File No. 33418
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.: 33418
Filed: 03/01/2010 04:10:12 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 26-18-3
- Section 26-1-5
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.
R414-60. Medicaid Policy for Pharmacy [
(1) The Department shall impose a co-payment in the amount of
$3 for each prescription filled when a non-co-payment exempt
Medicaid client, as designated on his Medicaid card, receives the
prescribed medication. (2) The Department shall deduct $3 from the reimbursement
paid to the provider for each prescription, up to a maximum
amount of $15 per month for each client.
(3) It is the providers responsibility to collect the
copayment amount from the Medicaid client for those prescriptions
that require a copayment.
(4) Co-payments do not apply to recipients and services
excluded from cost sharing requirements in 42 CFR 447.53
Date of Enactment or Last Substantive Amendment: [
January 4, 2006]
Notice of Continuation: May 21, 2007
Authorizing, and Implemented or Interpreted Law: 26-18-3; 26-1-5
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.
Text to be deleted is struck through and surrounded by brackets (e.g., [
example]). Text to be added is underlined (e.g., ). Older browsers may not depict some or any of these attributes on the screen or when the document is printed.
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.