§ 53-6-702

53-6-702. Definitions. As used in this part, the following definitions apply: (1) 'Department' means the department of public health and human services. (2) 'Health maintenance organization' means a health maintenance organization as defined in 33-31-102. (3) (a) 'Managed health care entity' or 'entity' means a health maintenance organization or an insurer regulated under Title 33 that: (i) contracts for an estimated annual value of $1 million or more of state and federal medicaid funds; or (ii) operates statewide or covers 20% or more of the medicaid population. (b) The term does not include: (i) a provider of health care services under a contract with the department on a fee-for-service basis; (ii) a medicaid primary care case management service within the meaning of 42 CFR 438; or (iii) a PACE organization as defined in 42 CFR 460.6 or an accountable care organization as defined in 33-31-102 that has received a waiver under 33-31-201. (4) 'Program' means an element of the integrated health care system created by this part. History: En. Sec. 2, Ch. 502, L. 1995; amd. Sec. 5, Ch. 466, L. 2001; amd. Sec. 3, Ch. 401, L. 2003; amd. Sec. 4, Ch. 403, L. 2003; amd. Sec. 3, Ch. 195, L.

d health care system created by this part. History: En. Sec. 2, Ch. 502, L. 1995; amd. Sec. 5, Ch. 466, L. 2001; amd. Sec. 3, Ch. 401, L. 2003; amd. Sec. 4, Ch. 403, L. 2003; amd. Sec. 3, Ch. 195, L. 2009; amd. Sec. 4, Ch. 346, L. 2011.