DAR File No. 32744
This filing was published in the 07/15/2009, issue, Vol. 2009, No. 14, of the Utah State Bulletin.
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:
HealthHealth 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 [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:
This rule is effective on:
07/01/2009
Authorized by:
David N. Sundwall, Executive Director
RULE TEXT
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
ADDITIONAL INFORMATION
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For questions regarding the content or application of this rule, please contact Kimi McNutt at the above address, by phone at 801-538-6381, by FAX at 801-538-6099, or by Internet E-mail at [email protected] For questions about the rulemaking process, please contact the Division of Administrative Rules (801-538-3764).
Last modified: 07/14/2009 7:44 AM