Integrated Healthcare

R414. Health and Human Services, Integrated Healthcare.R414-516. Nursing Facility Non-State Government-Owned Upper Payment Limit Quality Improvement Program. R414-516-1. Authority and Purpose. (1) Sections 26B-1-213 and 26B-3-108 authorize this rule. (2) This rule defines partici…

R414. Health and Human Services, Health Care Financing, Coverage and Reimbursement Policy.R414-517. Inpatient Hospital Provider Assessments. R414-517-1. Introduction and Authority. This rule defines the scope of hospital provider assessment. This rule is authorized under Title 26…

R414. Health and Human Services, Health Care Financing, Coverage and Reimbursement Policy.R414-518. Emergency Services Program for Non-Citizens. R414-518-1. Introduction and Authority. This rule is authorized by 42 U.S.C. 1396b, 42 CFR 440.255(c), and Subsection 1903(v)(1) of the…

R414. Health and Human Services, Integrated Healthcare.R414-519. Settings for Home and Community-Based Services. R414-519-1. Introduction and Authority. Settings for home and community-based services (HCBS) must include all the qualities defined in 42 CFR 441.301(c)(4)(5), based …

R414. Health and Human Services, Integrated Healthcare.R414-520. Admission Criteria for Medically Complex Children's Waiver. R414-520-1. Introduction and Authority. (1) This rule outlines the criteria used to evaluate initial and ongoing eligibility for the Medically Complex Chil…

R414. Health and Human Services, Health Care Financing, Coverage and Reimbursement Policy.R414-521. Accountable Care Organization Hospital Report. R414-521-1. Reporting Requirements. (1) In accordance with Section 26B-3-506, a Medicaid accountable care organization (ACO) shall su…

R414. Health and Human Services, Health Care Financing, Coverage and Reimbursement Policy.R414-522. Electronic Visit Verification Requirements for Personal Care and Home Health Care Services. R414-522-1. Introduction and Authority. This rule implements the electronic visit verifi…

R414. Health and Human Services, Integrated Healthcare.R414-523. Extraordinary Care Definition for Spousal Caregiver Compensation. R414-523-1. Introduction and Authority. This rule implements a definition for extraordinary care to use in the evaluation and authorization of caregi…

R414. Health and Human Services, Integrated Healthcare.R414-524. American Rescue Plan Act, Home and Community-Based Services Enhanced Funding. R414-524-1. Introduction and Authority. (1) This rule enacts supplemental payments to eligible providers as authorized under the American…

R414. Health and Human Services, Integrated Healthcare.R414-525. Interpretive Services Invoice Requirements. R414-525-1. Introduction and Authority. (1) Medicaid utilizes statewide interpretive service contracts to provide interpretive services for qualifying Medicaid members. (2…

R414. Health and Human Services, Integrated Healthcare.R414-526. Quality Standards for Inpatient and Outpatient Hospitals. R414-526-1. Introduction and Authority. The purpose of this rule is to incorporate certain factors into the payment rate structure for accountable care organ…

R414. Health and Human Services, Integrated Healthcare.R414-60. Medicaid Policy for Pharmacy Program. R414-60-1. Purpose and Authority. (1) The Medicaid Pharmacy program reimburses for covered outpatient drugs dispensed to eligible Medicaid members by a pharmacy enrolled with Uta…

R414. Health and Human Services, Integrated Healthcare.R414-60A. Drug Utilization Review Board. R414-60A-1. Introduction and Authority. (1) The Drug Utilization Review Board (DURB) aids in pharmacy policy oversight and drug utilization. (2) The DURB is authorized under 42 CFR 456…

R414. Health and Human Services, Integrated Healthcare.R414-60B. Preferred Drug List. R414-60B-1. Introduction and Authority. (1) The Division of Integrated Healthcare (DIH) has established a Preferred Drug List (PDL) to operate within the pharmacy program and at the Division's d…

R414. Health and Human Services, Integrated Healthcare.R414-61. Home and Community-Based Services Waivers. R414-61-1. Introduction and Authority. (1) This rule establishes authority for the Department of Health and Human Services to administer all Section 1915(c) waivers. (2) The…

R414. Health and Human Services, Integrated Healthcare.R414-70. Durable Medical Equipment, Prosthetics, Orthotics, and Supplies. R414-70-1. Introduction and Authority. (1) This rule governs the coverage and reimbursement policies of services related to durable medical equipment (…

R414. Health and Human Services, Integrated Healthcare.R414-71. Early and Periodic Screening, Diagnostic, and Treatment Program. R414-71-1. Introduction and Authority. (1) The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Program provides comprehensive preventio…

R414. Health and Human Services, Health Care Financing, Coverage and Reimbursement Policy.R414-9. Federally Qualified Health Centers and Rural Health Clinics. R414-9-1. Introduction and Authority. (1) This rule establishes Medicaid payment methodologies for federally qualified he…

R414. Health and Human Services, Integrated Healthcare.R414-90. Diabetes Self-Management Training. R414-90-1. Introduction and Authority. Diabetes self-management training, as outlined in this rule, is a component of the Medicaid State Plan and is authorized by 42 CFR 440.130. R4…