DAR File No. 44185

This rule was published in the November 15, 2019, issue (Vol. 2019, No. 22) of the Utah State Bulletin.


Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-302

Eligibility Requirements

Notice of Proposed Rule

(Amendment)

DAR File No.: 44185
Filed: 11/01/2019 05:12:51 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 [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:

12/16/2019

This rule may become effective on:

12/23/2019

Authorized by:

Joseph Miner, Executive Director

RULE TEXT

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.

R414-302. Eligibility Requirements.

R414-302-6. Residents of Institutions.

(1) For purposes of institutions, the definitions in 42 CFR 435.1010 apply.

(2) An individual who resides in a halfway house may receive Medicaid coverage if the halfway house meets the following criteria:

(a) The halfway house allows the individual to work outside the facility;

(b) The halfway house allows the individual to use community facilities at will, such as libraries, grocery stores, recreation areas, or schools; and

(c) The halfway house allows the individual to seek health care treatment in the community to the same extent as other Medicaid enrollees.

(3) The Department does not consider an individual who resides in a temporary shelter for a limited period of time as a resident of an institution.

(4) Individuals who are inmates of public institutions are not eligible for Medicaid coverage. As described in Section R414-308-10, individuals who are incarcerated will not be denied Medicaid eligibility nor will their cases be closed, but their cases will be placed in a suspended status.

(5) Individuals who reside in an institution for mental disease (IMD) are not eligible for Medicaid coverage with the following exceptions:

(a) Individuals 65 years of age or older;

(b) Individuals under 22 years of age who receive inpatient psychiatric services as described in 42 CFR 440.160; and

(c) Individuals who reside in an IMD that is licensed as a Substance Use Disorder (SUD) residential treatment program and are receiving treatment for an SUD.

 

KEY: state residency, citizenship, third party liability, Medicaid

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

Notice of Continuation: January 8, 2018

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


Additional Information

More information about a Notice of Proposed Rule is available online.

The Portable Document Format (PDF) version of the Bulletin is the official version. The PDF version of this issue is available at https://rules.utah.gov/publicat/bull_pdf/2019/b20191115.pdf. The HTML edition of the Bulletin is a convenience copy. Any discrepancy between the PDF version and HTML version is resolved in favor of the PDF version.

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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 801-237-0750, or by Internet E-mail at [email protected].  For questions about the rulemaking process, please contact the Office of Administrative Rules.