Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-49-3

Client Eligibility Requirements

Notice of Proposed Rule

(Amendment)

DAR File No.: 36105
Filed: 04/27/2012 02:10:23 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to comply with mandates set forth in the 2012 General Session of the Utah Legislature reinstating emergency dental to non-pregnant adult Medicaid clients.

Summary of the rule or change:

This change allows non-pregnant adults 21 years and older to receive limited emergency dental services.

State statutory or constitutional authorization for this rule:

• Section 26-1-5
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

This amendment is anticipated to be budget neutral as increased costs in the dental program are anticipated to be offset by savings in emergency room visits.

local governments:

There may be some reduction in revenues to local governments that own hospitals, because of reductions in emergency room visits resulting from this change.

small businesses:

There is an increase in annual revenue of approximately $832,224 for small dental businesses due to the changes in emergency dental services for non-pregnant adults ages 21 and older set forth by the Utah Legislature. There is also anticipated to be an $832,224 decrease in emergency room visit expenditures due to this change.

persons other than small businesses, businesses, or local governmental entities:

There is an increase in annual revenue of some portion of the amount noted above for businesses. There is also anticipated to be a decrease of some portion of the amount noted above in emergency room visit expenditures due to this change. Medicaid recipients who take advantage of the emergency dental program for non-pregnant adults ages 21 and older will see savings from not paying out of pocket expenses for these services.

Compliance costs for affected persons:

Dental providers will see an increase in revenues and emergency room providers will see a decrease in revenues resulting from this amendment. It is difficult to quantify the specific compliance costs for any specific provider as the future utilization is unknown.

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

Providers of dental service will benefit from having this a covered service.

David Patton, PhD, 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 [email protected]

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:

06/14/2012

This rule may become effective on:

07/01/2012

Authorized by:

David Patton, Executive Director

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

R414-49. Dental Services.

R414-49-3. Client Eligibility Requirements.

Dental services are available [only] to clients who are pregnant women or who are individuals eligible under the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program. Dental services to non-pregnant adults ages 21 and older are limited to emergency services only as defined in the Utah Medicaid State Plan Attachment 3.1-A, Attachment #10 and Attachment 3.1-B, Attachment #10.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [July 1, 2009]2012

Notice of Continuation: November 2, 2009

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