DAR File No. 32225

Health, Health Care Financing, Coverage and Reimbursement Policy

R414-52

Optometry Services

NOTICE OF PROPOSED RULE

DAR File No.: 32225
Filed: 12/17/2008, 05:33
Received by: NL

RULE ANALYSIS

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 eyeglasses under this rule. It further removes the $3 copayment for eyeglasses that the Department currently applies to recipients who fall under the copayment requirement.

State statutory or constitutional authorization for this rule:

Section 26-18-3

Anticipated cost or savings to:

the state budget:

The reduction of eyeglasses will result in savings to the General Fund and to the federal budget. Estimates of these savings are listed in the companion filing to this proposed rule (Rule R414-53). (DAR NOTE: The proposed filing on Rule R414-53 is under DAR No. 32226 in this issue, January 15, 2009, of the Bulletin.)

local governments:

This change does not impact local governments because they do not fund or provide optometry services to Medicaid clients.

small businesses and persons other than businesses:

The Department estimates annual losses in revenue to providers of eyeglasses. These estimates are listed in the companion filing to this proposed rule (Rule R414-53). The explanation and estimate of annual expenses to clients who elect to pay out-of-pocket to receive eyeglasses is also found in the companion filing to this proposed rule (Rule R414-53).

Compliance costs for affected persons:

The annual loss in revenue to a single provider of eyeglasses is listed in the companion filing to this proposed rule (Rule R414-53). The explanation and estimate of annual expenses to a single Medicaid client who elects to pay out-of-pocket to receive eyeglasses is also found in the companion filing to this proposed rule (Rule R414-53).

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 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:

02/17/2009

This rule may become effective on:

02/24/2009

Authorized by:

David N. Sundwall, Executive Director

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

R414-52. Optometry Services.

R414-52-3. Client Eligibility Requirements.

Optometry services are available to categorically and medically needy individuals, except that the provision of eyeglasses is available only to clients who are pregnant women or who are individuals eligible under the Early and Periodic Screening, Diagnosis and Treatment Program.

 

R414-52-5. Reimbursement.

(1) Fees for services for which the Department will pay optometrists are established from the physician's fees for CPT codes as described in the State Plan, Attachment 4.19-B, Section D Physicians.[ A $3 copayment for each pair of eyeglasses is applied to Medicaid recipients who fall under the copayment requirement.] 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.

 

KEY: Medicaid, optometry

Date of Enactment or Last Substantive Amendment: [February 1, 2008]2009

Notice of Continuation: May 19, 2008

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