2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 6 - Medicaid Expansion Hospital Assessment › Section 607 - Calculation of assessment.

Affected by 63I-1-226 on 7/1/2024
Effective 5/3/2023
26B-3-607.
Calculation of assessment.
(1)
(a) 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 accordance with this section.
(b) A private teaching hospital with more than 425 beds and more than 60 residents shall pay an assessment rate 2.5 times the uniform rate established under Subsection (1)(c).
(c) The division shall calculate the uniform assessment rate described in Subsection (1)(a) by dividing the hospital share for assessed private hospitals, as described in Subsection 26B-3-606(1), by the sum of:
(i) the total number of discharges for assessed private hospitals that are not a private teaching hospital; and
(ii) 2.5 times the number of discharges for a private teaching hospital, described in Subsection (1)(b).
(d) The division may make rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to adjust the formula described in Subsection (1)(c) to address unforeseen circumstances in the administration of the assessment under this part.
(e) The division shall apply any quarterly changes to the uniform assessment rate uniformly to all assessed private hospitals.
(2) Except as provided in Subsection (3), for each state fiscal year, the division shall determine a hospital's discharges as follows:
(a) for state fiscal year 2019, the hospital's cost report data for the hospital's fiscal year ending between July 1, 2015, and June 30, 2016; and
(b) for each subsequent state fiscal year, the hospital's cost report data for the hospital's fiscal year that ended in the state fiscal year two years before the assessment fiscal year.
(3)
(a) If a hospital's fiscal year Medicare cost report is not contained in the Centers for Medicare and Medicaid Services' Healthcare Cost Report Information System file:
(i) the hospital shall submit to the division a copy of the hospital's Medicare cost report applicable to the assessment year; and
(ii) the division shall determine the hospital's discharges.
(b) If a hospital is not certified by the Medicare program and is not required to file a Medicare cost report:
(i) the hospital shall submit to the division the hospital's applicable fiscal year discharges with supporting documentation;
(ii) the division shall determine the hospital's discharges from the information submitted under Subsection (3)(b)(i); and
(iii) if the hospital fails to submit discharge information, the division shall audit the hospital's records and may impose a penalty equal to 5% of the calculated assessment.
(4) Except as provided in Subsection (5), if a hospital is owned by an organization that owns more than one hospital in the state:
(a) the division shall calculate the assessment for each hospital separately; and
(b) each separate hospital shall pay the assessment imposed by this part.
(5) If multiple hospitals use the same Medicaid provider number:
(a) the department shall calculate the assessment in the aggregate for the hospitals using the same Medicaid provider number; and
(b) the hospitals may pay the assessment in the aggregate.
Renumbered and Amended by Chapter 306, 2023 General Session