Skip Navigation

Administrative Rules Home Administrative Rules

DAR File No. 32440

This filing was published in the 04/01/2009, issue, Vol. 2009, No. 7, of the Utah State Bulletin.

Health, Health Care Financing, Coverage and Reimbursement Policy

R414-510

Intermediate Care Facility for Individuals with Mental Retardation Transition Program

NOTICE OF PROPOSED RULE

DAR File No.: 32440
Filed: 03/12/2009, 12:04
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

This change is necessary to specify which individuals are eligible to participate in the Intermediate Care Facility for Individuals with Mental Retardation (ICF/MR) Transition Program.

Summary of the rule or change:

This change specifies which individuals are eligible to participate in the ICF/MR Transition Program. It also clarifies terminology used to describe this program.

State statutory or constitutional authorization for this rule:

Section 26-18-3

Anticipated cost or savings to:

the state budget:

There is no budget impact because this change only clarifies ongoing criteria to participate in the ICF/MR Transition Program. It does not affect payments or services.

local governments:

There is no impact to local governments because they do not determine eligibility for Medicaid programs and do not fund or provide Medicaid services.

small businesses and persons other than businesses:

There is no impact to other persons and small businesses because this change only clarifies ongoing criteria to participate in the ICF/MR Transition Program. It does not affect payments or services.

Compliance costs for affected persons:

There are no compliance costs to any individual or entity because this change only clarifies ongoing criteria to participate in the ICF/MR Transition Program. It does not affect payments or services.

Comments by the department head on the fiscal impact the rule may have on businesses:

This rule adds a definition and should not change reimbursement to any provider. There should be no fiscal impact. David N. Sundwall, MD, Executive Director

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:

05/01/2009

This rule may become effective on:

05/08/2009

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

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

R414-510. Intermediate Care Facility for Individuals with Mental Retardation Transition Program.

R414-510-1. Introduction and Authority.

(1) This rule implements the Intermediate Care Facility for Individuals with Mental Retardation (ICF/MR) Transition Program. Program participation is voluntary and allows an individual to transition out of an ICF/MR into the Community Supports Waiver for Individuals with Intellectual Disabilities and Other Related Conditions Home and Community-Based Services (HCBS) Waiver Program.

(2) This rule is authorized by Section 26-18-3. Waiver services for this program are optional and provided in accordance with 42 CFR 440.225.

 

R414-510-2. Definitions.

(1) "ICF/MR Transition Program applicant" is an individual who meets the eligibility requirements found in Section R414-510-3 of this rule, and who submits an ICF/MR Transition Program application to the Utah Department of Health, Division of Health Care Financing during the open application period as described in Subsection R414-510-4(2) of this rule.

(2) "Slot" refers to the funding that is available for one individual to participate in the ICF/MR Transition Program.

 

R414-510-[2]3. Client Eligibility Requirements.

Services are available to an individual who:

(1) receives ICF/MR benefits under the Utah Medicaid State Plan;

(2) has a diagnosis of mental retardation or a related condition;

(3) meets ICF/MR level of care criteria defined in Section R414-502-8;

(4) meets the Utah Department of Human Services, Division of Services for People with Disabilities state funding eligibility criteria found in Subsection 62A-5-102(4); and

(5) has resided in a Medicaid-certified ICF/MR located in Utah for at least 12 consecutive months.

 

R414-510-[3]4. Program Access Requirements.

(1) Legislative appropriations determine the number of [participants]individuals selected in the particular year for placement in the program.

(2) Upon new legislative appropriation for the program, the Department announces an open application period for accepting applications.

(3) After the open application period, the Department places the name of each ICF/MR Transition Program applicant on both a longevity list and a random list. On the longevity list, the Department ranks each ICF/MR Transition Program applicant according to length of consecutive stay in an ICF/MR in Utah. On the random list, the Department randomly ranks each ICF/MR Transition Program applicant based on a computerized random selection.

(4) The Department takes evenly from the longevity list and the random list for placement in the Community Supports Waiver for Individuals with Intellectual Disabilities and Other Related Conditions HCBS Waiver Program. If the Legislature funds an odd number of program [participants]slots, the Department places one additional individual from the longevity list.

(5) If an ICF/MR Transition Program applicant is selected for transition and has a spouse who also resides in a Utah ICF/MR and who meets the eligibility criteria in Section R414-510-2, the Department shall provide an additional slot for the spouse to participate in the transition program without affecting the number of available slots from the longevity and random lists.

(6) Once the Department places individuals into the program for the year's appropriation, the longevity and random lists are retired and no longer used. The Department makes no new placements into the program to replace individuals who leave the program for whatever reason.

(7) As the Legislature makes new appropriations for the program, the Department creates new longevity and random lists for each new appropriation and selects individuals for the program as described in subsections (2) through (4).

 

R414-510-[4]5. Service Coverage.

This rule incorporates by reference the services and limitations found in the Medicaid 1915(c) HCBS Services Waiver and the Community Supports Waiver for Individuals with Intellectual Disabilities and Other Related Conditions, State Implementation Plan, Effective July 1, 2005.

 

R414-510-[5]6. Reimbursement Methodology.

The Department of Human Services (DHS) contracts with DHCF to set 1915(c) HCBS waiver rates for waiver covered services. The DHS rate-setting process is designed to comply with requirements under the 1915(c) HCBS Waiver program and other applicable Medicaid rules. Medicaid requires that rates for services not exceed customary charges.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [March 10, 2008]2009

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

 

 

ADDITIONAL INFORMATION

Text to be deleted is struck through and surrounded by brackets (e.g., [example]). Text to be added is underlined (e.g., example). Older browsers may not depict some or any of these attributes on the screen or when the document is printed.

For questions regarding the content or application of this rule, please contact 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

For questions about the rulemaking process, please contact the Division of Administrative Rules (801-538-3764). Please Note: The Division of Administrative Rules is NOT able to answer questions about the content or application of these administrative rules.

Last modified:  03/30/2009 10:50 AM