Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-305

Resources

Notice of Proposed Rule

(Amendment)

DAR File No.: 33132
Filed: 11/02/2009 04:27:09 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to implement a provision of the Social Security Act that increases the resource limit for Medicare cost sharing programs to include Qualified Medicare Beneficiaries, Specified Low-Income Medicare Beneficiaries, and Qualifying Individuals.

Summary of the rule or change:

This change increases the resource limit for Medicare cost sharing programs to match the limit used for the Medicare Part D Low-Income Drug Subsidy program. The new limit is three times the limit used for the Supplemental Security Income program, plus annual increases due to increases in the Consumer Price Index.

State statutory or constitutional authorization for this rule:

• Section 26-18-3
• 42 U.S.C. Sec. 1396d(p)(1)(C)

This rule or change incorporates by reference the following material:

• Removes: Subsection 1905 of the Compilation of the Social Security Laws, 01/01/1999

Anticipated cost or savings to:

the state budget:

This change results in an estimated annual cost of $41,579 to the General Fund and $145,909 in federal dollars due to the increased number of individuals eligible for Medicare cost sharing programs.

local governments:

This change does not impact local governments because they do not fund or provide Medicare and Medicaid services.

small businesses:

This rule change will allow more Utah residents to qualify for Medicaid and providers that serve them may see additional revenue.

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

Individuals who become eligible for Medicare cost sharing programs under this change could save approximately $187,488 annually. In addition, there is an increase in annual revenue for some Medicaid providers, but there is no way to know how many additional services will result from this change.

Compliance costs for affected persons:

This rule change imposes no additional application requirements for either Medicaid recipients or providers. No compliance costs are expected.

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

This rule change is required by federal law and will increase the cost of the Medicaid program to the state. No impact on business is expected, other than the possibility of slightly higher revenue.

David N. Sundwall, MD, Executive Director

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

Health
Health Care Financing, Coverage and Reimbursement Policy
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 [email protected]

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:

12/15/2009

This rule may become effective on:

12/22/2009

Authorized by:

David Sundwall, Executive Director

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

R414-305. Resources.

R414-305-8. [QMB, SLMB, and QI ] Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary, and Qualifying Individual Resource Provisions.

(1) To determine eligibility for Qualified Medicare Beneficiaries, Specified Low-Income Medicare Beneficiaries, and Qualifying Individuals, [T]the Department [adopts]applies the resource limit defined in [Subsection 1905]42 U.S.C. Sec.1396d(p) (1)(C).[of the Compilation of the Social Security Laws, 1999 ed., which is incorporated by reference.

(2) The resource limit is the same for all medically needy individuals.

(3) The QMB, SLMB, and QI resource limit is $4,000 for an individual and $6,000 for a couple.]

(2) The Department determines countable resources in accordance with the provisions of Section R414-305-1.

 

KEY: Medicaid, resources

Date of Enactment or Last Substantive Amendment: [October 22], 2009

Notice of Continuation: January 31, 2008

Authorizing, and Implemented or Interpreted Law: 26-18