Utah § 26B-3-226 Medicaid waiver for rural healthcare for chronic conditions.

Utah Statutes

§ 26B-3-226 — Medicaid waiver for rural healthcare for chronic conditions.

Utah·Title 26B Utah Health and Human Services Code·Ch. 26B-3 Health Care - Administration and Assistance·Part 26B-3-2 Medicaid Waivers

(1)As used in this section:

(1)(a) "Qualified condition" means:

(1)(a)(i) diabetes;

(1)(a)(ii) high blood pressure;

(1)(a)(iii) congestive heart failure;

(1)(a)(iv) asthma;

(1)(a)(v) obesity;

(1)(a)(vi) chronic obstructive pulmonary disease; or

(1)(a)(vii) chronic kidney disease.

(1)(b) "Qualified enrollee" means an individual who:

(1)(b)(i) is enrolled in the Medicaid program;

(1)(b)(ii) has been diagnosed as having a qualified condition; and

(1)(b)(iii) is not enrolled in an accountable care organization.

(2)Before January 1, 2024, the department shall apply for a Medicaid waiver with CMS 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 entit

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(1) As used in this section:
(1)(a) "Qualified condition" means:
(1)(a)(i) diabetes;
(1)(a)(ii) high blood pressure;
(1)(a)(iii) congestive heart failure;
(1)(a)(iv) asthma;
(1)(a)(v) obesity;
(1)(a)(vi) chronic obstructive pulmonary disease; or
(1)(a)(vii) chronic kidney disease.
(1)(b) "Qualified enrollee" means an individual who:
(1)(b)(i) is enrolled in the Medicaid program;
(1)(b)(ii) has been diagnosed as having a qualified condition; and
(1)(b)(iii) is not enrolled in an accountable care organization.
(2) Before January 1, 2024, the department shall apply for a Medicaid waiver with CMS 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:
(3)(a) a telemedicine platform for the qualified enrollee to use;
(3)(b) an in-home initial visit to the qualified enrollee;
(3)(c) daily remote monitoring of the qualified enrollee's qualified condition;
(3)(d) all services in the qualified enrollee's language of choice;
(3)(e) individual peer monitoring and coaching for the qualified enrollee;
(3)(f) available access for the qualified enrollee to video-enabled consults and voice-enabled consults 24 hours a day, seven days a week;
(3)(g) in-home biometric monitoring devices to monitor the qualified enrollee's qualified condition; and
(3)(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:
(5)(a) the number of patients served under the waiver;
(5)(b) the cost of the waiver; and
(5)(c) any benefits of the waiver, including an estimate of:
(5)(c)(i) the reductions in emergency room visits or hospitalizations;
(5)(c)(ii) the reductions in 30-day hospital readmissions for the same diagnosis;
(5)(c)(iii) the reductions in complications related to qualified conditions; and
(5)(c)(iv) any improvements in health outcomes from baseline assessments.

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