DAR File No. 42096

Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-1-31

Withholding of Payments

Notice of Proposed Rule

(Amendment)

DAR File No.: 42096
Filed: 09/13/2017 10:59:58 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to update and clarify Medicaid policy in relation to a provider's response to a request for information and the withholding of payments.

Summary of the rule or change:

This amendment specifies when the Department may withhold provider payments, and clarifies the Department's responsibility to provide written notice for this purpose.

Statutory or constitutional authorization for this rule:

• Section 26-1-5
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget because this change only clarifies Medicaid policy in relation to a provider's response to a request for information and the withholding of payments.

local governments:

There is no budget impact to local governments because they do not reimburse providers under the Medicaid program.

small businesses:

There is no impact to small businesses because this change only clarifies Medicaid policy in relation to a provider's response to a request for information and the withholding of payments.

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

There is no impact to Medicaid providers and to Medicaid members because this change only clarifies Medicaid policy in relation to a provider's response to a request for information and the withholding of payments.

Compliance costs for affected persons:

There are no compliance costs to a single Medicaid provider or to a Medicaid member because this change only clarifies Medicaid policy in relation to a provider's response to a request for information and the withholding of payments.

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

After conducting a thorough analysis, it was determined that this proposed rule will not result in a fiscal impact to businesses.

Joseph K. Miner, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office 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:

10/31/2017

This rule may become effective on:

11/07/2017

Authorized by:

Joseph Miner, Executive Director

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

R414-1. Utah Medicaid Program.

R414-1-31. Withholding of Payments.

(1) In addition to other remedies allowed by law and unless specified otherwise, the Department may withhold payments to a provider if:

(a) the provider fails to provide the requested information within 30 calendar days from the date of a written request for information; or

(b) the provider has an outstanding balance owing the Department for any reason, including, but not limited to, claims adjustments or a provider assessment.

(2) The Department shall provide written notice before withholding payments.

(3) When the Department rescinds withholding of payments to a provider, it will, without notice, resume payments according to the regular claims payment cycle.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [July 1], 2017

Notice of Continuation: February 15, 2017

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