DAR File No. 38614

Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-59

Audiology-Hearing Services

Notice of Proposed Rule

(Amendment)

DAR File No.: 38614
Filed: 06/16/2014 09:53:58 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to streamline and consolidate the scope of audiology services for Medicaid recipients.

Summary of the rule or change:

This amendment consolidates the scope of audiology services by removing sections in the rule text that specify reimbursement, eligibility, and service coverage, and deferring to the scope of services found in the Speech-Language Pathology and Audiology Services Utah Medicaid Provider Manual and in the Medicaid State Plan. This amendment also changes the title of the rule to "Audiology Services."

State statutory or constitutional authorization for this rule:

• Section 26-18-3
• 42 CFR 440.110
• Section 26-18-5

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget because this change only consolidates the scope of audiology services for Medicaid recipients.

local governments:

There is no impact to local governments because they do not fund or provide audiology services to Medicaid recipients.

small businesses:

There is no impact to small businesses because this change only consolidates the scope of audiology services for Medicaid recipients.

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

There is no impact to Medicaid providers and to Medicaid recipients because this change only consolidates the scope of audiology services for Medicaid recipients.

Compliance costs for affected persons:

There are no compliance costs to a single Medicaid provider or to a Medicaid recipient because this change only consolidates the scope of audiology services for Medicaid recipients.

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

No effect on business as this does not change current practice.

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]
• Nina Baker at the above address, by phone at 801-538-9127, by FAX at 801-538-6412, 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:

07/31/2014

This rule may become effective on:

08/07/2014

Authorized by:

David Patton, Executive Director

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

R414-59. Audiology[-Hearing] Services.

R414-59. Introduction.

Audiology services provide a scope of services for Medicaid recipients in accordance with the Speech-Language Pathology and Audiology Services Utah Medicaid Provider Manual and Attachment 4.19-B of the Medicaid State Plan, as incorporated into Section R414-1-5.

[R414-59-1. Introduction and Authority.

(1) This rule governs the provision of audiology-hearing services.

(2) This rule is authorized by Sections 26-18-3 and 26-1-5.

(3) As required by Section 26-18-3, the Department provides these services in an efficient, economical manner, safeguarding against unnecessary, unreasonable, or inappropriate use of these services.

 

R414-59-2. Definitions.

(1) The definitions in the Speech-Language Pathology and Audiology Licensing Act, Title 58, Chapter 41, apply to this rule.

 

R414-59-3. Services.

(1) Audiology-hearing services are optional services.

(2) Audiology-hearing services are limited to services described in the Audiology Services Provider Manual.

(3) The Audiology Services Provider Manual specifies the reasonable and appropriate amount, duration, and scope of the service sufficient to reasonably achieve its purpose.

(4) Audiology-hearing services may be provided to an individual only after being referred by a physician. All audiology-hearing services must be provided by a licensed audiologist.

 

R414-59-4. Client Eligibility Requirements.

(1) Audiology-hearing services are available only to clients who are pregnant women or who are individuals eligible under the Early and Periodic Screening, Diagnosis and Treatment Program.

(2) An individual receiving audiology-hearing services may receive audiology services as described in the Audiology Services Provider Manual.

(3) An individual receiving audiology-hearing services must meet the criteria established in the Audiology Services Provider Manual and obtain prior approval if required.

 

R414-59-5. Reimbursement.

Audiology services are reimbursed using the fee schedule in the Utah Medicaid State Plan and incorporated by reference in R414-1-5.

]

KEY: Medicaid, audiology

Date of Enactment or Last Substantive Amendment: [November 15, 2011]2014

Notice of Continuation: October 13, 2010

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