Utah Admin. Code 414-1-6

Current through Bulletin No. 2024-21, November 1, 2024

Section R414-1-6 - Services Available

(1) Medical or hospital services available under the Medical Assistance Program are generally limited by federal guidelines as set forth under Title XIX, Social Security Act and Chapter I V, Subchapter C, 42 CFR (2024).

(2) The following services provided in the Medicaid State Plan are available to both categorically needy and medically needy individuals:

(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, including:

(i) intermittent or part-time nursing services provided by a home health agency;

(ii) home health aide services by a home health agency; and

(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, including:

(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), 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), Social Security Act;

(aa) case management services in accordance with Subsection 1905(a)(19) or Subsection 1915(g), Social Security Act;

(bb) extended services to pregnant women, pregnancy-related services, postpartum services for 12 months, 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, 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 (2024), 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; and

(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.

Utah Admin. Code R414-1-6

Amended by Utah State Bulletin Number 2017-14, effective 7/1/2017

Amended by Utah State Bulletin Number 2021-23, effective 11/15/2021

Amended by Utah State Bulletin Number 2024-21, effective 10/28/2024