1. (1) Utah Medicaid State Plan (2026), published by the Centers for Medicare and Medicaid Services, including the Coverage and Reimbursement Code Lookup Tool found at https://medicaid.utah.gov/coverage-and-reimbursement/; and

2. (2) Utah Medicaid Provider Manuals, published by the Division of Integrated Healthcare under the Utah Department of Health and Human Services, including:

   1. (a) Autism Spectrum Disorder Services, version January 2026;
   2. (b) Behavioral Health Services, version January 2026;
   3. (c) Dental, Oral Maxillofacial, and Orthodontia Services, version January 2026;
   4. (d) Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, version January 2026;

   5. (e) home and community-based services waivers, including the:

      1. (i) Home and Community-Based Services Waiver for Individuals with an Acquired Brain Injury, version September 2025;
      2. (ii) Home and Community-Based Services Waiver for Individuals with Physical Disabilities, version September 2025;
      3. (iii) Home and Community-Based Services Waiver for Technology Dependent, Medically Fragile Individuals, version July 2020;
      4. (iv) Home and Community-Based Waiver Services New Choices Waiver, version July 2021;
      5. (v) Medically Complex Children's Waiver, version July 2020;
      6. (vi) Utah Home and Community Based Services Waiver for Individuals with Intellectual Disabilities or Other Related Condition, version November 2025; and
      7. (vii) Utah Home and Community-Based Services Waiver for Individuals Age 65 or Older, version April 2022;
   6. (f) Home Health Services, version January 2026, including the manual's attachment for the Private Duty Nursing Acuity Grid;
   7. (g) Hospice Care Services, version January 2026;

   8. (h) Hospital Services, version January 2026, including the manual's attachments;

      1. (i) Housing Related Services and Supports, version September 2025;
   9. (j) Indian Health Services, version November 2025;

   10. (k) Integrated Healthcare Services, version January 2026;

       1. (l) Long Term Care Services in Nursing Facilities, version September 2025, including the manual's attachments;
   11. (m) Medical Supplies and Durable Medical Equipment, version November 2025, as applied in Rule R414-70, including the manual's attachment for Donor Human Milk Request Form;
   12. (n) Medical Transportation Services, version September 2025;
   13. (o) Personal Care Services, version January 2026;
   14. (p) Pharmacy Services, version January 2026, including the manual's attachments;
   15. (q) Physician Services, version January 2026, including the manual's attachments;
   16. (r) Physical Therapy and Occupational Therapy Services, version January 2026;
   17. (s) Rural Health Clinics and Federally Qualified Health Centers Services, version November 2025;
   18. (t) School-Based Skills Development Services, version January 2026;

   19. (u) Section I: General Information, version January 2026, including the general attachments;

       1. (v) Speech-Language Pathology and Audiology Services, version September 2025;

   20. (w) Targeted Case Management for Early Childhood, version July 2025;

       1. (x) Targeted Case Management for Individuals with Serious Mental Illness, version July 2025;
   21. (y) Vision Care Services, version November 2025; and
   22. (z) Women's Services and Family Planning, version March 2026.

The Department incorporates by reference the:

KEY: Medicaid

Date of Last Change: May 1, 2026

Notice of Continuation: December 13, 2021

Authorizing, and Implemented or Interpreted Law: 26B-1-213; 26B-3-108; 26B-3-1004; 26B-8-132