Utah Office of Administrative Rules

An official website of the state of Utah.

NOTICE OF SUBSTANTIVE CHANGE

TYPE OF FILING: Amendment

Rule or section number:

R539-16

Filing ID: 57822

Agency Information

1. 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

Contact persons:

Name:

Phone:

Email:

Bruce Quaglia

435-669-4855

bquaglia@utah.gov

Mariah Noble

385-214-1150

mariahnoble@utah.gov

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

General Information

2. Rule or section catchline:

R539-16. Caregiver Compensation

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

Upon internal review, the Division of Services for People with Disabilities (division) determined that it is necessary to update this rule to clarify that the review process for receiving public funds through the caregiver compensation service delivery method includes the possibility of an audit or other actions by the Department of Health and Human Services (department).

5. Summary of the new rule or change:

This filing reformats wording in Subsection R539-16-7(2) for consistency with other rules and compliance with the Rulewriting Manual for Utah.

It also adds Subsections R539-16-7(6) through R539-16-7(8) to specify that the department may audit any person who receives services through the caregiver compensation service delivery method and other actions that the department may take to reduce or terminate services delivered through the caregiver compensation service delivery method.

Additionally, "service" is added throughout this rule for consistency in terminology.

Fiscal Information

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

A. State budget:

There is no anticipated fiscal impact to the state budget as a result of this filing because state employees already complete reviews of public funds disbursed through the caregiver compensation service delivery method and the department already has the ability to authorize a change to the level of caregiver compensation or to terminate the caregiver compensation service delivery method for misuse of funds or inappropriate billing.

Adding clarifying language to this rule to specify that these processes may occur does not change the current process.

Through the review, individuals who fail to meet requirements may be required to pay back state funds, but that requirement is also already part of the process without this filing.

B. Local governments:

There is no anticipated fiscal impact to local governments because local governments do not interface with division programming.

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

There is no anticipated fiscal impact to small businesses because state employees already complete reviews of public funds disbursed through the caregiver compensation service delivery method and the department already has the ability to authorize a change to the level of caregiver compensation or to terminate the caregiver compensation service delivery method for misuse of funds or inappropriate billing.

Adding clarifying language to this rule to specify that these processes may occur does not change the current process.

Through the review, individuals who fail to meet requirements may be required to pay back state funds, but that requirement is also already part of the process without this filing.

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

There is no anticipated fiscal impact to non-small businesses because state employees already complete reviews of public funds disbursed through the caregiver compensation service delivery method and the department already has the ability to authorize a change to the level of caregiver compensation or to terminate the caregiver compensation service delivery method for misuse of funds or inappropriate billing.

Adding clarifying language to this rule to specify that these processes may occur does not change the current process.

Through the review, individuals who fail to meet requirements may be required to pay back state funds, but that requirement is also already part of the process without this filing.

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):

There is no anticipated fiscal impact to other persons because state employees already complete reviews of public funds disbursed through the caregiver compensation service delivery method and the department already has the ability to authorize a change to the level of caregiver compensation or to terminate the caregiver compensation service delivery method for misuse of funds or inappropriate billing.

Adding clarifying language to this rule to specify that these processes may occur does not change the current process.

Through the review, individuals who fail to meet requirements may be required to pay back state funds, but that requirement is also already part of the process without this filing.

F. Compliance costs for affected persons:

There are no anticipated compliance costs for affected persons, as there were no identified costs for any party as a result of this filing.

State employees already complete reviews of public funds disbursed through the caregiver compensation service delivery method and the department already has the ability to authorize a change to the level of caregiver compensation or to terminate the caregiver compensation service delivery method for misuse of funds or inappropriate billing.

Adding clarifying language to this rule to specify that these processes may occur does not change the current process.

Through the review, individuals who fail to meet requirements may be required to pay back state funds, but that requirement is also already part of the process without this filing.

G. Regulatory Impact Summary Table (This table includes only fiscal impacts the agency was able to measure. If the agency could not estimate an impact, it is excluded from this table but described in boxes A through F.)

Regulatory Impact Summary Table

Fiscal Cost

FY2026

FY2027

FY2028

FY2029

FY2030

State Budget

$0

$0

$0

$0

$0

Local Governments

$0

$0

$0

$0

$0

Small Businesses

$0

$0

$0

$0

$0

Non-Small Businesses

$0

$0

$0

$0

$0

Other Persons

$0

$0

$0

$0

$0

Total Fiscal Cost

$0

$0

$0

$0

$0

Fiscal Benefits

FY2026

FY2027

FY2028

FY2029

FY2030

State Budget

$0

$0

$0

$0

$0

Local Governments

$0

$0

$0

$0

$0

Small Businesses

$0

$0

$0

$0

$0

Non-Small Businesses

$0

$0

$0

$0

$0

Other Persons

$0

$0

$0

$0

$0

Total Fiscal Benefits

$0

$0

$0

$0

$0

Net Fiscal Benefits

$0

$0

$0

$0

$0

H. Department head comments on fiscal impact and approval of regulatory impact analysis:

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

Citation Information

7. 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-6-402

Section 26B-6-403

Public Notice Information

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

A. Comments will be accepted until:

04/14/2026

10. This rule change MAY become effective on:

04/21/2026

NOTE: The date above is the date the agency anticipates making the rule or its changes effective. It is NOT the effective date.

Agency Authorization Information

Agency head or

designee and title:

Tracy S. Gruber, Executive Director

Date:

02/25/2026

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

R539-16. Caregiver Compensation.

R539-16-1. Authority and Purpose.

(1) Sections 26B-6-402 and 26B-6-403 authorize this rule and give the division responsibility for the administration of its services.

(2) This rule provides:

(a) definitions relating to the caregiver compensation service delivery method;

(b) eligibility requirements for the caregiver compensation service delivery method;

(c) oversight of the caregiver compensation service delivery method;

(d) applicability of the caregiver compensation service delivery method to HCBS waivers; and

(e) limitations and penalties relating to the caregiver compensation service delivery method.

R539-16-2. Definitions.

(1) Terms used in this rule are the same as defined in Rule R539-13. Additionally:

(2) "Waiver administrator" means a department employee responsible for administering and following the regulations of an HCBS waiver.

R539-16-3. Eligibility and Authorization for the Caregiver Compensation Service Delivery Method.

(1) Before the caregiver compensation service delivery method is authorized, whether the person is initially entering services or seeking to change to caregiver compensation in an existing service plan, the person's support coordinator shall confirm in writing, and annually thereafter, that:

(a) caregiver compensation services will support the person's independence and community integration;

(b) the caregiver has the capacity to meet the service-specific needs of the person as identified in the PCSP;

(c) the choice of using caregiver compensation reflects the person's wishes;

(d) the provision of caregiver compensation is based on the person's assessed needs; and

(e) the provision of caregiver compensation is in the person's best interest.

(2) The division shall deny the request to use the caregiver compensation service delivery method if any condition in Subsection (1) is not met.

R539-16-4. Caregiver Compensation Service Delivery Method Specifications for the Community Supports Waiver, Community Transitions Waiver, and Acquired Brain Injury Waiver.

(1) Services delivered through the caregiver compensation service delivery method are implemented in accordance with the terms published in the service descriptions in the provider contract or in the SAS service code descriptions on the division's website.

(a) The division shall communicate changes to SAS service code descriptions to fiscal agents before the implementation of the change.

(b) Fiscal agents shall communicate changes to SAS service code descriptions to SAS employers and SAS employees before the implementation of the change.

(2) The number of hours supported living services can be provided through the caregiver compensation service delivery method shall be approved by the RFS committee and based on assessed need. The number of authorized hours falls into one of four categories, reflected in this table:

TABLE

Authorized Hours for Supported Living Services through the Caregiver Compensation Service Delivery Method

Category

Authorized Hours

Category 1

Up to 10 hours per week

Category 2

Up to 20 hours per week

Category 3

Up to 30 hours per week

Category 4

Up to 40 hours per week

(3) The categories represent the maximum number of compensated service hours a caregiver may receive to provide extraordinary care to a person.

(4) The category a person is determined eligible for is based on the assessed needs of the person and the specific waiver the person participates in.

(a) For a person participating in the Community Supports Waiver or Community Transitions Waiver, assessed need is determined by the person's Utah Comprehensive Assessment of Needs and Strengths (UCANS) score;

(b) For a person participating in the Acquired Brain Injury Waiver, assessed need is determined by the person's Utah Comprehensive Brain Injury Assessment (CBIA) score.

(c) Additional information provided by the support coordinator, in coordination with the family, including information related to medical or behavioral needs, shall also be considered.

(5) The caregiver compensation service delivery method is evaluated and approved or denied through the RFS process. If approved, the caregiver compensation service delivery method may be used to deliver supported living services to meet a person's needs.

(6) A support coordinator may submit a request through the RFS process for supported living services to be provided through the caregiver compensation service delivery method when a person seeks to use caregiver compensation as the service delivery method to receive any of the

person's needed supported living service, and:

(a) the person is entering services and is determined to need supported living;

(b) the person seeks to modify their PCSP and budget to move any part of the person's current budget to supported living delivered through the caregiver compensation service delivery method; or

(c) based on documentation provided through the RFS process, the RFS committee authorizes additional services due to an overall increase in the person's needs.

(7) Caregiver compensation shall be identified on the PCSP as the service delivery method for the person's supported living services when:

(a) the RFS committee has reviewed and approved the support coordinator's authorization for supported living to be delivered through the caregiver compensation service delivery method; and

(b) the number of hours requested by the support coordinator has been approved by the RFS committee pursuant to Sections R539-12-4 through R539-12-7 and this section.

R539-16-5. Caregiver Compensation Service Delivery Method Specifications for the Limited Supports Waiver.

(1) Services delivered through the caregiver compensation service delivery method are implemented in accordance with the terms published in the service descriptions in the provider contract or in the SAS service code descriptions on the division website.

(2) The caregiver compensation service delivery method is evaluated and approved or denied by the waiver administrator. If approved, the caregiver compensation service delivery method may be used to deliver attendant care to meet the person's needs.

(3) The caregiver compensation service delivery method may not exceed the budget limitations in the Limited Supports Waiver. Caregiver

compensation shall be identified on the PCSP as the service delivery method for the person's attendant care services when:

(a) the waiver administrator has reviewed and approved the support coordinator's authorization for attendant care to be delivered through the caregiver compensation service delivery method; and

(b) the number of hours requested by the support coordinator has been approved by the waiver administrator.

R539-16-6. Caregiver Compensation Service Delivery Method Limitations.

(1) A person may not exceed the budget limit in their person-centered budget.

(2) The caregiver compensation service delivery method of delivering supported living or attendant care services may not be provided at the same time as any other service.

(3) When supported living or attendant care services are delivered through the caregiver compensation service delivery method and as SAS, the caregiver may not serve as both the caregiver, or the SAS employee, and as the caregiver's supervisor, or the SAS employer.

(4) A person who enters services through the Emergency Services Management Committee described in Section R539-2-9 may not use the caregiver compensation service delivery method during the first year of receiving division services.

R539-16-7. Caregiver Compensation Review Process, Recovery of Funds, and Penalties.

(1)(a) Funds for supported living or attendant care services provided through the caregiver compensation service delivery method are public funds that are appropriated to, and approved by, the division.

(b) Funds are for the delivery of services for the person during the approved period and for the purposes stipulated in the service code descriptions.

(c) Public funds are subject to applicable federal, state, and local laws and regulations pertaining to the use of public funds.

(2) The division may require [the]a person to use a contracted provider rather than the caregiver compensation service delivery method if

the SAS employer has violated any law, rule, or SAS employer or employee agreement.[fails to meet a requirement in:

(a) federal or state law or rule;

(b) the SAS employee agreement; or

(c) the SAS employer agreement.]

(3) The support coordinator shall review any billing quarterly to ensure that, for each service, no duplication of a service, fraud, or overlap of submitted timesheets has occurred for SAS and provider-based caregiver compensation.

(4) The misuse of any funds provided for the caregiver compensation service delivery method for a purpose other than those in the service description may subject the caregiver and contracted provider, if applicable, to administrative sanctions, criminal prosecution, and liability for repayment of the misused funds.

(5) For any findings of duplication of services, erroneous timesheet submissions, or exceeding the amount of service authorized in the person's person-centered budget, the department:

(a) shall recover any associated fund; and

(b) may make a referral to the Utah Office of Inspector General and the Medicaid Fraud Control Unit if waste, fraud, or abuse of funds is suspected.

(6) The department may audit any person who receives services through the caregiver compensation service delivery method.

(7) The department may authorize a change to the level of caregiver compensation available to an eligible participant.

(8) The department may terminate the caregiver compensation service delivery method as a service option if any misuse of funds or

inappropriate billing has happened, pursuant to Subsections (4) and (5), or if the employer or provider agency violates any law, rule, or SAS

employer or employee agreement.

KEY: people with disabilities, caregiver compensation, HCBS waiver, Medicaid

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

Authorizing, and Implemented or Interpreted Law: 26B-6-402; 26B-6-403

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