Title 26B, Title 26B: Utah Health and Human Services Code

26B-3-511. Outpatient upper payment limit supplemental payments. (1) The department shall administer an outpatient upper payment limit program for private hospitals that supplements the reimbursement to private hospitals in accordance with Subsection (2). (2) The division shall e…

26B-3-512. Repeal of assessment. (1) The assessment imposed by this part shall be repealed when: the executive director certifies that: action by Congress is in effect that disqualifies the assessment imposed by this part from counting toward state Medicaid funds available to be …

26B-3-601. Definitions. As used in this part: (1) "Assessment" means the Medicaid expansion hospital assessment established by this part. (2) "CMS" means the Centers for Medicare and Medicaid Services within the United States Department of Health and Human Services. (3) "Discharg…

26B-3-602. Application. (1) Other than for the imposition of the assessment described in this part, nothing in this part shall affect the nonprofit or tax exempt status of any nonprofit charitable, religious, or educational health care provider under any: state law; ad valorem pr…

26B-3-603. Assessment. (1) An assessment is imposed on each private hospital: beginning upon the later of: April 1, 2019; and CMS approval of the assessment under this part; in the amount designated in Sectionsand; and 26B-3-606 26B-3-607 in accordance with Section. 26B-3-604 (2)…

26B-3-604. Collection of assessment -- Deposit of revenue -- Rulemaking. (1) The department shall act as the collecting agent for the assessment imposed under Section. 26B-3-603 (2) The department shall administer and enforce the provisions of this part, and may make rules, in ac…

26B-3-605. Hospital share. (1) The hospital share is 100% of the state's net cost of Medicaid expansion, after deducting appropriate offsets and savings as a result of implementing Medicaid expansion, including: savings from: the Medicaid program's former Primary Care Network pro…

26B-3-606. Hospital financing. (1) Private hospitals shall be assessed under this part for the portion of the hospital share described in Section. 26B-3-611 (2) In the report described in Subsection, the department shall calculate the state's net cost of Medicaid expansion. 26B-3…

26B-3-607. Calculation of assessment. (1) Except as provided in Subsection (1)(b), each private hospital shall pay an annual assessment due on the last day of each quarter in an amount calculated by the division at a uniform assessment rate for each hospital discharge, in accorda…

26B-3-608. State teaching hospital and non-state government hospital mandatory intergovernmental transfer. (1) A state teaching hospital and a non-state government hospital shall make an intergovernmental transfer to the Medicaid ACA Fund, in accordance with this section. (2) The…

26B-3-609. Penalties. (1) A hospital that fails to pay a quarterly assessment, make the mandated intergovernmental transfer, or file a return as required under this part, within the time required by this part, shall pay penalties described in this section, in addition to the asse…

26B-3-610. Hospital reimbursement. (1) To the extent allowed by law, the department shall in any contract with a Medicaid accountable care organization to implement Medicaid expansion include a requirement that the Medicaid accountable care organization reimburse hospitals in the…

26B-3-611. Hospital financing of the hospital share. (1) For the first two full fiscal years that the assessment is in effect, the department shall: assess private hospitals under this part for 69% of the hospital share; require the state teaching hospital to make an intergovernm…

26B-3-612. Suspension of assessment. (1) The department shall suspend the assessment imposed by this part when the executive director certifies that: action by Congress is in effect that disqualifies the assessment imposed by this part from counting toward state Medicaid funds av…

26B-3-701. Definitions. As used in this part: (1) "Accountable care organization" means a managed care organization, as defined in 42 C.F.R. Sec. 438, that contracts with the department under the provisions of Section. 26B-3-202 (2) "Assessment" means the Medicaid hospital provid…

26B-3-702. Legislative findings. (1) The Legislature finds that there is an important state purpose to improve the access of Medicaid patients to quality care in Utah hospitals because of continuous decreases in state revenues and increases in enrollment under the Utah Medicaid p…

26B-3-703. Application of part. (1) Other than for the imposition of the assessment described in this part, nothing in this part shall affect the nonprofit or tax exempt status of any nonprofit charitable, religious, or educational health care provider under: Section 501(c), as a…

26B-3-704. Assessment, collection, and payment of hospital provider assessment. (1) A uniform, broad based, assessment is imposed on each hospital as defined in Subsection: 26B-3-701(5)(a) in the amount designated in Section; and 26B-3-705 in accordance with Section. 26B-3-706 (2…

26B-3-705. Calculation of assessment. (1) An annual assessment is payable on a quarterly basis for each hospital in an amount calculated at a uniform assessment rate for each hospital discharge, in accordance with this section. The uniform assessment rate shall be determined usin…

26B-3-706. Quarterly notice -- Collection. Quarterly assessments imposed by this part shall be paid to the division within 15 business days after the original invoice date that appears on the invoice issued by the division.

26B-3-707. Medicaid hospital adjustment under Medicaid accountable care organization rates. (1) To preserve and improve access to hospital services, the division shall incorporate into the Medicaid accountable care organization rate structure calculation consistent with the certi…

26B-3-708. Penalties and interest. (1) A facility that fails to pay any assessment or file a return as required under this part, within the time required by this part, shall pay, in addition to the assessment, penalties and interest established by the department. (2) Consistent w…

26B-3-709. Repeal of assessment. (1) The repeal of the assessment imposed by this part shall occur upon the certification by the executive director of the department that the sooner of the following has occurred: the effective date of any action by Congress that would disqualify …

26B-3-801. Definitions. As used in this part: (1) "Ambulance service provider" means: an ambulance provider as defined in Section; or 26B-4-101 a non-911 service provider as defined in Section. 26B-4-101 (2) "Assessment" means the Medicaid ambulance service provider assessment es…

26B-3-802. Assessment, collection, and payment of ambulance service provider assessment. (1) An ambulance service provider shall pay an assessment to the division: in the amount designated in Section; 26B-3-803 in accordance with this part; quarterly, on a day determined by the d…

26B-3-803. Calculation of assessment. (1) The division shall calculate a uniform assessment per transport as described in this section. (2) The assessment due from a given ambulance service provider equals the non-federal portion divided by total transports, multiplied by the num…

26B-3-804. Medicaid ambulance service provider adjustment under fee-for-service rates. (1) Subject to Subsection, the division shall, if the assessment imposed by this part is approved by the Centers for Medicare and Medicaid Services, for fee-for-service rates effective on or af…

26B-3-805. Penalties. The division shall require an ambulance service provider that fails to pay an assessment due under this part to pay the division, in addition to the assessment, a penalty determined by the division by rule made in accordance with.

26B-3-806. Repeal of assessment. (1) This part is repealed when, as certified by the executive director of the department, any of the following occurs: an action by Congress that disqualifies the assessment imposed by this part from state Medicaid funds available to be used to de…

26B-3-901. Definitions. As used in this part: (1) "Child" means an individual who is younger than 19 years old. (2) "Member" means a child enrolled in the program. (3) "Plan" means the department's plan submitted to the United States Department of Health and Human Services pursua…

26B-3-902. Creation and administration of the Utah Children's Health Insurance Program. (1) There is created the Utah Children's Health Insurance Program to be administered by the department in accordance with the provisions of: this part; and the State Children's Health Insuranc…

26B-3-903. Eligibility. (1) A traditionally eligible child may enroll in the program if the child: is a bona fide Utah resident; does not have access to or coverage under other health insurance, including any coverage available through a parent or legal guardian's employer; is in…

26B-3-904. Program benefits. (1) Except as provided in Subsection, medical and dental program benefits shall be benchmarked, in accordance with 42 U.S.C. Sec. 1397cc, as follows: (3) medical program benefits, including behavioral health care benefits, shall be benchmarked effecti…

26B-3-905. Limitation of benefits. Abortion is not a covered benefit, except as provided in 42 U.S.C. Sec. 1397ee.

26B-3-906. Funding. (1) The program shall be funded by federal matching funds received under, together with state matching funds required by, 42 U.S.C. Sec. 1397ee. (2) Program expenditures in the following categories may not exceed 10% in the aggregate of all federal payments pu…

26B-3-907. Evaluation. The department shall develop performance measures and annually evaluate the program's performance.

26B-3-908. Managed care -- Contracting for services. (1) Program benefits provided to a member under the program, as described in Section, shall be delivered by a managed care organization if the department determines that adequate services are available where the member lives or…

26B-3-909. State contractor -- Employee and dependent health benefit plan coverage. (1) For purposes of Sections,,,,, and, "qualified health coverage" means, at the time the contract is entered into or renewed: 17B-2a-818.5 19-1-206 63A-5b-607 63O-2-403 72-6-107.5 79-2-404 a heal…

26B-3-910. Alternative eligibility -- Report -- Alternative Eligibility Account. (1) A child who is not a traditionally eligible child may enroll in the program if: the child: has been living in the state for at least 180 days before the day on which the child applies for the pro…