DAR File No. 29730

Health, Health Care Financing, Coverage and Reimbursement Policy

R414-300

Primary Care Network, Covered-at-Work Demonstration Waiver

NOTICE OF PROPOSED RULE

DAR File No.: 29730
Filed: 03/26/2007, 09:40
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

The repeal of this rule is necessary because the Covered-at-Work Demonstration Waiver program no longer exists. The program is replaced by Utah's Premium Partnership for Health Insurance (UPP) program, which is a Section 1115 demonstration waiver. This repealed rule describes the authority of the covered-at-work program and its program benefits.

Summary of the rule or change:

This rule is repealed in its entirety. The replacement program under the 1115 demonstration waiver is implemented in a separate, companion rule filing, Rule R414-310. (DAR NOTE: The proposed amendment to Rule R414-310 is under DAR No. 29731 in this issue, April 15, 2007, of the Bulletin.)

State statutory or constitutional authorization for this rule:

Sections 26-18-3 and 26-1-5

Anticipated cost or savings to:

the state budget:

There is no budget impact because of the repeal of this rule. The costs of the Covered-at-Work Demonstration Waiver program are being replaced by the UPP program.

local governments:

There is no budget impact because local governments do not fund waiver programs.

other persons:

There is no budget impact because of the repeal of this rule. The costs of the Covered-at-Work Demonstration Waiver program are being replaced by the UPP program.

Compliance costs for affected persons:

There is no budget impact because of the repeal of this rule. The costs of the Covered-at-Work Demonstration Waiver program are being replaced by the UPP program.

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

This repeals obsolete language and will have no fiscal impact on business. 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:

Health
Health Care Financing, Coverage and Reimbursement Policy
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY UT 84116-3231

Direct questions regarding this rule to:

Craig Devashrayee or Gayleen Henderson at the above address, by phone at 801-538-6641 or 801-538-6135, by FAX at 801-538-6099 or 801-538-6860, or by Internet E-mail at cdevashrayee@utah.gov or ghenderson@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:

05/15/2007

This rule may become effective on:

05/23/2007

Authorized by:

David N. Sundwall, Executive Director

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

[R414-300. Primary Care Network, Covered-at-Work Demonstration Waiver.

R414-300-1. Introduction and Authority.

This rule describes the benefits under the Primary Care Network (PCN)Covered-at-Work Program. The PCN Covered-at-Work Program is authorized by an amendment to a waiver of federal Medicaid requirements approved by the federal Center for Medicare and Medicaid Services and allowed under Section 1115 of the Social Security Act effective January 1, 1999. This rule is authorized by Title 26, Chapter 18.

 

R414-300-2. Definitions.

"Spouse" means an individual who is married to an applicant or enrollee and has not legally terminated the marriage.

 

R414-300-3. Nature of Program and Benefits.

(1) The Covered-at-Work Program provides cash reimbursement to an enrollee who meets the eligibility requirements and application requirements of R414-310. The Covered-at-Work Program provides benefits as described in this section.

(2) The reimbursement shall not exceed the amount the employee pays toward the cost of the employee's employer-sponsored coverage for the employee and the employee's spouse if covered under the employee's plan. The employer must pay at least 50 percent of the employee's health insurance premium.

(3) The amount of reimbursement for a single person or for a married couple when only one spouse is eligible for the reimbursement, will be provided on the following schedule, in the designated amounts:

(a) Up to $50 per month for the first 24 months of eligibility.

(b) Up to $40 per month for the next 12 months (third year)of eligibility.

(c) Up to $30 per month for the next 12 months (fourth year)of eligibility.

(d) Up to $20 per month for the last 12 months (fifth year)of eligibility.

(4) The amount of reimbursement for a married couple when both spouses are eligible for the reimbursement and both are covered under the same employer sponsored plan, will be provided on the following schedule, in the designated amounts:

(a) Up to $100 per month for the first 24 months of eligibility.

(b) Up to $80 per month for the next 12 months (third year)of eligibility.

(c) Up to $60 per month for the next 12 months (fourth year)of eligibility.

(d) Up to $40 per month for the last 12 months (fifth year) of eligibility.

(5) The amount of reimbursement for a married couple when both spouses are eligible for the reimbursement but are covered under their own separate employer-sponsored plans, will be provided as described in subsection (3) for each spouse.

(6) Benefits provided to a Covered-at-Work enrollee are limited to a lifetime maximum of 60 months.

 

KEY: Medicaid, primary care network, covered-at-work benefits

Date of Enactment or Last Substantive Amendment: February 10, 2004

Authorizing, and Implemented or Interpreted Law: 26-18-3]