Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-61

Home and Community-Based Services Waivers

Notice of Proposed Rule

(Amendment)

DAR File No.: 34034
Filed: 09/01/2010 09:47:19 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this amendment is to incorporate by reference changes to the Waiver for Technology Dependent/Medically Fragile Individuals, and changes to the Waiver for Individuals with Acquired Brain Injuries.

Summary of the rule or change:

This amendment incorporates by reference changes to the Waiver for Technology Dependent/Medically Fragile Individuals, effective 07/01/2008. One of these changes clarifies that the Division of Medicaid and Health Financing is responsible for the administration and operation of the waiver program. The waiver also clarifies that the Maternal and Child Health Title V Agency provides essential day-to-day administrative support for the waiver under an interagency memorandum of agreement. The waiver also adds an existing interagency memorandum of agreement between the Long Term Care Bureau and the Bureau of Health Facility Licensing, Certification and Residence Assessment. It further prioritizes admission criteria for applicants dependent on Bi-level Positive Airway Pressure (Bi-PAP), increases the number of recipients who may receive waiver services, adds reserved capacity slots for terminally ill children, and adds new family directed services that include financial management services, family directed support services, and family directed skilled nursing respite care services. In addition, the waiver adds home health certified nursing assistant services to allow these services to be provided on the same day and during the same time as home health agency nursing services. It also adds extended private duty nursing services for recipients when they reach the age of 21. Further, the waiver replaces the service of nutritional evaluation and in-home based treatment with in-home feeding therapy, and amends the current provider qualifications to add individual licensed speech therapists and occupational therapists. It also limits qualified Medicaid and Medicare certified home health agency employees to the same licensed professionals and eliminates the service of in-home respiratory care. This amendment also incorporates by reference changes to the Waiver for Individuals with Acquired Brain Injuries, effective 07/01/2009. These changes include several additional services such as occupational therapy, speech therapy, cognitive retraining, physical therapy, environmental adaptations, specialized medical equipment and supplies, and living start up costs. Previously unbundled services that remain available and are unbundled at this time include behavior consultation, professional medication monitoring, personal budget assistance, residential habilitation services, extended living supports, and supported living. In addition, changes in the waiver application for home and community-based services allow the Department to explain quality improvement strategies in greater detail in relation to participant direction of services, participant rights, participant safeguards, and systems improvements.

State statutory or constitutional authorization for this rule:

• Section 26-1-5
• Section 26-18-3

This rule or change incorporates by reference the following material:

• Updates Waiver for Individuals with Acquired Brain Injuries, published by Division of Medicaid and Health Financing, 07/01/2009
• Updates Waiver for Technology Dependent/Medically Fragile Individuals, published by Division of Medicaid and Health Financing, 07/01/2008

Anticipated cost or savings to:

the state budget:

The Department estimates that annual service expenditures under the Waiver for Technology Dependent/Medically Fragile Individuals increased $38,000 (state funds) in the first year as a result of the service changes in the waiver changes. In addition, the Department estimates a cost increase of $90,000 (state funds) in the first year of the waiver renewal for the Waiver for Individuals with Acquired Brain Injuries. The state funds for this program are seeded by the Department of Human Services.

local governments:

There is no impact to local governments because they do not fund or provide waiver services for Medicaid clients.

small businesses:

The Department estimates that Medicaid providers will receive $126,667 (state and federal funds) in increased revenue annually under the Waiver for Technology Dependent/Medically Fragile Individuals. In addition, the Department estimates Medicaid providers will receive $300,000 (state and federal funds) in increased revenue annually under the Waiver for Individuals with Acquired Brain Injuries.

persons other than small businesses, businesses, or local governmental entities:

The Department estimates that Medicaid providers will receive $126,667 (state and federal funds) in increased revenue annually under the Waiver for Technology Dependent/Medically Fragile Individuals. In addition, the Department estimates Medicaid providers will receive $300,000 (state and federal funds) in increased revenue annually under the Waiver for Individuals with Acquired Brain Injuries.

Compliance costs for affected persons:

There are no compliance costs because there are only increases in revenue for all Medicaid providers. In addition, these changes only result in savings to Medicaid clients.

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

This update to the rule will generate additional revenue to providers as waiver services are marginally increased.

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
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:

10/15/2010

This rule may become effective on:

10/22/2010

Authorized by:

David Sundwall, Executive Director

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

R414-61. Home and Community-Based Services Waivers.

R414-61-1. Introduction and Authority.

(1) This rule establishes authority for the Department of Health to administer all Section 1915(c) waivers.

(2) The rule is authorized by Section 26-18-3 and Section 1915(c) of the Social Security Act.

 

R414-61-2. Incorporation by Reference.

The Department incorporates by reference the following home and community-based services waivers:

(1) Waiver for Technology Dependent/Medically Fragile Individuals, [E]effective July 1, 200[3]8;

(2) Waiver for Individuals Age 65 or Older, [E]effective July 1, 2005;

(3) Waiver for Individuals with Acquired Brain Injuries, [E]effective July 1, 200[4]9;

(4) Waiver for Individuals with Physical Disabilities, [E]effective July 1, 2006;

(5) Community Supports Waiver for Individuals with Intellectual Disabilities and Other Related Conditions, [E]effective July 1, 2005;

(6) New Choices Waiver, [E]effective April 1, 2007.

These documents are available for public inspection during business hours at the Utah Department of Health, Division of Medicaid and Health [Care] Financing, located at 288 North 1460 West, Salt Lake City, UT, 84114-3102.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [June 26, 2007]2010

Notice of Continuation: February 24, 2010

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