No. 41321 (5-year Review): Rule R414-1. Utah Medicaid Program

DAR File No.: 41321
Filed: 02/15/2017 09:51:13 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 to implement Medicaid policy through administrative rules, which allow the Department to administer the Medicaid program. Additionally, Section 26-1-5 authorizes the Department to adopt rules that provide services and eligibility requirements for Medicaid recipients.

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 received comments from the Association for Utah Community Health in August 2015, after filing an amendment to incorporate all Medicaid provider manuals by reference to 07/01/2015. The comments noted inaccuracies regarding non-required services in the Rural Health Clinics and Federally Qualified Health Centers (FQHCs) Services Provider Manual, and suggested that "required primary health services" be consistent with federal regulations. The comments also recommended the Department clarify that FQHCs are not subject to regulations under the Emergency Medical Treatment and Labor Act because, like rural health clinics, they do not have emergency departments. The comments also noted a technical error in the manual regarding immunizations.

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

After considering the comments, the Department maintained that any inaccuracy or lack of clarity in the provider manual did not impact Medicaid services nor provider reimbursement. The Department, therefore, made the rule effective, but also made corrections to the provider manual during the next policy cycle (January 2016 Medicaid Information Bulletin update) to ensure the manual was consistent with federal regulations and contained correct immunization information. The Department will continue this rule because it sets forth services and eligibility for the Medicaid program, specifies provider and recipient policy, specifies the role of certain entities within the Medicaid program, specifies the availability of program manuals and policies, and serves as the basis for all other rules in the Medicaid program. There is no opposition to the rule itself, and the Department addressed previous concerns through the corrections noted above.

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:

02/15/2017

Authorized by:

Joseph Miner, Executive Director

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