26B-3-226. Medicaid waiver for rural healthcare for chronic conditions.
| (1) |
As used in this section:
Terms Used In Utah Code 26B-3-226- Baseline: Projection of the receipts, outlays, and other budget amounts that would ensue in the future without any change in existing policy. Baseline projections are used to gauge the extent to which proposed legislation, if enacted into law, would alter current spending and revenue levels.
- 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
| (a) |
“Qualified condition” means:
| (ii) |
high blood pressure; |
| (iii) |
congestive heart failure; |
| (vi) |
chronic obstructive pulmonary disease; or |
| (vii) |
chronic kidney disease. |
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| (b) |
“Qualified enrollee” means an individual who:
| (i) |
is enrolled in the Medicaid program; |
| (ii) |
has been diagnosed as having a qualified condition; and |
| (iii) |
is not enrolled in an accountable care organization. |
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| (2) |
Before January 1, 2024, the department shall apply for a Medicaid waiver with the Centers for Medicare and Medicaid Services to implement the coverage described in Subsection (3) for a three-year pilot program. |
| (3) |
If the waiver described in Subsection (2) is approved, the Medicaid program shall contract with a single entity to provide coordinated care for the following services to each qualified enrollee:
| (a) |
a telemedicine platform for the qualified enrollee to use; |
| (b) |
an in-home initial visit to the qualified enrollee; |
| (c) |
daily remote monitoring of the qualified enrollee’s qualified condition; |
| (d) |
all services in the qualified enrollee’s language of choice; |
| (e) |
individual peer monitoring and coaching for the qualified enrollee; |
| (f) |
available access for the qualified enrollee to video-enabled consults and voice-enabled consults 24 hours a day, seven days a week; |
| (g) |
in-home biometric monitoring devices to monitor the qualified enrollee’s qualified condition; and |
| (h) |
at-home medication delivery to the qualified enrollee. |
|
| (4) |
The Medicaid program may not provide the coverage described in Subsection (3) until the waiver is approved. |
| (5) |
Each year the waiver is active, the department shall submit a report to the Health and Human Services Interim Committee before November 30 detailing:
| (a) |
the number of patients served under the waiver; |
| (b) |
the cost of the waiver; and |
| (c) |
any benefits of the waiver, including an estimate of:
| (i) |
the reductions in emergency room visits or hospitalizations; |
| (ii) |
the reductions in 30-day hospital readmissions for the same diagnosis; |
| (iii) |
the reductions in complications related to qualified conditions; and |
| (iv) |
any improvements in health outcomes from baseline assessments. |
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Enacted by Chapter 336, 2023 General Session
Technical renumber of section for proper placement in Title and Chapter.
