DAR File No. 43227

Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-516

Nursing Facility Non-State Government-Owned Upper Payment Limit Quality Improvement Program

Notice of Proposed Rule

(Amendment)

DAR File No.: 43227
Filed: 09/28/2018 03:15:34 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to clarify Quality Improvement (QI) participation requirements for the Nursing Facility Non-State Government-Owned Upper Payment Limit (NF NSGO UPL) program.

Summary of the rule or change:

This amendment clarifies QI participation requirements for providers that enter the NF NSGO UPL program during the first program calendar year. It also makes other technical changes.

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 to the state budget because this change only clarifies QI participation requirements for the NF NSGO UPL program. It neither affects patient services nor provider reimbursement.

local governments:

There is no impact on local governments because they neither fund nor administer the NF NSGO UPL program.

small businesses:

There is no impact on small businesses because this change only clarifies QI participation requirements for the NF NSGO UPL program. It neither affects patient services nor provider reimbursement.

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

There is no impact on Medicaid providers and Medicaid members because this change only clarifies QI participation requirements for the NF NSGO UPL program. It neither affects patient services nor provider reimbursement.

Compliance costs for affected persons:

There are no compliance costs to a single Medicaid provider or to a Medicaid member because this change only clarifies QI participation requirements for the NF NSGO UPL program. It neither affects patient services 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 change 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 [email protected]

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:

11/14/2018

This rule may become effective on:

11/21/2018

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 50 non-state government-owned nursing facilities will be impacted because this change only clarifies participation requirements for the Quality Improvement (QI) program. It neither affects patient services nor provider reimbursement.

 

 

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

R414-516. Nursing Facility Non-State Government-Owned Upper Payment Limit Quality Improvement Program.

R414-516-1. Introduction and Authority.

This rule defines the participation requirements for the Quality Improvement (QI) program within the Nursing Care Facility Non-State Government-Owned Upper Payment Limit (NF NSGO UPL) program. This rule [only applies]applies only to [NF]nursing facility providers who are part of a [C]contract with the Department to participate in the NF NSGO UPL program. This rule is authorized by Sections 26-1-5 and 26-18-3.

 

R414-516-3. Quality Improvement Program Requirements of Participation.

(1) A program is required to earn quality improvement (QI) points to participate in the NF NSGO UPL Program. A program shall earn and document:

(a) In Calendar Year 2018, 10 or more QI points with a minimum of five QI points from S[ubs]ection R414-516-6;

(b) In Calendar Year 2019, 12 or more QI points with a minimum of six QI points from S[ubs]ection R414-516-6;

(c) In Calendar Year 2020 and beyond, 14 or more QI points with a minimum of seven from S[ubs]ection R414-516-6.

(2) QI points may be earned from any combination of the QI Program Categories as long as the minimum number of QI points are earned from S[ubs]ection R414-516-6.

(3) When calculating compliance under Section R414-516-6, a program shall not count residents who are in the facility less than 14 days.

(4) Each program shall submit to the Division a compliance form, using the current Division form, within 30 days of the end of the calendar year documenting that the program qualifies to earn points under the selected QI program categories. A compliance form must be mailed or electronically mailed to the correct address found at www.health.utah.gov/medicaid/stplan/longtermcarefqi.htm.

(5) The Division does not require a p rovider that enters the NF NSGO UPL program for only part of a calendar year to comply with the QI provisions of Section R414-516-3 in the first program calendar year.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [ January 1, ]2018

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