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Utah State Medicaid Plan*


Utah Department of Health
Division of Medicaid and Health Financing
Bureau of Coverage and Reimbursement Policy

UTAH STATE PLAN UNDER TITLE XIX
OF THE SOCIAL SECURITY ACT
MEDICAL ASSISTANCE PROGRAM

Note: Parenthesis (#) indicates page number


SECTION 1 - SINGLE STATE AGENCY ORGANIZATION (2)
1.1Designation and Authority (2)
1.2Organization for Administration (7)
1.3Statewide Operation (8)
1.4State Medical Care Advisory Committee (9)
1.5Pediatric Immunization Program (9a)

SECTION 2 - COVERAGE AND ELIGIBILITY (10)
2.1Application, Determination of Eligibility and Furnishing Medicaid (10)
2.2Coverage and Conditions of Eligibility (12)
2.3Residence (13)
2.4Blindness (14)
2.5Disability (15)
2.6Financial Eligibility (16)
2.7Medicaid Furnished Out-of-State (18)

SECTION 3 - SERVICES: GENERAL PROVISIONS (19)
3.1Amount, Duration and Scope of Services (19)
3.2Coordination of Medicaid with Medicare and Other Insurance (29)
3.3Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases (30)
3.4Special Requirements Applicable to Sterilization Procedures (31)
3.5Families Receiving Extended Medicaid Benefits (31a)

SECTION 4 - GENERAL PROGRAM ADMINISTRATION (32)
4.1Methods of Administration (32)
4.2Hearings for Applicants and Recipients (33)
4.3Safeguarding Information on Applicants and Recipients (34)
4.4Medicaid Quality Control (35)
4.5Medicaid Agency Fraud Detection and Investigation Program (36)
4.6Reports (37)
4.7Maintenance of Records (38)
4.8Availability of Agency Program Manuals (39)
4.9Reporting Provider Payments to the Internal Revenue Service (40)
4.10Free Choice of Providers (41)
4.11Relations with Standard-Setting and Survey Agencies (42)
4.12Consultation to Medical Facilities (44)
4.13Required Provider Agreement (45)
4.14Utilization/Quality Control (46)
4.15Inspections of Care in Intermediate Care Facilities for the Mentally
Retarded, Facilities Providing Inpatient Psychiatric Services for
Individuals Under 21, and Mental Hospitals (51)



4.16Relations with State Health and Vocational Rehabilitation Agencies and
Title V Grantees (52)


4.17Liens and Adjustments or Recoveries (53)
4.18Recipient Cost Sharing and Similar Charges (54)
4.19Payment for Services (57)
4.20Direct Payments to Certain Recipients for Physicians or Dentists
Services (67)


4.21Prohibition Against Reassignment of Provider Claims (68)
4.22Third Party Liability (69)
4.23Use of Contracts (71)
4.24Standards for Payments for Nursing Facility and Intermediate Care
Facility Services for the Mentally Retarded Services (72)


4.25Program for Licensing Administrators of Nursing Homes (73)
4.26Drug Utilization Review Program (74)
4.27Disclosure of Survey Information and Provider or Contractor Evaluation (75)
4.28Appeals Process (76)
4.29Conflict of Interest Provisions (77)
4.30Exclusion of Providers and Suspension of Practitioners and Other
Individuals (78, 78a, 78b)


4.31Disclosure of Information by Providers and Fiscal Agents (79)
4.32Income and Eligibility Verification System (79)
4.33Medicaid Eligibility Cards for Homeless Individuals (79a)
4.34Systematic Alien Verification for Entitlements (79b)
4.35Enforcement of Compliance for Nursing Facilities (79c)
4.36Required Coordination Between the Medicaid and WIC Programs (79d)
4.38Nurse Aide Training and Competency Evaluation for Nursing Facilities (79o, p, q, r)
4.39Preadmission Screening and Annual Resident Review in Nursing Facilities (79s, t)
4.41Resident Assessment for Nursing Facilities (79x)
4.42Employee Education about False Claims Recoveries (79y(1)-(3))
4.43Cooperation with the Medicaid Integrity Program Efforts (79y(4))
4.44Medicaid Prohibition on Payments to Institutions or Entities Located Outside
of the United States


4.46Provider Screening and Enrollment

SECTION 5 PERSONNEL ADMINISTRATION (80)
5.1Standards of Personnel Administration (80)
5.2RESERVED (81)
5.3Training Programs: Sub professional and Volunteer Programs (82)

SECTION 6 - FINANCIAL ADMINISTRATION (83)
6.1Fiscal Policies and Accountability (83)
6.2Cost Allocation (84)
6.3State Financial Participation (85)

SECTION 7 - GENERAL PROVISIONS (86)
7.1Plan Amendments (86)
7.2Nondiscrimination (87)
7.4State Governor's Review (89)

LIST OF ATTACHMENTS No. Title of Attachment
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
2.1-A Definition of an HMO that Is Not Federally Qualified
2.2-A Groups Covered and Agencies Responsible for Eligibility Determination
2.6-A Eligibility Conditions and Requirements
3.1-A Amount, Duration, and Scope of Medical and Remedial Care and Services Provided to the Categorically Needy

3.1-B Amount, Duration, and Scope of Services Provided Medically Needy Groups
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
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
4.18-H Emergency Room Co-payment for Non-emergency Care
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
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
4.30Sanctions 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
4.42-A False Claims Recoveries



*This website may not reflect recent changes
or updates to the State Plan.


Please contact Craig Devashrayee (801-538-6641) to receive the official version.




Last edited May 30, 2013