Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-302-4

Residents of Institutions

Notice of Proposed Rule

(Amendment)

DAR File No.: 33345
Filed: 01/27/2010 12:32:40 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to clarify who can receive Medicaid coverage when residing in a public institution.

Summary of the rule or change:

This change clarifies who can receive Medicaid coverage when residing in a public institution. It further corrects and removes unnecessary incorporated references from the text.

State statutory or constitutional authorization for this rule:

• Section 26-18-3

This rule or change incorporates by reference the following material:

• Removes: 20 Code of Federal Regulations 416.201, 10/01/1997
• Removes: 20 Code of Federal Regulations 416.211, 10/01/1997
• Removes: 42 Code of Federal Regulations 435.1008, 10/01/1997
• Adds: 42 Code of Federal Regulations 435.1009, 10/01/2009
• Adds: 42 Code of Federal Regulations 435.1010, 10/01/2009

Anticipated cost or savings to:

the state budget:

The Department does not expect any impact to the state budget because this change only specifies the limitations of Medicaid eligibility for residents of public institutions. It neither increases nor decreases coverage for Medicaid clients.

local governments:

There is no impact to local governments because they do not fund or provide Medicaid services to Medicaid clients.

small businesses:

The Department does not expect any change in revenue to small businesses because this change only specifies the limitations of Medicaid eligibility for residents of public institutions. It neither increases nor decreases coverage for Medicaid clients.

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

The Department does not expect any change in revenue to Medicaid providers because this change only specifies the limitations of Medicaid eligibility for residents of public institutions. It neither increases nor decreases coverage for Medicaid clients. Medicaid clients, therefore, will not see additional costs or savings in their Medicaid services.

Compliance costs for affected persons:

The Department does not expect any change in revenue to a single Medicaid provider because this change only specifies the limitations of Medicaid eligibility for residents of public institutions. It neither increases nor decreases coverage for a single Medicaid client. A Medicaid client, therefore, will not see additional costs or savings in his Medicaid services.

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

The proposed rule updates and clarifies language, with no expected changes to current practice. Therefore no expected fiscal impact on business.

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:

03/17/2010

This rule may become effective on:

03/24/2010

Authorized by:

David Sundwall, Executive Director

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

R414-302. Eligibility Requirements.

R414-302-4. Residents of Institutions.

(1) The Department provides Medicaid coverage to individuals who are residents of institutions [adopts 20 CFR 416.201 and 416.211, 1997 ed. and] subject to the limitations 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 [435.1008, 1997]435.1009, 2009 ed., which is incorporated by reference. The Department also incorporates by reference the definitions in 42 CFR 435.1010, 2009 ed.[, which are incorporated by reference.]

(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.

(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 as non-residents while on conditional or convalescent leave from the institution.

(5) The Department limits Medicaid eligibility for residents of institutions for mental disease to individuals residing in the Utah State Hospital who meet the age requirements and other eligibility criteria.

 

KEY: public assistance programs, application, eligibility, Medicaid

Date of Enactment or Last Substantive Amendment: [September 1, 2009]2010

Notice of Continuation: January 25, 2008

Authorizing, and Implemented or Interpreted Law: 26-18