Section 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.Utah Admin. Code R414-526-3
Adopted by Utah State Bulletin Number 2024-13, effective 6/24/2024