DAR File No. 39558

Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-307-13

Home and Community-Based Services Waiver for Medically Complex Children

Notice of Proposed Rule

(Amendment)

DAR File No.: 39558
Filed: 07/31/2015 09:39:11 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

This amendment complies with H.B. 199 passed during the 2015 General Session, which requires the Department to create a new Home and Community-Based Services (HCBS) waiver for children with disabilities and complex medical conditions for a three-year pilot program.

Summary of the rule or change:

This amendment implements the HCBS Waiver for Medically Complex Children, which serves children under 19 years of age who meet disability criteria described in Section R414-303-3.

State statutory or constitutional authorization for this rule:

• Section 26-18-3
• Section 26-1-5

Anticipated cost or savings to:

the state budget:

There is an annual cost to the General Fund of about $1,072,000 with matching federal funds of about $2,539,867.

local governments:

There is no impact to local governments because they do not fund or provide waiver services to Medicaid recipients.

small businesses:

Small businesses may see a portion of the total revenue generated by this new waiver that could reach about $3,611,867.

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

Medicaid providers may see a portion of the total revenue generated by this new waiver that could reach about $3,611,867. Eligible Medicaid recipients will also see out-of-pocket savings.

Compliance costs for affected persons:

There are no compliance costs to a single Medicaid provider who will see only potential revenue. Likewise, an eligible Medicaid recipient will see only out-of-pocket savings.

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

This proposed rule will fiscally impact business in that up to $3,611,867 in funds will be available to pay Medicaid providers for medical care services provided to children eligible under the waiver.

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:

10/01/2015

Authorized by:

David Patton, Executive Director

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

R414-307. Eligibility for Home and Community-Based Services Waivers.

R414-307-13. Home and Community-Based Services Waiver for Medically Complex Children.

(1) An individual must be under 19 years of age to be eligible for the HCBS Waiver for Medically Complex Children .

(a) The eligibility agency shall treat an individual as being under 19 years of age through the month in which the individual turns 19 years old.

(b) The agency shall end waiver eligibility after the month in which the individual turns 19 years old.

(2) The agency shall determine whether an individual meets the disability criteria described in Section R414-303-3.

(3) This waiver is in accordance with the provisions of the Community Supports Home and Community-Based Services waiver and all other eligibility requirements found in Section R414-307-7, except for the requirement of Subsection R414-307-7(1).

 

KEY: eligibility, waivers, special income group

Date of Enactment or Last Substantive Amendment: [ July 1, ]2015

Notice of Continuation: April 17, 2012

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