No. 30175 (Amendment): R414-1-5. State Plan

DAR File No.: 30175
Filed: 07/09/2007, 04:24
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

Subsection 26-18-3(2)(a) requires the Medicaid program to implement policy through administrative rules. Therefore, this change incorporates the most current Medicaid State Plan by reference.

Summary of the rule or change:

Subsection R414-1-5(2) is changed to update the incorporation of the State Plan by reference to the 01/01/2007 edition.

State statutory or constitutional authorization for this rule:

Sections 26-18-3 and 26-1-5

This rule or change incorporates by reference the following material:

Utah Medicaid State Plan, January 1, 2007

Anticipated cost or savings to:

the state budget:

There have been 18 State Plan Amendments approved since this rule was last amended. The following seven State Plan Amendments have no budget impact: 05-005-UT Special Modifiers; 05-009-UT Prescribed Drug Changes; 05-012-UT More Liberal Income and Resource Selections; 05-015-UT Low-Income Subsidy Determinations; 05-016-UT Family Related Medicaid; 06-008-UT Payment for Hospice Services; and 06-011-UT Preprint Modification. 05-011-UT Vaccine for Children had a federal cost of $26,373 and a state cost of $11,127 in FY 2005 and a federal cost of $52,746 with a state cost of $22,254 in FY 2006. 05-014-UT Medicare Enrollment had a federal cost of $8,750 and a state cost of $3,700 in FY 2005 and a federal cost $35,000 with a state cost of $14,800 in FY 2006. 05-017-UT Physician Payment Enhancement (Anesthesiologist) had a federal cost of $322,620 and a state cost of $136,356 in FY 2005 and a federal cost of $1,290,478 with a state cost of $545,422 in FY 2006. 06-002-UT Medicaid Work Incentive Premium Change had a federal cost of $286 and a state cost of $115 in FY 2006. Projected federal and state costs for FY 2007 are $1,142 and $458, respectively. 06-004-UT Optometry and Eyeglasses Services had a federal savings of $469,300 and a state savings of $198,375 in FY 2006. Federal and state savings for FY 2007 are $1,877,200 and $793,500, respectively. 06-006-UT Nursing Facility Payments had a federal cost of $4,457 and a state cost of $1,893 in FY 2006. Projected federal and state costs for FY 2007 are $17,828 and $7,572, respectively. 06-007-UT Foster Care Youths had a federal cost of $266,125 and a state cost of $112,475 in FY 2006. Projected federal and state costs for FY 2007 are $1,064,500 and $449,500, respectively. 06-009-UT San Juan and Grand County Home Health had a federal cost of $67,416 and a state cost of $28,485 in FY 2006. Projected federal and state costs for FY 2007 are $134,831 and $56,969, respectively. 06-012-UT DRA Long-Term Care Changes had a federal savings of $65,271 and a state savings of $27,579 in FY 2006. Projected federal and state savings for FY 2007 are $261,083 and $110,317, respectively. 07-001-UT Third Party Data Exchange has a projected federal savings of $537,225 and a projected state savings of $227,100 in FY 2007. Projected federal and state savings for FY 2008 are $716,300 and $302,800, respectively. 07-002-UT False Claims Recoveries has a projected federal cost of $5,625 and a projected state cost of $2,400 in FY 2007. Projected federal and state costs for FY 2008 are $7,500 and $3,200, respectively.

local governments:

There is no budget impact because these amendments do not affect local government programs and providers.

other persons:

As a result of 05-011-UT Vaccine for Children, providers and small businesses received an increase in annual revenue of approximately $75,000, based on a 5% fee increase per vaccination. As a result of 05-017-UT Physician Payment Enhancement (Anesthesiologist), providers received an increase in annual revenue of approximately $1,835,900. As a result of 06-004-UT Optometry and Eyeglasses Services, there is an annual cost of $2,670,700 to providers of vision care services which also includes small businesses. Approximately 60,000 adults will lose their vision care coverage, and the aggregate out of pocket expense for Medicaid clients is approximately $13,500,000. As a result of 06-009-UT San Juan and Grand County Home Health, providers will receive an annual increase in revenue of $191,800. As a result of 06-007-UT Foster Care Youths, approximately 500 foster care youths (19 to 20 years old) will receive additional Medicaid coverage that totals approximately $1,500,000. As a result of 06-012-UT DRA Long-Term Care Changes, providers and small businesses will receive approximately the same amount of revenue, because potential Medicaid clients will make private payments for nursing home care until they become Medicaid eligible. Admittance for long-term care for some clients will also be delayed.

Compliance costs for affected persons:

As a result of 06-004-UT Optometry and Eyeglasses Providers, a single vision care provider loses approximately $13,354 in revenue based on a total number of 200 vision care providers. A single Medicaid client also pays an out-of-pocket expense of approximately $225 for eyeglasses.

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

This rule change updates the incorporation of the Medicaid state plan into rule. Changes in the Medicaid program that affect business are detailed in "Costs for small businesses and other persons" above. It appears to me that they accurately detail the fiscal impact of business due to these changes in the Medicaid program that have already been implemented. David N. Sundwall, MD, 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:

08/31/2007

This rule may become effective on:

09/07/2007

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

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

R414-1. Utah Medicaid Program.

R414-1-5. State Plan.

(1) As a condition for receipt of federal funds under title XIX of the Act, the Utah Department of Health must submit a State Plan contract to the federal government for the medical assistance program, and agree to administer the program in accordance with the provisions of the State Plan, the requirements of Titles XI and XIX of the Act, and all applicable federal regulations and other official issuances of the United States Department of Health and Human Services. A copy of the State Plan is available for public inspection at the Division's offices during regular business hours.

(2) The department adopts the Utah State Plan Under Title XIX of the Social Security Act Medical Assistance Program, in effect [September]January 1, 200[5]7, which is incorporated by reference.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [May 16, 2006]2007

Notice of Continuation: April 16, 2007

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