Utah Administrative Code

The Utah Administrative Code is the body of all effective administrative rules as compiled and organized by the Division of Administrative Rules (see Subsection 63G-3-102(5); see also Sections 63G-3-701 and 702).

NOTE: For a list of rules that have been made effective since April 1, 2019, please see the codification segue page.

NOTE TO RULEFILING AGENCIES: Use the RTF version for submitting rule changes.


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

Rule R414-510. Intermediate Care Facility for Persons with Intellectual Disabilities Transition Program.

As in effect on April 1, 2019

Table of Contents

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 from an ICF/ID to 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 are optional and provided in accordance with 42 CFR 440.225.

R414-510-2. Definitions.

(1) "Division of Services for People with Disabilities (DSPD)" means the entity within the Department of Human Services that has responsibility to plan and deliver an appropriate array of services and supports to persons with disabilities in accordance with Section 62a-5-102.

(2) "Guardian" means an individual, who is legally authorized to make decisions on an individual's behalf.

(3) "Interested individual" means an individual who meets eligibility requirements and expresses interest, either directly or through a guardian, in participating in the Transition Program.

(4) "Length of stay" means the length of time an individual has continuously resided in ICFs in the state of Utah. The Department considers a continuous stay to include a stay in which an individual has a temporary break in stay of no more than 31 days due to inpatient hospitalization, admission to a nursing facility, or a temporary leave of absence.

(5) "Representative" means an individual, who is not a guardian, and does not have decision-making authority, but is identified as an individual who assists a potential Transition Program participant.

(6) "State staff" means employees of the Division of Medicaid and Health Financing or the Division of Services for People with Disabilities.

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

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

R414-510-3. Eligibility Requirements for the Transition Program.

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 at least a 12-month length of stay in any Medicaid-certified, privately-owned ICF/ID located in Utah.

R414-510-4. Transition Program Access.

(1) Each fiscal year, the Utah Department of Health (Department) shall determine if there are sufficient funds available to initiate the Transition Program and identify the amount of funds available for the Transition Program.

(2) Based on the funds available for the Transition Program, the Department shall enroll individuals into the CSW through the Transition Program until available funds are exhausted.

(3) If the Department has initiated the Transition Program in a given year, the Department shall make direct contact with potentially eligible ICF/ID residents by phone or in person to determine interest in participating in the Transition Program.

(4) If the Department has initiated the Transition Program in a given year, the Department shall publicize the availability of the Transition Program in the following manner:

(a) The Department shall provide a letter to each potentially eligible ICF/ID resident (or to the guardian or other identified representative, if the individual has a guardian or other identified representative). The letter shall, at a minimum:

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

(ii) identify the enrollment method to be used for the Transition Program in the given year;

(iii) state that Transition Program participation is voluntary; and

(iv) provide the phone number and other contact information for state staff who are available to answer questions about the Transition Program.

(b) The Department shall notify the administrator of each privately-owned ICF/ID.

(c) The Department shall post information about the Transition Program on the Utah Medicaid website and the DSPD website.

(5) To introduce and provide general education about the Transition Program in a given year, state staff shall hold at least one meeting at each private ICF/ID. The Department will send notice of the meeting via letter to each eligible ICF/ID resident (or to the guardian or other identified representative, if the individual has a guardian or other identified representative). The Department shall notify the administrator of each privately-owned ICF/ID of the date and time of the meeting. The meeting shall provide detailed education about the Transition Program to allow the individual or their guardian, the freedom to make an informed choice regarding the setting for receiving services. Meeting elements shall include:

(a) a description of the purpose of the Transition Program;

(b) a provision of materials and detailed information regarding how individuals' needs can be met in home and community based services or in the ICF/ID where the individual currently resides;

(c) a description of how the Transition Program operates with available funds;

(d) a description of how residents or guardians can express interest in participating in the Transition Program;

(e) a time period for questions and answers;

(f) the opportunity for state staff to schedule more detailed individual meetings with interested individuals, and their guardians or representatives; and

(g) the phone number and other contact information for state staff who are available to answer questions about the Transition Program.

(6) At the time of the meeting, individuals or their guardians may inform state staff of their choice regarding participation in the Transition Program.

(7) For individuals who express a choice at this time, state staff will document the choice in writing.

(8) Using a method described below in Subsection R414-510-4(8)(a) or (b), the Department will place the name of each potentially interested individual on both a weighted-score list and a random list.

(a) On the weighted-score list, the Department will rank each individual, from highest to lowest score. Scores shall be based on:

(i) the number of times the person has applied to participate in the Transition Program since Fiscal Year 2013;

(ii) whether the applicant has applied for home and community based services and is currently on the DSPD waiting list; and

(iii) length of consecutive stay in an ICF/ID in the state of Utah.

(A) If there are multiple individuals on the weighted-score list with the same score, the Department will rank individuals based on greatest length of stay.

(b) On the random list, the Department ranks each interested individual based on a computerized random selection.

(c) At least 70 percent of the individuals selected to participate in the Transition Program in a given year will be selected based on their ranking in the weighted-score list.

(9) Except for individuals who have made their preferences known as per Subsection R414-510-4(6) and (7), state staff will contact individuals on the two lists to provide detailed education about the Transition Program in order to allow the individual or their guardian the freedom to make an informed choice regarding the setting to receive services. The contact will also be used to determine if additional education is needed or wanted.

(a) For individuals without guardians, state staff will contact the individual and will provide Transition Program education. Upon completion of the education process, state staff will ask the individual to express their preference regarding whether they want to participate in the Transition Program. State staff will document and act upon the individual's decision.

(b) For individuals with guardians, state staff will contact the guardian and will rely on the decision rendered by the guardian regarding whether they want additional Transition Program education.

(i) If more in-depth, individualized training is requested by the guardian, state staff will schedule the training, and will document the guardian's choice regarding an individual's participation in the Transition Program.

(ii) If additional, training is not requested, state staff will document and act upon the guardian's decision.

(10) For individuals who express a desire to participate in the Transition Program, state staff will:

(a) work with the individual or their guardian, if the individual has a guardian, to schedule a meeting to conduct a service needs assessment and develop the individual's support plan and a timeline for anticipated transition;

(b) inform the ICF/ID administration of the individual's intent to transition, including information about the likely transition timeline;

(c) facilitate collaboration between the ICF/ID and home and community-based services providers to assist the individual in a safe and orderly transition.

(11) 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 include the spouse in the Transition Program.

(12) 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 Transition Program.

R414-510-5. Service Coverage.

Services and limitations of the Transition Program may be found in the Waiver State Implementation Plan.

R414-510-6. Reimbursement Methodology.

The Department of Human Services (DHS) contracts with the Department to set rates for waiver-covered services. The DHS rate-setting process is designed to comply with the requirements of Subsection 1915(c) of the Social Security Act 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 27, 2018

Notice of Continuation:

October 12, 2016

Authorizing, Implemented, or Interpreted Law

26-1-5; 26-18-3


Additional Information

Contact

For questions regarding the content or application of rules under Title R414, please contact the promulgating agency (Health, Health Care Financing, Coverage and Reimbursement Policy). A list of agencies with links to their homepages is available at http://www.utah.gov/government/agencylist.html or from http://www.rules.utah.gov/contact/agencycontacts.htm.