DAR File No. 43036

Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-55

Medicaid Policy for Hospital Emergency Department Copayment Procedures

Notice of Proposed Rule

(Repeal)

DAR File No.: 43036
Filed: 06/27/2018 09:09:25 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

Based on the five-year review for this rule, the Department of Health (Department) will repeal this rule because Medicaid cost-sharing policy is already set forth in the Medicaid State Plan.

Summary of the rule or change:

This rule is repealed in its entirety because all cost-sharing policy is consolidated in the Medicaid State Plan, making the rule unnecessary.

Statutory or constitutional authorization for this rule:

• Section 26-1-5
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

There is no impact on the state budget because this repeal neither affects service coverage nor provider reimbursement.

local governments:

There is no impact on local governments because they do not fund member services under the Medicaid program.

small businesses:

There is no impact on small businesses because this repeal neither affects service coverage nor provider reimbursement.

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

There is no impact on Medicaid providers or Medicaid members because this repeal neither affects service coverage nor provider reimbursement.

Compliance costs for affected persons:

There is no impact on a single Medicaid provider or a Medicaid member because this repeal 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 the repeal of this 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 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:

08/14/2018

This rule may become effective on:

08/21/2018

Authorized by:

Joseph Miner, Executive Director

Appendix 1: Regulatory Impact Summary Table*

Fiscal Costs	FY 2019	FY 2020	FY 2021
State Government	$0	$0	$0
Local Government	$0	$0	$0
Small Businesses	$0	$0	$0
Non-Small Businesses	$0	$0	$0
Other Person	$0	$0	$0
Total Fiscal Costs:	$0	$0	$0
Fiscal Benefits
State Government	$0	$0	$0
Local Government	$0	$0	$0
Small Businesses	$0	$0	$0
Non-Small Businesses	$0	$0	$0
Other Persons	$0	$0	$0
Total Fiscal Benefits:	$0	$0	$0
Net Fiscal Benefits:	$0	$0	$0

 

*This table only includes fiscal impacts that could be measured. If there are inestimable fiscal impacts, they will not be included in this table. Inestimable impacts for State Government, Local Government, Small Businesses and Other Persons are described in the narrative. Inestimable impacts for Non - Small Businesses are described in Appendix 2.

 

Appendix 2: Regulatory Impact to Non - Small Businesses

None of the 113 hospitals that provide outpatient emergency services will be impacted because cost-sharing policy is already implemented through the Medicaid State Plan. The repeal neither affects member services nor provider reimbursement.

 

 

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

[R414-55. Medicaid Policy for Hospital Emergency Department Copayment Procedures.

R414-55-1. Introduction and Authority.

This rule establishes Medicaid copayment policy for non-emergency use of outpatient hospital emergency departments by Medicaid clients who are not in any of the categories exempted from copayment requirements. The rule is authorized by 42 CFR 447.15 and 447.50 through 447.59, Oct. 2003 ed., which are adopted and incorporated by reference.

 

R414-55-2. Definitions.

In addition to the definitions in R414-1, the following definitions also apply to this rule:

(1) "Child" means any person under the age of 18.

(2) "Copayment" means that form of cost sharing required of a Medicaid client at the time a service is provided, with the amount of copayment specified beforehand.

(3) "Emergency Services" means those services defined by a select group of International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis codes which Medicaid shall identify for hospital Emergency Departments by means of Medicaid Information Bulletins.

(4) "Hospital Emergency Department" means that area of a hospital in which emergency services are provided on a 24-hour-a-day basis.

 

R414-55-3. Copayment Policy.

Each Medicaid client is responsible to pay a copayment amount that complies with the requirements of the Utah Medicaid State Plan and Rule R414-1.

 

KEY: Medicaid

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

Notice of Continuation: June 28, 2013

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