Utah Admin. Code R539-1-7 - Eligibility and Enrollment
(1) Matching
federal funds may be available through an HCBS waiver.
(a) A person shall meet financial eligibility
for Medicaid benefits as determined by the Department of Workforce
Services.
(b) A person shall meet a
waiver level of care as determined by the division.
(i) Pursuant to Rule R414-502, the department
may find a person meeting nursing facility level of care eligible for funding
through the:
(A) Acquired Brain Injury
Waiver;
(B) Limited Supports
Waiver; or
(C) Physical
Disabilities Waiver.
(ii) The department may find a person meeting
intermediate care facility level of care eligible for funding through the:
(A) Community Supports Waiver;
(B) Community Transitions Waiver;
or
(C) Limited Supports
Waiver.
(c)
After ensuring the person meets the waiver level of care, the division shall
submit a Form 927 to the Department of Workforce Services requesting a
determination of financial eligibility.
(d) Noncompliance with Department of
Workforce Services eligibility determination process requirements shall result
in a funding reduction as described in Subsection
R539-1-8(3)
(2)
(a) The division shall use a need assessment
tool to determine a person's need score.
(b) The adjusted critical need score equals
the person's total critical need score minus the time spent waiting
component.
(3) Ordering
of each person's need score identifies the most critical need
ranking.
(4) Except as described in
Subsections R539-1-6(5) through
(8), the division determines waiver
enrollment by the most critical need ranking.
(5) Pursuant to Section
26B-6-402, the division
determines waiver enrollment in the Limited Supports Waiver by:
(a) offering enrollment in order of time
spent waiting; and
(b) identifying
a person through:
(i) an adjusted critical
needs score at or below the person's age group threshold; and
(ii) no immediate need for out-of-home
residential support services.
(6) A person shall be enrolled in the limited
supports waiver only if the person's assessed needs can be safely met within
the individual budget limit.
(7)
When authorized, pursuant to Section
R414-510-3, a person shall be
enrolled in the Community Transitions Waiver.
(8) The Emergency Services Management
Committee may approve enrollment in the:
(a)
Acquired Brain Injury Waiver;
(b)
Community Supports Waiver; or
(c)
Physical Disabilities Waiver.
(9) If the department determines that
sufficient funding is available, a person may receive a waiver service by
diverting a person from an ICF into the Community Supports Waiver.
(10)
(a)
Any person offered enrollment in an HCBS waiver may choose not to
participate.
(b) If an eligible
person chooses not to participate in a waiver, the person shall receive only
the state funded portion of their assessed needs.
Notes
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