DAR File No. 32688

Health, Health Care Financing, Coverage and Reimbursement Policy

R414-7D

Intermediate Care Facility for the Mentally Retarded Transition Project

NOTICE OF PROPOSED RULE

DAR File No.: 32688
Filed: 05/21/2009, 04:05
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rule is no longer necessary because the criteria for the Intermediate Care Facility/Mental Retardation (ICF/MR) Transition Program for persons with mental retardation is already contained in Rule R414-510.

Summary of the rule or change:

This rule is repealed in its entirety.

State statutory or constitutional authorization for this rule:

Sections 26-1-5 and 26-18-3

Anticipated cost or savings to:

the state budget:

There is no budget impact because this rule repeal does not affect payments or services for Medicaid clients in ICF/MRs.

local governments:

There is no budget impact because local governments do not fund or provide ICF/MR services for Medicaid clients.

small businesses and persons other than businesses:

There is no budget impact to other persons and small businesses because this rule repeal does not affect payments or services for Medicaid clients in ICF/MRs.

Compliance costs for affected persons:

There are no compliance costs because this rule repeal does not affect payments or services for Medicaid clients in ICF/MRs.

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

This rule is redundant and unnecessary. These services are governed by Rule R414-510. No change for providers and 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:

07/15/2009

This rule may become effective on:

07/22/2009

Authorized by:

David N. Sundwall, Executive Director

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

[R414-7D. Intermediate Care Facility for the Mentally Retarded Transition Project.

R414-7D-1. Transition Project Authorized.

(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.

(2) A Medicaid recipient residing in an Intermediate Care Facility for the Mentally Retarded (ICF/MR) may at any time apply for enrollment to the Medicaid 1915c Home and Community-Based Waiver for Individuals with Developmental Disabilities or Mental Retardation (DD/MR Waiver) through the application process established in the federally approved waiver implementation plan. ICF/MR resident applications are processed consistent with all waiver applications.

(3) The Department, through an ICF/MR Transition Project, makes funds available to a limited number of ICF/MR residents to move from their current ICF/MR placement to community services through the Medicaid 1915c Home and Community-Based Waiver for Individuals with Developmental Disabilities or Mental Retardation. This funding is available to Medicaid recipients who have resided for 12 or more continuous months in a Medicaid certified ICF/MR. The Department makes the ICF/MR Transition Project available to eligible individuals during a specified time period up to the number of individuals authorized for the project by the Utah Legislature through appropriation for that time period.

 

R414-7D-2. ICF/MR Transition Project Open Enrollment.

(1) Based on a legislative appropriation enabling ICF/MR transition for a specified fiscal year, the Department determines the number of Medicaid recipients to be transitioned from ICFs/MR to the 1915c DD/MR Waiver during that fiscal year.

(a) The Department apportions the legislative appropriation so that approximately 50% of the available funds are targeted to applicants based on their continuous time as an ICF/MR resident and 50% of the available funds are targeted to applicants on a statistical process that ranks individuals based on random number tables.

(b) The Department ranks each individual who applies for participation in the ICF/MR transition project using length of continuous stay in an ICF/MR and a priority ranking assigned through a random numbering process.

(c) The Department allocates the legislative appropriation to individual applicants in accordance with R414-7D-2(1)(a) and in the order of priority ranking as determined in R414-7D-2(1)(b). The amount allocated to each individual is based on a State-conducted needs assessment and individualized service plan for DD/MR Waiver services at the point of initial enrollment. At the point the available funds have been fully allocated to the highest ranking individuals, the Department completes no further needs assessments and individualized service plans for the remaining applicants.

(2) The Department conducts an outreach campaign leading to an application period during which interested Medicaid recipients residing in Utah ICFs/MR may apply for transition to the DD/MR Waiver.

(a) The Department advertises the pending application period to all Medicaid recipients residing in Utah ICFs/MR for 30-days before taking applications.

(b) The application period will be open for 14 calendar days.

(c) The Department accepts applications in either electronic format or hard copy format. Electronic applications must be completed during the 14-day application period and hard copy applications must be postmarked during the 14-day application period.

(3) The Department of Human Services contacts applicants receiving a preliminary transition allocation through R414-7D-2(1)(c) to confirm their desire to participate.

(a) The Department retains the list of applicants remaining after available funds are fully allocated, if any, and their priority ranking for use in selecting alternate individuals in the event one or more of the initial selected persons withdraws prior to becoming enrolled in the DD/MR Waiver.

(b) In consultation with the Department of Human Services, the Department starts evaluations for enrollment as soon as possible after the close of the Legislative session. The Department coordinates the actual start date with the Department of Human Services enrollment workload resulting from new monies for increased DD/MR Waiver community enrollment to assure the individual transitions, once started, are completed in a timely manner.

(4) The Department submits a waiver amendment to the federal Centers for Medicare and Medicaid Services as necessary to increase the declared capacity of the DD/MR Waiver by the number of new enrollees.

(5) When the Department has allocated all appropriated funds to new enrollees in the DD/MR Waiver, the Department concludes the transition project for the fiscal year. There are no carryover of applications received during a specific fiscal year into future years for purposes of the ICF/MR transition project.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: January 3, 2005

Authorizing, and Implemented or Interpreted Law: 26-18]