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