Utah Code 26B-3-511. Outpatient upper payment limit supplemental payments
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(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).
Terms Used In Utah Code 26B-3-511
- Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
- Division: means the Division of Integrated Healthcare within the department. See Utah Code 26B-3-501
- Health coverage improvement program: means the health coverage improvement program described in Section 26B-3-207. See Utah Code 26B-3-501
- State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
- Upper payment limit gap: means the difference between the private hospital outpatient upper payment limit and the private hospital Medicaid outpatient payments, as determined in accordance with Utah Code 26B-3-501
(2) The division shall ensure that supplemental payment to Utah private hospitals under Subsection (1):
(2)(a) does not exceed the positive upper payment limit gap; and
(2)(b) is allocated based on the Medicaid state plan.
(3) The department shall use the same outpatient data to allocate the payments under Subsection (2) and to calculate the upper payment limit gap.
(4) The supplemental payments to private hospitals under Subsection (1) are payable for outpatient hospital services provided on or after the later of:
(4)(a) July 1, 2016;
(4)(b) the effective date of the Medicaid state plan amendment necessary to implement the payments under this section; or
(4)(c) the effective date of the coverage provided through the health coverage improvement program waiver.