DAR File No. 41070

Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-302-6

Residents of Institutions

Notice of Proposed Rule

(Amendment)

DAR File No.: 41070
Filed: 12/13/2016 09:23:31 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change to provide Medicaid coverage for individuals who reside in certain halfway houses.

Summary of the rule or change:

The Centers for Medicaid and Medicare Services has clarified that individuals who reside in certain halfway houses are eligible for Federal Financial Participation (FFP). This amendment, therefore, allows an individual who resides in a qualified halfway house to receive Medicaid coverage. Based upon the "quick enrollment" pilot project with state prisons, the Department anticipates that less than 15 individuals will qualify for Medicaid. This amendment also updates incorporations by reference, removes language associated with the incorporations, and makes other technical changes.

Statutory or constitutional authorization for this rule:

• Section 26-1-5
• Pub. L. No. 111-148
• Section 26-18-3

This rule or change incorporates by reference the following material:

• Adds 42 CFR 435.1009, published by Government Printing Office, 10/01/2015
• Adds 42 CFR 435.1010, published by Government Printing Office, 10/01/2015
• Removes 42 CFR 435.1009, published by Government Printing Office, 10/01/2012
• Removes 42 CFR 435.1010, published by Government Printing Office, 10/01/2012

Anticipated cost or savings to:

the state budget:

There is a total annual cost of about $45,400 to the state budget as a result of this amendment.

local governments:

There is no impact to local governments because they do not make eligibility determinations for the Medicaid program.

small businesses:

This amendment does not impose any new costs or requirements on small businesses because they do not make eligibility determinations for the Medicaid program.

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

This amendment does not impose any new costs or requirements on Medicaid providers and recipients because it does not affect Medicaid services.

Compliance costs for affected persons:

This amendment does not impose any new costs or requirements on a single Medicaid provider or recipient because it does not affect Medicaid services.

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

There is no fiscal impact on business because the proposed rule does not affect Medicaid services and increase in eligibility is slight.

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:

01/31/2017

This rule may become effective on:

02/07/2017

Authorized by:

Joseph Miner, Executive Director

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

R414-302. Eligibility Requirements.

R414-302-6. Residents of Institutions.

(1) The Department provides Medicaid coverage to individuals who are residents of institutions subject to the limitations in 42 CFR 435.1009 and 435.1010 (October 1, 2015), which the Department adopts and incorporates by reference.[related to residents of public institutions, patients in an institution for mental diseases who do not meet the age criteria, and patients in an institution for tuberculosis as defined in 42 CFR 435.1009, October 1, 2012 ed., which is incorporated by reference. The Department also adopts and incorporates by reference the definitions in 42 CFR 435.1010, 2012 ed.

(2) The Department does not consider persons under the age of 18 to be residents of an institution if they are living temporarily in the institution while arrangements are being made for other placement.]

(2) An individual who resides in a halfway house may receive Medicaid coverage if the halfway house meets the following criteria:

(a) The halfway house allows the individual to work outside the facility;

(b) The halfway house allows the individual to use community facilities at will, such as libraries, grocery stores, recreation areas, or schools; and

(c) The halfway house allows the individual to seek health care treatment in the community to the same extent as other Medicaid enrollees.

(3) The Department does not consider an individual who resides in a temporary shelter for a limited period of time as a resident of an institution.

[(4) The Department considers ineligible residents of institutions for mental disease (IMD) who are ages 21 through 64 as non-residents while on conditional or convalescent leave from the institution. A resident of an IMD who is under 21 years of age, or is under 22 years of age and enters an IMD before reaching 21 years of age, is considered to be a resident while on conditional or convalescent leave from the institution.]

( 4[5]) For individuals under 22 years of age who become residents of an IMD before reaching 21 years of age, the Department limits Medicaid eligibility to individuals residing in the Utah State Hospital.

 

KEY: state residency, citizenship, third party liability, Medicaid

Date of Enactment or Last Substantive Amendment: [July 1, 2016]2017

Notice of Continuation: January 23, 2013

Authorizing, and Implemented or Interpreted Law: 26-18-3