Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-3A

Outpatient Hospital Services

Five-Year Notice of Review and Statement of Continuation

DAR File No.: 36936
Filed: 10/10/2012 02:59:35 PM

NOTICE OF REVIEW AND STATEMENT OF CONTINUATION

Concise explanation of the particular statutory provisions under which the rule is enacted and how these provisions authorize or require the rule:

Section 26-18-3 requires the Department to implement Medicaid policy through administrative rule, which allow the Department to provide outpatient hospital services to Medicaid recipients. Language at 42 CFR 440.20 also requires the Department to provide these services to eligible Medicaid recipients.

Summary of written comments received during and since the last five-year review of the rule from interested persons supporting or opposing the rule:

The Department did not receive any written or oral comments regarding this rule.

Reasoned justification for continuation of the rule, including reasons why the agency disagrees with comments in opposition to the rule, if any:

The Department should continue this rule because it establishes requirements for outpatient hospital services that include client eligibility, program access, and the Prepaid Mental Health Plan. The Department should also continue this rule because it specifies service coverage and prior authorization requirements for Medicaid recipients, directs Medicaid recipients to the copayment policy, and directs Medicaid providers of outpatient hospital services to the methodology used for reimbursement.

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

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

Authorized by:

David Patton, Executive Director

Effective:

10/10/2012