and
776     medical coverage for the uninsured.
777          (6) (a) For each fiscal year beginning with fiscal year 2019, the State Tax Commission
778     shall distribute to the Medicaid Expansion Fund, created in Section 26-36b-208, any revenues
779     collected from a tax under this section in excess of the revenues collected from a tax under this
780     section in fiscal year 2018.
781          (b) The distribution in Subsection (6)(a) shall occur after the distributions described in
782     Subsections (5)(b)(i) and (5)(c).
783          Section 18. Section 63I-1-226 is amended to read:
784          63I-1-226. Repeal dates, Title 26.
785          (1) Section 26-1-40 is repealed July 1, 2019.
786          (2) Title 26, Chapter 9f, Utah Digital Health Service Commission Act, is repealed July
787     1, 2025.
788          (3) Section 26-10-11 is repealed July 1, 2020.
789          (4) Title 26, Chapter 33a, Utah Health Data Authority Act, is repealed July 1, 2024.
790          (5) Title 26, Chapter 36a, Hospital Provider Assessment Act, is repealed July 1, 2019.
791          (6) Title 26, Chapter 36b, Inpatient Hospital Assessment Act, is repealed July 1, 2021.
792          [(7) Section 26-38-2.5 is repealed July 1, 2017.]
793          [(8) Section 26-38-2.6 is repealed July 1, 2017.]
794          [(9)] (7) Title 26, Chapter 56, Hemp Extract Registration Act, is repealed July 1, 2021.
795          Section 19. Effective date.
796          If approved by two-thirds of all the members elected to each house, this bill takes effect
797     upon approval by the governor, or the day following the constitutional time limit of Utah
798     Constitution, Article VII, Section 8, without the governor's signature, or in the case of a veto,
799     the date of veto override.
800          Section 20. Coordinating H.B. 325 with H.B. 14 -- Superseding substantive and
801     technical amendments.
802           If this H.B. 325 and H.B. 14, Substance Abuse Treatment Facility Patient Brokering,
803     both pass and become law, it is the intent of the Legislature that the amendments to Section
804     26-36b-103 in this bill supersede the amendments to Section 26-36b-103 in H.B. 14, when the
805     Office of Legislative Research and General Counsel prepares the Utah Code database for
806     publication.
807          Section 21. Coordinating H.B. 325 with H.B. 472 -- Substantive and technical
808     amendments.
809          If this H.B. 325 and H.B. 472, Medicaid Expansion Revisions, both pass and become
810     law, it is the intent of the Legislature that the Office of Legislative Research and General
811     Counsel shall prepare the Utah Code database for publication by making the following
812     changes:
813          (1) modifying Subsection 26-18-415(3) to read:
814          "(3) (a) The division shall apply for a Medicaid waiver or a state plan amendment with
815     CMS to implement, within the state Medicaid program, the enhancement waiver program
816     described in this section within six months after the day on which:
817          (i) the division receives a notice from CMS that the waiver for the Medicaid waiver
818     expansion submitted under Section 26-18-415, Medicaid waiver expansion, will not be
819     approved; or
820          (ii) the division withdraws the waiver for the Medicaid waiver expansion submitted
821     under Section 26-18-415, Medicaid waiver expansion.
822          (b) The division may not apply for a waiver under Subsection (3)(a) while a waiver
823     request under Section 26-18-415, Medicaid waiver expansion, is pending with CMS.";
824          (2) modifying Subsection 26-36b-201(3) to read:
825          "(3) The first quarterly payment [shall not be] is not due until at least three months
826     after the earlier of the effective [date] dates of the coverage provided through:
827          (a) the health coverage improvement program [waiver under Section 26-18-411.];
828          (b) the enhancement waiver program; or
829          (c) the Medicaid waiver expansion.";
830          (3) modifying Section 26-36b-204 to read:
831          "26-36b-204.     Hospital financing of health coverage improvement program
832     Medicaid waiver -- Hospital share.
833          [(1) For purposes of this section, "hospital share":(a) means]
834          (1) The hospital share is:
835          (a) 45% of the state's net cost of[:(i)] the health coverage improvement program
836     [Medicaid waiver under Section 26-18-411;(ii)], including Medicaid coverage for individuals
837     with dependent children up to the federal poverty level designated under Section 26-18-411;
838     [and]
839          [(iii) the UPL gap, as that term is defined in Section 26-36b-210;]
840          (b) 45% of the state's net cost of the enhancement waiver program;
841          (c) if the waiver for the Medicaid waiver expansion is approved, $11,900,000; and
842          (d) 45% of the state's net cost of the upper payment limit gap.
843          [(b) for the hospital share of the additional coverage under Section 26-18-411,]
844          (2) (a) The hospital share is capped at no more than $13,600,000 annually, consisting
845     of:
846          (i) an $11,900,000 cap [on the hospital's share] for the programs specified in
847     Subsections (1)(a)[(i) and (ii)] through (c); and
848          (ii) a $1,700,000 cap for the program specified in Subsection [(1)(a)(iii);] (1)(d).
849          [(c) for the cap specified in Subsection (1)(b), shall be prorated]
850          (b) The department shall prorate the cap described in Subsection (2)(a) in any year in
851     which the programs specified in Subsection (1)(a) and (c) are not in effect for the full fiscal
852     year[; and].
853          [(d) if the Medicaid program expands in a manner that is greater than the expansion
854     described in Section 26-18-411, is capped at 33% of the state's share of the cost of the
855     expansion that is in addition to the program described in Section 26-18-411.]
856          [(2) The assessment for the private hospital share under Subsection (1) shall be:]
857          (3) Private hospitals shall be assessed under this chapter for:
858          (a) 69% of the portion of the hospital share for the programs specified in Subsections
859     (1)(a)[(i) and (ii)] through (c); and
860          (b) 100% of the portion of the hospital share specified in Subsection [(1)(a)(iii)] (1)(d).
861          [(3)] (4) (a) The department shall, on or before October 15, 2017, and on or before
862     October 15 of each subsequent year [thereafter], produce a report that calculates the state's net
863     cost of each of the programs described in Subsections (1)(a)[(i) and (ii)] through (c) that are in
864     effect for that year.
865          (b) If the assessment collected in the previous fiscal year is above or below the [private
866     hospital's share of the state's net cost as specified in Subsection (2),] hospital share for private
867     hospitals for the previous fiscal year, the underpayment or overpayment of the assessment by
868     the private hospitals shall be applied to the fiscal year in which the report [was] is issued.
869          [(4)] (5) A Medicaid accountable care organization shall, on or before October 15 of
870     each year, report to the department the following data from the prior state fiscal year for each
871     private hospital, state teaching hospital, and non-state government hospital provider that the
872     Medicaid accountable care organization contracts with:
873          (a) for the traditional Medicaid population[, for each private hospital, state teaching
874     hospital, and non-state government hospital provider]:
875          (i) hospital inpatient payments;
876          (ii) hospital inpatient discharges;
877          (iii) hospital inpatient days; and
878          (iv) hospital outpatient payments; and
879          [(b) for the Medicaid population newly eligible under Subsection 26-18-411, for each
880     private hospital, state teaching hospital, and non-state government hospital provider:]
881          (b) if the Medicaid accountable care organization enrolls any individuals in the health
882     coverage improvement program, the enhancement waiver program, or the Medicaid waiver
883     expansion, for the population newly eligible for any of those programs:
884          (i) hospital inpatient payments;
885          (ii) hospital inpatient discharges;
886          (iii) hospital inpatient days; and
887          (iv) hospital outpatient payments.
888          (6) The department shall, by rule made in accordance with Title 63G, Chapter 3, Utah
889     Administrative Rulemaking Act, provide details surrounding specific content and format for
890     the reporting by the Medicaid accountable care organization.";
891          (4) modifying Subsection 26-36b-206(3) to read:
892          "(3) The intergovernmental transfer [shall be paid in an amount divided] is apportioned
893     as follows:
894          (a) the state teaching hospital is responsible for:
895          (i) 30% of the portion of the hospital share specified in Subsections
896     26-36b-204(1)(a)[(i) and (ii)] through (c); and
897          (ii) 0% of the hospital share specified in Subsection 26-36b-204(1)[(a)(iii)](d); and
898          (b) non-state government hospitals are responsible for:
899          (i) 1% of the portion of the hospital share specified in Subsections 26-36b-204(1)(a)[(i)
900     and (ii)] through (c); and
901          (ii) 0% of the hospital share specified in Subsection 26-36b-204(1)[(a)(iii)](d).";
902          (5) modifying Section 26-36b-208 to read:
903          "26-36b-208.     Medicaid Expansion Fund.
904          (1) There is created an expendable special revenue fund known as the Medicaid
905     Expansion Fund.
906          (2) The fund consists of:
907          (a) assessments collected under this chapter;
908          (b) intergovernmental transfers under Section 26-36b-206;
909          (c) savings attributable to the health coverage improvement program [under Section
910     26-18-411] as determined by the department;
911          (d) savings attributable to the enhancement waiver program as determined by the
912     department;
913          (e) savings attributable to the Medicaid waiver expansion as determined by the
914     department;
915          [(d)] (f) savings attributable to the inclusion of psychotropic drugs on the preferred
916     drug list under Subsection 26-18-2.4(3) as determined by the department;
917          [(e)] (g) savings attributable to the services provided by the Public Employees' Health
918     Plan under Subsection 49-20-401(1)(u);
919          (h) the amount transferred under Subsection 32B-2-301(7);
920          (i) the amount transferred under Subsection 59-14-204(6);
921          [(f)] (j) gifts, grants, donations, or any other conveyance of money that may be made to
922     the fund from private sources; [and]
923          (k) interest earned on money in the fund; and
924          [(g)] (l) additional amounts as appropriated by the Legislature.
925          (3) (a) The fund shall earn interest.
926          (b) All interest earned on fund money shall be deposited into the fund.
927          (4) (a) A state agency administering the provisions of this chapter may use money from
928     the fund to pay the costs [of], not otherwise paid for with federal funds or other revenue
929     sources, of:
930          (i) the health coverage improvement [Medicaid waiver under Section 26-18-411, and]
931     program;
932          (ii) the enhancement waiver program;
933          (iii) the Medicaid waiver expansion; and
934          (iv) the outpatient [UPL] upper payment limit supplemental payments under Section
935     26-36b-210[, not otherwise paid for with federal funds or other revenue sources, except that
936     no].
937          (b) A state agency administering the provisions of this chapter may not use:
938          (i) funds described in Subsection (2)(b) may be used to pay the cost of private
939     outpatient [UPL] upper payment limit supplemental payments[.]; or
940          [(b)] (ii) Money in the fund [may not be used for any other] for any purpose not
941     described in Subsection (4)(a).";
942          (6) modifying Section 26-36b-209 to read:
943          "26-36b-209.     Hospital reimbursement.
944          (1) [The] If the health coverage improvement program, the enhancement waiver
945     program, or the Medicaid waiver expansion is implemented by contracting with a Medicaid
946     accountable care organization, the department shall, to the extent allowed by law, include, in a
947     contract [with a Medicaid accountable care organization] to provide benefits under the health
948     coverage improvement program, the enhancement waiver program, or the Medicaid waiver
949     expansion, a requirement that the Medicaid accountable care organization reimburse hospitals
950     in the accountable care organization's provider network[,] at no less than the Medicaid
951     fee-for-service rate.
952          (2) If the health coverage improvement program, the enhancement waiver program, or
953     the Medicaid waiver expansion is implemented by the department as a fee-for-service program,
954     the department shall reimburse hospitals at no less than the Medicaid fee-for-service rate.
955          (3) Nothing in this section prohibits a Medicaid accountable care organization from
956     paying a rate that exceeds the Medicaid fee-for-service [rates] rate." and
957          (7) Section 26-36b-211 in this H.B. 325 supersedes Section 26-36b-211 in H.B. 472.
958          Section 22. Coordinating H.B. 325 with S.B. 125 -- Superseding substantive and
959     technical amendments.
960           If this H.B. 325 and S.B. 125, Child Welfare Amendments, both pass and become law,
961     it is the intent of the Legislature that the amendments to Section 26-36b-103 in this bill
962     supersede the amendments to Section 26-36b-103 in S.B.125, when the Office of Legislative
963     Research and General Counsel prepares the Utah Code database for publication.