26B-3-223. Delivery system adjustments for the targeted adult Medicaid program.
| (1) |
As used in this section, “targeted adult Medicaid program” means the same as that term is defined in Section 26B-3-207. |
Terms Used In Utah Code 26B-3-223
- Contract: A legal written agreement that becomes binding when signed.
- Medicaid program: means the state program for medical assistance for persons who are eligible under the state plan adopted pursuant to Title XIX of the federal Social Security Act. See Utah Code 26B-3-101
- Process: means a writ or summons issued in the course of a judicial proceeding. See Utah Code 68-3-12.5
- State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
| (2) |
The department may implement the delivery system adjustments authorized under Subsection (3) only on the later of:
| (b) |
the department determining that the Medicaid program, including providers and managed care organizations, are satisfying the metrics established in collaboration with the working group convened under Subsection 26B-3-138(2). |
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| (3) |
The department may, for individuals who are enrolled in the targeted adult Medicaid program:
| (a) |
integrate the delivery of behavioral and physical health in certain counties; and |
| (b) |
deliver behavioral health services through an accountable care organization where implemented. |
|
| (4) |
Before implementing the delivery system adjustments described in Subsection (3) in a county, the department shall, at a minimum, seek input from:
| (a) |
individuals who qualify for the targeted adult Medicaid program who reside in the county; |
| (b) |
the county’s executive officer, legislative body, and other county officials who are involved in the delivery of behavioral health services; |
| (c) |
the local mental health authority and local substance abuse authority that serves the county; |
| (d) |
Medicaid managed care organizations operating in the state, including Medicaid accountable care organizations; |
| (e) |
providers of physical or behavioral health services in the county who provide services to enrollees in the targeted adult Medicaid program in the county; and |
| (f) |
other individuals that the department deems necessary. |
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| (5) |
If the department provides Medicaid coverage through a managed care delivery system under this section, the department shall include language in the department’s managed care contracts that require the managed care plan to:
| (a) |
be in compliance with federal Medicaid managed care requirements; |
| (b) |
timely and accurately process authorizations and claims in accordance with Medicaid policy and contract requirements; |
| (c) |
adequately reimburse providers to maintain adequacy of access to care; |
| (d) |
provide care management services sufficient to meet the needs of Medicaid eligible individuals enrolled in the managed care plan’s plan; and |
| (e) |
timely resolve any disputes between a provider or enrollee with the managed care plan. |
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| (6) |
The department may take corrective action if the managed care organization fails to comply with the terms of the managed care organization’s contract. |
Renumbered and Amended by Chapter 306, 2023 General Session
