Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-1-5

Incorporations by Reference

Notice of Proposed Rule

(Amendment)

DAR File No.: 34315
Filed: 12/15/2010 05:28:35 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

Subsection 26-18-3(2)(a) requires the Medicaid program to implement policy through administrative rules. The Department, in order to draw down federal funds, must have an approved State Plan with the Centers for Medicare and Medicaid Services. This change, therefore, incorporates the most current Medicaid State Plan by reference. It also implements by rule ongoing Medicaid policy for services described in the Utah Medicaid Provider Manual, Medical Supplies Manual and List, and policy described in the hospital services provider manual. It further incorporates these manuals by reference.

Summary of the rule or change:

Section R414-1-5 is changed to update the incorporation of the State Plan by reference to 01/01/2011. It also incorporates State Plan Amendments (SPAs) that become effective no later than 01/01/2011. Two SPAs that became effective since the last incorporation of the State Plan, and at the time of this proposed change, include SPA 10-005-UT Ambulatory Surgical Centers and SPA 10-014-UT Inpatient Payment Reductions. SPA 10-005-UT updated the percentage of charges paid to ambulatory surgical centers and also established fixed fee pricing for certain procedures. SPA 10-014-UT implemented inpatient hospital reductions due to state revenue shortfalls and budget reductions. Thus, the Diagnosis Related Group (DRG) payment for urban hospitals was reduced by 14.3% and the percent of charges for rural hospitals was decreased from 93% to 89%. This proposed change to Section R414-1-5 also incorporates by reference the Medical Supplies Manual and List and the hospital services provider manual, effective 01/01/2011.

State statutory or constitutional authorization for this rule:

• Section 26-1-5
• Section 26-18-3

This rule or change incorporates by reference the following material:

• Updates Hospital Services Provider Manual, published by Division of Medicaid and Health Financing, 01/01/2011
• Updates Utah Medicaid Provider Manual, Medical Supplies Manual and List, published by Division of Medicaid and Health Financing, 01/01/2011
• Updates Utah Medicaid State Plan, published by Division of Medicaid and Health Financing, 01/01/2011

Anticipated cost or savings to:

the state budget:

There is no budget impact because this change only fulfills the requirement to incorporate the State Plan by reference. Implementation of the State Plan is within legislative budget allotments. Further, the rule's incorporation of ongoing Medicaid policy described in the Medical Supplies Manual and List and in the hospital services provider manual does not create costs or savings to the Department or other state agencies.

local governments:

There is no budget impact because this change only fulfills the requirement to incorporate the State Plan by reference. Implementation of the State Plan is within legislative budget allotments. Further, the rule's incorporation of ongoing Medicaid policy described in the Medical Supplies Manual and List and in the hospital services provider manual does not create costs or savings to local governments.

small businesses:

There is no budget impact because this change only fulfills the requirement to incorporate the State Plan by reference. Implementation of the State Plan is within legislative budget allotments. Further, the rule's incorporation of ongoing Medicaid policy described in the Medical Supplies Manual and List and in the hospital services provider manual does not create costs or savings to small businesses.

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

There is no budget impact because this change only fulfills the requirement to incorporate the State Plan by reference. Implementation of the State Plan is within legislative budget allotments. Further, the rule's incorporation of ongoing Medicaid policy described in the Medical Supplies Manual and List and in the hospital services provider manual does not create costs or savings to other persons or entities.

Compliance costs for affected persons:

There are no compliance costs because this change only fulfills the requirement to incorporate the State Plan by reference. Implementation of the State Plan is within legislative budget allotments. Further, the rule's incorporation of ongoing Medicaid policy described in the Medical Supplies Manual and List and in the hospital services provider manual does not create costs or savings to a single Medicaid client or provider.

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

This rule should not have a direct fiscal impact on business. Incorporation of the State Plan by this rule assures that the Medicaid program is implemented through administrative rule.

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:

01/31/2011

This rule may become effective on:

02/07/2011

Authorized by:

David Sundwall, Executive Director

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

R414-1. Utah Medicaid Program.

R414-1-5. Incorporations by Reference.

(1) The Department incorporates by reference the Utah State Plan Under Title XIX of the Social Security Act Medical Assistance Program effective [October]January 1, 201[0]1. It also incorporates by reference State Plan Amendments that become effective no later than [October]January 1, 201[0]1.

(2) The Department incorporates by reference the Medical Supplies Manual and List described in the Utah Medicaid Provider Manual, Section 2, Medical Supplies, with its referenced attachment, Medical Supplies List, [October]January 1, 201[0]1, as applied in Rule R414-70.

(3) The Department incorporates by reference the Hospital Services Provider Manual, with its attachments, effective [October]January 1, 201[0]1.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [November 15, 2010]2011

Notice of Continuation: April 16, 2007

Authorizing, and Implemented or Interpreted Law: 23-34-2; 26-1-5; 26-18-3