Utah Medicaid pays for in-home personal care and related services through 2 programs, including the Aging Waiver (Waiver for Individuals Age 65 or Older) and the New Choices Waiver. Utah has eight 1915(c) waivers, including Aging, New Choices, Physical Disabilities, Community Supports (ID/RC), Limited Supports and Acquired Brain Injury. The Division of Aging and Adult Services runs the Aging Waiver; the DHHS Office of Long Term Services & Supports runs New Choices with contracted case management agencies. EVV disallowances for personal care began 2021-04-01; confirm New Choices services and state plan personal care with Utah DHHS.
Which Utah waivers can a home care agency bill?
Each waiver below lists who it covers, the services it pays for, and how providers bill.
Aging Waiver (Waiver for Individuals Age 65 or Older)
Population
Utah residents 65 or older who require nursing facility level of care and meet Medicaid financial eligibility; there is a waiting list.
Services covered
personal attendant services
homemaker services
chore services
adult companion services
respite care services
adult day health services
emergency response systems
supplemental meals
non-medical transportation
case management
Billing format
Personal care services require EVV under a provider choice model (providers pick their own Cures Act-compliant EVV system); Utah Medicaid runs annual post-payment EVV reviews.
People living long term in a nursing facility, licensed assisted living facility, Type N small health care facility or other licensed medical institution who meet nursing facility level of care and want to move to community living.
To bill Medicaid for home care you need a state license, a Type 2 NPI, state Medicaid enrollment and screening, waiver or managed care contracts, EVV and authorizations.
Private pay means higher rates and fast payment; Medicaid means steady volume at state-set rates with authorizations and EVV. Compare rates, cash timing and admin before you mix them.
Track units remaining, the end date and the service code for every client, and check them before each schedule change. Hours over the cap are unbillable.
Four units equal one hour. How to convert units to hours, the common HCPCS codes, how states round partial units, and how to stay inside the authorization.
These free tools are made by the team behind Caregiver Scheduling,
caregiver scheduling software for home care agencies.
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