No. 27505 (New Rule): R414-7D. Intermediate Care Facility for the Mentally Retarded Transition Project

DAR File No.: 27505
Filed: 10/25/2004, 11:30
Received by: NL

 

RULE ANALYSIS

Purpose of the rule or reason for the change:

Another rule required the Department to do an Intermediate Care Facility for the Mentally Retarded (ICF/MR) Transition Project in the Department of Health annually. This new rule provides for open enrollment in a transition project only in the years that the Legislature funds it. This rulemaking describes the procedures followed in an open enrollment in accordance with the previously adopted rule. This rulemaking also creates a new rule from what was a section within Rule R414-1 for better placement of the subject matter. Rule R414-1 is also being amended to reflect this change.

 

Summary of the rule or change:

Section R414-7D-1 authorizes the ICF/MR Transition Project, sets an application process, and establishes qualifications. Section R414-7D-2 creates an open enrollment program.

 

State statutory or constitutional authorization for this rule:

Sections 26-1-5 and 26-18-3

 

Anticipated cost or savings to:

the state budget:

Costs are dependent on Legislative appropriations in each fiscal year. It is anticipated that approximately $750,000 annually will be spent during those years when an open enrollment period occurs.

 

local governments:

There are no local government costs because local governments are not involved in paying for this project.

 

other persons:

There are no costs to other persons because other persons are not involved in paying for this project. Private providers that operate community-based programs will have increased revenues of approximately $525,000 for additional services provided. Some families in areas of the state distant from existing ICFs/MR may experience some savings by having their family members located closer to home.

 

Compliance costs for affected persons:

This program is cost-neutral for the Medicaid clients who move into the community. ICFs/MR that lose clients to the community will be able to refill to their capacity with little delay.

 

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

Medicaid services for those eligible under this rule will receive up to $35,000 per year in benefits. This additional cost to the Medicaid program is accounted for in the rule text through a provision that the open enrollment process will only be conducted in years when the Legislature allocates new money for the project and the number of qualifying persons will be limited by the legislative allocation. Current ICF/MR providers should not be significantly impacted given the continuing demand for their service, beds opened by this transition should fill quickly. 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:

Ross Martin at the above address, by phone at 801-538-6592, 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:

12/15/2004

 

This rule may become effective on:

12/16/2004

 

Authorized by:

Scott D. Williams, Executive Director

 

 

RULE TEXT

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

R414-7D. Intermediate Care Facility for the Mentally Retarded Transition Project.

R414-7D-1. Transition Project Authorized.

(1) Medical or hospital services available under the Medical Assistance Program are generally limited by federal guidelines as set forth under Title XIX of the federal Social Security Act and Title 42 of the Code of Federal Regulations.

(2) A Medicaid recipient residing in an Intermediate Care Facility for the Mentally Retarded (ICF/MR) may at any time apply for enrollment to the Medicaid 1915c Home and Community-Based Waiver for Individuals with Developmental Disabilities or Mental Retardation (DD/MR Waiver) through the application process established in the federally approved waiver implementation plan. ICF/MR resident applications are processed consistent with all waiver applications.

(3) The Department, through an ICF/MR Transition Project, makes funds available to a limited number of ICF/MR residents to move from their current ICF/MR placement to community services through the Medicaid 1915c Home and Community-Based Waiver for Individuals with Developmental Disabilities or Mental Retardation. This funding is available to Medicaid recipients who have resided for 12 or more continuous months in a Medicaid certified ICF/MR. The Department makes the ICF/MR Transition Project available to eligible individuals during a specified time period up to the number of individuals authorized for the project by the Utah Legislature through appropriation for that time period.

 

R414-7D-2. ICF/MR Transition Project Open Enrollment.

(1) Based on a legislative appropriation enabling ICF/MR transition for a specified fiscal year, the Department determines the number of Medicaid recipients to be transitioned from ICFs/MR to the 1915c DD/MR Waiver during that fiscal year.

(a) The Department apportions the legislative appropriation so that approximately 50% of the available funds are targeted to applicants based on their continuous time as an ICF/MR resident and 50% of the available funds are targeted to applicants on a statistical process that ranks individuals based on random number tables.

(b) The Department ranks each individual who applies for participation in the ICF/MR transition project using length of continuous stay in an ICF/MR and a priority ranking assigned through a random numbering process.

(c) The Department allocates the legislative appropriation to individual applicants in accordance with R414-7D-2(1)(a) and in the order of priority ranking as determined in R414-7D-2(1)(b). The amount allocated to each individual is based on a State-conducted needs assessment and individualized service plan for DD/MR Waiver services at the point of initial enrollment. At the point the available funds have been fully allocated to the highest ranking individuals, the Department completes no further needs assessments and individualized service plans for the remaining applicants.

(2) The Department conducts an outreach campaign leading to an application period during which interested Medicaid recipients residing in Utah ICFs/MR may apply for transition to the DD/MR Waiver.

(a) The Department advertises the pending application period to all Medicaid recipients residing in Utah ICFs/MR for 30-days before taking applications.

(b) The application period will be open for 14 calendar days.

(c) The Department accepts applications in either electronic format or hard copy format. Electronic applications must be completed during the 14-day application period and hard copy applications must be postmarked during the 14-day application period.

(3) The Department of Human Services contacts applicants receiving a preliminary transition allocation through R414-7D-2(1)(c) to confirm their desire to participate.

(a) The Department retains the list of applicants remaining after available funds are fully allocated, if any, and their priority ranking for use in selecting alternate individuals in the event one or more of the initial selected persons withdraws prior to becoming enrolled in the DD/MR Waiver.

(b) In consultation with the Department of Human Services, the Department starts evaluations for enrollment as soon as possible after the close of the Legislative session. The Department coordinates the actual start date with the Department of Human Services enrollment workload resulting from new monies for increased DD/MR Waiver community enrollment to assure the individual transitions, once started, are completed in a timely manner.

(4) The Department submits a waiver amendment to the federal Centers for Medicare and Medicaid Services as necessary to increase the declared capacity of the DD/MR Waiver by the number of new enrollees.

(5) When the Department has allocated all appropriated funds to new enrollees in the DD/MR Waiver, the Department concludes the transition project for the fiscal year. There are no carryover of applications received during a specific fiscal year into future years for purposes of the ICF/MR transition project.

 

KEY: Medicaid

2004

26-18