26B-3-312.  Appeals of division decision — Rulemaking authority — Application of act.

(1)  A decision by the director under this part to deny Medicaid certification for a nursing care facility program or to deny additional bed capacity for an existing certified program is subject to review under the procedures and requirements of Title 63G, Chapter 4, Administrative Procedures Act.

Terms Used In Utah Code 26B-3-312

  • Certified program: means a nursing care facility program with Medicaid certification. See Utah Code 26B-3-301
  • Division: means the Division of Integrated Healthcare within the department, established under Section 26B-3-102. See Utah Code 26B-3-101
  • Medicaid certification: means the right of a nursing care facility, as a provider of a nursing care facility program, to receive Medicaid reimbursement for a specified number of beds within the facility. See Utah Code 26B-3-301
  • Nursing care facility: means the following facilities licensed by the department under 2:
(i) skilled nursing facilities;
(ii) intermediate care facilities; and
(iii) an intermediate care facility for people with an intellectual disability. See Utah Code 26B-3-301
  • Nursing care facility program: means the personnel, licenses, services, contracts, and all other requirements that shall be met for a nursing care facility to be eligible for Medicaid certification under this part and division rule. See Utah Code 26B-3-301
  • Recipient: means a person who has received medical assistance under the Medicaid program. See Utah Code 26B-3-101
  • State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
    • (2)  The department shall make rules to administer and enforce Sections 26B-3-310 through 26B-3-313 in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.

    (3) 

    (a)  In the event the department is at risk for a federal disallowance with regard to a Medicaid recipient being served in a nursing care facility program that is not Medicaid certified, the department may grant temporary Medicaid certification to that facility for up to 24 months.

    (b) 

    (i)  The department may extend a temporary Medicaid certification granted to a facility under Subsection (3)(a):

    (A)  for the number of beds in the nursing care facility occupied by a Medicaid recipient; and

    (B)  for the period of time during which the Medicaid recipient resides at the facility.

    (ii)  A temporary Medicaid certification granted under this Subsection (3) is revoked upon:

    (A)  the discharge of the patient from the facility; or

    (B)  the patient no longer residing at the facility for any reason.

    (c)  The department may place conditions on the temporary certification granted under Subsections (3)(a) and (b), such as:

    (i)  not allowing additional admissions of Medicaid recipients to the program; and

    (ii)  not paying for the care of the patient after October 1, 2008, with state only dollars.

    Renumbered and Amended by Chapter 306, 2023 General Session

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