Utah Medicaid State Plan
UTAH MEDICAID STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM
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14-0004-MM – Single State Agency- Superseding State Plan Pages
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14-0005-MM – State Residency – Superseding State Plan Pages
- 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)
- 7.1 Plan Amendments (86)
- 7.2 Nondiscrimination (87)
- 7.4 State Governor’s Review (89)
- 7.5 Medicaid Disaster Relief for the COVID-19 National Emergency
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
- 4.19-E Definition of a Claim By Type of Service
- 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
- 4.42-A False Claims Recoveries
- 7-02-A Methods of Administration to Assure Non-Discrimination
MODIFIED ADJUSTED GROSS INCOME
- MAGI-Based Eligibility Groups
- Eligibility Process
- MAGI Income Methodology
- Single State Agency
- State Residency
- Citizenship and Immigration Status
- Presumptive Eligibility by Hospitals
- Presumptive Eligibility
- Medicaid Eligibility Marriage Policy
Medicaid Program (MACPro)
Medicaid Program (MMDL)
General Information |
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