No. 38973 (Amendment): Section R382-10-18. Enrollment Period

(Amendment)

DAR File No.: 38973
Filed: 11/21/2014 02:28:49 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to comply with provisions of the Patient Protection and Affordable Care Act in regard to completing an ex parte review for the Children's Health Insurance Program (CHIP).

Summary of the rule or change:

This amendment allows CHIP coverage to end if the eligibility agency completes an ex parte review and requests verification of health coverage, and the enrollee fails to verify creditable health coverage or is determined to have access to health insurance.

State statutory or constitutional authorization for this rule:

• Section 26-1-5
• Pub. L. No. 111-148
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget because this amendment only changes the method of review in determining CHIP coverage.

local governments:

There is no impact to local governments because they neither fund nor provide CHIP services to CHIP enrollees.

small businesses:

There is no impact to small businesses because this amendment only changes the method of review in determining CHIP coverage. It does not impose new costs or requirements.

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

There is no impact to CHIP providers and to CHIP enrollees because this amendment only changes the method of review in determining CHIP coverage. It does not impose new costs or requirements and does not create out-of-pocket expenses.

Compliance costs for affected persons:

There is no impact to a single CHIP provider or to a CHIP enrollee because this amendment only changes the method of review in determining CHIP coverage. It does not impose new costs or requirements and does not create out-of-pocket expenses.

Comments by the department head on the fiscal impact the rule may have on businesses:

This change has no impact on business because it does not change eligibility requirements or include additional procedures or costs.

David Patton, PhD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Children's Health Insurance Program
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 801-538-6099, or by Internet E-mail at [e-mail]

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:

01/14/2015

This rule may become effective on:

02/01/2015

Authorized by:

David Patton, Executive Director

RULE TEXT

R382. Health, Children's Health Insurance Program.

R382-10. Eligibility.

R382-10-18. Enrollment Period.

(1) Subject to the provisions in Subsection R382-10-18(2) and (3), a child eligible for CHIP enrollment receives 12 months of coverage that begins with the effective month of enrollment. If the eligibility agency allows a grace enrollment period that extends into the month before the application month, the days of the grace enrollment period do not count as a month in the 12-month enrollment period.

(2) CHIP coverage may end before the end of the 12-month certification period if the enrollee[child]:

(a) turns 19 years of age before the end of the 12-month enrollment period;

(b) moves out of the state;

(c) becomes eligible for Medicaid;

(d) begins to be covered under a group health plan or other health insurance coverage;

(e) enters a public institution or an institution for mental diseases; or

(f) does not pay the quarterly premium.

(3) If the eligibility agency completes a review as defined in 42 CFR 457.343 and requests verification of health coverage, CHIP coverage will end if the enrollee:

(a) fails to respond timely to a request to verify creditable health coverage; or

(b) is determined to have access to health insurance coverage as defined in Subsection R382-10-10(3).

([3]4) Certain changes affect an enrollee's eligibility during the 12-month certification period.

(a) If an enrollee gains access to health insurance under an employer-sponsored plan or COBRA coverage, the enrollee may switch to UPP. The enrollee must report the health insurance within ten calendar days of enrolling, or within ten calendar days of when coverage begins, whichever is later. The employer-sponsored plan must meet UPP criteria.

(b) If income decreases, the enrollee may report the income and request a redetermination. If the change makes the enrollee eligible for Medicaid, the eligibility agency shall end CHIP eligibility and enroll the child in Medicaid.

(c) If income increases during the certification period, eligibility remains unchanged through the end of the certification period.

([4]5) The agency shall redetermine eligibility if a family reports a decrease in income and requests a redetermination during the certification period. A decrease in the premium is effective as follows:

(a) The premium change is effective the month of report if income decreased that month and the family provides timely verification of income;

(b) The premium change is effective the month following the report month if the decrease in income is for the following month and the family provides timely verification of income;

(c) The premium change is effective the month in which verification of the decrease in income is provided, if the family does not provide timely verification of income.

([5]6) Failure to make a timely report of a reportable change may result in an overpayment of benefits.

 

KEY: children's health benefits

Date of Enactment or Last Substantive Amendment: [June 1, 2014]2015

Notice of Continuation: May 9, 2013

Authorizing, and Implemented or Interpreted Law: 26-1-5; 26-40

 

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