| Rule Number: |
10P032 |
| Title: |
State Fiscal Year 2011 Coverage Changes |
|
Type:
|
Standard |
|
Status:
|
Adopted |
| Agency: |
Agency of Human Services
|
| Legal Authority: |
33 V.S.A. ยง 1901 |
| Summary:
| This rule is being implemented as a permanent version of the emergency rules found in Bulletin 10-03, as directed by (H.789) Act 156 of the 2009 - 2010 Legislative Session, An Act Making Appropriations for the Support of Government. Section E309.1 of the Act authorizes DVHA to: 1) limit the number of covered visits for physical therapy, occupational therapy, and speech therapy
to 30 visits per year for adults (and all VHAP beneficiaries), except that DVHA shall allow additional visits through prior authorization for individuals with the following diagnoses: spinal cord injury, traumatic brain injury, stroke, amputation, or sever burn; 2) limit lab services for urine drug testing to 8 tests per calendar month for adults (and all VHAP beneficiaries); and 3) institute a prior authorization process for high-tech imaging. |
| Persons Affected:
| Medicaid beneficiaries, VHAP beneficiaries, providers, advocates, health care ombudsman. Initiative 1) limits the annual number of covered visits for physical therapy, occupational therapy, and speech therapy and affects all Medicaid adults (24,652 beneficiaries). Anticipated savings were based on an analysis which identified 200 people exceeding 30 visits in 2009. Initiative 2) limits the monthly number of drug tests and affects all Medicaid adults (24,652 beneficiaries) and VHAP beneficiaries (36,862 beneficiaries). Anticipated savings were based on an analysis which identified 704 beneficiaries affected. Initiative 3) institutes a prior authorization process for imaging and affects all Medicaid (126,164 beneficiaries) and VHAP beneficiar |
| Economic Impact:
| Beneficiaries, providers, community advocates, health care ombudsman will all be affected. Analysis of the costs and benefits was part of the legislative process. Anticipated Savings from General Fund - $899,088 |
| Posting date: |
Aug 04,2010 |
