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Utah Administrative Code (Current through November 1, 2019) |
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R414. Health, Health Care Financing, Coverage and Reimbursement Policy |
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R414-8. Electronic Personal Medical Records for the Medicaid Program |
| R414-8-1. Introduction and Authority |
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This rule is promulgated under authority granted in Section 26-18-3, as last amended by Laws of Utah 2012, Chapters 28 and 242. |
| R414-8-2. Purpose |
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This rule establishes requirements for enrolling Medicaid beneficiaries in the electronic exchange of clinical health information unless the individual opts out. |
| R414-8-3. Definitions |
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These definitions apply to Rule R414-8: (1) "Medicaid beneficiaries" mean individuals who receive assistance through the following programs: (a) Medicaid; (b) Primary Care Network; (c) Utah's Premium Partnership for Health Insurance; (d) Baby Your Baby; (e) Cost sharing programs that include Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualified Individual (QI). (2) "Technical Specifications" means the technical specifications document published by the Utah Health Information Network (UHIN) that describes the variables and formats of the data to be submitted as well as submission directions and guidelines. (3) "Program Website" means the Department of Health, Department of Workforce Services, Division of Medicaid and Health Financing, Utah's Premium Partnership for Health Insurance, and Primary Care Network websites. |
| R414-8-4. Enrollment Notification |
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(1) Prior to the enrollment process in the Clinical Health Information Exchange (cHIE), the Department will provide Notice of Intent to Medicaid beneficiaries in cHIE and the right of individuals to opt out. (2) The Department will provide additional education regarding the individual's right to opt out on the program websites. |
| R414-8-5. Enrollment Process |
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(1) The Department will provide cHIE an enrollment file of all Medicaid beneficiaries. (2) The enrollment file will contain the succeeding month's Medicaid enrollment. (3) cHIE will enroll Medicaid beneficiaries on the first day of the succeeding month. (4) Submission procedures and guidelines, including required data elements, will be described in detail in the technical specifications published by UHIN and will be included in the Department's Operating Agreement with cHIE. (5) The Department will use a secure format to transfer any enrollment files to cHIE. |
| R414-8-6. Exemptions |
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(1) An individual's previous consent status in cHIE will be honored by cHIE and will not be overridden by the Medicaid enrollment file. |