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 M-W and F; after these hours there is the option to leave a voicemail which will be returned within a few business days)

Email: newchoiceswaiver@utah.gov
Fax: 801-323-1586

Mailing:
UDOH Bureau 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.

For expedited processing of a New Choices Waiver application, please apply online starting April 4, 2023 (link coming soon). Our current paper application can be requested by calling the New Choices Waiver Program Office from 9:00am-12:00pm Monday-Wednesday and Friday at 800-662-9651, option 6.

Forms and Applications - Page Bookmarks
(Click a bookmark to jump to that section of the page)

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
   1. How to Access New Choices Waiver Provider Manual opens in a new tab
3. Program Guidance
   1. Policy Clarification Notices
   2. Attachment C: Self-Administered Services opens in a new tab
      NCW SAS FAQ (11.15.21) opens in a new tab
   3. Choking and Swallowing Advisory opens in a new tab
4. Reports
   1. New Choices Waiver-Waiver Year 01 372 Report opens in a new tab
   2. New Choices Waiver-Waiver Year 02 372 Report opens in a new tab
   3. New Choices Wavier-Waiver year 03 372 Report 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. PCCP Addendum PDF opens in a new tab | Word
  2. Notice of Decision opens in a new tab
  3. Cover Sheet opens in a new tab
  4. MDS-HC opens in a new tab
  5. Medication Management Review Form PDF opens in a new tab |  Word
  6. Memory Care Checklist opens in a new tab
  7. Incident Reporting opens in a new tab
  8. 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

Contact Information Utah Medicaid and Department of Workforce Services (DWS)

Participant Resources

NCW Fact Sheet opens in a new tab

Rights and Responsibilities opens in a new tab

Contact information for DWS, Medicaid Operations and Constituent Services

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 find out which case management agencies are available, look at the Freedom of Choice Consent Form 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

Adult Case Management
(385) 273-1456
Incident Report/Fax: (385) 273-1457
Email: info@adultcasemanagement.com
https://adultcasemanagement.com/ opens in a new tab

Advocates for Independence
323 N Main Street, Suite 404
Tooele UT 84074
(801) 679-6461
Incident Report Fax: (801) 948-8001
http://www.advocatesforindependence.com opens in a new tab
Advocates for Independence Brochure opens in a new tab

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

Davis County Health Department – Senior Services
22 South State
Clearfield, UT 84015
(801) 525-5050
Incident Report Fax: (801) 525-5071
http://www.daviscountyutah.gov/health/senior-services opens in a new tab
Davis County Health Department – Senior Services 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

EnVision Quality Supports
6364 S. Highland Drive #201
Salt Lake City, UT 84121
(801) 209-1357
Incident Report Fax: (801) 874-1753
Incident Report Email: info@envisionquality.com
http://www.envisionquality.com opens in a new tab
EnVision Quality Supports Brochure opens in a new tab

Five County Association of Governments
Area Agency on Aging
1070 W. 1600 S. Bldg. B
St. George, UT 84770
(435) 673-3548
Incident Report Fax: (435) 688-9088
Five County Association of Governments Brochure opens in a new tab

FlexCare (North)
1785 E 1450 S Ste 370
Clearfield, UT 84105
(801) 294-6747
Incident Report Fax: (801) 424-6250
http://www.valleycares.com/programs-services/medical-case-management/ opens in a new tab
FlexCare Brochure opens in a new tab

FlexCare (South)
4460 S. Highland Drive, Suite 300
Salt Lake City, UT 84124
(801) 273-6366
Incident Report Fax: (385) 388-8009
http://www.valleycares.com/programs-services/medical-case-management/ opens in a new tab
FlexCare 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

MAG
586 E. 800 N.
Orem, UT 84097
(801) 229-3804
Incident Report Fax: (801) 229-3671
http://www.mountainland.org/aging opens in a new tab

Roads To Independence
3355 Washington Blvd.
Ogden, UT 84401
(801) 612-3215
(866) 734-5678 Toll Free
Incident Report Fax: (801) 612-3732
Incident Report Email: Roads@roadstoindependence.org
http://www.RoadsToIndependence.org opens in a new tab
Roads To Independence 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

Utah Case Management
Draper, UT
(801) 407-0047
Incident Report Fax: (888) 400-9232
Incident Report Email: ucm@utahcasemanagement.com
http://utahcasemanagement.com/ opens in a new tab
Utah Case Management 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.

• 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 described further in this brochure as possible Critical Incidents

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. Submit report to ncwincidents@utah.gov
   • Incident Report Form (IR) PDF opens in a new tab | Word
   • Critical Incident Investigation Report (CIIR) PDF opens in a new tab | Word
   • Example Investigation Report opens in a new tab
   • Helpful Resources
     • Adult Protective Services (APS) opens in a new tab
     • Bureau of Health Facility Licensing.(BHFL) opens in a new tab
     • Ombudsman opens in a new tab

Case Management Agency Training

1. Appendix K (02.25.2021) opens in a new tab
2. Appendix K and Price Per Unit (03.04.2021) opens in a new tab
3. PCCP Addendum-Community Access (04.08.2021) opens in a new tab
4. Financial Transaction Services (05.22.2021)
5. CMA Transfers (6.10.21) opens in a new tab
6. General Updates and Training Topics opens in a new tab
7. Medication Management (09.09.2021) opens in a new tab
8. Self-Administered Services (10.14.2021) opens in a new tab

New Provider Training

1. New Case Management Agency Training opens in a new tab
2. Nursing Facility Level of Care Training opens in a new tab
3. Case Management Agency Self-Audit Review opens in a new tab
4. New Adult Residential Training (under development)
5. New All Other Providers Training (under development)
6. Final Settings Rule
7. PRISM Provider Enrollment Training

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 Transition 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 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
2. Provider User Access Agreement opens in a new tab
3. Provider Agreement opens in a new tab
4. Settings Rule

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 M-W and F; 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