DAR File No. 38532

Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-510

Intermediate Care Facility for Persons with Intellectual Disabilities Transition Program

Notice of Proposed Rule

(Amendment)

DAR File No.: 38532
Filed: 05/15/2014 10:17:15 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to provide the Department more flexibility in determining how funds dedicated to the Transition Program are allocated and to require a more inclusive application process within the program.

Summary of the rule or change:

This amendment implements changes to the Transition Program for persons with intellectual disabilities who reside in intermediate care facilities. At its discretion, the Department may set aside a portion of Transition Program money to fund individuals who meet Transition Program eligibility to transfer to the Community Supports Waiver when the individual is scheduled for discharge by the Intermediate Care Facility for Persons with Intellectual Disabilities (ICF/ID) in which they are residing, and for whom placement in an alternative ICF/ID is not an option. Additionally, individuals who meet eligibility program requirements for the Transition Program are considered candidates for the program and an application is longer required.

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 as a result of this amendment because the services affected by this change are within the allocation of funds set forth by the Legislature for the Transition Program in state fiscal year 2015.

local governments:

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

small businesses:

The Department does not anticipate any impact to small businesses as a result of this amendment because the services affected by this change are within the allocation of funds set forth by the Legislature for the Transition Program in state fiscal year 2015.

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

The Department does not anticipate any impact to Medicaid providers and to Medicaid recipients as a result of this amendment because the services affected by this change are within the allocation of funds set forth by the Legislature for the Transition Program in state fiscal year 2015.

Compliance costs for affected persons:

The Department does not anticipate any impact to a single Medicaid provider or to Medicaid recipient as a result of this amendment because the services affected by this change are within the allocation of funds set forth by the Legislature for the Transition Program in state fiscal year 2015.

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

Anticipate no impact on businesses because this does not provide additional money for services.

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:

07/01/2014

This rule may become effective on:

07/08/2014

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.

R414-510-1. Introduction and Authority.

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

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

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

(3) "Representative" means a parent or guardian who assists a potential Transition Program participant.

 

R414-510-3. Client Eligibility Requirements.

Waiver [S]services are potentially available to an individual who:

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

(2) has been diagnosed with an intellectual disability or a related condition;

(3) meets ICF/ID level of care criteria defined in Section R414-502-8;

(4) meets [the Department of Human Services, Division of Services for People with Disabilities ]state funding eligibility criteria for the Division of Services for People with Disabilities (DSPD) found in Subsection 62A-5-102(4); and

(5) has resided in a Medicaid-certified, privately-owned ICF/ID located in Utah for at least 12 consecutive months.

 

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 Transition [p]Program if funds are available.

(2) Based on funds dedicated to the Transition [p]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) At its discretion, the Department may reserve a number of slots for individuals:

(a) who meet the eligibility requirements of Section R414-510-3;

(b) who receive a discharge notice from the ICF/ID in which they reside;

(c) who have no viable option for alternative ICF/ID placement; and

(d) who DSPD accepts for ICF/ID placement.

[(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]shall place the names of [each]all ICF/ID [Transition Program applicant]residents who meet the eligibility requirements in Section R414-510-3 on both a longevity list and a random list. On the longevity list, the Department ranks each [ICF/ID Transition Program applicant]individual 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]individual based on a computerized random selection.

(5) The Department [takes]will then select individuals evenly [first ]from the top of 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]notification regarding voluntary participation in the Transition Program.

(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.]The Department shall notify individuals selected for voluntary participation in the Transition Program by providing a letter to each representative that describes:

(a) the purpose and operation of the Transition Program, including availability of funding;

(b) the selection process used to identify the individual as a potential participant;

(c) how participation in the program is optional;

(d) how Department staff will contact the individual or representative by phone or in- person, for the purpose of answering questions to allow the individual or representative to make an informed choice about participation in the Transition Program; and

(e) contact information for an individual or representative who has additional questions.

(7) The Department shall make follow-up phone calls or in-person visits to each individual or representative to provide information that describes:

(a) the purpose and operation of the Transition Program, including availability of funding;

(b) the selection process used to identify the individual as a potential participant;

(c) how participation in the program is optional;

(d) how Department staff will contact the individual or representative by phone or in- person, for the purpose of answering questions to allow the individual or representative to make an informed choice about participation in the Transition Program; and

(e) how in cases where a selected individual does not have or require a representative, a DSPD Transition Program coordinator will visit the selected individual in-person at the ICF/ID to verify if program participation is desired.

(8) When an individual or representative voluntarily confirms his desire to participate in the Transition Program, the Department shall provide a letter to the ICF/ID administrator to inform the administrator of the choice of the individual or representative to participate in the Transition Program.

[(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.](9) If an individual is selected for the Transition Program 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.

[(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.](10) Based on available funding, the Department shall continue to select eligible individuals through the aforementioned process until the Department exhausts the amount of funds committed to the program.

[(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.](11) The Department shall keep the longevity list and random lists open for the sole purpose of filling slots vacated through Transition Program attrition. If a waiver client who is admitted through the Transition Program leaves the program for any reason, the Department shall contact and enroll the next person on the list who is interested in moving into the Transition Program.

(12) The Department shall create new lists in accordance with Subsection R414-510-4(4) when there is funding available to open new Transition Program slots.

 

R414-510-5. Service Coverage.

[The s]Services and limitations within the Transition Program are found in the Community Supports Waiver for Individuals with Intellectual Disabilities and Other Related Conditions[ are incorporated by reference in Section R414-61-2].

 

R414-510-6. Reimbursement Methodology.

The Department of Human Services (DHS) contracts with [DMHF]the Department to set 1915(c) Home and Community-Based Services Waiver (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: [November 1, 2012]2014

Notice of Continuation: January 9, 2012

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