DAR File No. 37905

Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-1-5

Incorporations by Reference

Notice of 120-Day (Emergency) Rule

DAR File No.: 37905
Filed: 08/08/2013 09:14:53 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to implement by rule the provision of speech augmentative communication devices for Medicaid clients who meet medically necessary criteria.

Summary of the rule or change:

This amendment incorporates by reference the 08/02/2013 version of the Speech-Language Services Provider Manual to provide speech augmentative communication devices to Medicaid clients who meet medically necessary criteria.

Emergency rule reason and justification:

Regular rulemaking procedures would place the agency in violation of federal or state law.

Justification: This amendment is necessary to comply with provisions of federal law that require the Department to provide speech augmentative communication devices to Medicaid clients who meet medically necessary criteria.

State statutory or constitutional authorization for this rule:

• 42 U.S.C. Sec. 1396a
• Section 26-1-5
• Section 26-18-3

This rule or change incorporates by reference the following material:

• Updates Speech-Language Services Utah Medicaid Provider Manual, published by Division of Medicaid and Health Financing, 08/02/2013

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget because this amendment does not change the amount of funds that the Legislature has already appropriated for speech-language services.

local governments:

There is no impact to local governments because they neither fund nor provide speech-language services to Medicaid clients.

small businesses:

Small business providers may see a slight increase in revenue with this change that allows all Medicaid eligible clients to receive speech augmentative communication devices. Nevertheless, there is not enough data to estimate the basis or frequency of how many newly eligible clients will need this service.

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

Providers of speech-language services may see a slight increase in revenue with this change that allows all Medicaid eligible clients to receive speech augmentative communication devices. Nevertheless, there is not enough data to estimate the basis or frequency of how many newly eligible clients will need this service. In addition, there is not enough data to estimate the increase in savings to Medicaid clients who become eligible for this service.

Compliance costs for affected persons:

There are no compliance costs because this change only increases revenue or savings to a single Medicaid provider or to a Medicaid client.

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

It may benefit providers of speech augmentative devices because of expanded coverage.

David Patton, PhD, 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 [email protected]

This rule is effective on:

08/08/2013

Authorized by:

David Patton, Executive Director

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

R414-1. Utah Medicaid Program.

R414-1-5. Incorporations by Reference.

(1) The Department incorporates the August 2, 2013 version of the Speech-Language Services Utah Medicaid Provider Manual by reference:

(2) The Department incorporates the July 1, 2013 versions of the following by reference:

([1]a) Utah State Plan, including any approved amendments, under Title XIX of the Social Security Act Medical Assistance Program;

([2]b) Medical Supplies Utah Medicaid Provider Manual, Section 2, Medical Supplies, as applied in Rule R414-70;

([3]c) Hospital Services Utah Medicaid Provider Manual with its attachments;

([4]d) Definitions found in the Home Health Agencies Utah Medicaid Provider Manual, and the manual's attachment for the Private Duty Nursing Acuity Grid;

[(5) Speech-Language Services Utah Medicaid Provider Manual;

]([6]e) Audiology Services Utah Medicaid Provider Manual;

([7]f) Hospice Care Utah Medicaid Provider Manual;

([8]g) Long Term Care Services in Nursing Facilities Utah Medicaid Provider Manual with its attachments;

([9]h) Personal Care Utah Medicaid Provider Manual with its attachments;

([10]i) Utah Home and Community-Based Waiver Services for Individuals 65 or Older Utah Medicaid Provider Manual;

([11]j) Utah Home and Community-Based Waiver Services for Individuals with Acquired Brain Injury Age 18 and Older Utah Medicaid Provider Manual;

([12]k) Utah Home and Community-Based Waiver for Individuals with Intellectual Disabilities or Other Related Conditions Utah Medicaid Provider Manual;

([13]l) Utah Home and Community-Based Waiver Services for Individuals with Physical Disabilities Utah Medicaid Provider Manual;

([14]m) Utah Home and Community-Based Waiver Services New Choices Waiver Utah Medicaid Provider Manual;

([15]n) Utah Home and Community-Based Waiver Services for Technology Dependent, Medically Fragile Individuals Utah Medicaid Provider Manual;

([16]o) Utah Home and Community-Based Waiver Services Autism Waiver Utah Medicaid Provider Manual;

([17]p) Office of Inspector General Administrative Hearings Procedures Manual;

([18]q) Pharmacy Services Utah Medicaid Provider Manual with its attachments;

([19]r) Coverage and Reimbursement Code Look-up Tool found at http://health.utah.gov/medicaid/stplan/lookup/CoverageLookup.php;

([20]s) Certified Nurse - Midwife Services Utah Medicaid Provider Manual;

([21]t) CHEC Services Utah Medicaid Provider Manual with its attachments;

([22]u) Chiropractic Medicine Utah Medicaid Provider Manual;

([23]v) Dental Services Utah Medicaid Provider Manual;

([24]w) General Attachments for the Utah Medicaid Provider Manual;

([25]x) Indian Health Utah Medicaid Provider Manual;

([26]y) Laboratory Services Utah Medicaid Provider Manual with its attachments;

([27]z) Medical Transportation Utah Medicaid Provider Manual;

([28]aa) Mental Health Centers/Prepaid Mental Health Plans Utah Medicaid Provider Manual;

([29]bb) Non-Traditional Medicaid Health Plan Utah Medicaid Provider Manual with its attachments;

([30]cc) Certified Family Nurse Practitioner and Pediatric Nurse Practitioner Utah Medicaid Provider Manual;

([31]dd) Oral Maxillofacial Surgeon Services Utah Medicaid Provider Manual;

([32]ee) Physical Therapy and Occupational Therapy Services Utah Medicaid Provider Manual;

([33]ff) Physician Services and Anesthesiology Utah Medicaid Provider Manual with its attachments;

([34]gg) Podiatric Services Utah Medicaid Provider Manual;

([35]hh) Primary Care Network Utah Medicaid Provider Manual with its attachments;

([36]ii) Psychology Services Utah Medicaid Provider Manual;

([37]jj) Rehabilitative Mental Health and Substance Use Disorder Services Utah Medicaid Provider Manual;

([38]kk) Rehabilitative Mental Health Services for Children Under Authority of Department of Human Services, Division of Child and Family Services or Division of Juvenile Justice Services Utah Medicaid Provider Manual;

([39]ll) Rural Health Clinic Services Utah Medicaid Provider Manual with its attachments;

([40]mm) School-Based Skills Development Services Utah Medicaid Provider Manual;

([41]nn) Section I: General Information of the Utah Medicaid Provider Manual;

([42]oo) Services for Pregnant Women Utah Medicaid Provider Manual;

([43]pp) Substance Abuse Treatment Services & Targeted Case Management Services for Substance Abuse Utah Medicaid Provider Manual;

([44]qq) Targeted Case Management for CHEC Medicaid Eligible Children Utah Medicaid Provider Manual;

([45]rr) Targeted Case Management for the Chronically Mentally Ill Utah Medicaid Provider Manual;

([46]ss) Targeted Case Management for Early Childhood (Ages 0-4) Utah Medicaid Provider Manual; and

([47]tt) Vision Care Services Utah Medicaid Provider Manual.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [May 29, ]2013

Notice of Continuation: March 2, 2012

Authorizing, and Implemented or Interpreted Law: 26-1-5; 26-18-3; 26-34-2