DAR File No. 38705

Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-13

Psychology Services

Notice of Proposed Rule

(Amendment)

DAR File No.: 38705
Filed: 07/22/2014 11:13:44 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to remove sections of the rule specified in the summary provided below and to reflect the current Medicaid State Plan.

Summary of the rule or change:

This amendment removes sections in the rule text that specify reimbursement, eligibility, and service coverage, and defers to the scope of services found in the Psychology Services Utah Medicaid Provider Manual and in the Medicaid State Plan.

State statutory or constitutional authorization for this rule:

• Section 26-18-3
• Section 26-1-5

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget because the services provided to Medicaid recipients remain unaffected by this change.

local governments:

There is no impact to local governments because the services provided to Medicaid recipients remain unaffected by this change.

small businesses:

There is no impact to small businesses because the services provided to Medicaid recipients remain unaffected by this change.

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

There is no impact to Medicaid providers and to Medicaid recipients because the services provided to Medicaid recipients remain unaffected by this change.

Compliance costs for affected persons:

There are no compliance costs to a single Medicaid provider or to a Medicaid recipient because this change only consolidates the scope of psychology services for Medicaid recipients.

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

No impact on business because change will not alter current practice.

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:

• Karen Ford at the above address, by phone at 801-538-6637, by FAX at 801-538-6099, or by Internet E-mail at [email protected]
• 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:

09/15/2014

This rule may become effective on:

09/22/2014

Authorized by:

David Patton, Executive Director

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

R414-13. Psychology Services.

R414-13-1. Introduction.

Psychologists may provide services for Medicaid recipients in accordance with the Psychology Services Utah Medicaid Provider Manual and Attachment 4.19-B of the Medicaid State Plan, as incorporated into Section R414-1-5.

 

[R414-13-1. Introduction and Authority.

The psychology program is an optional Medicaid service authorized by 42 USC, 1396d(a)(6), 1994 ed., and 42 CFR 440.60(a), October 1993 ed., which are adopted and incorporated by reference.

 

R414-13-2. Definitions.

The definitions in R414-1 apply to this rule.

 

R414-13-3. Client Eligibility Requirements.

Evaluation, psychological testing, and individual and group therapy may be furnished only to individuals who are eligible for services under the federally-mandated program of early and periodic screening, diagnosis, and treatment for children under the age of 21.

 

R414-13-4. Program Access Requirements.

(1) A licensed independent psychologist practicing within the scope of his licensure in accordance with Title 58 may provide psychology services in a setting other than in an inpatient hospital setting or an intermediate care facility for the mentally retarded. Psychology services provided to hospital inpatients shall be covered under the hospital diagnostic related groups, and therefore are not eligible for reimbursement under this rule.

(2) After November 14, 1994, Medicaid may not authorize psychology services for Medicaid recipients over age 20.

(3) Through December 31, 1994, Medicaid may reimburse for psychology services authorized before November 14, 1994 for Medicaid recipients over age 20.

(4) Through December 31, 1994, Medicaid may reimburse for evaluation services that do not require prior authorization for Medicaid recipients over age 20.

 

R414-13-5. Service Coverage.

(1) Psychology services covered may include:

(a) evaluation;

(b) psychological testing;

(c) individual therapy; and

(d) group therapy.

(2) Evaluations that are not medically necessary or are only for court determinations on issues such as custody or visitation are not covered.

(3) Unless the provider satisfies the division that additional services are medically necessary, the division may only reimburse for the following services in a 12-month period:

(a) one evaluation;

(b) one psychological test or battery of tests;

(c) 12 sessions of individual therapy; and

(d) 24 sessions of group therapy.

 

]KEY: [m]Medicaid

Date of Enactment or Last Substantive Amendment: [1994]2014

Notice of Continuation: November 14, 2012

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