DAR File No. 39781

Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-1-5

Incorporations by Reference

Notice of 120-Day (Emergency) Rule

DAR File No.: 39781
Filed: 09/30/2015 09:49:57 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to incorporate by reference and implement by rule the Medically Complex Children's Waiver Utah Medicaid Provider Manual, which contains waiver provisions the department must implement by 10/01/2015.

Summary of the rule or change:

This amendment incorporates by reference and implements by rule the Medically Complex Children's Waiver Utah Medicaid Provider Manual, effective 10/01/2015. (DAR NOTE: A corresponding proposed amendment is under DAR No. 39800 in this issue, October 15, 2015, of the Utah State Bulletin.)

Emergency rule reason and justification:

Regular rulemaking procedures would place the agency in violation of federal or state law.

Justification: The Department must implement by rule provisions of the Medically Complex Children's Waiver by 10/01/2015, to comply with waiver approval from the Centers for Medicare and Medicaid Services for implementation on that date.

State statutory or constitutional authorization for this rule:

• Subsection 1915(c) of the Social Security Act
• Section 26-1-5
• Section 26-18-3

This rule or change incorporates by reference the following material:

• Adds Medically Complex Children's Waiver Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 10/01/2015

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget because this amendment does not affect the amount of funds the legislature previously appropriated for waiver services during the 2015 General Session.

local governments:

There is no impact to local governments because they neither fund nor provide waiver services to Medicaid recipients.

small businesses:

There is no impact to small businesses because this amendment does not affect the amount of funds the legislature previously appropriated for waiver services during the 2015 General Session.

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

There is no impact to Medicaid providers and to Medicaid recipients because this amendment does not affect the amount of funds the legislature previously appropriated for waiver services during the 2015 General Session.

Compliance costs for affected persons:

There are no compliance costs to a single Medicaid provider or to a Medicaid recipient because this amendment does not affect the amount of funds the legislature previously appropriated for waiver services during the 2015 General Session.

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

This amendment does not fiscally impact business because it does not decrease or add any regulation requirements governing business, and funds for the waiver were previously appropriated during the 2015 General Session.

Joseph K. Miner, MD, 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

This rule is effective on:

10/01/2015

Authorized by:

Joseph Miner, Executive Director

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

R414-1. Utah Medicaid Program.

R414-1-5. Incorporations by Reference.

(1) The Department incorporates by reference the October 1, 2015, version of the Medically Complex Children's Waiver Utah Medicaid Provider Manual.

(2) The Department incorporates the July 1, 2015, versions of the following by reference:

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

([2]b) Medical Supplies Utah Medicaid Provider Manual, Section 2, Medical Supplies, as applied in Rule R414-70, and the manual's attachment for Donor Human Milk Request Form;

([3]c) Hospital Services Utah Medicaid Provider Manual with its attachments;

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

([5]e) Speech-Language Pathology and Audiology Services Utah Medicaid Provider Manual;

([6]f) Hospice Care Utah Medicaid Provider Manual, and the manual's attachment for the Utah Medicaid Prior Authorization Request for Hospice Services;

([7]g) Long Term Care Services in Nursing Facilities Utah Medicaid Provider Manual with its attachments;

([8]h) Personal Care Utah Medicaid Provider Manual and the manual's attachment for the Request for Prior Authorization: Personal Care and Capitated Programs;

([9]i) Utah Home and Community-Based Waiver Services for Individuals Age 65 or Older Utah Medicaid Provider Manual;

([10]j) Utah Home and Community-Based Waiver Services for Individuals with an Acquired Brain Injury Utah Medicaid Provider Manual;

([11]k) Utah Community Supports Waiver for Individuals with Intellectual Disabilities or Other Related Conditions Utah Medicaid Provider Manual;

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

([13]m) Utah Home and Community-Based Waiver Services New Choices Waiver Utah Medicaid Provider Manual;

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

([15]o) Utah Home and Community-Based Waiver Services Medicaid Autism Waiver Utah Medicaid Provider Manual;

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

([17]q) Pharmacy Services Utah Medicaid Provider Manual with its attachments;

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

([19]s) CHEC Services Utah Medicaid Provider Manual with its attachments;

([20]t) Chiropractic Medicine Utah Medicaid Provider Manual;

([21]u) Dental, Oral Maxillofacial, and Orthodontia Services Utah Medicaid Provider Manual;

([22]v) General Attachments (All Providers) for the Utah Medicaid Provider Manual;

([23]w) Indian Health Utah Medicaid Provider Manual;

([24]x) Laboratory Services Utah Medicaid Provider Manual with its attachments;

([25]y) Medical Transportation Utah Medicaid Provider Manual;

([26]z) Non-Traditional Medicaid Plan Utah Medicaid Provider Manual with its attachments;

([27]aa) Licensed Nurse Practitioner Utah Medicaid Provider Manual;

([28]bb) Physical Therapy and Occupational Therapy Services Utah Medicaid Provider Manual, and the manual's attachment for Physical Therapy and Occupational Therapy Decision Tables;

([29]cc) Physician Services, Anesthesiology and Laboratory Services Utah Medicaid Provider Manual with its attachments;

([30]dd) Podiatric Services Utah Medicaid Provider Manual;

([31]ee) Primary Care Network Utah Medicaid Provider Manual with its attachments;

([32]ff) Psychology Services Utah Medicaid Provider Manual;

([33]gg) Rehabilitative Mental Health and Substance Use Disorder Services Utah Medicaid Provider Manual;

([34]hh) Rural Health Clinics and Federally Qualified Health Centers Services Utah Medicaid Provider Manual;

([35]ii) School-Based Skills Development Services Utah Medicaid Provider Manual;

([36]jj) Section I: General Information Utah Medicaid Provider Manual;

([37]kk) Targeted Case Management for Individuals with Serious Mental Illness Utah Medicaid Provider Manual;

([38]ll) Targeted Case Management for Early Childhood (Ages 0-4) Utah Medicaid Provider Manual;

([39]mm) Vision Care Services Utah Medicaid Provider Manual; and

([40]nn) Women's Services Utah Medicaid Provider Manual.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: October 1, 2015

Notice of Continuation: March 2, 2012

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