Chief Sponsor: Edward H. Redd

Senate Sponsor: Curtis S. Bramble

7     Cosponsors:
8     Cheryl K. Acton
9     Carl R. Albrecht
10     Patrice M. Arent
11     Joel K. Briscoe
12     Rebecca Chavez-Houck
13     Kim F. Coleman
14     Susan Duckworth
15     Rebecca P. Edwards
16     Steve Eliason
17     Gage Froerer
18     Brian M. Greene
Keith Grover
Stephen G. Handy
Sandra Hollins
Eric K. Hutchings
Michael S. Kennedy
Brian S. King
A. Cory Maloy
Carol Spackman Moss
Derrin R. Owens
Lee B. Perry
Dixon M. Pitcher
Val K. Potter
Marie H. Poulson
Susan Pulsipher
Paul Ray
Angela Romero
Douglas V. Sagers
Robert M. Spendlove
Raymond P. Ward
R. Curt Webb
Elizabeth Weight
Mark A. Wheatley


21     General Description:
22          This bill requires the Department of Health to establish, through a Medicaid waiver, an
23     ongoing program for children with disabilities and complex medical conditions.
24     Highlighted Provisions:
25          This bill:
26          ▸     requires the Department of Health to establish, through a Medicaid waiver, an
27     ongoing program for children with disabilities and complex medical conditions.

28     Money Appropriated in this Bill:
29          None
30     Other Special Clauses:
31          None
32     Utah Code Sections Affected:
33     AMENDS:
34          26-18-410, as enacted by Laws of Utah 2015, Chapter 209

36     Be it enacted by the Legislature of the state of Utah:
37          Section 1. Section 26-18-410 is amended to read:
38          26-18-410. Medicaid waiver for children with disabilities and complex medical
39     needs.
40          (1) As used in this section:
41          (a) "Additional eligibility criteria" means the additional eligibility criteria set by the
42     department under Subsection (4)(e).
43          [(a)] (b) "Complex medical condition" means a physical condition of an individual
44     that:
45          (i) results in severe functional limitations for the individual; and
46          (ii) is likely to:
47          (A) last at least 12 months; or
48          (B) result in death.
49          [(b)] (c) "Program" means the program for children with complex medical conditions
50     created in Subsection (3).
51          [(c)] (d) "Qualified child" means a child who:
52          (i) is less than 19 years old;
53          (ii) is diagnosed with a complex medical condition;
54          (iii) has a condition that meets the definition of disability in 42 U.S.C. Sec. 12102; and

55          (iv) meets the additional eligibility criteria [determined by the department under
56     Subsection (4)].
57          (2) The department shall apply[, no later than June 30, 2015,] for a Medicaid home and
58     community-based waiver with the Centers for Medicare and Medicaid Services within the
59     United States Department of Health and Human Services to implement, within the state
60     Medicaid program, the program described in Subsection (3).
61          (3) If the waiver described in Subsection (2) is approved, the department shall offer a
62     program that:
63          (a) as funding permits, provides treatment for qualified children; [and]
64          (b) accepts applications for the program during periods of open enrollment[.]; and
65          (c) if approved by the Centers for Medicare and Medicaid Services:
66          (i) requires periodic reevaluations of an enrolled child's eligibility based on the
67     additional eligibility criteria; and
68          (ii) at the time of reevaluation, allows the department to disenroll a child who does not
69     meet the additional eligibility criteria.
70          (4) The department shall:
71          (a) seek to prioritize, in the waiver described in Subsection (2), entrance into the
72     program based on the:
73          (i) complexity of a qualified child's medical condition; and
74          (ii) financial needs of a qualified child and the qualified child's family;
75          (b) convene a public process to determine:
76          (i) the benefits and services to offer a qualified child under the program; and
77          (ii) additional eligibility criteria for a qualified child; [and]
78          (c) evaluate, on an ongoing basis, the cost and effectiveness of the program[.];
79          (d) if funding for the program is reduced, develop an evaluation process to reduce the
80     number of children served based on the criteria in Subsection (4)(a); and
81          (e) establish, by rule made in accordance with Title 63G, Chapter 3, Utah

82     Administrative Rulemaking Act, additional eligibility criteria based on the factors described in
83     Subsections (4)(a)(i) and (ii).
84          (5) The department shall annually report[, beginning in 2016,] to the Legislature's
85     Health and Human Services Interim Committee before November 30 while the waiver is in
86     effect regarding:
87          (a) the number of qualified children served under the program;
88          (b) the cost of the program; and
89          (c) the effectiveness of the program.