No. 29868 (Amendment): R414-2A-7. Limitations

DAR File No.: 29868
Filed: 04/26/2007, 04:01
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

This amendment is necessary to clarify Medicaid policy regarding hyperbaric oxygen therapy services.

Summary of the rule or change:

This change specifies that only a level one facility accredited by the Undersea and Hyperbaric Medical Society may provide hyperbaric oxygen therapy.

State statutory or constitutional authorization for this rule:

Sections 26-18-3 and 26-1-5

Anticipated cost or savings to:

the state budget:

There is an estimated annual savings of $22,395 to the General Fund and $52,605 in federal funds that results from the companion filings of Sections R414-2A-7 and R414-3A-6. (DAR NOTE: The proposed amendment to Section R414-3A-6 is under DAR No. 29869 in this issue, May 15, 2007, of the Bulletin.)

local governments:

There is no budget impact that results from the companion filings of Sections R414-2A-7 and R414-3A-6, because local governments do not fund hyperbaric oxygen therapy services.

other persons:

Providers lose an estimated $75,000 in annual revenue, which results from the companion filings of Sections R414-2A-7 and R414-3A-6.

Compliance costs for affected persons:

Five current providers may lose up to $15,000 each in annual revenue, unless they achieve the required accreditation proposed in the companion filings of Sections R414-2A-7 and R414-3A-6.

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

The Department believes that requiring this accreditation of providers is appropriate to assure quality care for Medicaid recipients and that the fiscal impact on business is justified. 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:

06/14/2007

This rule may become effective on:

06/22/2007

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

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

R414-2A. Inpatient Hospital Services.

R414-2A-7. Limitations.

(1) Inpatient admissions for 24 hours or more solely for observation or diagnostic evaluation do not qualify for reimbursement under the DRG system.

(2) Inpatient hospital care for treatment of alcoholism or drug dependency is limited to medical treatment of symptoms associated with drug or alcohol detoxification.

(3) Abortion procedures must first be reviewed and preauthorized by the Department as meeting the requirements of Utah Code 26-18-4 and 42 CFR 441.203.

(4) Sterilization and hysterectomy procedures must first be reviewed and preauthorized by the Department as meeting the requirements of 42 CFR 441, Subpart F.

(5) Organ transplant services are governed by R414-10A, Transplant Services Standards.

(6) Take home supplies, dressings, non-rental durable medical equipment, and drugs are reimbursed as part of payment under the DRG.

(7) Hyperbaric oxygen therapy is limited to service in a hospital facility in which the hyperbaric unit [has been]is accredited [or approved]as a level one facility by the Undersea and Hyperbaric Medical Society.

(8) Inpatient services solely for pain management do not qualify for reimbursement under the DRG system. Pain management is adjunct to other Medicaid services.

(9) Medicaid does not cover inpatient admissions for the treatment of eating disorders.

(10) Physician services provided by a physician who is paid by a hospital are inpatient services reimbursed as part of payment billed on a 1500 form. Payment for physician services provided by providers who are not paid by the hospital is governed by R414-10, Physician Services.

(11) Inpatient rehabilitation services must first be reviewed and preauthorized.

(12) Inpatient psychiatric services not covered by mental health contractual agreements must first be reviewed and preauthorized by the Department to assure that the admission meets the requirements of 42 CFR 412.27 and Part 441, Subpart D.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [March 3, 2006]2007

Notice of Continuation: November 26, 2002

Authorizing, and Implemented or Interpreted Law: 26-1-5; 26-18-3; 26-18-3.5