DAR File No. 32744

Health, Health Care Financing, Coverage and Reimbursement Policy

R414-308-3

Application and Signature

NOTICE OF 120-DAY (EMERGENCY) RULE

DAR File No.: 32744
Filed: 06/24/2009, 01:55
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

This change is to implement The American Recovery and Reinvestment Act of 2009 (ARRA), which requires the state to not have additional restrictive standards, methodologies or procedures other than those that were in place on 07/01/2008, in order to receive the enhanced federal matching funds.

Summary of the rule or change:

This filing changes the way the state determines the date of application so that in certain circumstances, the agency will date applications as being received on Friday. When the state moved to the four-day work week, it meant that Medicaid eligibility offices would be closed on Fridays and applicants could not submit applications on Fridays. This change will require the state to date applications as received on Fridays when they are delivered or sent to the Medicaid office on Fridays, even though the offices are closed. This change must be made to protect the state from losing the enhanced federal matching funds under the ARRA of 2009. (DAR NOTE: A corresponding amendment is under DAR No. 32743 in this issue, July 15, 2009, of the Bulletin.)

State statutory or constitutional authorization for this rule:

Section 26-18-3

Anticipated cost or savings to:

the state budget:

The Department does not have an accurate way to estimate the total cost. Nevertheless, if the Department fails to make this change, it could lose up to $68,263,000 in enhanced federal matching funds under the ARRA.

local governments:

This change does not impact local governments because they do not determine Medicaid eligibility or provide Medicaid services

small businesses and persons other than businesses:

This change could result in a savings for some Medicaid applicants if they are able to receive additional Medicaid coverage. Nevertheless, there is insufficient data to estimate what that savings will be.

Compliance costs for affected persons:

There are no compliance costs to a Medicaid client because the client does not have to pay more for medical assistance and does not lose any Medicaid coverage.

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

This rule change implements changes in federal law and will not have a fiscal impact on business. David N. Sundwall, MD, Executive Director

Emergency rule reason and justification:

Regular rulemaking procedures would cause an imminent budget reduction because of budget restraints or federal requirements.place the agency in violation of federal or state law.

The ARRA provides enhanced federal matching funds to states for Medicaid assistance if the state meets specific requirements. One of the requirements is that the state cannot have any eligibility standards, methodologies, or procedures in place that are more restrictive than what the state had in place on 07/01/2008. In August 2008, the state moved to a four-day work week, and Medicaid eligibility offices are now closed on Fridays. The four-day work week is more restrictive because applications that are sent or delivered to the state after the offices close on Thursday are not dated as received until the next day that the offices are open. The Department must change this so as not to lose the enhanced federal matching funds.

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:

Kimi McNutt at the above address, by phone at 801-538-6381, by FAX at 801-538-6099, or by Internet E-mail at KMCNUTT@utah.gov

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:

This rule is effective on:

07/01/2009

Authorized by:

David N. Sundwall, Executive Director

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

R414-308. Application, Eligibility Determinations and Improper Medical Assistance.

R414-308-3. Application and Signature.

(1) An individual may apply for medical assistance by completing and signing any Department-approved application form for Medicaid, Qualified Medicare Beneficiaries, Specified Low-Income Medicare Beneficiaries, or Qualified Individuals assistance and delivering it to the Medicaid eligibility agency. If available, an individual may complete an on-line application for medical assistance and send it electronically to the Medicaid eligibility agency.

(a) If an applicant cannot write, the applicant must make his mark on the application form and have at least one witness to the signature.

(b) For on-line applications, the individual must either send the Medicaid eligibility agency an original signature on a printed signature page, or if available on-line, submit an electronic signature that conforms with state law for electronic signatures.

(c) A representative may apply on behalf of an individual. A representative may be a legal guardian, a person holding a power of attorney, a representative payee or other responsible person acting on behalf of the individual. In this case, the Medicaid eligibility agency may send notices, requests and forms to both the individual and the individual's representative, or to just the individual's representative.

(d) If the Division of Child and Family Services (DCFS) has custody of a child and the child is placed in foster care, DCFS completes the application. DCFS determines eligibility for the child pursuant to a written agreement with the Department. DCFS also determines eligibility for children placed under a subsidized adoption agreement.

(e) An authorized representative may apply for the individual if unusual circumstances or death prevent an individual from applying on his own. The individual must sign the application form if possible. If the individual cannot sign the application, the representative must sign the application. The Medicaid eligibility agency may assign someone to act as the authorized representative when the individual requires help to apply and is unable to appoint a representative.

(2) [The date of application is determined as follows:

(a) The application date is the date the agency receives a completed, signed application at a local office by the close of business on a business day. This applies to paper applications delivered in person or by mail, paper applications sent via facsimile transmission, and electronic applications sent via the Internet.

(b) For applications delivered to the agency by facsimile, Internet, or to an office dropbox after the close of business of a business day, or on a non-business day, the date of application is the next business day.]The Medicaid eligibility agency determines the date of application as follows:

(a) The date of application is the date that the Medicaid eligibility agency receives a completed application by the close of normal business hours on a week day that is not a Saturday, Sunday or state holiday. If an application is received after the normal close of business hours on a weekday that is not a Saturday, Sunday or state holiday, the date of application is the next weekday that is not a Saturday, Sunday or state holiday.

([c]b) The Medicaid eligibility agency determines the application date for applications delivered to an outreach location [is ]as follows:

(i) If the application is delivered at a time when the outreach staff is working at that location, the date of application is the date the outreach staff receives the application.

(ii) If the application is delivered on a non-business day or at a time when the outreach office is closed, the date of application is the last business day that a staff person from the state Medicaid eligibility agency was available to receive or pick up applications from that location.

([d]c) [The due date for verifications needed to complete an application and determine eligibility is the close of business on the last day of the application period.]An applicant must provide the verifications needed to process an application and determine eligibility no later than the close of business on the last day of the application period. If the last day of the application processing period falls on a day of the week when the Medicaid eligibility office is closed, then the applicant has until the close of business on the next day that the Medicaid eligibility agency is open immediately following the last day of the application processing period. An applicant may request more time to provide verifications. The request must be made by the last day of the application processing period.

(3) The Medicaid eligibility agency accepts a signed application sent via facsimile as a valid application and does not require it to be signed again.

(4) If an applicant submits an unsigned, or incomplete[d] application form to the Medicaid eligibility agency, the Medicaid eligibility agency will notify the applicant that he or she must sign and complete the application [within 30 days of the application date]no later than the last day of the application processing period. The Medicaid eligibility agency will send a signature page to the applicant [within 10 days for the client]and give the applicant at least ten days to sign and return the signature page. When the application is incomplete, the Medicaid eligibility agency will notify the applicant of the need to complete the application through an interview process, by mail, or by coming to an office to complete the form.

(a) If the Medicaid eligibility agency receives a signature page signed by the applicant, and the applicant completes the application within [30 days of receiving the completed application, the original application date is retained]the application processing period, the date of application will be the date the Medicaid eligibility agency received the application form that was not complete or signed.

(b) If the Medicaid eligibility agency does not receive a signed signature page, and the applicant does not complete the application form within [30 days of when it received the completed application]the application processing period, the application is void and the Medicaid eligibility agency will send a denial notice to the applicant. The previous application date will not be protected.

(c) If the Medicaid eligibility agency receives a signed signature page and the completed application after the application processing period but during the 30 calendar days immediately after the denial notice is mailed, the Medicaid eligibility agency will contact the applicant to ask if the applicant wants to reapply for medical assistance. If the applicant wants to reapply, the Medicaid eligibility agency may use the previous [completed ]application form it received, but the application date will be the date the Medicaid eligibility agency receive[d]s both the signed signature page and completed application form according to the same provisions in Subsection R414-308-3(2).

(d) If the Medicaid eligibility agency receives a signed signature page and the completed application more than 30 calendar days after the denial notice is sent, the applicant will need to reapply by completing and submitting a new application form. The original application date is not retained. The new application date will be the date the Medicaid eligibility agency receives a new application.[

(5) If an application is not complete, but it is signed by the applicant, the eligibility worker will ask the applicant to complete the application. If the client completes and returns the application within 30 days of the date the agency received the application, the agency will determine eligibility based on the original application date. If the client does not complete the application within 30 days, the original application date is not retained and the agency denies the application.]

 

KEY: public assistance programs, application, eligibility, Medicaid

Date of Enactment or Last Substantive Amendment: July 1, 2009

Notice of Continuation: January 31, 2008

Authorizing, and Implemented or Interpreted Law: 26-18