No. 27516 (New Rule): R414-35. Mental Health Services for Children in State Custody

DAR File No.: 27516
Filed: 11/01/2004, 08:46
Received by: NL

 

RULE ANALYSIS

Purpose of the rule or reason for the change:

This proposed new rule is necessary to comply with Subsection 26-18-3(2)(a), which requires that programs previously allowed to be implemented by policy now be implemented by rule.

 

Summary of the rule or change:

This is a new rule for Mental Health Services for Children in State Custody that puts into rule the program that Section 26-18-3 previously allowed to be in policy.

 

State statutory or constitutional authorization for this rule:

Subsection 26-18-3(2)(a) and 42 CFR 440.130 (October 2003 ed.)

 

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget associated with this rulemaking because the program was previously implemented by policy and now needs to be implemented pursuant to Subsection 26-18-3(2)(a).

 

local governments:

There is no budget impact to local governments as a result of this rulemaking because the program was previously implemented by policy and now needs to be implemented pursuant to Subsection 26-18-3(2)(a).

 

other persons:

There is no budget impact to other persons as a result of this rulemaking because the program was previously implemented by policy and now needs to be implemented pursuant to Subsection 26-18-3(2)(a).

 

Compliance costs for affected persons:

There are no compliance costs for affected persons because the program was previously implemented by policy and now needs to be implemented pursuant to Subsection 26-18-3(2)(a).

 

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

This rule moves from policy to rule an established program for diagnostic and rehabilitative outpatient mental health services provided to children in the custody of Department of Human Services (DHS) eligible for these Medicaid services. No fiscal impact on business. Scott D. Williams, MD

 

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:

12/15/2004

 

This rule may become effective on:

12/16/2004

 

Authorized by:

Scott D. Williams, Executive Director

 

 

RULE TEXT

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

R414-35. Mental Health Services for Children in State Custody.

R414-35-1. Introduction and Authority.

(1) This rule outlines the diagnostic and rehabilitative outpatient mental health services provided to CHEC (EPSDT)-eligible Medicaid clients in the custody of Department of Human Services (DHS).

(2) This rule is authorized under UCA 26-18-3 and governs the services allowed under 42 CFR 440.130, Oct. 2003 ed.

 

R414-35-2. Definitions.

In this rule:

"CHEC" means Utah's version of the federally-mandated Early and Periodic Screening Diagnosis and Treatment (EPSDT) program. The CHEC program is designed to ensure access to needed medical care for Medicaid clients from birth through the month of the client's 21st birthday.

"Diagnostic services" means any medical procedure recommended by a physician or other licensed mental health therapist to enable him to identify the existence, nature, or extent of a mental health disorder in a client.

"Rehabilitative services" means any medical or remedial services recommended by a physician or other licensed mental health therapist for maximum reduction of a client's mental health disorder and restoration of the client to his best possible functional level.

 

R414-35-3. Client Eligibility Requirements.

Diagnostic and rehabilitative outpatient mental health services are available to CHEC-eligible children in the custody of DHS.

 

R414-35-4. Program Access Requirements.

Diagnostic and rehabilitative outpatient mental health services must be provided by a licensed mental health therapist under contract with DHS, a psychosocial rehabilitative treatment program operated by or under contract with DHS or a community mental health center.

 

R414-35-5. Service Coverage.

(1) Services must be recommended by a licensed mental health therapist.

(2) The scope of diagnostic and rehabilitative mental health services includes:

(a) psychiatric diagnostic interview examination;

(b) psychological testing;

(c) individual psychotherapy;

(d) group psychotherapy;

(e) family psychotherapy with patient present;

(f) family psychotherapy without patient present;

(g) pharmacologic management;

(h) psychosocial rehabilitative services;

(i) intensive psychosocial rehabilitative services for children ages 0 through the month of their 13th birthday; and

(j) residential treatment services including:

(i) psychiatric health facility;

(ii) comprehensive community support services; and

(iii) foster care, therapeutic, child.

 

R414-35-6. Qualified Providers.

Diagnostic and rehabilitative services must be provided by an individual, as limited by the scope of his license, who is:

(1) a licensed physician, a licensed psychologist, a licensed clinical social worker, a licensed certified social worker, a licensed social service worker, a licensed advanced practice registered nurse specializing in mental health nursing, a licensed registered nurse, a licensed professional counselor, a licensed marriage and family therapist or a licensed substance abuse counselor; or

(2) an individual working toward licensure in one of the professions identified in subsection (1) to the extent permitted by Title 58 of the Utah Code; or

(3) a licensed practical nurse or other trained staff working under the supervision of one of the individuals identified in subsection (1) or (2).

 

R414-35-7. Reimbursement Methodology.

The Department pays the lower of the amount billed or the rate on the DHS contractors' fee schedule. The fee schedule was initially established after consultation with DHS. A provider shall not charge the Department a fee that exceeds the provider's usual and customary charges for the provider's private pay patients.

 

KEY: Medicaid

2004

26-18-3