Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-510

Intermediate Care Facility for Individuals with Mental Retardation Transition Program

Change in Proposed Rule

DAR File No.: 36379
Filed: 08/31/2012 03:10:20 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

Based on public comments received by the Department, the purpose of this change is to clarify the notification and application process for the Intermediate Care Facility for Persons with Intellectual Disabilities (ICF/ID) Transition Program.

Summary of the rule or change:

This amendment clarifies the notification and application process for the ICF/ID Transition Program. (DAR NOTE: This change in proposed rule has been filed to make additional changes to a proposed amendment that was published in the July 1, 2012, issue of the Utah State Bulletin, on page 70. Underlining in the rule below indicates text that has been added since the publication of the proposed rule mentioned above; strike-out indicates text that has been deleted. You must view the change in proposed rule and the proposed amendment together to understand all of the changes that will be enforceable should the agency make this rule effective.)

State statutory or constitutional authorization for this rule:

• Section 26-18-3
• Section 26-1-5

Anticipated cost or savings to:

the state budget:

The Department does not anticipate any impact to the state budget because this change only clarifies the notification and application process for the ICF/ID Transition Program.

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 impact to small businesses because this change only clarifies the notification and application process for the ICF/ID Transition Program.

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

The Department does not anticipate any impact to HCBS providers and to Medicaid recipients because this change only clarifies the notification and application process for the ICF/ID Transition Program.

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 change only clarifies the notification and application process for the ICF/ID Transition Program.

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

Greater awareness of the option for residents of ICF/ID facilities to move into community placements is good public policy and this rule supports that policy. Notice and meeting requirements are placed on the state rather than the facility to minimize business 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 [email protected]

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:

10/15/2012

This rule may become effective on:

10/22/2012

Authorized by:

David Patton, Executive Director

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

R414-510. Intermediate Care Facility for Persons with Intellectual Disabilities Transition Program.

 

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R414-510-4. Program Access Requirements.

(1) Each fiscal year, 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.

(3) During a fiscal year when the Transition Program is open, the Department shall announce an open application period for accepting applications. The Department will publicize the availability of the program in the following manner:

(a) Provide a letter to the administrator of each privately-owned ICF/ID and to the parent(s) of each ICF/ID resident under the age of 18 or where one has been appointed, the guardian of each resident over the age of 18. The letter will:

(i) Be written on a developmentally appropriate level;

(ii) Describe the purpose and operation of the program, including availability of funding;

(iii) Describe how to apply;

(iv) Contain contact information for additional questions.

(b) Post information about program availability on the Utah Medicaid website.

(c) Hold at least one open and public meeting information session introducing the program. The meeting will be held pursuant to public notice requirements and a notice of the meeting will also be publicized in the same manner as the letter in Subsection R414-510-4(3)(a) above. Meeting information will include:

(i) A description of the purpose(s) of the program;

(ii) An explanation of the operation of the program including availability of funding;

(iii) A question and answer period; and

(iv) An opportunity for residents and guardians to apply for the program.

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

(5) The Department takes evenly first from the longevity list and then from the random list for placement in 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.

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

 

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KEY: Medicaid

Date of Enactment or Last Substantive Amendment: 2012

Notice of Continuation: January 9, 2012

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