(c) have a need for a personal assistance service to accomplish an activity of daily living or an instrumental activity of daily living;(d) be 18 years of age or older;
(e) be medically stable;
(f) be capable of selecting, training, and supervising a personal attendant;
(g) have at least one available personal attendant trained or willing to be trained;
(h) live in a safe residence that can accommodate the personnel and equipment needed to adequately and safely care for the applicant;
(i) be capable of managing personal financial and legal matters;
(j) have three or more substantial functional limitations; and
(k) be a state resident.
(3) The division shall:
(a) determine if an applicant is eligible for physical disability services within 90 days of receiving needed documentation; and
(b) keep supporting documentation in the applicant's electronic record.
(4) The division shall use the following supporting documentation to determine eligibility:
(a) Physical Disabilities Services Application Form 3-1 Part B signed by a medical professional whose scope of licensure includes the ability to render diagnoses[licensed physician or licensed nurse practitioner] attesting to each eligibility requirement; and (b) the Minimum Data Set-Home and Community-based (MDS-HC).
(5) This section does not apply to an applicant who meets the eligibility criteria for an intellectual disability and related conditions or brain injury as described in Sections R539-1-4 and R539-1-6.
R539-1-6. Services for People with Brain Injury.
(1) The division shall only offer services for a brain injury to an eligible applicant with a disability as defined in Subsections 26B-6-401(3) and 26B-6-401(9).
(2) An eligible applicant shall meet the following requirements:
(a) have a documented diagnosis of a qualifying acquired neurological brain injury from a medical professional whose scope of licensure includes the ability to render diagnoses[licensed physician or licensed nurse practitioner]; (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 state resident.
(3) For the exclusive purposes of this type of disability, 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 acquired brain injury services within 90 days of receiving eligibility documentation.
(b) The division shall keep supporting documentation in the applicant's electronic record.
(5) The division shall use the following supporting documentation to determine eligibility:
(a) documentation of a diagnosis of a qualifying acquired brain injury diagnosis signed by a medical professional whose scope of licensure includes the ability to render diagnoses; and
(b) Comprehensive Brain Injury Assessment Form 4-1, parts A through L.
(6) This section does not apply to an applicant who meets the eligibility criteria for an intellectual disability and related conditions or physical disability as described in Sections R539-1-4 and R539-1-5.
R539-1-7. Eligibility and Enrollment.
(1) Matching federal funds may be available through an HCBS waiver.
(a) A person shall meet financial eligibility for Medicaid benefits as determined by the Department of Workforce Services.
(b) A person shall meet a waiver level of care as determined by the division.
(i) Pursuant to Rule R414-502, the division[department] may find a person meeting nursing facility level of care eligible for funding through the: (A) Acquired Brain Injury Waiver;
(B) Limited Supports Waiver; or
(C) Physical Disabilities Waiver.
(ii) The division[department] may find a person meeting intermediate care facility level of care eligible for funding through the: (A) Community Supports Waiver;
