No. 28716: R539-1-8. Non-waiver Services for People with Brain Injury

DAR File No.: 28716
Filed: 05/05/2006, 01:46
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to establish criteria for receiving brain injury services.

 

Summary of the rule or change:

This change provides comprehensive definitions for evaluating applicants for brain injury services.

 

State statutory or constitutional authorization for this rule:

Section 62A-5-101

 

Anticipated cost or savings to:

the state budget:

This change clarifies definitions as they apply to eligibility and ongoing services for brain injury services. These definition assure that applicants are properly classified for the services that the Division provides. These classifications do not make any savings or cause additional costs. There will be no cost or savings as the result of this change.

 

local governments:

The Division provides these services directly to persons eligible for services. The Division has evaluated the possible role of local government and has concluded that local governments do not provide any assistance or financial support to the persons with disabilities receiving brain injury services. Local governments are not affected by the definitions in this rule. Local governments do not provide these types of services and will not have any cost or savings because of this change.

 

other persons:

The Division provides these services directly to persons eligible for services. The Division has evaluated the possible role of other persons and has concluded that other persons do not provide any assistance or financial support to the persons with disabilities receiving brain injury services. Other persons do not provide these services will not have any cost or savings because of this change.

 

Compliance costs for affected persons:

There are no costs to apply for these services or to receive these services or to comply with eligibility requirements for this service. There will be no compliance costs for affected persons.

 

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

Private businesses provide brain injury services under contract with the Department of Human Services and the Division of Services for People with Disabilities. Lisa-Michele Church, Executive Director

 

Emergency rule reason and justification:

Regular rulemaking procedures would place the agency in violation of federal or state law.

H.B. 213 was passed during the 2006 General Session and made significant changes to the definitions that determine eligibility for Division brain injury services. H.B. 213 is effective on 05/01/2006 and applicants must be adjudicated according to the new statutory standards. This rule provides comprehensive definitions need to determine applicant eligibility. (DAR NOTE: H.B. 213 is found at Chapter 351, Laws of Utah 2006, and was effective 05/01/2006.)

 

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Human Services
Services for People with Disabilities
120 N 200 W
SALT LAKE CITY UT 84103-1500

 

Direct questions regarding this rule to:

Steven Bradford at the above address, by phone at 801-538-4197, by FAX at 801-538-4279, or by Internet E-mail at [e-mail]

 

This rule is effective on:

05/05/2006

 

Authorized by:

George Kelner, Director

 

 

RULE TEXT

R539. Human Services, Services for People with Disabilities.

R539-1. Eligibility.

R539-1-8. Non-Waiver Services for People with Brain Injury.

(1) The Division will serve those Applicants who meet the eligibility requirements for brain injury services. To be determined eligible for non-waiver brain injury services the Applicant must:

(a) have a documented acquired neurological brain injury;

(b) Be 18 years of age or older;

(c) score between 40 and 120 on the [Brain Injury ]Comprehensive Brain Injury Assessment Form 4-1.

(d) meet at least three of the functional limitations listed under number (4).

(2) Applicants with functional limitations due solely to mental illness, substance abuse or deteriorating diseases like Multiple Sclerosis, Muscular Dystrophy, Huntington's Chorea, Ataxia or Cancer [as a primary diagnosis ]are ineligible for [these ]non-waiver services.

(3) Applicants with mental retardation or related conditions are ineligible for these non-waiver services.

(4) In addition to the definitions in Section 62A-5-101(3) and (5), eligibility for brain injury services will be evaluated according to the Applicant's functional limitations as described in the following definitions:

(a) Memory or Cognition means the Applicant's brain injury resulted in substantial problems with recall of information, concentration, attention, planning, sequencing, executive level skills, or orientation to time and place.

(b) Activities of Daily Life means the Applicant's brain injury resulted in substantial dependence on others to move, eat, bathe, toilet, shop, prepare meals, or pay bills.

(c) Judgment and Self-protection means the Applicant's brain injury resulted in substantial limitation of the ability to:

(i) provide personal protection;

(ii) provide necessities such as food, shelter, clothing, or mental or other health care;

(iii) obtain services necessary for health, safety, or welfare;

(iv) comprehend the nature and consequences of remaining in a situation of abuse, neglect, or exploitation.

(d) Control of Emotion means the Applicant's brain injury resulted in substantial limitation of the ability to regulate mood, anxiety, impulsivity, agitation, or socially appropriate conduct.

(e) Communication means the Applicant's brain injury resulted in substantial limitation in language fluency, reading, writing, comprehension, or auditory processing.

(f) Physical Health means the Applicant's brain injury resulted in substantial limitation of the normal processes and workings of the human body.

(g) Employment means the Applicant's brain injury resulted in substantial limitation in obtaining and maintaining a gainful occupation without ongoing supports.

([4]5) The Applicant shall be provided with information concerning service options available through the Division and a copy of the Division's Guide to Services.

([5]6) The Applicant or the Applicant's Guardian must be physically present in Utah and provide evidence of residency[a resident of the State of Utah] prior to the [Division's final] determination of eligibility.

([6]7) It is the Applicant's or Applicant's Representative's responsibility to provide the intake worker with documentation of brain injury, signed by a licensed physician;

([7]8) The intake worker will complete or compile the following documents as needed to make an eligibility determination:

(a) [Brain Injury Intake, Screening and ]Comprehensive Brain Injury Assessment Form 4-1, Part I through Part VII; and

(b) Brain Injury Social History Summary Form 824BI, completed or updated within one year of eligibility determination;

([8]9) If eligibility documentation is not completed within 90 calendar days of initial contact, a written notification letter shall be sent to the Applicant or the Applicant's Representative indicating that the intake case will be placed in inactive status.

(a) The Applicant or Applicant's Representative may activate the application at anytime thereafter by providing the remaining required information.

(b) The Applicant or Applicant's Representative shall be required to update information.

([9]10) When all necessary eligibility documentation is received from the Applicant or Applicant's Representative, region staff shall determine the Applicant eligible or ineligible for funding for brain injury supports.

([10]11) A Notice of Agency Action, Form 522-I, and a Hearing Request, Form 490S, shall be mailed to each Applicant or Applicant's Representative upon completion of the determination of eligibility or ineligibility for funding. The Notice of Agency Action, Form 522, shall inform the Applicant or Applicant's Representative of eligibility determination and placement on the waiting list. The Applicant or Applicant's Representative may challenge the Notice of Agency Action by filing a written request for an administrative hearing before the Department of Human Services, Office of Administrative Hearings.

(12) Persons receiving Brain Injury services will have their eligibility re-determined on an annual basis. Persons who are determined to no longer be eligible for services will have a transition plan developed to discontinue services and ensure that health and safety needs are met.

 

KEY: human services, disability

Date of Enactment or Last Substantive Amendment: May 5, 2006

Notice of Continuation: December 18, 2002

Authorizing, and Implemented or Interpreted Law: 62A-5-103; 62A-5-105