DAR File No. 37422

Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-1-5

Incorporations by Reference

Notice of Proposed Rule

(Amendment)

DAR File No.: 37422
Filed: 03/21/2013 08:58:26 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 Utah Medicaid 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 Utah Medicaid Provider Manual; Speech-Language Services Utah Medicaid Provider Manual; Audiology Services Utah Medicaid Provider Manual; Hospice Care Utah Medicaid Provider Manual; Long Term Care Services in Nursing Facilities Utah Medicaid Provider Manual; Personal Care Utah Medicaid Provider Manual; Utah Home and Community-Based Waiver Services for Individuals 65 or Older Utah Medicaid Provider Manual; Utah Home and Community-Based Waiver Services for Individuals with Acquired Brain Injury Age 18 and Older Utah Medicaid Provider Manual; Utah Home and Community-Based Waiver Services for Individuals with Intellectual Disabilities or Other Related Conditions Utah Medicaid Provider Manual; Utah Home and Community-Based Waiver Services for Individuals with Physical Disabilities Utah Medicaid Provider Manual; Utah Home and Community-Based Waiver Services New Choices Waiver Utah Medicaid Provider Manual; Utah Home and Community-Based Waiver Services for Technology Dependent, Medically Fragile Individuals Utah Medicaid Provider Manual; Utah Home and Community-Based Waiver Services Autism Waiver Utah Medicaid Provider Manual; Office of Inspector General Administrative Hearings Procedures Manual; Pharmacy Services Utah Medicaid Provider Manual; and Coverage and Reimbursement Code Look-up Tool.

Summary of the rule or change:

Section R414-1-5 is changed to incorporate the State Plan and approved State Plan Amendments (SPAs) by reference to 04/01/2013. These SPAs include SPA 13-001-UT, Pharmacy Services, which changes Medicaid coverage for barbiturates and benzodiazepines for dual eligible beneficiaries by excluding coverage when Medicare Part D coverage for those products is in effect and Medicaid coverage overlaps under the State Plan; and SPA 13-004-UT Physician Services, which requires psychiatrists and other qualified prescribing providers to use evaluation and management procedure codes rather than the current unique code for psychiatric pharmacologic management for physician services. This rule change also incorporates by reference the Medical Supplies Utah Medicaid Provider Manual and the Hospital Services Utah Medicaid provider manual, effective 04/01/2013; incorporates by reference both the definitions and the attachment for the Private Duty Nursing Acuity Grid found in the Home Health Agencies Utah Medicaid Provider Manual, effective 04/01/2013; incorporates by reference the Speech-Language Services Utah Medicaid Provider Manual, effective 04/01/2013; incorporates by reference the Audiology Services Utah Medicaid Provider Manual, effective 04/01/2013; incorporates by reference the Hospice Care Utah Medicaid Provider Manual, effective 04/01/2013; incorporates by reference the Long Term Care Services in Nursing Facilities Utah Medicaid Provider Manual, with its attachments, effective 04/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals 65 or Older Utah Medicaid Provider Manual, effective 04/01/2013; incorporates by reference the Personal Care Utah Medicaid Provider Manual, with its attachments, effective 04/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Acquired Brain Injury Age 18 and Older Utah Medicaid Provider Manual, effective 04/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Intellectual Disabilities or Other Related Conditions Utah Medicaid Provider Manual, effective 04/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Physical Disabilities Utah Medicaid Provider Manual, effective 04/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services New Choices Waiver Utah Medicaid Provider Manual, effective 04/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Technology Dependent, Medically Fragile Individuals Utah Medicaid Provider Manual, effective 04/01/2013; Utah Home and Community-Based Waiver Services Autism Waiver Utah Medicaid Provider Manual, effective 04/01/2013; Office of Inspector General Administrative Hearings Procedures Manual, effective 04/01/2013; Pharmacy Services Utah Medicaid Provider Manual with its attachments, effective 04/01/2013; and Coverage and Reimbursement Code Look-up Tool, effective 04/01/2013.

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 Technology Dependent, Medically Fragile Individuals Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 04/01/2013
• Updates Utah Home and Community-Based Waiver Services New Choices Waiver Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 04/01/2013
• Updates Utah Medicaid Provider Manual, Medical Supplies Manual, published by Division of Medicaid and Health Financing, 04/01/2013
• Updates Utah Medicaid State Plan, published by Centers for Medicare & Medicaid Services, 04/01/2013
• Updates Utah Home and Community-Based Waiver Services for Individuals 65 or Older Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 04/01/2013
• Updates Personal Care Utah Medicaid Provider Manual, with its attachments, published by Division of Medicaid and Health Financing, 04/01/2013
• Updates Office of Inspector General Administrative Hearings Procedures Manual, published by Division of Medicaid and Health Financing, 04/01/2013
• Adds Utah Home and Community-Based Waiver Services Autism Waiver Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 04/01/2013
• Updates Utah Home and Community-Based Waiver Services for Individuals with Physical Disabilities Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 04/01/2013
• Updates Utah Home and Community-Based Waiver Services for Individuals with Intellectual Disabilities or Other Related Conditions Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 04/01/2013
• Updates Utah Home and Community-Based Waiver Services for Individuals with Acquired Brain Injury Age 18 and Older Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 04/01/2013
• Updates Speech-Language Services Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 04/01/2013
• Updates Audiology Services Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 04/01/2013
• Updates Hospital Services Utah Medicaid Provider Manual, with its attachments, published by Division of Medicaid and Health Financing, 04/01/2013
• Updates Definitions found in the Home Health Agencies Utah Medicaid Provider Manual, and the manual's attachment for the Private Duty Nursing Acuity Grid, published by Division of Medicaid and Health Financing, 04/01/2013
• Updates Coverage and Reimbursement Code Look-up Tool, published by Division of Medicaid and Health Financing, 04/01/2013
• Updates Pharmacy Services Provider Manual with its attachments, published by Division of Medicaid and Health Financing, 04/01/2013
• Updates Hospice Care Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 04/01/2013
• Updates Long Term Care Services in Nursing Facilities Utah Medicaid Provider Manual, with its attachments, published by Division of Medicaid and Health Financing, 04/01/2013

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 and in the Look-up Tool do 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 and in the Look-up Tool do 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 and in the Look-up Tool do 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 and in the Look-up Tool do 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 and in the Look-up Tool do 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:

05/15/2013

This rule may become effective on:

05/22/2013

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 [January]April 1, 2013 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 Utah Medicaid Provider Manual with its attachments;

(4) Definitions [and the attachment for the Private Duty Nursing Acuity Grid ]found in the Home Health Agencies Utah Medicaid Provider Manual, and the manual's attachment for the Private Duty Nursing Acuity Grid;

(5) Speech-Language Services Utah Medicaid Provider Manual;

(6) Audiology Services Utah Medicaid Provider Manual;

(7) Hospice Care Utah Medicaid Provider Manual;

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

(9) Personal Care Utah Medicaid Provider Manual with its attachments;

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

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

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

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

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

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

(16) Utah Home and Community-Based Waiver Services Autism Waiver Utah Medicaid Provider Manual;

(1[6]7) Office of Inspector General Administrative Hearings Procedures Manual;[ and]

(1[7]8) Pharmacy Services Utah Medicaid Provider Manual with its attachments[.]; and

(1[8]9) 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: [March 1, ]2013

Notice of Continuation: March 2, 2012

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