DAR File No. 39553

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.: 39553
Filed: 07/29/2015 11:38:21 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to update and clarify eligibility requirements for individuals who wish to transfer to the Community Supports Waiver.

Summary of the rule or change:

This amendment updates and clarifies access requirements for the Transition Program, which include an open application process and a selection process for both Program applicants and eligible individuals. It also specifies public notice requirements for the agency, includes new definitions to clarify the text, and makes other technical changes.

State statutory or constitutional authorization for this rule:

• Section 26-1-5
• 42 CFR 440.225
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget because any services affected by this change are within the allocation of funds set forth by the legislature for the Transition Program in state fiscal year 2016.

local governments:

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

small businesses:

There is no impact to small businesses because any services affected by this change are within the allocation of funds set forth by the legislature for the Transition Program in state fiscal year 2016.

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

There is no impact to Medicaid providers and to Medicaid recipients because any services affected by this change are within the allocation of funds set forth by the legislature for the Transition Program in state fiscal year 2016.

Compliance costs for affected persons:

There are no compliance costs to a single Medicaid provider or to Medicaid recipient because any services affected by this change are within the allocation of funds set forth by the legislature for the Transition Program in state fiscal year 2016.

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

There is no fiscal impact to business because any services affected by this change fall within funds allocated to the Medicaid program.

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:

09/14/2015

This rule may become effective on:

09/21/2015

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.

(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) 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.

(2) "Program" means the Intermediate Care Facility for Persons with Intellectual Disabilities Transition Program.

(3) "Program applicant" means an individual who meets eligibility requirements and submits an application to the Department during the open application period.

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

([3]5) "Representative" means a parent or guardian who assists a potential [Transition ]Program participant.

(6) "Waiver" means the Community Supports Waiver for Individuals with Intellectual Disabilities and Other Related Conditions.

 

R414-510-3. [ Client ]Eligibility Requirements.

Waiver services are potentially available to an individual who:

(1) receives ICF/ID benefits under the 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 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 ny 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 ]Program if funds are available.

(2) Based on funds dedicated to the [Transition ]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 [p]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.

(4) During a fiscal year in which the Program receives funding for new applicants, the Department shall announce an open application period. The Department shall publicize the availability of the Transition Program in the following manner:

(a) The Department shall provide a letter to the administrator of each privately-owned ICF/ID, each ICF/ID resident and to the representative of each ICF/ID resident. The letter shall:

(i) describe the purpose and operation of the Program, including availability of funding;

(ii) identify the selection process utilized for the Program;

(iii) state that Program participation is voluntary; and

(iv) provide Program contact information.

(b) The Department shall post information about Program availability on the Utah Medicaid website.

(c) The Department shall hold at least one open and public meeting to introduce the Program and send notice of the meeting via letter to the administrator of each privately-owned ICF/ID, each ICF/ID resident and to the representative of each ICF/ID resident. The meeting must:

(i) cover the purpose of the Program;

(ii) cover how the Program operates with available funds;

(iii) cover how residents or guardians may apply for the Program; and

(iv) allow a time period for questions and answers.

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

(6) The Department then selects evenly first from the longevity list and then from the random list for placement in the Waiver until the amount of funding allocated to the Program is disbursed to care for the admitted individuals.

([4]7) The Department conducts a periodic alternate selection process as follows:

(a) [t]The Department shall place the names of all ICF/ID residents who meet the eligibility requirements in Section R414-510-3 on both a longevity list and a random list. The use of longevity and random lists shall follow the same process as identified in Subsection R414-510-4(5) through (6), except that all eligible individuals are considered.[On the longevity list, the Department ranks each individual according to length of consecutive stay in an ICF/ID in Utah. On the random list, the Department ranks each individual based on a computerized random selection.]

[(5) The Department will then select individuals evenly from the top of the longevity list and then the random list for notification regarding voluntary participation in the Transition Program.

] ([6]b) The Department shall [notify individuals selected for voluntary participation in the Transition Program by providing]send a letter to each selected resident and their representative . The letter must comply with requirements noted in Subsection R414-510-4(4)(a)(i) through (iv), and [that ]describe[s:

(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]c) The Department shall make follow-up phone calls or in-person visits to each individual or representative to provide information that [describes]reiterates the requirements described in Subsection R414-510-4(a)(i) through (iv).[:]

[(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]d) [how i]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]e) When an individual or representative voluntarily confirms [his]a 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.

([9]8) 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.

([10]9) 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 [p]Program.

([11]10) 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 [w]Waiver [client]participant who is admitted through the [Transition ]Program leaves the Waiver program for any reason, the Department shall contact and enroll the next person on the list who is interested in moving [into]through the [Transition ]Program.

([12]11) The Department shall create new lists in accordance with Subsection R414-510-4(4) through (6) or (7) when there is funding available to open new [Transition ]Program slots.

 

R414-510-5. Service Coverage.

Services and limitations [within]of the [Transition ]Program [are]may be found in the Waiver State Implementation Plan[Community Supports Waiver for Individuals with Intellectual Disabilities and Other Related Conditions].

 

R414-510-6. Reimbursement Methodology.

The Department of Human Services (DHS) contracts with the Department to set [1915(c) Home and Community-Based Services Waiver (HCBS) waiver ]rates for [w]Waiver-covered services. The DHS rate-setting process is designed to comply with the requirements of [under the]Subsection 1915(c) of the Social Security Act[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: [July 15, 2014]2015

Notice of Continuation: January 9, 2012

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