Current through Bulletin 2024-18, September 15, 2024
(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.
