1. (1) "Choice of Health Care Delivery Program," "CHCDP," or "program" means the freedom-of-choice waiver program that allows the department to require certain groups of Medicaid members living in Box Elder, Cache, Davis, Iron, Morgan, Rich, Salt Lake, Summit, Tooele, Utah, Wasatch, Washington, and Weber counties to select a physical health plan that provides services in accordance with the program's waiver. The waiver limits freedom of choice in choosing a health care provider.
2. (2) "Department" means the Department of Health and Human Services.
3. (3) "Health plan" means a federally defined managed care organization under contract with the department to provide health care services to members.
4. (4) "Managed care organization" or "MCO" means an entity that has, or is seeking to qualify for, a comprehensive risk contract with the department to make the services it provides to its Medicaid members as accessible, in terms of amount, duration, scope, and timeliness, as those services are to other Medicaid members within the area served by the entity. The CHCDP requires MCOs to provide or arrange for services described in the CHCDP.
5. (5) "Mandatory enrollment county" means a county in which a member is required to enroll in a health plan.
6. (6) "Member" means an individual enrolled in Medicaid who lives in a mandatory enrollment county and is enrolled in a health plan.
7. (7) "Section 1931" means Section 1931 of the Social Security Act, which raises the income limits for Medicaid eligibility.

Terms used in this rule are defined in Rule R414-1. Additionally:

KEY: Medicaid, enrollee, PIHP, PCCM

Date of Last Change: November 13, 2025

Notice of Continuation: June 4, 2024

Authorizing, and Implemented or Interpreted Law: 26B-1-213; 26B-3-108