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 R414-27. Medicaid Enrollment Process for Nursing Care Facilities.

As in effect on July 1, 2019

Table of Contents

R414-27-1. Introduction and Authority.

(1) This rule governs the enrollment of nursing care facilities to receive Medicaid payments for services to Medicaid eligible individuals.

(2) This rule outlines the duties of the transferor and transferee following a change of ownership.

(3) This rule is authorized under Sections 26-18-3 and 26-18-5.

R414-27-2. Definitions.

(1) "Change of Ownership" (CHOW) means the owner of a licensed and certified nursing care facility program (transferor) transfers ownership of that program to another entity (transferee).

(2) "Transferor" is the entity or nursing care facility program transferring ownership to another entity.

(3) "Transferee" is the entity receiving ownership of the nursing care facility program from another entity.

(4) "Independent analysis" referred to in Subsection 26-18-503(5)(b) means an analysis performed by independent third-party certified public accountants in accordance with generally accepted accounting principles.

R414-27-3. Medicaid Certification Subsequent to CHOW.

(1) The Division of Medicaid and Health Financing (DMHF) may not process an enrollment application for the transferee until the transferor has voided all claims for services on or after the effective date of the CHOW.

(2) A transferor shall settle any outstanding amounts it owes to Medicaid within 30 days of Medicaid enrollment by the transferee. If the transferor fails to return any outstanding amounts as required in Subsection R414-27-3(2):

(a) The transferor shall be subject to a penalty of the greater of $50 or 5 percent of the outstanding amount;

(b) Interest shall also be accrued at a rate of 12 percent annually on any outstanding amount and shall be accrued beginning on the 31st day following the effective date of the CHOW;

(c) DMHF may waive the imposition of a penalty for good cause.

(3) The transferee shall:

(a) Once a provisional license is issued, submit the following to the DMHF Provider Enrollment team in a timely manner:

(i) A provider enrollment application; and

(ii) A copy of the provisional license.

(b) Be enrolled in Medicaid as a new provider before submitting claims.

(4) If the transferee seeks Medicare certification and the Medicare certification date is different than the issued provisional license or Medicaid enrollment effective begin date, then the Medicaid enrollment date shall be the later of the Medicare certification date or the provisional license date. If the Medicare certification date is later than the issued provisional license date, then the transferor may submit Medicaid claims up to, but not including, the Medicare certification date for the transferee in accordance with all other applicable regulations.

(5) If the transferee seeks Medicare certification, the transferee may be enrolled in Medicaid before becoming Medicare-certified provided the transferee is an approved provider, in accordance with 42 CFR 455, Subpart E.

KEY

Medicaid

Date of Enactment or Last Substantive Amendment

December 1, 2017

Notice of Continuation

January 2, 2018

Authorizing, Implemented, or Interpreted Law

26-1-5; 26-18-3; 26-18-503


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.