26-36a-205 - Medicaid hospital inpatient access payments.
26-36a-205. Medicaid hospital inpatient access payments.
(1) To preserve and improve access to hospitals, the division shall make Medicaidinpatient hospital access payments to hospitals in accordance with this section, Section26-36a-204, and Subsection 26-36a-203(7).
(2) (a) The Medicaid inpatient hospital access payment amount to a particular hospitalshall be established by the division.
(b) The aggregate of all hospital's Medicaid inpatient hospital access payments shall be:
(i) equal to the upper payment limit gap for inpatient services for all hospitals; and
(ii) designated as the Medicaid inpatient hospital access payment pool.
(3) In addition to any other funds paid to hospitals during fiscal years 2010 and 2011 forinpatient hospital services to Medicaid patients, a Medicaid hospital inpatient access paymentshall be made:
(a) for state fiscal years 2010 and 2011:
(i) the amount of $825 per Medicaid fee for service day, to a hospital that:
(A) was not a specialty hospital; and
(B) had less than 300 select access inpatient cases during state fiscal year 2008; and
(ii) inpatient hospital access payments as determined by dividing the remaining spendingroom available in the current year UPL, after offsetting the payments authorized underSubsection (3)(a)(i) by the total 2008 Medicaid inpatient hospital payments, multiplied by thehospital's Medicaid inpatient payments for state fiscal year 2008, exclusive of medical educationand Medicaid disproportionate share payments;
(b) for state fiscal year 2012, using state fiscal year 2009 paid Medicaid inpatient claimsdata; and
(c) for state fiscal year 2013, using state fiscal year 2010 paid Medicaid inpatient claimsdata.
(4) For both state fiscal years 2012 and 2013, the division shall submit adjustments to thepayment rates in Subsection (3)(a) to the Hospital Policy Review Board for their review.
(5) Medicaid inpatient hospital access payments shall be made:
(a) on a quarterly basis for inpatient hospital services furnished to Medicaid individualsduring each quarter; and
(b) within 15 days after the end of each quarter.
(6) A hospital's Medicaid inpatient access payment shall not be used to offset any otherpayment by Medicaid for hospital inpatient or outpatient services to Medicaid beneficiaries,including a:
(a) fee-for-service payment;
(b) per diem payment;
(c) hospital inpatient adjustment; or
(d) cost settlement payment.
(7) A hospital shall not be guaranteed that the hospital's Medicaid inpatient hospitalaccess payments will equal or exceed the amount of the hospital's assessment.
Enacted by Chapter 179, 2010 General Session