Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-31-3

Program Access Requirements

Notice of Proposed Rule

(Amendment)

DAR File No.: 32977
Filed: 09/15/2009 03:26:04 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to clarify physician certification requirements for inpatient psychiatric services.

Summary of the rule or change:

This change removes the word "or" to clarify that a physician must certify a recipient's need for inpatient treatment under the direction of a physician.

State statutory or constitutional authorization for this rule:

• Section 26-1-5
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget because this change only clarifies ongoing certification requirements for inpatient psychiatric services.

local governments:

There is no impact to local governments because they do not fund or provide psychiatric services for Medicaid clients.

small businesses:

There is no impact to small businesses because this change only clarifies ongoing certification requirements for inpatient psychiatric services.

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

There is no impact to persons other than small businesses, businesses, or local government entities because this change only clarifies ongoing certification requirements for inpatient psychiatric services.

Compliance costs for affected persons:

There are no compliance costs to a single person or entity because this change only clarifies ongoing certification requirements for inpatient psychiatric services.

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

There should be no fiscal impact. Physician certification for this service has always been required and the rule change does not change that requirement.

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
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 [email protected]

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:

11/02/2009

This rule may become effective on:

11/09/2009

Authorized by:

David Sundwall, Executive Director

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

R414-31. Inpatient Psychiatric Services for Individuals Under Age 21.

R414-31-3. Program Access Requirements.

(1) Before admission for inpatient psychiatric services or before authorization for Medicaid payment, a facility physician must make a medical evaluation of the recipient's need for care in the hospital and certify that inpatient services are needed.

(2) The certification must document that:

(a) ambulatory care resources available in the community do not meet the treatment needs of the recipient;

(b) proper treatment of the recipient's psychiatric condition requires services on an inpatient basis [or ]under the direction of a physician; and

(c) the services can reasonably be expected to improve the recipient's condition or prevent further regression so that services will no longer be needed.

(3) The Bureau of Health Facility Licensing, Certification and Resident Assessment, within the Division of Health Systems Improvement, under the Department of Health, reviews the medical evaluation and certification and determines that the client meets certification of need requirements.

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [ June 15, 2005 ] 2009

Notice of Continuation: October 6, 2004

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