Utah Admin. Code R539-12-5 - Budget Adjustment

(1) Except as described in Section R539-12-6, a support coordinator shall submit any budget adjustment to the committee for review and approval before changing a person-centered budget. A budget adjustment includes:

(a) an increase or decrease to a plan total;

(b) adding or removing a service in a person-centered budget; or

(c) an increase or decrease to a restricted service code.

(2) A voting committee member shall review each request for services as described in Subsection R539-12-3(1) within 14-days of the date of submission.

(a) The voting committee member must review each supporting document included in the request for services.

(b) The voting committee member must use the criteria for each service code included in the request to evaluate the request for services.

(c) The voting committee member may submit any request for services to the committee for additional review.

(3) A voting committee member or the committee may defer a decision on a request for services.

(a) A voting committee member or the committee may use a deferral to:

(i) clarify the narrative explanation;

(ii) request additional documentation; or

(iii) clarify the requested number of units or reimbursement rate for a service code.

(b) A support coordinator must respond to a deferred request for services within 30 days of the date of deferral.

(4) A voting committee member or the committee may use the modified approval to adjust the number of units or reimbursement rate for a requested service.

(5) A voting committee member or the committee shall deny a request for services that:

(a) does not meet the service criteria;

(b) requests an excessive amount of a service;

(c) requests an amount of service that is not supported by documentation; or

(d) the described use of a service code, number of units, or reimbursement rate does not comply with:

(i) federal Medicaid law and state law;

(ii) the state implementation plan for the 1915c Medicaid waiver; and

(iii) each scope of work and service description requirement in the contract.

(6) A support coordinator may submit an emergency request for services if a person in-service is in immediate jeopardy and needs the service change within 72 hours of the request submission date.

(a) The support coordinator may request units of service equal to or less than 30 days of service. The units of service must be used within a 30-day period beginning on the effective start date.

(b) The committee chair shall review an emergency request within 72 hours of the request submission date.

(c) The committee chair may approve an emergency request after determining that the person is in immediate jeopardy and requires a service change within 72 hours of the request submission date.

Notes

Utah Admin. Code R539-12-5

Adopted by Utah State Bulletin Number 2022-07, effective 3/25/2022