Utah Administrative Code
Topic - Health
Title R414 - Integrated Healthcare
Rule R414-501 - Preadmission Authorization, Retroactive Authorization, and Continued Stay Review
Section R414-501-4 - Immediate Placement Authorization
Universal Citation: UT Admin Code R 414-501-4
Current through Bulletin 2024-06, March 15, 2024
(1) The Department will reimburse a nursing facility for five days if the Department gives telephone prior approval for a resident who is an immediate placement.
(a)
An immediate placement will meet one of the following criteria:
(i) The resident exhausted acute care
benefits or was discharged by a hospital;
(ii) A Medicare fiscal intermediary changed
the resident's level of care, or the Medicare benefit days terminated and there
is a need for continuing services reimbursed under Medicaid;
(iii) Protective services in the Department
of Human Services placed the resident for care;
(iv) A tragedy, such as fire or flood, has
occurred in the home, and the resident is injured, or an accident leaves a
dependent person in imminent danger and requires immediate
institutionalization;
(v) A family
member who has been providing care to the resident dies or suddenly becomes
ill;
(vi) A nursing facility
terminated services, either through an adverse certification action or closure
of the facility, and the resident must be transferred to meet his medical or
habilitation needs; or
(vii) A
disaster or other emergency as defined by the Department has
occurred.
(b) The
Department will deny an immediate placement unless the PASRR Level I screening
is completed and the Department determines a PASRR Level II evaluation is not
required, or if the PASRR Level II evaluation is required, then the PASRR Level
II evaluation is completed and the Department determines the nursing facility
applicant qualifies for placement in a nursing facility. The two exceptions to
this requirement are when the nursing facility applicant is a provisional
placement for less than seven days or when the placement is after an acute
hospital admission and the physician certifies in writing that the placement
will be for less than 30 days.
(c)
Telephone prior approval for an immediate placement will be effective for no
more than five working days. During that period the nursing facility will
submit a preadmission transmittal, and will begin preparing the complete
contact for the nursing facility applicant. If the nursing facility fails to
submit the preadmission transmittal in a timely manner, the Department will not
make any payments until the Department receives the preadmission transmittal
and the nursing facility complies with all preadmission requirements.
Disclaimer: These regulations may not be the most recent version. Utah may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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