DAR File No. 27935

Health, Health Care Financing, Coverage and Reimbursement Policy

R414-507

Medicaid Long Term Care Managed Care

NOTICE OF PROPOSED RULE

DAR File No.: 27935
Filed: 05/24/2005, 04:25
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rule change adds a definition of a term later used in the rule and clarifies evaluation and reevaluation of the nursing facility level of care.

Summary of the rule or change:

In Section R414-507-2, the definition of the term "Minimum Data Set-HOME CARE (MDS-HC)" is added to the rule. In Section R414-507-7, the word "Director" is added after Department for specificity purposes, the word "its" is deleted because it does not correspond to the term "Director"; the words "may" and "or" are added while the word "and" is deleted in order to avoid applying the conditions of evaluation and reevaluation simultaneously, the word "initial" is changed to "initially"; the word "evaluates" is changed to "evaluate"; and the word "reevaluates" is changed to "reevaluate."

State statutory or constitutional authorization for this rule:

Section 26-18-3

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget associated with this rulemaking because the changes only add a definition and include language that clarifies evaluation and reevaluation of the nursing facility level of care.

local governments:

There is no budget impact to local governments as a result of this rulemaking because the changes only add a definition and include language that clarifies evaluation and reevaluation of the nursing facility level of care.

other persons:

There is no budget impact to other persons as a result of this rulemaking because the changes only add a definition and include language that clarifies evaluation and reevaluation of the nursing facility level of care.

Compliance costs for affected persons:

There are no compliance costs because the changes only add a definition and include language that clarifies evaluation and reevaluation of the nursing facility level of care.

Comments by the department head on the fiscal impact the rule may have on businesses:

This rule does not change current practice in Medicaid as to evaluation of nursing facility level of care. It should not have any fiscal impact on providers. There may be some minor savings to providers resulting from the rule being clearer and more easily applied by providers. David N. Sundwall, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

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 cdevashrayee@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

07/15/2005

This rule may become effective on:

07/16/2005

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-507. Medicaid Long Term Care Managed Care.

R414-507-2. Definitions.

The definitions in R414-1 apply to this rule. In addition:

(1) "Care Coordination" is a process where representatives of Medicaid programs serving an individual, and the individual's attending physician when possible, participate in the exchange of information and service planning to assure that the individual's health and welfare needs are identified, develop a comprehensive service plan, and implement the service plan to achieve integration of care across programs.

(2) "Long Term Care" (LTC) means a comprehensive array of services provided to persons of all ages who are experiencing chronic functional limitations due to illness, disability or injury.

(3) "LTC Managed Care Project Contractor" is a Medicaid Primary Inpatient Health Plan or a Medicaid Prepaid Mental Health Plan that has contracted with the Medicaid agency to provide a long term care service package as part of its array of covered services.

(4) "Minimum Data Set-HOME CARE (MDS-HC)" is a trademark standardized assessment instrument developed by the nonprofit consortium known as interRAI.

R414-507-7. Evaluation and Reevaluation of Nursing Facility Level of Care.

The Department Director, or [its ]designee, may initially evaluate[s and], or periodically reevaluate[s] at least annually each LTC Managed Care enrollee to determine whether the individual meets the admission criteria of R414-502.

KEY: Medicaid

[February 15, ]2005

26-1-5

26-18-3

ADDITIONAL INFORMATION

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For questions regarding the content or application of this rule, please contact Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at cdevashrayee@utah.gov

For questions about the rulemaking process, please contact the Division of Administrative Rules (801-538-3764). Please Note: The Division of Administrative Rules is NOT able to answer questions about the content or application of these administrative rules.