(1) The general assembly finds that many families who attempt to care for severely disabled or terminally ill children at home often are burdened with the excessive financial and personal costs of providing continuous care. Private insurance companies rarely support essential, long-term custodial services and often establish monetary limits that are well below the levels required by these disabled children. When coverage is available, care is frequently provided in a medical model that is marginally appropriate to the needs of the children and the family and usually more expensive to the payor. The resulting pressures often contribute to family disintegration and increased dependency on public programs. The general assembly finds that it is in the best interests of the citizens of the state to encourage the preservation of families with children with disabilities.
(2) As used in this section, unless the context otherwise requires, "eligible disabled children" means children eighteen years of age or younger:
Who have medical needs that, pursuant to state department rules, would qualify themfor institutionalization or place them at risk of institutionalization in an acute care hospital or nursing facility;
Who have gross incomes, including the amount of parental income and resources tobe attributed to the child's gross income according to rules to be promulgated by the state board, that do not exceed three hundred percent of the current federal supplemental security income benefit level;
Who are not receiving long-term services from any alternative waiver program established under this title;
For whom a licensed physician or an advanced practice nurse has certified that inhome care is an appropriate way to meet the child's needs; and
For whom the cost of care outside of the institution is no higher than the estimatedmedicaid cost of appropriate institutional care.
There is hereby established in the state department the children's personal assistanceservices and family support waiver program, referred to in this section as the "program", to provide services to eligible disabled children in their homes rather than in the confines of an acute care hospital or nursing facility. The number of children enrolled in this program or any other model 200 program shall not exceed the state department's ability to cover the costs of the programs within the annual appropriations for this program and any other model 200 program.
Priority for participation in the program shall be given first to children who are onthe waiting list for other model 200 programs and secondly to children whose parents will return to work if appropriate care for their disabled child is provided under the program. Spaces in the program shall also be available to children who were already covered by medicaid but who were rendered temporarily ineligible for a period of not more than three months due to a periodic or cyclical peak in their parents' income.
The state board shall adopt rules to govern the program consistent with any federalwaivers including, but not limited to, rules concerning:
(a) Services that are reimbursable under this section including, but not limited to:
Respite care, to the degree its additional cost is offset by collection of a parentalcopayment;
Case management; and
Medically necessary professional or community services beyond those specified insection 25.5-5-102 or 25.5-5-202, to the degree that they provide a cost-effective and medically appropriate alternative to covered services;
Provider selection and certification;
Documentation for assessment and recertification;(d) Case management agency selection and responsibility; and (e) Reimbursement.
The case management agency, in coordination with the eligible disabled child's family and the child's physician, shall include in each case plan a process by which the eligible disabled child may receive necessary care, which may include respite care, if the eligible disabled child's family or care provider is unavailable due to an emergency situation or to unforeseen circumstances. The eligible disabled child's family shall be duly informed by the case management agency of these alternative care provisions at the time the case plan is initiated.
If the state department finds it cost-effective and all necessary federal waivers areobtained, parents of eligible disabled children may be authorized to hire and manage care providers from certified medicaid agencies. Case management agencies shall work with parents to develop the skills necessary for ongoing care management.
The state department is authorized to seek waivers from the federal government toqualify for federal financial participation in the program.
The state department is authorized to charge and collect copayments from parents forservices rendered.
The state department is directed to study the advisability of setting an upper limit onparental income for participation in this program and other children's medicaid waiver programs.
Source: L. 2006: Entire article added with relocations, p. 1962, § 7, effective July 1. L. 2008: (2)(d) amended, p. 134, § 22, effective January 1, 2009.
Editor's note: This section is similar to former § 26-4-509.2 as it existed prior to 2006.