DAR File No. 41562

Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-49

Dental, Oral and Maxillofacial Surgeons and Orthodontia

Notice of Proposed Rule

(Amendment)

DAR File No.: 41562
Filed: 05/01/2017 06:07:51 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to implement provisions of both S.B. 39 passed during the 2016 General Session, and S.B. 274 passed during the 2017 General Session, which direct the Department of Health to seek a federal waiver to provide dental services to blind or disabled Medicaid members who are 18 years of age or older.

Summary of the rule or change:

This amendment implements the scope of dental services available to blind or disabled Medicaid members who are 18 years of age or older. It also specifies program access requirements and where to reference covered services and limitations.

Statutory or constitutional authorization for this rule:

• Section 26-18-3
• Section 26-1-5

Anticipated cost or savings to:

the state budget:

There is an expected annual cost of about $5,456,300 to implement these provisions. This figure is based on a total of about 34,500 Medicaid members who may become eligible for dental services.

local governments:

There is no impact to local governments because they do not fund dental services under the Medicaid program.

small businesses:

Small businesses may see revenue up to $5,456,300 as a result of this change. The exact amount, however, cannot be determined since it will depend on services needed by Medicaid members.

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

Medicaid providers may see revenue up to $5,456,300 as a result of this change. The exact amount, however, cannot be determined since it will depend on services needed by Medicaid members. Medicaid members who qualify for these services will see out-of-pocket savings based on this amount, but the exact savings cannot be determined as it will depend on what services they receive.

Compliance costs for affected persons:

There are no compliance costs because this change can only result in increased revenue to a single Medicaid provider and savings to a Medicaid member.

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

Businesses that are Medicaid providers will be fiscally impacted through an increase in revenue for certain dental services covered by Medicaid.

Joseph K. Miner, MD, Executive Director

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 [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:

06/14/2017

This rule may become effective on:

07/01/2017

Authorized by:

Joseph Miner, Executive Director

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

R414-49. Dental, Oral and Maxillofacial Surgeons and Orthodontia.

R414-49-1. Introduction.

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

 

R414-49-2. Dental Services for the Blind or Disabled.

(1) Introduction and Authority.

(a) This section defines the scope of dental services available to blind or disabled Medicaid members who are 18 years of age or older.

(b) Dental services are authorized by 42 CFR 440.100, 440.120, and 483.460. This rule is also authorized under Sections 26-1-5 and 26-18-3.

(2) Definitions.

(a) "Dental services" whether furnished in the office, a hospital, a skilled nursing facility, or elsewhere, means covered services performed within the scope of the Medicaid dental provider's license as defined in Title 58, Occupations and Professions.

(b) "Blind or disabled" is as defined in Subsection 1614(a) of the Social Security Act.

(3) Client Eligibility Requirements.

(a) Dental Services are available to blind or disabled members who are 18 years of age or older.

(4) Program Access Requirements.

(a) Dental services are available only from a dental provider who has a current Utah Medicaid provider agreement, and has complied with all relevant laws and policy.

(5) Covered Services.

(a) Covered Services and limitations are maintained in the Utah Medicaid Coverage and Reimbursement Code Lookup and the Dental, Oral Maxillofacial, and Orthodontia Services Utah Medicaid Provider Manual.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [January 10, 2014]2017

Notice of Continuation: June 17, 2014

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