DAR File No. 38984

Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-310-7

Household Composition and Income Provisions

Notice of Proposed Rule

(Amendment)

DAR File No.: 38984
Filed: 12/01/2014 11:52:03 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

By legislative request, the income limit for the Primary Care Network (PCN) program will decrease from 100% of the federal poverty level (FPL) to 95% of FPL. This decrease will allow those PCN recipients who lose coverage due to the income limit change to receive better, more comprehensive medical coverage through the Federally Facilitated Marketplace (FFM).

Summary of the rule or change:

This amendment changes the current PCN income limit from 100% of FPL to 95% of FPL to allow those individuals losing PCN coverage to attain better medical coverage through the FFM.

State statutory or constitutional authorization for this rule:

• Section 26-1-5
• Pub. L. No. 111-148
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

There are minimal savings to the state budget with some individuals losing PCN coverage, but there is no data to estimate what the total savings will be. This change affects less than 500 PCN recipients.

local governments:

There is no impact to local governments because they do not fund or provide PCN services to PCN recipients.

small businesses:

There is no impact because this change does not impose new costs or requirements on small businesses.

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

There is no impact because this change does not impose new costs or requirements on PCN providers. PCN recipients, however, may see some savings as they become eligible for better medical coverage through the FFM.

Compliance costs for affected persons:

There are no compliance costs because this change does not impose new requirements on a single PCN provider, and a PCN recipient will only become eligible for better medical coverage through the FFM.

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

This change does not impose additional costs or requirements upon PCN providers and therefore will have no impact on business.

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 [email protected]

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:

01/14/2015

This rule may become effective on:

02/01/2015

Authorized by:

David Patton, Executive Director

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

R414-310. Medicaid Primary Care Network Demonstration Waiver.

R414-310-7. Household Composition and Income Provisions.

(1) The eligibility agency determines household composition and countable household income according to the provisions in R414-304-5.

(2) For an individual to be eligible to enroll in PCN, countable MAGI-based income for the individual must be equal to or less than [100]95% of the federal poverty guideline for the applicable household size.

 

KEY: Medicaid, primary care, demonstration

Date of Enactment or Last Substantive Amendment: [April 21, 2014]2015

Notice of Continuation: June 4, 2012

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