No. 32229 (Amendment): R414-99-2. Client Eligibility Requirements

DAR File No.: 32229
Filed: 12/17/2008, 05:51
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 chiropractic services.

State statutory or constitutional authorization for this rule:

Section 26-18-3

Anticipated cost or savings to:

the state budget:

The Department estimates an annual savings of $65,158 to the General Fund and $157,300 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 chiropractic services to Medicaid clients.

small businesses and persons other than businesses:

Providers of chiropractic services will lose approximately $222,458 in annual revenue as a result of this change. 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 elect to obtain these services.

Compliance costs for affected persons:

The annual loss in revenue to a single provider of chiropractic services is approximately $931 based on the total number of providers and client visits per year. The annual out-of-pocket expense to a single Medicaid client who elects to pay for chiropractic 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 $78 based on an average of four chiropractic 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.

R414-99. Chiropractic Services.

R414-99-2. Client Eligibility Requirements.

Chiropractic services are available only to clients who are [categorically and medically needy individuals]pregnant women or who are individuals eligible under the Early and Periodic Screening, Diagnosis and Treatment Program.

 

KEY: Medicaid, chiropractic services

Date of Enactment or Last Substantive Amendment: [February 17, 2004]2009

Authorizing, and Implemented or Interpreted Law: 26-18