Summary


The Department incorporates by reference the Utah Medicaid State Plan and approved State Plan Amendments (SPAs) to 10/01/2016. Specifically, the Department incorporates by reference the following SPAs: SPA 16-0007-UT Non-Routine Services, QI Incentive, and Other Clarifications, which updates hyperbaric oxygen therapy as a non-routine service and removes certain education requirements for the Quality Improvement Incentive Program. It also incorporates by reference SPA 16-0011-UT Reimbursement for Home Health Services, which updates the effective date of rates for home health services to 07/01/2016; SPA 16-0012-UT Reimbursement for Physician and Anesthesia Services, which updates the effective date of rates for physician and anesthesia services to 07/01/2016; SPA 16-0013-UT Reimbursement for Optometry Services, which updates the effective date of rates for optometry services to 07/01/2016; SPA 16-0014-UT Reimbursement for Speech Pathology Services, which updates the effective date of rates for speech pathology services to 07/01/2016; SPA 16-0015 Reimbursement for Audiology Services, which updates the effective date of rates for audiology services to 07/01/2016; SPA 16-0016-UT Reimbursement for Chiropractic Services, which updates the effective date of rates for chiropractic services to 07/01/2016; SPA 16-0017-UT Reimbursement for Eyeglasses Services, which updates the effective date of rates for eyeglasses services to 07/01/2016; SPA 16-0018-UT Reimbursement for Clinic Services, which updates the effective date of rates for clinic services to 07/01/2016; SPA 16-0019-UT Reimbursement for Physical Therapy and Occupational Therapy, which updates the effective date of rates for physical and occupational therapy to 07/01/2016; SPA 16-0020-UT Reimbursement for Rehabilitative Mental Health Services, which updates the effective date of rates for rehabilitative mental health services to 07/01/2016; SPA 16-0021-UT Reimbursement for Transportation Services, which updates the effective date of rates for transportation services to 07/01/2016; SPA 16-0022-UT Outpatient Hospital Supplemental Payments, which updates the trend for the outpatient hospital upper payment limit to 4.1% for State Fiscal Year 2017; SPA 16-0023-UT Payment for Dialysis Services, which updates the effective date of rates for dialysis services to 04/01/2016; SPA 16-0024-UT Pediatric Dental Fee, which provides a fee-for-service supplemental payment to pediatric dental providers in accordance with legislative appropriations for pediatric dental services; and SPA 16-0026-UT Citizenship and Non-Citizen Eligibility, which implements the state's option to provide Medicaid coverage to individuals who are under 19 years of age, are otherwise eligible, and are lawfully residing in the United States. This option also waives the five-year bar for these individuals. 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 10/01/2016; Hospital Services Utah Medicaid Provider Manual with its attachments, effective 10/01/2016; the Home Health Agencies Utah Medicaid Provider Manual and the manual's attachment for the Private Duty Nursing Acuity Grid, effective 10/01/2016; the Speech-Language Pathology and Audiology Services Utah Medicaid Provider Manual, effective 10/01/2016; the Hospice Care Utah Medicaid Provider Manual and the manual's attachment for the Utah Medicaid Prior Authorization Request for Hospice Services, effective 10/01/2016; the Long Term Care Services in Nursing Facilities Utah Medicaid Provider Manual with its attachments, effective 10/01/2016; the Utah Home and Community-Based Waiver Services for Individuals Age 65 or Older Utah Medicaid Provider Manual, effective 10/01/2016; the Personal Care Utah Medicaid Provider Manual and the manual's attachment for the Request for Prior Authorization: Personal Care and Capitated Programs effective 10/01/2016; the Utah Home and Community-Based Waiver Services for Individuals with an Acquired Brain Injury Utah Medicaid Provider Manual, effective 10/01/2016; Utah Community Supports Waiver for Individuals with Intellectual Disabilities or Other Related Conditions Utah Medicaid Provider Manual, effective 10/01/2016; the Utah Home and Community-Based Services Waiver for Individuals with Physical Disabilities Utah Medicaid Provider Manual, effective 10/01/2016; the Utah Home and Community-Based Waiver Services New Choices Waiver Utah Medicaid Provider Manual, effective 10/01/2016; the Utah Home and Community-Based Services Waiver for Technology Dependent, Medically Fragile Individuals Utah Medicaid Provider Manual, effective 10/01/2016; the Utah Home and Community-Based Waiver Services Medicaid Autism Waiver Utah Medicaid Provider Manual, effective 10/01/2016; the Office of Inspector General (OIG) Administrative Hearings Procedures Manual, effective 10/01/2016; the Pharmacy Services Utah Medicaid Provider Manual with its attachments, effective 10/01/2016; the Coverage and Reimbursement Code Look-up Tool, effective 10/01/2016; the CHEC Services Utah Medicaid Provider Manual with its attachments, effective 10/01/2016; the Chiropractic Medicine Utah Medicaid Provider Manual, effective 10/01/2016; the Dental, Oral Maxillofacial, and Orthodontia Services Utah Medicaid Provider Manual, effective 10/01/2016; the General Attachments (All Providers) for the Utah Medicaid Provider Manual, effective 10/01/2016; the Indian Health Utah Medicaid Provider Manual, effective 10/01/2016; the Laboratory Services Utah Medicaid Provider Manual with its attachments, effective 10/01/2016; the Medical Transportation Utah Medicaid Provider Manual, effective 10/01/2016; the Non-Traditional Medicaid Plan Utah Medicaid Provider Manual with attachment, effective 10/01/2016; the Licensed Nurse Practitioner Utah Medicaid Provider Manual, effective 10/01/2016; 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 10/01/2016; the Physician Services, Anesthesiology and Laboratory Services Utah Medicaid Provider Manual with its attachments, effective 10/01/2016; the Podiatric Services Utah Medicaid Provider Manual, effective 10/01/2016; the Primary Care Network Utah Medicaid Provider Manual with its attachments, effective 10/01/2016; the Rehabilitative Mental Health and Substance Use Disorder Services Utah Medicaid Provider Manual, effective 10/01/2016; the Rural Health Clinics and Federally Qualified Health Centers Services Utah Medicaid Provider Manual, effective 10/01/2016; the School-Based Skills Development Services Utah Medicaid Provider Manual, effective 10/01/2016; Section I: General Information Utah Medicaid Provider Manual, effective 10/01/2016; the Targeted Case Management for Individuals with Serious Mental Illness Utah Medicaid Provider Manual, effective 10/01/2016; Targeted Case Management for Early Childhood (Ages 0-4) Utah Medicaid Provider Manual, effective 10/01/2016; Vision Care Services Utah Medicaid Provider Manual, effective 10/01/2016; Women's Services Utah Medicaid Provider Manual, effective 10/01/2016; Medically Complex Children?s Waiver Utah Medicaid Provider Manual, effective 10/01/2016; and Autism Spectrum Disorder Related Services for EPSDT Eligible Individuals Utah Medicaid Provider Manual, effective 10/01/2016.