1. (1) Waiver services are available to an individual who:

   1. (a) receives ICF benefits under the Medicaid State Plan;
   2. (b) has been diagnosed with an intellectual disability or a related condition;
   3. (c) meets ICF level-of-care criteria defined in Section R414-502-8;
   4. (d) meets state funding eligibility criteria for DSPD found in Subsection 26B-6-402(6); and

   5. (e) has at least a 365-day length-of-stay in one, or any combination of, the following within the state:

      1. (i) a Medicaid-certified ICF;
      2. (ii) a nursing facility;
      3. (iii) a hospital; or
      4. (iv) a 1915(c) HCBS waiver program.

2. (2) The department may allow an exception to the requirements in Subsection (1)(e) if:

   1. (a) there is a closure of an ICF where an individual resides;
   2. (b) an individual mutually consents to transition into HCBS to the same residential provider with a sibling residing in an ICF who meets the 365-day length-of-stay requirement;
   3. (c) a physician finds that continued ICF placement would exacerbate an individual's physical condition and a nurse with the department assesses that HCBS is appropriate through a health need assessment;
   4. (d) a licensed mental health professional finds that continued ICF placement would exacerbate an individual's mental health condition and a nurse with the department assesses that HCBS is appropriate through a health heed assessment;
   5. (e) Adult Protective Services (APS), Child Protective Services (CPS), the Office of Licensing (OL), or law enforcement substantiate evidence of abuse, neglect, or exploitation of an individual who resides in an ICF;

   6. (f) a transition program employee within the department assesses that abuse, neglect, or exploitation occurred through a reasonable person standard that requires:

      1. (i) direct observation; and
      2. (ii) findings of facts that define abuse, neglect, or exploitation; or

   7. (g) an individual mutually consents to transition into HCBS to the same residential provider with another individual who:

      1. (i) has already met the 365-day length-of-stay requirement;
      2. (ii) has an agreement with the individual that communicates a special bond or relationship; and
      3. (iii) the preferred HCBS residential provider cannot hold an available placement to accommodate the individual who has not yet met the 365-day length-of-stay requirement.
3. (3) To request an exception for a reason in Subsections (2)(b) through (g), an individual or representative shall submit a written request to the department with the rationale for the request, including the anticipated risk if the individual remains in the ICF.
4. (4) Within ten business days of receiving the request, the department shall provide a written determination of approval or denial, made in concurrent agreement with the administrators responsible for waiver oversight at DIH and DSPD.

KEY: Medicaid

Date of Last Change: June 24, 2026

Notice of Continuation: September 14, 2021

Authorizing, and Implemented or Interpreted Law: 26B-3-108; 26B-6-402