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.