DAR File No. 38952

Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-11

Podiatric Services

Notice of Proposed Rule

(Amendment)

DAR File No.: 38952
Filed: 11/13/2014 03:57:11 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to consolidate the scope of podiatric services for Medicaid recipients.

Summary of the rule or change:

This amendment removes sections in the rule text that specify reimbursement, eligibility, and service coverage, and defers to the scope of services found in the Podiatric Services Utah Medicaid Provider Manual and in the Medicaid State Plan.

State statutory or constitutional authorization for this rule:

• Section 26-18-3
• 42 CFR 440.60
• Section 26-1-5

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget because the services provided to Medicaid recipients remain unaffected by this change.

local governments:

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

small businesses:

There is no impact to small businesses because the services provided to Medicaid recipients remain unaffected by this change.

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

There is no impact to Medicaid providers and to Medicaid recipients because the services provided to Medicaid recipients remain unaffected by this change.

Compliance costs for affected persons:

There are no compliance costs to a single Medicaid provider or to a Medicaid recipient because the services provided remain unaffected by this change.

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

This amendment will have no effect on business because it does not impose new costs or requirements on service providers nor does it change the services currently provided to Medicaid recipients.

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 cdevashrayee@utah.gov

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:

12/31/2014

This rule may become effective on:

01/07/2015

Authorized by:

David Patton, Executive Director

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

R414-11. Podiatric Services.

R414-11-1. Introduction.

The Podiatric Services program provides a scope of services for Medicaid recipients in accordance with the Podiatric Services Utah Medicaid Provider Manual and Attachment 4.19-B of the Medicaid State Plan, as incorporated into Section R414-1-5.

[R414-11-1. Introduction and Authority.

Podiatric services are authorized by 42 CFR 440.50 and include the examination, diagnosis, or treatment of the foot. Podiatric services are optional and provided in accordance with 42 CFR 440.225.

 

R414-11-2. Client Eligibility Requirements.

Podiatric services are available to categorically and medically needy individuals.

 

R414-11-3. Service Coverage.

Podiatric services are limited to the services described in the Podiatric Services Utah Medicaid Provider Manual. A physician, osteopath, or podiatrist may provide podiatric services within the scope of their respective professional license.

 

R414-11-4. Limitations.

Podiatric service limitations are described in the Podiatric Services Utah Medicaid Provider Manual.

 

R414-11-5. Non-Covered Services.

Non-covered services are described in the Podiatric Services Utah Medicaid Provider Manual.

 

R414-11-6. Reimbursement for Podiatric Services.

(1) Reimbursement for services is limited to one podiatric office visit per day.

(2) A podiatrist may bill for laboratory procedures necessary for diagnosis and treatment of the patient if equipment necessary for the laboratory procedure is available in the podiatrist's office. Laboratory services requested by a podiatrist but provided by an independent laboratory or hospital outpatient laboratory must be billed directly by the laboratory.

(3) Palliative care is included in the specific service and must be billed by that service only, not through the use of an office call procedure code.

(4) Payments are based on the established fee schedule unless a lower amount is billed. The amount billed cannot exceed usual and customary charges to private pay patients.

 

R414-11-7. Copayment Policy.

Each Medicaid client is responsible to pay a copayment amount that complies with the requirements of the Medicaid State Plan and Rule R414-1.]

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [July 1, 2013]2015

Notice of Continuation: March 18, 2014

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