Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-1-5

Incorporations by Reference

Notice of Proposed Rule

(Amendment)

DAR File No.: 36871
Filed: 09/27/2012 04:51:49 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; Utah Home and Community-Based Waiver Services for Technology Dependent, Medically Fragile Individuals Provider Manual; the Office of Inspector General Administrative Hearings Procedures Manual; and the Pharmacy Services Provider Manual.

Summary of the rule or change:

Section R414-1-5 is changed to update the incorporation of the State Plan by reference to 10/01/2012, which includes any approved State Plan Amendments (SPAs). SPAs that became effective during the third quarter of Calendar Year 2012 include SPA 11-014-UT, Pharmacy Services, which simplifies the over-the-counter prescribed drug list and incorporates an interim replacement for the average wholesale price of prescription drugs; SPA 12-002-UT, Reimbursement for Physician and Anesthesia Services, which updates the frequency of rebasing for physician and anesthesia services as well as clarifies the methodology for making supplemental payments for physicians employed by the University of Utah Medical Group. SPA 12-003-UT, Quality Improvement Incentive; which updates and continues quality incentive programs for nursing facilities and intermediate care facilities for persons with intellectual disabilities in future state fiscal years and makes other clarifications. SPA 12-004-UT, Medical Education Payments, which updates the direct graduate medical education payment pool for 2013 and rewords the payment amount and time period for the payment pool so the Department does not have to update it each year; SPA 12-006-UT, Federally Qualified Health Centers, which clarifies that a federally qualified health center must calculate only covered beneficiary charges when it calculates the ratio of beneficiary charges to total charges applied to allowable cost as part of its agreement with the federal government; SPA 12-007-UT, Dental Services, which provides limited emergency dental services to non-pregnant clients and to non-EPSDT clients; SPA 12-009-UT, Disproportionate Share Hospital Payments, which allows non-government hospitals that have the support of a government entity (e.g., special services district, county government) for the non-federal match dollars to participate in disproportionate share hospital payments; and SPA 12-012-UT, Reimbursement for Home Health Services, which changes the effective date of home health rates from 07/01/2007 to 07/01/2012. This rule change also incorporates by reference the Medical Supplies Manual and List and the hospital services provider manual, effective 10/01/2012; 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 10/01/2012; incorporates by reference the Speech-Language Services Provider Manual, effective 10/01/2012; incorporates by reference the Audiology Services Provider Manual, effective 10/01/2012; incorporates by reference the Hospice Care Provider Manual, effective 10/01/2012; incorporates by reference the Long Term Care Services in Nursing Facilities Provider Manual, with its attachments, effective 10/01/2012; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals 65 or Older Provider Manual, effective 10/01/2012; incorporates by reference the Personal Care Provider Manual, with its attachments, effective 10/01/2012; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Acquired Brain Injury Age 18 and Older Provider Manual, effective 10/01/2012; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Intellectual Disabilities or Other Related Conditions Provider Manual, effective 10/01/2012; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Physical Disabilities Provider Manual, effective 10/01/2012; incorporates by reference the Utah Home and Community-Based Waiver Services New Choices Waiver Provider Manual, effective 10/01/2012; incorporates by reference the Utah Home and Community-Based Waiver Services for Technology Dependent, Medically Fragile Individuals Provider Manual, effective 10/01/2012; the Office of Inspector General Administrative Hearings Procedures Manual, effective 10/01/2012; and the Pharmacy Services Provider Manual with its attachments, effective 10/01/2012.

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 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, 10/01/2012
• Updates Utah Home and Community-Based Waiver Services for Individuals 65 or Older Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2012
• Updates Utah Home and Community-Based Waiver Services for Technology Dependent, Medically Fragile Individuals Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2012
• Updates Utah Home and Community-Based Waiver Services New Choices Waiver Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2012
• Updates Utah Home and Community-Based Waiver Services for Individuals with Physical Disabilities Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2012
• 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, 10/01/2012
• Updates Hospital Services Provider Manual, with its attachments, published by Division of Medicaid and Health Financing, 10/01/2012
• 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, 10/01/2012
• Updates Pharmacy Services Provider Manual with its attachments, published by Division of Medicaid and Health Financing, 10/01/2012
• Updates Office of Inspector General Administrative Hearings Procedures Manual, published by Division of Medicaid and Health Financing, 10/01/2012
• Updates Personal Care Provider Manual, with its attachments, published by Division of Medicaid and Health Financing, 10/01/2012
• Updates Hospice Care Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2012
• Updates Long Term Care Services in Nursing Facilities Provider Manual, with its attachments, published by Division of Medicaid and Health Financing, 10/01/2012
• Updates Speech-Language Services Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2012
• Updates Audiology Services Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2012
• Updates Utah Medicaid State Plan, published by Centers for Medicare and Medicaid Services, 10/01/2012
• Updates Utah Medicaid Provider Manual, Medical Supplies Manual and List, published by Division of Medicaid and Health Financing, 10/01/2012

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:

11/14/2012

This rule may become effective on:

11/21/2012

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.

The Department incorporates the [July]October 1, 2012 versions of the following by reference:

(1) [the] Utah State Plan, including any approved amendments, under Title XIX of the Social Security Act Medical Assistance Program[.];

(2) [the] Medical Supplies Manual and List described in the Utah Medicaid Provider Manual, Section 2, Medical Supplies, with its referenced attachment, Medical Supplies List, as applied in Rule R414-70;

(3) [the] Hospital Services Provider Manual with its attachments;

(4) [both the d]Definitions and the attachment for the Private Duty Nursing Acuity Grid found in the Home Health Agencies Provider Manual;

(5) [the] Speech-Language Services Provider Manual;

(6) [the] Audiology Services Provider Manual;

(7) [the] Hospice Care Provider Manual;

(8) [the] Long Term Care Services in Nursing Facilities Provider Manual with its attachments;

(9) [the] Personal Care Provider Manual with its attachments;

(10) [the] Utah Home and Community-Based Waiver Services for Individuals 65 or Older Provider Manual;

(11) [the] Utah Home and Community-Based Waiver Services for Individuals with Acquired Brain Injury Age 18 and Older Provider Manual;

(12) [the] Utah Home and Community-Based Waiver for Individuals with Intellectual Disabilities or Other Related Conditions Provider Manual;

(13) [the] Utah Home and Community-Based Waiver Services for Individuals with Physical Disabilities Provider Manual;

(14) [the] Utah Home and Community-Based Waiver Services New Choices Waiver Provider Manual;

(15) [the] Utah Home and Community-Based Waiver Services for Technology Dependent, Medically Fragile Individuals Provider Manual;

(16) [the] Office of Inspector General Administrative Hearings Procedures Manual; and

(17) [the] Pharmacy Services Provider Manual with its attachments.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [August 10, ]2012

Notice of Continuation: March 2, 2012

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