Utah Medicaid State Plan

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

  • 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)
  • 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)
  • 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)
  • 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 (78, 78a, 78b)
    • 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 (79o, p, q, r)
    • 4.39    Preadmission Screening and Annual Resident Review in Nursing Facilities (79s, t)
    • 4.41    Resident Assessment for Nursing Facilities (79x)
    • 4.42    Employee Education about False Claims Recoveries (79y(1)-(3))
    • 4.43    Cooperation with the Medicaid Integrity Program Efforts (79y(4))
    • 4.44    Medicaid Prohibition on Payments to Institutions or Entities Located Outside of the United States
    • 4.46    Provider Screening and Enrollment
  • 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)
  • SECTION 6 – FINANCIAL ADMINISTRATION (83)
    • 6.1     Fiscal Policies and Accountability (83)
    • 6.2     Cost Allocation (84)
    • 6.3     State Financial Participation (85)
  • SECTION 7 – GENERAL PROVISIONS (86)

LIST OF ATTACHMENTS No. Title of Attachment

MODIFIED ADJUSTED GROSS INCOME

  • MAGI-Based Eligibility Groups
    •        S14
    •        S25
    •        S28
    •        S32
    •        S33
    •        S50
    •        S51
    •        S52
    •        S53
    •        S54
    •        S55
    •        S57
    •        S59
  • Eligibility Process
    •        S94
  • MAGI Income Methodology
    •        S10
  • Single State Agency
  • State Residency
    •        S88
  • Citizenship and Immigration Status
    •        S89
  • Presumptive Eligibility by Hospitals
    •        S21
  • Presumptive Eligibility
    •        S30
  • Medicaid Eligibility Marriage Policy
    •        S12

Medicaid Program (MACPro)

General Information