Representative Edward H. Redd proposes the following substitute bill:


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     

9     LONG TITLE
10     General Description:
11          This bill directs the Department of Health to apply for a Medicaid waiver for children
12     with disabilities and complex medical conditions.
13     Highlighted Provisions:
14          This bill:
15          ▸     directs the Department of Health to apply for a Medicaid waiver for children with
16     disabilities and complex medical conditions.
17     Money Appropriated in this Bill:
18          None
19     Other Special Clauses:
20          None
21     Utah Code Sections Affected:
22     ENACTS:
23          26-18-410, Utah Code Annotated 1953
24     

25     Be it enacted by the Legislature of the state of Utah:

26          Section 1. Section 26-18-410 is enacted to read:
27          26-18-410. Medicaid waiver for children with disabilities and complex medical
28     needs.
29          (1) As used in this section:
30          (a) "Complex medical condition" means a physical condition of an individual that:
31          (i) results in severe functional limitations for the individual; and
32          (ii) is likely to:
33          (A) last at least 12 months; or
34          (B) result in death.
35          (b) "Program" means the program for children with complex medical conditions
36     created in Subsection (3).
37          (c) "Qualified child" means a child who:
38          (i) is less than 19 years old;
39          (ii) is diagnosed with a complex medical condition;
40          (iii) has a condition that meets the definition of disability in 42 U.S.C. Sec. 12102; and
41          (iv) meets the additional eligibility criteria determined by the department under
42     Subsection (4).
43          (2) The department shall apply, no later than June 30, 2015, for a Medicaid home and
44     community-based waiver with the Centers for Medicare and Medicaid Services within the
45     United States Department of Health and Human Services to implement, within the state
46     Medicaid program, the program described in Subsection (3).
47          (3) If the waiver described in Subsection (2) is approved, the department shall offer a
48     program that:
49          (a) as funding permits, provides treatment for qualified children; and
50          (b) accepts applications for the program during periods of open enrollment.
51          (4) The department shall:
52          (a) seek to prioritize, in the waiver described in Subsection (2), entrance into the
53     program based on the:
54          (i) complexity of a qualified child's medical condition; and
55          (ii) financial needs of a qualified child and the qualified child's family;
56          (b) convene a public process to determine:

57          (i) the benefits and services to offer a qualified child under the program; and
58          (ii) additional eligibility criteria for a qualified child; and
59          (c) evaluate, on an ongoing basis, the cost and effectiveness of the program.
60          (5) The department shall annually report, beginning in 2016, to the Legislature's Health
61     and Human Services Interim Committee before November 30 while the waiver is in effect
62     regarding:
63          (a) the number of qualified children served under the program;
64          (b) the cost of the program; and
65          (c) the effectiveness of the program.