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Utah State Medicaid Plan*
Utah Department of Health
Division of Health Care Finance
Bureau of Coverage and Reimbursement Policy
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UTAH STATE PLAN UNDER TITLE XIX
OF THE SOCIAL SECURITY ACT
MEDICAL ASSISTANCE PROGRAM
Note: Parenthesis (#) indicates
page number
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SECTION 1 - SINGLE
STATE AGENCY ORGANIZATION (2)
1.1 Designation and Authority (2)
1.2 Organization for Administration
(7)
1.3 Statewide Operation (8)
1.4 State Medical Care Advisory Committee
(9)
1.5 Pediatric Immunization Program
(9a)
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SECTION 2 -
COVERAGE
AND ELIGIBILITY (10)
2.1 Application, Determination of
Eligibility and Furnishing Medicaid (10)
2.2 Coverage and Conditions of Eligibility
(12)
2.3 Residence (13)
2.4 Blindness (14)
2.5 Disability (15)
2.6 Financial Eligibility (16)
2.7 Medicaid Furnished Out-of-State
(18)
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SECTION 3 - SERVICES:
GENERAL PROVISIONS (19)
3.1 Amount, Duration and Scope of
Services (19)
3.2 Coordination of Medicaid with
Medicare and Other Insurance (29)
3.3 Medicaid for Individuals Age 65
or Over in Institutions for Mental Diseases (30)
3.4 Special Requirements Applicable
to Sterilization Procedures (31)
3.5 Families Receiving Extended Medicaid
Benefits (31a)
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SECTION 4 - GENERAL
PROGRAM ADMINISTRATION (32)
4.1 Methods of Administration (32)
4.2 Hearings for Applicants and Recipients
(33)
4.3 Safeguarding Information on Applicants
and Recipients (34)
4.4 Medicaid Quality Control (35)
4.5 Medicaid Agency Fraud Detection
and Investigation Program (36)
4.6 Reports (37)
4.7 Maintenance of Records (38)
4.8 Availability of Agency Program
Manuals (39)
4.9 Reporting Provider Payments to
the Internal Revenue Service (40)
4.10 Free Choice of Providers (41)
4.11 Relations with Standard-Setting
and Survey Agencies (42)
4.12 Consultation to Medical Facilities
(44)
4.13 Required Provider Agreement (45)
4.14 Utilization/Quality Control (46)
4.15 Inspections of Care in Intermediate
Care Facilities for the Mentally
Retarded,
Facilities Providing Inpatient Psychiatric Services for
Individuals
Under 21, and Mental Hospitals (51)
4.16 Relations with State Health and
Vocational Rehabilitation Agencies and
Title
V Grantees (52)
4.17 Liens and Adjustments or Recoveries
(53)
4.18 Recipient Cost Sharing and Similar
Charges (54)
4.19 Payment for Services (57)
4.20 Direct Payments to Certain Recipients
for Physicians or Dentists
Services
(67)
4.21 Prohibition Against Reassignment
of Provider Claims (68)
4.22 Third Party Liability (69)
4.23 Use of Contracts (71)
4.24 Standards for Payments for Nursing
Facility and Intermediate Care
Facility
Services for the Mentally Retarded Services (72)
4.25 Program for Licensing Administrators
of Nursing Homes (73)
4.26 Drug Utilization Review Program
(74)
4.27 Disclosure of Survey Information
and Provider or Contractor Evaluation (75)
4.28 Appeals Process (76)
4.29 Conflict of Interest Provisions
(77)
4.30 Exclusion of Providers and Suspension
of Practitioners and Other Individuals
4.31 Disclosure of Information by
Providers and Fiscal Agents (79)
4.32 Income and Eligibility Verification
System (79)
4.33 Medicaid Eligibility Cards for
Homeless Individuals (79a)
4.34 Systematic Alien Verification
for Entitlements (79b)
4.35 Enforcement of Compliance for
Nursing Facilities (79c)
4.36 Required Coordination Between
the Medicaid and WIC Programs (79d)
4.38 Nurse Aide Training and Competency
Evaluation for Nursing Facilities
4.39 Preadmission Screening and Annual
Resident Review in Nursing Facilities
4.41 Resident Assessment for Nursing
Facilities (79x)
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SECTION 5 PERSONNEL
ADMINISTRATION (80)
5.1 Standards of Personnel Administration
(80)
5.2 RESERVED (81)
5.3 Training Programs: Sub professional
and Volunteer Programs (82)
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SECTION 6 - FINANCIAL
ADMINISTRATION (83)
6.1 Fiscal Policies and Accountability
(83)
6.2 Cost Allocation (84)
6.3 State Financial Participation
(85)
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SECTION 7 - GENERAL
PROVISIONS (86)
7.1 Plan Amendments (86)
7.2 Nondiscrimination (87)
7.4 State Governor's Review (89)
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LIST OF ATTACHMENTS No. Title
of Attachment |
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*1.1-A Attorney
General?s Certification
1.2-A Description, Function
and Organization of State Agency
1.2-B Organization and Function
of Medical Assistance Unit
1.2-C Professional Medical
Personnel and Supporting Staff
1.2-D Description of Staff
Making Eligibility Determination
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2.1-A Definition
of an HMO that Is Not Federally Qualified
*2.2-A Groups Covered and Agencies
Responsible for Eligibility Determination
* Supplement 1 - Reasonable
Classification of Individuals Under the Age of
21, 20, 19 and 18
* Supplement 2 - Non-Financial Criteria
* Supplement 3 - Method of Determining
Cost Effectiveness of Caring for
Certain Disabled Children
at Home
*2.6-A Eligibility Conditions and Requirements
* Supplement 1 - Income
Eligibility Levels - Categorically Needy, Medically
Needy and Qualified Medicare
Beneficiaries
* Supplement 2 - Resource Levels -
Categorically Needy and Medically Needy
* Supplement 3 - Reasonable Limits
on Amounts for Necessary Medical or
Remedial Care Not Covered
Under Medicaid
* Supplement 4 - Methodologies for
Treatment of Income That Differ From Those
of the SSI Program
* Supplement 5 - Methodologies for
Treatment of Resources that Differ from
Those of the SSI Program
* Supplement 5a - Methodologies for
Treatment of Resources for Individuals
with Incomes Up to a Percentage
of the Federal Poverty Level
* Supplement 6 - Standards for Optional
State Supplementary Payments
* Supplement 7 - Income Levels Categorically
Needy Who Are Covered Under
Requirements More Restrictive
Than SSI
* Supplement 8 - Resource Standards
for Categorically Needy
* Supplement 8a - More Liberal Methods
of Treating Income Under Section
1902(r)(2) of the Act
* Supplement 8b - More Liberal Methods
of Treating Resources Under
Section 1902(r)(2)
of the Act
* Supplement 9 - Transfer of Resources
* Supplement 9a - Transfer of Assets
* Supplement 10 - Consideration of
Medicaid Qualifying Trusts - Undue Hardship
* Supplement 10a - Transfer of Assets
- Undue Hardship
* Supplement 11 - Cost-effective Methods
for COBRA Groups
* Supplement 13 - Section 1924 Provisions
* Supplement 14 - Eligibility Conditions
and Requirement
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*3.1-A Amount,
Duration, and Scope of Medical and Remedial Care and Services
Provided to the Categorically Needy
* Supplement 1 -
Case Management Services
*3.1-B Amount, Duration, and Scope
of Services Provided Medically Needy Groups
* Supplement 1 - Case
Management Services
3.1-C Standards and Methods of
Assuring High Quality Care
3.1-D Methods of Providing
Transportation
*3.1-E Coverage of Organ Transplant
Services
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4.11-A Standards
for Institutions
4.16-A Cooperative
Arrangements with State Health and State Vocational Rehabilitation
Agencies and with Title V Grantees
4.17-A Liens and
Adjustments or Recoveries
*4.18-A Charges
Imposed on Categorically Needy
*4.18-B Medically Needy - Premium
*4.18-C Charges Imposed on Medically
Needy for Services
*4.18-D Premiums Imposed on Low
Income Pregnant Women and Infants
*4.18-E Premiums Imposed on Qualified
Disabled and Working Individuals
4.19-A Methods
and Standards for Establishing Payment Rates - Inpatient Hospital
Care
4.19-B Methods and Standards
for Establishing Payment Rates - Other Types of Care
* Supplement 1 -
Payment of Medicare Part A and Part B Deductible/Coinsurance
4.19-C Payments for Reserved
Beds
4.19-D Methods and Standards
for Establishing Payment Rates - Skilled Nursing and Intermediate
Care Facility Services
4.22-A Requirements
for Third Party Liability -- Identifying Liable Resources
*4.22-B Requirements for Third
Party Liability -- Payment of Claims
4.22-C Cost Effectiveness
of Employer-Based Group Health Plans
4.30 Sanctions
for Psychiatric Hospitals
*4.32-A Income
and Eligibility Verification System Procedures: Requests to
Other State Agencies
*4.33-A Methods
for Issuance of Medicaid Eligibility Cards to Homeless Individuals
4.35-A Eligibility
Conditions and Requirements, Enforcement of Compliance for
Nursing Facilities
4.35-B Alternative Remedies
to Specified Remedies for Nursing Facilities
4.35-C Temporary Management
4.35-D Denial of Payment
for New Admissions
4.35-E Civil Money Penalty
4.35-F State Monitoring
4.35-G Transfer of Residents
with Facility Closure
4.35-H Additional Remedies
4.38 Disclosure
of Additional Registry Information
4.38-A Nurse Aide Registry
4.39 Definition
of Specialized Services
4.39-A Categorical Determinations
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*This website may not reflect recent changes
or updates to the the State Plan.
Please contact Craig
Devashrayee (801-538-6641) to receive the official version.
State Plan Index Maintained
by
Randy
Baker
State Plan Section Content Maintained
by
Barbara Brownell and Craig Devashrayee
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