Utah Code 26B-3-125. Medicaid — Continuous eligibility — Promoting payment and delivery reform

26B-3-125. Medicaid — Continuous eligibility — Promoting payment and delivery reform.

(1)

In accordance with Subsection (2), and within appropriations from the Legislature, the department may amend the state Medicaid plan to:

Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
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
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
United States: includes each state, district, and territory of the United States of America. See Utah Code 68-3-12.5

(a)	create continuous eligibility for up to 12 months for an individual who has qualified for the state Medicaid program;

(b)	provide incentives in managed care contracts for an individual to obtain appropriate care in appropriate settings; and

(c)	require the managed care system to accept the risk of managing the Medicaid population assigned to the plan amendment in return for receiving the benefits of providing quality and cost effective care.

(2)

If the department amends the state Medicaid plan under Subsection (1)(a) or (b), the department:

(a)

shall ensure that the plan amendment:

(i)	is cost effective for the state Medicaid program;

(ii)	increases the quality and continuity of care for recipients; and

(iii)

calculates and transfers administrative savings from continuous enrollment from the Department of Workforce Services to the department; and

(b)	may limit the plan amendment under Subsection (1)(a) or (b) to select geographic areas or specific Medicaid populations.

(3)	The department may seek approval for a state plan amendment, waiver, or a demonstration project from the Secretary of the United States Department of Health and Human Services if necessary to implement a plan amendment under Subsection (1)(a) or (b).

Renumbered and Amended by Chapter 306, 2023 General Session