hospital services must be medically necessary and ordered by an appropriate
Medicaid-enrolled provider for the diagnosis and treatment of a member's
(2) Services performed for
a member by the admitting hospital or by an entity wholly-owned or
wholly-operated by the hospital within three days of patient admission, are
considered inpatient services. This three-day window applies to diagnostic and
non-diagnostic services that are clinically related to the reason for the
member's inpatient admission regardless of whether the inpatient, outpatient,
or observation diagnoses are the same.
(3) Medical supplies, appliances, drugs, and
equipment required for the care and treatment of a member during an inpatient
stay are included in the inpatient reimbursement.
(4) Outpatient hospital services during an
inpatient episode are included in the inpatient reimbursement.
(5) Inpatient hospital psychiatric services
are available to all Medicaid members. If the member is not enrolled in a PMHP,
providers may bill the State directly on a fee-for-service basis. Otherwise,
the provider must bill the member's PMHP.
Inpatient hospital intensive physical
rehabilitation services must meet the classification criteria of 42 CFR
(7) Inpatient hospital
intensive physical rehabilitation services are covered for acute conditions
from birth through any age and are available one time per event.
Utah Admin. Code
State Bulletin Number 2018-1, effective
State Bulletin Number 2019-20, effective