DAR File No. 30917

Health, Health Care Financing, Coverage and Reimbursement Policy

R414-510

Intermediate Care Facility for Individuals with Mental Retardation Transition Program

NOTICE OF PROPOSED RULE

DAR File No.: 30917
Filed: 01/15/2008, 04:17
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

This amendment is necessary to change the title of the "Community Based Services Waiver for Individuals with Mental Retardation and Other Related Conditions" to the "Community Based Services Waiver for Individuals with Intellectual Disabilities and Other Related Conditions." This amendment also allows eligible spouses, when both reside in a Utah Intermediate Care Facility for the Mentally Retarded (ICF/MR) transition program, the opportunity to participate together in the ICF/MR.

Summary of the rule or change:

This amendment changes the title for the ICF/MR of the waiver for the transition program, and allows eligible spouses residing in an ICF/MR to participate in the ICF/MR waiver transition program.

State statutory or constitutional authorization for this rule:

Sections 26-18-3, 26-1-5, and 62A-5-102; 42 CFR 440.225; and Section 1915(c) of the Social Security Act

Anticipated cost or savings to:

the state budget:

The budget impact is uncertain because the number of eligible spouses who would qualify is rare. In the ten years that this program or a similar program has been in effect, only one spouse has qualified at a $20,428.67 annual cost. The costs would be covered under general Medicaid appropriations.

local governments:

There is no budget impact because local governments do not fund or receive ICF/MR services.

small businesses and persons other than businesses:

There is no budget impact to other persons and small businesses because recipients will continue to receive service and providers will continue to receive payment. There is no budget impact to small business as open beds will immediately be filled by Medicaid recipients on the waiting list. It is estimated that less than one eligible spouse per year may qualify.

Compliance costs for affected persons:

There are no compliance costs because a person will transfer ICF/MR Medicaid coverage to the transition waiver.

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

No negative fiscal impact on business is expected, but will be finally evaluated after public 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 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:

03/03/2008

This rule may become effective on:

03/10/2008

Authorized by:

David N. Sundwall, Executive Director

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

R414-510. Intermediate Care Facility for Individuals with Mental Retardation Transition Program.

R414-510-1. Introduction and Authority.

(1) This rule implements the Intermediate Care Facility for Individuals with Mental Retardation (ICF/MR) Transition Program. Program participation is voluntary and allows an individual to transition out of an ICF/MR into the Community Supports Waiver for Individuals with [Mental Retardation]Intellectual Disabilities and Other Related Conditions Home and Community-Based Services (HCBS) Waiver Program.

(2) This rule is authorized by Section 26-18-3. Waiver services for this program are optional and provided in accordance with 42 CFR 440.225.

 

R414-510-3. Program Access Requirements.

(1) Legislative appropriations determine the number of participants selected in the particular year for placement in the program.

(2) Upon new legislative appropriation for the program, the Department announces an open application period for accepting applications.

(3) After the open application period, the Department places the name of each applicant on both a longevity list and a random list. On the longevity list, the Department ranks each applicant according to length of consecutive stay in an ICF/MR in Utah. On the random list, the Department randomly ranks each applicant based on a computerized random selection.

(4) The Department takes evenly from the longevity list and the random list for placement in the Community Supports Waiver for Individuals with [Mental Retardation]Intellectual Disabilities and Other Related Conditions [Home and Community-Based Services]HCBS Waiver Program. If the Legislature funds an odd number of program participants, the Department places one additional individual from the longevity list.

(5) If an applicant is selected for transition and has a spouse who also resides in a Utah ICF/MR and who meets the eligibility criteria in Section R414-510-2, the Department shall provide an additional slot for the spouse to participate in the transition program without affecting the number of available slots from the longevity and random lists.

([5]6) Once the Department places individuals into the program for the year's appropriation, the longevity and random lists are retired and no longer used. The Department makes no new placements into the program to replace individuals who leave the program for whatever reason.

([6]7) As the Legislature makes new appropriations for the program, the Department creates new longevity and random lists for each new appropriation and selects individuals for the program as described in subsections (2) through (4).

 

R414-510-4. Service Coverage.

This rule incorporates by reference the services and limitations found in the Medicaid 1915(c) [Home and Community Based]HCBS Services Waiver and the Community Supports Waiver for Individuals with [Mental Retardation]Intellectual Disabilities and Other Related Conditions, State Implementation Plan, Effective July 1, 2005.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [January 17, 2007]2008

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