No. 43036 (Repeal): Rule R414-55. Medicaid Policy for Hospital Emergency Department Copayment Procedures  

  • (Repeal)

    DAR File No.: 43036
    Filed: 06/27/2018 09:09:25 AM

    RULE ANALYSIS

    Purpose of the rule or reason for the change:

    Based on the five-year review for this rule, the Department of Health (Department) will repeal this rule because Medicaid cost-sharing policy is already set forth in the Medicaid State Plan.

    Summary of the rule or change:

    This rule is repealed in its entirety because all cost-sharing policy is consolidated in the Medicaid State Plan, making the rule unnecessary.

    Statutory or constitutional authorization for this rule:

    Anticipated cost or savings to:

    the state budget:

    There is no impact on the state budget because this repeal neither affects service coverage nor provider reimbursement.

    local governments:

    There is no impact on local governments because they do not fund member services under the Medicaid program.

    small businesses:

    There is no impact on small businesses because this repeal neither affects service coverage nor provider reimbursement.

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

    There is no impact on Medicaid providers or Medicaid members because this repeal neither affects service coverage nor provider reimbursement.

    Compliance costs for affected persons:

    There is no impact on a single Medicaid provider or a Medicaid member because this repeal neither affects service coverage nor provider reimbursement.

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

    After conducting a thorough analysis, it was determined that the repeal of this rule will not result in a fiscal impact to businesses.

    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:

    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:

    08/14/2018

    This rule may become effective on:

    08/21/2018

    Authorized by:

    Joseph Miner, Executive Director

    RULE TEXT

    Appendix 1: Regulatory Impact Summary Table*

    Fiscal Costs

    FY 2019

    FY 2020

    FY 2021

    State Government

    $0

    $0

    $0

    Local Government

    $0

    $0

    $0

    Small Businesses

    $0

    $0

    $0

    Non-Small Businesses

    $0

    $0

    $0

    Other Person

    $0

    $0

    $0

    Total Fiscal Costs:

    $0

    $0

    $0





    Fiscal Benefits




    State Government

    $0

    $0

    $0

    Local Government

    $0

    $0

    $0

    Small Businesses

    $0

    $0

    $0

    Non-Small Businesses

    $0

    $0

    $0

    Other Persons

    $0

    $0

    $0

    Total Fiscal Benefits:

    $0

    $0

    $0





    Net Fiscal Benefits:

    $0

    $0

    $0

     

    *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 in the narrative. Inestimable impacts for Non - Small Businesses are described in Appendix 2.

     

    Appendix 2: Regulatory Impact to Non - Small Businesses

    None of the 113 hospitals that provide outpatient emergency services will be impacted because cost-sharing policy is already implemented through the Medicaid State Plan. The repeal neither affects member services nor provider reimbursement.

     

     

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

    [R414-55. Medicaid Policy for Hospital Emergency Department Copayment Procedures.

    R414-55-1. Introduction and Authority.

    This rule establishes Medicaid copayment policy for non-emergency use of outpatient hospital emergency departments by Medicaid clients who are not in any of the categories exempted from copayment requirements. The rule is authorized by 42 CFR 447.15 and 447.50 through 447.59, Oct. 2003 ed., which are adopted and incorporated by reference.

     

    R414-55-2. Definitions.

    In addition to the definitions in R414-1, the following definitions also apply to this rule:

    (1) "Child" means any person under the age of 18.

    (2) "Copayment" means that form of cost sharing required of a Medicaid client at the time a service is provided, with the amount of copayment specified beforehand.

    (3) "Emergency Services" means those services defined by a select group of International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis codes which Medicaid shall identify for hospital Emergency Departments by means of Medicaid Information Bulletins.

    (4) "Hospital Emergency Department" means that area of a hospital in which emergency services are provided on a 24-hour-a-day basis.

     

    R414-55-3. Copayment Policy.

    Each Medicaid client is responsible to pay a copayment amount that complies with the requirements of the Utah Medicaid State Plan and Rule R414-1.

     

    KEY: Medicaid

    Date of Enactment or Last Substantive Amendment: October 1, 2015

    Notice of Continuation: June 28, 2013

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


Document Information

Effective Date:
8/21/2018
Publication Date:
07/15/2018
Type:
Notices of Proposed Rules
Filed Date:
06/27/2018
Agencies:
Health, Health Care Financing, Coverage and Reimbursement Policy
Rulemaking Authority:

Section 26-1-5

Section 26-18-3

Authorized By:
Joseph Miner, Executive Director
DAR File No.:
43036
Summary:

This rule is repealed in its entirety because all cost-sharing policy is consolidated in the Medicaid State Plan, making the rule unnecessary.

CodeNo:
R414-55
CodeName:
{38830|R414-55|R414-55. Medicaid Policy for Hospital Emergency Department Copayment Procedures}
Link Address:
HealthHealth Care Financing, Coverage and Reimbursement PolicyCANNON HEALTH BLDG288 N 1460 WSALT LAKE CITY, UT 84116-3231
Link Way:

Craig Devashrayee, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at cdevashrayee@utah.gov

AdditionalInfo:
More information about a Notice of Proposed Rule is available online. The Portable Document Format (PDF) version of the Bulletin is the official version. The PDF version of this issue is available at https://rules.utah.gov/publicat/bull_pdf/2018/b20180715.pdf. The HTML edition of the Bulletin is a convenience copy. Any discrepancy between the PDF version and HTML version is resolved in favor of the PDF version. Text to be deleted is struck through and surrounded by brackets ([example]). Text ...
Related Chapter/Rule NO.: (1)
R414-55. Medicaid Policy for Hospital Emergency Department Copayment Procedures.