DAR File No. 40295

Health, Children's Health Insurance Program

Section R382-10-17

Effective Date of Enrollment and Renewal

Notice of Proposed Rule

(Amendment)

DAR File No.: 40295
Filed: 04/04/2016 02:58:39 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to extend the reporting requirement for the Children's Health Insurance Program (CHIP) when adding a newborn or newly adopted child to eliminate gaps in coverage for individuals who transfer from the Federally Facilitated Marketplace (FFM).

Summary of the rule or change:

This amendment extends the reporting requirement for CHIP when adding a newborn or newly adopted child when the change report comes from 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 is no impact to the state budget because this amendment neither increases nor decreases the number of individuals who become eligible for CHIP.

local governments:

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

small businesses:

There is no impact to small businesses because this amendment neither increases nor decreases the number of individuals who become eligible for CHIP.

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

There is no impact to CHIP providers and to CHIP recipients because this amendment neither increases nor decreases the number of individuals who become eligible for CHIP.

Compliance costs for affected persons:

There is no impact to a single CHIP provider or to a CHIP recipient because this amendment neither increases nor decreases the number of individuals who become eligible for CHIP.

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

There is no fiscal impact on business because the amendment does not change the number of recipients eligible for CHIP.

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
Children's Health Insurance Program
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:

05/31/2016

This rule may become effective on:

06/07/2016

Authorized by:

Joseph Miner, Executive Director

R382. Health, Children's Health Insurance Program.

R382-10. Eligibility.

R382-10-17. Effective Date of Enrollment and Renewal.

(1) Subject to the limitations in Section R414-306-6, Section R382-10-10, and the provisions in Subsection R414-308-3(7), the effective date of CHIP enrollment is the first day of the application month.

(2) If the eligibility agency receives an application during the first four days of a month, the agency shall allow a grace enrollment period that begins no earlier than four days before the date that the agency receives a completed and signed application.

(a) If the eligibility agency allows a grace enrollment period that extends into the month before the application month, the days of the grace enrollment period do not count as a month in the 12-month enrollment period.

(b) During the grace enrollment period, the individual must receive medical services, meet eligibility criteria, and have an emergency situation that prevents the individual from applying. The Department may not pay for any services that the individual receives before the effective enrollment date.

(3) For a family who has a child enrolled in CHIP and who adds a newborn or adopted child, the effective date of enrollment is the date of birth or placement for adoption if the family requests the coverage within [3]60 days of the birth or adoption. If the family makes the request more than [3]60 days after the birth or adoption, enrollment in CHIP [will be effective beginning]becomes effective the first day of the month in which the date of report occurs, subject to the limitations in Section R414-306-6, Section R382-10-10, and the provisions of Subsection R382-10-17(2).

(4) For an individual who transfers from the Federally Facilitated Marketplace (FFM), the effective date of enrollment to add a newborn or adopted child is the date of birth or placement for adoption if the individual requests FFM coverage within 60 days of the birth or adoption. If the request is more than 60 days after the birth or adoption, enrollment in CHIP becomes effective the first day of the month in which the date of report occurs, subject to the limitations in Section R414-306-6, Section R382-10-10, and the provisions of Subsection R382-10-17(2).

( 5[4]) The effective date of enrollment for a new certification period after the review month is the first day of the month after the review month, if the review process is completed by the end of the review month. If a due process month is approved, the effective date of enrollment for a renewal is the first day of the month after the due process month if the review process is completed by the end of the due process month. The enrollee must complete the review process and continue to be eligible to be reenrolled in CHIP at review.

 

KEY: children's health benefits

Date of Enactment or Last Substantive Amendment: [November 16, 2015]2016

Notice of Continuation: May 9, 2013

Authorizing, and Implemented or Interpreted Law: 26-1-5; 26-40