- (1) The department shall determine hospital quality measures that correspond to hospital performance for directed payments.
- (2) The department may select different hospital quality measures for urban, rural, and specialty hospitals.
- (3) The department shall select hospital quality measures appropriate to a hospital type and specialty.
(4) For each measure, a hospital shall:
- (a) perform at or above a national or state benchmark or;
- (b) improve over its preceding state fiscal year (SFY) scores by an improvement margin defined by the department.
- (5) The department requires only Medicaid-certified hospitals that receive directed payments to comply with this rule.
- (6) Hospitals must meet targeted standards and improvement goals to receive full directed payments.
- (7) The department shall continue directed payments during the period targeted standards and improvement goals are under development.
- (8) The department shall develop a technical guide that includes details on the hospital quality measures, performance criteria, and penalties, and furnish the technical guide before the period for which performance is measured.
- (9) Quality standards are not applicable to directed payments associated with Subsection 26B-3-707(1)(a) or other private and government hospital inpatient and outpatient directed payment levels in place at the end of SFY 2023.
- (10) The department shall remove hospital quality standard requirements if directed payments, to which hospital quality performance are tied, are discontinued.
KEY: Medicaid
Date of Last Change: June 24, 2024
Authorizing, and Implemented or Interpreted Law: 26B-1-213; 26B-3-108