Summary


The Department incorporates by reference the Utah Medicaid State Plan and approved State Plan Amendments (SPAs) to 01/01/2017. Specifically, the Department incorporates by reference the following SPAs: SPA 16-0003-UT Mandatory Coverage for Pregnant Women, which updates mandatory coverage for pregnant women with accompanying applications for food stamps, financial assistance, child care, and medical assistance; SPA 16-0004-UT General Eligibility Requirements, which updates general eligibility requirements with accompanying applications for food stamps, financial assistance, child care, medical assistance, and combined medical assistance programs; SPA 16-0005-UT Presumptive Eligibility by Hospitals, which updates presumptive eligibility by hospitals with accompanying applications for both combined medical assistance programs and hospital presumptive eligibility; and SPA 16-0027-UT Medicaid Recovery Audit Contractors, which reimburses recovery audit contractors on a flat-fee basis rather than a contingency basis for the work of identifying overpayments and underpayments in the Medicaid program. This proposed rule also incorporates by reference the following Medicaid provider manuals: Medical Supplies and Durable Medical Equipment Utah Medicaid Provider Manual, and the manual's attachment for Donor Human Milk Request Form, effective 01/01/2017; Hospital Services Utah Medicaid Provider Manual with its attachments, effective 01/01/2017; the Home Health Agencies Utah Medicaid Provider Manual, and the manual's attachment for the Private Duty Nursing Acuity Grid, effective 01/01/2017; the Speech-Language Pathology and Audiology Services Utah Medicaid Provider Manual, effective 01/01/2017; the Hospice Care Utah Medicaid Provider Manual, and the manual's attachment for the Utah Medicaid Prior Authorization Request for Hospice Services, effective 01/01/2017; the Long Term Care Services in Nursing Facilities Utah Medicaid Provider Manual, with its attachments, effective 01/01/2017; the Utah Home and Community-Based Waiver Services for Individuals Age 65 or Older Utah Medicaid Provider Manual, effective 01/01/2017; the Personal Care Utah Medicaid Provider Manual, and the manual's attachment for the Request for Prior Authorization: Personal Care and Capitated Programs effective 01/01/2017; the Utah Home and Community-Based Waiver Services for Individuals with an Acquired Brain Injury Utah Medicaid Provider Manual, effective 01/01/2017; Utah Community Supports Waiver for Individuals with Intellectual Disabilities or Other Related Conditions Utah Medicaid Provider Manual, effective 01/01/2017; the Utah Home and Community-Based Services Waiver for Individuals with Physical Disabilities Utah Medicaid Provider Manual, effective 01/01/2017; the Utah Home and Community-Based Waiver Services New Choices Waiver Utah Medicaid Provider Manual, effective 01/01/2017; the Utah Home and Community-Based Services Waiver for Technology Dependent, Medically Fragile Individuals Utah Medicaid Provider Manual, effective 01/01/2017; the Utah Home and Community-Based Waiver Services Medicaid Autism Waiver Utah Medicaid Provider Manual, effective 01/01/2017; the Office of Inspector General (OIG) Administrative Hearings Procedures Manual, effective 01/01/2017; the Pharmacy Services Utah Medicaid Provider Manual with its attachments, effective 01/01/2017; the Coverage and Reimbursement Code Look-up Tool, effective 01/01/2017; the CHEC Services Utah Medicaid Provider Manual with its attachments, effective 01/01/2017; the Chiropractic Medicine Utah Medicaid Provider Manual, effective 01/01/2017; the Dental, Oral Maxillofacial, and Orthodontia Services Utah Medicaid Provider Manual, effective 01/01/2017; the General Attachments (All Providers) for the Utah Medicaid Provider Manual, effective 01/01/2017; the Indian Health Utah Medicaid Provider Manual, effective 01/01/2017; the Laboratory Services Utah Medicaid Provider Manual with its attachments, effective 01/01/2017; the Medical Transportation Utah Medicaid Provider Manual, effective 01/01/2017; the Non-Traditional Medicaid Plan Utah Medicaid Provider Manual with attachment, effective 01/01/2017; the Licensed Nurse Practitioner Utah Medicaid Provider Manual, effective 01/01/2017; the Physical Therapy and Occupational Therapy Services Utah Medicaid Provider Manual, and the manual's attachment for Physical Therapy and Occupational Therapy Decision Tables, effective 01/01/2017; the Physician Services, Anesthesiology and Laboratory Services Utah Medicaid Provider Manual with its attachments, effective 01/01/2017; the Podiatric Services Utah Medicaid Provider Manual, effective 01/01/2017; the Primary Care Network Utah Medicaid Provider Manual with its attachments, effective 01/01/2017; the Rehabilitative Mental Health and Substance Use Disorder Services Utah Medicaid Provider Manual, effective 01/01/2017; the Rural Health Clinics and Federally Qualified Health Centers Services Utah Medicaid Provider Manual, effective 01/01/2017; the School-Based Skills Development Services Utah Medicaid Provider Manual, effective 01/01/2017; Section I: General Information Utah Medicaid Provider Manual, effective 01/01/2017; the Targeted Case Management for Individuals with Serious Mental Illness Utah Medicaid Provider Manual, effective 01/01/2017; Targeted Case Management for Early Childhood (Ages 0-4) Utah Medicaid Provider Manual, effective 01/01/2017; Vision Care Services Utah Medicaid Provider Manual, effective 01/01/2017; Women's Services Utah Medicaid Provider Manual, effective 01/01/2017; Medically Complex Children?s Waiver Utah Medicaid Provider Manual, effective 01/01/2017; and Autism Spectrum Disorder Related Services for EPSDT Eligible Individuals Utah Medicaid Provider Manual, effective 01/01/2017.