Summary


Section R414-1-5 is changed to incorporate the Utah Medicaid State Plan and approved State Plan Amendments (SPAs) by reference to 01/01/2015. These SPAs include: SPA 14-032-UT Outpatient Hospital Supplemental Payments, which updates the utilization trend used for the outpatient hospital Upper Payment Limit (UPL); SPA 14-033-UT Primary Care Physician Enhancement Payments, which implements the Medicaid fee schedule increase for certain primary care services furnished by qualifying physicians in calendar years (CYs) 2013 and 2014 up to rates equal to CYs 2013 and 2014 Medicare rates, or the rates that would be derived using the CY 2009 conversion factor; SPA 14-034-UT Long-Term Care Insurance Partnership; which allows a beneficiary under a long-term care insurance policy to receive a resource disregard equal to insurance benefit payments made to or on behalf of the individual. This SPA also requires training for sellers of partnership policies, and clarifies the responsibility of the Department of Health and the Insurance Department to oversee training and reporting requirements; SPA 14-0035-UT Presumptive Eligibility, which ends a pilot program for presumptive eligibility for children who are under 19 years old due to lack of enrollment. This pilot program was used to help the state qualify for the federal bonus under the Children's Health Insurance Program Reauthorization Act (CHIPRA) in 2012 and 2013; and SPA 14-0036-UT Coverage for Kinship Guardianship, which allows children who leave the foster care system, and are placed permanently with a relative, to continue to qualify for Medicaid. This rule change also incorporates by reference the Medical Supplies Utah Medicaid Provider Manual, effective 01/01/2015; incorporates by reference the Hospital Services Utah Medicaid Provider Manual with its attachments, effective 01/01/2015; incorporates by reference the Home Health Agencies Utah Medicaid Provider Manual, and the manual's attachment for the Private Duty Nursing Acuity Grid, effective 01/01/2015; incorporates by reference the Speech-Language Pathology and Audiology Services Utah Medicaid Provider Manual, effective 01/01/2015; incorporates by reference the Hospice Care Utah Medicaid Provider Manual, effective 01/01/2015; incorporates by reference the Long Term Care Services in Nursing Facilities Utah Medicaid Provider Manual, with its attachments, effective 01/01/2015; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals 65 or Older Utah Medicaid Provider Manual, effective 01/01/2015; incorporates by reference the Personal Care Utah Medicaid Provider Manual, with its attachments, effective 01/01/2015; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Acquired Brain Injury Age 18 and Older Utah Medicaid Provider Manual, effective 01/01/2015; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Intellectual Disabilities or Other Related Conditions Utah Medicaid Provider Manual, effective 01/01/2015; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Physical Disabilities Utah Medicaid Provider Manual, effective 01/01/2015; incorporates by reference the Utah Home and Community-Based Waiver Services New Choices Waiver Utah Medicaid Provider Manual, effective 01/01/2015; incorporates by reference the Utah Home and Community-Based Waiver Services for Technology Dependent, Medically Fragile Individuals Utah Medicaid Provider Manual, effective 01/01/2015; incorporates by reference the Utah Home and Community-Based Waiver Services Autism Waiver Utah Medicaid Provider Manual, effective 01/01/2015; incorporates by reference the Office of Inspector General (OIG) Administrative Hearings Procedures Manual, effective 01/01/2015; incorporates by reference the Pharmacy Services Utah Medicaid Provider Manual with its attachments, effective 01/01/2015; incorporates by reference the Coverage and Reimbursement Code Look-up Tool, effective 01/01/2015; incorporates by reference the CHEC Services Utah Medicaid Provider Manual with its attachments, effective 01/01/2015; incorporates by reference the Chiropractic Medicine Utah Medicaid Provider Manual, effective 01/01/2015; incorporates by reference the Dental, Oral Maxillofacial, and Orthodontia Services Utah Medicaid Provider Manual, effective 01/01/2015; incorporates by reference the General Attachments for the Utah Medicaid Provider Manual, effective 01/01/2015; incorporates by reference the Indian Health Utah Medicaid Provider Manual, effective 01/01/2015; incorporates by reference the Laboratory Services Utah Medicaid Provider Manual with its attachments, effective 01/01/2015; incorporates by reference the Medical Transportation Utah Medicaid Provider Manual, effective 01/01/2015; incorporates by reference the Non-Traditional Medicaid Health Plan Utah Medicaid Provider Manual with its attachments, effective 01/01/2015; incorporates by reference the Licensed Nurse Practitioner Utah Medicaid Provider Manual, effective 01/01/2015; incorporates by reference the Physical Therapy and Occupational Therapy Services Utah Medicaid Provider Manual, effective 01/01/2015; incorporates by reference the Physician Services and Anesthesiology Utah Medicaid Provider Manual with its attachments, effective 01/01/2015; incorporates by reference the Podiatric Services Utah Medicaid Provider Manual, effective 01/01/2015; incorporates by reference the Primary Care Network Utah Medicaid Provider Manual with its attachments, effective 01/01/2015; incorporates by reference the Psychology Services Utah Medicaid Provider Manual, effective 01/01/2015; incorporates by reference the Rehabilitative Mental Health and Substance Use Disorder Services Utah Medicaid Provider Manual, effective 01/01/2015; incorporates by reference the Rural Health Clinics and Federally Qualified Health Centers Services Utah Medicaid Provider Manual with its attachments, effective 01/01/2015; incorporates by reference the School-Based Skills Development Services Utah Medicaid Provider Manual, effective 01/01/2015; incorporates by reference Section I: General Information of the Utah Medicaid Provider Manual, effective 01/01/2015; incorporates by reference the Services for Pregnant Women Utah Medicaid Provider Manual, effective 01/01/2015; incorporates by reference the Targeted Case Management for Individuals with Serious Mental Illness Utah Medicaid Provider Manual, effective 01/01/2015; Targeted Case Management for Early Childhood (Ages 0-4) Utah Medicaid Provider Manual, effective 01/01/2015; Vision Care Services Utah Medicaid Provider Manual, effective 01/01/2015; and Women's Services Utah Medicaid Provider Manual, effective 01/01/2015.