DAR File No. 27652

Human Services, Services for People with Disabilities

R539-3

Service Coordination

NOTICE OF PROPOSED RULE

DAR File No.: 27652
Filed: 01/14/2005, 08:38
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

The removal of this rule is proposed after a comprehensive revision of the Division's rules.

Summary of the rule or change:

This rule is being repealed and being replaced with two new rules. This rule is repealed in its entirety. (DAR NOTE: The two proposed new rules are: R539-2 entitled Service Coordination that is under DAR No. 27626, and R539-3 entitled Rights and Protections that is under DAR No. 27627. Both were published in the January 15, 2005, Bulletin.)

State statutory or constitutional authorization for this rule:

Sections 62A-5-102 and 62A-5-103

Anticipated cost or savings to:

the state budget:

None--This revision does not alter the basic operations or functions of the Division and, therefore, does not result in either a cost or savings to the state.

local governments:

None--Local government funding is not used. Therefore, there is no cost to local governments.

other persons:

None--This revision does not alter the basic operations or functions of the Division and, therefore, does not result in either a cost or savings to other persons.

Compliance costs for affected persons:

None--This revision does not alter the basic operations or functions of the Division and, therefore, does not result in either a cost or savings to affected persons.

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

None--This revision does not alter the basic operations or functions of the Division and, therefore, does not have an impact on businesses.

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

Direct questions regarding this rule to:

Suzie Totten at the above address, by phone at 801-538-4197, by FAX at 801-538-4279, or by Internet E-mail at stotten@utah.gov

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:

03/03/2005

This rule may become effective on:

03/04/2005

Authorized by:

Ron Stromberg, Acting Executive Director

RULE TEXT

R539. Human Services, Services for People with Disabilities.

[R539-3. Service Coordination.

R539-3-1. Waiting List.

A. Policy.

(1) The Division shall determine a Person's eligibility for service, followed by a determination of that Person's priority relative to others who are also eligible. Each region shall use a standardized Needs Assessment to score and prioritize the Person's level of need. Persons with the highest scores shall receive support first. The Support Coordinator shall assess with the Person or Representative the array of supports that may be needed. If funding is not immediately available, the Person will be placed on a waiting list for the support. Persons who have been determined eligible for the Division's Medicaid Waiver can choose to wait for Division Support services or seek services available through Medicaid in an Intermediate Care Facility for Persons with Mental Retardation (ICF/MR).

B. Procedures.

(1) If the Person requires support services on the day of intake, the Person has an immediate need.

(2) A Needs Assessment form 2-2 shall be completed for all Persons with an immediate need for support services. The Needs Assessment determines the score of each Person in accordance with subsection 62A-5-102(3)

(3) The region Needs Assessment committee determines the Person's score, rank orders the scores within each region to determine the order in which each Person receives funding, and enters the Person's name and score on the waiting list.

(4) A Person's ranking may change as Needs Assessments are completed for new applicants.

(5) A child, upon reaching age 16, who is in a school district special education program and meets all eligibility requirements for division services shall be entered on the waiting list as having a future need for supported employment or day training. No age limitations apply to a Person placed on the waiting list for Community Living Support or Family Support.

R539-3-2. Person-Centered Process.

(1) The Division supports Person-Centered Planning, which includes assessing, planning, implementing, and evaluating. This process must have an individualized focus and incorporates the principles of Person-Centered Planning, self-determination, informed choice, and equity. Input from the Person and the Person's Team should guide and direct this process.

(a) The Person's Team will work with the Person to identify goals.

(i) The Person receiving supports or the Person's Representative determines the membership of the Team, which will include the Support Coordinator.

(ii) The Team meets at least annually (within twelve months of last meeting), or more often as the Person or other members of the Team determine necessary.

(b) The Person, Provider, and Family will assess, plan, implement and evaluate goals and supports for which they are responsible, as agreed upon and listed on the Action Plan Form 1-16 in the planning meeting.

(c) The Team shall decide the level of detail required to describe the actions involved in the assessing, planning, implementing and evaluating needed for the supports based on the experience and expertise of the staff providing the Person's supports. The use of the philosophical Person-Centered Planning approach will be demonstrated and documented in the Person's file.

(d) If any interested party believes that Person-Centered Planning is not being implemented as outlined or receives a request from the Person/Representative, they should contact the Support Coordinator immediately to resolve the issue informally and, if necessary, through the formal resolution process outlined in R539-2-5 Notice and Hearings for Service Changes and R539-3-4 Discharge and R539-3-5 Consumer Placement Review.

R539-3-3. Referral to Services.

A. Procedures.

1. Referrals for services are made by the case manager to established providers of service in the following fashion:

a. The individual and legal representative select a service with the case manager.

b. A referral packet with current information is submitted to the identified service provider.

c. The Provider will schedule a placement meeting. The purchase of service provider will coordinate the placement meeting, which consists of the person with disabilities, legal representative (advocate), case manager(s), and other relevant members, including the Utah State Developmental Center staff, education representative for school-age individuals, and Division staff. The meeting should be held at the prospective site of placement whenever possible. The prospective Provider shall chair the meeting.

2. The prospective Provider will submit an acceptance or denial letter within ten working days to the case manager(s), person with disabilities, and legal representative. The referral file contents of a person denied for services will be returned to the case manager.

a. An acceptance letter shall include a written description of the following:

(1) services to be provided.

(2) location of the service.

(3) name and address of the primary care physician or other medical specialists, including, for example, neurologist or dentist.

(4) a training and in-service schedule for the staff to meet with the admitted person.

(5) proposed date of admission.

b. A denial letter shall include a written description of the specific reason for the denial. The letter will be submitted with the returned file.

c. A copy of the denial or acceptance letter will be submitted to the Director of Planning and Program Development and the Chairperson of the Community Based Committee.

3. Admission to Division programs from a Nursing Facility under OBRA 1987 will be coordinated by the OBRA specialist at the Division with the nursing facility social worker, the case manager, the prospective provider, and the person with disabilities.

4. The physical move to a receiving residential facility will be the responsibility of the Provider who submits the billing as the first day of service or last day as negotiated with the new Provider.

R539-3-4. Discharge.

A. Policy.

1. Any interested member of the interdisciplinary team who recommends that a recipient be discharged or may benefit from service change shall contact the individual's case manager.

B. Procedures.

1. In the event that a request for discharge is received, the DSDP case manager shall arrange with the Provider for a discharge meeting. The following people shall be invited to attend:

a. The individual with disabilities.

b. Legal representative, as appropriate.

c. DSDP case manager.

d. Provider, teacher.

e. Receiving agency, as appropriate.

2. Topics in the discharge meeting shall include at a minimum:

a. A detailed discussion of the recipient's progress and current status in the program.

b. Specific reasons for the request for discharge outlined by the individual initiating the request.

3. Consensus decision must be reached regarding discharge from a program (see R539-2-5, Notice and Hearings). The decision shall be documented in the Individual Program Plan.

4. If the decision is to discharge an individual, a discharge summary shall be completed prior to the actual date of such action. A discharge summary shall be written by the Provider to include:

a. Reason for termination.

b. Summary of services provided.

c. Evaluation of strengths and needs; achievement of goals and objectives.

d. Signature and title of Provider preparing the summary.

5. The written summary will be sent to the receiving case manager, client and legal representative, discharging case manager, and provider within ten days of the person's last day of service.

6. A Provider may not request discharge of a person who has been identified by the Division as "zero reject", that is an individual with severe challenges, without 90 days notice.

R539-3-5. Consumer Placement Review.

A. Policy.

It is the intent of the Division of Services for People with Disabilities that service providers shall offer programs that best meet the needs of individuals with disabilities, and promote a sufficient choice of service options for individuals and legal representatives to consider. An existing provider of services, therefore, will have the opportunity to proper notice and the opportunity to resolve concerns regarding services to a consumer.

B. Procedures.

1. The recipient of services or legal representative must be notified in writing of all actions taken pursuant to the above process, must be invited to all meetings to discuss individual services, and must receive notice of final resolution within 30 working days of the first meeting of the Individual Program Plan team to discuss the issue.

2. If a review is requested by the service provider, it must be made in writing to the appropriate Region Supervisor or Director within ten working days of the Individual Program Plan team meeting. Except in an emergency or unless requested by the individual or legal representative, services will continue unchanged during the review process. It is the responsibility of the Region Supervisor or Director to attempt to resolve the disagreement.

3. If the issue is not resolved to the services provider's satisfaction, a subsequent joint review by the Division Director and Region Director may be requested in writing by the service provider within 20 days of the date of the original Individual Program Plan meeting.

4. Providers may pursue their right to a formal hearing with the Department of Human Services via the Utah Administrative Procedures Act.

R539-3-6. Targeted Case Management.

A. Policy

The Division of Services for People with Disabilities will provide Targeted Case Management for people with disabilities who are eligible in accordance with R414-33. Targeted Case Management is available only to individuals eligible for Division services who are also eligible for Medicaid. Pending a change in the state Medicaid Plan, only individuals under the age of 21 are eligible for Targeted Case Management. Individuals receiving case management services under the Home and Community-Based Waiver are not eligible.

B. Procedures

Documentation of eligibility will include a form 19 (Eligibility for Services), an Inventory for Client and Agency Planning (documenting the need for targeted case management services), and verification the individual is eligible for Medicaid.

R539-3-7. Individual Family Support Plan.

A. Policy.

An Individual Family Support Plan will be developed for all individuals receiving family support services funded by the Division. These services are provided to help support a family in keeping a relative with a disability at home.

B. Procedures.

1. The Individual Family Support Plan will be developed by the family, the region case manager and the providers within 30 days following approval for service.

2. It is the responsibility of the agency provider to write the portion of the Plan document regarding the supports and services they will provide.

KEY: social services, disabled persons

May 20, 2003

Notice of Continuation September 6, 2002

62A-5-103]

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For questions regarding the content or application of this rule, please contact Suzie Totten at the above address, by phone at 801-538-4197, by FAX at 801-538-4279, or by Internet E-mail at stotten@utah.gov

For questions about the rulemaking process, please contact the Division of Administrative Rules (801-538-3764). Please Note: The Division of Administrative Rules is NOT able to answer questions about the content or application of these administrative rules.