26B-3-206. Medicaid waiver for children with disabilities and complex medical needs.

421 words·~2 min read·/ut/title-26b/chapter-3/26b-3-206

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Effective 7/1/2023

(1)As used in this section:

(a)"Additional eligibility criteria" means the additional eligibility criteria set by the department under Subsection (4)(e) .

(b)"Complex medical condition" means a physical condition of an individual that:

(i)results in severe functional limitations for the individual; and

(ii)is likely to:

(A)last at least 12 months; or

(B)result in death.

(c)"Program" means the program for children with complex medical conditions created in Subsection

(3).

(d)"Qualified child" means a child who:

(i)is less than 19 years old;

(ii)is diagnosed with a complex medical condition;

(iii)has a condition that meets the definition of disability in 42 U.S.C. Sec. 12102; and

(iv)meets the additional eligibility criteria.

(2)The department shall apply for a Medicaid home and community-based waiver with CMS to implement, within the state Medicaid program, the program described in Subsection

(3).

(3)If the waiver described in Subsection

(2)is approved, the department shall offer a program that:

(a)as funding permits, provides treatment for qualified children;

(b)accepts applications for the program on an ongoing basis;

(c)requires periodic reevaluations of an enrolled child's eligibility and other applicants or eligible children waiting for services in the program based on the additional eligibility criteria; and

(d)at the time of reevaluation, allows the department to disenroll a child if the child is no longer a qualified child.

(4)The department shall:

(a)establish by rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act , criteria to prioritize qualified children's participation in the program based on the following factors, in the following priority order:

(i)the complexity of a qualified child's medical condition; and

(ii)the financial needs of the qualified child and the qualified child's family;

(b)convene a public process to determine the benefits and services to offer a qualified child under the program;

(c)evaluate, on an ongoing basis, the cost and effectiveness of the program;

(d)if funding for the program is reduced, develop an evaluation process to reduce the number of children served based on the participation criteria established under Subsection (4)(a) ; and

(e)establish, by rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act , additional eligibility criteria based on the factors described in Subsections (4)(a)(i) and

(ii).

Amended by Chapter 286 , 2023 General Session

Renumbered and Amended by Chapter 306 , 2023 General Session