DAR File No. 32622

Health, Health Care Financing, Coverage and Reimbursement Policy

R414-50-3

Client Eligibility Requirements

NOTICE OF PROPOSED RULE

DAR File No.: 32622
Filed: 04/30/2009, 04:21
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 2009 General 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 (EPSDT) Program to receive oral and maxillofacial surgery services. It also clarifies that services performed by an oral surgeon are still available to all categorically and medically needy clients.

State statutory or constitutional authorization for this rule:

Sections 26-1-5 and 26-18-3

Anticipated cost or savings to:

the state budget:

The reduction of oral and maxillofacial surgery services will result in savings to the General Fund and to the federal budget. Estimates of these savings are listed in the companion filing to this proposed rule (Rule R414-49). (DAR NOTE: The proposed amendment to Rule R414-49 is under DAR No. 32617 in this issue, May 15, 2009, of the Bulletin.)

local governments:

There is no budget impact because local governments do not fund or provide oral and maxillofacial surgery services to Medicaid clients.

small businesses and persons other than businesses:

The Department estimates annual losses in revenue to providers of oral and maxillofacial surgery services. Estimates of these savings are listed in the companion filing to this proposed rule (Rule R414-49).

Compliance costs for affected persons:

The annual loss in revenue to a single provider of oral and maxillofacial surgery services is listed in the companion filing to this proposed rule (Rule R414-49).

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

The 2009 Legislature did not appropriate funds to permit continuation of these services. David N. Sundwall, MD, 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 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:

06/15/2009

Interested persons may attend a public hearing regarding this rule:

5/26/2009 at 1:00 PM, Utah Department of Health, Cannon Health Building, Room 114

This rule may become effective on:

07/01/2009

Authorized by:

David N. Sundwall, Executive Director

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

R414-50. Dental, Oral and Maxillofacial Surgeons.

R414-50-3. Client Eligibility Requirements.

Oral and maxillofacial surgery services [is]are available [to categorically and medically needy clients who are ages 20 and younger or who are pregnant. Dental services to non-pregnant adults ages 21 and older are limited to emergency services only]only to clients who are pregnant women or who are individuals eligible under the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program. Nevertheless, physician, medical and surgical services performed by an oral surgeon are available to all categorically and medically needy clients.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [January 28, 2004]2009

Notice of Continuation: November 3, 2004

Authorizing, and Implemented or Interpreted Law: 26-1-4.1; 26-1-5; 26-18-3