No. 36511 (Amendment): Section R414-1-30. Governing Hierarchy

(Amendment)

DAR File No.: 36511
Filed: 07/18/2012 09:05:51 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to implement by rule the governing hierarchy of regulations to administer the Medicaid program.

Summary of the rule or change:

This new section of the rule implements the governing hierarchy federal waivers, the Utah Medicaid State Plan, and administrative rules to clarify the authority used by the Department to administer the Medicaid program.

State statutory or constitutional authorization for this rule:

• Section 26-1-5
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

Clarification of the standards and their relative authority will provide clarity to all regulated entities, providers and Medicaid recipients. It is the intent that this rule be budget neutral. Ambiguity in the past has led to Medicaid in some cases paying more for or covering a service that was not intended. This clarification may increase or decrease reimbursement to an individual provider, but the overall effect should be neutral on the state budget.

local governments:

Clarification of the standards and their relative authority will provide clarity to all regulated entities, providers and Medicaid recipients. It is the intent that this rule be budget neutral. Ambiguity in the past has led to Medicaid in some cases paying more for or covering a service that was not intended. This clarification may increase or decrease reimbursement to an individual provider, but the overall effect should be neutral to local government.

small businesses:

Clarification of the standards and their relative authority will provide clarity to all regulated entities, providers and Medicaid recipients. It is the intent that this rule be budget neutral. Ambiguity in the past has led to Medicaid in some cases paying more for or covering a service that was not intended. This clarification may increase or decrease reimbursement to an individual provider, but the overall effect should be neutral for small business.

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

Clarification of the standards and their relative authority will provide clarity to all regulated entities, providers and Medicaid recipients. It is the intent that this rule be budget neutral. Ambiguity in the past has led to Medicaid in some cases paying more for or covering a service that was not intended. This clarification may increase or decrease reimbursement to an individual provider, but the overall effect should be neutral on other persons.

Compliance costs for affected persons:

Clarification of the standards and their relative authority will provide clarity to all regulated entities, providers and Medicaid recipients. It is the intent that this rule be budget neutral. Ambiguity in the past has led to Medicaid in some cases paying more for or covering a service that was not intended. This clarification may increase or decrease reimbursement to an individual provider.

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

Clarification of the standards and their relative authority will provide clarity to all regulated entities, providers and Medicaid recipients. Ambiguity in the past has led to Medicaid in some cases paying more for or covering a service that was not intended. This clarification may increase or decrease reimbursement to an individual provider, but the overall effect should be neutral to regulated entities. Comments will be carefully evaluated to assess fiscal impact.

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:

09/14/2012

This rule may become effective on:

09/21/2012

Authorized by:

David Patton, Executive Director

RULE TEXT

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

R414-1. Utah Medicaid Program.

R414-1-30. Governing Hierarchy.

(1) The Utah Medicaid State Plan under Title XIX of the Social Security Act Medical Assistance Program and any Waivers to that State Plan ("State Plan") shall be the governing authority for implementing the Medicaid program to the extent incorporated by rule. If a conflict exists between a Waiver and the Utah Medicaid State Plan, the Waiver shall govern.

(2) If an administrative rule addresses an issue that is not fully addressed by the State Plan, the administrative rule adopted by the Department shall govern the implementation of the Medicaid program, after giving full effect to the State Plan.

(3) Statements or actions by department employees shall not constitute exceptions or waivers to the governing authority of Subsection R414-1-30 (1) or (2).

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [July 1, ]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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