53-6-1310. Health risk analysis.
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53-6-1310 . Health risk analysis.
(1)Within 1 year of a program participant's enrollment in the program, the department shall use available claims data and other information collected directly from the participant to assess whether the participant would be better served in a coordinated care or other treatment model approved by the department.
(2)Coordinated care models may include but are not limited to a:
(a)medicaid health home;
(b)patient-centered or advanced primary care medical home;
(c)substance use disorder or mental health treatment or other treatment or prevention programs;
(d)care coordination program;
(e)tribal health improvement program; or
(f)primary care case management arrangement.
(3)The department is not required to complete a separate analysis for a participant who:
(a)is already being served through a coordinated care model listed in subsection (2); or
(b)has received primary care or preventative care services within the last 12 months.