26B-3-206. Medicaid waiver for children with disabilities and complex medical needs.
(1) As used in this section: "Additional eligibility criteria" means the additional eligibility criteria set by the department under Subsection. (4)(e) "Complex medical condition" means a physical condition of an individual that: results in severe functional limitations for the individual; and is likely to: last at least 12 months; or result in death. "Program" means the program for children with complex medical conditions created in Subsection. (3) "Qualified child" means a child who: is less than 19 years old; is diagnosed with a complex medical condition; has a condition that meets the definition of disability in 42 U.S.C. Sec. 12102; and 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 Subsectionis approved, the department shall offer a program that: (2) as funding permits, provides treatment for qualified children; accepts applications for the program on an ongoing basis; 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 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: establish by rule made in accordance with, criteria to prioritize qualified children's participation in the program based on the following factors, in the following priority order: Title 63G, Chapter 3, Utah Administrative Rulemaking Act the complexity of a qualified child's medical condition; and the financial needs of the qualified child and the qualified child's family; convene a public process to determine the benefits and services to offer a qualified child under the program; evaluate, on an ongoing basis, the cost and effectiveness of the program; 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; and (4)(a) establish, by rule made in accordance with, additional eligibility criteria based on the factors described in Subsectionsand. Title 63G, Chapter 3, Utah Administrative Rulemaking Act (4)(a)(i) (ii)