DAR File No. 29543

Health, Health Care Financing, Coverage and Reimbursement Policy

R414-303-17

Personal Assistance Waiver for Adults with Physical Disabilities

NOTICE OF PROPOSED RULE

DAR File No.: 29543
Filed: 02/22/2007, 12:50
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

This amendment is necessary to change the way a spenddown is determined for individuals eligible for the Physical Disabilities Waiver to meet requirements set by the Centers for Medicare and Medicaid Services. It changes the calculation to match the way spenddown is calculated for non-waiver clients.

Summary of the rule or change:

In order to match the level of spenddown for non-waiver clients, this rule changes the level of spenddown for individuals eligible for the Physical Disabilities Waiver. This allows a Physical Disabilities Waiver client to retain income equal to the 100% federal poverty rate for one person instead of spending down to the basic maintenance standard. It also adds language to comply with the provisions of the Deficit Reduction Act of 2005, Pub. L. No. 109-171, that restrict waiver services when a person has over $500,000 in home equity.

State statutory or constitutional authorization for this rule:

Title 26, Chapter 18

This rule or change incorporates by reference the following material:

42 CFR 435.726, 435.832 and 435.217, 2006 ed.; Section 1915(c) of the Social Security Act, January 1, 2005

Anticipated cost or savings to:

the state budget:

There is no cost at this time because there are no waiver clients who pay a spenddown. Nevertheless, increasing the spenddown income limit could reduce the amount of spenddown the state may collect. There have never been more than two individuals who have had to spenddown to meet eligibility. Assuming that two individuals would spenddown under the amendments, the state would collect $10,440 less per year, which is split between federal and state funds. The reduction is the difference between the federal poverty rate and the basic maintenance standard, which is a difference of $435 a month per individual. The Department has no experience to estimate the impact of the $500,000 home equity limit as no client has had home equity at that level.

local governments:

There is no budget impact because local governments do not determine Medicaid eligibility and are not affected by the spenddown changes.

other persons:

Other persons will experience no savings because at this time there are no individuals who pay a spenddown on the Physical Disabilities Waiver. Nevertheless, the formula for aggregate savings is the difference between the 100% federal poverty rate and the basic maintenance standard times the number of individuals on the Physical Disabilities Waiver who must pay a spenddown. There have never been more than two individuals who have had to spenddown to meet eligibility. Assuming that two individuals would spenddown under the amendments, the individuals would collectively save $10,440 less per year. The reduction is the difference between the federal poverty rate and the basic maintenance standard, which is a difference of $435 a month per individual. The Department has no experience to estimate the impact of the $500,000 home equity limit as no client has had home equity at that level.

Compliance costs for affected persons:

There are no compliance costs because there are only savings for an individual who pays a spenddown on the Physical Disabilities Waiver.

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

This rule change is required by changes in federal policy. Fiscal impact should be minimal. 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:

Gayle M. Six or Craig Devashrayee at the above address, by phone at 801-538-6895 or 801-538-6641, by FAX at 801-538-6952 or 801-538-6099, or by Internet E-mail at gaylesix@utah.gov or cdevashrayee@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:

04/16/2007

This rule may become effective on:

04/24/2007

Authorized by:

David N. Sundwall, Executive Director

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

R414-303. Coverage Groups.

R414-303-17. [Personal Assistance]Physical Disabilities Waiver[ for Adults with Physical Disabilities].

(1) The Department adopts 42 CFR 435.726, 435.832 and 435.217, [2001]2006 ed., which are incorporated by reference. The Department adopts Title XIX of the Social Security Act, Section 1915(c) in effect January 1, [2001]2005, which is incorporated by reference.

(2) The Department operates this program statewide with a limited number of slots, and eligibility for this waiver is limited to individuals 18 years of age and over.

(3) The individual must meet non-financial criteria for Aged, Blind, or Disabled Medicaid.

(4) A client must qualify for a nursing home level of care. Eligibility is limited to those referred by the Division of Services to People with Disabilities and determined medically eligible by the Bureau of Medicare/Medicaid Program Certification and Resident Assessment.

(5) A client's resources must be equal to or less than $2000. The spousal impoverishment resource provisions for married, institutionalized clients in R414-305-3 apply to this rule.

(6) Countable income is determined using income rules of Aged, Blind, or Disabled Institutional Medicaid. All income is counted, unless excluded under other federal laws that exclude certain income from being counted to determine eligibility for federally-funded, needs-based medical assistance. After determining countable income, eligibility is determined counting only the gross income of the client.

(7) The client's income can not exceed three times the SSI benefit amount payable under Section 1611(b)(1) of the Social Security Act, except that individuals with income over this amount can spenddown to [the Medicaid Basic Maintenance Standard for a household of one.]become eligible. To determine the spenddown amount, the income rules for non-institutionalized aged, blind or disabled individuals in R414-304 apply except that income is not deemed from the client's spouse.

(8) Transfer of resource provisions described in R414-305-6 apply to this rule.

(9) The Department does not pay for waiver services when an individual has home equity that exceeds the limit set forth by the Deficit Reduction Act of 2005, Pub. L. 109-171.

(a) That limit is the minimum level allowed under the Deficit Reduction Act of 2005, Pub. L. 109-171.

(b) An individual who has excess home equity and meets eligibility criteria under a community Medicaid eligibility group is not disqualified from receiving Medicaid for services other than home and community-based waiver or nursing home services.

 

KEY: income, coverage groups, independent foster care adolescent

Date of Enactment or Last Substantive Amendment: [July 1, 2006]2007

Notice of Continuation: January 31, 2003

Authorizing, and Implemented or Interpreted Law: 26-18-3; 26-1-5