1. (1) The Department uses the following criteria to determine waiver eligibility:

   1. (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
   2. (b) an evaluation to determine whether a child meets nursing facility level-of-care in accordance with Section R414-502-3.

2. (2) For a child who meets the criteria in Subsection (1), a point value is attributed to the initial application and annual re-evaluation that includes the following:

   1. (a) current medical providers;
   2. (b) condition or diagnosis;
   3. (c) date of last medical visit;
   4. (d) documentation of more than three months of dependence on medical devices, treatments, therapies, or subspecialty services to reach a minimum medical score; and
   5. (e) an evaluation of the impact on the parent or guardian who has provided care to the child with complex medical needs during the last 12 months.

KEY: Medicaid

Date of Last Change: November 10, 2023

Notice of Continuation: December 29, 2023

Authorizing, and Implemented or Interpreted Law: 26B-1-213; 26B-3-108; 26B-3-206