DAR File No. 38431

Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-45

Personal Supervision by a Physician

Notice of Proposed Rule

(Repeal)

DAR File No.: 38431
Filed: 04/15/2014 01:17:32 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rule repeal is necessary because the criteria and requirements found in the rule text already exist in the Medicaid State Plan, corresponding Medicaid provider manuals, and in state and federal law.

Summary of the rule or change:

This rule is repealed in its entirety.

State statutory or constitutional authorization for this rule:

• Section 26-1-5
• Title 58, Chapter 31b
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget because this rule repeal does not affect ongoing nurse practitioner services.

local governments:

There is no impact to local governments because they do not fund or provide nurse practitioner services to Medicaid recipients.

small businesses:

There is no impact to small businesses because this rule repeal does not affect ongoing nurse practitioner services.

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

There is no impact to Medicaid providers and to Medicaid recipients because this rule repeal does not affect ongoing nurse practitioner services.

Compliance costs for affected persons:

There is no impact to a single Medicaid provider or to a Medicaid recipient because this rule repeal does not affect ongoing nurse practitioner services.

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

No effect on business because there is no change in current practices.

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]
• Nina Baker at the above address, by phone at 801-538-9127, by FAX at 801-538-6412, 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:

06/02/2014

This rule may become effective on:

06/09/2014

Authorized by:

David Patton, Executive Director

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

[R414-45. Personal Supervision by a Physician.

R414-45-1. Introduction and Authority.

This rule defines medical services provided under the supervision of a physician or osteopath. Physician services are authorized by Sections 1901 and 1905(a)(5) of the Social Security Act, and 42 CFR 440.50, 491.2, October 1992 ed., which are adopted and incorporated by reference. Reference is also made to Title 58, Chapters 12 and 31; and R156-12d, R156-31.

 

R414-45-2. Definitions.

In addition to the definitions in R414-1 and R156-12d-3, the following definitions also apply to this rule:

(1) "Consultation and referral plan" means a written document defined to include the nature, frequency, and methods of consultation and supervision, and the methods of documentation of records.

(2) "Non-physician" means a nurse practitioner or a physician assistant.

(3) "Non-physician services" means those medical services rendered, incident to a physician's services, by a nurse practitioner or a physician assistant.

(4) "Personal supervision" means the critical observation and guidance by a physician of a non-physician's activities within the non-physician's scope of practice.

 

R414-45-3. Client Eligibility Requirements.

Medical services under the personal supervision of a physician or osteopath are available to categorically and medically needy individuals.

 

R414-45-4. Program Access Requirements.

(1) A physician licensed to practice medicine or osteopathy under Title 58, Chapter 12, must personally render medical services or supervise those services, rendered incident to the physician's services, by a nurse practitioner or a physician assistant.

(a) When a consultation and referral plan regarding supervised procedures is in place in both the physician's office and the non-physician's office, the Medicaid standard for personal supervision is the physician's availability by telephone.

(b) Any non-physician medical service provided in the course of treatment prescribed by a physician for any Medicaid client must meet the personal supervision requirement.

(2) A physician must be present for sufficient periods of time to provide the medical direction, services, consultation, supervision, and signing of the medical records, as specified in R156-12d-8(1).

(3) This rule does not apply to Rural Health Clinics.

 

R414-45-5. Service Coverage.

Services under this rule may include medical services provided personally by a physician or osteopath or those services rendered, incident to the physician's services, by a nurse practitioner or a physician assistant, under the personal supervision of the physician.

 

KEY: medicaid

Date of Enactment or Last Substantive Amendment: 1994

Notice of Continuation: January 24, 2012

Authorizing, and Implemented or Interpreted Law: 26-1-5; 26-18-3; 58-12; 58-31]