DAR File No. 39356

Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-52

Optometry Services

Notice of Proposed Rule

(Amendment)

DAR File No.: 39356
Filed: 05/07/2015 11:02:49 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to consolidate the scope of optometry services to the Medicaid provider manual.

Summary of the rule or change:

This amendment removes all provisions in the rule text and defers to the scope of services found in the Vision Care Services Utah Medicaid Provider Manual and in the Medicaid State Plan.

State statutory or constitutional authorization for this rule:

• Section 26-1-5
• 42 CFR 440.120
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

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

local governments:

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

small businesses:

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

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

The amendment does not impact business because it does not change the services currently provided to Medicaid recipients.

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]

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:

07/01/2015

This rule may become effective on:

07/08/2015

Authorized by:

David Patton, Executive Director

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

R414-52. Optometry Services.

R414-52-1. Introduction.

The Optometry Services Program provides a scope of services for Medicaid recipients in accordance with the Vision Care Services Utah Medicaid Provider Manual and Attachment 4.19-B of the Medicaid State Plan, as incorporated into Section R414-1-5.

[R414-52-1. Introduction and Authority.

The Optometry Program provides optometry services to meet the optometry needs of Medicaid clients. This rule is authorized under Utah Code 26-18-3 and governs the services allowed under 42 CFR 440.60.

 

R414-52-2. Definitions.

The definitions in the Utah Optometry Practice Act, Title 58, Chapter 16a, apply to this rule.

 

R414-52-3. Client Eligibility Requirements.

Optometry services are available to categorically and medically needy individuals, except that the provision of eyeglasses is available only to clients who are pregnant women or who are individuals eligible under the Early and Periodic Screening, Diagnosis and Treatment Program.

 

R414-52-4. Service Coverage.

(1) Optometry services include examination, evaluation, diagnosis and treatment of visual deficiency, removal of a foreign body, and the provision of eyeglasses. In addition, Medicaid medical services performed by physicians may also be performed by optometrists under the Utah Optometry Practice Act.

(2) The optometrist must document in the patient record that the eye examination is medically necessary.

 

R414-52-5. Reimbursement.

(1) Fees for services for which the Department will pay optometrists are established from the physician's fees for CPT codes as described in the State Plan, Attachment 4.19-B, Section D Physicians. Fee schedules were initially established after consultation with provider representatives. Adjustments to the schedule are made in accordance with appropriations and to produce efficient and effective services.

(2) The Department pays the lower of the amount billed and the rate on the schedule. 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, optometry

Date of Enactment or Last Substantive Amendment: [February 24, 2009]2015

Notice of Continuation: May 1, 2013

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