No. 36929 (5-year Review): Rule R414-29. Client Review/Education and Restriction Policy

DAR File No.: 36929
Filed: 10/05/2012 04:13:13 PM

NOTICE OF REVIEW AND STATEMENT OF CONTINUATION

Concise explanation of the particular statutory provisions under which the rule is enacted and how these provisions authorize or require the rule:

Section 26-18-3 requires the Department to implement Medicaid policy through administrative rules, which prevent the overutilization of services by Medicaid recipients. In addition, 42 CFR 431.54(e) authorizes restrictions on Medicaid recipients who over utilize Medicaid services, and 42 CFR 456.3 requires the Department to implement safeguards that prevent unnecessary or inappropriate use of Medicaid services.

Summary of written comments received during and since the last five-year review of the rule from interested persons supporting or opposing the rule:

The Department did not receive any written or oral comments regarding this rule.

Reasoned justification for continuation of the rule, including reasons why the agency disagrees with comments in opposition to the rule, if any:

The Department should continue this rule because it implements a restriction program for Medicaid recipients who over utilize Medicaid services. The continuation of this rule, therefore, will allow the Department to provide cost effective and medically necessary services to all Medicaid recipients.

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]

Authorized by:

David Patton, Executive Director

Effective:

10/05/2012

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