8 LONG TITLE
9 General Description:
10 This bill requires the Department of Health to establish, through a Medicaid waiver, an
11 ongoing program for children with disabilities and complex medical conditions.
12 Highlighted Provisions:
13 This bill:
14 ▸ requires the Department of Health to establish, through a Medicaid waiver, an
15 ongoing program for children with disabilities and complex medical conditions.
16 Money Appropriated in this Bill:
18 Other Special Clauses:
20 Utah Code Sections Affected:
22 26-18-410, as enacted by Laws of Utah 2015, Chapter 209
24 Be it enacted by the Legislature of the state of Utah:
25 Section 1. Section 26-18-410 is amended to read:
26 26-18-410. Medicaid waiver for children with disabilities and complex medical
28 (1) As used in this section:
29 (a) "Additional eligibility criteria" means the additional eligibility criteria set by the
30 department under Subsection (4)(e).
33 (i) results in severe functional limitations for the individual; and
34 (ii) is likely to:
35 (A) last at least 12 months; or
36 (B) result in death.
38 created in Subsection (3).
40 (i) is less than 19 years old;
41 (ii) is diagnosed with a complex medical condition;
42 (iii) has a condition that meets the definition of disability in 42 U.S.C. Sec. 12102; and
43 (iv) meets the additional eligibility criteria [
45 (2) The department shall apply[
46 community-based waiver with the Centers for Medicare and Medicaid Services within the
47 United States Department of Health and Human Services to implement, within the state
48 Medicaid program, the program described in Subsection (3).
49 (3) If the waiver described in Subsection (2) is approved, the department shall offer a
50 program that:
51 (a) as funding permits, provides treatment for qualified children; [
52 (b) accepts applications for the program during periods of open enrollment[
53 (c) if approved by the Centers for Medicare and Medicaid Services:
54 (i) requires periodic reevaluations of an enrolled child's eligibility based on the
55 additional eligibility criteria; and
56 (ii) at the time of reevaluation, allows the department to disenroll a child who does not
57 meet the additional eligibility criteria.
58 (4) The department shall:
59 (a) seek to prioritize, in the waiver described in Subsection (2), entrance into the
60 program based on the:
61 (i) complexity of a qualified child's medical condition; and
62 (ii) financial needs of a qualified child and the qualified child's family;
63 (b) convene a public process to determine:
64 (i) the benefits and services to offer a qualified child under the program; and
65 (ii) additional eligibility criteria for a qualified child; [
66 (c) evaluate, on an ongoing basis, the cost and effectiveness of the program[
66a Ŝ→ [
67 (d) if funding for the program is reduced, develop an evaluation process to reduce the
68 number of children served based on the criteria in Subsection (4)(a); and
69 (e) establish, by rule made in accordance with Title 63G, Chapter 3, Utah
70 Administrative Rulemaking Act, additional eligibility criteria based on the factors described in
71 Subsections (4)(a)(i) and (ii).
72 (5) The department shall annually report[
73 Health and Human Services Interim Committee before November 30 while the waiver is in
74 effect regarding:
75 (a) the number of qualified children served under the program;
76 (b) the cost of the program; and
77 (c) the effectiveness of the program.