R414. Health and Human Services, Integrated Healthcare.R414-523. Extraordinary Care Definition for Spousal Caregiver Compensation.
R414-523-1. Introduction and Authority.
This rule implements a definition for extraordinary care to use in the evaluation and authorization of caregiver compensation in applicable home and community-based services waiver programs. This rule is authorized by Section 26B-3-222.
R414-523-2. Definitions.
(1) "Care planning team" means the case manager or support coordinator selected or assigned to the participant and includes other individuals based on the participant's preference who help determine the support a participant receives.
(2) "HCBS waiver" means a home and community-based waiver program authorized under Subsection 1915(c) of the Social Security Act.
(3) "Participant" means a participant in the HCBS Waiver who is enrolled in the applicable program and for whom usage of caregiver compensation is evaluated.
R414-523-3. State Definition of Extraordinary Care.
Extraordinary care means care that exceeds the range of activities of daily living (ADLs) or instrumental activities of daily living (IADLs) that a legally responsible individual would ordinarily perform in the household on behalf of a person without a disability or chronic illness of the same age, and which is necessary to assure the health and welfare of the participant and avoid institutionalization. Extraordinary care may include specialized skills and tasks that the individual needs to perform for the waiver participant.
R414-523-4. Eligibility for Spousal Caregiver Compensation.
(1) A spouse may be eligible to perform direct care if:
(a) the spouse is the choice of the participant and supported by the care planning team;
(b) the spouse is not directing services on behalf of the participant;
(c) the spouse agrees to provide no more than what is approved, limited, and established in the participant's care or service plan; and
(d) the spouse can meet the needs of the participant. For example, the spouse has specialized training such as nursing licensure or is determined able by the Department to meet the participant's health and safety needs.
R414-523-5. Limitations.
(1) The availability of spousal caregiver compensation is restricted to HCBS waiver programs, and if part of the state's approved waiver implementation plan.
(2) This rule does not pertain to the evaluation and authorization of caregiver compensation for parents of minor children or guardians or when a guardian is not the spouse of a participant.
R414-523-6. Denial of Access to Spousal Caregiver Compensation.
(1) During initial and subsequent care planning meetings, the participant's case manager or support coordinator reviews the authorization for caregiver compensation to determine whether:
(a) the choice of the spouse to provide waiver services reflects the participant's wishes and desires;
(b) the provision of services is in the participant's and family's best interests;
(c) the provision of services is appropriate and based on the participant's identified needs; and
(d) the services will increase the participant's independence and community integration.
(2) The Department shall deny the request for spousal caregiver compensation if the caregiver does not meet any of the conditions in Subsection (1).
(3) The participant may appeal the Department's denial in accordance with the hearing rights described under Rule R410-14.
KEY: Medicaid
Date of Last Change: November 10, 2023
Authorizing, and Implemented or Interpreted Law: 26B-1-213; 26B-3-108; 26B-3-222
