No. 27323 (New Rule): R414-34. Substance Abuse Services

DAR File No.: 27323
Filed: 08/02/2004, 12:09
Received by: NL

 

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rulemaking is necessary to comply with Subsection 26-18-3(2)(a), which requires that programs previously allowed to be implemented by policy now be implemented by rule.

 

Summary of the rule or change:

This is a proposed new rule for Substance Abuse Services that puts into rule the program that Section 26-18-3 previously allowed to be in policy.

 

State statutory or constitutional authorization for this rule:

Section 26-18-3 and 42 CFR 440.130 (October 2003)

 

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget associated with this rulemaking because the program was previously implemented by policy and now needs to be implemented in rule pursuant to Subsection 26-18-3(2)(a).

 

local governments:

There is no budget impact to local governments as a result of this rulemaking because the program was previously implemented by policy and now needs to be implemented in rule pursuant to Subsection 26-18-3(2)(a).

 

other persons:

There is no budget impact to other persons as a result of this rulemaking because the program was previously implemented by policy and now needs to be implemented in rule pursuant to Subsection 26-18-3(2)(a).

 

Compliance costs for affected persons:

There are no compliance costs for affected persons because the program was previously implemented by policy and now needs to be implemented in rule pursuant to Subsection 26-18-3(2)(a).

 

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

There is no fiscal impact on businesses because of this rulemaking as it only places in rule a program that was previously allowed to be in policy. Scott Williams, 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:

09/14/2004

 

This rule may become effective on:

09/15/2004

 

Authorized by:

Scott D. Williams, Executive Director

 

 

RULE TEXT

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

R414-34. Substance Abuse Services.

R414-34-1. Introduction and Authority.

(1) This rule outlines the program designed to evaluate and treat individuals with substance abuse disorders.

(2) This rule is authorized under UCA 26-18-3 and governs the services allowed under 42 CFR 440.130, Oct. 2003 ed.

 

R414-34-2. Definitions.

In this rule:

(a) "Diagnostic services '' means any medical procedure recommended by a physician or other licensed mental health therapist to enable him to identify the existence, nature, or extent of substance abuse disorder in a client.

(b) "Rehabilitative services '' means any medical or remedial services recommended by a physician or other licensed mental health therapist for maximum reduction of a client's substance abuse disorder and restoration of the client to his best possible functional level.

(c) "Substance abuse disorder" means diagnoses listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision (DSM-IV-TR), in the range of 291.00-291.99, 292.00-292.99, 303.00-303.99, 304.00-304.99 and 305.00-305.99.

 

R414-34-3. Client Eligibility Requirements.

Substance abuse treatment is available to any categorically or medically needy Medicaid client.

 

R414-34-4. Program Access Requirements.

(1) Diagnostic and rehabilitative substance abuse services must be provided by or through a substance abuse program that is under contract with or directly operated by a local county substance abuse authority.

(2) The substance abuse treatment program must evaluate the client to determine if:

(a) the client carries a primary diagnosis of a substance abuse disorder and requires substance abuse treatment services; or

(b) the client 's child requires services to reduce the child's risk of developing a substance abuser disorder.

 

R414-34-5. Service Coverage.

(1) Services must be recommended by a licensed mental health therapist.

(2) The scope of diagnostic and rehabilitative substance abuse services includes the following:

(a) psychiatric diagnostic interview examination;

(b) alcohol and drug assessment by a non-physician;

(c) psychological testing;

(d) individual psychotherapy;

(e) group psychotherapy;

(f) individual psychotherapy with medical evaluation and management services;

(g) family psychotherapy with client present;

(h) family psychotherapy without client present;

(i) therapeutic behavioral services;

(j) pharmacologic management;

(k) individual skills training and development;

(l) psychosocial rehabilitative services; and

(m) intensive psychosocial rehabilitative services for children through the month of their thirteenth birthday.

(3) Medicaid adult clients in the Non-Traditional Medicaid Plan have the following service exclusions:

(a) hypnosis, occupational, and recreational therapy; and

(b) office calls in conjunction with medication management for repetitive therapeutic injections; and

(4) Psychiatric diagnosis interview examinations for legal purposes only, such as for custodial or visitation rights are excluded from coverage for all Medicaid clients.

 

R414-34-6. Qualified Providers.

(1) Diagnostic and rehabilitative services must be provided by an individual, as limited by the scope of his license, who is:

(a) a licensed physician, a licensed psychologist, a licensed clinical social worker, a licensed certified social worker, a licensed social service worker, a licensed advanced practice registered nurse specializing in mental health nursing, a licensed registered nurse, a licensed professional counselor, a licensed substance abuse counselor, or a licensed marriage and family counselor; or

(b) an individual working toward licensure in one of the professions identified in subsection (a); or

(c) a licensed practical nurse or other trained staff working under the supervision of one of the individuals identified in subsection (1)(a) or (b).

 

R414-34-7. Reimbursement Methodology.

The Department pays the lower of the amount billed or the rate on the substance abuse treatment providers' fee schedule. The fee schedule was initially established after consultation with provider representatives. 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

2004

26-18-3