1     
PILOT PROGRAM FOR ASSISTANCE FOR CHILDREN

2     
WITH DISABILITIES AND COMPLEX MEDICAL

3     
CONDITIONS

4     
2015 GENERAL SESSION

5     
STATE OF UTAH

6     
Chief Sponsor: Edward H. Redd

7     
Senate Sponsor: Curtis S. Bramble

8     Cosponsors:
9     Rebecca Chavez-Houck
10     Brad M. Daw
11     Jack R. Draxler
12     Steve Eliason
13     Francis D. Gibson
Brian M. Greene
Sandra Hollins
Michael S. Kennedy
David E. Lifferth
Lee B. Perry
Paul Ray
Angela Romero
Robert M. Spendlove
Earl D. Tanner
Norman K Thurston
Raymond P. Ward
John R. Westwood
14     

15     LONG TITLE
16     General Description:
17          This bill directs the Department of Health to apply for a Medicaid waiver for children
18     with disabilities and complex medical conditions.
19     Highlighted Provisions:
20          This bill:
21          ▸     directs the Department of Health to apply for a Medicaid waiver for children with
22     disabilities and complex medical conditions.
23     Money Appropriated in this Bill:
24          None
25     Other Special Clauses:
26          None
27     Utah Code Sections Affected:

28     ENACTS:
29          26-18-410, Utah Code Annotated 1953
30     

31     Be it enacted by the Legislature of the state of Utah:
32          Section 1. Section 26-18-410 is enacted to read:
33          26-18-410. Medicaid waiver for children with disabilities and complex medical
34     needs.
35          (1) As used in this section:
36          (a) "Complex medical condition" means a physical condition of an individual that:
37          (i) results in severe functional limitations for the individual; and
38          (ii) is likely to:
39          (A) last at least 12 months; or
40          (B) result in death.
41          (b) "Program" means the program for children with complex medical conditions
42     created in Subsection (3).
43          (c) "Qualified child" means a child who:
44          (i) is less than 19 years old;
45          (ii) is diagnosed with a complex medical condition;
46          (iii) has a condition that meets the definition of disability in 42 U.S.C. Sec. 12102; and
47          (iv) meets the additional eligibility criteria determined by the department under
48     Subsection (4).
49          (2) The department shall apply, no later than June 30, 2015, for a Medicaid home and
50     community-based waiver with the Centers for Medicare and Medicaid Services within the
51     United States Department of Health and Human Services to implement, within the state
52     Medicaid program, the program described in Subsection (3).
53          (3) If the waiver described in Subsection (2) is approved, the department shall offer a
54     program that:
55          (a) as funding permits, provides treatment for qualified children; and

56          (b) accepts applications for the program during periods of open enrollment.
57          (4) The department shall:
58          (a) seek to prioritize, in the waiver described in Subsection (2), entrance into the
59     program based on the:
60          (i) complexity of a qualified child's medical condition; and
61          (ii) financial needs of a qualified child and the qualified child's family;
62          (b) convene a public process to determine:
63          (i) the benefits and services to offer a qualified child under the program; and
64          (ii) additional eligibility criteria for a qualified child; and
65          (c) evaluate, on an ongoing basis, the cost and effectiveness of the program.
66          (5) The department shall annually report, beginning in 2016, to the Legislature's Health
67     and Human Services Interim Committee before November 30 while the waiver is in effect
68     regarding:
69          (a) the number of qualified children served under the program;
70          (b) the cost of the program; and
71          (c) the effectiveness of the program.