DAR File No. 37122

Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-1-5

Incorporations by Reference

Notice of Proposed Rule

(Amendment)

DAR File No.: 37122
Filed: 12/28/2012 10:21:42 AM

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; the Pharmacy Services Provider Manual; and the Coverage and Reimbursement Code Look-up Tool.

Summary of the rule or change:

Section R414-1-5 is changed to update the incorporation of the State Plan by reference to 01/01/2013 which includes any approved State Plan Amendments (SPAs). SPAs that became effective during the fourth quarter of Calendar Year 2012 include SPA 12-011-UT, Nursing Facility Evacuation Payments, which adds wording to define how payments to facilities will be administered and what payment limits will be in place during a time of a declared disaster; SPA 12-013-UT, Reimbursement for Optometry Services, which clarifies reimbursement methodology and changes the effective date of rates for optometry from 07/01/2007, to 07/01/2012; SPA 12-014-UT, Reimbursement for Speech Pathology Services, which clarifies reimbursement methodology and changes the effective date of rates for speech pathology from 11/01/2008 to 07/01/2012; SPA 12-015-UT, Reimbursement for Audiology Services, which clarifies reimbursement methodology and changes the effective date of rates for audiology from 11/01/2008, to 07/01/2012; SPA 12-016-UT, Reimbursement for Chiropractic Services, which clarifies reimbursement methodology and changes the effective date of rates for chiropractic services from 11/01/2008, to 07/01/2012; SPA 12-017-UT, Reimbursement for Eyeglasses Services, which clarifies reimbursement methodology and changes the effective date of rates for eyeglasses from 07/01/2007 to 07/01/2012; SPA 12-018-UT, Reimbursement for Clinic Services, which clarifies reimbursement methodology and changes the effective date of rates for clinic services from 05/25/2010 to 07/01/2012. This SPA also clarifies services and limitations in freestanding birth centers; SPA 12-019-UT, Reimbursement for Physical and Occupational Therapy, which changes the effective date of rates for physical therapy and occupational therapy from 07/01/2009 to 07/01/2012; and SPA 12-020-UT, Reimbursement for Rehabilitative Mental Health Services, which clarifies reimbursement methodology and changes the effective date of rates for rehabilitative mental health services from 01/01/2002 to 07/01/2012. This rule change also incorporates by reference the Medical Supplies Manual and List and the hospital services provider manual, effective 01/01/2013; 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 01/01/2013; incorporates by reference the Speech-Language Services Provider Manual, effective 01/01/2013; incorporates by reference the Audiology Services Provider Manual, effective 01/01/2013; incorporates by reference the Hospice Care Provider Manual, effective 01/01/2013; incorporates by reference the Long Term Care Services in Nursing Facilities Provider Manual, with its attachments, effective 01/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals 65 or Older Provider Manual, effective 01/01/2013; incorporates by reference the Personal Care Provider Manual, with its attachments, effective 01/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Acquired Brain Injury Age 18 and Older Provider Manual, effective 01/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Intellectual Disabilities or Other Related Conditions Provider Manual, effective 01/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Physical Disabilities Provider Manual, effective 01/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services New Choices Waiver Provider Manual, effective 01/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Technology Dependent, Medically Fragile Individuals Provider Manual, effective 01/01/2013; the Office of Inspector General Administrative Hearings Procedures Manual, effective 01/01/2013; the Pharmacy Services Provider Manual with its attachments, effective 01/01/2013; and the Coverage and Reimbursement Code Look-up Tool, effective 01/01/2013.

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, 01/01/2013
• Updates Utah Medicaid State Plan, published by Centers for Medicare and Medicaid Services, 01/01/2013
• Updates Speech-Language Services Provider Manual, published by Division of Medicaid and Health Financing, 01/01/2013
• Updates Utah Home and Community-Based Waiver Services New Choices Waiver Provider Manual, published by Division of Medicaid and Health Financing, 01/01/2013
• Updates Personal Care Provider Manual, with its attachments, published by Division of Medicaid and Health Financing, 01/01/2013
• Updates Pharmacy Services Provider Manual with its attachments, published by Division of Medicaid and Health Financing, 01/01/2013
• Updates Utah Home and Community-Based Waiver Services for Individuals with Physical Disabilities Provider Manual, published by Division of Medicaid and Health Financing, 01/01/2013
• 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, 01/01/2013
• Updates Office of Inspector General Administrative Hearings Procedures Manual, published by Office of Inspector General, 01/01/2013
• Updates Audiology Services Provider Manual, published by Division of Medicaid and Health Financing, 01/01/2013
• 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, 01/01/2013
• Updates Utah Home and Community-Based Waiver Services for Individuals 65 or Older Provider Manual, published by Division of Medicaid and Health Financing, 01/01/2013
• Updates Long Term Care Services in Nursing Facilities Provider Manual, with its attachments, published by Division of Medicaid and Health Financing, 01/01/2013
• Updates Hospice Care Provider Manual, published by Division of Medicaid and Health Financing, 01/01/2013
• Updates Hospital Services Provider Manual, with its attachments, published by Division of Medicaid and Health Financing, 01/01/2013
• Adds Coverage and Reimbursement Code Look-up Tool, published by Division of Medicaid and Health Financing, 01/01/2013
• Updates Utah Home and Community-Based Waiver Services for Technology Dependent, Medically Fragile Individuals Provider Manual, published by Division of Medicaid and Health Financing, 01/01/2013
• Updates Utah Medicaid Provider Manual, Medical Supplies Manual and List, published by Centers for Medicare and Medicaid Services, 01/01/2013

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:

02/14/2013

This rule may become effective on:

02/21/2013

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 [October]January 1, 201[2]3 versions of the following by reference:

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

(2) 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) Hospital Services Provider Manual with its attachments;

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

(5) Speech-Language Services Provider Manual;

(6) Audiology Services Provider Manual;

(7) Hospice Care Provider Manual;

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

(9) Personal Care Provider Manual with its attachments;

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

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

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

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

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

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

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

(17) Pharmacy Services Provider Manual with its attachments.

(18) Coverage and Reimbursement Code Look-up Tool found at http://health.utah.gov/medicaid/stplan/lookup/CoverageLookup.php.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [November 30, 2012]2013

Notice of Continuation: March 2, 2012

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