Health, Children's Health Insurance Program

Rule R382-10

Eligibility

Notice of Proposed Rule

(Amendment)

DAR File No.: 32928
Filed: 09/01/2009 05:05:33 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to make the Children's Health Insurance Program (CHIP) application procedures consistent with Medicaid application procedures.

Summary of the rule or change:

This amendment changes the procedure that CHIP uses to determine the date of application and allows applications to be received on a Friday. When the state moved to the four-day workweek, medical eligibility offices closed on Fridays and applicants could not submit their applications on that day. This change requires CHIP to date applications as received on a Friday when they are delivered or sent to medical eligibility offices by the close of business on that day.

State statutory or constitutional authorization for this rule:

• Section 26-40-103

Anticipated cost or savings to:

the state budget:

This change results in a limited budget cost because in most cases, applicants who submit an application on a Friday now receive three additional days of eligibility. Nevertheless, there is insufficient data to estimate this cost because there is no way to determine how many applications will be submitted on a Friday.

local governments:

This change does not impact local governments because they do not determine CHIP eligibility and do not fund or provide CHIP services.

small businesses:

There is no impact to small businesses because they do not determine CHIP eligibility and this change does not create new requirements for these entities.

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

There are limited savings to CHIP enrollees who receive one to three more days of CHIP coverage as a result of this change. CHIP providers may also see a limited increase in revenue. Nevertheless, there is insufficient data to estimate these savings or increased revenue because there is no way to determine how many applications will be submitted on a Friday.

Compliance costs for affected persons:

There are no compliance costs because this change only creates savings and increased revenue for a CHIP enrollee and a CHIP provider.

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

This change should better serve the public by making the application process easier for applicants for CHIP.

David N. Sundwall, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Children's Health Insurance Program
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 cdevashrayee@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:

10/15/2009

This rule may become effective on:

10/22/2009

Authorized by:

David Sundwall, Executive Director

R382. Health, Children's Health Insurance Program.

R382-10. Eligibility.

R382-10-18. Effective Date of Enrollment and Renewal.

(1) The effective date of CHIP enrollment is the date a completed and signed application is received at a local office by the close of normal business [on a business day]hours on a weekday and not on a Saturday, Sunday, or a state or federal holiday. This applies to paper applications delivered in person or by mail, paper applications sent via facsimile transmission, and electronic applications sent via the internet. If a local office receives an application after the normal close of business hours on a [business ] weekday or on a Saturday, Sunday, or a state or federal holiday, the effective date of CHIP enrollment is the next [business day]weekday.

(2) The effective date of CHIP enrollment for applications delivered to an outreach location is as follows:

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

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

(3) 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 medical eligibility office is closed, then the applicant has until the close of business on the next day that the medical eligibility agency is open. An applicant may request more time to provide verifications. The request must be made by the last day of the application processing period.

([3]4) The Department may allow a grace enrollment period beginning no earlier than four days before the date a completed and signed application is received by the Department. The Department shall not pay for any services received before the effective enrollment date.

([4]5) For a family who has a child enrolled in CHIP and who adds a newborn or adopted child, the effective date of enrollment is the date of birth or adoption if the family requests the coverage within 30 days of the birth or adoption. If the request is made more than 30 days after the birth or adoption, enrollment in CHIP will be effective beginning the date of report, except as otherwise provided in R382-10-18(1).

([5]6) The effective date of enrollment for a renewal is the first day of the month after the renewal month, if the renewal process is completed by the end of the renewal month, or by the last day of the month immediately following the renewal month, and the child continues to be eligible.

([6]7) If the renewal process is not completed by the end of the renewal month, the case will be closed unless the enrollee has good cause for not completing the renewal process on time. Good cause includes a medical emergency, death of an immediate family member, or natural disaster, or other similar occurrence.

([7]8) The Department may require an interview with the parent, child, or adult who has assumed responsibility for the care or supervision of a child, or other authorized representative as part of the renewal process.

R382-10-21. Termination and Notice.

(1) The Department shall notify an applicant or enrollee in writing of the eligibility decision made on the application or at renewal.

(2) The Department shall notify an enrollee in writing ten days before taking a proposed action adversely affecting the enrollee's eligibility.

(3) Notices under this section shall provide the following information:

(a) the action to be taken;

(b) the reason for the action;

(c) the regulations or policy that support the action;

(d) the applicant's or enrollee's right to a hearing;

(e) how an applicant or enrollee may request a hearing; and

(f) the applicant's or enrollee's right to represent himself, or use legal counsel, a friend, relative, or other spokesperson.

(4) The Department need not give ten-day notice of termination if:

(a) the child is deceased;

(b) the child has moved out of state and is not expected to return;

(c) the child has entered a public institution; or

(d) the child has enrolled in other health insurance coverage, in which case eligibility ends the day before the new coverage begins.

(e) the child's whereabouts are unknown and the post office has returned mail to indicate that there is no forwarding address.

KEY: children's health benefits

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

Notice of Continuation: May 19, 2008

Authorizing, and Implemented or Interpreted Law: 26-1-5; 26-40