This filing was published in the 01/15/2009, issue, Vol. 2009, No. 2, of the Utah State Bulletin.
Health, Health Care Financing, Coverage and Reimbursement Policy
NOTICE OF PROPOSED RULE
DAR File No.: 32224
Filed: 12/17/2008, 05:26
Received by: NL
Purpose of the rule or reason for the change:
The purpose of this change is to comply with budget reduction mandates set forth in the 2008 Second Special Session of the Utah Legislature.
Summary of the rule or change:
This change allows only pregnant women and individuals eligible under the Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT) to receive physical and occupational therapy. It also allows Medicaid to cover physical and occupational therapy as a component of inpatient and outpatient hospital services.
State statutory or constitutional authorization for this rule:
Anticipated cost or savings to:
the state budget:
The Department estimates an annual savings of $45,225 to the General Fund and $109,180 in federal dollars as a result of this change.
This change does not impact local governments because they do not fund or provide physical and occupational therapy to Medicaid clients.
small businesses and persons other than businesses:
Providers of physical therapy and occupational therapy will lose a combined total of $154,405 in annual revenue as a result of this change. The total out-of-pocket expense to Medicaid clients who elect to pay out-of-pocket is difficult to estimate because it is impossible to know how many clients would elect to obtain these services.
Compliance costs for affected persons:
The annual loss in revenue to a single provider of physical therapy is approximately $457.52, while the annual loss in revenue to a single provider of occupational therapy is approximately $873.82. These estimates are based on the total number of providers and client visits per year. The annual out-of-pocket expense to a single Medicaid client who elects to pay for physical and occupational therapy is difficult to estimate because the fees will vary depending on the provider's fee schedule. According to current Medicaid rates, the out-of pocket cost for physical therapy would exceed $117 based on an average of four physical therapy visits per year, while the out-of-pocket expense to a single Medicaid client who elects to pay for occupational therapy would exceed $87 based on an average of three occupational therapy visits per year.
Comments by the department head on the fiscal impact the rule may have on businesses:
This rule change reflects the reductions passed in S.B. 2001 (2008 2nd Spec Sess) and are necessary to file under emergency authority to immediately implement the budget reductions. David N. Sundwall, MD, Executive Director (DAR NOTE: S.B. 2001 (2008 2nd Spec Sess) is found at Chapter 2, Laws of Utah 2008 (2nd Spec Sess) and was effective 09/29/2008.)
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 email@example.com
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:
This rule may become effective on:
David N. Sundwall, Executive Director
R414. Health, Health Care Financing, Coverage and Reimbursement Policy.
R414-21. Physical and Occupational Therapy.
R414-21-2. Eligibility Requirements.
and occupational therapy services are available to [
categorically and medically needy individuals under Medicaid].
Date of Enactment or Last Substantive
January 10, 2008]
Notice of Continuation: April 16, 2007
Authorizing, and Implemented or Interpreted Law: 26-1-4.1; 26-1-5; 26-18-3
Text to be deleted is struck through and surrounded by brackets (e.g., [
example]). Text to be added is underlined (e.g., ). Older browsers may not depict some or any of these attributes on the screen or when the document is printed.
For questions regarding the content or application of this rule, please contact Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at firstname.lastname@example.org
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.
Last modified: 01/13/2009 6:22 PM