File No. 34365
This rule was published in the February 1, 2011, issue (Vol. 2011, No. 3) of the Utah State Bulletin.
Use of Statistical Sampling
Notice of Proposed Rule
DAR File No.: 34365
Filed: 01/14/2011 03:55:19 PM
Purpose of the rule or reason for the change:
In their report to the Legislature, Number 2009-12, and in subsequent reports, the Office of Legislative Auditor General recommended that the State Medicaid program obtain authority to use statistical sampling to establish overpayment recoveries due the State. This rule sets forth the methodology to adopt that sampling methodology and sets standards for its use.
Summary of the rule or change:
Statistical sampling techniques are authorized when: 1) a pattern of errors are discovered during an audit such that an error rate greater than 10% is discovered; 2) sampling size must establish a confidence level of 95% and a confidence interval of plus or minus 5%; and 3) the estimated error rate will then be extrapolated to the universe from which the sample is drawn to establish the overpayment.
State statutory or constitutional authorization for this rule:
- Section 26-1-5
- Section 26-18-3
Anticipated cost or savings to:
the state budget:
Data gathered by the Office of Legislative Auditor General and reported at pages 64 to 65 in report 2009-12 suggests the potential of a 2,000 percent increase in recoveries. Savings are anticipated to the state budget. The exact amount cannot be predicted. Some state agencies are Medicaid providers in some instances and recoveries are possible. Exact amount cannot be predicted.
Local governments are Medicaid providers in some instances and recoveries are possible. Exact amount cannot be predicted.
Small businesses are Medicaid providers in some instances and recoveries are possible. Exact amount cannot be predicted.
persons other than small businesses, businesses, or local governmental entities:
Other businesses are Medicaid providers in some instances and recoveries are possible. Exact amount cannot be predicted.
Compliance costs for affected persons:
There may be significant costs to Medicaid providers to respond to sampling established recoveries if they choose to hire their own experts to verify the work by state auditors. Exact amount unknown.
Comments by the department head on the fiscal impact the rule may have on businesses:
This method to increase recoveries of overpayments may have a significant impact on businesses that incorrectly bill Medicaid or other Department of Health programs. Based on the recommendation of the Office of Legislative Auditor General, I support proposing this rule to allow for public comments. A public hearing will be held in anticipation of strong interest in this rule.
David Patton, Acting Executive Director
The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:Health
288 N 1460 W
SALT LAKE CITY, UT 84116-3231
Direct questions regarding this rule to:
- Doug Springmeyer at the above address, by phone at 801-538-6971, by FAX at 801-538-6306, or by Internet E-mail at firstname.lastname@example.org
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:
Interested persons may attend a public hearing regarding this rule:
- 02/17/2011 06:00 PM, Utah State Capitol, 350 N State Street, Capitol Board Room (second floor east end), Salt Lake City, UT
This rule may become effective on:
David Sundwall, Executive Director
R380. Health, Administration.
The Portable Document Format (PDF) version of the Bulletin is the official version. The PDF version of this issue is available at https://rules.utah.gov/publicat/bull-pdf/2011/b20110201.pdf. The HTML edition of the Bulletin is a convenience copy. Any discrepancy between the PDF version and HTML version is resolved in favor of the PDF version.
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For questions regarding the content or application of this rule, please contact Doug Springmeyer at the above address, by phone at 801-538-6971, by FAX at 801-538-6306, or by Internet E-mail at email@example.com.