Utah Admin. Code R539-1-6 - Services for People with Brain Injury

Current through Bulletin 2022-07, April 1, 2022

(1) The division shall only offer services for a brain injury to an eligible applicant with a disability as defined in Subsections 62A-5-101(3) and 62A-5-101(9). Applicants with an intellectual disability or related condition are ineligible for brain injury services.
(2) An eligible applicant must meet the following requirements:
(a) have a documented qualifying acquired neurological brain injury from a licensed physician;
(b) be 18 years of age or older;
(c) have three or more functional limitations;
(d) score between 36 and 136 on the Comprehensive Brain Injury Assessment Form 4-1; and
(e) be a resident of the state.
(3) Functional limitations are defined as:
(a) "Memory" or "Cognition" means an applicant's brain injury resulted in a substantial problem with recall of information, concentration, attention, planning, sequencing, executive level skills, or orientation to time and place.
(b) "Activities of daily life" means an applicant's brain injury resulted in substantial dependence on another individual to move, eat, bathe, toilet, shop, prepare a meal, or pay a bill.
(c) "Judgment" and 'Self-protection" means the applicant's brain injury resulted in substantial limitation of the ability to:
(i) provide personal protection;
(ii) provide a necessity including food, shelter, clothing, mental health care, or any other health care;
(iii) obtain a service necessary for health, safety, or welfare; or
(iv) comprehend the nature and consequence of remaining in a situation of abuse, neglect, or exploitation.
(d) "Control of emotion" means the applicant's brain injury resulted in substantial limitation of the ability to regulate mood, anxiety, impulsivity, agitation, or socially appropriate conduct.
(e) "Communication" means the applicant's brain injury resulted in substantial limitation in language fluency, reading, writing, comprehension, or auditory processing.
(f) "Physical health" means the applicant's brain injury resulted in substantial limitation of the normal process and working of the human body.
(g) "Employment" means the applicant's brain injury resulted in substantial limitation in obtaining and maintaining a gainful occupation without ongoing 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 eligibility documentation.
(b) The division shall keep eligibility documentation in the applicant's electronic record.
(5) The division shall use the following documents to determine eligibility:
(a) documentation of a qualifying acquired brain injury diagnosis signed by a licensed physician;
(b) Comprehensive Brain Injury Assessment Form 4-1, Sections A through L; and
(c) Brain Injury Social History Summary Form 824L completed within one year of the date of application;
(6) An applicant shall submit to the division the documentation needed to determine eligibility.
(a) If needed documentation is not submitted within 90 days of initial contact, the division shall change the intake case status to inactive and send the applicant written notification of an intake status change to inactive.
(b) An applicant may reactivate the intake case by submitting any eligibility 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 R539-1-6 does not apply to an applicant who meets the eligibility criteria for intellectual disability and related conditions or physical disability as described in Sections R539-1-4 and R539-1-5, respectively.

Notes

Utah Admin. Code R539-1-6
Amended by Utah State Bulletin Number 2016-22, effective 10/25/2016 Amended by Utah State Bulletin Number 2017-22, effective 10/23/2017 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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