Utah Office of Administrative Rules

NOTICE OF SUBSTANTIVE CHANGE

TYPE OF FILING: Repeal and Readopt

Filing ID: 57094

Rule or section number:

R539-12

1. Agency Information

Title catchline:

Health and Human Services, Services for People with Disabilities

Building:

Cannon Health Building

Street address:

288 N 1460 W

City, state:

Salt Lake City, UT

Mailing address:

PO Box 145145

City, state and zip:

Salt Lake City, UT 84114-5145

2. Contact Persons

Name:

Phone:

Email:

Tyler Black

801-380-9960

tdblack@utah.gov

Mariah Noble

385-214-1150

mariahnoble@utah.gov

Please address questions regarding information on this notice to the persons listed above.

3. General Information

A. Rule or section catchline:

R539-12. Person-Centered Budget

B. Purpose of the new rule or reason for the change:

In response to a Department of Health and Human Services (department)-wide goal to review each rule, the Division of Services for People with Disabilities (division) determined it is appropriate to update this rule to provide greater clarity for existing provisions, remove duplicative language, and more accurately reflect current procedure.

Due to the number of markups needed for these changes, the division determined it is appropriate to format these changes as a repeal and readopt filing.

C. Summary of the new rule or change:

This filing updates language for consistency of terms used in this and other rules.

This filing adds definitions for "budget adjustment threshold" and "funding misalignment threshold" to allow the division greater flexibility in making dollar amount adjustments to these variables, which are frequently updated, in division policy rather than in rule.

Definitions for "committee" and "committee chair" have been removed because that information already exists in division policy.

Definitions have been added for "request for services determination" or "RFS determination," "request for services meeting" or "RFS meeting," "request for services program administrator" or "RFS administrator," and "request for services team" or "RFS team" to align with recent changes to division policy.

The term "request for services team" replaces the term "request for services committee" throughout this rule to more accurately reflect that there is not a single standing committee but, rather, a variety of meetings that are held with different members of the RFS team to make decisions, as described in this rule and in division policy.

Accordingly, the terms "voting committee member" and "non-voting committee member" have been changed to "voting member" and "non-voting member.

A definition for the division case management system, "Utah System for Tracking Eligibility, Planning, and Services" or "USTEPS" has been added for consistency across division rule and policy.

The definition of "immediate jeopardy" has been replaced with a new definition for the term "imminent risk" for accuracy and to avoid a potential conflict with the meaning of that term that appears in Centers for Medicare and Medicaid Services (CMS) guidance on "immediate jeopardy" in clinical settings.

Section R539-12-3 has been shortened, simplified, and renamed to "Request for Services." Section R539-12-6 has also been revised and renamed to "Needs Adjustment Request" to reflect changes to terminology and procedure.

Other style and formatting changes bring this rule into alignment with the Rulewriting Manual for Utah and other rules under the department.

5. Fiscal Information

Provide an estimate and written explanation of the aggregate anticipated cost or savings to:

A. State budget:

This filing is not anticipated to have any fiscal impact on the state budget because it does not introduce any new requirements for agency staff or support coordinators, who are the groups to which this rule applies.

It also does not reduce any of the requirements for agency staff.

This filing primarily focuses on updating terminology and simplifying language that is not anticipated to change existing practices.

B. Local governments:

This rule update is not anticipated to have any fiscal impact on local governments, because local governments have no involvement with this program, which applies exclusively to state agencies.

This rule does not apply to this group.

C. Small businesses ("small business" means a business employing 1-49 persons):

This rule update is not anticipated to have any fiscal impact on small businesses, because it does not introduce any new requirements or reduce any existing requirements for small businesses.

The changes in this filing do not apply to this group.

D. Non-small businesses ("non-small business" means a business employing 50 or more persons):

This rule update is not anticipated to have any fiscal impact on non-small businesses, because it does not introduce any new requirements or reduce existing requirements for non-small businesses.

The changes in this filing do not apply to this group.

E. Persons other than small businesses, non-small businesses, state, or local government entities ("person" means any individual, partnership, corporation, association, governmental entity, or public or private organization of any character other than an agency):

This rule update is not anticipated to have any fiscal impact on persons other than small business, non-small businesses, state, or local government entities because it applies exclusively to state agencies.

The changes in this filing do not apply to this group.

F. Compliance costs for affected persons:

This rule update is not anticipated to create or reduce compliance costs because it will not add any regulation beyond the current process for compliance regulation with contracted providers.

This filing primarily focuses on updating terminology and simplifying language that is not anticipated to change existing practices.

6. Regulatory Impact Summary Table

Enter the cost or savings in the relevant cell. If there is no cost or savings, enter, "$0." If a cost or savings is inestimable, enter, "inestimable."

Fiscal Cost

FY2027

FY2028

FY2029

FY2030

FY2031

State Budget

Local Governments

Small Businesses

Non-Small Businesses

Other Persons

Total Fiscal Cost

Fiscal Benefits

FY2027

FY2028

FY2029

FY2030

FY2031

State Budget

Local Governments

Small Businesses

Non-Small Businesses

Other Persons

Total Fiscal Benefits

Net Fiscal Benefits

7. Regulatory Impact Analysis Approval

The Commissioner of the Department of Health and Human Services, Tracy S. Gruber, has reviewed and approved this regulatory impact analysis.

8. Family Impact Information

A. The agency has considered this rule's impact on family health, stability, and formation:

☒

9. Citation Information

Provide citations to the statutory authority for the rule. If there is also a federal requirement for the rule, provide a citation to that requirement:

Section 26B-6-403

11. Public Notice Information

The public may submit written or oral comments to the agency identified in box 1.

A. Comments will be accepted until:

08/14/2026

12. Effective Date Information

This rule change MAY become effective on:

(NOTE: This is the date the agency anticipates making the filing effective. It is NOT the effective date)

08/21/2026

13. Agency Authorization Information

Agency head or

designee and title:

Tracy S. Gruber, Commissioner

Date:

06/29/2026

R539. Health and Human Services, Services for People with Disabilities.

R539-12. Person-Centered Budget.

[R539-12-1. Authority and Purpose.

(1) Subsections 26B-6-403(2)(l) and 26B-6-403(2)(q) authorize this rule.

(2) This rule establishes a process and standard for creating, adjusting, and reviewing the budget for each person-centered support plan

(PCSP).

R539-12-2. Definitions.

Terms used in this rule are defined in Section 26B-6-401 and Rule R539-13. Additionally:

(1) "Committee" means the Request for Services (RFS) Committee.

(2)(a) "Committee chair" means the RFS administrator.

(b) Alternates for the position of committee chair shall include:

(i) any supervisor that the RFS administrator reports to;

(ii) the assistant division director; and

(iii) the division director.

(3) "Immediate jeopardy" means danger of loss, harm, or failure within 30 days.

(4) "Non-voting committee member" means a division budget specialist or a specialist or administrator that provides subject matter

expertise or consultation.

(5)(a) "Plan cycle" means the period between the PCSP's effective start date and effective end date.

(b) A plan cycle is typically 365 days or, during a leap year, 366 days.

(6)(a) "Plan total" means the sum of each service line item in the budget.

(b) Each service line item multiplies the service rate by any service unit.

(7) "Restricted service code" means a service code related to a residential service, day support, or public transportation, including RHS,

HHS, PPS, DSG, DSI, DSP, EPR, and UTA.

(8) "Surplus" means the difference between the plan maximum and the plan cycle expenditures within two consecutive and closed plan

cycles.

(9) "Voting committee member" means an employee of the division who:

(a) reviews and makes a decision about an RFS; and

(b)(i) is supervised by the committee chair; or

(ii) is designated by the division director.

R539-12-3. Request for Services Committee.

(1) The committee shall review protected health information to determine the amount of a person-centered budget based on the person's

assessed need.

(2) The committee shall consist of a minimum of six division employees.

(a) Each committee member shall be a full-time employee with a minimum job classification of program specialist II.

(b) The committee chair shall have a minimum job classification of administrator I.

(3) Each voting committee member shall review each RFS assigned to that voting committee member.

(a) A voting committee member may make a decision for any RFS with a budget adjustment amount of less than $5,000.

(b) A voting committee member shall submit an RFS to the committee for a decision if the RFS includes:

(i) a budget adjustment amount equal to or greater than $5,000;

(ii) a change from an in-home service to an out-of-home service; or

(iii) an adaptive equipment request.

(4)(a)(i) The committee shall meet at least once a week, except during a week in which a recognized holiday, as described in Section 63G-

1-301, or a lack of quorum interferes with the meeting.

(ii) If the committee is unable to meet due to a holiday or lack of quorum, the committee chair shall reschedule the meeting for the

preceding or following week.

(b) For the committee to make a decision about an RFS:

(i) at least three voting committee members must be in attendance; and

(ii) at least one non-voting committee member who is a division budget specialist must be in attendance.

(5) The committee shall:

(a) use the RFS process to review each initial budget and person-centered budget adjustment;

(b) complete the person-centered budget review each year; and

(6) The division shall maintain at least three non-voting committee members who can act as a voting committee member in the event of an

emergency situation, including:

(a) a declared public health emergency or natural disaster;

(b) a vacancy in an employee position that reports to the committee chair; or

(7) Except for a division budget specialist, a non-voting committee member may act as a voting member in the event of an emergency

after:

(a) 32 hours of participation in committee meetings as a non-voting member;

(b) a complete review of training material;

(d) approval by the division director.

R539-12-4. Initial Budget.

(1) A division support coordinator, administrative case manager, or specialist shall develop an initial budget that reflects the person's

assessed need and preference.

(2) A division support coordinator, administrative case manager, or specialist shall submit an initial budget to the committee through an

RFS.

(3) The division may disburse funding to an initial person-centered budget through an RFS approved by the committee.

(4) The committee shall make a decision about an RFS within a reasonable timeframe but no later than 30 days after the initial budget

submission.

R539-12-5. Budget Adjustment.

(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

(2) A voting committee member shall review each RFS as described in Subsection R539-12-3(1) within 14-days of the date of submission.

(a) The voting committee member shall review each supporting document included in the RFS.

(b) The voting committee member shall use the criteria for each service code included in the request to evaluate the RFS.

(3) A voting committee member or the committee may defer a decision about an RFS.

(a) A voting committee member or the committee may use a deferral to:

(i) clarify the narrative explanation;

(ii) clarify the requested number of units or reimbursement rate for a service code; or

(iii) request additional documentation.

(b) A support coordinator shall respond to a deferred RFS 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 an RFS that:

(a) does not meet the service criteria;

(b) requests an excessive amount of a service;

(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; or

(iii) each scope of work and service description requirement in the contract.

(6) A support coordinator may submit an emergency RFS if a person in service is in immediate jeopardy and needs the service change

within 72 hours of the request submission date.

(a)(i) The support coordinator may request units of service equal to or fewer than 30 days of service.

(ii) The units of service shall be used within a 30-day period beginning on the effective start date.

(b) The committee chair shall review an emergency RFS within 72 hours of the request submission date.

(c) The committee chair may approve an emergency RFS after determining that the person is in immediate jeopardy and needs the service

change within 72 hours of the request submission date.

R539-12-6. Budget-Neutral Change.

(1) A support coordinator may make a budget-neutral change to a person-centered budget without review by a voting committee member.

(a) Except as described in Subsections (2) and (3), a support coordinator may not adjust the following services in a budget-neutral change:

(i) a restricted service code;

(ii) a service code that requires completion of an individualized budget worksheet to determine the daily rate; or

(iii) a service code for which any other agency pays the state match rate as defined in Section R539-13.

(b) The support coordinator shall review each criterion, justification, and documentation requirement for each service before making a

need-based change.

(d) A budget-neutral change shall maintain the integrity of the PCSP.

(e)(i) The support coordinator shall document any budget-neutral change in the person-centered support plan and the division case

management system.

(ii) The support coordinator shall:

(A) update the budget, goal, support, and service;

(B) document the person's and person-centered planning team's involvement in the service change;

(C) document any justification for a service change in a log note in the Utah System for Tracking Eligibility, Planning and Services

(USTEPS); and

(D) include the date of a related log note in the addendum to the PCSP.

(2) If the day program daily rate is sufficient to cover the extended living services (ELS) daily rate as defined in the contract, a support

coordinator may move the dollar value of the units not used in the day program to fund additional days of ELS.

(a) The ELS exception may be used if the person:

(i) does not attend the day program because of illness or any other unforeseen issue; and

(ii) uses a residential service.

(b) The support coordinator must document use of the standard 16 days of ELS built into the individualized budget worksheet for a

residential service before requesting additional ELS funding.

(3) A support coordinator may adjust the absentee days for the residential habilitation service (RHS) by contacting a division budget

specialist.

(a) The change to absentee days may not increase the overall cost of RHS.

(b) A division budget specialist may make an adjustment to absentee days if the described use of the absentee days complies with:

(i) federal and state law related to Medicaid;

(ii) the state implementation plan for the 1915c Medicaid waiver; and

(iii) each scope of work and service description requirement in the contract.

(4) The support coordinator shall notify the division of a budget-neutral change through noa@utah.gov.

R539-12-7. Budget Review.

(1) The division shall annually review the use of person-centered budgets to maintain alignment of funding and a person's needs.

(a) The division administrative services director shall begin the review process in August of each fiscal year.

(b) A committee member shall review each budget that has potential funding misalignment.

(2) The division shall reduce a person-centered budget after two consecutive and closed plan cycles of underuse due to a misalignment of

funding and actual need.

(a) A budget with a $2,000 or more surplus shall be subject to a budget reduction that realigns funding with actual need.

(b) The division shall presume that the person-centered budget aligns with the person's need if underuse is caused by:

(i) hospitalization, including placement in the Utah State Hospital;

(ii) incarceration;

(iii) temporary placement in facility-based care, including placement in a nursing facility or a private intermediate care facility;

(iv) temporary placement at the developmental center;

(v) a public health or other declared emergency;

(vi) limited access to a service provider; or

(vii) for a person participating in the self-administered services model, limited access to a direct care employee.

(c) The division administrative services director may consider budget underuse for a reason not listed in Subsection (2)(b).

(3) The division must notify the support coordinator of a budget reduction at least 30 days before sending a notice of agency action.

(a) A support coordinator must submit written justification within 30 days of notification to dispute the reduction.

(b) The support coordinator shall include documentation that explains:

(i) why the unused service continues to represent the person's need;

(ii) why the service was not used; and

(iii) how the underuse is being remedied.

(4) The committee shall review the documentation and determine whether the justification is adequate.

(5) If the division reduces the unused portion of the person-centered budget, the division shall send a notice of agency action as described

in Section R539-3-7.

(6) The division shall coordinate any appeal of the person-centered budget review process as described in Section R539-3-7.

(7) The support coordinator shall reduce the person's plan cycle total within 30 days of the notice of agency action.

(a) The division shall monitor compliance with each budget reduction.

(b) If the support coordinator fails to reduce the person's plan cycle total within 30 days of the notice of agency action, the division shall

send the support coordinator a second notice.

(i) The support coordinator shall make the requested change to the person's plan cycle total within 15 days of the date of the second notice.

(ii) The division shall refer the support coordinator to the Office of Service Review for any failure to make the requested change.]

R539-12-1. Authority and Purpose.

(1) Section 26B-6-403 establishes Division of Services for People with Disabilities (division) authority for this rule.

(2) This rule establishes a process and standard for creating, adjusting, and reviewing the budget for each person-centered support plan

(PCSP).

R539-12-2. Definitions.

Terms used in this rule are defined in Section 26B-6-401 and Rule R539-13. Additionally:

(1)(a) "Budget adjustment threshold" means a budget adjustment amount that is set as a limit in Division Policy 1.49, Request for Services.

(b) For any amount below the budget adjustment threshold, an individual RFS team member may make an RFS determination, as

described in Section R539-12-3.

(2) "Funding misalignment threshold" means a gap between budget utilization and available funding that exceeds what the division

considers normal over a specified period and requires additional review by the RFS team.

(3) "Imminent risk" means danger of serious injury, harm, or death within 30 days.

(4) "Non-voting member" means assigned division staff who provide subject matter expertise or consultation during an RFS meeting but

do not vote on the RFS determination.

(5)(a) "Plan cycle" means the period between the PCSP's effective start date and effective end date.

(b) A plan cycle is typically 365 days or, during a leap year, 366 days.

(6)(a) "Plan total" means the sum of each service line item in a person-centered budget.

(b) Each service line item multiplies the service rate by the allocated service units.

(7) "Request for services determination" or "RFS determination" means a decision made by the RFS team, or a RFS team member, on a

request for services. Possible determinations are:

(a) approved;

(b) denied; or

(8) "Request for services meeting" or "RFS meeting" means a meeting of RFS team members to review new budgets, budget adjustments,

and to deliberate and make other RFS determinations.

(9)(a) "Request for services program administrator" or "RFS administrator" means the division staff who assigns RFS cases for

determination to individual members of the RFS team, or as part of an RFS meeting.

(b) An alternate RFS administrator may be designated by the division director as needed.

(10) "Request for services team" or "RFS team" means the division staff with assigned responsibilities to make RFS determinations.

(11) "Restricted service code" means a service code for which the rate and unit amounts cannot be exceeded for the duration specified in

USTEPS.

(12) "Surplus" means the difference between the plan maximum and the plan cycle expenditures for two consecutive and closed plan

cycles.

(13) "Utah System for Tracking Eligibility, Planning, and Services" or "USTEPS" means the secure, web-based case management system

used by the division to track eligibility, manage individualized support plans, and monitor service data for a person.

(14) "Voting member" means a division staff who is supervised by the RFS administrator and makes RFS determinations.

R539-12-3. Request for Services.

(1) The RFS team shall hold an RFS meeting to review requests to adjust the services or budget in a person's PCSP to determine the

amount of a person-centered budget based on the person's assessed service need.

(2) A RFS meeting shall be held to make a determination for any RFS with a budget adjustment amount equal to or greater than the budget

adjustment threshold amount, as set in Division Policy 1.49, Request for Services.

(3)(a) An individual voting member may make a determination for any RFS with a budget adjustment amount of less than the budget

adjustment threshold.

(b) Each voting member shall review each RFS assigned to that voting member.

(4) If the RFS includes a budget adjustment amount equal to or greater than the budget adjustment threshold, an individual voting member

shall submit the RFS for a determination to be made in a RFS meeting with at least three voting members and one non-voting member.

(5) A voting member may also submit a RFS for a determination to be made in a RFS meeting if the RFS includes:

(a) a change from an in-home service to a residential service; or

(b) an adaptive equipment request.

(6) A RFS meeting shall take place at least once a week, except during a week in which a recognized holiday occurs, as described in

Section 63G-1-301.

(7) The RFS team member shall:

(a) use the RFS process to review each initial budget, person-centered budget adjustment, closed payment request, and emergency request

for services; and

(b) complete the person-centered budget review each year.

R539-12-4. Initial Budget.

(1) A division staff shall develop an initial budget that reflects the person's assessed need and service preference.

(2) A division staff shall submit an initial budget to the RFS administrator through a RFS.

(3) The RFS team or a RFS team member shall make a determination about a RFS within 30 days of the initial budget submission.

(4) The division may disburse funding to an initial person-centered budget through an approved RFS determination.

R539-12-5. Budget Adjustment.

(1) Except as described in Section R539-12-6, a support coordinator shall submit a budget adjustment to the RFS team for review and

approval before changing a person-centered budget. A budget adjustment includes:

(a) an increase to a plan total;

(b) adding a service in a person-centered budget; or

(2)(a) The RFS team or a RFS team member shall review a RFS within 14 days after the submission.

(b) The voting member shall review each supporting document included in the RFS.

(d) The voting member may submit a RFS to the RFS team for additional review.

(3) An individual voting member or the voting members of a RFS meeting may defer a determination about a RFS to:

(a) clarify the narrative explanation;

(b) clarify the requested number of units or reimbursement rate for a service code; or

(4)(a) A support coordinator shall respond to a deferred RFS within 14 days of the date of deferral.

(b) The RFS team or a RFS team member may defer a decision no more than twice before making a determination to approve, deny, or

offer a modified approval.

(5) An individual voting member or the voting members of a RFS meeting may use the modified approval to adjust the number of units or

reimbursement rate for a requested service.

(6) An individual voting member or the voting members of a RFS meeting shall deny a RFS if:

(a) the RFS does not meet the service criteria;

(b) the RFS request seeks an increase in a service or the addition of a service that exceeds the person's assessed need;

(d) the described use of a service code, number of units, or the reimbursement rate does not comply with federal Medicaid law, state law,

the state implementation plan for the 1915(c) Medicaid waiver, or each scope of work and service description requirement in the contract.

(7)(a) A support coordinator may submit an emergency RFS if a person is at imminent risk and needs the service change within 72 hours

of the request submission date.

(b) The support coordinator may request one-time units of service equal to or fewer than 30 days of service.

(d) The RFS administrator or designee shall review an emergency RFS within 72 hours of the request submission date.

(e) The RFS administrator or designee may approve an emergency RFS after determining that the person is at imminent risk and needs the

service change within 72 hours of the request submission date.

R539-12-6. Needs Adjustment Request.

(1) A support coordinator may make a needs adjustment request to a person-centered budget without a review by a voting member of the

RFS team.

(2) A support coordinator may not adjust the following services in a needs adjustment request:

(a) a restricted service code;

(b) a service code that requires completion of an individualized budget worksheet to determine the daily rate;

(d) changes made within the professional nursing service codes.

(3) The support coordinator shall review each criterion, justification, and documentation requirement for each service before making a

needs adjustment request.

(4) A needs adjustment request shall include a proposal for how the funds will be maintained within the plan total for the plan cycle.

(5) A needs adjustment request shall maintain the integrity of the PCSP so the person's needs shall continue to be met for the rest of the

plan cycle.

(6) The support coordinator shall document a needs adjustment request in the PCSP and in USTEPS.

R539-12-7. Budget Review.

(1)(a) The division shall review annually the use of person-centered budgets to maintain alignment of funding with a person's needs.

(b) The division's individual budgets team manager shall begin the review process at the start of each fiscal year for budgets that exceed

the funding misalignment threshold.

(c) The RFS administrator shall assign cases that exceed the funding misalignment threshold for full review by a voting member.

(d) A voting member shall review each assigned budget that exceeds the funding misalignment threshold.

(2) If the review described in Subsection (1) determines that there is a budget misalignment, and that a budget reduction may be necessary,

the division shall notify the support coordinator by email of the intent to initiate a budget reduction at least 30 days before sending a notice of agency

action.

(3) The support coordinator may submit written justification to dispute a reduction within 14 calendar days of the date the email

notification was sent.

(4) The support coordinator shall include in the justification detailed documentation that explains:

(a) why the unused service continues to represent the person's need;

(b) why the service was not used; and

(5) The division shall review the submitted documentation and determine whether the justification is adequate.

(6) If the division reduces the unused portion of the person-centered budget, the division shall send a notice of agency action, as described

in Section R539-3-7.

(7) The division shall coordinate any appeal of the person-centered budget reduction, as described in Section R539-3-7.

(8) Pending the conclusion of any hearing request that results from Subsection (6), the support coordinator shall reduce the person's plan

cycle total within 30 days of the notice of agency action.

(9)(a) Pending the conclusion of any hearing request that results from Subsection (6), the division shall monitor compliance with each

budget reduction.

(b) If the support coordinator fails to reduce the person's plan cycle total within 30 days of the notice of agency action, the division shall

send the support coordinator a second notice.

(c) The support coordinator shall make the requested change to the person's plan cycle total within 15 days of the date of the second notice.

(d) The division shall refer the support coordinator to the Office of Service Review for any failure to make the division's requested change.

KEY: disabilities, budget, request for services

Date of Last Change: [July 23, 2025]2026

Authorizing, and Implemented or Interpreted Law: 26B-6-403

!--dar--

Navigation Menu

Navigation Menu

Health and Human Services

Services for People with Disabilities

Rule 12: Person-Centered Budget