DAR File No. 32227

Health, Health Care Financing, Coverage and Reimbursement Policy

R414-54

Speech-Language Pathology Services

NOTICE OF PROPOSED RULE

DAR File No.: 32227
Filed: 12/17/2008, 05:42
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to comply with budget reduction mandates set forth in the 2008 Second Special Session of the Utah Legislature.

Summary of the rule or change:

This change allows only pregnant women and individuals eligible under the Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT) to receive speech-language pathology services. It also incorporates by reference the Speech-Language Pathology Services Provider Manual, effective 01/01/2009.

State statutory or constitutional authorization for this rule:

Section 26-18-3

This rule or change incorporates by reference the following material:

Speech-Language Pathology Services Provider Manual, effective 01/01/2009

Anticipated cost or savings to:

the state budget:

The Department estimates an annual savings of $46,045 to the General Fund and $111,159 in federal dollars as a result of this change.

local governments:

This change does not impact local governments because they do not fund or provide speech-language pathology services to Medicaid clients.

small businesses and persons other than businesses:

Providers of speech-language pathology services will lose approximately $157,204 in annual revenue as a result of this change. However, the total out-of-pocket expense to Medicaid clients who elect to pay out-of-pocket to receive these services is difficult to estimate because it is impossible to know how many clients would choose to obtain these services.

Compliance costs for affected persons:

The annual loss in revenue to a single provider of speech-language pathology services is approximately $2,620 based on the total number of providers and approximate client visits per year. However, the annual out-of-pocket expense to a single Medicaid client who elects to pay for speech-language pathology services is difficult to estimate because the fees will vary depending on the provider's fee schedule. According to current Medicaid rates, the out-of-pocket costs would exceed $164 based on an average of three speech therapy visits per year.

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

This rule change reflects the reductions passed in S.B. 2001 (2008 2nd Spec Sess) and are necessary to file under emergency authority to immediately implement the budget reductions. David N. Sundwall, MD, Executive Director (DAR NOTE: S.B. 2001 (2008 2nd Spec Sess) is found at Chapter 2, Laws of Utah 2008 (2nd Spec Sess) and was effective 09/29/2008.)

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 cdevashrayee@utah.gov

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:

02/17/2009

This rule may become effective on:

02/24/2009

Authorized by:

David N. Sundwall, Executive Director

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

R414-54. Speech-Language Pathology Services.

R414-54-3. Services.

(1) Speech-language pathology services are optional.

(2) Speech-language pathology services are limited to services described in the Speech-Language Pathology Services Provider Manual, effective January 1, 2009, which is incorporated by reference.

(3) The Speech-Language Pathology Services Provider Manual specifies the reasonable and appropriate amount, duration, and scope of the service sufficient to reasonably achieve its purpose.

(4) Speech-language pathology services may be provided by licensed speech-language pathologists, or speech-language pathology aides under the supervision of speech-language pathologists.

 

R414-54-4. [Services for Individuals Eligible for Optional Services]Client Eligibility Requirements.

(1) Speech-language pathology services are available only to clients who are pregnant women or who are individuals eligible under the Early and Periodic Screening, Diagnosis and Treatment Program.

([1]2) An individual receiving speech-language pathology services may receive speech-language pathology services as described in the Speech-Language Pathology Provider Manual.

([2]3) An individual receiving speech-language pathology services must meet the criteria established in the Speech-Language Pathology Provider Manual and obtain prior approval if required.

 

KEY: Medicaid, speech-language pathology services

Date of Enactment or Last Substantive Amendment: [October 2, 2008]2009

Notice of Continuation: March 23, 2004

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