Enrolled Copy S.B. 269
1 CHRONIC CONDITIONS SUPPORT AMENDMENTS
2 2023 GENERAL SESSION
3 STATE OF UTAH
4 Chief Sponsor: David P. Hinkins
5 House Sponsor: Steve Eliason
6
7 LONG TITLE
8 General Description:
9 This bill requires the Department of Health and Human Services to apply for a
10 Medicaid waiver to provide additional services for individuals with certain conditions.
11 Highlighted Provisions:
12 This bill:
13 < defines terms;
14 < requires the Department of Health and Human Services to apply for a Medicaid
15 waiver to provide additional services for individuals with certain conditions; and
16 < creates a reporting requirement.
17 Money Appropriated in this Bill:
18 None
19 Other Special Clauses:
20 None
21 Utah Code Sections Affected:
22 ENACTS:
23 26-18-430, Utah Code Annotated 1953
24
25 Be it enacted by the Legislature of the state of Utah:
26 Section 1. Section 26-18-430 is enacted to read:
27 26-18-430. Medicaid waiver for rural healthcare for chronic conditions.
28 (1) As used in this section:
29 (a) "Qualified condition" means:
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30 (i) diabetes;
31 (ii) high blood pressure;
32 (iii) congestive heart failure;
33 (iv) asthma;
34 (v) obesity;
35 (vi) chronic obstructive pulmonary disease; or
36 (vii) chronic kidney disease.
37 (b) "Qualified enrollee" means an individual who:
38 (i) is enrolled in the Medicaid program;
39 (ii) has been diagnosed as having a qualified condition; and
40 (iii) is not enrolled in an accountable care organization.
41 (2) Before January 1, 2024, the department shall apply for a Medicaid waiver with the
42 Centers for Medicare and Medicaid Services to implement the coverage described in
43 Subsection (3) for a three-year pilot program.
44 (3) If the waiver described in Subsection (2) is approved, the Medicaid program shall
45 contract with a single entity to provide coordinated care for the following services to each
46 qualified enrollee:
47 (a) a telemedicine platform for the qualified enrollee to use;
48 (b) an in-home initial visit to the qualified enrollee;
49 (c) daily remote monitoring of the qualified enrollee's qualified condition;
50 (d) all services in the qualified enrollee's language of choice;
51 (e) individual peer monitoring and coaching for the qualified enrollee;
52 (f) available access for the qualified enrollee to video-enabled consults and
53 voice-enabled consults 24 hours a day, seven days a week;
54 (g) in-home biometric monitoring devices to monitor the qualified enrollee's qualified
55 condition; and
56 (h) at-home medication delivery to the qualified enrollee.
57 (4) The Medicaid program may not provide the coverage described in Subsection (3)
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58 until the waiver is approved.
59 (5) Each year the waiver is active, the department shall submit a report to the Health
60 and Human Services Interim Committee before November 30 detailing:
61 (a) the number of patients served under the waiver;
62 (b) the cost of the waiver; and
63 (c) any benefits of the waiver, including an estimate of:
64 (i) the reductions in emergency room visits or hospitalizations;
65 (ii) the reductions in 30-day hospital readmissions for the same diagnosis;
66 (iii) the reductions in complications related to qualified conditions; and
67 (iv) any improvements in health outcomes from baseline assessments.
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