DAR File No. 42594

Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-3A-5

Services

Notice of Proposed Rule

(Amendment)

DAR File No.: 42594
Filed: 02/14/2018 11:10:59 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to include all accreditation organizations that certify sleep disorder centers in accordance with the Centers for Medicare and Medicaid Services (CMS).

Summary of the rule or change:

This amendment specifies that coverage for sleep studies is available only through the three accreditation organizations listed in the text. This revised list allows sleep centers more options for accreditation and improves access to sleep study services for Medicaid members.

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 no impact to the state budget because funding and accreditation for sleep studies is within budget allotments set forth by the legislature.

local governments:

There is no impact to local governments because they do not fund outpatient hospital services for Medicaid members.

small businesses:

Small businesses will see more revenue through this revised list of accreditation organizations. Nevertheless, there are not sufficient nor cost effective data available to determine what those increases may be.

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

Medicaid providers and accreditation organizations will see more revenue through this revised list. Nevertheless, there are not sufficient nor cost effective data available to determine what those increases may be. Medicaid members will likewise see an increased, yet undetermined amount of out-of-pocket savings through improved access to services.

Compliance costs for affected persons:

There are no compliance costs because this change can only result in increased revenue and out-of-pocket savings.

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

Businesses will see more revenue through this revised list of accreditation organizations. Nevertheless, there are not sufficient nor cost effective data available to determine what those increases may be.

Joseph K. Miner, M.D., 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:

04/02/2018

This rule may become effective on:

04/09/2018

Authorized by:

Joseph Miner, Executive Director

Appendix 1: Regulatory Impact Summary Table*

Fiscal Costs	FY 2018	FY 2019	FY 2020
State Government	$0	$0	$0
Local Government	$0	$0	$0
Small Businesses	$0	$0	$0
Non-Small Businesses	$0	$0	$0
Other Person	$0	$0	$0
Total Fiscal Costs:	$0	$0	$0
Fiscal Benefits
State Government	$0	$0	$0
Local Government	$0	$0	$0
Small Businesses	Undetermined business revenue	Undetermined business revenue	Undetermined business revenue
Non-Small Businesses	Undetermined business revenue	Undetermined business revenue	Undetermined business revenue
Other Persons	Undetermined business revenue	Undetermined business revenue	Undetermined business revenue
Total Fiscal Benefits:	Undetermined business revenue	Undetermined business revenue	Undetermined business revenue
Net Fiscal Benefits:	Undetermined business revenue	Undetermined business revenue	Undetermined business revenue

*This table only includes fiscal impacts that could be measured. If there are inestimable fiscal impacts, they will not be included in this table. Inestimable impacts for State Government, Local Government, Small Businesses and Other Persons are described above. Inestimable impacts for Non-Small Businesses are described below.

 

Appendix 2: Regulatory Impact to Non-Small Businesses

 

Businesses will see more revenue through the revised list of sleep accreditation organizations that now includes three organizations. Nevertheless, there are not sufficient nor cost effective data available to determine what those increases may be.

 

The Executive Director of the Department of Health, Joseph K. Miner, M.D., has reviewed and approved this fiscal analysis.

 

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

R414-3A. Outpatient Hospital Services.

R414-3A-5. Services.

(1) Services appropriate in the outpatient hospital setting encompass medically necessary diagnostic, therapeutic, rehabilitative, or palliative medical services and supplies.

(2) Outpatient hospital services include:

(a) the service of nurses or other personnel necessary to complete the service and provide member care during the provision of service;

(b) the use of hospital facilities, equipment, and supplies; and

(c) the technical portion of clinical laboratory and radiology services.

(3) Cosmetic or reconstructive procedures are set forth in Section R414-1-29.

(4) [Sleep studies are available only in a sleep disorder center accredited by the American Academy of Sleep Medicine.]Coverage of sleep studies requires sleep center accreditation through one of the following nationally recognized accreditation organizations:

(a) American Academy of Sleep Medicine (AASM);

(b) Accreditation Commission for Health Care (ACHC); or

(c) The Joint Commission (TJC).

(5) Hyperbaric oxygen therapy is limited to service in a facility in which the hyperbaric unit is accredited by the Undersea and Hyperbaric Medical Society. Hyperbaric oxygen therapy is therapy that places the member in an enclosed pressure chamber for medical treatment.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: July 1, 2017

Notice of Continuation: September 15, 2017

Authorizing, and Implemented or Interpreted Law: 26-1-5; 26-18-2.3; 26-18-3(2); 26-18-4