No. 36431 (New Rule): Rule R414-8. Electronic Personal Medical Records for the Medicaid Program

(New Rule)

DAR File No.: 36431
Filed: 07/02/2012 01:03:51 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

H.B. 46, 2012 General Session, requires the Department to implement by rule a program to enroll individuals who receive Medicaid services in the Clinical Health Information Exchange (cHIE). The bill also requires the Department to notify these individuals of their right to opt out of cHIE. This rule describes the process the Department will use to enroll individuals in cHIE.

Summary of the rule or change:

The rule states that all individuals who receive Medicaid services are subject to this rule. The rule also states that the Department will provide notice to individuals before they enroll in cHIE. The rule further specifies when cHIE enrollment will occur and describes how cHIE will address cases for when an individual already declares his status with cHIE before enrolling in Medicaid.

State statutory or constitutional authorization for this rule:

• Section 26-18-3
• Section 26-1-5

Anticipated cost or savings to:

the state budget:

The Department estimates about $160,000 in one-time costs for programming changes to existing systems and for mailing notification letters to all current Medicaid clients. Costs are covered by a federal grant and by a reduction in the Department's payments to the Utah Health Information Network (UHIN) for cHIE.

local governments:

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

small businesses:

The Department does not anticipate any costs or savings because this rule does not impose new requirements or administrative expenses on small businesses.

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

The Department does not anticipate any costs or savings because this rule does not impose new requirements or administrative expenses on Medicaid providers. There are also no administrative costs to Medicaid clients who choose to submit a form if they opt out of cHIE.

Compliance costs for affected persons:

The Department does not anticipate any costs to a single Medicaid provider or to a single UHIN insurer because this rule does not impose new requirements or administrative expenses on these persons or entities. There are also no administrative costs to a single Medicaid client who chooses to submit a form through a provider if the client opts out of cHIE.

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

H.B. 46, 2012 General Session, requires the Department to implement by rule a program to enroll individuals who receive services under the Children's Health Insurance Program (CHIP) and the Medicaid Program in the Clinical Health Information Exchange (cHIE). This should have a positive fiscal impact on providers serving these persons by making treatment records available.

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:

08/14/2012

This rule may become effective on:

09/01/2012

Authorized by:

David Patton, Executive Director

RULE TEXT

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

R414-8. Electronic Personal Medical Records for the Medicaid Program.

R414-8-1. Introduction and Authority.

This rule is promulgated under authority granted in Section 26-18-3, as last amended by Laws of Utah 2012, Chapters 28 and 242.

 

R414-8-2. Purpose.

This rule establishes requirements for enrolling Medicaid beneficiaries in the electronic exchange of clinical health information unless the individual opts out.

 

R414-8-3. Definitions.

These definitions apply to Rule R414-8:

(1) "Medicaid beneficiaries" mean individuals who receive assistance through the following programs:

(a) Medicaid;

(b) Primary Care Network;

(c) Utah's Premium Partnership for Health Insurance;

(d) Baby Your Baby;

(e) Cost sharing programs that include Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualified Individual (QI).

(2) "Technical Specifications" means the technical specifications document published by the Utah Health Information Network (UHIN) that describes the variables and formats of the data to be submitted as well as submission directions and guidelines.

(3) "Program Website" means the Department of Health, Department of Workforce Services, Division of Medicaid and Health Financing, Utah's Premium Partnership for Health Insurance, and Primary Care Network websites.

 

R414-8-4. Enrollment Notification.

(1) Prior to the enrollment process in the Clinical Health Information Exchange (cHIE), the Department will provide Notice of Intent to Medicaid beneficiaries in cHIE and the right of individuals to opt out.

(2) The Department will provide additional education regarding the individual's right to opt out on the program websites.

 

R414-8-5. Enrollment Process.

(1) The Department will provide cHIE an enrollment file of all Medicaid beneficiaries.

(2) The enrollment file will contain the succeeding month's Medicaid enrollment.

(3) cHIE will enroll Medicaid beneficiaries on the first day of the succeeding month.

(4) Submission procedures and guidelines, including required data elements, will be described in detail in the technical specifications published by UHIN and will be included in the Department's Operating Agreement with cHIE.

(5) The Department will use a secure format to transfer any enrollment files to cHIE.

 

R414-8-6. Exemptions.

(1) An individual's previous consent status in cHIE will be honored by cHIE and will not be overridden by the Medicaid enrollment file.

 

KEY: Medicaid, cHIE

Date of Enactment or Last Substantive Amendment: 2012

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

 

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