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 August 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 R414-505. Participation in the Nursing Facility Non-State Government-Owned Upper Payment Limit Program.
As in effect on August 1, 2019
Table of Contents
- R414-505-1. Introduction and Authority.
- R414-505-2. Definitions.
- R414-505-3. Nursing Care Facility Non-State Government-Owned Upper Payment Limit Payment Program.
- R414-505-4. Notice of Intent to Participate.
- R414-505-5. Requirements to Participate in the NF NSGO UPL Program.
- R414-505-6. Intergovernmental Transfer (IGT) Certification.
- Date of Enactment or Last Substantive Amendment
- Authorizing, Implemented, or Interpreted Law
This rule defines the participation requirements in the Nursing Care Facility Non-State Government-Owned Upper Payment Limit (NF NSGO UPL) program. This rule is authorized under Attachment 4.19-D of the Utah Medicaid State Plan, and by Sections 26-1-5 and 26-18-3.
In addition to the following, the definitions in Section 26-18-502 and Attachment 4.19-D of the Medicaid State Plan apply to this rule:
(1) "Non-state governmental entity (NSGE)" means a hospital authority, hospital district, healthcare district, special services district, county, or city.
(2) "Non-state government-owned (NSGO) nursing care facility" means a nursing care facility where an NSGE holds the license and is party to the facility's Medicaid provider contract.
(3) "Eligible nursing care facilities" means facilities that are NSGO nursing facilities which comply with the requirements described in this rule.
(4) "Public funds" means funds derived from taxes, assessments, levies, investments, governmental operations, and revenue generated by a special services district and other public revenues within the sole and unrestricted control of an NSGE that holds the license and is party to the Medicaid contract of the eligible nursing care facility. Public funds do not include gifts, grants, trusts, or donations, the use of which is conditioned on supplying a benefit solely to the donor or grantor of the funds and may not be derived from an impermissible source, including recycled Medicaid payments, federal money precluded from use as the non-federal share, impermissible taxes, and non-bona fide provider-related donations.
(5) "Effective date of the change of ownership" means the issue date of the license for the new owner by the Utah Department of Health.
The NF NSGO UPL supplemental payment program is governed by Attachment 4.19-D of the Medicaid State Plan.
(1) Required application. Before an NSGO nursing care facility may receive supplemental payments, the appropriate NSGE must certify certain facts, representations, and assurances regarding program requirements. The NSGE must complete the "NF NSGO UPL Program Notice of Participation Form", prescribed by the Medicaid agency.
(2) The required application must be mailed to the correct address, as follows:
Via United States Postal Service:
Utah Department of Health
Attn: Reimbursement Unit
P.O. Box 143102
Salt Lake City, UT 84114-3102
Via United Parcel Service, Federal Express, and similar:
Utah Department of Health
Attn: Reimbursement Unit
288 North 1460 West
Salt Lake City, UT 84116-3231
(3) The "NSGO NF UPL Program Notice of Participation Form" must be complete and accurate or it will be returned. Incomplete forms shall not be considered as providing notice of intent to participate.
(1)(a) The nursing care facility must be owned by an NSGE.
(b) Prior to the Medicaid agency initiating a contract, the nursing care facility owner shall provide appropriate legal evidence, as determined by the Medicaid agency, demonstrating the nursing care facility is owned by an NSGE.
(c) A nursing care facility participating in this supplemental payment program must notify the Reimbursement Unit within the Bureau of Coverage and Reimbursement Policy, at the address noted above, of changes in ownership that may affect the nursing care facility's continued eligibility within 14 calendar days after such change.
(2) The Utah Medicaid provider enrollment process must be complete.
(3)(a) The NSGE must have an NF NSGO UPL contract in effect, signed by the Utah Department of Health's authorized representative.
(b) The effective date for an NF NSGO UPL contract for a nursing care facility to participate in the NF NSGO UPL supplemental payments shall be the latter of the following dates:
(i) The effective date of the Change of Ownership (CHOW);
(ii) The postmark date of the notice of intent to participate as noted in Section R414-505-4; or
(iii) The effective date of the Medicaid provider enrollment.
(4) Once a contract is in effect, the payments will be made in accordance with Attachment 4.19-D of the Medicaid State Plan and the NF NSGO UPL contract.
(5)(a) State funding for supplemental payments authorized in this rule is limited to and obtained through Intergovernmental Transfer (IGT) Agreements of public funds or other permissible source-of-seed funding from the NSGE that holds the license and is party to the Medicaid contract of the nursing care facility.
(b) The NSGE shall ensure that the funds provided to the Department for the non-federal share, via IGT, meet the requirements of 42 CFR 433, Subpart B.
With its IGT, using the "IGT Certification Form" prescribed by the Medicaid agency, the NSGE shall specify the dollar amount and certify the source of the IGT funds. The NSGE shall specify, on the form, a detailed description of the IGT monies and the legal basis for the monies ability to be used to match federal funds.
August 12, 2016
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.