No. 30368 (Amendment): R414-502-8. Criteria for Intermediate Care for the Mentally Retarded

DAR File No.: 30368
Filed: 08/27/2007, 12:17
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

This amendment is necessary because it removes the mandate that the Department of Human Services (DHS) act as the entity responsible for authorizing admission into an Intermediate Care Facility for the Mentally Retarded (ICF/MR).

Summary of the rule or change:

This amendment removes language that requires DHS to make eligibility determinations. It also removes language requiring DHS to furnish written verification, stating that an individual meets ICF/MR admission criteria.

State statutory or constitutional authorization for this rule:

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

Anticipated cost or savings to:

the state budget:

There are only negligible savings because this amendment only removes a minor administrative task from DHS.

local governments:

There is no budget impact because local governments do not determine eligibility for ICF/MR admission.

small businesses and persons other than businesses:

There is no budget impact because this amendment does not affect the operations of providers and small businesses. There is no budget impact to Medicaid recipients or their families because this amendment does not change or create any new requirements for the Medicaid recipient of their families.

Compliance costs for affected persons:

There are no costs because the rule reduces the cost of performing eligibility determinations.

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

No unacceptable fiscal impact is expected on businesses impacted by this rule change. This will be evaluated after the public has an opportunity to comment. 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:

10/15/2007

This rule may become effective on:

10/22/2007

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

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

R414-502. Nursing Facility Levels of Care.

R414-502-8. Criteria for Intermediate Care for the Mentally Retarded.

The following criteria must be met before the department may authorize Medicaid coverage for an applicant in an intermediate care facility for the mentally retarded:

(1) The applicant is mentally retarded, except that even if the applicant is mentally retarded, he will not qualify for care in an intermediate care facility for the mentally retarded if the applicant is ambulatory, continent, only moderately or mildly mentally retarded without complicating conditions, is in need of less than weekly intervention by or under the supervision of a health care professional or trained habilitative personnel, and is capable of daily attendance in work settings or day treatment. Day treatment is training and habilitation services outside the nursing facility that are:

(a) intended to aid the self-help and self-sufficiency skill development of a mentally retarded resident;

(b) sufficient to meet the specialized rehabilitative service requirements of 42 CFR 435.1009 for the mentally retarded; and

(c) coordinated with the active treatment program of the intermediate care facility for the mentally retarded.

([2) The appropriate local office of the Department of Human Services:

(a) informs the applicant or his legal representative of any feasible alternatives available under the home and community based services waiver, and gives him the choice of either nursing facility or home and community based services; and

(b) states in writing that without home and community based services, the applicant would require the level of care provided in an intermediate care facility for the mentally retarded; and

(3]2) The applicant has at least one of the following conditions:

(a) Is severely or profoundly retarded;

(b) Is under six years of age;

(c) Is severely multiply handicapped in that he has at least two of the conditions identified in the definition of mental retardation found in the Diagnostic and Statistical Manual of Mental Disorders IV, Revised, 1994;

(d) More than once per week is physically aggressive or assaultive towards himself or others;

(e) Is a security risk or wanders away at least once per week;

(f) Is diagnosed as severely hyperactive;

(g) Demonstrates psychotic-like behavior; or

(h) Has conditions requiring at least weekly intervention by or under the supervision of a health care professional or trained habilitative personnel.

 

KEY: [m]Medicaid

Date of Enactment or Last Substantive Amendment: [July 18, 2001]2007

Notice of Continuation: August 27, 2004

Authorizing, and Implemented or Interpreted Law: 26-1-5; 26-18-3; 63-46a-7(1)(a)