No. 40869 (5-year Review): Rule R414-510. Intermediate Care Facility for Persons with Intellectual Disabilities Transition Program

DAR File No.: 40869
Filed: 10/12/2016 02:29:02 PM

NOTICE OF REVIEW AND STATEMENT OF CONTINUATION

Concise explanation of the particular statutory provisions under which the rule is enacted and how these provisions authorize or require the rule:

Section 26-18-3 requires the Department to implement Medicaid policy through administrative rules, which allow the Department to administer the Medicaid program. Additionally, Section 26-1-5 allows the Department to adopt administrative rules to provide services to Medicaid recipients and reimbursement for Medicaid providers. 42 CFR 440.225 further allows the Department to provide optional services under the Transition Program.

Summary of written comments received during and since the last five-year review of the rule from interested persons supporting or opposing the rule:

After filing an amendment to this rule in 2012, the Department received written comments from the Disability Law Center (DLC), which suggested the Department set forth specific procedures to notify the public of the open application process and to implement an annual meeting to introduce the Transition Program. The Department agreed with DLC's assessment and changed the proposed rule to clarify and implement new notification requirements. The Department again received written comments from DLC after filing an amendment in 2014. DLC first expressed concern that the proposed application process would reduce resources available to those individuals whom the program was intended to help by the amendment's inclusion of persons facing eviction into Intermediate Care Facilities for Persons with Intellectual Disabilities (ICFs/ID). The Department, however, maintained that the new process would be more inclusive of all ICF/ID residents who meet Transition Program requirements because the Department will educate these residents about the option to participate in the program if selected for potential admission. DLC then expressed concern about the 12-month residency requirement as a condition of eligibility. The Department answered that the vast majority of Medicaid clients with intellectual disabilities or related conditions are already served in the Community Supports Waiver, with the minority being served in ICFs/ID. The intent, therefore, is to facilitate movement of eligible long-term residents of ICFs/ID into the Community Supports Waiver. DLC also expressed concern that allowing the Department to allocate a number of slots for individuals who are being involuntarily discharged from an ICF/ID will reduce the number of people allowed to voluntarily select participation in the Transition Program. The Department responded that its proposal will allow the agency, on a case-by-case basis, the discretion to authorize a limited number of transitions from an ICF/ID into the Community Supports Waiver when no other options are available for the resident. The Department further stated that these difficult cases frequently result in individuals being admitted to inpatient hospitals and staying longer than is necessary because no ICF/ID is willing to admit or readmit an individual. The proposed provision will allow the agency to have greater flexibility to provide needed services.

Reasoned justification for continuation of the rule, including reasons why the agency disagrees with comments in opposition to the rule, if any:

The Department will continue this rule because it sets forth eligibility and program access requirements for recipients who wish to transition into the Waiver for Individuals with Intellectual Disabilities and Other Related Conditions, and because it implements service coverage and provider reimbursement under the Transition Program. There is no opposition to the rule itself from outside parties, and the Department has resolved all concerns to previous amendments per its responses above.

The full text of this rule may be inspected, during regular business hours, at the Office 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]

Effective:

10/12/2016

Authorized by:

Joseph Miner, Executive Director

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