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Utah Administrative Code (Current through November 1, 2019) |
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R539. Human Services, Services for People with Disabilities |
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R539-5. Self-Administered Services |
| R539-5-1. Purpose |
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(1) The purpose of this rule is to establish procedures and standards for Persons and their families receiving Self-Administered Services. |
| R539-5-2. Authority |
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(1) This rule establishes procedures and standards for Self-Administered Services as required by Subsection 62A-5-103(8). |
| R539-5-3. Definitions |
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(1) Terms used in this rule are defined in Section 62A-5-101 and R539-1-2. (2) In addition: (a) "Direct Services" means services delivered by an employee in the physical presence of the Person. (b) "Employee" means any individual hired to provide services to a Person receiving Self-Administered Services. (c) "Fiscal Agent" means an individual or entity contracted by the Division to perform fiscal, legal, and management duties. (d) "Grant" means a budget allocated by the Division to the Person through which Self-Administered Services are purchased. (e) "Grant Agreement" means a written agreement between the Person and the Division that outlines requirements the Person must follow while receiving Self-Administered Services. (f) "Self-Administered Services" means a structure for a Person or Representative to administer Division paid services. This program allows the Person to hire, train, and supervise employees who will provide direct services from selected services as outlined in the current State of Utah Home and Community Based Services Waivers (Medicaid 1915C). Once the Person is allocated a budget, a Grant is issued for the purpose of purchasing specific services. Grant funds are only disbursed to pay for actual services rendered. All payments are made through a Fiscal Agent under contract with the Division. Payments are not issued to the Person, but to and in the name of the Employee. |
| R539-5-4. Participant Requirements |
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(1) In addition to Division Rule, a Person receiving Self-Administered Services must adhere to the terms of their Grant Agreement. (2) If the Person does not meet the requirements in Rule and the Grant Agreement, the Division may require the Person to use a contracted Provider. (3) The Person shall ensure that each Employee completes the requirements outlined in R539-5-5. (4) The Person shall provide the Fiscal Agent with the following documents for each Employee hired to provide services: (a) Original Form W-4; (b) Original Form I-9 (including supporting documentation); (c) Copy of the signed Employment Agreement; and (d) Original signed Timesheets, verifying the time worked is true and accurate. (5) The Person or Representative shall complete a Monthly Summary of services for each month in which services are rendered and submit it to the Support Coordinator by the 15th of the month following the month of services. (a) If the Person does not provide this information to the Division for a three month period, the fourth month's payment shall be withheld until the monthly summaries are submitted. (b) If the Person submits all required monthly summaries within the fourth month, payment will be reinstated. (c) If monthly summaries are not provided for the fifth month, then at the sixth month, the Division will require the Person to use a contracted Provider and not participate in Self-Administered Services. (6) The Division may require the Person to use some form of technical assistance, if needed (i.e. Behaviorist, Accountant, Division Supervisor, etc.). Technical assistance is available to the Person, even if not required by the Division. (7) The Person's Representative shall notify the Support Coordinator if any of the following occurs: (a) If the Person moves; (b) If the Person is in the hospital or nursing home; or (c) Death of the Person. |
| R539-5-5. Employee Requirements |
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(1) All Employees hired by the Person must be 16 years of age or older. Employees under age 18 must have the Employee Agreement co-signed by their parent/Guardian. (2) Parents, Guardians, or step-parents shall not be paid to provide services to the Person, nor shall an individual be paid to provide services to a spouse with the exception that spouses who were approved by the Division to provide reimbursed support for a Person in a non-Medicaid funded program prior to May 17, 2005 may continue to be reimbursed. This exception is only valid for support of the current spouse receiving Division services and shall not be allowed by the Division in the event that the spouses divorce or if one spouse dies. A spouse who is approved by the Division to provide support under this provision is limited to a maximum of $15,000 during the State Fiscal year, which begins on July 1st and ends the following year on June 30th. (3) Employees must complete the following prior to working with the Person and receiving payment from the Fiscal Agent: (a) Complete and sign Form W-4; (b) Complete and sign Form I-9 (including supporting documentation); (c) Complete and sign the Employee Agreement Form; (d) Read and sign the Department and Division Code of Conduct (Department Policy 05-03 and Division Directive 1.20); and (e) Review the approved and prohibited Behavior Supports as identified in R539-3-10, the Support Book, and other best practice sources recommended by the Division, if applicable. Behavior Supports shall not violate R495-876, R512-202, Sections 62A-3-301 through 62A-3-321, and Sections 62A-4a-402 through 62A-4-412 prohibiting abuse. (f) Review the Person's Support Book. (g) Complete any screenings and trainings necessary to provide for the health and safety of the Person (i.e., training for any specialized medical needs of the Person). (h) If applicable, be trained on the Person's Behavior Support Plan. (i) Complete and sign the Application for Certification Form. |
| R539-5-6. Incident Reports |
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(1) The Person or Representative shall notify the Division by phone, email, or fax of any reportable incident that occurs while the Person is in the care of an Employee, within 24 hours of the occurrence. (2) Within five business days of the occurrence of an incident, the Person or Representative shall complete a Form 1-8, Incident Report, and file it with the Division. (3) The following incidents require the filing of a report: (a) Actual and suspected incidents of abuse, neglect, exploitation, or maltreatment per the DHS/DSPD Code of Conduct and Sections 62-A-3-301 through 321 for adults and Sections 62-4a-401 through 412 for children; (b) Drug or alcohol abuse; (c) Medication overdoses or errors reasonably requiring medical intervention; (d) Missing Person; (e) Evidence of seizure in a Person with no seizure diagnosis; (f) Significant property destruction (Damage totaling $500.00 or more is considered significant); (g) Physical injury reasonably requiring a medical intervention; (h) Law enforcement involvement; (i) Use of mechanical restraints, time-out rooms or highly noxious stimuli that is not outlined in the Behavior Support Plan, as defined in R539-4; or (j) Any other instances the Person or Representative determines should be reported. (4) After receiving an incident report, the Support Coordinator shall review the report and determine if further review is warranted. |
| R539-5-7. Service Delivery Methods |
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(1) Persons authorized to receive Self-Administered Services may also receive services through a Provider Agency in order to obtain the array of services that best meet the Person's needs. |
| R539-5-8. Limitation |
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(1) The amount allowed for direct services (all self- administered services are allowed other than Fiscal Management) is limited to no more than $50,000 for each fiscal year. If a Self-Administered Services program exceeds this amount the method of service delivery must change to either a contracted provider service delivery method or a combination of Self-Administered Services and contracted provider service delivery method. If it is determined by the Division that a contracted provider service delivery method is not possible, the Division Director can grant a waiver to the cost limit for a Self-Administered method of service delivery. |