1. (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:

   1. (a) emergency room visits with low acuity CPT codes 99281 or 99282;
   2. (b) actions the ACO takes to expand primary care and urgent care for Medicaid members who are enrolled in the Accountable Care Plan; and

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

      1. (i) weekday, evening, and weekend access to primary care providers and community health centers for Medicaid beneficiaries;
      2. (ii) other innovations for expanding access to primary care; and
      3. (iii) other quality of care for Medicaid members who are enrolled in an ACO as required by the department.

KEY: Medicaid

Date of Last Change: February 12, 2024

Notice of Continuation: September 13, 2023

Authorizing, and Implemented or Interpreted Law: 26B-1-213; 26B-3-108; 26B-3-204