Utah Admin. Code R414-526-3 - Quality Metrics and Standards
(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.
Notes
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