Utah Administrative Code

The Utah Administrative Code is the body of all effective administrative rules as compiled and organized by the Division of Administrative Rules (see Subsection 63G-3-102(5); see also Sections 63G-3-701 and 702).

NOTE: For a list of rules that have been made effective since July 1, 2019, please see the codification segue page.

NOTE TO RULEFILING AGENCIES: Use the RTF version for submitting rule changes.


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

Rule R414-8. Electronic Personal Medical Records for the Medicaid Program.

As in effect on July 1, 2019

Table of Contents

R414-8-1. Introduction and Authority.

This rule is promulgated under authority granted in Section 26-18-3, as last amended by Laws of Utah 2012, Chapters 28 and 242.

R414-8-2. Purpose.

This rule establishes requirements for enrolling Medicaid beneficiaries in the electronic exchange of clinical health information unless the individual opts out.

R414-8-3. Definitions.

These definitions apply to Rule R414-8:

(1) "Medicaid beneficiaries" mean individuals who receive assistance through the following programs:

(a) Medicaid;

(b) Primary Care Network;

(c) Utah's Premium Partnership for Health Insurance;

(d) Baby Your Baby;

(e) Cost sharing programs that include Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualified Individual (QI).

(2) "Technical Specifications" means the technical specifications document published by the Utah Health Information Network (UHIN) that describes the variables and formats of the data to be submitted as well as submission directions and guidelines.

(3) "Program Website" means the Department of Health, Department of Workforce Services, Division of Medicaid and Health Financing, Utah's Premium Partnership for Health Insurance, and Primary Care Network websites.

R414-8-4. Enrollment Notification.

(1) Prior to the enrollment process in the Clinical Health Information Exchange (cHIE), the Department will provide Notice of Intent to Medicaid beneficiaries in cHIE and the right of individuals to opt out.

(2) The Department will provide additional education regarding the individual's right to opt out on the program websites.

R414-8-5. Enrollment Process.

(1) The Department will provide cHIE an enrollment file of all Medicaid beneficiaries.

(2) The enrollment file will contain the succeeding month's Medicaid enrollment.

(3) cHIE will enroll Medicaid beneficiaries on the first day of the succeeding month.

(4) Submission procedures and guidelines, including required data elements, will be described in detail in the technical specifications published by UHIN and will be included in the Department's Operating Agreement with cHIE.

(5) The Department will use a secure format to transfer any enrollment files to cHIE.

R414-8-6. Exemptions.

(1) An individual's previous consent status in cHIE will be honored by cHIE and will not be overridden by the Medicaid enrollment file.

KEY

Medicaid, cHIE

Date of Enactment or Last Substantive Amendment

September 1, 2012

Notice of Continuation

July 28, 2017

Authorizing, Implemented, or Interpreted Law

26-1-5; 26-18-3


Additional Information

Contact

For questions regarding the content or application of rules under Title R414, please contact the promulgating agency (Health, Health Care Financing, Coverage and Reimbursement Policy). A list of agencies with links to their homepages is available at http://www.utah.gov/government/agencylist.html or from http://www.rules.utah.gov/contact/agencycontacts.htm.