(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.

(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.

(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.

(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.

(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 during periods of open enrollment; and (c) if approved by CMS: (i) requires periodic reevaluations of an enrolled child's eligibility based on the additional eligibility criteria; and (ii) at the time of reevaluation, allows the department to disenroll a child who does not meet the additional eligibility criteria.

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

(b) accepts applications for the program during periods of open enrollment; and

(c) if approved by CMS: (i) requires periodic reevaluations of an enrolled child's eligibility based on the additional eligibility criteria; and (ii) at the time of reevaluation, allows the department to disenroll a child who does not meet the additional eligibility criteria.

(i) requires periodic reevaluations of an enrolled child's eligibility based on the additional eligibility criteria; and

(ii) at the time of reevaluation, allows the department to disenroll a child who does not meet the additional eligibility criteria.

(4) The department shall: (a) seek to prioritize, in the waiver described in Subsection (2), entrance into the program based on the: (i) complexity of a qualified child's medical condition; and (ii) financial needs of a qualified child and the qualified child's family; (b) convene a public process to determine: (i) the benefits and services to offer a qualified child under the program; and (ii) additional eligibility criteria for a qualified child; (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 criteria in 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).

(a) seek to prioritize, in the waiver described in Subsection (2), entrance into the program based on the: (i) complexity of a qualified child's medical condition; and (ii) financial needs of a qualified child and the qualified child's family;

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

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

(b) convene a public process to determine: (i) the benefits and services to offer a qualified child under the program; and (ii) additional eligibility criteria for a qualified child;

(i) the benefits and services to offer a qualified child under the program; and

(ii) additional eligibility criteria for a qualified child;

(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 criteria in 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).