No. 36102 (Amendment): Section R414-1-29. Provider-Preventable Conditions

(Amendment)

DAR File No.: 36102
Filed: 04/27/2012 11:41:58 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this amendment is to clarify legal authority and reporting requirements for provider-preventable conditions as established under administrative rules and state and federal law.

Summary of the rule or change:

This amendment clarifies legal authority and reporting requirements for provider-preventable conditions. It also specifies the federal statute that prohibits reimbursement for provider-preventable conditions, and the sections of the Medicaid State Plan that implement that authority.

State statutory or constitutional authorization for this rule:

• Section 26-1-5
• 42 CFR 447.26
• Section 26-18-3

This rule or change incorporates by reference the following material:

• Updates 42 CFR 447.26, published by Government Printing Office, 10/01/2011

Anticipated cost or savings to:

the state budget:

The Department does not anticipate any impact to the state budget because this amendment only clarifies legal authority and reporting requirements for provider-preventable conditions. It does not impose new requirements on hospital and providers.

local governments:

The Department does not anticipate any impact to local governments because they do not fund or provide Medicaid services.

small businesses:

The Department does not anticipate any impact to small businesses because this amendment only clarifies legal authority and reporting requirements for provider-preventable conditions. It does not impose new requirements on small businesses.

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

The Department does not anticipate any costs or savings to other persons because this amendment only clarifies legal authority and reporting requirements for provider-preventable conditions. It does not impose new requirements on Medicaid providers and does not create out-of-pocket expenses for Medicaid recipients.

Compliance costs for affected persons:

The Department does not anticipate any compliance costs because this amendment only clarifies legal authority and reporting requirements for provider-preventable conditions. It does not impose new requirements on a single Medicaid provider and does not create out-of-pocket expenses for a single Medicaid recipient.

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

After extensive meetings with regulated providers and other interested parties, these amendments are proposed to meet federal requirements in a less burdensome manner.

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
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:

06/14/2012

This rule may become effective on:

07/01/2012

Authorized by:

David Patton, Executive Director

RULE TEXT

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

R414-1. Utah Medicaid Program.

R414-1-29. Provider-Preventable Conditions.

[ The following applies to inpatient hospital services provided to Medicaid recipients and dual eligible beneficiaries:

] (1) In accordance with [76 FR 32837]42 CFR 447.26, October 1, 2011 ed., which is incorporated by reference, Medicaid will not reimburse providers or contractors for provider-preventable conditions [as defined in this CMS rule]as noted therein. Please see Utah Medicaid State Plan Attachments 4.19-A and 4.19-B for detail.[ Providers and contractors are prohibited from submitting claims for payment of these conditions except as permitted in 76 FR 32837 when the provider-preventable condition existed prior to the initiation of treatment by the provider.]

(2) Medicaid providers who treat Medicaid eligible patients must report all provider-preventable conditions whether or not reimbursement for the services is sought. Medicaid providers shall meet this requirement by complying with existing state reporting requirements (rules and legislation) of these events that include:

(a) Rule R380-200;

(b) Rule R380-210;

(c) Rule R386-705;

(d) Rule R428-10; and

(e) Section 26-6-31.

(3) Utilizing the reporting mechanism from one of the rules noted above shall not impact confidentiality and privacy protections for reporting entities as noted in Title 26, Chapter 25, Confidential Information Release.[must complete the Provider-Preventable Conditions Report as found at http://health.utah.gov/medicaid/index.html. Completed reports must be mailed to one of the following addresses within 30 calendar days of the event, as appropriate:

(a) Via U.S. Post Office: Utah Department of Health; DHCF, BCRP; Attn: Provider-Preventable Conditions Reporting; PO Box 143102; Salt Lake City, UT 84114-3102; or

(b) Via UPS or FedEx: Utah Department of Health; DHCF, BCRP; Attn: Provider-Preventable Conditions Reporting; 288 North 1460 West; Salt Lake City, UT 84116-3231.]

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [February 21, ]2012

Notice of Continuation: March 2, 2012

Authorizing, and Implemented or Interpreted Law: 26-1-5; 26-18-3; 26-34-2

 

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