No. 30776 (Amendment): R414-53. Eyeglasses Services

DAR File No.: 30776
Filed: 11/30/2007, 09:05
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 adult vision care services to 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 eyeglasses services. It also adds a $3 copayment to Medicaid recipients for each pair of eyeglasses they receive. (DAR NOTE: A companion filing for Rule R414-52, Optometry Services, is under DAR No. 30775 in this issue, December 15, 2007, of the Bulletin.)

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:

There is an anticipated cost of $174,000 to the general fund and $431,400 in federal funds.

local governments:

There is no budget impact because local governments do not fund eyeglasses services and they are not Medicaid providers.

small businesses and persons other than businesses:

Eyeglasses providers and small businesses receive an annual increase in revenue of approximately $605,400. There is, however, a total cost of $18,600 to Medicaid clients who make a $3 copayment for each pair of eyeglasses they receive.

Compliance costs for affected persons:

There is a $3 compliance cost per recipient based on the estimate of one visit per year by a single client. In addition, there are compliance costs to eyeglasses providers who are unable or choose not to collect payments from recipients; however, the amount is variable for each provider.

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

Adult vision care with a small copayment 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.

R414-53. Eyeglasses Services.

R414-53-3. Client Eligibility Requirements.

Eyeglasses are available to categorically and medically needy individuals[ except for non-pregnant adult recipients ages 21 and older].

 

R414-53-5. Reimbursement.

(1) The Department pays for lenses and standard frames on a fee-for-service basis, based on CPT codes as described in the State Plan, Attachment 4.19-B. A $3 copayment for each pair of eyeglasses is applied to Medicaid recipients who fall under the copayment requirement.

(2) The Department pays the lower of the amount billed or 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.

(3) 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.

 

KEY: Medicaid, eyeglasses

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