Integrated Healthcare

R414. Health and Human Services, Integrated Healthcare.R414-1. Utah Medicaid Program. R414-1-1. Authority and Purpose. (1)(a) Title XIX of the Social Security Act and Sections 26B-1-213, 26B-3-102, and 26B-3-104 authorize this rule. (b) Section 26B-3-1004 authorizes the Departmen…

R414. Health and Human Services, Integrated Healthcare.R414-10. Physician Services. R414-10-1. Introduction and Authority. (1) The Physician Services Program provides a scope of physician services to meet the basic medical needs of eligible Medicaid members. It encompasses the ar…

R414. Health and Human Services, Integrated Healthcare.R414-10A. Transplant Services Standards. R414-10A-1. Introduction and Authority. (1) This rule establishes standards and requirements for tissue and organ transplantation services for the State of Utah Medicaid Program. (2) T…

R414. Health and Human Services, Health Care Financing, Finance Policy.R414-12. Laboratory Services. R414-12-1. Purpose and Authority. (1) Laboratory services provide a scope of services to meet the basic medical needs of eligible Medicaid members. (2) Laboratory services are a m…

R414. Health and Human Services, Health Care Financing, Coverage and Reimbursement Policy.R414-14. Home Health Services. R414-14-1. Introduction and Authority. (1) Home health services are part-time intermittent health care services based on medical necessity and provided to elig…

R414. Health and Human Services, Integrated Healthcare.R414-140. Choice of Health Care Delivery Program. R414-140-1. Authority and Purpose. (1) Subsection 26B-3-108(2)(a) authorizes this rule. (2) This rule outlines the Choice of Health Care Delivery Program that operates under a…

R414. Health and Human Services, Integrated Healthcare.R414-14A. Hospice Care. R414-14A-1. Introduction and Authority. This rule defines the scope of hospice care services available to Medicaid members. Authorization of this rule is in accordance with Sections 26B-1-213 and 26B-3…

R414. Health and Human Services, Integrated Healthcare.R414-15. Residents Personal Needs Fund. R414-15-1. Introduction and Authority. (1) This policy ensures proper administration of the personal funds of a Medicaid client who is a resident in a long term care facility. The admin…

R414. Health and Human Services, Health Care Financing, Coverage and Reimbursement Policy.R414-19A. Coverage for Dialysis Services by an End-Stage Renal Disease Facility. R414-19A-0. Policy Statement. Dialysis services are provided under the Medicaid State Plan to cover Medicaid …

R414. Health and Human Services, Integrated Healthcare.R414-1B. Payment for Limited Abortion Services. R414-1B-1. Introduction and Authority. This rule is to assure compliance with the prohibition on using public funds for certain abortion services as provided in the Hyde Amendme…

R414. Health and Human Services, Integrated Healthcare.R414-22. Administrative Sanction Procedures and Regulations. R414-22-1. Introduction and Authority. (1) To maintain the integrity of the Medicaid program and to assure the safety of Medicaid members, the department may implem…

R414. Health and Human Services, Integrated Healthcare.R414-23. Provider Enrollment. R414-23-1. Purpose and Authority. (1) Sections 26B-1-213 and 26B-3-108 authorize this rule. (2) This rule implements requirements for provider revalidation as set forth in the Code of Federal Reg…

R414. Health and Human Services, Integrated Healthcare.R414-27. Medicaid Enrollment Process for Nursing Care Facilities. R414-27-1. Introduction and Authority. (1) This rule governs the enrollment of nursing care facilities to receive Medicaid payments for services to Medicaid el…

R414. Health and Human Services, Integrated Healthcare.R414-29. Client Review and Restriction Policy. R414-29-1. Introduction and Authority. (1) This rule sets out the criteria and process to restrict a Medicaid member to specific Medicaid providers if the member is found to have…

R414. Health and Human Services, Integrated Healthcare.R414-2A. Inpatient Hospital Services. R414-2A-1. Introduction and Authority. This rule defines the scope of inpatient hospital services that are available to Medicaid members. This rule is authorized under Section 26B-3-108 a…

R414. Health and Human Services, Integrated Healthcare.R414-301. Medicaid General Provisions. R414-301-1. Authority and Purpose. (1) This rule is established under the authority of Section 26B-3-108. (2) The purpose of this rule is to establish general provisions governing eligib…

R414. Health and Human Services, Integrated Healthcare.R414-302. Eligibility Requirements. R414-302-1. Authority and Purpose. This rule is authorized by Section 26B-1-213 and Section 26B-3-108 and establishes eligibility requirements for Medicaid and the Medicare Cost Sharing pro…

R414. Health and Human Services, Integrated Healthcare.R414-303. Coverage Groups. R414-303-1. Authority and Purpose. This rule is authorized by Sections 26B-1-213 and 26B-3-108 and establishes eligibility requirements for Medicaid and the Medicare Cost Sharing programs. R414-303-…

R414. Health and Human Services, Integrated Healthcare.R414-304. Income and Budgeting. R414-304-1. Authority and Purpose. (1) This rule is established under the authority of Section 26B-3-108. (2) The purpose of this rule is to establish the income eligibility criteria for determ…

R414. Health and Human Services, Integrated Healthcare.R414-305. Resources. R414-305-1. Purpose and Authority. This rule is established under the authority of Section 26B-3-108 and establishes the resource provisions for Medicaid eligibility. R414-305-2. Definitions. (1) The defi…

R414. Health and Human Services, Integrated Healthcare.R414-306. Program Benefits and Date of Eligibility. R414-306-1. Medicaid Benefits and Coordination with Other Programs. (1) The Department provides medical benefits to Medicaid recipients as outlined in Section R414-1-6. (2) …

R414. Health and Human Services, Integrated Healthcare.R414-307. Eligibility for Home and Community-Based Services Waivers. R414-307-1. Introduction and Authority. (1) Section 26B-3-108 authorizes this rule. It establishes eligibility requirements for Medicaid coverage for home a…

R414. Health and Human Services, Integrated Healthcare.R414-308. Application, Eligibility Determinations, Improper Medical Assistance, and Suspension of Benefits. R414-308-1. Authority and Purpose. (1) This rule is authorized by Section 26B-3-108. (2) The purpose of this rule is …

R414. Health and Human Services, Health Care Financing, Coverage and Reimbursement Policy.R414-309. Medicare Drug Benefit Low-Income Subsidy Determination. R414-309-1. Introduction and Authority. (1) This rule is authorized by Title 26B, Chapter 3, Health Care - Administration an…

R414. Health and Human Services, Integrated Healthcare.R414-31. Inpatient Psychiatric Services for Individuals Under 21 Years of Age. R414-31-1. Introduction and Authority. (1) Except for certain age groups, Medicaid excludes coverage of patients in an institution for mental dise…

R414. Health and Human Services, Integrated Healthcare.R414-311. Targeted Adult Medicaid. R414-311-1. Introduction and Authority. (1) This rule is authorized by Sections 26B-1-213 and 26B-3-108 and allowed under Subsection 1115(f) of the Social Security Act. (2) This rule establi…

R414. Health and Human Services, Integrated Healthcare.R414-312. Adult Expansion Medicaid. R414-312-1. Introduction and Authority. (1) This rule is authorized by Sections 26B-1-213 and 26B-3-108 and allowed under Subsection 1115(f) of the Social Security Act. (2) This rule establ…

R414. Health and Human Services, Health Care Financing, Coverage and Reimbursement Policy.R414-32. Hospital Recordkeeping Policy. R414-32-1. Introduction. A hospital that provides care for a Medicaid member must provide sufficient documentary evidence that ancillary services for …

R414. Health and Human Services, Integrated Healthcare.R414-320. Medicaid Health Insurance Flexibility and Accountability Demonstration Waiver. R414-320-1. Authority and Purpose. (1) This rule is authorized by Sections 26B-1-213 and 26B-3-108 and allowed under Section 1115(a) of …

R414. Health and Human Services, Integrated Healthcare.R414-36. Behavioral Health Services. R414-36-1. Authority and Purpose. (1) Sections 26B-1-213 and 26B-3-108 authorize this rule. (2) This rule provides the circumstances under which Medicaid provides behavioral health service…

R414. Health and Human Services, Integrated Healthcare.R414-3A. Outpatient Hospital Services. R414-3A-1. Introduction and Authority. This rule defines the scope of outpatient hospital services available to Medicaid members for the treatment of disorders other than mental disease.…

R414. Health and Human Services, Integrated Healthcare.R414-40. Private Duty Nursing Services. R414-40-1. Introduction and Authority. (1) This rule outlines eligibility, access requirements, coverage, limitations, and reimbursement for private duty nursing. This rule is authorize…

R414. Health and Human Services, Integrated Healthcare.R414-401. Nursing Care Facility Assessment. R414-401-1. Introduction and Authority. (1) This rule implements the assessment imposed on certain nursing care facilities by Title 26B, Chapter 3, Part 4, Nursing Care Facility Ass…

R414. Health and Human Services, Integrated Healthcare.R414-42. Telehealth. R414-42-1. Authority and Purpose. (1) Section 26B-3-122 authorizes the Department of Health and Human Services to adopt rules to establish telehealth services and the reimbursement methodology for telehea…

R414. Health and Human Services, Integrated Healthcare.R414-49. Dental, Oral, and Maxillofacial Surgeons and Orthodontia. R414-49-1. Authority and Purpose. (1) Sections 26B-1-213 and 26B-3-108 authorize this rule. (2) This rule provides a scope of dental services for Medicaid mem…

R414. Health and Human Services, Integrated Healthcare.R414-5. Doula Services. R414-5-1. Authority and Purpose. (1) Sections 26B-1-213, 26B-3-108, and 26B-3-229 authorize this rule. (2) This rule provides measures for doula services to be provided to Medicaid members during a pre…

R414. Health and Human Services, Integrated Healthcare.R414-501. Preadmission Authorization, Retroactive Authorization, and Continued Stay Review. R414-501-1. Introduction and Authority. This rule implements the nursing facility and utilization requirements of 42 U.S.C. Sec. 1396…

R414. Health and Human Services, Integrated Healthcare.R414-502. Nursing Facility Levels of Care. R414-502-1. Purpose and Authority. (1) This rule defines the levels of care provided in nursing facilities. (2) Sections 26B-1-213 and 26B-3-108 authorize this rule. R414-502-2. Defi…

R414. Health and Human Services, Health Care Financing, Coverage and Reimbursement Policy.R414-503. Preadmission Screening and Resident Review. R414-503-1. Introduction and Authority. This rule implements 42 U.S.C. 1396r(b)(3) and (e)(7) and Pub. L. No. 104 315, which require pre…

R414. Health and Human Services, Integrated Healthcare.R414-504. Nursing Facility Payments. R414-504-1. Introduction. (1) This rule adopts a case mix or severity-based payment system for nursing facilities that are not intermediate care facilities for persons with intellectual di…

R414. Health and Human Services, Integrated Healthcare.R414-505. Participation in the Nursing Facility Non-State Government-Owned Upper Payment Limit Program. R414-505-1. Purpose and Authority. (1) This rule defines the participation requirements in the nursing care facility non-…

R414. Health and Human Services, Integrated Healthcare.R414-506. Hospital Provider Assessments. R414-506-1. Introduction and Authority. This rule defines the scope of hospital provider assessment. This rule is authorized under Title 26B, Chapter 3, Part 7, Hospital Provider Asses…

R414. Health and Human Services, Integrated Healthcare.R414-507. Ground Ambulance Service Provider Assessments. R414-507-1. Authority and Purpose. (1) Sections 26B-1-213 and 26B-3-108 authorize this rule. (2) This rule defines the scope of the ground ambulance service provider as…

R414. Health and Human Services, Integrated Healthcare.R414-508. Requirements for Transfer of Bed Licenses. R414-508-1. Introduction and Authority. (1) This rule implements requirements that a Medicaid-certified nursing care facility program must meet to transfer licensed bed cap…

R414. Health and Human Services, Integrated Healthcare.R414-510. Intermediate Care Facility for Persons with Intellectual Disabilities Transition Program and Education. R414-510-1. Introduction and Authority. (1) This rule implements the Intermediate Care Facility for Persons wit…

R414. Health and Human Services, Integrated Healthcare.R414-511. Medicaid Accountable Care Organization Incentives to Appropriately Use Emergency Room Services. R414-511-1. Introduction and Authority. (1) This rule is established under the authority of Section 26B-3-204. (2) This…

R414. Health and Human Services, Integrated Healthcare.R414-512. Use of Extrapolation in Provider Audits. R414-512-1. Introduction and Authority. This rule implements rulemaking required by Section 26B-3-129. It sets forth the conditions under which the department or one of its c…

R414. Health and Human Services, Integrated Healthcare.R414-513. Intergovernmental Transfers. R414-513-1. Introduction and Authority. This rule requires documentation accompanying intergovernmental transfer of funds for use as non-federal share of Medicaid payments or administrat…

R414. Health and Human Services, Integrated Healthcare.R414-514. Requirements for Moratorium Exception. R414-514-1. Introduction and Authority. (1) This rule implements requirements that a Medicaid-certified nursing facility program must meet for certification of additional nursi…

R414. Health and Human Services, Health Care Financing, Coverage and Reimbursement Policy.R414-515. Long-Term Acute Care. R414-515-1. Purpose and Authority. (1) This rule defines the scope of inpatient long-term acute care (LTAC) hospital services available to Medicaid members to…