DAR File No. 42291

Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-60-12

Provider-Administered Drugs for the Treatment of Opioid Use Disorders

Notice of Proposed Rule

(Amendment)

DAR File No.: 42291
Filed: 11/01/2017 04:24:56 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to implement by rule a policy for the treatment of opioid treatment disorders.

Summary of the rule or change:

This amendment clarifies payment for pharmacies that dispense drugs directly to providers for the treatment of opioid use disorders. It also clarifies that only providers may receive and administer these drugs to their patients.

Statutory or constitutional authorization for this rule:

• Section 26-1-5
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget because this change only clarifies pharmacy services and does not affect reimbursement.

local governments:

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

small businesses:

Some pharmacies may incur expenses related to delivery of medications to providers. Nevertheless, these expenses are negligible and are offset by potential revenue.

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

There is no impact to Medicaid providers and to Medicaid members because this change only clarifies pharmacy services and does not affect reimbursement.

Compliance costs for affected persons:

There is no impact to a single Medicaid provider or to a Medicaid member because this change only clarifies pharmacy services and does not affect reimbursement.

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

After conducting a thorough analysis, it was determined that this proposed rule change will not result in a fiscal impact to businesses.

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 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:

12/15/2017

This rule may become effective on:

01/01/2018

Authorized by:

Joseph Miner, Executive Director

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

R414-60. Medicaid Policy for Pharmacy Program.

R414-60-12. Provider-Administered Drugs for the Treatment of Opioid Use Disorders.

A pharmacy may bill Medicaid for any covered, provider-administered drug not directly dispensed to a patient for the treatment of an opioid use disorder. The pharmacy may only release the drug to the administering provider or the provider's staff for treatment.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [October 1], 2017

Notice of Continuation: April 28, 2017

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