No. 32228 (Amendment): R414-59-4. Services for Individuals Eligible for Optional Services

DAR File No.: 32228
Filed: 12/17/2008, 05:47
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to comply with budget reduction mandates set forth in the 2008 Second Special Session of the Utah Legislature.

Summary of the rule or change:

This change allows only pregnant women and individuals eligible under the Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT) to receive audiology-hearing services. It also incorporates by reference the Audiology Provider Manual, effective 01/01/2009.

State statutory or constitutional authorization for this rule:

Section 26-18-3

This rule or change incorporates by reference the following material:

Audiology Provider Manual, effective 01/01/2009

Anticipated cost or savings to:

the state budget:

The Department estimates an annual savings of $69,082 to the General Fund and $166,774 in federal dollars as a result of this change.

local governments:

This change does not impact local governments because they do not fund or provide audiology-hearing services to Medicaid clients.

small businesses and persons other than businesses:

Providers of audiology-hearing services will lose approximately $235,856 in annual revenue as a result of this change. However, the total out-of-pocket expense to Medicaid clients who elect to pay out-of-pocket to receive these services is difficult to estimate because it is impossible to know how many clients would choose to obtain these services.

Compliance costs for affected persons:

The annual loss in revenue to a single provider of audiology-hearing services is approximately $2,650 based on the total number of providers and client visits per year. However, the annual out-of-pocket expense to a single Medicaid client who elects to pay for audiology-hearing services is difficult to estimate because the fees will vary depending on the provider's fee schedule. According to current Medicaid rates, the out-of-pocket costs would exceed $165 based on an average of two audiology-hearing visits per year.

Comments by the department head on the fiscal impact the rule may have on businesses:

This rule change reflects the reductions passed in S.B. 2001 (2008 2nd Spec Sess) and are necessary to file under emergency authority to immediately implement the budget reductions. David N. Sundwall, MD, Executive Director (DAR NOTE: S.B. 2001 (2008 2nd Spec Sess) is found at Chapter 2, Laws of Utah 2008 (2nd Spec Sess) and was effective 09/29/2008.)

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Health Care Financing, Coverage and Reimbursement Policy
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY UT 84116-3231

Direct questions regarding this rule to:

Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

02/17/2009

This rule may become effective on:

02/24/2009

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-59. Audiology-Hearing Services.

R414-59-4. [Services for Individuals Eligible for Optional Services]Client Eligibility Requirements.

(1) Audiology-hearing services are available only to clients who are pregnant women or who are individuals eligible under the Early and Periodic Screening, Diagnosis and Treatment Program.

([1]2) An individual receiving audiology-hearing services may receive audiology services as described in the Audiology Provider Manual, effective January 1, 2009, which is incorporated by reference.

([2]3) An individual receiving audiology-hearing services must meet the criteria established in the Audiology Provider Manual and obtain prior approval if required.

 

KEY: Medicaid, audiology

Date of Enactment or Last Substantive Amendment: [October 2, 2008]2009

Notice of Continuation: November 22, 2005

Authorizing, and Implemented or Interpreted Law: 26-1-5; 26-18-3