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Utah Administrative Code (Current through November 1, 2019) |
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R414. Health, Health Care Financing, Coverage and Reimbursement Policy |
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R414-520. Admission Criteria for Medically Complex Children's Waiver |
| R414-520-1. Introduction and Authority |
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(1) This rule outlines the criteria used to evaluate initial and ongoing eligibility for the Medically Complex Children's Waiver. (2) This rule is authorized by Section 26-18-3. Waiver services are optional and provided in accordance with 42 CFR 440.225. |
| R414-520-2. Definitions |
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(1) "Waiver" means the Medically Complex Children's Waiver. |
| R414-520-3. Eligibility Requirements |
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(1) The Department uses the following criteria to determine waiver eligibility: (a) An assessment of a child's ability to perform age-appropriate activities of daily living and that child's level of independence in the performance of the activity; and (b) An evaluation to determine whether a child meets nursing facility level of care in accordance with Section R414-502-3. (2) For a child who meets the criteria in Subsection R414-520-3(1), a point value is attributed to the initial application and annual re-evaluation that includes the following: (a) Current medical providers; (b) Condition or diagnosis; (c) Date of last medical visit; (d) Documentation of more than three months of dependence on medical devices, treatments, therapies, or subspecialty services to reach a minimum medical score; and (e) An evaluation of the impact on the parents or guardians who have provided care to the medically complex child during the last 12 months. |
| R414-520-4. Waiver Access |
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(1) The Department periodically assesses funding for the waiver to determine the number of children who may be served. It also derives a point value associated with the criteria found in Subsection R414-520-3(2)(d) through (e) to determine which children to enroll. In the event of multiple applications with the same point value, the Department will use the point value derived from Subsection R414-520-3(2)(d) to make its determination. In the event of multiple applications with the same point value derived from Subsection R414-520-3(2)(d), the Department will create a randomized list to determine which children are served. (2) An applicant who is not admitted to the waiver, or a child who is disenrolled from the waiver, may appeal the decision in accordance with 42 CFR 431, Subpart E. |
| R414-520-5. Service Coverage |
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Services and limitations are found in the State Implementation Plan for the Medically Complex Children's Waiver. |