Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-308-3

Application and Signature

Notice of Proposed Rule

(Amendment)

DAR File No.: 33133
Filed: 11/02/2009 04:40:19 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to comply with a provision in the Social Security Act. Utah will now accept data transmitted from Social Security from low-income subsidy applicants and avoid having the applicant fill out a form twice.

Summary of the rule or change:

This change requires the state to accept data transmitted from Social Security from low-income subsidy applicants. It also defines the application date for such applications, the application processing period, and how the agency will treat a request for Medicaid from the applicant.

State statutory or constitutional authorization for this rule:

• Section 26-18-3
• 42 U.S.C. Sec. 1396u-5(a)(4)

Anticipated cost or savings to:

the state budget:

This change results in an annual cost to the General Fund of approximately $263,332 and $924,092 in federal dollars.

local governments:

This change does not impact local governments because they do not fund or process applications for Medicare and Medicaid cost sharing programs.

small businesses:

Small businesses could see an increase in revenue based on the fact that more clients will have funding for their needed medical services. This increase in funding will allow them to spend their resources in other ways that could benefit businesses and the economy in general. Nevertheless, there is insufficient data to quantify an exact amount of business revenue.

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

Individuals who become eligible for Medicare cost sharing programs under this change could save approximately $1,187,424 annually. In addition, there is an increase in annual revenue for some Medicaid providers, but there is no way to know how many additional services will result from this change.

Compliance costs for affected persons:

There are only savings and no compliance costs because an individual who is found eligible for a Medicare cost sharing program will receive a benefit in the form of payment on his Medicare Part B premium. Furthermore, there is only an increase in annual revenue for a single Medicaid provider.

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

This rule change is required by federal law and will increase the cost of the Medicaid program to the state. No impact on business is expected, other than the possibility of slightly higher revenue.

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
Health Care Financing, Coverage and Reimbursement Policy
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:

12/15/2009

This rule may become effective on:

12/22/2009

Authorized by:

David 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 Medicaid eligibility agency will process low-income subsidy application data transmitted from the Social Security Administration in accordance with 42 U.S.C. Sec. 1935(a)(4) as an application for Medicare cost sharing programs. The agency will take appropriate steps to gather the required information and verifications from the applicant to determine the applicant's eligibility.

(a) Data transmitted from social security is not an application for Medicaid.

(b) Individuals who want to apply for Medicaid when contacted for information to process the application for Medicare cost-sharing programs must complete and sign a Medicaid application form. The date of application for Medicaid is the date the Medicaid eligibility agency receives the application.

([2] 3) 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.

(b) The Medicaid eligibility agency determines the application date for applications delivered to an outreach location 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.

(c) When the state receives application data transmitted from social security pursuant to the requirements of 42 U.S.C. Sec. 1396u-5(a)(4), the Medicaid eligibility agency uses the date the individual submitted the low-income subsidy application to the Social Security Administration as the application date for Medicare cost sharing programs. The application processing period for the transmitted data begins on the date the Medicaid eligibility agency receives the transmitted data from social security. The transmitted data meets the signature requirements for applications for Medicare cost sharing programs.

([c] d) 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] 4) 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] 5) If an applicant submits an unsigned, or incomplete 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 no later than the last day of the application processing period. The Medicaid eligibility agency will send a signature page to the applicant and give the applicant at least [ten] 10 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 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 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 application form it received, but the application date will be the date the Medicaid eligibility agency receives 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.

 

KEY: public assistance programs, application, eligibility, Medicaid

Date of Enactment or Last Substantive Amendment: [September 15], 2009

Notice of Continuation: January 31, 2008

Authorizing, and Implemented or Interpreted Law: 26-18