DAR File No. 43425

Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-61-2

Incorporation by Reference

Notice of Proposed Rule

(Amendment)

DAR File No.: 43425
Filed: 12/07/2018 09:23:45 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to incorporate by reference updates to the Medically Complex Children's Waiver, effective 10/01/2018.

Summary of the rule or change:

This renewal incorporates by reference updates to the Medically Complex Children�s Waiver, effective 10/01/2018. These updates include: adjustments made to eligibility targeted criteria for initial and annual determinations; developing criteria to evaluate level of care based on the performance of age appropriate activities of daily living; the development of a transition plan for individuals who may no longer meet criteria for program participation; and the revision of quality-improvement performance measures to better align with waiver assurances and sub-assurances.

Statutory or constitutional authorization for this rule:

• Section 26-1-5
• Section 26-18-3

This rule or change incorporates by reference the following material:

• Updates Medically Complex Children�s Waiver, published by Centers for Medicare & Medicaid Services, 10/01/2018

Anticipated cost or savings to:

the state budget:

There is no impact on the state budget because these waiver updates do not provide new services, and ongoing services are within previous allocations set forth by the Legislature.

local governments:

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

small businesses:

There is no impact on small businesses because these waiver updates do not provide new services, and ongoing services are within previous allocations set forth by the Legislature.

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

There is no impact on Medicaid providers because these waiver updates do not provide new services, and ongoing services are within previous allocations set forth by the Legislature. Children who are currently enrolled in the waiver, or would have been enrolled in the waiver, may lose or not be able to obtain eligibility due to new entrance requirements and assessment criteria. On the other hand, children who would not have previously been enrolled in the waiver will gain coverage due to the new requirements and criteria. No cost-effective data exists to determine what the fiscal impact would be on either of these groups.

Compliance costs for affected persons:

A child who is currently enrolled in the waiver, or would have been enrolled in the waiver, may lose or not be able to obtain eligibility due to new entrance requirements and assessment criteria. There is, however, no cost-effective data to estimate what the fiscal impact would be.

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

After conducting a thorough analysis, it was determined that this proposed rule change will not result in a fiscal impact to businesses.

Joseph K. Miner, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office 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:

01/31/2019

This rule may become effective on:

02/07/2019

Authorized by:

Joseph Miner, Executive Director

Appendix 1: Regulatory Impact Summary Table*

Fiscal Costs	FY 2019	FY 2020	FY 2021
State Government	$0	$0	$0
Local Government	$0	$0	$0
Small Businesses	$0	$0	$0
Non-Small Businesses	$0	$0	$0
Other Person	$0	$0	$0
Total Fiscal Costs:	$0	$0	$0
Fiscal Benefits
State Government	$0	$0	$0
Local Government	$0	$0	$0
Small Businesses	$0	$0	$0
Non-Small Businesses	$0	$0	$0
Other Persons	$0	$0	$0
Total Fiscal Benefits:	$0	$0	$0
Net Fiscal Benefits:	$0	$0	$0

 

*This table only includes fiscal impacts that could be measured. If there are inestimable fiscal impacts, they will not be included in this table. Inestimable impacts for State Government, Local Government, Small Businesses and Other Persons are described in the narrative. Inestimable impacts for Non - Small Businesses are described in Appendix 2.

 

Appendix 2: Regulatory Impact to Non - Small Businesses

This rule change does not affect cost or revenue to the 182 Medicaid home and community-based service providers, as fiscal impacts are within previous allocations set forth by the Legislature.

 

 

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

R414-61. Home and Community-Based Services Waivers.

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, 2018;

(2) Waiver for Individuals Age 65 or Older, effective July 1, 2015;

(3) Waiver for Individuals with Acquired Brain Injuries, effective July 1, 2014;

(4) Waiver for Individuals with Physical Disabilities, effective July 1, 2016;

(5) Community Supports Waiver for Individuals with Intellectual Disabilities and Other Related Conditions, effective July 1, 2015;

(6) New Choices Waiver, effective July 1, 2015;

(7) Medicaid Autism Waiver, effective October 1, 2015; and

(8) Medically Complex Children's Waiver, effective October 1, 201[5]8.

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: [July 27, 2018]2019

Notice of Continuation: October 30, 2014

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