DAR File No. 37976

Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-1-5

Incorporations by Reference

Notice of Proposed Rule

(Amendment)

DAR File No.: 37976
Filed: 09/10/2013 12:31:51 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 (CMS). The purpose of this change, therefore, is to incorporate the most current Medicaid State Plan by reference and to implement by rule both the definitions and the attachment for the Private Duty Nursing Acuity Grid found in the Home Health Agencies Utah Medicaid Provider Manual, and to implement by rule ongoing Medicaid policy for services described in the Medical Supplies Utah Medicaid Provider Manual; Hospital Services Utah Medicaid Provider Manual with its attachments; Speech-Language Services Utah Medicaid Provider Manual; Audiology Services Utah Medicaid Provider Manual; Hospice Care Utah Medicaid Provider Manual; Long Term Care Services in Nursing Facilities Utah Medicaid Provider Manual; Personal Care Utah Medicaid Provider Manual; Utah Home and Community-Based Waiver Services for Individuals 65 or Older Utah Medicaid Provider Manual; Utah Home and Community-Based Waiver Services for Individuals with Acquired Brain Injury Age 18 and Older Utah Medicaid Provider Manual; Utah Home and Community-Based Waiver Services for Individuals with Intellectual Disabilities or Other Related Conditions Utah Medicaid Provider Manual; Utah Home and Community-Based Waiver Services for Individuals with Physical Disabilities Utah Medicaid Provider Manual; Utah Home and Community-Based Waiver Services New Choices Waiver Utah Medicaid Provider Manual; Utah Home and Community-Based Waiver Services for Technology Dependent, Medically Fragile Individuals Utah Medicaid Provider Manual; Utah Home and Community-Based Waiver Services Autism Waiver Utah Medicaid Provider Manual; Office of Inspector General Administrative Hearings Procedures Manual; Pharmacy Services Utah Medicaid Provider Manual; Coverage and Reimbursement Code Look-up Tool; Certified Nurse - Midwife Services Utah Medicaid Provider Manual; CHEC Services Utah Medicaid Provider Manual with its attachments; Chiropractic Medicine Utah Medicaid Provider Manual; Dental Services Utah Medicaid Provider Manual; General Attachments for the Utah Medicaid Provider Manual; Indian Health Utah Medicaid Provider Manual; Laboratory Services Utah Medicaid Provider Manual with its attachments; Medical Transportation Utah Medicaid Provider Manual; Mental Health Centers/Prepaid Mental Health Plans Utah Medicaid Provider Manual; Non-Traditional Medicaid Health Plan Utah Medicaid Provider Manual with its attachments; Certified Family Nurse Practitioner and Pediatric Nurse Practitioner Utah Medicaid Provider Manual; Oral Maxillofacial Surgeon Services Utah Medicaid Provider Manual; Physical Therapy and Occupational Therapy Services Utah Medicaid Provider Manual; Physician Services and Anesthesiology Utah Medicaid Provider Manual with its attachments; Podiatric Services Utah Medicaid Provider Manual; Primary Care Network Utah Medicaid Provider Manual with its attachments; Psychology Services Utah Medicaid Provider Manual; Rehabilitative Mental Health and Substance Use Disorder Services Utah Medicaid Provider Manual; Rehabilitative Mental Health Services for Children Under Authority of Department of Human Services, Division of Child and Family Services or Division of Juvenile Justice Services Utah Medicaid Provider Manual; Rural Health Clinic Services Utah Medicaid Provider Manual with its attachments; School-Based Skills Development Services Utah Medicaid Provider Manual; Section I: General Information of the Utah Medicaid Provider Manual; Services for Pregnant Women Utah Medicaid Provider Manual; Substance Abuse Treatment Services and Targeted Case Management Services for Substance Abuse Utah Medicaid Provider Manual; Targeted Case Management for CHEC Medicaid Eligible Children Utah Medicaid Provider Manual; Targeted Case Management for the Chronically Mentally Ill Utah Medicaid Provider Manual; Targeted Case Management for Early Childhood (Ages 0-4) Utah Medicaid Provider Manual; and Vision Care Services Utah Medicaid Provider Manual.

Summary of the rule or change:

Section R414-1-5 is changed to incorporate the State Plan and approved State Plan Amendments (SPAs) by reference to 10/01/2013. These SPAs include: SPA 13-008-UT, Psychologist Services, which updates and modifies the psychologist sections of the State Plan for clarification purposes; SPA 13-018-UT Medical Education Payments, which updates the graduate medical education payment pool methodology based on specified percentages to specified hospitals; and SPA 13-020-UT Preadmission Screening by Categorical Determination, which allows the Department to add the Short Stay Categorical Determination as a new category type. This new category allows an individual who suffers from an acute physical illness in a community setting to be admitted directly to a nursing facility for a short stay to stabilize the illness. This rule change also incorporates by reference the Medical Supplies Utah Medicaid Provider Manual; the Hospital Services Utah Medicaid Provider Manual with its attachments, effective 10/01/2013; incorporates by reference both the definitions and the attachment for the Private Duty Nursing Acuity Grid found in the Home Health Agencies Utah Medicaid Provider Manual, effective 10/01/2013; incorporates by reference the Speech-Language Services Utah Medicaid Provider Manual, effective 10/01/2013; incorporates by reference the Audiology Services Utah Medicaid Provider Manual, effective 10/01/2013; incorporates by reference the Hospice Care Utah Medicaid Provider Manual, effective 10/01/2013; incorporates by reference the Long Term Care Services in Nursing Facilities Utah Medicaid Provider Manual, with its attachments, effective 10/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals 65 or Older Utah Medicaid Provider Manual, effective 10/01/2013; incorporates by reference the Personal Care Utah Medicaid Provider Manual, with its attachments, effective 10/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Acquired Brain Injury Age 18 and Older Utah Medicaid Provider Manual, effective 10/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Intellectual Disabilities or Other Related Conditions Utah Medicaid Provider Manual, effective 10/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Physical Disabilities Utah Medicaid Provider Manual, effective 10/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services New Choices Waiver Utah Medicaid Provider Manual, effective 10/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Technology Dependent, Medically Fragile Individuals Utah Medicaid Provider Manual, effective 10/01/2013; Utah Home and Community-Based Waiver Services Autism Waiver Utah Medicaid Provider Manual, effective 10/01/2013; Office of Inspector General Administrative Hearings Procedures Manual, effective 10/01/2013; Pharmacy Services Utah Medicaid Provider Manual with its attachments, effective 10/01/2013; Coverage and Reimbursement Code Look-up Tool, effective 10/01/2013; Certified Nurse - Midwife Services Utah Medicaid Provider Manual, effective 10/01/2013; CHEC Services Utah Medicaid Provider Manual with its attachments, effective 10/01/2013; Chiropractic Medicine Utah Medicaid Provider Manual; Dental Services Utah Medicaid Provider Manual, effective 10/01/2013; General Attachments for the Utah Medicaid Provider Manual, effective 10/01/2013; Indian Health Utah Medicaid Provider Manual, effective 10/01/2013; Laboratory Services Utah Medicaid Provider Manual with its attachments, effective 10/01/2013; Medical Transportation Utah Medicaid Provider Manual; Mental Health Centers/ Prepaid Mental Health Plans Utah Medicaid Provider Manual, effective 10/01/2013; Non-Traditional Medicaid Health Plan Utah Medicaid Provider Manual with its attachments, effective 10/01/2013; Certified Family Nurse Practitioner and Pediatric Nurse Practitioner Utah Medicaid Provider Manual, effective 10/01/2013; Oral Maxillofacial Surgeon Services Utah Medicaid Provider Manual; Physical Therapy and Occupational Therapy Services Utah Medicaid Provider Manual, effective 10/01/2013; Physician Services and Anesthesiology Utah Medicaid Provider Manual with its attachments, effective 10/01/2013; Podiatric Services Utah Medicaid Provider Manual; Primary Care Network Utah Medicaid Provider Manual with its attachments, effective 10/01/2013; Psychology Services Utah Medicaid Provider Manual; Rehabilitative Mental Health and Substance Use Disorder Services Utah Medicaid Provider Manual, effective 10/01/2013; Rehabilitative Mental Health Services for Children Under Authority of Department of Human Services, Division of Child and Family Services or Division of Juvenile Justice Services Utah Medicaid Provider Manual, effective 10/01/2013; Rural Health Clinic Services Utah Medicaid Provider Manual with its attachments, effective 10/01/2013; School-Based Skills Development Services Utah Medicaid Provider Manual, effective 10/01/2013; Section I: General Information of the Utah Medicaid Provider Manual, effective 10/01/2013; Services for Pregnant Women Utah Medicaid Provider Manual, effective 10/01/2013; Substance Abuse Treatment Services and Targeted Case Management Services for Substance Abuse Utah Medicaid Provider Manual, effective 10/01/2013; Targeted Case Management for CHEC Medicaid Eligible Children Utah Medicaid Provider Manual, effective 10/01/2013; Targeted Case Management for the Chronically Mentally Ill Utah Medicaid Provider Manual, effective 10/01/2013; Targeted Case Management for Early Childhood (Ages 0-4) Utah Medicaid Provider Manual, effective 10/01/2013; and Vision Care Services Utah Medicaid Provider Manual, effective 10/01/2013.

State statutory or constitutional authorization for this rule:

• Section 26-18-3
• Section 26-1-5

This rule or change incorporates by reference the following material:

• Updates Indian Health Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates School-Based Skills Development Services Utah Medicaid Provider Manual, October 1, 2013, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Physician Services and Anesthesiology Utah Medicaid Provider Manual with its attachments, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Section I: General Information of the Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Chiropractic Medicine Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Dental Services Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Rehabilitative Mental Health Services for Children Under Authority of Department of Human Services, Division of Child and Family Services or Division of Juvenile Justice Services Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Hospital Services Utah Medicaid Provider Manual with its attachments, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates CHEC Services Utah Medicaid Provider Manual with its attachments, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Speech-Language Services Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Audiology Services Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Utah Home and Community-Based Waiver Services for Individuals with Intellectual Disabilities or Other Related Conditions Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Utah Home and Community-Based Waiver Services for Individuals with Physical Disabilities Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Definitions found in the Home Health Agencies Utah Medicaid Provider Manual, and the manual's attachment for the Private Duty Nursing Acuity Grid, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Utah Home and Community-Based Waiver Services for Technology Dependent, Medically Fragile Individuals Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Services for Pregnant Women Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Coverage and Reimbursement Code Look-up Tool, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Long-Term Care Services in Nursing Facilities Utah Medicaid Provider Manual with its attachments, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Hospice Care Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Targeted Case Management for Early Childhood (Ages 0-4) Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Non-Traditional Medicaid Health Plan Utah Medicaid Provider Manual with its attachments, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Targeted Case Management for the Chronically Mentally Ill Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Certified Nurse - Midwife Services Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Vision Care Services Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Utah Home and Community-Based Waiver Services for Individuals with Acquired Brain Injury Age 18 and Older Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Oral Maxillofacial Surgeon Services Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates General Attachments for the Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Psychology Services Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Rural Health Clinic Services Utah Medicaid Provider Manual with its attachments, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Medical Transportation Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Medical Supplies Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Utah Home and Community-Based Waiver Services New Choices Waiver Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Certified Family Nurse Practitioner and Pediatric Nurse Practitioner Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Utah Medicaid State Plan, published by Centers for Medicare and Medicaid Services, 10/01/2013
• Updates Substance Abuse Treatment Services and Targeted Case Management Services for Substance Abuse Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Utah Home and Community-Based Waiver Services Autism Waiver Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Services for Pregnant Women Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Mental Health Centers/Prepaid Mental Health Plans Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Primary Care Network Utah Medicaid Provider Manual with its attachments, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Podiatric Services Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Physical Therapy and Occupational Therapy Services Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Laboratory Services Utah Medicaid Provider Manual with its attachments, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Utah Home and Community-Based Waiver Services for Individuals 65 or Older Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Office of Inspector General Administrative Hearings Procedures Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Personal Care Utah Medicaid Provider Manual with its attachments, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Targeted Case Management for CHEC Medicaid Eligible Children Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2013
• Updates Pharmacy Services Utah Medicaid Provider Manual with its attachments, published by Division of Medicaid and Health Financing, 10/01/2013

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 provider manuals and in the Look-up Tool 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 provider manuals and in the Look-up Tool 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 provider manuals and in the Look-up Tool 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 provider manuals and in the Look-up Tool does not create costs or savings to Medicaid recipients and to Medicaid providers.

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 provider manuals and in the Look-up Tool does not create costs or savings to a single Medicaid recipient or to a Medicaid provider.

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

No impact on business. It simply ensures continuity and accuracy of Medicaid information.

David Patton, PhD, 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
CANNON HEALTH BLDG
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:

10/31/2013

This rule may become effective on:

11/07/2013

Authorized by:

David Patton, Executive Director

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

R414-1. Utah Medicaid Program.

R414-1-5. Incorporations by Reference.

The Department incorporates the [July]October 1, 2013 versions of the following by reference:

(1) Utah State Plan, including any approved amendments, under Title XIX of the Social Security Act Medical Assistance Program;

(2) Medical Supplies Utah Medicaid Provider Manual, Section 2, Medical Supplies, as applied in Rule R414-70;

(3) Hospital Services Utah Medicaid Provider Manual with its attachments;

(4) Definitions found in the Home Health Agencies Utah Medicaid Provider Manual, and the manual's attachment for the Private Duty Nursing Acuity Grid;

(5) Speech-Language Services Utah Medicaid Provider Manual;

(6) Audiology Services Utah Medicaid Provider Manual;

(7) Hospice Care Utah Medicaid Provider Manual;

(8) Long Term Care Services in Nursing Facilities Utah Medicaid Provider Manual with its attachments;

(9) Personal Care Utah Medicaid Provider Manual with its attachments;

(10) Utah Home and Community-Based Waiver Services for Individuals 65 or Older Utah Medicaid Provider Manual;

(11) Utah Home and Community-Based Waiver Services for Individuals with Acquired Brain Injury Age 18 and Older Utah Medicaid Provider Manual;

(12) Utah Home and Community-Based Waiver for Individuals with Intellectual Disabilities or Other Related Conditions Utah Medicaid Provider Manual;

(13) Utah Home and Community-Based Waiver Services for Individuals with Physical Disabilities Utah Medicaid Provider Manual;

(14) Utah Home and Community-Based Waiver Services New Choices Waiver Utah Medicaid Provider Manual;

(15) Utah Home and Community-Based Waiver Services for Technology Dependent, Medically Fragile Individuals Utah Medicaid Provider Manual;

(16) Utah Home and Community-Based Waiver Services Autism Waiver Utah Medicaid Provider Manual;

(17) Office of Inspector General Administrative Hearings Procedures Manual;

(18) Pharmacy Services Utah Medicaid Provider Manual with its attachments;

(19) Coverage and Reimbursement Code Look-up Tool found at http://health.utah.gov/medicaid/stplan/lookup/CoverageLookup.php;

(20) Certified Nurse - Midwife Services Utah Medicaid Provider Manual;

(21) CHEC Services Utah Medicaid Provider Manual with its attachments;

(22) Chiropractic Medicine Utah Medicaid Provider Manual;

(23) Dental Services Utah Medicaid Provider Manual;

(24) General Attachments for the Utah Medicaid Provider Manual;

(25) Indian Health Utah Medicaid Provider Manual;

(26) Laboratory Services Utah Medicaid Provider Manual with its attachments;

(27) Medical Transportation Utah Medicaid Provider Manual;

(28) Mental Health Centers/Prepaid Mental Health Plans Utah Medicaid Provider Manual;

(29) Non-Traditional Medicaid Health Plan Utah Medicaid Provider Manual with its attachments;

(30) Certified Family Nurse Practitioner and Pediatric Nurse Practitioner Utah Medicaid Provider Manual;

(31) Oral Maxillofacial Surgeon Services Utah Medicaid Provider Manual;

(32) Physical Therapy and Occupational Therapy Services Utah Medicaid Provider Manual;

(33) Physician Services and Anesthesiology Utah Medicaid Provider Manual with its attachments;

(34) Podiatric Services Utah Medicaid Provider Manual;

(35) Primary Care Network Utah Medicaid Provider Manual with its attachments;

(36) Psychology Services Utah Medicaid Provider Manual;

(37) Rehabilitative Mental Health and Substance Use Disorder Services Utah Medicaid Provider Manual;

(38) Rehabilitative Mental Health Services for Children Under Authority of Department of Human Services, Division of Child and Family Services or Division of Juvenile Justice Services Utah Medicaid Provider Manual;

(39) Rural Health Clinic Services Utah Medicaid Provider Manual with its attachments;

(40) School-Based Skills Development Services Utah Medicaid Provider Manual;

(41) Section I: General Information of the Utah Medicaid Provider Manual;

(42) Services for Pregnant Women Utah Medicaid Provider Manual;

(43) Substance Abuse Treatment Services & Targeted Case Management Services for Substance Abuse Utah Medicaid Provider Manual;

(44) Targeted Case Management for CHEC Medicaid Eligible Children Utah Medicaid Provider Manual;

(45) Targeted Case Management for the Chronically Mentally Ill Utah Medicaid Provider Manual;

(46) Targeted Case Management for Early Childhood (Ages 0-4) Utah Medicaid Provider Manual; and

(47) Vision Care Services Utah Medicaid Provider Manual.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [August 7, ]2013

Notice of Continuation: March 2, 2012

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