Utah Administrative Code (Current through November 1, 2019) |
R414. Health, Health Care Financing, Coverage and Reimbursement Policy |
R414-140. Choice of Health Care Delivery Program |
R414-140-4. Restrictions on Changes in Enrollment
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(1) The Department must give Medicaid clients a choice of at least two health plans. Each new applicant for Medicaid in the urban counties is offered an orientation about Medicaid and the Choice of Health Care Delivery Program. A health program representative employed by the Department conducts the orientation and also enrolls Medicaid clients in a health plan. During the orientation the clients are presented with health plan options.
(2) The Department restricts the disenrollment rights of enrollees who are required to enroll with a health plan in accordance with the regulations at 42 CFR 438.56. Disenrollment rights are restricted for a period of up to 12 months with the following exceptions:
(a) during the first three months of the enrollee's initial enrollment with a health plan, the enrollee may select a different health plan without cause;
(i) if the enrollee moves out of the health plan's service area;
(ii) if the enrollee requests to select a different health plan for good cause and the Department approves the request; or
(iii) if the enrollee chooses a different health plan during the Department's annual disenrollment period.