DAR File No. 42306

Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-4x

Policy Statement on Denial of Payment to Medicaid Provider When Client Fails to Keep Scheduled Appointment

Notice of Proposed Rule

(Repeal)

DAR File No.: 42306
Filed: 11/07/2017 09:34:17 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

Based on its five-year review of this rule, the Department of Health will file a repeal because one provision no longer applies to Medicaid policy, and the other provision is already set forth in the Medicaid provider manual.

Summary of the rule or change:

This rule is repealed in its entirety. The rule's policy statement on failed appointments no longer applies and provisions for fraudulent billing practices are spelled out in the Medicaid provider manual.

Statutory or constitutional authorization for this rule:

• Section 26-1-4
• Section 26-1-5

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget because this rule repeal only updates and clarifies Medicaid policy. It neither affects service coverage nor provider reimbursement.

local governments:

There is no impact to local governments because they neither fund nor administer the Medicaid program.

small businesses:

There is no impact to small businesses because this rule repeal only updates and clarifies Medicaid policy. It neither affects service coverage nor provider reimbursement.

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

There is no impact to Medicaid providers and to Medicaid members because this rule repeal only updates and clarifies Medicaid policy. It neither affects service coverage nor provider reimbursement.

Compliance costs for affected persons:

There is no impact to a single Medicaid provider or to a Medicaid member because this rule repeal only updates and clarifies Medicaid policy. It neither affects service coverage nor provider reimbursement.

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 repeal 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 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:

01/02/2018

This rule may become effective on:

01/09/2018

Authorized by:

Joseph Miner, Executive Director

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

[R414-4x. Policy Statement on Denial of Payment to Medicaid Provider When Client Fails to Keep Scheduled Appointment.

R414-4x-1.

This policy is developed in accordance with the Medicare Update Bulletin, January 1982 (82-01), and the Utah Medicaid Information Bulletin 83-20.

Reimbursement shall not be made to a provider for service not actually furnished to a client because the client failed to keep a scheduled appointment.

Billing for services not rendered is improper, and may constitute fraud. If a provider, physician or supplier of services does not render a specifically identifiable service to a client, there is no basis for submitting a bill for reimbursement for services rendered.

Further information can be found in the Medicaid Provider Manual Section III.

 

KEY: medicaid

Date of Enactment or Last Substantive Amendment: 1987

Notice of Continuation: November 15, 2012

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