No. 41689 (5-year Review): Rule R414-310. Medicaid Primary Care Network Demonstration Waiver

DAR File No.: 41689
Filed: 05/22/2017 10:23:04 AM

NOTICE OF REVIEW AND STATEMENT OF CONTINUATION

Concise explanation of the particular statutory provisions under which the rule is enacted and how these provisions authorize or require the rule:

Section 26-18-3 requires the Department of Health to implement Medicaid policy through administrative rules while Section 26-1-5 authorizes the Department to adopt rules that provide services under the Primary Care Network (PCN). This rule is also authorized under Section 1115 of the Social Security Act, which allows services under a waiver of federal Medicaid requirements.

Summary of written comments received during and since the last five-year review of the rule from interested persons supporting or opposing the rule:

The Department did not receive any written or oral comments regarding this rule.

Reasoned justification for continuation of the rule, including reasons why the agency disagrees with comments in opposition to the rule, if any:

The Department will continue this PCN rule because it specifies enrollee rights and responsibilities, sets forth eligibility and verification requirements, spells out eligibility as it relates to creditable health coverage, specifies provisions for income and budgeting, specifies application procedures, sets forth procedures for eligibility decisions and reviews, clarifies the effective date of enrollment, outlines criteria for reporting changes, specifies notice and termination procedures, and clarifies the meaning of improper medical coverage.

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]

Effective:

05/22/2017

Authorized by:

Joseph Miner, Executive Director

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