Utah Admin. Code R539-1-4 - Services for People with Intellectual Disabilities or Related Conditions

Current through Bulletin 2022-07, April 1, 2022

(1) The division shall only offer services for an intellectual disability or a related condition to an eligible applicant with a disability as defined in Subsection 62A-5-101(9).
(2) An eligible applicant must meet the following requirements:
(a) have a diagnosed intellectual disability or related condition as defined in Subsection 62A-5-101(9) and Section R414-502-8;
(b) have three or more functional limitations; and
(c) be a resident of the state.
(3) Functional limitations are defined as:
(a) "Self-care" means an applicant requires assistance, training, or supervision with eating, dressing, grooming, bathing, or toileting.
(b) "Expressive and receptive language" means an applicant:
(i) lacks functional communication skills;
(ii) requires the use of an assistive device to communicate;
(iii) does not demonstrate an understanding of requests; or
(iv) cannot follow a two-step instruction.
(c) "Learning" means an applicant has a valid diagnosis of intellectual disability based on the criteria found in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders DSM-5 (2013), incorporated by reference.
(d) "Mobility" means an applicant:
(i) requires the use of assistive devices for mobility; and
(ii) cannot self-evacuate from a building during an emergency without the assistive device.
(e) "Capacity for Independent Living" means the following:
(i) A minor applicant, at least seven years of age, cannot:
(A) locate and use a telephone;
(B) cross a street safely; or
(C) understand that it is not safe to accept a ride, food, or money from a stranger.
(ii) An adult applicant who lacks basic survival skills in the areas of shopping, preparing food, housekeeping, or paying a bill.
(f) "Self-direction" means an applicant is:
(i) unable to provide informed consent for medical care, personal safety, legal matters, financial matters, habilitative care, or residential matters;
(ii) declared legally incompetent;
(iii) a significant danger to self or any other individual without supervision; or
(iv) a minor applicant, at least seven years of age, significantly at risk in making an age appropriate decision.
(g) "Economic self-sufficiency" means an adult applicant:
(i) receives disability benefits; and
(ii) cannot work more than 20 hours a week or is paid less than minimum wage without employment support.
(4) The division determines eligibility.
(a) The division shall determine if an applicant is eligible for non-waiver services within 90 days of receiving needed documentation.
(b) To determine functional limitations for an applicant aged seven years or older, the division shall consider age appropriate ability.
(c) The division shall keep eligibility documentation in the applicant's electronic record.
(5) The division shall use the following documents to determine eligibility:
(a) Eligibility for Services Form 19 or Eligibility for Services Form 19C for a child younger than seven years of age;
(b) an assessment of functional limitations and need;
(c) a social history of the applicant completed within one year of the date of application;
(d) a psychological evaluation or a developmental assessment for a child younger than seven years of age; and
(e) supporting documentation for each eligibility requirement. Supporting documentation includes mental health assessment, educational record, neuropsychological evaluation, and medical healthcare visit summary.
(6) An applicant shall submit to the division the supporting documentation needed to determine eligibility.
(a) If needed supporting documentation is not submitted within 90 days of initial contact, the division shall change the intake case status to inactive. The division shall send the applicant written notification of an intake status change to inactive.
(b) An applicant may reactivate the intake case by submitting any needed supporting documentation.
(c) An applicant must update eligibility documentation as needed.
(7) The division shall notify an applicant of the eligibility determination by mailing a Notice of Agency Action Form 522-I and a Hearing Request Form 490S.
(a) The Notice of Agency Action Form 522-I indicates:
(i) the eligibility determination; and
(ii) placement on the waiting list, when applicable.
(b) An applicant may challenge the eligibility determination by filing a written request for an administrative hearing before the Department of Human Services, Office of Administrative Hearings.
(8) The division shall annually re-determine eligibility for each person receiving a service. If a person receiving a service is determined to be ineligible, the division shall develop a transition plan to discontinue each service that ensures any health and safety need is met.
(9) A person who receives a non-waiver service may have their non-waiver service package reduced or terminated because of:
(a) a division budget shortfall;
(b) a reduced legislative allocation; or
(c) a reevaluation of eligibility.
(10) Section R539-1-4 does not apply to an applicant who meets the eligibility criteria for physical disability or brain injury as described in Sections R539-1-5 and R539-1-6, respectively.

Notes

Utah Admin. Code R539-1-4
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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