Rep. Norm Thurston — Voting Record

Bill

Number

H.B. 325 Fourth Substitute (2018GS)

Sponsor

Rep. Eliason, S.

Final action

Governor Signed 3/21/2018

Outcome

Became law — signed by Gov. Gary R. Herbert

Summary

What it does

• This bill:
• directs the Department of Health to apply for a new waiver or an amendment to an existing waiver to implement the Primary Care Network enhancement waiver program described in this bill; and
• amends the Inpatient Hospital Assessment Act to pay for the cost of the enhancement waiver program.

Every vote on this bill

Bill text

PRIMARY CARE NETWORK AMENDMENTS
GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Steve Eliason
Senate Sponsor: 
Brian Zehnder
LONG TITLE
General Description:
This bill creates a new waiver program to provide enhanced benefits for certain
individuals in the Medicaid program, and provides funding for the enhancement waiver
program through an existing hospital assessment and a portion of the growth in alcohol
and tobacco tax revenues.
Highlighted Provisions:
This bill:
▸ directs the Department of Health to apply for a new waiver or an amendment to an
existing waiver to implement the Primary Care Network enhancement waiver
program described in this bill; and
▸ amends the Inpatient Hospital Assessment Act to pay for the cost of the
enhancement waiver program.
Money Appropriated in this Bill:
None
Other Special Clauses:
This bill provides coordination clauses.
Utah Code Sections Affected:
AMENDS:
26-18-411
, as enacted by Laws of Utah 2016, Chapter 279
26-36b-102
, as enacted by Laws of Utah 2016, Chapter 279
26-36b-103
, as enacted by Laws of Utah 2016, Chapter 279
26-36b-201
, as enacted by Laws of Utah 2016, Chapter 279
26-36b-202
, as enacted by Laws of Utah 2016, Chapter 279
26-36b-203
, as enacted by Laws of Utah 2016, Chapter 279
26-36b-204
, as enacted by Laws of Utah 2016, Chapter 279
26-36b-205
, as enacted by Laws of Utah 2016, Chapter 279
26-36b-206
, as enacted by Laws of Utah 2016, Chapter 279
26-36b-207
, as enacted by Laws of Utah 2016, Chapter 279
26-36b-208
, as enacted by Laws of Utah 2016, Chapter 279
26-36b-209
, as enacted by Laws of Utah 2016, Chapter 279
26-36b-210
, as enacted by Laws of Utah 2016, Chapter 279
26-36b-211
, as enacted by Laws of Utah 2016, Chapter 279
63I-1-226
, as last amended by Laws of Utah 2017, Chapters 177 and 443
ENACTS:
26-18-415
, Utah Code Annotated 1953
Utah Code Sections Affected by Coordination Clause:
26-18-415
, Utah Code Annotated 1953
26-36b-103
, as enacted by Laws of Utah 2016, Chapter 279
26-36b-201
, as enacted by Laws of Utah 2016, Chapter 279
26-36b-204
, as enacted by Laws of Utah 2016, Chapter 279
26-36b-206
, as enacted by Laws of Utah 2016, Chapter 279
26-36b-208
, as enacted by Laws of Utah 2016, Chapter 279
26-36b-209
, as enacted by Laws of Utah 2016, Chapter 279
26-36b-211
, as enacted by Laws of Utah 2016, Chapter 279
Be it enacted by the Legislature of the state of Utah:
Section 1. Section 
26-18-411
 is amended to read:
26-18-411.
Health coverage improvement program -- Eligibility -- Annual report
-- Expansion of eligibility for adults with dependent children.
(1) For purposes of this section:
(a) "Adult in the expansion population" means an individual who:
(i) is described in 42 U.S.C. Sec. 1396a(10)(A)(i)(VIII); and
(ii) is not otherwise eligible for Medicaid as a mandatory categorically needy
individual.
(b) "CMS" means the Centers for Medicare and Medicaid Services within the United
States Department of Health and Human Services.
(c) "Enhancement waiver program" means the Primary Care Network enhancement
waiver program described in Section 
26-18-415
.
[
(c)
] 
(d)
 "Federal poverty level" means the poverty guidelines established by the
Secretary of the United States Department of Health and Human Services under 42 U.S.C. Sec.
9909(2).
(e) "Health coverage improvement program" means the health coverage improvement
program described in Subsections (3) through (10).
[
(d)
] 
(f)
 "Homeless":
(i) means an individual who is chronically homeless, as determined by the department;
and
(ii) includes someone who was chronically homeless and is currently living in
supported housing for the chronically homeless.
[
(e)
] 
(g)
 "Income eligibility ceiling" means the percent of federal poverty level:
(i) established by the state in an appropriations act adopted pursuant to Title 63J,
Chapter 1, Budgetary Procedures Act; and
(ii) under which an individual may qualify for Medicaid coverage in accordance with
this section.
(2) Beginning July 1, 2016, the department shall amend the state Medicaid plan to
allow temporary residential treatment for substance abuse, for the traditional Medicaid
population, in a short term, non-institutional, 24-hour facility, without a bed capacity limit that
provides rehabilitation services that are medically necessary and in accordance with an
individualized treatment plan, as approved by CMS and as long as the county makes the
required match under Section 
17-43-201
.
(3) Beginning July 1, 2016, the department shall amend the state Medicaid plan to
increase the income eligibility ceiling to a percentage of the federal poverty level designated by
the department, based on appropriations for the program, for an individual with a dependent
child.
[
(2) (a) No later than
]
(4) Before
 July 1, 2016, the division shall submit to CMS a request for waivers, or an
amendment of existing waivers, from federal statutory and regulatory law necessary for the
state to implement the health coverage improvement program in the Medicaid program in
accordance with this section.
[
(b)
] 
(5) (a)
 An adult in the expansion population is eligible for Medicaid if the adult
meets the income eligibility and other criteria established under Subsection [
(3)
] 
(6)
.
[
(c)
] 
(b)
 An adult who qualifies under Subsection [
(3)
] 
(6)
 shall receive Medicaid
coverage:
(i) through[
: (A)
] the traditional fee for service Medicaid model in counties without
Medicaid accountable care organizations or the state's Medicaid accountable care organization
delivery system, where implemented; [
and
]
[
(B)
] 
(ii)
 except as provided in Subsection [
(2)(c)(ii)
] 
(5)(b)(iii)
, for behavioral health,
through the counties in accordance with Sections 
17-43-201
 and 
17-43-301
;
[
(ii)
] 
(iii)
 that integrates behavioral health services and physical health services with
Medicaid accountable care organizations in select geographic areas of the state that choose an
integrated model; and
[
(iii)
] 
(iv)
 that permits temporary residential treatment for substance abuse in a short
term, non-institutional, 24-hour facility, without a bed capacity limit, as approved by CMS, that
provides rehabilitation services that are medically necessary and in accordance with an
individualized treatment plan.
[
(d)
] 
(c)
 Medicaid accountable care organizations and counties that elect to integrate
care under Subsection [
(2)(c)(ii)
] 
(5)(b)(iii)
 shall collaborate on enrollment, engagement of
patients, and coordination of services.
[
(3)
] 
(6)
 (a) An individual is eligible for the health coverage improvement program
under Subsection [
(2)(b)
] 
(5)
 if:
(i) at the time of enrollment, the individual's annual income is below the income
eligibility ceiling established by the state under Subsection (1)[
(e)
]
(g)
; and
(ii) the individual meets the eligibility criteria established by the department under
Subsection [
(3)
] 
(6)
(b).
(b) Based on available funding and approval from CMS, the department shall select the
criteria for an individual to qualify for the Medicaid program under Subsection [
(3)
] 
(6)
(a)(ii),
based on the following priority:
(i) a chronically homeless individual;
(ii) if funding is available, an individual:
(A) involved in the justice system through probation, parole, or court ordered
treatment; and
(B) in need of substance abuse treatment or mental health treatment, as determined by
the department; or
(iii) if funding is available, an individual in need of substance abuse treatment or
mental health treatment, as determined by the department.
(c) An individual who qualifies for Medicaid coverage under Subsections [
(3)
] 
(6)
(a)
and (b) may remain on the Medicaid program for a 12-month certification period as defined by
the department. Eligibility changes made by the department under Subsection (1)[
(e)
]
(g)
 or
[
(3)
] 
(6)
(b) shall not apply to an individual during the 12-month certification period.
[
(4)
] 
(7)
 The state may request a modification of the income eligibility ceiling and
other eligibility criteria under Subsection [
(3)
] 
(6)
 each fiscal year based on enrollment in the
health coverage improvement program, projected enrollment, costs to the state, and the state
budget.
[
(5) On or before September 30, 2017, and on or before
]
(8) Before
 September 30 
of
 each year [
thereafter
], the department shall report to the
[
Legislature's
] Health and Human Services Interim Committee and to the [
Legislature's
]
Executive Appropriations Committee:
(a) the number of individuals who enrolled in Medicaid under Subsection [
(3)
] 
(6)
;
(b) the state cost of providing Medicaid to individuals enrolled under Subsection [
(3)
]
(6)
; and
(c) recommendations for adjusting the income eligibility ceiling under Subsection [
(4)
]
(7)
, and other eligibility criteria under Subsection [
(3)
] 
(6)
, for the upcoming fiscal year.
[
(6) In addition to the waiver under Subsection (2), beginning July 1, 2016, the
department shall amend the state Medicaid plan:
]
[
(a) for an individual with a dependent child, to increase the income eligibility ceiling
to a percent of the federal poverty level designated by the department, based on appropriations
for the program; and
]
[
(b) to allow temporary residential treatment for substance abuse, for the traditional
Medicaid population, in a short term, non-institutional, 24-hour facility, without a bed capacity
limit that provides rehabilitation services that are medically necessary and in accordance with
an individualized treatment plan, as approved by CMS and as long as the county makes the
required match under Section 
17-43-201
.
]
[
(7)
] 
(9)
 The current Medicaid program and the health coverage improvement program,
when implemented, shall coordinate with a state prison or county jail to expedite Medicaid
enrollment for an individual who is released from custody and was eligible for or enrolled in
Medicaid before incarceration.
[
(8)
] 
(10)
 Notwithstanding Sections 
17-43-201
 and 
17-43-301
, a county does not have
to provide matching funds to the state for the cost of providing Medicaid services to newly
enrolled individuals who qualify for Medicaid coverage under the health coverage
improvement program under Subsection [
(3)
] 
(6)
.
[
(9) The department shall:
]
[
(a) study, in consultation with health care providers, employers, uninsured families,
and community stakeholders:
]
[
(i) options to maximize use of employer sponsored coverage for current Medicaid
enrollees; and
]
[
(ii) strategies to increase participation of currently Medicaid eligible, and uninsured,
children; and
]
[
(b) report the findings of the study to the Legislature's Health Reform Task Force
before November 30, 2016.
]
(11) If the enhancement waiver program is implemented, the department:
(a) may not accept any new enrollees into the health coverage improvement program
after the day on which the enhancement waiver program is implemented;
(b) shall transition all individuals who are enrolled in the health coverage improvement
program into the enhancement waiver program;
(c) shall suspend the health coverage improvement program within one year after the
day on which the enhancement waiver program is implemented;
(d) shall, within one year after the day on which the enhancement waiver program is
implemented, use all appropriations for the health coverage improvement program to
implement the enhancement waiver program; and
(e) shall work with CMS to maintain any waiver for the health coverage improvement
program while the health coverage improvement program is suspended under Subsection
(11)(c).
(12) If, after the enhancement waiver program takes effect, the enhancement waiver
program is repealed or suspended by either the state or federal government, the department
shall reinstate the health coverage improvement program and continue to accept new enrollees
into the health coverage improvement program in accordance with the provisions of this
section.
Section 2. Section 
26-18-415
 is enacted to read:
 26-18-415.
Primary Care Network enhancement waiver program.
(1) As used in this section:
(a) "CMS" means the Centers for Medicare and Medicaid Services within the United
States Department of Health and Human Services.
(b) "Enhancement waiver program" means the Primary Care Network enhancement
waiver program described in this section.
(c) "Federal poverty level" means the poverty guidelines established by the secretary of
the United States Department of Health and Human Services under 42 U.S.C. Sec. 9902(2).
(d) "Health coverage improvement program" means the same as that term is defined in
Section 
26-18-411
.
(e) "Income eligibility ceiling" means the percentage of federal poverty level:
(i) established by the Legislature in an appropriations act adopted pursuant to Title 63J,
Chapter 1, Budgetary Procedures Act; and
(ii) under which an individual may qualify for coverage in the enhancement waiver
program in accordance with this section.
(f) "Optional population" means the optional expansion population under PPACA if
the expansion provides coverage for individuals at or above 95% of the federal poverty level.
(g) "PPACA" means the same as that term is defined in Section 
31A-1-301
.
(h) "Primary Care Network" means the state Primary Care Network program created by
the Medicaid primary care network demonstration waiver obtained under Section 
26-18-3
.
(2) The department shall continue to implement the Primary Care Network program for
qualified individuals under the Primary Care Network program.
(3) Before July 1, 2018, the division shall apply for a Medicaid waiver or a state plan
amendment with CMS to implement, within the state Medicaid program, the enhancement
waiver program described in this section.
(4) An individual who is eligible for the enhancement waiver program may receive the
following benefits under the enhancement waiver program:
(a) the benefits offered under the Primary Care Network program;
(b) diagnostic testing and procedures;
(c) medical specialty care;
(d) inpatient hospital services;
(e) outpatient hospital services;
(f) outpatient behavioral health care, including outpatient substance abuse care; and
(g) for an individual who qualifies for the health coverage improvement program, as
approved by CMS, temporary residential treatment for substance abuse in a short term,
non-institutional, 24-hour facility, without a bed capacity limit, that provides rehabilitation
services that are medically necessary and in accordance with an individualized treatment plan.
(5) An individual is eligible for the enhancement waiver program if, at the time of
enrollment:
(a) the individual is qualified to enroll in the Primary Care Network or the health
coverage improvement program;
(b) the individual's annual income is below the income eligibility ceiling established by
the Legislature under Subsection (1)(e); and
(c) the individual meets the eligibility criteria established by the department under
Subsection (6).
(6) (a) Based on available funding and approval from CMS and subject to Subsection
(6)(d), the department shall determine the criteria for an individual to qualify for the
enhancement waiver program, based on the following priority:
(i) adults in the expansion population, as defined in Section 
26-18-411
, who qualify for
the health coverage improvement program;
(ii) adults with dependent children who qualify for the health coverage improvement
program under Subsection 
26-18-411
(3) ;
(iii) adults with dependent children who do not qualify for the health coverage
improvement program; and
(iv) if funding is available, adults without dependent children.
(b) The number of individuals enrolled in the enhancement waiver program may not
exceed 105% of the number of individuals who were enrolled in the Primary Care Network on
December 31, 2017.
(c) The department may only use appropriations from the Medicaid Expansion Fund
created in Section 
26-36b-208
 to fund the state portion of the enhancement waiver program.
(d) The money deposited into the Medicaid Expansion Fund under Subsections
26-36b-208
(g) and (h) may only be used to pay the cost of enrolling individuals who qualify for
the enhancement waiver program under Subsections (6)(a)(iii) and (iv).
(7) The department may request a modification of the income eligibility ceiling and the
eligibility criteria under Subsection (6) from CMS each fiscal year based on enrollment in the
enhancement waiver program, projected enrollment in the enhancement waiver program, costs
to the state, and the state budget.
(8) The department may implement the enhancement waiver program by contracting
with Medicaid accountable care organizations to administer the enhancement waiver program.
(9) In accordance with Subsections 
26-18-411
(11) and (12), the department may use
funds that have been appropriated for the health coverage improvement program to implement
the enhancement waiver program.
(10) If the department expands the state Medicaid program to the optional population,
the department:
(a) except as provided in Subsection (11), may not accept any new enrollees into the
enhancement waiver program after the day on which the expansion to the optional population 
is effective;
(b) shall suspend the enhancement waiver program within one year after the day on
which the expansion to the optional population is effective; and
(c) shall work with CMS to maintain the waiver for the enhancement waiver program
submitted under Subsection (3) while the enhancement waiver program is suspended under
Subsection (10)(b).
(11) If, after the expansion to the optional population described in Subsection (10)
takes effect, the expansion to the optional population is repealed by either the state or the
federal government, the department shall reinstate the enhancement waiver program and
continue to accept new enrollees into the enhancement waiver program in accordance with the
provisions of this section.
Section 3. Section 
26-36b-102
 is amended to read:
26-36b-102.
Application.
(1) Other than for the imposition of the assessment described in this chapter, nothing in
this chapter shall affect the nonprofit or tax exempt status of any nonprofit charitable, religious,
or educational health care provider under 
any
:
[
(a) Section 501(c), as amended, of the Internal Revenue Code;
]
[
(b) other applicable federal law;
]
[
(c)
] 
(a)
 [
any
] state law;
[
(d)
] 
(b)
 [
any
] ad valorem property taxes;
[
(e)
] 
(c)
 [
any
] sales or use taxes; or
[
(f)
] 
(d)
 [
any
] other taxes, fees, or assessments, whether imposed or sought to be
imposed, by the state or any political subdivision[
, county, municipality, district, authority, or
any agency or department thereof
] 
of the state
.
(2) All assessments paid under this chapter may be included as an allowable cost of a
hospital for purposes of any applicable Medicaid reimbursement formula.
(3) This chapter does not authorize a political subdivision of the state to:
(a) license a hospital for revenue;
(b) impose a tax or assessment upon a hospital; or
(c) impose a tax or assessment measured by the income or earnings of a hospital.
Section 4. Section 
26-36b-103
 is amended to read:
26-36b-103.
Definitions.
As used in this chapter:
(1) "Assessment" means the inpatient hospital assessment established by this chapter.
(2) "CMS" means the [
same as that term is defined in Section 
26-18-411
] 
Centers for
Medicare and Medicaid Services within the United States Department of Health and Human
Services
.
(3) "Discharges" means the number of total hospital discharges reported on:
(a) Worksheet S-3 Part I, column 15, lines 14, 16, and 17 of the 2552-10 Medicare cost
report for the applicable assessment year; or
(b) a similar report adopted by the department by administrative rule, if the report
under Subsection (3)(a) is no longer available.
(4) "Division" means the Division of Health Care Financing within the department.
(5) "Enhancement waiver program" means the program established by the Primary
Care Network enhancement waiver program described in Section 
26-18-415
.
(6) "Health coverage improvement program" means the health coverage improvement
program described in Section 
26-18-411
.
(7) "Hospital share" means the hospital share described in Section 
26-36b-203
.
(8) "Medicaid 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 
26-18-405
.
[
(5)
] 
(9)
 "Medicare cost report" means CMS-2552-10, the cost report for electronic
filing of hospitals.
[
(6)
] 
(10) (a)
 "Non-state government hospital"[
:(a)
] means a hospital owned by a
non-state government entity[
; and
]
.
(b) 
"Non-state government hospital" 
 does not include:
(i) the Utah State Hospital; or
(ii) a hospital owned by the federal government, including the Veterans Administration
Hospital.
[
(7)
] 
(11) (a)
 "Private hospital"[
:(a)
] means:
(i) a [
privately owned
] general acute hospital [
operating in the state
]
,
 as defined in
Section 
26-21-2
, that is privately owned and operating in the state
; and
(ii) a privately owned specialty hospital operating in the state, [
which shall include
]
including
 a privately owned hospital whose inpatient admissions are predominantly 
for
:
(A) rehabilitation;
(B) psychiatric 
care
;
(C) chemical dependency 
services
; or
(D) long-term acute care services[
; and
]
.
(b) 
"Private hospital"
 does not include a 
facility for
 residential [
care or
] treatment
[
facility
] as defined in Section 
62A-2-101
.
[
(8)
] 
(12)
 "State teaching hospital" means a state owned teaching hospital that is part of
an institution of higher education.
(13) "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 42 C.F.R. Sec. 447.321.
Section 5. Section 
26-36b-201
 is amended to read:
26-36b-201.
Assessment.
(1) An assessment is imposed on each private hospital:
(a) beginning upon the later of CMS approval of:
(i) the health coverage improvement program waiver under Section 
26-18-411
; and
(ii) the assessment under this chapter;
(b) in the amount designated in Sections 
26-36b-204
 and 
26-36b-205
; and
(c) in accordance with Section 
26-36b-202
.
(2) Subject to Section 
26-36b-203
, the assessment imposed by this chapter is due and
payable on a quarterly basis, after payment of the outpatient upper payment limit supplemental
payments under Section 
26-36b-210
 have been paid.
(3) The first quarterly payment [
shall not be
] 
is not
 due until at least three months after
the 
earlier of the
 effective [
date
] 
dates
 of the coverage provided through
:
(a)
 the health coverage improvement program [
waiver under Section 
26-18-411
.
]
; or
(b) the enhancement waiver program.
Section 6. Section 
26-36b-202
 is amended to read:
26-36b-202.
Collection of assessment -- Deposit of revenue -- Rulemaking.
(1) The collecting agent for the assessment imposed under Section 
26-36b-201
 is the
department.
(2)
 The department is vested with the administration and enforcement of this chapter,
[
including the right to adopt administrative
] 
and may make
 rules in accordance with Title 63G,
Chapter 3, Utah Administrative Rulemaking Act, necessary to:
[
(a) implement and enforce the provisions of this chapter;
]
(a) collect the assessment, intergovernmental transfers, and penalties imposed under
this chapter;
(b) audit records of a facility that:
(i) is subject to the assessment imposed by this chapter; and
(ii) does not file a Medicare cost report; and
(c) select a report similar to the Medicare cost report if Medicare no longer uses a
Medicare cost report.
(2) The department shall:
(a) administer the assessment in this [
part separate
] 
chapter separately
 from the
assessment in Chapter 36a, Hospital Provider Assessment Act; and
(b) deposit assessments collected under this chapter into the Medicaid Expansion Fund
created by Section 
26-36b-208
.
Section 7. Section 
26-36b-203
 is amended to read:
26-36b-203.
Quarterly notice.
(1)
 Quarterly assessments imposed by this chapter shall be paid to the division within
15 business days after the original invoice date that appears on the invoice issued by the
division.
(2)
 The department may, by rule, extend the time for paying the assessment.
Section 8. Section 
26-36b-204
 is amended to read:
26-36b-204.
Hospital financing of health coverage improvement program
Medicaid waiver -- Hospital share.
[
(1) For purposes of this section, "hospital share":(a) means
]
(1) The hospital share is:
(a)
 45% of the state's net cost of[
: (i)
] the health coverage improvement program
[
Medicaid waiver under Section 
26-18-411
; (ii)
]
, including
 Medicaid coverage for individuals
with dependent children up to the federal poverty level designated under Section 
26-18-411
;
[
and
]
[
(iii) the UPL gap, as that term is defined in Section 
26-36b-210
;
]
(b) 45% of the state's net cost of the enhancement waiver program; and
(c) 45% of the state's net cost of the upper payment limit gap.
[
(b) for the hospital share of the additional coverage under Section 
26-18-411
,
]
(2) (a) The hospital share
 is capped at no more than $13,600,000 annually, consisting
of:
(i) an $11,900,000 cap [
on the hospital's share
] for the programs specified in
Subsections (1)(a)[
(i) and (ii)
] 
and (b)
; and
(ii) a $1,700,000 cap for the program specified in Subsection [
(1)(a)(iii);
] 
(1)(c).
[
(c) for the cap specified in Subsection (1)(b), shall be prorated
]
(b) The department shall prorate the cap described in Subsection (2)(a)
 in any year in
which the programs specified in [
Subsection
] 
Subsections
 (1)(a) 
and (c)
 are not in effect for the
full fiscal year[
; and
]
.
[
(d)
] 
(c)
 [
if
] 
If
 the Medicaid program expands in a manner that is greater than the
expansion described in Section 
26-18-411
[
,
] 
and the enhancement described in Section
26-18-415
, the hospital share
 is capped at 33% of the state's share of the cost of the expansion
or enhancement
 that is in addition to the [
program
] 
programs
 described in Section 
26-18-411
or
26-18-415
.
[
(2) The assessment for the private hospital share under Subsection (1) shall be:
]
(3) Private hospitals shall be assessed under this chapter for:
(a) 69% of the portion of the hospital share specified in Subsections (1)(a)[
(i) and (ii)
]
and (b)
; and
(b) 100% of the portion of the hospital share specified in Subsection (1)[
(a)(iii)
]
(c)
.
[
(3)
] 
(4)
 (a) The department shall, on or before October 15, 2017, and on or before
October 15 of each 
subsequent
 year [
thereafter
], produce a report that calculates the state's net
cost of the programs described in Subsections (1)(a)[
(i) and (ii)
] 
and (b) that are in effect for
that year
 .
(b) If the assessment collected in the previous fiscal year is above or below the [
private
hospital's share of the state's net cost as specified in Subsection (2),
] 
hospital share for private
hospitals
 for the previous fiscal year, the underpayment or overpayment of the assessment by
the private hospitals shall be applied to the fiscal year in which the report [
was
] 
is
 issued.
[
(4)
] 
(5)
 A Medicaid accountable care organization shall, on or before October 15 of
each year, report to the department the following data from the prior state fiscal year 
for each
private hospital, state teaching hospital, and non-state government hospital provider that the
Medicaid accountable care organization contracts with
:
(a) for the traditional Medicaid population[
, for each private hospital, state teaching
hospital, and non-state government hospital provider
]:
(i) hospital inpatient payments;
(ii) hospital inpatient discharges;
(iii) hospital inpatient days; and
(iv) hospital outpatient payments; and
[
(b) for the Medicaid population newly eligible under Subsection 
26-18-411
, for each
private hospital, state teaching hospital, and non-state government hospital provider:
]
(b) if the Medicaid accountable care organization enrolls any individuals in the health
coverage improvement program or the enhancement waiver program, for the population newly
eligible for either program:
(i) hospital inpatient payments;
(ii) hospital inpatient discharges;
(iii) hospital inpatient days; and
(iv) hospital outpatient payments.
(6) The department shall, by rule made in accordance with Title 63G, Chapter 3, Utah
Administrative Rulemaking Act, provide details surrounding specific content and format for
the reporting by the Medicaid accountable care organization.
Section 9. Section 
26-36b-205
 is amended to read:
26-36b-205.
Calculation of assessment.
(1) (a) Except as provided in Subsection (1)(b), an annual assessment is payable on a
quarterly basis for each private hospital 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 60 residents shall pay an
assessment rate [
2.50
] 
2.5
 times the uniform rate established under Subsection (1)(c).
(c) The 
division shall calculate the
 uniform assessment rate [
shall be determined using
the total number of hospital discharges for assessed private hospitals, the percentages in
Subsection 
26-36b-204
(2), and rule adopted by the department.
] 
described in Subsection (1)(a)
by dividing the hospital share for assessed private hospitals, described in Subsection
26-36b-204
(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, by rule made in accordance with Title 63G, Chapter 3, Utah
Administrative Rulemaking Act, adjust the formula described in Subsection (1)(c) to address
unforeseen circumstances in the administration of the assessment under this chapter.
[
(d)
] 
(e)
 Any quarterly changes to the uniform assessment rate shall be applied
uniformly to all assessed private hospitals.
[
(2) (a) For each state fiscal year, discharges shall be determined using the data from
each hospital's Medicare cost report contained in the Centers for Medicare and Medicaid
Services' Healthcare Cost Report Information System file. The hospital's discharge data will be
derived as follows:
]
(2) Except as provided in Subsection (3), for each state fiscal year, the division shall
determine a hospital's discharges as follows:
[
(i)
] 
(a)
 for state fiscal year 2017, the hospital's cost report data for the hospital's fiscal
year ending between July 1, 2013, and June 30, 2014; and
[
(ii)
] 
(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.
[
(b)
] 
(3) (a)
 If a hospital's fiscal year Medicare cost report is not contained in the
[
Centers for Medicare and Medicaid Services'
] 
CMS
 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.
[
(c)
] 
(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 [
(2)(c)(i)
] 
(3)(b)(i)
; and
(iii) [
the
] failure to submit discharge information shall result in an audit of the
hospital's records and a penalty equal to 5% of the calculated assessment.
[
(3)
] 
(4)
 Except as provided in Subsection [
(4)
] 
(5)
, if a hospital is owned by an
organization that owns more than one hospital in the state:
(a) the assessment for each hospital shall be separately calculated by the department;
and
(b) each separate hospital shall pay the assessment imposed by this chapter.
[
(4) Notwithstanding the requirement of Subsection (3), if
]
(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.
Section 10. Section 
26-36b-206
 is amended to read:
26-36b-206.
State teaching hospital and non-state government hospital
mandatory intergovernmental transfer.
(1) [
A
] 
The
 state teaching hospital and a non-state government hospital shall make an
intergovernmental transfer to the Medicaid Expansion Fund created in Section 
26-36b-208
, in
accordance with this section.
(2) The [
intergovernmental transfer shall be paid
] 
hospitals described in Subsection (1)
shall pay the intergovernmental transfer
 beginning on the later of CMS approval of:
(a) the health improvement program waiver under Section 
26-18-411
; 
or
(b) the assessment for private hospitals in this chapter[
; and
]
.
[
(c) the intergovernmental transfer in this section.
]
(3) The intergovernmental transfer [
shall be paid in an amount divided
] 
is apportioned
as follows:
(a) the state teaching hospital is responsible for:
(i) 30% of the portion of the hospital share specified in Subsections
26-36b-204
(1)(a)[
(i) and (ii)
] 
and (b)
; and
(ii) 0% of the hospital share specified in Subsection 
26-36b-204
(1)[
(a)(iii)
]
(c)
; and
(b) non-state government hospitals are responsible for:
(i) 1% of the portion of the hospital share specified in Subsections 
26-36b-204
(1)(a)[
(i)
and (ii)
] 
and (b)
; and
(ii) 0% of the hospital share specified in Subsection 
26-36b-204
(1)[
(a)(iii)
]
(c)
.
(4) The department shall, by rule made in accordance with Title 63G, Chapter 3, Utah
Administrative Rulemaking Act, designate
:
(a)
 the method of calculating the [
percentages
] 
amounts
 designated in Subsection (3)
;
and
(b)
 the schedule for the intergovernmental transfers.
Section 11. Section 
26-36b-207
 is amended to read:
26-36b-207.
Penalties.
(1) A hospital that fails to pay [
any
] 
a quarterly
 assessment, make the mandated
intergovernmental transfer, or file a return as required under this chapter, within the time
required by this chapter, shall pay penalties 
described in this section
, in addition to the
assessment or intergovernmental transfer[
, and interest established by the department
].
[
(2) (a) Consistent with Subsection (2)(b), the department shall adopt rules in
accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, that establish
reasonable penalties and interest for the violations described in Subsection (1).
]
[
(b)
] 
(2)
 If a hospital fails to timely pay the full amount of a quarterly assessment or the
mandated intergovernmental transfer, the department shall add to the assessment or
intergovernmental transfer:
[
(i)
] 
(a)
 a penalty equal to 5% of the quarterly amount not paid on or before the due
date; and
[
(ii)
] 
(b)
 on the last day of each quarter after the due date until the assessed amount and
the penalty imposed under Subsection (2)[
(b)(i)
]
(a)
 are paid in full, an additional 5% penalty
on:
[
(A)
] 
(i)
 any unpaid quarterly assessment or intergovernmental transfer; and
[
(B)
] 
(ii)
 any unpaid penalty assessment.
[
(c)
] 
(3)
 Upon making a record of the division's actions, and upon reasonable cause
shown, the division may waive, reduce, or compromise any of the penalties imposed under this
chapter.
Section 12. Section 
26-36b-208
 is amended to read:
26-36b-208.
Medicaid Expansion Fund.
(1) There is created an expendable special revenue fund known as the Medicaid
Expansion Fund.
(2) The fund consists of:
(a) assessments collected under this chapter;
(b) intergovernmental transfers under Section 
26-36b-206
;
(c) savings attributable to the health coverage improvement program [
under Section
26-18-411
] as determined by the department;
(d) savings attributable to the enhancement waiver program as determined by the
department;
[
(d)
] 
(e)
 savings attributable to the inclusion of psychotropic drugs on the preferred
drug list under Subsection 
26-18-2.4
(3) as determined by the department;
[
(e)
] 
(f)
 savings attributable to the services provided by the Public Employees' Health
Plan under Subsection 
49-20-401
(1)(u);
[
(f)
] 
(g)
 gifts, grants, donations, or any other conveyance of money that may be made to
the fund from private sources; [
and
]
(h) interest earned on money in the fund; and
[
(g)
] 
(i)
 additional amounts as appropriated by the Legislature.
(3) (a) The fund shall earn interest.
(b) All interest earned on fund money shall be deposited into the fund.
(4) (a) A state agency administering the provisions of this chapter may use money from
the fund to pay the costs [
of
]
, not otherwise paid for with federal funds or other revenue
sources, of:
(i)
 the health coverage improvement [
Medicaid waiver under Section 
26-18-411
, and
]
program;
(ii) the enhancement waiver program; and
(iii)
 the outpatient [
UPL
] 
upper payment limit
 supplemental payments under Section
26-36b-210
[
, not otherwise paid for with federal funds or other revenue sources, except that
no
]
.
(b) A state agency administering the provisions of this chapter may not use:
(i)
 funds described in Subsection (2)(b) [
may be used
] to pay the cost of 
private
outpatient [
UPL
] 
upper payment limit
 supplemental payments[
.
]
; or
[
(b)
] 
(ii)
 [
Money
] 
money
 in the fund [
may not be used
] for any [
other
] purpose 
not
described in Subsection (4)(a)
.
Section 13. Section 
26-36b-209
 is amended to read:
26-36b-209.
Hospital reimbursement.
(1)
 [
The
] 
If the health coverage improvement program or the enhancement waiver
program is implemented by contracting with a Medicaid accountable care organization, the
department shall, to the extent allowed by law, include
,
 in a contract [
with a Medicaid
accountable care organization
] 
to provide benefits under the health coverage improvement
program or the enhancement waiver program,
 a requirement that the 
Medicaid
 accountable care
organization reimburse hospitals in the accountable care organization's provider network[
,
] 
at
no less than the Medicaid fee-for-service rate.
(2) If the health coverage improvement program or the enhancement waiver program is
implemented by the department as a fee-for-service program, the department shall reimburse
hospitals at no less than the Medicaid fee-for-service rate.
(3)
 Nothing in this section prohibits a Medicaid accountable care organization from
paying a rate that exceeds 
the
 Medicaid fee-for-service [
rates
] 
rate
.
Section 14. Section 
26-36b-210
 is amended to read:
26-36b-210.
Outpatient upper payment limit supplemental payments.
[
(1) For purposes of this section, "UPL gap" means the difference between the private
hospital outpatient upper payment limit and the private hospital Medicaid outpatient payments,
as determined in accordance with 42 C.F.R. 447.321.
]
[
(2)
] 
(1)
 Beginning on the effective date of the assessment imposed under this chapter,
and for each 
subsequent
 fiscal year [
thereafter
], the department shall implement an outpatient
upper payment limit program for private hospitals that shall supplement the reimbursement to
private hospitals in accordance with Subsection [
(3)
] 
(2)
.
[
(3)
] 
(2)
 The 
division shall ensure that
 supplemental payment to Utah private hospitals
under Subsection [
(2) shall
] 
(1)
:
(a) 
does
 not exceed the positive [
UPL
] 
upper payment limit
 gap; and
(b) [
be
] 
is
 allocated based on the Medicaid state plan.
[
(4)
] 
(3)
 The 
department shall use the same
 outpatient data [
used to calculate the UPL
gap under Subsection (1) shall be the same outpatient data used
] to allocate the payments under
Subsection [
(3)
] 
(2) and to calculate the upper payment limit gap
.
[
(5)
] 
(4)
 The supplemental payments to private hospitals under Subsection [
(2) shall
be
] 
(1) are
 payable for outpatient hospital services provided on or after the later of:
(a) July 1, 2016;
(b) the effective date of the Medicaid state plan amendment necessary to implement the
payments under this section; or
(c) the effective date of the coverage provided through the health coverage
improvement program [
waiver under Section 
26-18-411
].
Section 15. Section 
26-36b-211
 is amended to read:
26-36b-211.
Repeal of assessment.
(1) The [
repeal of the
] assessment imposed by this chapter shall [
occur upon the
certification by the executive director of the department that the sooner of the following has
occurred
] 
be repealed when
:
[
(a) the effective date of any
]
(a) the executive director certifies that:
(i)
 action by Congress [
that would disqualify
] 
is in effect that disqualifies
 the
assessment imposed by this chapter from counting toward state Medicaid funds available to be
used to determine the 
amount of
 federal financial participation;
[
(b) the effective date of any
]
(ii) a
 decision, enactment, or other determination by the Legislature or by any court,
officer, department, or agency of the state, or of the federal government, [
that has the effect of
]
is in effect that
:
[
(i) disqualifying
] 
(A) disqualifies
 the assessment from counting toward state
Medicaid funds available to be used to determine federal financial participation for Medicaid
matching funds; or
[
(ii) creating
] 
(B) creates
 for any reason a failure of the state to use the assessments for
at least one of
 the Medicaid [
program as
] 
programs
 described in this chapter; 
or
[
(c) the effective date of
]
(iii)
 a change 
is in effect
 that reduces the aggregate hospital inpatient and outpatient
payment rate below the aggregate hospital inpatient and outpatient payment rate for July 1,
2015; [
and
] 
or
[
(d) the sunset of
] 
(b)
 this chapter 
is repealed
 in accordance with Section 
63I-1-226
.
[
(2) If the assessment is repealed under Subsection (1), money in the fund that was
derived from assessments imposed by this chapter, before the determination made under
Subsection (1), shall be disbursed under Section 
26-36b-207
 to the extent federal matching is
not reduced due to the impermissibility of the assessments. Any funds remaining in the special
revenue fund shall be refunded to the hospitals in proportion to the amount paid by each
hospital.
]
(2) If the assessment is repealed under Subsection (1):
(a) the division may not collect any assessment or intergovernmental transfer under this
chapter;
(b) the department shall disburse money in the special Medicaid Expansion Fund in
accordance with the requirements in Subsection 
26-36b-208
(4), to the extent federal matching
is not reduced by CMS due to the repeal of the assessment;
(c) any money remaining in the Medicaid Expansion Fund after the disbursement
described in Subsection (2)(b) that was derived from assessments imposed by this chapter shall
be refunded to the hospitals in proportion to the amount paid by each hospital for the last three
fiscal years; and
(d) any money remaining in the Medicaid Expansion Fund after the disbursements
described in Subsections (2)(b) and (c) shall be deposited into the General Fund by the end of
the fiscal year that the assessment is suspended.
Section 16. Section 
63I-1-226
 is amended to read:
63I-1-226.
Repeal dates, Title 26.
(1) Section 
26-1-40
 is repealed July 1, 2019.
(2) Title 26, Chapter 9f, Utah Digital Health Service Commission Act, is repealed July
1, 2025.
(3) Section 
26-10-11
 is repealed July 1, 2020.
(4) Title 26, Chapter 33a, Utah Health Data Authority Act, is repealed July 1, 2024.
(5) Title 26, Chapter 36a, Hospital Provider Assessment Act, is repealed July 1, 2019.
(6) Title 26, Chapter 36b, Inpatient Hospital Assessment Act, is repealed July 1, 2021.
[
(7) Section 
26-38-2.5
 is repealed July 1, 2017.
]
[
(8) Section 
26-38-2.6
 is repealed July 1, 2017.
]
[
(9)
] 
(7)
 Title 26, Chapter 56, Hemp Extract Registration Act, is repealed July 1, 2021.
Section 17. 
 Coordinating H.B. 325 with H.B. 14 -- Superseding substantive and
technical amendments.
If this H.B. 325 and H.B. 14, Substance Abuse Treatment Facility Patient Brokering,
both pass and become law, it is the intent of the Legislature that the amendments to Section
26-36b-103
 in this bill supersede the amendments to Section 
26-36b-103
 in H.B. 14, when the
Office of Legislative Research and General Counsel prepares the Utah Code database for
publication.
Section 18. 
 Coordinating H.B. 325 with H.B. 472 -- Substantive and technical
amendments.
If this H.B. 325 and H.B. 472, Medicaid Expansion Revisions, both pass and become
law, it is the intent of the Legislature that the Office of Legislative Research and General
Counsel shall prepare the Utah Code database for publication by making the following
changes:
(1) modifying Subsection 
26-18-415
(3) to read:
"(3) (a) The division shall apply for a Medicaid waiver or a state plan amendment with
CMS to implement, within the state Medicaid program, the enhancement waiver program
described in this section within six months after the day on which:
(i) the division receives a notice from CMS that the waiver for the Medicaid waiver
expansion submitted under Section 
26-18-415
, Medicaid waiver expansion, will not be
approved; or
(ii) the division withdraws the waiver for the Medicaid waiver expansion submitted
under Section 
26-18-415
, Medicaid waiver expansion.
(b) The division may not apply for a waiver under Subsection (3)(a) while a waiver
request under Section 
26-18-415
, Medicaid waiver expansion, is pending with CMS.";
(2) modifying Subsection 
26-36b-201
(3) to read:
"
(3) The first quarterly payment [
shall not be
] 
is not
 due until at least three months
after 
the earlier of
 the effective [
date
] 
dates
 of the coverage provided through
:
(a)
 the health coverage improvement program [
waiver under Section 
26-18-411
.
]
;
(b) the enhancement waiver program; or
(c) the Medicaid waiver expansion.";
(3) modifying Section 
26-36b-204
 to read:
"
26-36b-204. Hospital financing of health coverage improvement program
Medicaid waiver -- Hospital share.
[
(1) For purposes of this section, "hospital share":(a) means
]
(1) The hospital share is:
(a)
 45% of the state's net cost of[
:(i)
] the health coverage improvement program
[
Medicaid waiver under Section 
26-18-411
;(ii)
]
, including
 Medicaid coverage for individuals
with dependent children up to the federal poverty level designated under Section 
26-18-411
;
[
and
]
[
(iii) the UPL gap, as that term is defined in Section 
26-36b-210
;
]
(b) 45% of the state's net cost of the enhancement waiver program;
(c) if the waiver for the Medicaid waiver expansion is approved, $11,900,000; and
(d) 45% of the state's net cost of the upper payment limit gap.
[
(b) for the hospital share of the additional coverage under Section 
26-18-411
,
]
(2) (a) The hospital share
 is capped at no more than $13,600,000 annually, consisting
of:
(i) an $11,900,000 cap [
on the hospital's share
] for the programs specified in
Subsections (1)(a)[
(i) and (ii)
] 
through (c)
; and
(ii) a $1,700,000 cap for the program specified in Subsection [
(1)(a)(iii);
] 
(1)(d).
[
(c) for the cap specified in Subsection (1)(b), shall be prorated
]
(b) The department shall prorate the cap described in Subsection (2)(a)
 in any year in
which the programs specified in [
Subsection
] 
Subsections
 (1)(a) 
and (d)
 are not in effect for the
full fiscal year[
; and
]
.
[
(d) if the Medicaid program expands in a manner that is greater than the expansion
described in Section 
26-18-411
, is capped at 33% of the state's share of the cost of the
expansion that is in addition to the program described in Section 
26-18-411
.
]
[
(2) The assessment for the private hospital share under Subsection (1) shall be:
]
(3) Private hospitals shall be assessed under this chapter for:
(a) 69% of the portion of the hospital share 
for the programs
 specified in Subsections
(1)(a)[
(i) and (ii)
] 
through (c)
; and
(b) 100% of the portion of the hospital share specified in Subsection [
(1)(a)(iii)
] 
(1)(d)
.
[
(3)
] 
(4)
 (a) The department shall, on or before October 15, 2017, and on or before
October 15 of each 
subsequent
 year [
thereafter
], produce a report that calculates the state's net
cost of 
each of
 the programs described in Subsections (1)(a)[
(i) and (ii)
] 
through (c) that are in
effect for that year
.
(b) If the assessment collected in the previous fiscal year is above or below the [
private
hospital's share of the state's net cost as specified in Subsection (2),
] 
hospital share for private
hospitals
 for the previous fiscal year, the underpayment or overpayment of the assessment by
the private hospitals shall be applied to the fiscal year in which the report [
was
] 
is
 issued.
[
(4)
] 
(5)
 A Medicaid accountable care organization shall, on or before October 15 of
each year, report to the department the following data from the prior state fiscal year 
for each
private hospital, state teaching hospital, and non-state government hospital provider that the
Medicaid accountable care organization contracts with
:
(a) for the traditional Medicaid population[
, for each private hospital, state teaching
hospital, and non-state government hospital provider
]:
(i) hospital inpatient payments;
(ii) hospital inpatient discharges;
(iii) hospital inpatient days; and
(iv) hospital outpatient payments; and
[
(b) for the Medicaid population newly eligible under Subsection 
26-18-411
, for each
private hospital, state teaching hospital, and non-state government hospital provider:
]
(b) if the Medicaid accountable care organization enrolls any individuals in the health
coverage improvement program, the enhancement waiver program, or the Medicaid waiver
expansion, for the population newly eligible for any of those programs:
(i) hospital inpatient payments;
(ii) hospital inpatient discharges;
(iii) hospital inpatient days; and
(iv) hospital outpatient payments.
(6) The department shall, by rule made in accordance with Title 63G, Chapter 3, Utah
Administrative Rulemaking Act, provide details surrounding specific content and format for
the reporting by the Medicaid accountable care organization.";
(4) modifying Subsection 
26-36b-206
(3) to read:
"
(3) The intergovernmental transfer [
shall be paid in an amount divided
] 
is apportioned
as follows:
(a) the state teaching hospital is responsible for:
(i) 30% of the portion of the hospital share specified in Subsections
26-36b-204
(1)(a)[
(i) and (ii)
] 
through (c)
; and
(ii) 0% of the hospital share specified in Subsection 
26-36b-204
(1)[
(a)(iii)
]
(d)
; and
(b) non-state government hospitals are responsible for:
(i) 1% of the portion of the hospital share specified in Subsections 
26-36b-204
(1)(a)[
(i)
and (ii)
] 
through (c)
; and
(ii) 0% of the hospital share specified in Subsection 
26-36b-204
(1)[
(a)(iii)
]
(d)
.
";
(5) modifying Section 
26-36b-208
 to read:
"
26-36b-208. Medicaid Expansion Fund.
(1) There is created an expendable special revenue fund known as the Medicaid
Expansion Fund.
(2) The fund consists of:
(a) assessments collected under this chapter;
(b) intergovernmental transfers under Section 
26-36b-206
;
(c) savings attributable to the health coverage improvement program [
under Section
26-18-411
] as determined by the department;
(d) savings attributable to the enhancement waiver program as determined by the
department;
(e) savings attributable to the Medicaid waiver expansion as determined by the
department;
[
(d)
] 
(f)
 savings attributable to the inclusion of psychotropic drugs on the preferred
drug list under Subsection 
26-18-2.4
(3) as determined by the department;
[
(e)
] 
(g)
 savings attributable to the services provided by the Public Employees' Health
Plan under Subsection 
49-20-401
(1)(u);
[
(f)
] 
(h)
 gifts, grants, donations, or any other conveyance of money that may be made to
the fund from private sources; [
and
]
(i) interest earned on money in the fund; and
[
(g)
] 
(j)
 additional amounts as appropriated by the Legislature.
(3) (a) The fund shall earn interest.
(b) All interest earned on fund money shall be deposited into the fund.
(4) (a) A state agency administering the provisions of this chapter may use money from
the fund to pay the costs [
of
]
, not otherwise paid for with federal funds or other revenue
sources, of:
(i)
 the health coverage improvement [
Medicaid waiver under Section 
26-18-411
, and
]
program;
(ii) the enhancement waiver program;
(iii) the Medicaid waiver expansion; and
(iv)
 the outpatient [
UPL
] 
upper payment limit
 supplemental payments under Section
26-36b-210
[
, not otherwise paid for with federal funds or other revenue sources, except that
no
]
.
(b) A state agency administering the provisions of this chapter may not use:
(i)
 funds described in Subsection (2)(b) may be used to pay the cost of 
private
outpatient [
UPL
] 
upper payment limit
 supplemental payments[
.
]
; or
[
(b)
] 
(ii)
 [
Money
] 
money
 in the fund [
may not be used for any other
] 
for any
 purpose
not described in Subsection (4)(a)
.
";
(6) modifying Section 
26-36b-209
 to read:
"
26-36b-209. Hospital reimbursement.
(1)
 [
The
] 
If the health coverage improvement program, the enhancement waiver
program, or the Medicaid waiver expansion is implemented by contracting with a Medicaid
accountable care organization, the
 department shall, to the extent allowed by law, include
,
 in a
contract [
with a Medicaid accountable care organization
] 
to provide benefits under the health
coverage improvement program, the enhancement waiver program, or the Medicaid waiver
expansion,
 a requirement that the 
Medicaid
 accountable care organization reimburse hospitals
in the accountable care organization's provider network[
,
] 
at
 no less than the Medicaid
fee-for-service rate.
(2) If the health coverage improvement program, the enhancement waiver program, or
the Medicaid waiver expansion is implemented by the department as a fee-for-service program,
the department shall reimburse hospitals at no less than the Medicaid fee-for-service rate.
(3)
 Nothing in this section prohibits a Medicaid accountable care organization from
paying a rate that exceeds 
the
 Medicaid fee-for-service [
rates
] 
rate
.
"; and
(7) Section 
26-36b-211
 in this H.B. 325 supersedes Section 
26-36b-211
 in H.B. 472.
Section 19. 
 Coordinating H.B. 325 with S.B. 125 -- Superseding substantive and
technical amendments.
If this H.B. 325 and S.B. 125, Child Welfare Amendments, both pass and become law,
it is the intent of the Legislature that the amendments to Section 
26-36b-103
 in this bill
supersede the amendments to Section 
26-36b-103
 in S.B. 125, when the Office of Legislative
Research and General Counsel prepares the Utah Code database for publication.