Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-510

Intermediate Care Facility for Individuals with Mental Retardation Transition Program

Notice of Proposed Rule

(Amendment)

DAR File No.: 36379
Filed: 06/15/2012 10:30:53 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this amendment is to clarify Transition Program procedures and to make appropriate changes to terms of disability in accordance with H.B. 235, 2011 General Session.

Summary of the rule or change:

This amendment specifies the responsibilities of the Department of Health and the Division of Services for People with Disabilities as they relate to the Transition Program. It also clarifies procedural steps of the transition process and makes appropriate changes to terms of disability throughout the text.

State statutory or constitutional authorization for this rule:

• Section 26-1-5
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

The Department does not anticipate any cost or savings to the state budget because this amendment only clarifies Transition Program responsibilities and procedures.

local governments:

There is no impact to local governments because they neither fund nor provide home and community-based services (HCBS) to Medicaid recipients.

small businesses:

The Department does not anticipate any cost or savings to small businesses because this amendment only clarifies Transition Program responsibilities and procedures.

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

The Department does not anticipate any cost or savings to HCBS providers and to Medicaid recipients because this amendment only clarifies Transition Program responsibilities and procedures.

Compliance costs for affected persons:

The Department does not anticipate any compliance costs to a single HCBS provider or to a Medicaid recipient because this amendment only clarifies Transition Program responsibilities and procedures.

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

Updating the process for certain parts of the Community Support Waiver does not appear to have any fiscal impact on business. Updating terms will have no fiscal impact.

David Patton, PhD, 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:

07/31/2012

This rule may become effective on:

08/07/2012

Authorized by:

David Patton, Executive Director

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

R414-510. Intermediate Care Facility for [Individuals]Persons with [Mental Retardation]Intellectual Disabilities Transition Program.

R414-510-1. Introduction and Authority.

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

(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) "Department" means the Department of Health.

(2) The term "Intermediate Care Facility for the Mentally Retarded" (ICF/MR) has been replaced with the term "Intermediate Care Facility for Persons with Intellectual Disabilities" (ICF/ID). ICF/ID is equivalent to ICF/MR as described under federal law.

([1]3) "ICF/[MR]ID 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]ID Transition Program application to the [Utah] Department of Health, Division of Medicaid and Health [Care] Financing (DMHF) during the open application period as described in Subsection R414-510-4([2]3) of this rule.

([2]4) "Slot" refers to the funding that is available for one individual to participate in the ICF/[MR]ID Transition Program.

 

R414-510-3. Client Eligibility Requirements.

Services are available to an individual who:

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

(2) has been [a diagnosis of mental retardation]diagnosed with an intellectual disability or a related condition;

(3) meets ICF/[MR]ID 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 , privately-owned ICF/[MR]ID located in Utah for at least 12 consecutive months.

 

R414-510-4. Program Access Requirements.

(1) [Legislative appropriations] Each fiscal year,[determine the number of individuals selected in the particular year for placement in the program] the Department shall determine whether there are sufficient funds available to open slots in the Transition Program. The Department shall stipulate to the amount of funds that it dedicates to the program if funds are available.

(2) Based on funds dedicated to the program, the Department shall estimate the number of slots available. The Department estimates the number of slots available by dividing the total amount of funds dedicated to the program in a fiscal year by the state portion of the average daily ICF/ID rate.

([2]3) [Upon new legislative appropriation for the program,]During a fiscal year when the Transition Program is open, the Department shall announce[s] an open application period for accepting applications.

([3]4) After the open application period, the Department places the name of each ICF/[MR]ID Transition Program applicant on both a longevity list and a random list. On the longevity list, the Department ranks each ICF/[MR]ID Transition Program applicant according to length of consecutive stay in an ICF/[MR]ID in Utah. On the random list, the Department randomly ranks each ICF/[MR]ID Transition Program applicant based on a computerized random selection.

([4]5) The Department takes evenly first from the longevity list and the n from the random list for placement in [the Community Supports Waiver for Individuals with Intellectual Disabilities and Other Related Conditions HCBS Waiver Program]CSW until the amount of funds committed to the program is disbursed for the care of the individuals. If the Legislature funds an odd number of program slots, the Department places one additional individual from the longevity list.

([5]6) If an ICF/[MR]ID Transition Program applicant is selected for transition and has a spouse who also resides in a Utah ICF/[MR]ID and who meets the eligibility criteria in Section R414-510-[2]3, 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.

(7) The Department shall use the lists to admit new applicants into CSW from the Transition Program until the amount of funds committed to the program is disbursed for the care of the individuals.

(8) The Department shall keep these lists open for the purpose of filling slots vacated through program attrition. If the Department admits a CSW client through the Transition Program, and the client leaves the program for any reason, the Department shall contact and enroll the next person on the list.

(9) The Department shall create new lists in accordance with Subsection R414-510-4(4) when funds are available to open new Transition Program slots.

[ (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).

]

R414-510-5. Service Coverage.

[This rule incorporates by reference t]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] are incorporated by reference in Section R414-61-2.

 

R414-510-6. Reimbursement Methodology.

The Department of Human Services (DHS) contracts with [DHCF]DMHF 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: [May 21, 2009]2012

Notice of Continuation: January 9, 2012

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