DAR File No. 38709

Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-35

Mental Health Services for Children in State Custody

Notice of Proposed Rule

(Repeal)

DAR File No.: 38709
Filed: 07/22/2014 11:40:03 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this rule repeal is to consolidate the scope of mental health services for children in state custody into Rule R414-36 and the corresponding provider manual (Rehabilitative Mental Health and Substance Use Disorder Services Utah Medicaid Provider Manual). (DAR NOTE: The proposed amendment to Rule R414-36 is under DAR No. 38710 in this issue, August 15, 2014, of the Bulletin.)

Summary of the rule or change:

This rule is repealed in its entirety.

State statutory or constitutional authorization for this rule:

• Section 26-18-3

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There is no impact to a single Medicaid provider or to a Medicaid recipient because the services that are repealed in this rule are consolidated in the corresponding provider manual.

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.

[R414-35. Mental Health Services for Children in State Custody.

R414-35-1. Introduction and Authority.

(1) This rule outlines the diagnostic and rehabilitative outpatient mental health services provided to CHEC (EPSDT)-eligible Medicaid clients in the custody of Department of Human Services (DHS).

(2) This rule is authorized under UCA 26-18-3 and governs the services allowed under 42 CFR 440.130, Oct. 2003 ed.

 

R414-35-2. Definitions.

In this rule:

"CHEC" means Utah's version of the federally-mandated Early and Periodic Screening Diagnosis and Treatment (EPSDT) program. The CHEC program is designed to ensure access to needed medical care for Medicaid clients from birth through the month of the client's 21st birthday.

"Diagnostic services" means any medical procedure recommended by a physician or other licensed mental health therapist to enable him to identify the existence, nature, or extent of a mental health disorder in a client.

"Rehabilitative services" means any medical or remedial services recommended by a physician or other licensed mental health therapist for maximum reduction of a client's mental health disorder and restoration of the client to his best possible functional level.

 

R414-35-3. Client Eligibility Requirements.

Diagnostic and rehabilitative outpatient mental health services are available to CHEC-eligible children in the custody of DHS.

 

R414-35-4. Program Access Requirements.

Diagnostic and rehabilitative outpatient mental health services must be provided by a licensed mental health therapist under contract with DHS, a psychosocial rehabilitative treatment program operated by or under contract with DHS or a community mental health center.

 

R414-35-5. Service Coverage.

(1) Services must be recommended by a licensed mental health therapist.

(2) The scope of diagnostic and rehabilitative mental health services includes:

(a) psychiatric diagnostic interview examination;

(b) psychological testing;

(c) individual psychotherapy;

(d) group psychotherapy;

(e) family psychotherapy with patient present;

(f) family psychotherapy without patient present;

(g) pharmacologic management;

(h) psychosocial rehabilitative services;

(i) intensive psychosocial rehabilitative services for children ages 0 through the month of their 13th birthday; and

(j) residential treatment services including:

(i) psychiatric health facility;

(ii) comprehensive community support services; and

(iii) foster care, therapeutic, child.

 

R414-35-6. Qualified Providers.

Diagnostic and rehabilitative services must be provided by an individual, as limited by the scope of his license, who is:

(1) a licensed physician, a licensed psychologist, a licensed clinical social worker, a licensed certified social worker, a licensed social service worker, a licensed advanced practice registered nurse specializing in mental health nursing, a licensed registered nurse, a licensed professional counselor, a licensed marriage and family therapist or a licensed substance abuse counselor; or

(2) an individual working toward licensure in one of the professions identified in subsection (1) to the extent permitted by Title 58 of the Utah Code; or

(3) a licensed practical nurse or other trained staff working under the supervision of one of the individuals identified in subsection (1) or (2).

 

R414-35-7. Reimbursement Methodology.

The Department pays the lower of the amount billed or the rate on the DHS contractors' fee schedule. The fee schedule was initially established after consultation with DHS. A provider shall not charge the Department a fee that exceeds the provider's usual and customary charges for the provider's private pay patients.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: December 16, 2004

Notice of Continuation: November 2, 2009

Authorizing, and Implemented or Interpreted Law: 26-18-3]