DAR File No. 27894

Labor Commission, Industrial Accidents

R612-2-1

Definitions

NOTICE OF PROPOSED RULE

DAR File No.: 27894
Filed: 05/13/2005, 11:54
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this amendment is to add a definition for "Usual and Customary Rate (UCR)" and specify what the term "insurer" means.

Summary of the rule or change:

This amendment defines "Usual and Customary Rate (UCR)" as the rate of payment to a dental provider using Ingenix, or a similar service, for charges for services for a particular zip code. It also specifies that the term "insurer" includes workers' compensation insurance carriers and self-insured employers, unless otherwise specified.

State statutory or constitutional authorization for this rule:

Sections 34A-2-101 et seq., 34A-3-101 et seq., and 34A-1-104

Anticipated cost or savings to:

the state budget:

There should be no cost or savings to the state budget, as this rule only adds definitions.

local governments:

There should be no cost or savings to local government, as this rule only adds definitions.

other persons:

There should be no cost or savings to other persons, as this rule only adds definitions.

Compliance costs for affected persons:

There should be no compliance costs for affected persons, as this rule only adds definitions.

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

There should be no fiscal impact on businesses because of this amendment, as the amendment only adds definitions. R. Lee Ellertson, Commissioner

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Direct questions regarding this rule to:

Joyce Sewell at the above address, by phone at 801-530-6988, by FAX at 801-530-6804, or by Internet E-mail at jsewell@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:

07/01/2005

This rule may become effective on:

07/02/2005

Authorized by:

R Lee Ellertson, Commissioner

RULE TEXT

R612. Labor Commission, Industrial Accidents.

R612-2. Workers' Compensation Rules-Health Care Providers.

R612-2-1. Definitions.

A. All definitions in Rule R612-1 apply to this section.

B. "Medical Practitioner" - means any person trained in the healing arts and licensed by the State in which such person practices.

C. "Global Fee Cases" - are those flat fee cases where fees include pre-operative and follow-up or aftercare.

D. "Usual and Customary Rate (UCR)" is the rate of payment to a dental provider using Ingenix, or a similar service, for charges for services for a particular zip code.

E. Unless otherwise specified, the term "insurer" includes workers' compensation insurance carriers and self-insured employers.

KEY: workers' compensation, fees, medical practitioner

[July 2, 2003]2005

Notice of Continuation May 28, 2003

34A-2-101 et seq.

34A-3-101 et seq.

34A-1-104

ADDITIONAL INFORMATION

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For questions regarding the content or application of this rule, please contact Joyce Sewell at the above address, by phone at 801-530-6988, by FAX at 801-530-6804, or by Internet E-mail at jsewell@utah.gov

For questions about the rulemaking process, please contact the Division of Administrative Rules (801-538-3764). Please Note: The Division of Administrative Rules is NOT able to answer questions about the content or application of these administrative rules.