New Choices Waiver

The New Choices Waiver Program is designed to serve individuals who are residing long term in a nursing facility, licensed assisted living facility, licensed small health care (Type N) facility or another type of Utah licensed medical institution (except institutions for mental disease). The Program offers an option for these individuals to move into integrated community-based settings if they wish to do so and if their needs can be safely met in the setting that they have chosen. When an individual is enrolled in the New Choices Waiver Program, they may receive an expanded package of supportive services through Medicaid which are intended to help with community-based living and are based on the assessed need of the individual. A description of the available services can be found below.

PLEASE NOTE: Individuals who are not currently living in one of the types of facilities listed above are not eligible to apply to the New Choices Waiver Program. There is a minimum length of stay requirement in each type of setting. For more information, please contact the New Choices Waiver Program at (800)662-9651, option 6 or newchoiceswaiver@utah.gov.

Apply for New Choices Waiver Here opens in a new tab

For fastest processing, submit an online application for the New Choices Wavier Program. (First -time applicants will be required to create a UtahID account.)

Paper applications will experience a delay and may be requested via our contact information below.

Please refer to the New Choices Waiver Fact Sheet opens in a new tab for more information.

Contact Information

From the Salt Lake City area: 801-538-6155, option 6
Outside the Salt Lake city area: 800-662-9651, option 6
( Phones are staffed 9:00am-12:00pm Monday, Wednesday, Thursday, and Friday. After these hours, there is the option to leave a voicemail which will be returned within a few business days )

Mailing:
DHHS Office of Long Term Services & Supports
P.O. Box 143112
288 N 1460 W
SLC, UT 84114-3112

Services

New Choices Waiver offers an expanded package of supportive services that are intended to facilitate a participant's ability to reside in a home or community-based setting. Services are available based on the assessed need of the participant and include those listed below. The New Choices Waiver Description of Services opens in a new tab provides a brief description of each service.

Financial Management Services

Adult Residential Services

Assistive Technology Devices

Home Delivered Meals

Medication Assistance Services

Personal Budget Assistance

Community Living Services

Consumer Preparation Services

Specialized Medical Equipment

Emergency Response Systems

Environmental Accessibility Adaptations

Policies and Forms

Policy

1. New Choices Waiver State Implementation Plan Effective 07.01.2021 opens in a new tab
2. Utah Medicaid Information Bulletin and Provider Manuals
3. Program Guidance
   1. Attachment C: Self-Administered Services opens in a new tab
      NCW SAS FAQ (11.15.21) opens in a new tab
   2. Choking and Swallowing Advisory opens in a new tab

   Forms

   This is not an all-inclusive list of required forms for the New Choices Waiver. If a provider needs to obtain forms that do not appear in this list, please contact the New Choices Waiver Program.

   • NCW Release of Information (ROI)
   • Case Management Forms
     1. Notice of Decision opens in a new tab
     2. Cover Sheet opens in a new tab
     3. MDS-HC opens in a new tab
     4. Medication Management Review Form PDF opens in a new tab | Word
     5. Memory Care Checklist PDF | Word
     6. Incident Reporting opens in a new tab
     7. 114AR DWS Release Form opens in a new tab
   • Rights and Responsibilities
     1. Know Your Rights opens in a new tab
     2. Know Your Responsibilities opens in a new tab
   • Self-Administered Services (SAS)
     1. Attachment C: Self-Administered Service opens in a new tab
     2. NCW SAS Code of Conduct and Certificate of Understanding opens in a new tab
     3. NCW SAS Employment Agreement opens in a new tab
     4. NCW SAS Health and Safety Checklist opens in a new tab
     5. NCW SAS Home Safety Checklist opens in a new tab
     6. NCW SAS Participant Letter of Agreement opens in a new tab
     7. NCW SAS Unit Allocation for Attendant Care Services opens in a new tab

   Case Management Services are services that assist participants to gain access to needed waiver services and other Medicaid State Plan services, as well as needed medical, social, educational, and other services, regardless of the funding source. For more information on the Case Management agencies that work with New Choices Waiver, please see the Case Management Agencies section.

   Participants have the right to change case management agencies at any time; to facilitate a change the participant or their representative should contact the New Choices Waiver Program.

   Helpful Links

   Participant Resources

   Case Management Agencies

   As you consider which case management agency you’d like to choose, keep in mind that all New Choices Waiver case management agencies are required to perform certain preset activities for each New Choices Waiver participant. Those include things like assessment of client’s needs, working with clients to develop person centered care plans to meet their assessed needs and to help achieve personal goals, performing at least once monthly monitoring, coordinating services, advocating for their clients and keeping accurate records. However, case management agencies are private contracted organizations that are able to establish their own business hours, establish their own approach to how they will respond to urgent client situations, decide whether they will offer other programs or resources within their organization and determine which areas within the community-based system of care that they will choose to specialize in. For this reason it’s important to do a little research to know which agency is right for your own needs and preferences.

   To receive a county specific Freedom of Choice Form contact the New Choices Waiver Program at (800) 662-9651, option 6 or newchoiceswaiver@utah.gov. Then begin reviewing agencies in your county by referring to their contact information below.

   Case Management Agency Contacts

   Abundant Solutions, LLC
   (435) 754-4882
   Email: mariah@abundantcma.com
   Fax: (385) 316-8840
   991 Shepard Ln, Ste 210
   Farmington, Utah 84025

   Care Advocates
   451 E Bishop Federal Ln
   Suite 150
   Salt Lake City, UT 84115-2357
   (801) 722-4229
   Incident Report Fax: (801) 702-8002
   Care Advocates Brochure opens in a new tab

   De Novo Case Management Services
   (801) 263-1056
   Incident ReportFax: (801) 991-2903
   Incident Report Email: carol@denoservices.org
   De Novo Services Case Management Brochure opens in a new tab

   Generations Case Management
   (801) 979-2436
   Incident Report Fax: (385) 389-3632
   Email: kara@generationscm.org

   MACS Plan
   205 26th Street, Suite 12
   Ogden, UT 84401
   (801) 625-3786
   Incident Report Fax: (801) 778-6818
   Incident Report Email: lauraw@weberhs.org
   MACS Plan Brochure opens in a new tab

   Salt Lake County Aging and Adult Services
   2001 S. State Street #S1-600
   Salt Lake City, UT 84114
   (385) 468-3270
   Incident Report Fax: (801) 487-6353
   Incident Report Email: tnagahiro@slco.org
   http://slco.org/aging-adult-services/ opens in a new tab
   Salt Lake County Aging and Adult Services Brochure opens in a new tab

   Southeastern Utah Association of Local Governments
   375 S. Carbon Avenue
   Price, UT 84501
   (435) 613-0036
   Incident Report Fax: (435) 637-5448
   Southeastern Utah Association of Local Governments Brochure opens in a new tab

   All negative events experienced by NCW participants must be reported by NCW service providers to the participant’s case management agency within 24 hours of discovery. The list below includes examples of negative events that should be reported; this list is not all-inclusive and the Incident Reporting Protocol opens in a new tab should be referenced for further information.

   Per the NCW Service Implementation Plan, the case management agency must notify the NCW Program Office of any negative events/incidents experienced by participants within 24 hours or on the first business day after the incident .

   • Death, regardless of the circumstances
   • Changes in medical or functional status
   • Falls with or without injury
   • ER treatment for any reason
   • Hospital admission for any reason
   • Mental health decline
   • Start or stop of hospice or home health services
   • A move to a skilled nursing facility
   • Any negative event that occurs at the client’s place of residence or that occur while the client is in the community
   • Events that rise to a comparable level as those described in the Incident Reporting Protocol brochure

   Case management agencies must review all negative events experienced by NCW participants and report any possible critical incidents to the NCW Program within 24 hours of receiving notification. To report a critical incident:

   1. Complete the Incident Report (IR) form (a provider/facility specific incident report may also be used to report the incident)
   2. • Incident Report Form (IR) PDF opens in a new tab | Word
      • Critical Incident Investigation Report (CIIR) PDF opens in a new tab | Word
      • Submit report to ncwincidents@utah.gov
      • Helpful Resources
        • Adult Protective Services (APS) opens in a new tab
        • Office of Licensing opens in a new tab
        • Long-Term Care Ombudsman opens in a new tab

   The New Choices Waiver Program strongly encourages providers to contact the Program prior to submitting or validating PRISM records to verify all of the items needed. The Program can be reached at (801)538-6497 or email newchoiceswaiver@utah.gov.

   Enrollment

   All New Choices Waiver providers must complete an Attachment B that corresponds to the New Choices Waiver service(s) that the provider is qualified to provide and intends to offer. If the provider plans to offer more than one New Choices Waiver service, the provider must complete a separate Attachment B for each of the distinct services. The final (signature) page of each Attachment B must be uploaded to PRISM.

   For Adult Residential Services providers including assisted living facilities, independent living facilities, community residential treatment facilities and small health care (Type N) facilities, if your facility offers more than one level of care it is important to complete a separate Attachment B for each/all of the residential levels of care that you are licensed or certified to provide. (For example, a licensed ALF with a secure memory care unit should complete an Attachment B for ALF Type 1 & 2 and a separate Attachment B for ALF secure memory care. Another example, a licensed ALF (non-memory care) that has a certified independent living wing should complete an Attachment B for ALF Type 1 & 2 and a separate Attachment B for certified independent living.)

   All Home and Community-Based Services (HCBS) Medicaid waiver providers must be compliant with the Settings Rule by March 2022. As part of submitting an application providers are required to complete a Settings Rule self- attestation (based on setting); quiz and survey. Please visit HCBS Settings Rule Transition Planning for more information.

   Validation

   For existing providers going through the validation process, it is very important that your PRISM provider profile matches existing New Choices Waiver provider enrollment records. Services that you have previously been approved for should be added under the “specialties'' section in PRISM if they are not already listed. Please verify that the counties of service selected are reflective of your current business operations. If your PRISM file does not align with previously approved services, or your agency is desiring to add additional services, your application may be returned for edit to ensure congruence in the records. If you need to verify which service(s) your agency has signed up to offer through New Choices Waiver, please return to your provider profile within the PRISM Portal and review this information in the section labeled “HCBS Waiver and EPAS.” An Attachment B must be submitted for each of the approved NCW services.

   Forms

   1. Attachment B
      1. Adult Day Care S5102 – Att B opens in a new tab
      2. Adult Residential Services – ALF Memory Care T2016 – Att B opens in a new tab
      3. Adult Residential Services – ALF Type 1 & 2 and Type N T2031 – Att B opens in a new tab
      4. Adult Residential Services – Certified Independent Living Facility H0043 – Att B opens in a new tab
      5. Adult Residential Services – Licensed Community Residential Care T2033- Att B opens in a new tab
      6. Assistive Technology Devices T2028 – Att B opens in a new tab
      7. Attendant Care Services S5125 – Att B opens in a new tab
      8. Caregiver Training S5115 – Att B opens in a new tab
      9. Case Management Services T1016 and T2024 – Att B opens in a new tab
      10. Chore Services S5120 – Att B opens in a new tab
      11. Community Living Services T2038 – Att B opens in a new tab
      12. Consumer Preparation Services S5108 – Att B opens in a new tab
      13. Environmental Access – Home Modifications S5165 – Att B opens in a new tab
      14. Environmental Access – Vehicle Modifications T2039 – Att B opens in a new tab
      15. Financial Management Services T2040 – Att B opens in a new tab
      16. Habilitation Services T2017 – Att B opens in a new tab
      17. Home Delivered Meals S5170 – Att B opens in a new tab
      18. Homemaker Services S5130 – Att B opens in a new tab
      19. Medication Admin – Med Reminder System S5185 – Att B opens in a new tab
      20. Medication Admin – Med Set-Up and Admin H0034 – Att B opens in a new tab
      21. Non-Medical Transportation T2003, S0215, T2004 – Att B 2024-05-20 DHHS NCW – Non-Medical Transportation T2003, S0215, T2004 – Attch B.pdf opens in a new tab
      22. Personal Budget Assistance H0038 – Att B opens in a new tab
      23. Personal Emergency Response System S5160, S5161, and S5162 – Att B opens in a new tab
      24. Respite Care – Hourly S5150 – Att B opens in a new tab
      25. Respite Care – Overnight, Out of Home, Room and Board Included H0045 – Att B opens in a new tab
      26. Specialized Medical Equipment, Supplies & Supplements T2029 – Att B opens in a new tab
      27. Supportive Maintenance T1021 – Att B opens in a new tab

      Billing

      1. NCW FY23 Rate Sheet Effective 7.1.2023 opens in a new tab
      2. Electronic Visit Verification
      3. Place of Service Codes (CMS) opens in a new tab
      4. Utah Medicaid Coverage and Reimbursement
      5. Medicaid Claims
      6. UHIN opens in a new tab

      Contact Information

      Email: newchoiceswaiver@utah.gov
      From the Salt Lake City area: 801-538-6155, option 6
      Outside the Salt Lake City area: 800-662-9651, option 6
      ( Phones are staffed 9:00am-12:00pm Monday, Wednesday, Thursday, and Friday. After these hours, there is the option to leave a voicemail which will be returned within a few business days )

      PRISM Provider Training for New Choices Waiver

      • Introduction to Provider Reimbursement Information System for Medicaid (PRISM) opens in a new tab
      • New Choices Waiver: An Overview opens in a new tab
      • Processing Initial Enrollment for New Choices Waivers (Provider) opens in a new tab
      • New Choices Waiver Annual Review by a Provider opens in a new tab
      • New Choices Waiver Care Plan Amendment for a Provider opens in a new tab
      • New Choices Waiver - Inpatient Admission for a Provider opens in a new tab
      • New Choices Waiver - Incident Report (Provider) opens in a new tab
      • New Choices Waiver - Disenrollment (Provider) opens in a new tab
      • New Choices Waiver - Return to Community from Inpatient for a Provider opens in a new tab
      • New Choices Waiver - Change in Living Arrangement for a Provider opens in a new tab
      • New Choices Waiver - Agency Transfer for a Provider opens in a new tab
      • New Choices Waiver - Substantial Change in Health Status for a Provider opens in a new tab
      • New Choices Waiver Supporting - Comprehensive Care Plan (Provider) opens in a new tab
      • Entering an Application for the New Choices Waiver When Currently Living in a Nursing Facility opens in a new tab
      • Entering an Application for the New Choices Waiver When Currently Living in an Assisted Living Facility opens in a new tab
      • Introduction to Filing an Appeal Hearing/Complaints/Release of PHI opens in a new tab
      • Performing Prior Authorization Inquiries opens in a new tab