DAR File No. 42182
This rule was published in the October 15, 2017, issue (Vol. 2017, No. 20) of the Utah State Bulletin.
Health, Health Care Financing, Coverage and Reimbursement Policy
Medicaid Certification of Nursing Care Facilities
Notice of Proposed Rule
(Repeal and Reenact)
DAR File No.: 42182
Filed: 10/02/2017 05:20:14 PM
Purpose of the rule or reason for the change:
The purpose of this change is to comply with new provisions found in Section 26-18-503, which relate to the transfer of Medicaid-certified programs and the settling of outstanding amounts.
Summary of the rule or change:
In contrast to the old rule, the new rule includes definitions that apply to the transfer of ownership of nursing care facility programs. It also includes provisions for penalties and interest for outstanding amounts the transferor owes Medicaid, and requires the transferor to void all previous claims for services. The new rule also includes transferee application, enrollment, and submission requirements upon the transferee becoming a Medicaid provider. The old rule included items found in Section 26-18-503.
Statutory or constitutional authorization for this rule:
- Section 26-18-503
- Section 26-18-3
Anticipated cost or savings to:
the state budget:
There is no impact to the state budget because the Legislature has already allocated funds to cover the cost of implementing these changes in accordance with state law.
There is no cost to local governments because they do not fund nursing care facility programs under Medicaid.
There is no impact to small businesses because the Legislature has already allocated funds to cover the cost of implementing these changes in accordance with state law.
persons other than small businesses, businesses, or local governmental entities:
There is no impact to Medicaid providers or to Medicaid members because the Legislature has already allocated funds to cover the cost of implementing these changes in accordance with state law.
Compliance costs for affected persons:
There are no compliance costs to a single Medicaid provider or to a Medicaid member because the Legislature has already allocated funds to cover the cost of implementing these changes in accordance with state law.
Comments by the department head on the fiscal impact the rule may have on businesses:
After conducting a thorough analysis, it was determined that this proposed rule will not result in a fiscal impact to businesses.
Joseph K. Miner, MD, Executive Director
The full text of this rule may be inspected, during regular business hours, at the Office 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 firstname.lastname@example.org
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:
This rule may become effective on:
Joseph Miner, Executive Director
R414. Health, Health Care Financing, Coverage and Reimbursement Policy.
R414-27. Medicaid Certification of Nursing Care
R414-27-1. Introduction and Authority.
(1) This rule governs the certification of nursing care
facilities to receive Medicaid payments for services to Medicaid
eligible individuals. (2) This rule implements Title 26, Chapter 18, Part
5. (3) Section 26-18-3 authorizes this rule.
R414-27-2. Medicaid Certification Requirements.
(1) The director of the Division of Health Care Financing
(DHCF) within the Department of Health may authorize Medicaid
certification for a nursing care facility that: (a) is in compliance with 42 CFR Part 483 or has a plan
of correction approved by the Department to remedy areas of
noncompliance; (b) is in compliance with the Health Care Facility
Licensing and Inspection Act, Title 26, Chapter 21, and the rules
applicable to nursing homes made pursuant to that act or has a
plan of correction approved by the Department to remedy areas of
noncompliance; (c) has not increased its certified bed capacity
by more than 30 percent annually after March 31, 2004, except as
authorized in Subsection 26-18-503(5); (d) is Medicare-certified by the Centers for Medicare and
Medicaid Services to provide care for Medicare clients; (e) since March 18, 2008, has not increased its licensed
bed capacity except in conjunction with an increase in certified
bed capacity as authorized in Subsection 26-18-503(5) or for
which the DHCF Director has approved the increase in the nursing
care facility program's certified bed capacity expansion
before October 15, 2007; and (f) since March 18, 2008, has not increased its certified
bed capacity except as authorized in Subsection
26-18-503(5). (2) The "independent analysis" referred to in
Subsection 26-18-503(5)(b) must be performed by unrelated
certified public accountants in accordance with generally
accepted accounting principles. (3) A nursing care facility is not eligible for Medicaid
certification if it expands bed capacity without prior approval
from the DHCF Director as authorized in this section, except as
outlined in Section 26-18-505.
R414-27-3. Medicaid Certification Subsequent to Change of
(1) The owner of a nursing care facility program may
transfer ownership to another person. The transferred nursing
care facility may become Medicaid certified if: (a) the nursing care facility is in compliance with
Section R414-27-2 at the time of transfer; (b) the transferee operates the nursing care facility at
the same physical location as the previous Medicaid-certified
program; (c) the transferee agrees to pay the Department's
litigation costs if any third party asserts a right to operate
the transferred Medicaid-certified nursing care
facility; (d) the transferee certifies that bed capacity will not
expand through a third party owner with a legitimate claim to
operate the transferred Medicaid-certified nursing care
facility; (e) the transferee applies for and takes all necessary
steps to become Medicaid-certified within one year of the date
the previously certified nursing care facility ceased to provide
medical assistance to a Medicaid client; (2) If a third party is found, by final agency action of
the Department after exhaustion of all administrative and
judicial appeal rights, to be entitled to operate a certified
program at the physical facility, the transferee shall
voluntarily comply with Subsection 26-18-503(4)(b). The
Department of Health may revoke Medicaid certification if the
transferee does not comply with Subsection
26-18-503(4)(b). (3) the transferee that receives Medicaid certification
after taking ownership under the provisions of Subsection
R414-27-3(1) does not assume the Medicaid liabilities of the
previous nursing care facility program if the transferee is not a
third party owner in whole or in part of the previous nursing
care facility program.
R414-27-4. Medicaid Certification Subsequent to Renovation
or Construction of a New Physical Facility.
A nursing care facility operating in a new or renovated
facility is eligible for re-certification if the nursing care
facility: (1) was certified at the time of renovation or new
construction; (2) was in compliance with Sections R414-27-2 and
R414-27-3 when it ceased providing care to Medicaid clients at
the prior location or before beginning renovations; (3) is in the same county or within a five mile radius of
the original facility; (4) the construction is completed no later than three
years after the date the nursing care facility ceased to operate
in the original facility; and (5) notifies DHCF no later than 90 days after the date
outlined in Subsection R414-27-4(1) of its intent to retain its
Date of Enactment or Last Substantive Amendment: [
May 12, 2009]
Notice of Continuation: January 9, 2013
Authorizing, and Implemented or Interpreted Law: 26-1-5; 26-18-3; 26-18-503
More information about a Notice of Proposed Rule is available online.
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For questions regarding the content or application of this rule, please contact 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@example.com. For questions about the rulemaking process, please contact the Office of Administrative Rules.