Utah Admin. Code R414-510-3 - Eligibility Requirements for the Transition Program

(1) Waiver services are available to an individual who:

(a) receives ICF benefits under the Medicaid State Plan;

(b) has been diagnosed with an intellectual disability or a related condition;

(c) meets ICF level-of-care criteria defined in Section R414-502-8;

(d) meets state funding eligibility criteria for DSPD found in Subsection 26B-6-402(6); and

(e) has at least a 12-month length-of-stay in any Medicaid-certified, privately owned ICF or nursing facility located in the state.

(2) The department allows break-in-stay exceptions for:

(a) inpatient hospitalization;

(b) admission to a nursing facility; or

(c) due to the closure of an ICF where an individual resides;

(3) The department may also allow break-in-stay exceptions:

(a) due to substantiated findings of abuse; and

(b) neglect or exploitation of an individual that occurred while residing in the current ICF.

(4) To request a length-of-stay exception for the reasons noted in Subsection (3)(a)(b), an individual or representative shall submit a written request to the department and include the rationale for the request, including the anticipated risk if the individual remains in the ICF.

(5) The department shall provide a written determination to approve or deny the request within ten business days of receiving it.

Notes

Utah Admin. Code R414-510-3

Amended by Utah State Bulletin Number 2015-20, effective 9/29/2015 Amended by Utah State Bulletin Number 2018-16, effective 7/27/2018 Amended by Utah State Bulletin Number 2019-15, effective 7/15/2019 Amended by Utah State Bulletin Number 2021-11, effective 5/12/2021 Adopted by Utah State Bulletin Number 2024-01, effective 1/1/2024