DAR File No. 38318

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.: 38318
Filed: 02/27/2014 12:30:05 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this amendment is to incorporate by reference changes to the Waiver for Technology Dependent/Medically Fragile Individuals, effective 07/01/2013.

Summary of the rule or change:

This amendment incorporates by reference changes to the Waiver for Technology Dependent/Medically Fragile Individuals, effective 07/01/2013. These changes include an update to eligibility criteria. For example, to determine total income of waiver applicants, there is an allowance for the needs of the waiver recipient of 100% of the Health and Human Services (HHS) Poverty Guidelines. This allowance is for one person plus an amount of earned income up to the substantial gainful activity level of earnings defined in Section 223(d)(4) of the Compilation of the Social Security Laws. The waiver also adds the Self-Administered Services (SAS) Delivery method as an option for more waiver services. Recipients and their families have more flexibility and choice as the existing services of In-Home Feeding Therapy and Family Support Services are available as recipient and family directed services, in addition to the traditional agency-based option. The Department has also enhanced its quality improvement strategies to develop a Critical Incidents and Events Reporting Requirements Standard Operating Procedure to safeguard waiver recipients. Further, references to the bureaus and agencies within the State Medicaid Agency are modified to reflect current assignments. In addition, the Department has replaced the term "institution" with "facility" to accommodate current preferences within the community. The intent of these statements and references remains unchanged. Finally, the Department has clarified its offering of home health aide and private duty nursing services as extended State Plan services. Adjustments to service descriptions are in accordance with other waivers that similarly offer extended State Plan services.

State statutory or constitutional authorization for this rule:

• Section 26-18-3
• Section 26-1-5

This rule or change incorporates by reference the following material:

• Updates Waiver for Technology Dependent/Medically Fragile Individuals, published by Centers for Medicare and Medicaid Services, 07/01/2013

Anticipated cost or savings to:

the state budget:

The Department does not anticipate any costs to the state budget because there are no new services based on the waiver renewal.

local governments:

There is no impact to local governments because they neither fund nor provide waiver services for Medicaid recipients.

small businesses:

The Department neither anticipates an increase in revenue nor costs to small businesses because there are no new services based on the waiver renewal.

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

The Department neither anticipates an increase in revenue nor costs to Medicaid providers because there are no new services based on the waiver renewal. Likewise, there are no additional costs or savings to Medicaid recipients.

Compliance costs for affected persons:

There are no compliance costs to a single Medicaid provider or to a Medicaid recipient because there are no new services based on the waiver renewal.

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

This will have no impact on business because it makes no change in current policy.

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:

04/14/2014

This rule may become effective on:

04/21/2014

Authorized by:

David Patton, 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, 20[08]13;

(2) Waiver for Individuals Age 65 or Older, effective July 1, 2010;

(3) Waiver for Individuals with Acquired Brain Injuries, effective July 1, 2009;

(4) Waiver for Individuals with Physical Disabilities, effective July 1, 2011;

(5) Community Supports Waiver for Individuals with Intellectual Disabilities and Other Related Conditions, effective July 1, 2010;

(6) New Choices Waiver, effective July 1, 2010.

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

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [January 24, 2012]2014

Notice of Continuation: February 24, 2010

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