No. 29960: R414-1A. Medicaid Policy for Experimental, Investigational or Unproven Medical Practices

DAR File No.: 29960
Filed: 05/21/2007, 03:58
Received by: NL

NOTICE OF REVIEW AND STATEMENT OF CONTINUATION

Concise explanation of the particular statutory provisions under which the rule is enacted and how these provisions authorize or require the rule:

Section 26-1-5 authorizes the Department to adopt, amend, or rescind rules as necessary to carry out the provisions of this title. Sections 26-1-15 and 26-18-6 authorize the executive director with the approval of the governor to accept, bind, receive, and expend federal dollars to administer programs established by any executive or legislative provisions promulgated or enacted by the federal government or any agency thereof. Subsections 26-18-3(2) and 26-18-5(4) authorize the Division to establish administrative rules compliant with the Social Security Act and other federal law to determine what constitutes experimental, investigational, or unproven medical practices and to exclude them from covered Medicaid services.

Summary of written comments received during and since the last five-year review of the rule from interested persons supporting or opposing the rule:

No written or oral comments have been received regarding this rule.

Reasoned justification for continuation of the rule, including reasons why the agency disagrees with comments in opposition to the rule, if any:

This rule is necessary because it serves as a utilization review and cost saving control. As most experimental and investigational procedures are very expensive and of unproven value, it is important to allocate dollars to proven medical care, thereby preventing unnecessary expenditures that may limit available funds to clients. Therefore, this rule should be continued.

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]

Authorized by:

David N. Sundwall, Executive Director