State Affairs and Government

CHAPTER 42-12.3
Health Care for Children and Pregnant Women

SECTION 42-12.3-5

§ 42-12.3-5. Managed care.

The delivery and financing of the health care services provided pursuant to §§ 42-12.3-3 and 42-12.3-4 shall be provided through a system of managed care.

A managed care system integrates an efficient financing mechanism with quality service delivery, provides a "medical home" to assure appropriate care and deter unnecessary and inappropriate care, and places emphasis on preventive and primary health care. In developing a managed care system the department of human services shall consider managed care models recognized by the health care financing administration. The department of human services is hereby authorized and directed to seek any necessary approvals or waivers from the U.S. Department of Health and Human Services, Health Care Financing Administration, needed to assure that services are provided through a mandatory managed care system. Certain health services may be provided on an interim basis through a fee for service arrangement upon a finding that there are temporary barriers to implementation of mandatory managed care for a particular population or particular geographic area. Nothing in this section shall prohibit the department of human services from providing enhanced services to medical assistance recipients within existing appropriations.

History of Section.
(P.L. 1993, ch. 398, § 1; P.L. 1995, ch. 370, art. 22, § 1.)