§40-8.4-19  Managed health care delivery systems for families. –


Published: 2015

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TITLE 40

Human services

CHAPTER 40-8.4

Health Care For Families

SECTION 40-8.4-19



   § 40-8.4-19  Managed health care delivery

systems for families. –

(a) Notwithstanding any other provision of state law, the delivery and

financing of the health care 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 assure 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 U.S. 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.



History of Section.

(P.L. 2008, ch. 100, art. 17, § 4; P.L. 2009, ch. 68, art. 22, § 2;

P.L. 2009, ch. 69, § 2.)

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