DAR File No. 28240

Health, Health Care Financing, Coverage and Reimbursement Policy

R414-307

Eligibility Determination and Redetermination

NOTICE OF PROPOSED RULE

DAR File No.: 28240
Filed: 09/15/2005, 12:14
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rulemaking repeals Rule R414-307 because the provisions in Rule R414-307 are being combined into a reenacted version of Rule R414-308. The provisions in these two rules are closely related. By including them in one rule, the provisions will not contain confusing duplication, will be more consistent, and easier to understand. Rule R414-308 will be repealed and reenacted so that it contains only those provisions of both rules that are needed, and so that the provisions from both rules are more consistent and easier to understand. (DAR NOTE: The repeal and reenactment of Rule R414-308 is under DAR No. 28239 in this issue.)

Summary of the rule or change:

Rule R414-307 is repealed in its entirety and consolidated into Rule R414-308. The repeal and reenactment of Rule R414-308 is filed concurrently with this rulemaking.

State statutory or constitutional authorization for this rule:

Title 26, Chapter 18

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget. This rulemaking does not add new benefits or remove benefits. This is a rewrite intended to make the rules more understandable.

local governments:

This is no impact to local government. This is a rewrite intended to make the rules more understandable.

other persons:

There is no impact to the state budget. This rulemaking does not add new benefits or remove benefits. This is a rewrite intended to make the rules more understandable.

Compliance costs for affected persons:

There is no compliance costs for affected persons as this does not add requirements or remove benefits.

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

The content of this rule is being moved to Rule R414-308. This repeal will have no direct fiscal impact on businesses since the substance of the requirements are not changed. 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:

Ross Martin at the above address, by phone at 801-538-6592, by FAX at 801-538-6099, or by Internet E-mail at rmartin@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:

10/31/2005

This rule may become effective on:

11/01/2005

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

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

[R414-307. Eligibility Determination and Redetermination.

R414-307-1. Application.

(1) The Department adopts 42 CFR 435.907 and 435.908, 2001 ed., which are incorporated by reference.

(2) Definitions:

The definitions in R414-1 and R414-301 apply to this rule.

(3) The Department accepts any Department-approved application form for Medicaid, UMAP. PCN, QMB, SLMB, or QI-1 assistance.

(a) If applicants cannot write, they must make their mark on the application form and have at least one witness to the signature.

(b) The date of application is the day the completed, signed application form is received by the local office.

(i) If a signed application is mailed to the Department, the application date is the date postmarked on the envelope.

(ii) If an unsigned application is received, including an application made over the telephone or electronically submitted, the applicant must return a signed signature page to the eligibility worker or come to the office and sign the application within the application processing time period. If a signature is received within the application processing time period, the date of application is the date the application form was received by the local office. Otherwise, the unsigned application is considered invalid, and the Department will not process the application.

(iii) A signed application form submitted via a FAX machine is a valid application and does not have be re-signed.

(c) If a legal guardian or power of attorney has been appointed, or there is a payee for the individual, the Department shall make all forms and other documents in the name of both the individual and the individual's representative.

(d) If the Division of Child and Family Services (DCFS) has custody of a child and the child is placed in foster care, DCFS shall complete the application. DCFS shall determine eligibility for the child pursuant to written agreement with the Department.

(e) An authorized representative may apply for the client if unusual circumstances or death prevent an individual from appearing in person. The applicant must sign the application form if possible.

(f) The Department shall reinstate a medical case without requiring a new application if the case was closed in error. The Department shall not require a new application if the case was closed for failure to complete a review or comply with a request for verification if the client complies before the end of the month following the month of closure.

R414-307-2. Eligibility Decisions.

The Department adopts 42 CFR 435.911 and 435.912, 2001 ed., which are incorporated by reference.

R414-307-3. Eligibility Period.

The Department adopts 42 CFR 435.916 and 435.919, 2001 ed., which are incorporated by reference.

(1) The first month of eligibility is the first month for which assistance is approved.

(2) The last month of eligibility is the recertification month.

(3) The Department requires recertification at least once every 12 months.

(4) The Department may require recertification whenever necessary to ensure continued eligibility.

(5) Clients must complete the recertification process by the end of the recertification month, and continue to meet all eligibility criteria to receive benefits without interruption.

(6) If a client fails to complete the recertification process during the recertification month, but completes it by the end of the following month, benefits can be reinstated back to the first day of that month if the client meets all eligibility criteria.

(7) The Department shall issue notice of eligibility by the end of the month following the recertification month, provided the client completes the recertification process and is eligible for continued assistance.

(8) For individuals selected for coverage under the Qualifying Individuals Group 1 program, eligibility extends through the end of the calendar year if the individual continues to meet eligibility criteria.

R414-307-4. Verification.

(1) The Department adopts 42 CFR 435.945, 435.948, 435.952, 435.955, and 435.960, 2001 ed., which are incorporated by reference.

(2) Applicants must verify all factors of eligibility in accordance with the CFR sections listed above.

(3) To be eligible under Section 1902(a)(10)(A)(ii)(XIII), the Medicaid Work Incentive program, the individual must provide verification of earned income such as paycheck stubs showing deductions of FICA tax; self-employment tax filing documents; or for newly self-employed individuals who have not filed tax forms yet, a written business plan.

KEY: public assistance programs, eligibility, Medicaid

September 9, 2003

Notice of Continuation January 31, 2003

26-18]

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For questions regarding the content or application of this rule, please contact Ross Martin at the above address, by phone at 801-538-6592, by FAX at 801-538-6099, or by Internet E-mail at rmartin@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.