File No. 33419
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.: 33419
Filed: 03/01/2010 04:17:19 PM
Purpose of the rule or reason for the change:
The purpose of this change is to update the rule to be consistent with the cost sharing policy found in the 1115 Demonstration Waiver, and to list American Indians as a cost sharing-exempt group in accordance with the American Recovery and Reinvestment Act of 2009.
Summary of the rule or change:
This change updates the cost sharing policy for Non-Traditional Medicaid clients and also lists American Indians as a cost sharing-exempt group.
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). (DAR NOTE: The proposed amendment to Rule R414-1 is under DAR No. 33414 in this issue, March 15, 2010, of the Bulletin.)
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 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 email@example.com
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.
R414-200. Non-Traditional Medicaid Health Plan Services.
R414-200-4. Cost Sharing.
(1) An enrollee is responsible to pay to the:
(a) hospital a $220 co-insurance payment for each inpatient hospital admission;
(b) hospital a $6 copayment for each non-emergency use of hospital emergency services;
(c) provider a $3 copayment for outpatient office visits for physician, physician-related, mental health services, physical therapy, and occupational therapy services; except, no copayment is due for preventive services, immunizations and health education; and
(d) pharmacy a $3 copayment per prescription for prescription drugs.
(2) The out-of-pocket maximum payment for copayments or co-insurance is limited to $500 per enrollee per calendar year.
KEY: Medicaid, non-traditional, cost sharing
Date of Enactment or Last Substantive Amendment: [
July 1, 2009]
Notice of Continuation: May 24, 2007
Authorizing, and Implemented or Interpreted Law: 26-18
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 firstname.lastname@example.org.