Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-61

Home and Community-Based Services Waivers

Notice of Proposed Rule

(Amendment)

DAR File No.: 34033
Filed: 09/01/2010 09:39:27 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this amendment is to incorporate by reference changes to the Community Supports Waiver for Individuals with Intellectual Disabilities and Other Related Conditions, effective 07/01/2010, and to incorporate by reference changes to the Waiver for Individuals Age 65 or Older, effective 07/01/2010.

Summary of the rule or change:

This amendment incorporates by reference changes to the Community Supports Waiver for Individuals with Intellectual Disabilities and Other Related Conditions, effective 07/01/2010, and also incorporates by reference changes to the Waiver for Individuals Age 65 or Older, effective 07/01/2010. The Community Supports Waiver for Individuals with Intellectual Disabilities and Other Related Conditions clarifies that any appeal decision that the Department of Human Services (DHS) makes through the fair hearing process is the final decision. This waiver also amends the professional medication monitoring service to permit limited medication administration. In addition, this waiver allows the Department to explain quality improvement strategies in further detail. The Waiver for Individuals Age 65 or Older adds three services that include community transition, personal budget assistance, and financial management (previously offered only as an administrative service). It also modifies seven existing services to improve their functionality. In addition, changes for home and community-based services allow the Department to explain quality improvement strategies in greater detail that relate to participant direction of services, participant rights, participant safeguards, and systems improvements.

State statutory or constitutional authorization for this rule:

• Section 26-1-5
• Section 26-18-3

This rule or change incorporates by reference the following material:

• Updates Waiver for Individuals Age 65 or Older, published by Division of Medicaid and Health Financing, 07/01/2010
• Updates Community Supports Waiver for Individuals with Intellectual Disabilities and Other Related Conditions, published by Division of Medicaid and Health Financing, 07/01/2010

Anticipated cost or savings to:

the state budget:

The Department estimates an increased cost of $1,500,000 (state funds) in the first year of the waiver renewal for the Community Supports Waiver for Individuals with Intellectual Disabilities and Other Related Conditions. The state funds for this program are seeded by DHS. On the other hand, the Department estimates no cost or savings in the first year of the waiver renewal for the Waiver for Individuals Age 65 or Older. The state funds for this program are also seeded by DHS.

local governments:

There is no impact to local governments because they do not fund or provide waiver services for Medicaid clients.

small businesses:

The Department estimates that Medicaid providers will receive $5,000,000 in increased annual revenue under the Community Supports Waiver for Individuals with Intellectual Disabilities and Other Related Conditions. On the other hand, the Department estimates no cost or savings in the first year of the waiver renewal for the Waiver for Individuals Age 65 or Older.

persons other than small businesses, businesses, or local governmental entities:

The Department estimates that Medicaid providers will receive $5,000,000 in increased annual revenue under the Community Supports Waiver for Individuals with Intellectual Disabilities and Other Related Conditions. On the other hand, the Department estimates no cost or savings in the first year of the waiver renewal for the Waiver for Individuals Age 65 or Older.

Compliance costs for affected persons:

There are no compliance costs because there are only increases in revenue for all Medicaid providers. In addition, these changes only result in savings to Medicaid clients.

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

This update to the rule will generate additional revenue to providers and have a positive 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
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:

10/15/2010

This rule may become effective on:

10/22/2010

Authorized by:

David Sundwall, Executive Director

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

R414-61. Home and Community-Based Services Waivers.

R414-61-1. Introduction and Authority.

(1) This rule establishes authority for the Department of Health to administer all Section 1915(c) waivers.

(2) The rule is authorized by Section 26-18-3 and Section 1915(c) of the Social Security Act.

 

R414-61-2. Incorporation by Reference.

The Department incorporates by reference the following home and community-based services waivers:

(1) Waiver for Technology Dependent/Medically Fragile Individuals, Effective July 1, 2003;

(2) Waiver for Individuals Age 65 or Older, Effective July 1, 20[05]10;

(3) Waiver for Individuals with Acquired Brain Injuries, Effective July 1, 2004;

(4) Waiver for Individuals with Physical Disabilities, Effective July 1, 2006;

(5) Community Supports Waiver for Individuals with Intellectual Disabilities and Other Related Conditions, Effective July 1, 20[05]10;

(6) New Choices Waiver, Effective April 1, 2007.

These documents are available for public inspection during business hours at the Utah Department of Health, Division of Health Care Financing, located at 288 North 1460 West, Salt Lake City, UT, 84114-3102.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [June 26, 2007]2010

Notice of Continuation: February 24, 2010

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