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.