Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-4x

Policy Statement on Denial of Payment to Medicaid Provider When Client Fails to Keep Scheduled Appointment

Five-Year Notice of Review and Statement of Continuation

DAR File No.: 37057
Filed: 11/15/2012 08:50:24 AM

NOTICE OF REVIEW AND STATEMENT OF CONTINUATION

Concise explanation of the particular statutory provisions under which the rule is enacted and how these provisions authorize or require the rule:

Subsection 26-18-3(7) requires the Department to provide disciplinary measures and sanctions for Medicaid providers who fail to comply with the rules and procedures of the Medicaid program. Further, 42 CFR 455 requires the Department to investigate fraud, and if necessary, to impose sanctions against providers.

Summary of written comments received during and since the last five-year review of the rule from interested persons supporting or opposing the rule:

The Department did not receive any written or oral comments regarding this rule.

Reasoned justification for continuation of the rule, including reasons why the agency disagrees with comments in opposition to the rule, if any:

The Department will continue this rule to ensure the proper utilization of Medicaid services and to eliminate fraudulent billing practices by Medicaid providers.

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

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]

Authorized by:

David Patton, Executive Director

Effective:

11/15/2012