No. 27586 (Amendment): R414-61-2. Incorporation by Reference

DAR File No.: 27586
Filed: 12/14/2004, 09:58
Received by: NL

 

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rulemaking is necessary to update the dates and titles of the listed waivers contained in the rule as necessary to meet statutory requirements that Medicaid policies be placed into rule.

 

Summary of the rule or change:

In Subsection R414-61-2(1), the year of the "Waiver for Technology Dependent/Medically Fragile Individuals" is updated from "1998" to "2003." This waiver deletes "portable oxygen" as a covered waiver benefit and adds "Expressive/Child Life Therapists" as qualified providers in the "Family Support Services" program. "Family Support Services" is the new name for the program that was previously known as "In Home Family Counseling Service." In Subsection R414-61-2(2), the title of the waiver has been changed to "Waiver for Individuals Age 65 and Older." Specifically, the word "elderly" is deleted and the year of the waiver is updated from "2000" to "2004." This waiver clarifies the State Medicaid Agency's final authority for level of care determination, adds new information describing the State Medicaid Agency's review protocols for involuntary disenrollment from the waiver program, clarifies the process in which case management integrates with the waiver enrollee's individual service plan, and describes the rate setting methodologies that are used to establish reimbursement rates for covered waiver services. In the title of the waiver in Subsection R414-61-2(3), the word "injury" has been changed to "injuries," "18 years of age and older" has been deleted, and the year of the waiver has been changed from "1999" to "2004." Thus, the new title is "Waiver for Individuals with Acquired Brain Injuries." The entire waiver document was replaced and the five-year renewal of the waiver was approved with an effective date of July 1, 2004. Some of the changes included in the new waiver are financial projections, services provided, and provider qualifications. Subsection R414-61-2(4) is updated from "1998" to "2003." This "Waiver for Individuals with Physical Disabilities" clarifies that individuals must be determined eligible to receive state matching funds in order to participate in the Home and Community Based System (HCBS) Waiver program, designates Tonya Keller as the state contact person for the waiver, updates the interagency agreement content description, reassigns responsibility for level of care determination to the State Medicaid Agency, describes the State Medicaid Agency's review protocols for involuntary disenrollment from the waiver program, removes outdated language relating to the use of a Department of Human Services United States Service Delivery System (USSDS) system, reflects new estimates for cost-neutrality factors involving some of the waiver years, and describes the rate setting methodologies that are used to establish reimbursement rates for covered waiver services. Finally, the year of the waiver in Subsection R414-61-2(5) is updated from "2000" to "2003." This waiver for "Individuals with Developmental Disabilities or Mental Retardation" removes all elements of the Home Dual Diagnosis pilot project from the waiver document. Develop mentally Disabled/Mentally Retarded (DD/MR) enrollees now receive waiver support coordination services through a waiver Support Coordination Agency rather than from home project case managers. This waiver also updates the interagency agreement content description, clarifies the State Medicaid Agency's final authority for level of care determination, describes the State Medicaid Agency's review protocols for involuntary disenrollment from the waiver program, clarifies the process in which support coordination integrates with the waiver enrollee's individual service plan, and describes the rate setting methodologies that are used to establish reimbursement rates for covered waiver services.

 

State statutory or constitutional authorization for this rule:

Section 26-18-3

 

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget associated with this rulemaking because it only updates the dates and titles of the listed waivers.

 

local governments:

There is no impact to local governments as a result of this rulemaking because it only updates the dates and titles of the listed waivers.

 

other persons:

There is no impact to other persons as a result of this rulemaking because it only updates the dates and titles of the listed waivers.

 

Compliance costs for affected persons:

There are no compliance costs because this rulemaking only updates the dates and titles of the listed waivers.

 

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

The proposed amendment updates references to existing waivers from federal requirements granted by the federal government for implementation of the Utah Medicaid program. There should be no fiscal impact on regulated businesses. Scott D. Williams, MD

 

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 [e-mail]

 

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:

01/31/2005

 

This rule may become effective on:

02/01/2005

 

Authorized by:

Scott D. Williams, Executive Director

 

 

RULE TEXT

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

R414-61. Home and Community Based Waivers.

R414-61-2. Incorporation by Reference.

The Department adopts the document entitled "Utah State Plan under Title XIX of the Social Security Act" 1999 edition, and the document entitled "Home and Community Based Waiver Implementation Plan", 1999 edition, which are incorporated by reference within this rule. These documents are available for public inspection during normal working hours, at the State Health Department Building, located at 288 North, 1460 West, Salt Lake City, UT, 84114-3102, at the office of the Division of Health Care Financing. These documents will be used by the Division for the provision of services under the following waivers:

(1) Waiver for Technology Dependent/Medically Fragile Individuals, dated July 1, [1998]2003;

(2) Waiver for [Elderly ]Individuals Age 65 [Years of Age ]and Older, dated July 1, 200[0]4;

(3) Waiver for Individuals with Acquired Brain Injur[y]ies,[18 Years of Age and Older,] dated July 1, [1999]2004;

(4) Waiver for Individuals with Physical Disabilities, dated July 1, [1998]2003;

(5) Waiver for Individuals with Developmental Disabilities or Mental Retardation, dated July 1, 200[0]3.

 

KEY: M[m]edicaid

[August 9, 2001]2005

26-18-3