Utah Administrative Code
Topic - Health
Title R382 - Children's Health Insurance Program
Rule R382-3 - Managed Care Organization Incentives to Appropriately Use Emergency Room Services in the Children's Health Insurance Program
Section R382-3-3 - Performance Measures
Universal Citation: UT Admin Code R 382-3-3
Current through Bulletin 2024-06, March 15, 2024
(1) An MCO that contracts with the Department to provide services to CHIP beneficiaries shall report the following information to the Department in accordance with the terms of its contract:
(a) emergency room visits
with low acuity CPT codes 99281or 99282;
(b) actions the MCO takes to expand primary
care and urgent care for CHIP beneficiaries who are enrolled in the managed
care plan;
(c) actions the MCO
takes to implement emergency room diversion plans that include weekday,
evening, and weekend access to primary care providers and community health
centers for CHIP beneficiaries; other innovations for expanding access to
primary care; and
(d) other
quality of care for CHIP beneficiaries who are enrolled in an MCO as required
by the Department.
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