Utah Administrative Code
Topic - Health
Title R414 - Integrated Healthcare
Rule R414-1 - Utah Medicaid Program
Section R414-1-6 - Services Available
Universal Citation: UT Admin Code R 414-1-6
Current through Bulletin 2024-06, March 15, 2024
(1) Medical or hospital services available under the Medical Assistance Program are generally limited by federal guidelines as set forth under Title XIX of the federal Social Security Act and Title 42 of the Code of Federal Regulations (CFR).
(2) The following services provided in the Utah Medicaid State Plan are available to both the categorically needy and medically needy:
(a)
inpatient hospital services, with the exception of those services provided in
an institution for mental diseases;
(b) outpatient hospital services and rural
health clinic services;
(c) other
laboratory and x-ray services;
(d)
skilled nursing facility services, other than services in an institution for
mental diseases, for individuals 21 years of age or older;
(e) early and periodic screening and
diagnoses of individuals under 21 years of age, and treatment of conditions
found, are provided in accordance with federal requirements;
(f) family planning services and supplies for
individuals of child-bearing age;
(g) physician services, whether furnished in
the office, the patient's home, a hospital, a skilled nursing facility, or
elsewhere;
(h) podiatrist
services;
(i) optometrist
services;
(j) psychologist
services;
(k) interpreter
services;
(l) home health services:
(i) intermittent or part-time nursing
services provided by a home health agency;
(ii) home health aide services by a home
health agency;
(iii) medical
supplies, equipment, and appliances;
(m) private duty nursing services for
children under 21 years of age;
(n)
clinic services;
(o) dental
services;
(p) physical therapy and
related services;
(q) services for
individuals with speech, hearing, and language disorders furnished by or under
the supervision of a speech pathologist or audiologist;
(r) prescribed drugs, dentures, and
prosthetic devices and eyeglasses prescribed by a physician skilled in diseases
of the eye or by an optometrist;
(s) other diagnostic, screening, preventive,
and rehabilitative services other than those provided elsewhere in the Utah
Medicaid State Plan;
(t) services
for individuals 65 years of age or older in institutions for mental diseases:
(i) inpatient hospital services for
individuals 65 years of age or older in institutions for mental
diseases;
(ii) skilled nursing
services for individuals 65 years of age or older in institutions for mental
diseases; and
(iii) intermediate
care facility services for individuals 65 years of age or older in institutions
for mental diseases.
(u)
intermediate care facility services, other than services in an institution for
mental diseases. These services are for individuals determined, in accordance
with Subsection 1902(a)(31)(A) of the Social Security Act, to be in need of
this care, including those services furnished in a public institution for the
mentally retarded or for individuals with related conditions;
(v) inpatient psychiatric facility services
for individuals under 22 years of age;
(w) nurse-midwife services;
(x) family or pediatric nurse practitioner
services;
(y) physician assistant
services;
(z) hospice care in
accordance with Subsection 1905(o) of the Social Security Act;
(aa) case management services in accordance
with Subsection 1905(a)(19) or Subsection 1915(g) of the Social Security
Act;
(bb) extended services to
pregnant women, pregnancy-related services, postpartum services for 60 days,
and additional services for any other medical conditions that may complicate
pregnancy;
(cc) ambulatory prenatal
care for pregnant women furnished during a presumptive eligibility period by a
qualified provider in accordance with Section 1920 of the Social Security Act;
and
(dd) other medical care and
other types of remedial care recognized under state law, specified by the
Secretary of the United States Department of Health and Human Services,
pursuant to
42
CFR 440.60 and
440.170,
including:
(i) medical or remedial services
provided by licensed practitioners, other than physician services, within the
scope of practice as defined by state law;
(ii) transportation services;
(iii) skilled nursing facility services for
patients under 21 years of age;
(iv) emergency hospital services;
(v) personal care services in the recipient's
home, prescribed in a plan of treatment and provided by a qualified person,
under the supervision of a registered nurse; and
(ee) other medical care, medical supplies,
and medical equipment not otherwise a Medicaid service if the Division
determines that it meets both of the following criteria:
(i) it is medically necessary and more
appropriate than any Medicaid -covered service; and
(ii) it is more cost effective than any
Medicaid -covered service.
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