Utah Admin. Code R539-1-10 - Graduated Fee Schedule

Current through Bulletin 2022-07, April 1, 2022

(1) Pursuant to Subsections 62A-5-105(2)(b) and (c) the division establishes a graduated fee schedule.
(2) The graduated fee schedule applies to any person determined ineligible for a Medicaid waiver.
(a) A person offered waiver enrollment that does not meet financial eligibility for Medicaid benefits as determined by the Department of Workforce Services.
(b) A person offered waiver enrollment that does not meet waiver level of care as determined by the division.
(c) Except a person determined ineligible for a Medicaid waiver who receives only the state match rate as described in Section R539-1-9.
(3) Each person offered waiver enrollment must apply for a determination of financial eligibility for Medicaid benefits within 30 days of the offer.
(a) If the person meets waiver level of care, the division shall submit a Form 927 requesting a determination of financial eligibility.
(b) If the person does not meet waiver level of care, the person shall:
(i) apply for state plan Medicaid; and
(ii) provide the support coordinator with the financial determination letter within 10 days of receipt of the determination.
(c) Noncompliance results in a funding reduction as described in Section R539-1-9.
(4) A person determined ineligible for a Medicaid waiver shall submit to the division a Graduated Fee Assessment Form 2-1G to report the following information:
(a) cash assets;
(b) annual gross income; and
(c) number of family members living together.
(5) The Form 2-1G shall be reviewed at the annual planning meeting.
(a) The person shall return a Form 2-1G to the support coordinator before delivery of a new service.
(b) A person receiving a service must return a completed and signed Form 2-1G to their support coordinator within 60 days of receiving notice of this rule.
(c) Noncompliance results in a funding reduction as described in Section R539-1-9.
(6) The person's available income determines the fee percent assessed.
(a) Available income shall be calculated using the formula (cash assets + annual gross income)/the total number of family members living together.
(b) The annual fee amount shall be calculated by multiplying available income by the fee percent.
(i) No fee shall be assessed if available income is less than 300% of the federal poverty guideline.
(ii) A 1% fee shall be assessed if available income is between 300% and 399% of the federal poverty guideline.
(iii) A 2% fee shall be assessed if available income is between 400% and 499% of the federal poverty guideline.
(iv) A 3% fee shall be assessed if available income is more than 500% of the federal poverty guideline.
(c) An assessed fee shall not exceed 3% of a person's available income.
(d) The division incorporates by reference the 2021 annual poverty guidelines updated periodically in the Federal Register by the U.S. Department of Health and Human Services under the authority of 42 U.S.C. 9902(2).
(7) Only one fee shall be assessed per family, regardless of the number of children in the family receiving services.
(a) A person ineligible for a Medicaid waiver who is younger than 18 years of age shall be assessed a fee based upon the parent's annual gross income and cash assets.
(b) A person ineligible for a Medicaid waiver who is 18 years of age or older shall be assessed a fee based upon individual annual gross income and cash assets.
(8) If a fee is assessed, the person shall pay the Division of Services for People with Disabilities or designee the total amount assessed.
(a) A person may submit a monthly prorated payment of 1/12 of the assessed fee amount.
(b) Payment shall begin the month after the division sends notice of the assessed fee amount to the person.
(c) Payment must be submitted before the last day of each month.
(9) If the person fails to pay the fee for six months, the division may reduce the person's annual funding from the next fiscal year to recover the amount due.
(10) If a person can show good cause as to why the fee cannot be paid, the division director may grant an exception on a case-by-case basis.

Notes

Utah Admin. Code R539-1-10
Amended by Utah State Bulletin Number 2016-22, effective 10/25/2016 Amended by Utah State Bulletin Number 2020-08, effective 4/8/2020 Amended by Utah State Bulletin Number 2020-22, effective 11/9/2020 Amended by Utah State Bulletin Number 2022-05, effective 2/22/2022

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