No. 34562 (Amendment): Section R414-501-3. Preadmission Authorization

(Amendment)

DAR File No.: 34562
Filed: 04/07/2011 05:24:22 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to clarify that a nursing facility must submit an authorization request to the Department no later than the next business day after the date of admission. This change is at the request of business.

Summary of the rule or change:

This amendment clarifies that a nursing facility must submit an authorization request to the Department no later than the next business day after the date of admission.

State statutory or constitutional authorization for this rule:

• Section 26-1-5
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

The Department does not anticipate any impact to the state budget because this change only clarifies when a nursing facility must submit an authorization request to the Department. This change does not affect nursing facility services for Medicaid clients.

local governments:

There is no impact to local governments because they do not fund or provide nursing facility services for Medicaid clients.

small businesses:

The Department does not anticipate any fiscal impact to small businesses because this change only clarifies when a nursing facility must submit an authorization request to the Department. This change does not affect nursing facility services for Medicaid clients.

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

The Department does not anticipate any fiscal impact to either nursing facility providers or to Medicaid clients because this change only clarifies when a nursing facility must submit an authorization request to the Department.

Compliance costs for affected persons:

There are no compliance costs to a single nursing facility provider or to a Medicaid client because this change only clarifies when a nursing facility must submit an authorization request to the Department.

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

Regulated business requested this change to give them an additional day to get permission to admit a patient. Fiscal impact should be positive.

W. 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
Health Care Financing, Coverage and Reimbursement Policy
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:

05/31/2011

This rule may become effective on:

06/07/2011

Authorized by:

W. David Patton, Executive Director

RULE TEXT

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

R414-501. Preadmission Authorization, Retroactive Authorization, and Continued Stay Review.

R414-501-3. Preadmission Authorization.

(1) A nursing facility will perform a preadmission assessment when admitting a nursing facility applicant. Preadmission authorization is not transferable from one nursing facility to another.

(2) A nursing facility must obtain [prior] approval from the Department [before]when admitting a nursing facility applicant. The nursing facility must submit a request for prior approval to the Department no later than the next business day after the date of admission. A request for prior approval may be in writing or by telephone and will include:

(a) the name, age, and Medicaid eligibility of the nursing facility applicant;

(b) the date of transfer or admission to the nursing facility;

(c) the reason for acute care inpatient hospitalization or emergency placement, if any;

(d) a description of the care and services needed;

(e) the nursing facility applicant's current functional and mental status;

(f) the established diagnoses;

(g) the medications and treatments currently ordered for the nursing facility applicant;

(h) a description of the nursing facility applicant's discharge potential;

(i) the name of the hospital discharge planner or nursing facility employee who is requesting the prior approval;

(j) the Preadmission Screening and Resident Review (PASRR) Level I screening, except the screening is not required for admission to an intermediate care facility for people with mental retardation; and

(k) the Preadmission Screening and Resident Review (PASRR) Level II determination, as required by 42 CFR 483.112.

(4) If the Department gives a telephone prior approval, the nursing facility will submit to the Department within five working days a preadmission transmittal for the nursing facility applicant, and will begin preparing the complete contact for the nursing facility applicant. The complete contact is a written application containing all the elements of a request for prior authorization plus:

(a) the preadmission continued stay transmittal;

(b) a history and physical;

(c) the signed and dated physician's orders, including physician certification; and

(d) an MDS assessment completed no later than 14 calendar days after the resident is admitted to a nursing facility.

(5) The requirements in Section R414-501-3 do not apply in cases in which a facility is seeking Retroactive Authorization described in Section R414-501-5.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [October 14, 2009]2011

Notice of Continuation: August 20, 2009

Authorizing, and Implemented or Interpreted Law: 26-1-5; 26-18-3; 63G-3-304(1)(a)

 

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