No. 30927 (Amendment): R414-308-7. Change Reporting and Benefit Changes

DAR File No.: 30927
Filed: 01/28/2008, 10:01
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

In accordance with Subsection 26-18-3(2), this amendment is necessary to place federal Medicaid policy into rule and reflects ongoing applications. The change, therefore, requires the agency to provide ten-day notice to institutionalized and noninstitutionalized clients when changing their benefits.

Summary of the rule or change:

This change removes language that previously allowed the agency to modify benefits for institutionalized individuals without sending ten-day notice. Ten-day notice now applies to all Medicaid recipients, and complies with federal Medicaid notice requirements that apply equally to institutionalized and noninstitutionalized clients.

State statutory or constitutional authorization for this rule:

Sections 26-18-3 and 26-1-5

Anticipated cost or savings to:

the state budget:

There is no budget impact because this change simply implements ongoing policy into rule in accordance with Subsection 26-18-3(2).

local governments:

There is no budget impact because local governments do not determine Medicaid eligibility and they are not Medicaid providers.

small businesses and persons other than businesses:

There is no impact to other persons and small businesses because this change simply implements ongoing policy into rule in accordance with Subsection 26-18-3(2).

Compliance costs for affected persons:

There are no compliance costs because this change simply implements ongoing policy into rule in accordance with Subsection 26-18-3(2).

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

This change giving additional notice consistent with the requirements of federal law, is not expected to have a negative fiscal impact on business. David N. Sundwall, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division 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 801-538-6099, 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:

03/17/2008

This rule may become effective on:

03/24/2008

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

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

R414-308. Application, Eligibility Determinations and Improper Medical Assistance.

R414-308-7. Change Reporting and Benefit Changes.

(1) A client must report to the agency reportable changes in the client's circumstances. Reportable changes are defined in R414-301-2.

(a) The due date for reporting changes is 5:00 p.m. on the 10th calendar day after the client learns of the change.

(b) When the change is receipt of income from a new source, or an increase in income the client receives, the due date for reporting the income change is 5:00 p.m. on the day that is ten calendar days after the date the client receives such income.

(c) The due date for providing verifications of changes is 5:00 p.m. on the date the agency sets as the due date in a written notice to the client.

(2) The agency may receive information from credible sources other than the client such as computer income matches, and from anonymous citizen reports. If the agency receives information from sources other than the client that may affect the client's eligibility, the agency will verify the information as needed depending on the source of information before using the information to change the client's eligibility for medical assistance. Information from citizen reports must always be verified by other reliable proofs.

(3) The date of report is the date the client reports the change to the agency by 5:00 p.m. on a business day by phone, by mail, by fax transmission or in person, or the date the agency receives the information from another source.

(4) If the agency needs verification of the reported change from the client, the agency requests it in writing and provides at least ten calendar days for the client to respond.

(5) A client who provides change reports, forms or verifications by 5:00 p.m. on the due date has provided the information on time.

(6)(a) If the reported information causes an increase in a client's benefits and the agency requests verification, the increase in benefits is effective the first day of the month following:

(i) the date of the report if the agency receives verifications within ten days of the request; or

(ii) the date the verifications are received if verifications are received more than ten days after the date of the request.

(b) The agency cannot increase benefits if the agency does not receive requested verifications.

(7) If the reported information causes a decrease in the client's benefits, the agency makes changes as follows:

(a) If the agency has sufficient information to adjust benefits, the change is effective the first day of the month after the month in which the agency sends proper notice of the decrease, regardless of whether verifications have been received.

(b) If the agency does not have sufficient information to adjust benefits, the agency requests verifications from the client. The due date is at least 10 days from the date of the request.

(i) Upon receiving the verifications, the agency adjusts benefits effective the first day of the month following the month in which the agency can send proper notice.

(ii) If the verifications are not returned on time, the agency discontinues benefits for the affected individuals effective the end of the month in which the agency can send proper notice.

(8) Any time the agency requests verifications to determine or redetermine eligibility for an individual or a household, the agency may discontinue benefits if all required factors of eligibility are not verified by the due date. If a change does not affect all household members and verifications are not provided, the agency discontinues benefits only for the individual or individuals affected by the change.

(9) If a client fails to timely report a change or return verifications or forms by the due date, the client must repay all services and benefits paid by the Department for which the client was ineligible.

(10) If a due date falls on a weekend or holiday, the due date will be 5:00 p.m. on the first business day immediately after the due date.[

(11) Notwithstanding the provisions of subsections (6) and (7), changes affecting an institutionalized client's eligibility are effective as of the date of the change.]

 

KEY: public assistance programs, application, eligibility, Medicaid

Date of Enactment or Last Substantive Amendment: [April 1, 2007]2008

Notice of Continuation: January 31, 2003

Authorizing, and Implemented or Interpreted Law: 26-18