Utah Admin. Code R414-1-26 - General Rule Format

The following format is used generally throughout the rules of the Division. Section headings as indicated and the following general definitions are for guidance only. The section headings are not part of the rule content itself. In certain instances, this format may not be appropriate and will not be implemented due to the nature of the subject matter of a specific rule.

(1) A concise statement as to what Medicaid service is covered by the rule, and a listing of specific federal statutes and regulations and state statutes that authorize or require the rule.

(2) Definitions that have special meaning to the particular rule.

(3) Categories of Medicaid members eligible for the service covered by the rule that include categorically needy members, medically needy members, or both. Conditions precedent to the member's obtaining coverage such as age limitations or otherwise.

(4) Program access requirements that include conditions external to the member obtaining service, such as type of certification needed from attending physician, whether available only in an inpatient setting or otherwise.

(5) Service coverage that details specific services available under the rule, including limitations, such as number of procedures in a given period or otherwise.

(6) As necessary, a description of the procedures for obtaining prior authorization for services available under the particular rule. Prior authorization, however, may not be used as a substitute for regulatory practice that should be in rule.

(7) As necessary under the particular rule, additional sections may be indicated. Other sections include regulatory language that does not fit into Subsections (1) through (5).

Notes

Utah Admin. Code R414-1-26

Amended by Utah State Bulletin Number 2022-14, effective 7/1/2022