DAR File No. 41125

Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-10A

Transplant Services Standards

Five-Year Notice of Review and Statement of Continuation

DAR File No.: 41125
Filed: 01/06/2017 12:20:19 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 rules, which allow the Department to administer the Medicaid program. Additionally, Section 26-1-5 allows the Department to adopt rules that provide access to Medicaid services, and 42 CFR 482.68 sets forth special requirements for transplant service centers.

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 received written comments from Molina Health Care, National Marrow Donor Program, Intermountain Health Care, and University of Utah Health Care, after filing a notice of repeal and reenactment for this rule to clarify Medicaid policy in June 2016. The comments reflected concerns over coverage for stem cell transplant services that include research, searches for donors, and requests to expand coverage for various childhood illnesses that may be responsive to stem cell treatment.

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

The Department will continue this rule because it defines important terms and provisions, sets forth eligibility and access requirements, specifies service coverage and prior authorization, clarifies covered and non-covered services for stem cell transplantation, and lists criteria for requests of non-covered services. There is no opposition to the rule itself and the Department filed a change in proposed rule that addresses the written comments and makes other clarifications.

The full text of this rule may be inspected, during regular business hours, at the Office 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

Effective:

01/06/2017

Authorized by:

Joseph Miner, Executive Director