5160-10-20 Covered orthotic and prosthetic services and associated limitations.

 

 

 

Rule Summary and Fiscal Analysis (Part A)

 

Ohio Department of Medicaid

Agency Name

 

Tommi Potter

Division                                                                  Contact

 

50 West Town Street Suite 400 Columbus OH 43218-2709

614-752-3877

Agency Mailing Address (Plus Zip)                                       Phone                     Fax

[e-mail]

Email

5160-10-20

Rule Number

NEW

TYPE of rule filing

Rule Title/Tag Line              Orthotic devices, prosthetic devices, and related services.

RULE SUMMARY

1.  Is the rule being filed for five year review (FYR)? No

2.  Are you proposing this rule as a result of recent legislation? No

3.  Statute prescribing the procedure in accordance with the agency is required to adopt the rule: 119.03

4.  Statute(s) authorizing agency to adopt the rule: 5164.02

5.  Statute(s) the rule, as filed, amplifies or implements: 5164.02

6.  State the reason(s) for proposing (i.e., why are you filing,) this rule:

This rule is being proposed for adoption to update policy related to the administration of the Medicaid program and to meet five-year review requirements.

7.  If the rule is an AMENDMENT, then summarize the changes and the content of the proposed rule; If the rule type is RESCISSION, NEW or NO CHANGE, then summarize the content of the rule:

This rule sets forth coverage and payment policies for orthotic devices, prosthetic

devices, and related services. It replaces a rescinded rule of the same number. The body of the rule is streamlined, and prior authorization (PA) requirements are removed for certain items and services listed in the revised appendix.

8.  If the rule incorporates a text or other material by reference and the agency claims the incorporation by reference is exempt from compliance with sections

121.71 to 121.74 of the Revised Code because the text or other material is generally available to persons who reasonably can be expected to be affected by the rule, provide an explanation of how the text or other material is generally available to those persons:

This rule incorporates one or more references to the Ohio Revised Code. This question is not applicable to any incorporation by reference to the Ohio Revised Code because such reference is exempt from compliance with RC 121.71 to 121.74 pursuant to RC 121.76(A)(1).

This rule incorporates one or more references to another rule or rules of the Ohio Administrative Code. This question is not applicable to any incorporation by reference to another OAC rule because such reference is exempt from compliance with RC 121.71 to 121.74 pursuant to RC 121.76(A)(3).

9.  If the rule incorporates a text or other material by reference, and it was infeasible for the agency to file the text or other material electronically, provide an explanation of why filing the text or other material electronically was infeasible:

Not Applicable.

10.  If the rule is being rescinded and incorporates a text or other material by reference, and it was infeasible for the agency to file the text or other material, provide an explanation of why filing the text or other material was infeasible:

Not Applicable.

11.  If revising or refiling this rule, identify changes made from the previously filed version of this rule; if none, please state so. If applicable, indicate each specific paragraph of the rule that has been modified:

No change was made to the rule. The correct CSI documents were reattached.

12.  Five Year Review (FYR) Date:

(If the rule is not exempt and you answered NO to question No. 1, provide the

scheduled review date. If you answered YES to No. 1, the review date for this rule is the filing date.)

NOTE: If the rule is not exempt at the time of final filing, two dates are required: the current review date plus a date not to exceed 5 years from the effective date for Amended rules or a date not to exceed 5 years from the review date for No Change rules.

FISCAL ANALYSIS

13.  Estimate the total amount by which this proposed rule would increase / decrease either revenues / expenditures for the agency during the current biennium (in dollars): Explain the net impact of the proposed changes to the budget of your agency/department.

This will have no impact on revenues or expenditures.

$0

Any changes in payment associated with this rule are accounted for in the separate filing of proposed rule 5160-1-60.

14.  Identify the appropriation (by line item etc.) that authorizes each expenditure necessitated by the proposed rule:

651-525

15.  Provide a summary of the estimated cost of compliance with the rule to all directly affected persons. When appropriate, please include the source for your information/estimated costs, e.g. industry, CFR, internal/agency:

The removal of the requirement for prior authorization (PA) of certain items and services actually reduces the cost of compliance for providers of orthotic devices or prosthetic devices. The amount of the reduction for an individual provider depends on the volume of those items and services provided.

16.  Does this rule have a fiscal effect on school districts, counties, townships, or municipal corporations? Yes

You must complete Part B of the Rule Summary and Fiscal Analysis in order to comply with Am. Sub. S.B. 33 of the 120th General Assembly.

17.  Does this rule deal with environmental protection or contain a component

dealing with environmental protection as defined in R. C. 121.39? No

S.B. 2 (129th General Assembly) Questions

18.  Has this rule been filed with the Common Sense Initiative Office pursuant to

R.C. 121.82? Yes

19.  Specific to this rule, answer the following:

A.) Does this rule require a license, permit, or any other prior authorization to engage in or operate a line of business? Yes

This rule limits Medicaid coverage and payment for an orthotic device, prosthetic device, or related service to those providers enrolled in Medicaid as durable medical equipment (DME) suppliers with orthotic/prosthetic specification.

B.) Does this rule impose a criminal penalty, a civil penalty, or another sanction, or create a cause of action, for failure to comply with its terms? No

C.) Does this rule require specific expenditures or the report of information as a condition of compliance? Yes

This rule requires the report of information.

                                                                                                                                             

Page B-1                                                                                   Rule Number: 5160-10-20

Rule Summary and Fiscal Analysis (Part B)

1.  Does the Proposed rule have a fiscal effect on any of the following?

(a)  School Districts

(b)    Counties                                 (c) Townships           (d) Municipal

Corporations

No                                Yes                              No                                Yes

2.  Please provide an estimate in dollars of the cost of compliance with the proposed rule for school districts, counties, townships, or municipal corporations. If you are unable to provide an estimate in dollars, please provide a written explanation of why it is not possible to provide such an estimate.

To the extent that a Medicaid provider is a governmental entity, it could be affected by the proposed rule.

The changes in this rule eliminate the requirement for prior authorization of payment (PA) for certain items and services. To the extent that it provides those items and services, a provider will see a reduction in the cost associated with submission of a PA request. The department cannot provide an estimate of the impact on a particular provider, however, because the amount of any reduction will depend on which items and services are supplied and how often they are provided.

3.  If the proposed rule is the result of a federal requirement, does the proposed rule exceed the scope and intent of the federal requirement? No

4.  If the proposed rule exceeds the minimum necessary federal requirement, please provide an estimate of, and justification for, the excess costs that exceed the cost of the federal requirement. In particular, please provide an estimate of the excess costs that exceed the cost of the federal requirement for (a) school districts, (b) counties, (c) townships, and (d) municipal corporations.

Not Applicable.

5.  Please provide a comprehensive cost estimate for the proposed rule that includes the procedure and method used for calculating the cost of compliance. This comprehensive cost estimate should identify all of the major cost categories including, but not limited to, (a) personnel costs, (b) new equipment or other capital costs, (c) operating costs, and (d) any indirect central service costs.

Page B-2                                                                                   Rule Number: 5160-10-20

Comprehensive cost estimates are provided in the following sections.

(a)  Personnel Costs

The department does not expect that the proposed rule will result in any increase to Medicaid providers in personnel costs.

(b)  New Equipment or Other Capital Costs

The department does not expect that the proposed rule will result in any increase to Medicaid providers in new equipment or other capital costs.

(c)  Operating Costs

The department does not expect that the proposed rule will result in any increase to Medicaid providers in operating costs.

(d)  Any Indirect Central Service Costs

The department does not expect that the proposed rule will result in any increase to Medicaid providers in indirect central service costs.

(e)  Other Costs

The department cannot provide an estimate of the impact on a particular provider, because the amount of any increase or reduction will depend on which items or services are supplied and how often they are provided.

6.  Please provide a written explanation of the agency's and the local government's ability to pay for the new requirements imposed by the proposed rule.

No implementation cost is anticipated for any local governmental entity.

7.  Please provide a statement on the proposed rule's impact on economic development.

This proposed rule has no discernible impact on economic development.