§ 40-8.4-19. Managed healthcare delivery systems for families.
(a) Notwithstanding any other provision of state law, the delivery and financing of the
healthcare services provided under this chapter shall be provided through a system
of managed care. "Managed care� is defined as systems that: integrate an efficient
financing mechanism with quality service delivery; provide a "medical home� to ensure
appropriate care and deter unnecessary services; and place emphasis on preventive
and primary care.
(b) Enrollment in managed care health delivery systems is mandatory for individuals eligible
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§ 40-8.4-19. Managed healthcare delivery systems for families.
(a) Notwithstanding any other provision of state law, the delivery and financing of the
healthcare services provided under this chapter shall be provided through a system
of managed care. "Managed care� is defined as systems that: integrate an efficient
financing mechanism with quality service delivery; provide a "medical home� to ensure
appropriate care and deter unnecessary services; and place emphasis on preventive
and primary care.
(b) Enrollment in managed care health delivery systems is mandatory for individuals eligible
for medical assistance under this chapter. This includes children in substitute care,
children receiving medical assistance through an adoption subsidy, and children eligible
for medical assistance based on their disability. Beneficiaries with third-party medical
coverage or insurance may be exempt from mandatory managed care in accordance with
rules and regulations promulgated by the department of human services for such purposes.
(c) Individuals who can afford to contribute shall share in the cost. The department of human services is authorized and directed to apply for and obtain
any necessary waivers and/or state plan amendments from the Secretary of the United
States Department of Health and Human Services, including, but not limited to, a waiver
of the appropriate sections of Title XIX, 42 U.S.C. § 1396 et seq., to require that beneficiaries eligible under this chapter or chapter 12.3 of title 42, with incomes equal to or greater than one hundred fifty percent (150%) of the federal
poverty level, pay a share of the costs of health coverage based on the ability to
pay. The department of human services shall implement this cost-sharing obligation
by regulation, and shall consider co-payments, premium shares, or other reasonable
means to do so in accordance with approved provisions of appropriate waivers and/or
state plan amendments approved by the Secretary of the United States Department of
Health and Human Services.