File No. 33415
This rule was published in the March 15, 2010, issue (Vol. 2010, No. 6) of the Utah State Bulletin.
Health, Health Care Financing, Coverage and Reimbursement Policy
Notice of Proposed Rule
DAR File No.: 33415
Filed: 03/01/2010 03:54:38 PM
Purpose of the rule or reason for the change:
The purpose of this change is to consolidate the Medicaid copayment policy into one administrative rule.
Summary of the rule or change:
This change removes the specific requirements of the copayment policy and references those requirements to Rule R414-1. (DAR NOTE: The proposed amendment to Rule R414-1 is under DAR No. 33414 in this issue, March 15, 2010, of the Bulletin.)
State statutory or constitutional authorization for this rule:
- Section 26-1-5
- Section 26-18-3
Anticipated cost or savings to:
the state budget:
The explanation of impact to the state budget is detailed in the companion filing to this proposed change (Rule R414-1).
The explanation of budget impact to local governments is detailed in the companion filing to this proposed change (Rule R414-1).
The explanation of budget impact to small businesses is detailed in the companion filing to this proposed change (Rule R414-1).
persons other than small businesses, businesses, or local governmental entities:
The explanation of budget impact to persons other than small businesses, businesses, or local government entities is detailed in the companion filing to this proposed change (Rule R414-1).
Compliance costs for affected persons:
The explanation of compliance costs for affected persons is detailed in the companion filing to this proposed change (Rule R414-1).
Comments by the department head on the fiscal impact the rule may have on businesses:
This rule change implements requirements of the American Recovery and Reinvestment Act of 2009 and will have no fiscal impact on business since the Medicaid program will absorb the cost.
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
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 firstname.lastname@example.org
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:
This rule may become effective on:
David Sundwall, Executive Director
R414. Health, Health Care Financing, Coverage and Reimbursement Policy.
R414-10. Physician Services.
R414-10-6. Copayment Policy.
This section establishes copayment policy for physician
services for Medicaid clients who are not in any of the federal
categories exempted from copayment requirements. is authorized by
42 CFR 447.15 and 447.50, Oct. 1, 2000 ed., which are adopted and
incorporated by reference. (1) The Department shall impose a copayment in the amount of
$3 for each physician visit when a non-exempt Medicaid client, as
designated on his Medicaid card, receives that physician service.
The Department shall limit the out-of-pocket expense of the
Medicaid client to $100 annually.
(2) The Department shall deduct $3 from the reimbursement
paid to the provider for each physician visit, limited to one per
(3) The provider should collect the copayment amount from
the Medicaid client for each physician visit, limited to one per
day. The provider may deny service for any client who refuses to
make the copayment if the client's medical card indicates
copayment is required.
(4) Medicaid clients in the following categories are exempt
from copayment requirements:
(b) pregnant women;
(c) institutionalized individuals;
(d) individuals whose total gross income, before exclusions
or deductions, is below the Temporary Assistance to Needy
Families (TANF) standard payment allowance. These individuals
must indicate their income status to their eligibility case
worker on a monthly basis to maintain their exemption from the
(5) Physician services for family planning purposes are exempt
from the copayment requirements.]
Date of Enactment or Last Substantive Amendment: [
December 28, 2006]
Notice of Continuation: January 26, 2007
Authorizing, and Implemented or Interpreted Law: 26-1-5; 26-18-3
The Portable Document Format (PDF) version of the Bulletin is the official version. The PDF version of this issue is available at https://rules.utah.gov/publicat/bull-pdf/2010/b20100315.pdf. The HTML edition of the Bulletin is a convenience copy. Any discrepancy between the PDF version and HTML version is resolved in favor of the PDF version.
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For questions regarding the content or application of this rule, please contact 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@example.com.