(1) The department may by rule provide for different benefit packages for different
categories of persons enrolled in the program. Alcohol and substance abuse services, services for mental disorders, services related
to children with chronic or acute conditions requiring longer-term treatment and followup,
and rehabilitation care provided by a freestanding rehabilitation hospital or a rehabilitation
unit may be excluded from a benefit package and those services may be made available
through a separate delivery system. If a service is excluded from the program but made available in a separate delivery
system by a managed health care entity, that managed health care entity is subject
to this part. An exclusion does not prohibit the department from developing and implementing demonstration
projects for categories of persons or services. Benefit packages for persons eligible for medical assistance under Title 53, chapter
6, parts 1 and 4, may be based on the requirements of those parts and must be consistent
with the Title XIX of the Social Security Act. This part applies only to services purchased by the department.
(2) The program established by this part may be implemented by the department in various
contracting areas at various times. The health care delivery systems and providers available under the program may vary
throughout the state. Except as otherwise provided in a contract for mental health services and subject
to the public comment and review provisions of 53-6-710 and 53-6-711, a licensed managed health care entity must be permitted to contract in any geographic
area for which it has a sufficient provider network and that otherwise meets the requirements
of the state contract.
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature or via Westlaw before relying on it for your legal needs.
Was this helpful?
Welcome to FindLaw's Cases & Codes
A free source of state and federal court opinions, state laws, and the United States Code. For more information about the legal concepts addressed by these cases and statutes, visit FindLaw's Learn About the Law.