The department shall:
(1) Design and manage a utilization management program and third party recovery system for the medically indigent program.
Terms Used In Idaho Code 31-3503C
- Application: means the combined application for state and county medical assistance pursuant to sections 31-3504 and 31-3503E, Idaho Code. See Idaho Code 31-3502
- Board: means the board of the catastrophic health care cost program, as established in section 31-3517, Idaho Code. See Idaho Code 31-3502
- Department: means the department of health and welfare. See Idaho Code 31-3502
- Hospital: means a facility licensed and regulated pursuant to sections 39-1301 through 39-1314, Idaho Code, or an out-of-state hospital providing necessary medical services for residents of Idaho, wherein a reciprocal agreement exists, in accordance with section 31-3503B, Idaho Code, excluding state institutions. See Idaho Code 31-3502
- Medically indigent: means any person who is in need of necessary medical services and who, if an adult, together with his or her spouse, or whose parents or guardian if a minor or dependent, does not have income and other resources available to him from whatever source sufficient to pay for necessary medical services. See Idaho Code 31-3502
- Utilization management: means the evaluation of medical necessity, appropriateness and efficiency of the use of health care services, procedures and facilities. See Idaho Code 31-3502
(2) Have the authority to engage one (1) or more contractors or third party administrators to perform the duties assigned to it pursuant to this chapter including, but not limited to, utilization management and third party recovery for the medically indigent program.
(3) Implement a medicaid eligibility determination process for all potential applicants.
(4) Develop and implement by July 1, 2010, in cooperation with the Idaho association of counties and the Idaho hospital association, a uniform form to be used for both the initial review, pursuant to section 31-3503E, Idaho Code, and the application for financial assistance pursuant to section 31-3504, Idaho Code.
(5) Cooperate with the counties and the board in providing the services required of it pursuant to this chapter.
(6) Promulgate rules to implement its duties and responsibilities under the provisions of this chapter.