No. 30692: R414-2A. Inpatient Hospital Services

DAR File No.: 30692
Filed: 11/08/2007, 08:17
Received by: NL

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 enact administrative rules to implement Medicaid programs. Section 26-1-5 authorizes the department to adopt, amend, or rescind rules, and Section 1905(a)(1) of the Social Security Act authorizes the Department to provide inpatient hospital 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 Utah Hospital Association (UHA) requested that the proposed rule not list "cost effectiveness" as a primary factor in combining Diagnosis Related Group (DRG) payments for 30-day readmissions. The Division of Health Care Financing (DHCF), therefore, amended the rule to state that cost effectiveness is not a primary factor in making this determination, but may be part of the determination process. UHA also pointed out that physician services paid by a hospital are inpatient services billed on a 1500 form and not under the DRG. DHCF, therefore, amended the rule accordingly. The American Osteopathic Association (AOA) pointed out that osteopathic surgeons and physicians are defined as "physicians" under Utah law, and requested that DHCF remove the phrase "a doctor of osteopathy" from the proposed rule's definition of "Other Practitioner of the Healing Arts." DHCF, therefore, removed the phrase.

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

This rule is necessary because it establishes eligibility, hospital admission requirements, service coverage, limitations, and reimbursement methodology for inpatient hospital services. Therefore, this rule should be continued.

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 N. Sundwall, Executive Director