Representative Edward H. Redd proposes the following substitute bill:





Chief Sponsor: Edward H. Redd

Senate Sponsor: Curtis S. Bramble


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:
17          None
18     Other Special Clauses:
19          None
20     Utah Code Sections Affected:
21     AMENDS:
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
27     needs.
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).
31          [(a)] (b) "Complex medical condition" means a physical condition of an individual
32     that:
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.
37          [(b)] (c) "Program" means the program for children with complex medical conditions
38     created in Subsection (3).
39          [(c)] (d) "Qualified child" means a child who:
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 [determined by the department under
44     Subsection (4)].
45          (2) The department shall apply[, no later than June 30, 2015,] for a Medicaid home and
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; [and]
52          (b) accepts applications for the program during periods of open enrollment[.]; and
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; [and]
66          (c) evaluate, on an ongoing basis, the cost and effectiveness of the program[.]; and
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[, beginning in 2016,] to the Legislature's
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.