DAR File No. 30693

Health, Health Care Financing, Coverage and Reimbursement Policy

R414-3A

Outpatient Hospital Services

FIVE-YEAR NOTICE OF REVIEW AND STATEMENT OF CONTINUATION

DAR File No.: 30693
Filed: 11/08/2007, 08:20
Received by: NL

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 enact administrative rules to implement Medicaid programs. Section 26-1-5 authorizes the department to adopt, amend, or rescind rules, and 42 CFR 440.20 authorizes the department to provide outpatient hospital services.

Summary of written comments received during and since the last five-year review of the rule from interested persons supporting or opposing the rule:

LDS Hospital requested an amendment to the rule to allow a "diplomate" to provide sleep study services. According to the hospital, the inclusion of diplomates would allow several hospitals to comply with sleep study program criteria, and would increase statewide access to services. The Division of Health Care Financing, therefore, removed staffing restrictions from the rule, and included language to allow any sleep disorder center accredited by the American Academy of Sleep Medicine to provide sleep study services.

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

This rule is necessary because it establishes eligibility, program access requirements, prior authorization, copayment, and reimbursement methodology for outpatient hospital services. It also requires recipients residing in a county with a prepaid mental health contractor to obtain psychiatric services from that contractor. Therefore, this rule should be continued.

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

Authorized by:

David N. Sundwall, Executive Director