DAR File No. 44184

Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-308

Application, Eligibility Determinations and Improper Medical Assistance

Notice of Proposed Rule

(Amendment)

DAR File No.: 44184
Filed: 11/01/2019 04:57:25 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to implement H.B. 460, passed during the 2019 General Session, and to implement provisions of the Support for Patients and Communities Act, passed by the 115th Congress.

Summary of the rule or change:

This amendment implements a suspension of Medicaid coverage for incarcerated individuals, but neither denies nor terminates their eligibility.

Statutory or constitutional authorization for this rule:

• 42 U.S.C 1396a(84)(A)
• 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 the suspension of Medicaid coverage neither affects current nor future appropriations.

local governments:

There is no impact to local governments because they neither fund Medicaid services nor determine eligibility under the Medicaid program.

small businesses:

There is no impact to small businesses because the suspension of Medicaid coverage neither affects current nor future appropriations.

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

There is no impact to Medicaid providers and to Medicaid members because the suspension of Medicaid coverage neither affects current nor future appropriations.

Compliance costs for affected persons:

There is no impact to a single Medicaid provider or to a Medicaid member because the suspension of Medicaid coverage neither affects current nor future appropriations.

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 amendment 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 801-237-0750, 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:

12/16/2019

This rule may become effective on:

12/23/2019

Authorized by:

Joseph Miner, Executive Director

Appendix 1: Regulatory Impact Summary Table*

Fiscal Costs	FY 2020	FY 2021	FY 2022
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 approximate 27,000 non-small business providers of Medicaid services will be impacted because the suspension of Medicaid coverage neither affects current nor future appropriations.

 

The Executive Director of the Department of Health, Joseph K. Miner, MD, has reviewed and approved this fiscal analysis.

 

 

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

R414-308. Application, Eligibility Determinations[ and], Improper Medical Assistance, and Suspension of Benefits.

R414-308-2. Definitions.

(1) The definitions in Rules R414-1 and R414-301 apply to this rule.

(2) In addition, the following definitions apply:

(a) "Due date" means the date that a recipient is required to report a change or provide requested verification to the eligibility agency.

(b) "Eligibility review" means a process by which the eligibility agency reviews current information about a recipient's circumstances to determine whether the recipient is still eligible for medical assistance.

(c) "Open enrollment" means a period of time when the eligibility agency accepts applications.

(d) "Suspension of Benefits" means a period of time when an incarcerated individual is still Medicaid eligible, but loses Medicaid coverage.

 

R414-308-10. Suspension of Benefits.

Individuals who are inmates of a public institution will not be closed or denied Medicaid eligibility, but placed in a suspended status. The following apply to suspension of benefits:

(1) Suspension of benefits applies to all Medicaid coverage groups;

(2) All factors of eligibility must be met to be suspended;

(3) Reviews must be completed for all individuals in a suspended status, with the exception of an individual who is under 21 years of age, or eligible for the Former Foster Care program.

 

KEY: public assistance programs, applications, eligibility, Medicaid

Date of Enactment or Last Substantive Amendment: [May 8, 2018]2019

Notice of Continuation: January 8, 2018

Authorizing, and Implemented or Interpreted Law: 26-18