No. 42627 (Amendment): Section R414-302-6. Residents of Institutions

(Amendment)

DAR File No.: 42627
Filed: 02/27/2018 10:50:15 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this rule change is to comply with the provisions of H.B. 437, passed during the 2016 General Session, which require the Department of Health to expand Medicaid coverage to individuals who reside in certain institutions for mental disease (IMDs).

Summary of the rule or change:

This amendment expands coverage to individuals who reside in an IMD licensed as a Substance Use Disorder (SUD) residential treatment program.

Statutory or constitutional authorization for this rule:

• Section 26-1-5
• 42 CFR 435.1009
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

There is an annual cost of about $3,000,000 to the General Fund and about $7,000,000 in federal funds to treat individuals who reside in an IMD licensed for SUD treatment purposes.

local governments:

There is no impact to local governments because they do not fund IMDs under the Medicaid program.

small businesses:

Institutions for SUD treatment may see a portion of annual revenue that totals $10,000,000 based on 241 beds available to treat residents under expanded Medicaid coverage.

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

Medicaid providers in institutions for SUD treatment may see a portion of annual revenue that totals $10,000,000 based on 241 beds available to treat residents under expanded Medicaid coverage. Residents who qualify for treatment coverage will also see a portion of $10,000,000 in out-of-pocket savings.

Compliance costs for affected persons:

There are no compliance costs because a single institution for SUD treatment will only see potential revenue and a resident who qualifies for SUD treatment will only see out-of-pocket savings.

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

Institutions for SUD treatment may see a portion of annual revenue that totals $10,000,000 based on 241 beds available to treat residents under expanded Medicaid coverage.

Joseph K. Miner, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office 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:

04/16/2018

This rule may become effective on:

04/23/2018

Authorized by:

Joseph Miner, Executive Director

RULE TEXT

Appendix 1: Regulatory Impact Summary Table*

Fiscal Costs

FY 2018

FY 2019

FY 2020

State Government

$10,000,000

$10,000,000

$10,000,000

Local Government

$0

$0

$0

Small Businesses

$0

$0

$0

Non-Small Businesses

$0

$0

$0

Other Person

$0

$0

$0

Total Fiscal Costs:

$10,000,000

$10,000,000

$10,000,000

Fiscal Benefits

State Government

$0

$0

$0

Local Government

$0

$0

$0

Small Businesses

A portion of $10,000,000

A portion of 10,000,000

A portion of 10,000,000

Non-Small Businesses

A portion of $10,000,000

A portion of 10,000,000

A portion of 10,000,000

Other Persons

A portion of $10,000,000

A portion of 10,000,000

A portion of 10,000,000

Total Fiscal Benefits:

$10,000,000

$10,000,000

$10,000,000

Net Fiscal Benefits:

Portions of $10,000,000

Portions of 10,000,000

Portions of 10,000,000

 

*This table only includes fiscal impacts that could be measured. If there are inestimable fiscal impacts, they will not be included in this table. Inestimable impacts for State Government, Local Government, Small Businesses and Other Persons are described above. Inestimable impacts for Non - Small Businesses are described below.

 

Appendix 2: Regulatory Impact to Non - Small Businesses

Institutions for Substance Use Disorder (SUD) treatment may see a portion of annual revenue that totals $10,000,000, based on 241 beds available to treat residents under expanded Medicaid coverage.

 

The Executive Director of the Department of Health, Joseph K. Miner, MD, has reviewed and approved this fiscal analysis.

 

 

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

R414-302. Eligibility Requirements.

R414-302-6. Residents of Institutions.

(1) [The Department provides Medicaid coverage to individuals who are residents of institutions subject to the limitations in 42 CFR 435.1009 and 435.1010 (October 1, 2015), which the Department adopts and incorporates by reference]For purposes of institutions, the definitions in 42 CFR 435.1010 apply.

(2) An individual who resides in a halfway house may receive Medicaid coverage if the halfway house meets the following criteria:

(a) The halfway house allows the individual to work outside the facility;

(b) The halfway house allows the individual to use community facilities at will, such as libraries, grocery stores, recreation areas, or schools; and

(c) The halfway house allows the individual to seek health care treatment in the community to the same extent as other Medicaid enrollees.

(3) The Department does not consider an individual who resides in a temporary shelter for a limited period of time as a resident of an institution.

(4) [For individuals under 22 years of age who become residents of an IMD before reaching 21 years of age, the Department limits Medicaid eligibility to individuals residing in the Utah State Hospital.]Individuals who are inmates of public institutions are not eligible for Medicaid coverage.

(5) Individuals who reside in an institution for mental disease (IMD) are not eligible for Medicaid coverage with the following exceptions:

(a) Individuals 65 years of age or older;

(b) Individuals under 22 years of age who receive inpatient psychiatric services as described in 42 CFR 440.160; and

(c) Individuals who reside in an IMD that is licensed as a Substance Use Disorder (SUD) residential treatment program and are receiving treatment for an SUD.

 

KEY: state residency, citizenship, third party liability, Medicaid

Date of Enactment or Last Substantive Amendment: [February 15, 2017]2018

Notice of Continuation: January 8, 2018

Authorizing, and Implemented or Interpreted Law: 26-18-3

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