No. 30775 (Amendment): R414-52. Optometry Services

DAR File No.: 30775
Filed: 11/30/2007, 08:58
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

In accordance with appropriations authorized during the 2007 General Session of the Utah Legislature (H.B. 150), this amendment is necessary to restore the provision of eyeglasses to adult Medicaid clients. (DAR NOTE: H.B. 150 (2007) is found at Chapter 371, Laws of Utah 2007, and was effective 07/01/2007.)

Summary of the rule or change:

This amendment removes language that excludes nonpregnant adults ages 21 and older from the provision of eyeglasses. It also adds a $3 copayment to Medicaid recipients for each pair of eyeglasses they receive.

State statutory or constitutional authorization for this rule:

Section 26-18-3, and 42 CFR 440.60 and 440.120(d)

Anticipated cost or savings to:

the state budget:

The companion filing for this rulemaking, Rule R414-53, Eyeglasses Services, details the state budget impact through the restoration of vision care services. (DAR NOTE: The proposed amendment to Rule R414-53 is under DAR No. 30776 in this issue, December 15, 2007, of the Bulletin.)

local governments:

There is no budget impact because local governments do not fund or provide eyeglasses under the Optometry Program.

small businesses and persons other than businesses:

The companion filing for this rulemaking, Rule R414-53, details the budget impact to other persons and small businesses through the restoration of vision care services.

Compliance costs for affected persons:

The companion filing for this rulemaking, Rule R414-53, details the budget impact for affected persons through the restoration of vision care services.

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

Adult vision care with a small co-payment restored as a Medicaid benefit will have a positive impact on business. David N. Sundwall, MD, Executive Director

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:

01/14/2008

This rule may become effective on:

01/21/2008

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

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

R414-52. Optometry Services.

R414-52-3. Client Eligibility Requirements.

Optometry services are available to categorically and medically needy individuals[, except that non-pregnant adult recipients ages 21 and older do not receive eyeglasses under this rule].

 

R414-52-5. Reimbursement.

(1) Fees for services for which the Department will pay optometrists are established from the physician's fees for CPT codes as described in the State Plan, Attachment 4.19-B, Section D Physicians. A $3 copayment for each pair of eyeglasses is applied to Medicaid recipients who fall under the copayment requirement. Fee schedules were initially established after consultation with provider representatives. Adjustments to the schedule are made in accordance with appropriations and to produce efficient and effective services.

(2) The Department pays the lower of the amount billed and the rate on the schedule. 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, optometry

Date of Enactment or Last Substantive Amendment: [July 1, 2006]2008

Notice of Continuation: June 6, 2003

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