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