Health and Human Services

Integrated Healthcare

Rule R414-510: Intermediate Care Facility for Persons with Intellectual Disabilities Transition Program and Education

Effective Date: 06/24/2026

Admin. Code Reference: R414-510

Rule Type: Current Rule

R414. Health and Human Services, Integrated Healthcare.

R414-510. Intermediate Care Facility for Persons with Intellectual Disabilities Transition Program and Education.

R414-510-1. Introduction and Authority.

(1) This rule implements the Intermediate Care Facility for Persons with Intellectual Disabilities (ICF) transition program. The ICF transition program participation is voluntary and allows an individual to transition from a privately-owned ICF to the Community Transitions Waiver.

(2) This rule is authorized under Section 26B-3-108. Waiver services are optional and provided in accordance with 42 CFR 440.225.

R414-510-2. Definitions.

(1) "Department" means the Department of Health and Human Services.

(2) "Division of Integrated Healthcare (DIH)" means the division within the department that administers the Medicaid program.

(3) "Division of Licensing and Background Checks (DLBC)" means the entity within the department that licenses foster homes, child care facilities, human services programs, and health facilities.

(4) "Division of Services for People with Disabilities (DSPD)" means the entity within the department that has responsibility to plan and deliver an appropriate array of services and supports to persons with disabilities in accordance with Subsection 26B-6-402(2).

(5) "Education and in-reach (EI) staff" means staff employed by the department to provide individuals with information and resources to help them make informed decisions about where they want to receive their long-term services and supports.

(6) "Guardian" means an individual who is legally authorized to make decisions on an individual's behalf.

(7) "Healthcare decision-making" means decision-making as defined in Subsection 75-2a-103(12).

(8) "Home and community-based services (HCBS)" means person-centered care delivered in the home and community, designed to enable individuals to stay in their homes, rather than living in a facility for care.

(9) "Interested individual designation" means the status of an individual who resides in an ICF and expresses interest in participating in the ICF transition program.

(10) "ICF" means a privately owned intermediate care facility for individuals with intellectual disabilities.

(11) "Length-of-stay" means the length of time an individual has resided continuously in an ICF within the state. The department considers a continuous stay to include a stay in which an individual has a temporary break-in-stay of no more than 31 days.

(12) "Long-term services and supports (LTSS)" means a broad range of Medicaid- reimbursed assistance provided to individuals who experience difficulty completing self-care tasks as a result of an intellectual disability or related condition. LTSS may be provided in facilities or in HCBS settings.

(13) "Representative" means a person, who is not a legal guardian, but is identified as an individual who assists a potential transition program participant.

(14) "Transition worker" means a staff person employed by the department who is assigned to assist an individual who has expressed interest in moving into HCBS.

(15) "Supported decision-making (SDM) tool" means the form completed by EI staff to determine an individual's communication abilities and preferences, and to assist in supporting an individual's current ability to engage in decision-making.

(16) "Unable to determine interest designation" means the status of an individual who cannot clearly express in writing, or by any other means through which a reasonable person would recognize, a preference for where the individual wants to receive LTSS.

(17) "Undecided designation" means the status of an individual who has yet to make a decision about where to receive LTSS.

(18) "Waiver" means the Community Transitions Waiver, a Medicaid waiver program authorized under Subsection 1915(c) of the Social Security Act.

R414-510-3. Eligibility Requirements for the Transition Program.

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

(a) receives ICF benefits under the Medicaid State Plan;

(b) has been diagnosed with an intellectual disability or a related condition;

(d) meets state funding eligibility criteria for DSPD found in Subsection 26B-6-402(6); and

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

(i) a Medicaid-certified ICF;

(ii) a nursing facility;

(iii) a hospital; or

(iv) a 1915(c) HCBS waiver program.

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

(a) there is a closure of an ICF where an individual resides;

(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;

(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;

(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;

(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;

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

(i) direct observation; and

(ii) findings of facts that define abuse, neglect, or exploitation; or

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

(i) has already met the 365-day length-of-stay requirement;

(ii) has an agreement with the individual that communicates a special bond or relationship; and

(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) 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) 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.

R414-510-4. Department Responsibilities to Provide HCBS Education to Individuals Who Reside in ICFs.

(1) EI staff shall:

(a) provide ongoing HCBS education, as described in Subsections (2) through (5), to each individual residing in an ICF;

(b) display transition program and staff contact information in conspicuous locations within each ICF;

(c) hold a recurring meeting at least four times a year available to every ICF resident, guardian, and representative that informs each attendee about the option to:

(i) visit an HCBS setting;

(ii) receive support from a peer who has experience moving from an ICF to HCBS; and

(iii) request a meeting with a peer; and

(d) upon the request of an individual, guardian, or representative, arrange a meeting between any requestor and a peer.

(2) EI staff shall provide education about the transition program and HCBS in a way that is responsive to each individual's method of communication, which may include:

(a) in-person discussion;

(b) communication by telephone or email;

(d) interaction in a community-based setting, including a:

(i) visit to an HCBS setting;

(ii) meeting with a peer who has experience moving from an ICF to HCBS; and

(iii) discussion with an HCBS provider.

(3) EI staff shall provide educational materials including through print or another medium.

(4) As EI staff provide ongoing HCBS education to any individual without a guardian:

(a) the individual may invite anyone to participate in the decision-making process to express whether the individual wants to participate in the transition program;

(b) EI staff shall work with the individual and anyone participating in the process; and

(5) As EI staff provide ongoing HCBS education to any individual with a guardian, EI staff shall work with the individual and the guardian on the decision-making process.

(a) If the guardian has decision-making authority on where the individual lives, EI staff shall rely on the decision rendered by the guardian regarding whether the individual will participate in the transition program.

(b) If the guardian's decision conflicts with the expressed interest of the individual, the transition worker shall:

(i) confirm the guardian's authority to make health care decisions;

(ii) request a meeting with the guardian to discuss the individual's expressed interest in accordance with Subsection 75-5-312(1)(e); and

(iii) provide the guardian with a copy of the department letter about involvement of the ward in decision-making to the extent possible and the responsibility of the guardian to consider the preferences of the individual.

(c)(i) EI staff shall inform each individual and guardian that the individual or guardian may express interest in participating in the transition program:

(A) at any time; and

(B) in writing, or by any other means through which a reasonable person would believe that the individual is interested

in living in the community.

(ii) The individual or guardian retains the right to change the decision at any time.

(6) If an ICF administrator or employee discourages an individual, guardian, or representative, the department shall review the event and respond with an individualized approach to correct any misinformation the ICF administrator or employee may have provided, consistent with Subsection R414-510-5(5).

R414-510-5. HCBS Education - ICF Responsibilities.

(1)(a) To ensure that EI staff provide transition program education to individuals who reside in ICFs, their legal guardians, and to others the individual may identify to assist in the decision-making process, the ICF administrator shall submit to the department the contact information for each individual on a biannual basis, in July and January of each year.

(b) ICFs shall send updates to the department that include:

(i) names of each individual who resides at the facility and the individual's known personal contact information, including phone numbers and email addresses;

(ii) names of individuals, guardians, representatives, family members, and their known contact information including phone numbers, email addresses, and physical addresses.

(c) In between scheduled updates, as ICFs become aware of changes to contact information, ICFs shall communicate the changes in writing directly to the department within ten days of becoming aware of the change.

(2)(a) In accordance with the Utah Medicaid Provider Agreement signed by each ICF, the ICF administrator shall provide to department staff timely access to requested member records.

(b) ICFs shall fulfill written documentation requests they receive from the department within five business days of the request. The department shall report cases of non-compliance to DLBC for investigation.

(3) Within 90 days of ICF employment, ICF direct-care staff shall participate in HCBS general training. The department shall provide the training curriculum and include specialized training for the care of children and youth with intellectual disabilities. An ICF shall provide evidence of employee training records to the department upon request.

(4) The facility administrator and employees shall ensure the rights of individuals are protected and shall:

(a) provide the means for individuals and guardians to access information about HCBS;

(b) not discourage an individual from accessing information, making decisions about, learning about, or moving into HCBS; and

(5) A facility administrator or employee is considered to have discouraged access to HCBS under Subsection (4)(b) if they seek to prevent member access by:

(a) limiting member access to information;

(b) providing false information;

(d) seeking to impose individual goals for the individual to meet before seeking HCBS;

(e) preventing communication with department staff or other outside organizations; or

(f) interfering with or delaying an individual's move to HCBS.

(6) For allegations of non-compliance with Rule R414-510, the department shall:

(a) review the allegation with the ICF administrator and seek remedies to address the issue;

(b) track allegations, and if a pattern of recurrence is detected, require a written plan of correction from the provider; and

R414-510-6. HCBS Education - Department Responsibilities.

(1)(a) Before admission to an ICF, an individual or guardian shall contact EI staff to receive education about, and referral to, HCBS and local resources.

(b) For individuals under 22 years of age, the department shall perform an additional evaluation of services to determine whether HCBS are available to assure informed choice before admission to an ICF.

(c) The DIH director or designee, and the DSPD director or designee, shall authorize in writing ICF admissions of individuals under 22 years of age.

(d) An ICF may not admit an individual under 22 years of age, unless the admission has been authorized as stated in Subsection (1)(a). After admission, the ICF shall keep a copy of the written authorization in the individual's medical record. An individual who admits to an ICF and meets the requirements described in Section R414-510-3, is eligible to participate in the transition program.

(e) Upon completing education and referral with EI staff, an individual who is over 22 years of age and decides to move into an ICF, shall be given a written confirmation verifying the education process occurred before admission.

(f) ICFs may not admit an individual who has not received the required EI staff education and referral. After admission, the ICF shall keep a copy of the written confirmation form in the individual's medical record.

(2)(a) Due to an urgent or emergent need, an individual may admit to an ICF immediately. EI staff shall provide education and assistance with resources after admission.

(b) An ICF shall:

(i) notify the department of the admission;

(ii) explain the reason the admission was considered urgent or emergent; and

(iii) provide contact information for the individual, guardian, or representative.

(c) EI staff shall provide education within 30 days of ICF admission unless an individual's health or other external factors make it necessary to provide education at a later date.

(d) Once EI staff provide education, the department shall provide the ICF with a written confirmation of the education form, and the ICF shall keep the form in the individual's medical record.

R414-510-7. Categorizing Interest in the Transition Program.

(1)(a) The department shall inform an individual or guardian that the individual or guardian may express interest in receiving HCBS:

(i) at any time; and

(ii) in writing or by any other means responsive to the individual's method of communication and through which a reasonable person would believe that the individual is interested in living in the community.

(b) The individual or guardian retains the right to amend the choice at any time.

(a) interest in moving to HCBS;

(b) interest in learning more about HCBS;

(d) no interest in learning more about or moving to HCBS.

(2) Based on an individual's expression of interest in receiving HCBS, the department shall review the capacity of the Community Transitions Waiver and make efforts to increase capacity to address the interest.

R414-510-8. Formal Decision-Making Process for Individuals Identified as Unable to Determine Interest.

(1) To support the decision-making process, the department shall train EI staff on best practices and techniques to effectively communicate and best support individuals with intellectual disabilities during interactions, meetings, and interviews. The department shall also train staff on using SDM tools.

(2) EI staff shall meet routinely with an individual or guardian to determine interest in HCBS.

(3) For an individual whose preference has not been determined through routine meetings described in Section R414-510-4, and who does not have a guardian, EI staff shall use the SDM tool. EI staff shall use the SDM tool:

(a) to help organize and document what is observed when interacting with the person;

(b) to assist in developing strategies to improve individual access to communication; and

(4) Using information obtained from the SDM tool, EI staff shall work closely with the Utah Center for Assistive Technology and others to adapt communication methods to best meet the needs of each person.

(5) EI staff shall ensure American sign language and other language interpretation services are used when needed.

(6) EI staff shall use communication strategies identified through the SDM when engaging with individuals.

(7) If EI staff can determine an individual's preference after using these strategies, they then shall update the individual's interest designation according to the individual's identified preference.

(8)(a) For an individual whom EI staff continues to identify as unable to determine interest, the department shall take the following actions.

(b) For an individual with involved family members or friends, EI staff shall work with family to assist the individual with healthcare decision-making in accordance with Title 75, Chapter 2a, Advance Health Care Directive Act.

(c) For an individual who has family members or friends who are not involved in the individual's life, or if the individual does not have any known family members or friends to assist the individual with healthcare decision-making, EI staff shall refer the case to the Office of Public Guardian (OPG) for review.

R414-510-9. Referring Undetermined Cases to the Office of Public Guardian (OPG).

(1) For cases referenced in Section R414-510-8, OPG shall review an individual case to determine whether the case is in accordance with Subsection 75-2a-104(2).

(2) If OPG determines that an individual cannot decide where to receive long-term services and supports, it shall seek to work with family or friends, if known and available, to determine whether they can assist the individual with decision-making in accordance with Section 75-2a-108.

(3) If OPG cannot identify family members or friends for this role, it shall petition the court to obtain the least restrictive guardianship option available that will meet the needs of the individual.

KEY: Medicaid

Date of Last Change: June 24, 2026

Notice of Continuation: September 2, 2026

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