No. 41379 (Amendment): Section R414-60-2. Definitions  

  • (Amendment)

    DAR File No.: 41379
    Filed: 03/20/2017 02:45:33 PM

    RULE ANALYSIS

    Purpose of the rule or reason for the change:

    The purpose of this change is to clarify the definition of a "covered outpatient drug".

    Summary of the rule or change:

    This amendment clarifies the definition of a "covered outpatient drug".

    Statutory or constitutional authorization for this rule:

    Anticipated cost or savings to:

    the state budget:

    There is no impact to the state budget because this amendment only clarifies a definition. It neither affects prescribed drug services nor drug reimbursement.

    local governments:

    There is no impact to local governments because this amendment only clarifies a definition. It neither affects prescribed drug services nor drug reimbursement.

    small businesses:

    There is no impact to small businesses because this amendment only clarifies a definition. It neither affects prescribed drug services nor drug reimbursement.

    persons other than small businesses, businesses, or local governmental entities:

    There is no impact to Medicaid clients and to Medicaid providers because this amendment only clarifies a definition. It neither affects prescribed drug services nor drug reimbursement.

    Compliance costs for affected persons:

    There are no compliance costs to a single Medicaid client or to a Medicaid provider because this amendment only clarifies a definition. It neither affects prescribed drug services nor drug reimbursement.

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

    There is no fiscal impact on business because the proposed rule does not change any requirements under the existing rule.

    Joseph K. Miner, MD, Executive Director

    The full text of this rule may be inspected, during regular business hours, at the Office 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:

    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:

    05/15/2017

    This rule may become effective on:

    05/22/2017

    Authorized by:

    Joseph Miner, Executive Director

    RULE TEXT

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

    R414-60. Medicaid Policy for Pharmacy Program.

    R414-60-2. Definitions.

    (1) "Covered outpatient drug" means a drug that meets all of the following criteria:

    (a) Requires a prescription for dispensing;

    (b) Has a National Drug Code number;

    (c) Is eligible for Federal Medical Assistance Percentages funds;

    (d) Has been approved by the Food and Drug Administration; and

    (e) Is listed in the [Medi-Span drug file]nationally recognized drug pricing index under contract with the Department.

    (2) "Full-benefit dual eligible beneficiary" means an individual who has Medicare and Medicaid benefits.

    (3) "Rural pharmacy" means a pharmacy located in the state of Utah, which is outside of Weber County, Davis County, Utah County, and Salt Lake County.

    (4) "Urban pharmacy" means a pharmacy located in Weber County, Davis County, Utah County, Salt Lake County, or in another state.

    (5) "Usual and customary charge" is the lowest amount a pharmacy charges the general public for a covered outpatient drug, which reflects all advertised savings, discounts, special promotions, or any other program available to the general public.

     

    KEY: Medicaid

    Date of Enactment or Last Substantive Amendment: [December 1, 2016]2017

    Notice of Continuation: April 30, 2012

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


Document Information

Effective Date:
5/22/2017
Publication Date:
04/15/2017
Type:
Notices of Proposed Rules
Filed Date:
03/20/2017
Agencies:
Health, Health Care Financing, Coverage and Reimbursement Policy
Rulemaking Authority:

Section 26-18-3

Section 26-1-5

Authorized By:
Joseph Miner, Executive Director
DAR File No.:
41379
Summary:

This amendment clarifies the definition of a "covered outpatient drug".

CodeNo:
R414-60-2
CodeName:
{44573|R414-60-2|R414-60-2. Definitions}
Link Address:
HealthHealth Care Financing, Coverage and Reimbursement PolicyCANNON HEALTH BLDG288 N 1460 WSALT LAKE CITY, UT 84116-3231
Link Way:

Craig Devashrayee, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at cdevashrayee@utah.gov

AdditionalInfo:
More information about a Notice of Proposed Rule is available online. The Portable Document Format (PDF) version of the Bulletin is the official version. The PDF version of this issue is available at https://rules.utah.gov/publicat/bull_pdf/2017/b20170415.pdf. The HTML edition of the Bulletin is a convenience copy. Any discrepancy between the PDF version and HTML version is resolved in favor of the PDF version. Text to be deleted is struck through and surrounded by brackets ([example]). Text ...
Related Chapter/Rule NO.: (1)
R414-60-2. Definitions.