No. 43352 (New Rule): Rule R414-521. Accountable Care Organization Hospital Report

(New Rule)

DAR File No.: 43352
Filed: 11/01/2018 08:23:58 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose is to implement by rule, reporting requirements for Medicaid accountable care organizations (ACOs), in accordance with Section 26-36b-204.

Summary of the rule or change:

This new rule implements an annual ACO reporting requirement, and provides details regarding specific procedures, content, and format.

Statutory or constitutional authorization for this rule:

• Section 26-1-5
• Section 26-36b-204
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

There is no impact on the state budget because this rule only implements a reporting requirement for ACOs, which does not create administrative costs, and does not affect member services or provider reimbursement.

local governments:

There is no impact on local governments because they neither fund ACOs nor provide ACO services under the Medicaid program.

small businesses:

There is no impact on small businesses because this rule only implements a reporting requirement for ACOs and does not affect member services or provider reimbursement.

persons other than small businesses, businesses, or local governmental entities:

There is no impact on Medicaid providers or Medicaid members because this rule only implements a reporting requirement for ACOs. The cost, if any, of this to the ACOs would already be covered by the administrative costs paid in the capitated rates, and does not affect member services or provider reimbursement.

Compliance costs for affected persons:

There is no impact to a single Medicaid provider nor a single Medicaid member because this rule only implements a reporting requirement for ACOs. The cost, if any, to a single ACO would already be covered by the administrative costs paid in the capitated rates.

Comments by the department head on the fiscal impact the rule may have on businesses:

After conducting a thorough analysis, it was determined that this proposed rule will not result in a fiscal impact to businesses.

Joseph K. Miner, M.D., Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office of Administrative Rules, or at:

Health
Health Care Financing, Coverage and Reimbursement Policy
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

12/17/2018

This rule may become effective on:

12/24/2018

Authorized by:

Joseph Miner, Executive Director

RULE TEXT

Appendix 1: Regulatory Impact Summary Table*

Fiscal Costs

FY 2019

FY 2020

FY 2021

State Government

$0

$0

$0

Local Government

$0

$0

$0

Small Businesses

$0

$0

$0

Non-Small Businesses

$0

$0

$0

Other Person

$0

$0

$0

Total Fiscal Costs:

$0

$0

$0

Fiscal Benefits

State Government

$0

$0

$0

Local Government

$0

$0

$0

Small Businesses

$0

$0

$0

Non-Small Businesses

$0

$0

$0

Other Persons

$0

$0

$0

Total Fiscal Benefits:

$0

$0

$0

Net Fiscal Benefits:

$0

$0

$0

 

*This table only includes fiscal impacts that could be measured. If there are inestimable fiscal impacts, they will not be included in this table. Inestimable impacts for State Government, Local Government, Small Businesses and Other Persons are described in the narrative. Inestimable impacts for Non - Small Businesses are described in Appendix 2.

 

Appendix 2: Regulatory Impact to Non - Small Businesses

 

None of the four Medicaid Accountable Care Organizations will be impacted by this rule, as it only implements a reporting requirement and does not affect member services or provider reimbursement. Any administrative costs would be covered through payments within the capitated rates.

 

 

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-521. Accountable Care Organization Hospital Report.

R414-521-1. Reporting Requirements.

(1) In accordance with Section 26-36b-204, a Medicaid accountable care organization (ACO) shall submit by October 15 of each year, a completed ACO hospital report for the most recent state fiscal year.

(a) The ACO shall use the ACO hospital report spreadsheet template available on the Utah Medicaid website, and follow the specified instructions.

(b) The ACO shall return the completed template in its native file type and format to the specified email provided within the template.

(2) An ACO shall work with the State to resolve any questions the State may have regarding the report, and provide additional data within 15 days of a request or as specified by the State.

 

KEY: Medicaid, reporting requirements

Date of Enactment or Last Substantive Amendment: 2018

Authorizing, and Implemented or Interpreted Law: 26-1-5; 26-18-3; 26-36b-204

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