No. 29197 (New Rule): R414-510. Intermediate Care Facility for Individuals with Mental Retardation Transition Program

DAR File No.: 29197
Filed: 11/06/2006, 02:14
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

This proposed rule implements the Intermediate Care Facility for Individuals with Mental Retardation (ICF/MR) Transition Program, which allows an individual to transition out of an ICF/MR to receive home and community-based waiver services.

Summary of the rule or change:

This new rule states that participation in the ICF/MR Transition Program is voluntary and provided at the state's option. It also outlines client eligibility requirements, program access requirements, and reimbursement methodology for the ICF/MR Transition Program. The rule incorporates by reference services and limitations found in the Home and Community-Based Services Waiver for Individuals with Mental Retardation and Other Related Conditions. Waiver services include behavioral services, companion services, support services, environmental adaptations, family training services, financial services, homemaker services, residential habilitation services, respite care, employment services, medical equipment, and non-medical transportation. Waiver support coordination services include eligibility determination, needs assessment, service access, and discharge planning.

State statutory or constitutional authorization for this rule:

Sections 26-1-5 and 26-18-3, and 42 CFR 440.225

This rule or change incorporates by reference the following material:

Medicaid 1915(c) Home and Community-Based Services Waiver for Individuals with Mental Retardation and Other Related Conditions, State Implementation Plan, July 1, 2005, ed.

Anticipated cost or savings to:

the state budget:

The annual cost is variable depending on legislative appropriations. For fiscal year 2006, the cost to the general fund is $241,484 which is matched with $571,320 in federal funds.

local governments:

There is no cost or savings because no local funds are used in this program.

other persons:

There is no cost or savings because only state and federal dollars are used in this program. Nevertheless, providers receive revenue when legislative appropriations fund new participants.

Compliance costs for affected persons:

There are no compliance costs because only state and federal dollars are used in this program.

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

This rule implements a voluntary program, subject to legislative appropriations, to transition clients into the community. Fiscal impact on business should be positive as business serves these clients. David N. Sundwall, MD, 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 [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:

01/02/2007

This rule may become effective on:

01/10/2007

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

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

R414-510. Intermediate Care Facility for Individuals with Mental Retardation Transition Program.

R414-510-1. Introduction and Authority.

(1) This rule implements the Intermediate Care Facility for Individuals with Mental Retardation (ICF/MR) Transition Program. Program participation is voluntary and allows an individual to transition out of an ICF/MR into the Mental Retardation and Related Conditions Home and Community-Based Services Waiver Program.

(2) This rule is authorized by Section 26-18-3. Waiver services for this program are optional and provided in accordance with 42 CFR 440.225.

 

R414-510-2. Client Eligibility Requirements.

Services are available to an individual who:

(1) receives ICF/MR benefits under the Utah Medicaid State Plan;

(2) has a diagnosis of mental retardation or a related condition;

(3) meets ICF/MR level of care criteria defined in Section R414-502-8;

(4) meets the Utah Department of Human Services, Division of Services for People with Disabilities state funding eligibility criteria found in Subsection 62A-5-102(4); and

(5) has resided in a Medicaid-certified ICF/MR located in Utah for at least 12 consecutive months.

 

R414-510-3. Program Access Requirements.

(1) Legislative appropriations determine the number of participants selected in the particular year for placement in the program.

(2) Upon new legislative appropriation for the program, the Department announces an open application period for accepting applications.

(3) After the open application period, the Department places the name of each applicant on both a longevity list and a random list. On the longevity list, the Department ranks each applicant according to length of consecutive stay in an ICF/MR in Utah. On the random list, the Department randomly ranks each applicant based on a computerized random selection.

(4) The Department takes evenly from the longevity list and the random list for placement in the Mental Retardation and Related Conditions Home and Community-Based Services Waiver Program. If the Legislature funds an odd number of program participants, the Department places one additional individual from the longevity list.

(5) Once the Department places individuals into the program for the year's appropriation, the longevity and random lists are retired and no longer used. The Department makes no new placements into the program to replace individuals who leave the program for whatever reason.

(6) As the Legislature makes new appropriations for the program, the Department creates new longevity and random lists for each new appropriation and selects individuals for the program as described in subsections (2) through (4).

 

R414-510-4. Service Coverage.

This rule incorporates by reference the services and limitations found in the Medicaid 1915(c) Home and Community-Based Services Waiver for Individuals with Mental Retardation and Other Related Conditions, State Implementation Plan, Effective July 1, 2005.

 

R414-510-5. Reimbursement Methodology.

The Department of Human Services (DHS) contracts with DHCF to set 1915(c) HCBS waiver rates for waiver covered services. The DHS rate-setting process is designed to comply with requirements under the 1915(c) HCBS Waiver program and other applicable Medicaid rules. Medicaid requires that rates for services not exceed customary charges.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: 2007

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