Special Notice

This notice was published in the June 1, 2013, issue (Vol. 2013, No. 11) of the Utah State Bulletin.

Special Notice: Crossover Payments

The Division of Medicaid and Health Financing (DMHF) is submitting a change to the Medicaid State Plan through "Attachment 4.19-B, SPA 13-023-UT Crossover Payments". The purpose of this change is to clarify that Medicaid, as a payor of last resort, utilizes third-party payment methodology for crossover claims of Medicare beneficiaries.

This amendment, therefore, clarifies that Medicaid pays only for a patient's liability on a crossover claim, and will only pay the lower of the allowed Medicaid payment rate less the amounts paid by Medicare and other payors, or the Medicare co-insurance and deductible.

DMHF does not expect any annual costs or expenditures to result from this clarification.

A copy of this change may be obtained from Craig Devashrayee (801-538-6641), or by writing the Technical Writing Unit, Utah Department of Health, P.O. Box 143102, Salt Lake City, UT 84114-3102. Comments are welcome at the same address. Copies of this change are also available at local county health department offices.

Additional Information

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/2013/b20130601.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.

For questions regarding this notice, please contact Craig Devashrayee, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at cdevashrayee@utah.gov.