Utah Administrative Code

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…

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…

R428. Health and Human Services, Data, Systems and Evaluation, Research and Evaluation, Health Care Statistics.R428-10. Health Data Authority Healthcare Facility Data Reporting Rule. R428-10-1. Authority. This rule is promulgated in accordance with Title 26B, Chapter 8, Part 5, U…

R428. Health and Human Services, Data, Systems and Evaluation, Research and Evaluation, Health Care Statistics.R428-12. Health Data Authority Survey of Enrollees in Health Plans. R428-12-1. Authority. This rule is promulgated in accordance with Title 26B, Chapter 8, Part 5, Utah …

R428. Health and Human Services, Data, Systems and Evaluation, Research and Evaluation, Health Care Statistics.R428-13. Health Data Authority Audit and Reporting of Health Plan Performance Measures. R428-13-1. Authority. This rule is promulgated in accordance with Title 26B, Chap…

R428. Health and Human Services, Data, Systems and Evaluation, Research and Evaluation, Health Care Statistics.R428-15. Health Data Authority Health Insurance Claims Reporting. R428-15-1. Authority. This rule is promulgated in accordance with Title 26B, Chapter 8, Part 5, Utah He…

R428. Health and Human Services, Data, Systems and Evaluation, Research and Evaluation, Health Care Statistics.R428-2. Health Data Authority Standards for Health Data. R428-2-1. Authority and Purpose. (1) Title 26B, Chapter 8, Part 5, Utah Health Data Authority authorizes this ru…

R429. Health and Human Services, Patient Safety Program.R429-1. Patient Safety Surveillance and Improvement Program (PSSIP). R429-1-1. Purpose and Authority. (1) This rule establishes a Patient Safety Surveillance and Improvement program (PSSIP) which extends the past Sentinel Ev…

R429. Health and Human Services, Patient Safety Program.R429-2. Health Care Facility Patient Safety Program. R429-2-1. Purpose and Authority. (1) This rule establishes the requirement for designated facilities to have a patient safety program and effective internal patient safety…

R430. Health and Human Services, Residential Child Care Licensing.R430-50. Residential Certificate Child Care. R430-50-1. Authority and Purpose. (1) Section 26B-2-402 authorizes this rule. (2) This rule establishes the foundational standards necessary to protect the health and sa…

R430. Health and Human Services, Residential Child Care Licensing.R430-8. Exemptions From Child Care Licensing. R430-8-1. Authority and Purpose. (1) Section 26B-2-402 authorizes this rule. (2) This rule defines what constitutes child care that is excluded from any of the regulato…

R430. Health and Human Services, Residential Child Care Licensing.R430-90. Licensed Family Child Care. R430-90-1. Authority and Purpose. (1) Section 26B-2-402 authorizes this rule. (2) This rule establishes the foundational standards necessary to protect the health and safety of …

R432. Health and Human Services, Health Care Facility Licensing.R432-1. General Licensing Provisions. R432-1-1. Legal Authority. This rule is authorized by Section 26B-2-202. R432-1-2. Purpose. The purpose of this rule is to define the standard terms for licensed health care faci…

R432. Health and Human Services, Family Health and Preparedness, Licensing.R432-10. Specialty Hospital - Long-Term Acute Care Construction Rule. R432-10-1. Legal Authority. This rule is adopted pursuant to Title 26, Chapter 21, Health Care Facility Licensing and Inspection Act. R…

R432. Health and Human Services, Health Care Facility Licensing.R432-100. General Hospital Standards. R432-100-1. Authority and Purpose. (1) Sections 26B-2-202 and 26B-2-203 authorize this rule. (2)(a) This rule promotes public health and welfare through the establishment and enf…

R432. Health and Human Services, Health Care Facility Licensing.R432-101. Specialty Hospital - Psychiatric. R432-101-1. Legal Authority. This rule is authorized by Section 26B-2-202. R432-101-2. Purpose. The purpose of this rule is to promote the public health and welfare through…

R432. Health and Human Services, Health Care Facility Licensing.R432-102. Specialty Hospital - Substance Use Disorder. R432-102-1. Legal Authority. This rule is authorized by Section 26B-2-202. R432-102-2. Purpose. This rule applies to a specialty hospital whose primary specialty…

R432. Health and Human Services, Health Care Facility Licensing.R432-103. Specialty Hospital - Rehabilitation. R432-103-1. Authority. This rule is adopted pursuant to Title 26, Chapter 21, Health Care Facility Licensing and Inspection Act. R432-103-2. Purpose. The purpose of this…

R432. Health and Human Services, Health Care Facility Licensing.R432-104. Specialty Hospital - Long-Term Acute Care. R432-104-1. Legal Authority. This rule is authorized by 26B-2-202. R432-104-2. Purpose. The purpose of this rule is to promote the public health and welfare throug…

R432. Health and Human Services, Health Care Facility Licensing.R432-105. Specialty Hospital - Orthopedic. R432-105-1. Authority. This rule is authorized by 26B-2-202. R432-105-2. Purpose. The purpose of this rule is to promote public health and welfare through the establishment …

R432. Health and Human Services, Health Care Facility Licensing.R432-106. Specialty Hospital - Critical Access. R432-106-1. Authority. This rule is authorized by 26B-2-202. R432-106-2. Purpose. (1) The purpose of this rule is to promote public health and welfare through establish…