DAR File No. 31644

Health, Health Care Financing, Coverage and Reimbursement Policy

R414-54

Speech-Language Pathology Services

NOTICE OF PROPOSED RULE

DAR File No.: 31644
Filed: 07/01/2008, 09:36
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to repeal and reenact Rule R414-54 to clarify speech-language pathology services for Medicaid recipients.

Summary of the rule or change:

The reenacted rule clarifies that speech-language pathology services are optional and refers Medicaid recipients to the Speech-Language Pathology Services Provider Manual for a complete list of service criteria. The previous rule only lists in general terms some of the services and criteria for speech-language pathology services. In addition, the new rule refers providers and recipients to the State Plan for reimbursement information.

State statutory or constitutional authorization for this rule:

Sections 26-1-5 and 26-18-3

Anticipated cost or savings to:

the state budget:

No significant impact to the state budget is expected. The rule clarifies ongoing Medicaid policy for speech-language pathology services. The majority of Medicaid recipients will receive the same services under this rule. On balance it is expected to be budget neutral.

local governments:

There is no budget impact because local governments do not fund or provide speech-language-pathology hearing services to Medicaid recipients.

small businesses and persons other than businesses:

No significant impact to business is expected. The rule clarifies ongoing Medicaid policy for speech-language pathology services. The majority of Medicaid recipients will receive the same services under this rule. Providers and recipients should find it easier to determine what is available.

Compliance costs for affected persons:

There are no compliance costs because this change only clarifies ongoing Medicaid policy for speech-language pathology services.

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

Speech-Language Pathology Services are an optional service in Medicaid. This rule should make it easier for providers and recipients to know what services are authorized and may have a small positive fiscal impact on business. The current level of authorized funding in this category should not change as a result of this rule. A. Richard Melton, Acting Executive Director

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

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:

08/14/2008

This rule may become effective on:

08/21/2008

Authorized by:

Richard Melton, Deputy Director

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

R414-54. Speech-Language Pathology Services.

[R414-54-1. Introduction and Authority.

(1) The Speech-Language Pathology Program provides speech-language services to meet the basic speech-language pathology needs of Medicaid clients.

(2) Speech-language pathology services are described in 42 CFR, subsection 440.110(c)(1)(2), October 1997 edition, which is adopted and incorporated by reference.

 

R414-54-2. Definitions.

(1) The definitions in the Speech-language Pathology and Audiology Licensing Act, Title 58, Chapter 41, apply to this rule.

(2) In addition, "Client", "Categorically Needy", and "Medically Needy" have the same meanings as defined in R414-1.

 

R414-54-3. Client Eligibility Requirements.

Speech-language pathology services are available to Categorically Needy and Medically Needy individuals.

 

R414-54-4. Program Access Requirements.

A physician must refer clients to a speech-language pathologist before any service may be provided.

 

R414-54-5. Service Coverage.

(1) Speech-language services for individuals or groups with speech or language disorders or dysphagia include: evaluative, diagnostic, screening, treatment, preventive, and corrective processes. Only speech-language pathologists, or speech-language pathology aides under supervision of speech-language pathologists, may provide these services.

(2) All services must be related to a medical need. Treatments for social, educational, and developmental needs, while important to the individual, are not covered services.

(3) Only speech-language pathologists may bill for reimbursable services.

 

R414-54-6. Reimbursement.

(1) The Department pays for speech and language pathology services according to an established fees schedule, based on CPT codes as described in the State Plan, Attachment 4.19-B. Fee schedules were initially established after consultation with provider representatives. Adjustments to the schedule are made in accordance with appropriations and to produce efficient and effective services.

(2) The Department pays the lower of the amount billed and the rate on the schedule. A provider shall not charge the Department a fee that exceeds the provider's usual and customary charges for the provider's private-pay patients.]

R414-54-1. Introduction and Authority.

(1) This rule governs the provision of speech-language pathology services.

(2) This rule is authorized by Sections 26-18-3 and 26-18-5.

(3) As required by Section 26-18-3, the Department provides these services in an efficient, economical manner, safeguarding against unnecessary, unreasonable, or inappropriate use of these services.

 

R414-54-2. Definitions.

(1) The definitions in the Speech-Language Pathology and Audiology Licensing Act, Title 58, Chapter 41, apply to this rule.

 

R414-54-3. Services.

(1) Speech-language pathology services are optional.

(2) Speech-language pathology services are limited to services described in the Speech-Language Pathology Services Provider Manual.

(3) The Speech-Language Pathology Services Provider Manual specifies the reasonable and appropriate amount, duration, and scope of the service sufficient to reasonably achieve its purpose.

(4) Speech-language pathology services may be provided by licensed speech-language pathologists, or speech-language pathology aides under the supervision of speech-language pathologists.

 

R414-54-4. Services for Individuals Eligible for Optional Services.

(1) An individual receiving speech-language pathology services may receive speech-language pathology services as described in the Speech-Language Pathology Provider Manual.

(2) An individual receiving speech-language pathology services must meet the criteria established in the Speech-Language Pathology Provider Manual and obtain prior approval if required.

 

R414-54-5. Reimbursement.

Speech-language pathology services are reimbursed using the fee schedule in the Utah Medicaid State Plan and incorporated by reference in R414-1-5.

 

KEY: Medicaid, speech-language pathology services

Date of Enactment or Last Substantive Amendment: [October 25, 2004]2008

Notice of Continuation: March 23, 2004

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