No. 32105: R414-21-2. Eligibility Requirements

DAR File No.: 32105
Filed: 10/30/2008, 02:55
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 physical and occupational therapy. It also allows Medicaid to cover physical and occupational therapy as a component of inpatient and outpatient hospital 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 $45,225 to the General Fund and $109,180 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 physical and occupational therapy to Medicaid clients.

small businesses and persons other than businesses:

Providers of physical therapy and occupational therapy will lose a combined total of $154,405 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 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 physical therapy is approximately $457.52, while the annual loss in revenue to a single provider of occupational therapy is approximately $873.82. These estimates are 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 physical and occupational therapy 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 cost for physical therapy would exceed $117 based on an average of four physical therapy visits per year, while the out-of-pocket expense to a single Medicaid client who elects to pay for occupational therapy would exceed $87 based on an average of three occupational therapy 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 9, Laws of Utah 2008, and was effective 10/15/2008.)

Emergency rule reason and justification:

Regular rulemaking procedures would cause an imminent budget reduction because of budget restraints or federal requirements.

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

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:

This rule is effective on:

11/01/2008

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

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

R414-21. Physical and Occupational Therapy.

R414-21-2. Eligibility Requirements.

Physical therapy and occupational therapy services are available only to clients who are [categorically and medically needy individuals under Medicaid]pregnant women and individuals eligible under the Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT). In addition, physical therapy and occupational therapy services are available to a client as a component of inpatient or outpatient hospital services.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: November 1, 2008

Notice of Continuation: April 16, 2007

Authorizing, and Implemented or Interpreted Law: 26-1-4.1; 26-1-5; 26-18-3