Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-1-5

Incorporations by Reference

Notice of Proposed Rule

(Amendment)

DAR File No.: 35994
Filed: 03/29/2012 05:54:09 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

Subsection 26-18-3(2)(a) requires the Medicaid program to implement policy through administrative rules. The Department, in order to draw down federal funds, must have an approved State Plan with the Centers for Medicare and Medicaid Services (CMS). The purpose of this change, therefore, is to incorporate the most current Medicaid State Plan by reference and to implement by rule both the definitions and the attachment for the Private Duty Nursing Acuity Grid found in the Home Health Agencies Provider Manual, and to implement by rule ongoing Medicaid policy for services described in the Utah Medicaid Provider Manual, Medical Supplies Manual and List; Hospital Services Provider Manual; Speech-Language Services Provider Manual; Audiology Services Provider Manual; Hospice Care Provider Manual; Long Term Care Services in Nursing Facilities Provider Manual; Personal Care Provider Manual; Utah Home and Community-Based Waiver Services for Individuals 65 or Older Provider Manual; Utah Home and Community-Based Waiver Services for Individuals with Acquired Brain Injury Age 18 and Older Provider Manual; Utah Home and Community-Based Waiver Services for Individuals with Intellectual Disabilities or Other Related Conditions Provider Manual; Utah Home and Community-Based Waiver Services for Individuals with Physical Disabilities Provider Manual; Utah Home and Community-Based Waiver Services New Choices Waiver Provider Manual; and Utah Home and Community-Based Waiver Services for Technology Dependent, Medically Fragile Individuals (HCBWS) Provider Manual.

Summary of the rule or change:

Section R414-1-5 is changed to update the incorporation by reference date of the State Plan to 04/01/2012. It also incorporates by reference State Plan Amendments (SPAs) that become effective no later than 04/01/2012. SPAs for this incorporation of the State Plan include: SPA 11-005-UT Disproportionate Share Hospital Payments, which allows the State Hospital to receive direct disproportionate share payments at different intervals in a fiscal period based on the uncompensated care cost survey data that the hospital submits; SPA 11-006-UT Quality Improvement Incentive, which continues quality incentive programs for nursing facilities, updates the incentive period to be 07/01/2011 through 05/31/2012, and updates routine services to reflect daily rate and ancillary services; SPA 11-008-UT Outpatient Hospital Payments, which updates the State Plan to move to Medicare's reimbursement methodology for outpatient hospital services; SPA 11-010-UT Clarification of Peer Support Services, which clarifies that peer support services, when provided to children, are provided to the child's parents and legal guardians as appropriate to the child's age, clarifies that the services are directed exclusively to the treatment of the Medicaid-eligible child, and clarifies that provider qualifications include a parent of a child with serious emotional disturbance or an adult who has an ongoing and personal relationship with a family member with serious emotional disturbance; SPA 11-011 Tobacco Cessation Counseling Services for Pregnant Women, which specifies who can provide face-to-face tobacco cessation counseling services for pregnant women and specifies the limitations; and SPA 11-012-UT (companion to SPA 11-008-UT), which updates another section of the State Plan to move to Medicare's reimbursement methodology for outpatient hospital services. This rule change also incorporates by reference the Medical Supplies Manual and List and the hospital services provider manual, effective 04/01/2012; incorporates by reference both the definitions and the attachment for the Private Duty Nursing Acuity Grid found in the Home Health Agencies Provider Manual, effective 04/01/2012; incorporates by reference the Speech-Language Services Provider Manual, effective 04/01/2012; incorporates by reference the Audiology Services Provider Manual, effective 04/01/2012; incorporates by reference the Hospice Care Provider Manual, effective 04/01/2012; incorporates by reference the Long Term Care Services in Nursing Facilities Provider Manual, with its attachments, effective 04/01/2012; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals 65 or Older Provider Manual, effective 04/01/2012; incorporates by reference the Personal Care Provider Manual, with its attachments, effective 04/01/2012; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Acquired Brain Injury Age 18 and Older Provider Manual, effective 04/01/2012; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Intellectual Disabilities or Other Related Conditions Provider Manual, effective 04/01/2012; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Physical Disabilities Provider Manual, effective 04/01/2012; incorporates by reference the Utah Home and Community-Based Waiver Services New Choices Waiver Provider Manual, effective 04/01/2012; and incorporates by reference the Utah Home and Community-Based Waiver Services for Technology Dependent, Medically Fragile Individuals (HCBWS) Provider Manual, effective 04/01/2012.

State statutory or constitutional authorization for this rule:

• Section 26-18-3
• Section 26-1-5

This rule or change incorporates by reference the following material:

• Updates Personal Care Provider Manual, with its attachments, published by Division of Medicaid and Health Financing, 04/01/2012
• Updates Long Term Care Services in Nursing Facilities Provider Manual, with its attachments, published by Division of Medicaid and Health Financing, 04/01/2012
• Updates Hospital Services Provider Manual, with its attachments, published by Division of Medicaid and Health Financing, 04/01/2012
• Updates Definitions and the Attachment for the Private Duty Nursing Acuity Grid in the Home Health Agencies Provider Manual, published by Division of Medicaid and Health Financing, 04/01/2012
• Updates Speech-Language Services Provider Manual, published by Division of Medicaid and Health Financing, 04/01/2012
• Updates Audiology Services Provider Manual, published by Division of Medicaid and Health Financing, 04/01/2012
• Updates Hospice Care Provider Manual, published by Division of Medicaid and Health Financing, 04/01/2012
• Updates Utah Home and Community-Based Waiver Services for Individuals 65 or Older Provider Manual, published by Division of Medicaid and Health Financing, 04/01/2012
• Updates Utah Home and Community-Based Waiver Services for Technology Dependent, Medically Fragile Individuals (HCBWS) Provider Manual, published by Division of Medicaid and Health Financing, 04/01/2012
• Updates Utah Home and Community-Based Waiver Services New Choices Waiver Provider Manual, published by Division of Medicaid and Health Financing, 04/01/2012
• Updates Utah Home and Community-Based Waiver Services for Individuals with Acquired Brain Injury Age 18 and Older Provider Manual, published by Division of Medicaid and Health Financing, 04/01/2012
• Updates Utah Home and Community-Based Waiver Services for Individuals with Intellectual Disabilities or Other Related Conditions Provider Manual, published by Division of Medicaid and Health Financing, 04/01/2012
• Updates Utah Home and Community-Based Waiver Services for Individuals with Physical Disabilities Provider Manual, published by Division of Medicaid and Health Financing, 04/01/2012
• Updates Utah Medicaid State Plan, published by Division of Medicaid and Health Financing, 04/01/2012
• Updates Utah Medicaid Provider Manual, Medical Supplies Manual and List, published by Division of Medicaid and Health Financing, 04/01/2012

Anticipated cost or savings to:

the state budget:

There is no budget impact because this change only fulfills the requirement to incorporate the State Plan by reference. Implementation of the State Plan is within legislative budget allotments. Further, the rule's incorporation of ongoing Medicaid policy described in the provider manuals does not create costs or savings to the Department or other state agencies.

local governments:

There is no budget impact because this change only fulfills the requirement to incorporate the State Plan by reference. Implementation of the State Plan is within legislative budget allotments. Further, the rule's incorporation of ongoing Medicaid policy described in the provider manuals does not create costs or savings to local governments.

small businesses:

There is no budget impact because this change only fulfills the requirement to incorporate the State Plan by reference. Implementation of the State Plan is within legislative budget allotments. Further, the rule's incorporation of ongoing Medicaid policy described in the provider manuals does not create costs or savings to small businesses.

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

There is no budget impact because this change only fulfills the requirement to incorporate the State Plan by reference. Implementation of the State Plan is within legislative budget allotments. Further, the rule's incorporation of ongoing Medicaid policy described in the provider manuals does not create costs or savings to other persons or entities.

Compliance costs for affected persons:

There are no compliance costs because this change only fulfills the requirement to incorporate the State Plan by reference. Implementation of the State Plan is within legislative budget allotments. Further, the rule's incorporation of ongoing Medicaid policy described in the provider manuals does not create costs or savings to a single Medicaid recipient or provider.

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

This rule should not have a direct fiscal impact on business. Incorporation of the State Plan by this rule assures that the Medicaid program is implemented through administrative rule.

David Patton, PhD, 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
CANNON HEALTH BLDG
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:

05/15/2012

This rule may become effective on:

05/22/2012

Authorized by:

David Patton, Executive Director

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

R414-1. Utah Medicaid Program.

R414-1-5. Incorporations by Reference.

(1) The Department incorporates by reference the Utah State Plan Under Title XIX of the Social Security Act Medical Assistance Program effective [January]April 1, 2012. It also incorporates by reference State Plan Amendments that become effective no later than [January]April 1, 2012.

(2) The Department incorporates by reference the Medical Supplies Manual and List described in the Utah Medicaid Provider Manual, Section 2, Medical Supplies, with its referenced attachment, Medical Supplies List, effective [January]April 1, 2012, as applied in Rule R414-70.

(3) The Department incorporates by reference the Hospital Services Provider Manual, with its attachments, effective [January]April 1, 2012.

(4) The Department incorporates by reference both the definitions and the attachment for the Private Duty Nursing Acuity Grid found in the Home Health Agencies Provider Manual, effective [January]April 1, 2012.

(5) The Department incorporates by reference the Speech-Language Services Provider Manual, effective [January]April 1, 2012.

(6) The Department incorporates by reference the Audiology Services Provider Manual, effective [January]April 1, 2012.

(7) The Department incorporates by reference the Hospice Care Provider Manual, effective [January]April 1, 2012.

(8) The Department incorporates by reference the Long Term Care Services in Nursing Facilities Provider Manual, with its attachments, effective [January]April 1, 2012.

(9) The Department incorporates by reference the Personal Care Provider Manual, with its attachments, effective [January]April 1, 2012.

(10) The Department incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals 65 or Older Provider Manual, effective [January]April 1, 2012.

(11) The Department incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Acquired Brain Injury Age 18 and Older Provider Manual, effective [January]April 1, 2012.

(12) The Department incorporates by reference the Utah Home and Community-Based Waiver for Individuals with Intellectual Disabilities or Other Related Conditions Provider Manual, effective [January]April 1, 2012.

(13) The Department incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Physical Disabilities Provider Manual, effective [January]April 1, 2012.

(14) The Department incorporates by reference the Utah Home and Community-Based Waiver Services New Choices Waiver Provider Manual, effective [January]April 1, 2012.

(15) The Department incorporates by reference the Utah Home and Community-Based Waiver Services for Technology Dependent, Medically Fragile Individuals (HCBWS) Provider Manual, effective [January]April 1, 2012.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [February 21], 2012

Notice of Continuation: March 2, 2012

Authorizing, and Implemented or Interpreted Law: 26-1-5; 26-18-3; 26-34-2