Utah Admin. Code R414-511-3 - Performance Measures

(1) An ACO that contracts with the department to provide services to Medicaid members 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 99281 or 99282;

(b) actions the ACO takes to expand primary care and urgent care for Medicaid members who are enrolled in the Accountable Care Plan; and

(c) actions the ACO takes to implement emergency room diversion plans that include:

(i) weekday, evening, and weekend access to primary care providers and community health centers for Medicaid beneficiaries;

(ii) other innovations for expanding access to primary care; and

(iii) other quality of care for Medicaid members who are enrolled in an ACO as required by the department.

Notes

Utah Admin. Code R414-511-3

Amended by Utah State Bulletin Number 2024-04, effective 2/12/2024