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H.B. 272 Enrolled





Sponsor: Mary Carlson

    This act affects sections of Utah Code Annotated 1953 as follows:
         26-18-3.7, as last amended by Chapter 250, Laws of Utah 1996
         26-21-1, as last amended by Chapter 114, Laws of Utah 1990
         26-21-2, as last amended by Chapter 79, Laws of Utah 1996
         26-21-2.1, as enacted by Chapter 114, Laws of Utah 1990
         26-21-3, as last amended by Chapter 243, Laws of Utah 1996
         26-21-5, as last amended by Chapter 28, Laws of Utah 1995
         26-21-6, as last amended by Chapters 4 and 234, Laws of Utah 1993
         26-21-8, as last amended by Chapter 201, Laws of Utah 1993
         26-21-11, as last amended by Chapter 114, Laws of Utah 1990
         26-21-12, as last amended by Chapter 114, Laws of Utah 1990
         26-21-16, as last amended by Chapter 241, Laws of Utah 1991
         26-21-20, as last amended by Chapter 114, Laws of Utah 1990
         26-35-103, as enacted by Chapter 170, Laws of Utah 1992
         26-36-104, as last amended by Chapter 209, Laws of Utah 1995
         59-12-102, as last amended by Chapters 126, 170, 232, 274, 287 and 342, Laws of Utah
         62A-3-202, as last amended by Chapter 176, Laws of Utah 1993
         78-30-4.13, as enacted by Chapter 168, Laws of Utah 1995

         26-21-10, as last amended by Chapter 114, Laws of Utah 1990
    Be it enacted by the Legislature of the state of Utah:
        Section 1. Section 26-18-3.7 is amended to read:
         26-18-3.7. Prepaid health care delivery systems.
        (1) (a) Before July 1, 1996, the division shall submit to the Health Care Financing
    Administration within the United States Department of Health and Human Services, an amendment
    to the state's freedom of choice waiver. That amendment shall provide that the following persons
    who are eligible for services under the state plan for medical assistance, who reside in Salt Lake,
    Utah, Davis, or Weber counties, shall enroll in the recipient's choice of a health care delivery system
    that meets the requirements of Subsection (2):
        (i) by July 1, 1994, 40% of eligible persons;
        (ii) by July 1, 1995, 65% of eligible persons; and
        (iii) by July 1, 1996, 100% of eligible persons.
        (b) The division may not enter into any agreements with mental health providers that
    establish a prepaid capitated delivery system for mental health services that were not in existence
    prior to July 1, 1993, until the application of the Utah Medicaid Hospital Provider Temporary
    Assessment Act with regard to a specialty hospital as defined in [Subsection 26-21-2(19)] Section
    26-21-2 that may be engaged exclusively in rendering psychiatric or other mental health treatment
    is repealed.
        (c) The following are exempt from the requirements of Subsection (a):
        (i) persons who:
        (A) receive medical assistance for the first time after July 1, 1996;
        (B) have a mental illness, as that term is defined in Section 62A-12-202; and
        (C) are receiving treatment for that mental illness. The division, when appropriate, shall
    enroll these persons in a health care delivery system that meets the requirements of this section;
        (ii) persons who are institutionalized in a facility designated by the division as a nursing
    facility or an intermediate care facility for the mentally retarded; or
        (iii) persons with a health condition that requires specialized medical treatment that is not

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    available from a health care delivery system that meets the requirements of this section.
        (2) In submitting the amendment to the state's freedom of choice waiver under Subsection
    (1), the division shall ensure that the proposed health care delivery systems have at least the
    following characteristics, so that the system:
        (a) is financially at risk, for a specified continuum of health care services, for a defined
    population, and has incentives to balance the patient's need for care against the need for cost control;
        (b) follows utilization and quality controls developed by the department;
        (c) is encouraged to promote the health of patients through primary and preventive care;
        (d) coordinates care to avoid unnecessary duplication and services;
        (e) conserves health care resources; and
        (f) if permissible under the waiver, utilizes private insurance plans including health
    maintenance organizations and other private health care delivery organizations.
        (3) Subsection (2) does not prevent the division from contracting with other health care
    delivery organizations if the division determines that it is advantageous to do so.
        (4) Health care delivery systems that meet the requirements of this section may provide all
    services otherwise available under the state plan for medical assistance, except prescribed drugs.
        (5) The division shall periodically report to the Legislative Health and Environment and
    Human Services Interim Committees regarding the development and implementation of the
    amendment to the state's freedom of choice waiver required under this section.
        Section 2. Section 26-21-1 is amended to read:
         26-21-1. Title.
        This chapter is known as the "Health Care Facility [Licensure] Licensing and Inspection
        Section 3. Section 26-21-2 is amended to read:
         26-21-2. Definitions.
        As used in this chapter:
        (1) "Abortion clinic" means a facility, other than a general acute or specialty hospital, that
    performs abortions and provides abortion services during the second trimester of pregnancy.

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        (2) "Activities of daily living" means essential activities including:
        (a) dressing;
         (b) eating;
         (c) grooming;
         (d) bathing;
         (e) toileting;
         (f) ambulation;
        (g) transferring; and
        (h) self-administration of medication.
        [(2)] (3) "Ambulatory surgical facility" means a freestanding facility, which provides
    surgical services to patients not requiring hospitalization.
        (4) "Assistance with activities of daily living" means providing of or arranging for the
    provision of assistance with activities of daily living.
        [(3)] (5) "Assisted living facility" means a residential facility with a home-like setting that
    provides an array of coordinated supportive personal and health care services, available 24 hours per
    day, to residents who have been assessed under division rule to need any of these services. Each
    resident shall have a service plan based on the assessment, which may include:
        (a) specified services of intermittent nursing care;
        (b) administration of medication; and
        (c) support services promoting residents' independence and self sufficiency.
        [(4)] (6) "Birthing center" means a freestanding facility, receiving maternal clients and
    providing care during pregnancy, delivery, and immediately after delivery.
        [(5)] (7) "Committee" means the Health Facility Committee created in Section 26-1-7.
        [(6)] (8) "Consumer" means any person not primarily engaged in the provision of health care
    to individuals or in the administration of facilities or institutions in which such care is provided and
    who does not hold a fiduciary position, or have a fiduciary interest in any entity involved in the
    provision of health care, and does not receive, either directly or through his spouse, more than 1/10
    of his gross income from any entity or activity relating to health care.

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        [(7)] (9) "End stage renal disease facility" means a facility which furnishes staff-assisted
    kidney dialysis services, self-dialysis services, or home-dialysis services on an outpatient basis.
        [(8)] (10) "Freestanding" means existing independently or physically separated from another
    health care facility by fire walls and doors and administrated by separate staff with separate records.
        [(9)] (11) "General acute hospital" means a facility which provides diagnostic, therapeutic,
    and rehabilitative services to both inpatients and outpatients by or under the supervision of
        [(10)] (12) "Governmental unit" means the state, or any county, municipality, or other
    political subdivision or any department, division, board, or agency of the state, a county,
    municipality, or other political subdivision.
        [(11)] (13) (a) "Health care facility" means general acute hospitals, specialty hospitals, home
    health agencies, hospices, nursing care facilities, residential [health care facilities,] assisted living
    facilities, birthing centers, ambulatory surgical facilities, small health care facilities, abortion clinics,
    facilities owned or operated by health maintenance organizations, end stage renal disease facilities,
    and any other health care facility which the committee designates by rule.
        (b) "Health care facility" does not include the offices of private physicians or dentists,
    whether for individual or group practice.
        [(12)] (14) "Health maintenance organization" means an organization, organized under the
    laws of any state which:
        (a) is a qualified health maintenance organization under Section 1310 (d) of the Public
    Health Service Act; or
        (b) (i) provides or otherwise makes available to enrolled participants at least the following
    basic health care services: usual physician services, hospitalization, laboratory, x-ray, emergency,
    and preventive services and out-of-area coverage;
        (ii) is compensated, [(]except for copayments[)], for the provision of the basic health services
    listed in Subsection [(12)] (14)(b)(i) to enrolled participants by a payment which is paid on a
    periodic basis without regard to the date the health services are provided and which is fixed without
    regard to the frequency, extent, or kind of health services actually provided; and

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        (iii) provides physicians' services primarily directly through physicians who are either
    employees or partners of such organizations, or through arrangements with individual physicians or
    one or more groups of physicians organized on a group practice or individual practice basis.
        [(13)] (15) (a) "Home health agency" means an agency, organization, or facility or a
    subdivision of an agency, organization, or facility [employing] which employs two or more direct
    care staff persons [which provides] who provide licensed nursing services, therapeutic services [(]
    of physical therapy, speech therapy, occupational therapy, medical social services, or home health
    aide services[), or both,] on a visiting basis.
        (b) "Home health agency" does not [include] mean an individual who provides services
    under the authority of a private license.
        [(14)] (16) "Hospice" means a program of care for the terminally ill and their families which
    occurs in a home or in a health care facility and which provides medical, palliative, psychological,
    spiritual, and supportive care and treatment.
        [(15)] (17) "Nursing care facility" means a health care facility, other than a general acute or
    specialty hospital, constructed, licensed, and operated to provide patient living accommodations,
    24-hour staff availability, and at least two of the following patient services:
        (a) a selection of patient care services, under the direction and supervision of a registered
    nurse, ranging from continuous medical, skilled nursing, psychological, or other professional
    therapies to intermittent health-related or paraprofessional personal care services;
        (b) a structured, supportive social living environment based on a professionally designed and
    supervised treatment plan, oriented to the individual's habilitation or rehabilitation needs; or
        (c) a supervised living environment that provides support, training, or assistance with
    individual activities of daily living.
        [(16)] (18) "Person" means any individual, firm, partnership, corporation, company,
    association, or joint stock association, and the legal successor thereof.
        (19) "Resident" means a person 21 years of age or older who:
        (a) as a result of physical or mental limitations or age requires or requests services provided
    in a residential health care facility or assisted living facility; and

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        (b) does not require intensive medical or nursing services as provided in a hospital or nursing
    care facility.
        [(17)] (20) "Residential health care facility" means a facility providing assistance with
    activities of daily living and social care to two or more residents who require protected living
        [(18)] (21) "Small health care facility" means a four to sixteen bed facility that provides
    licensed health care programs and services to residents who generally do not need continuous
    nursing care or supervision.
        [(19)] (22) "Specialty hospital" means a facility which provides specialized diagnostic,
    therapeutic, or rehabilitative services in the recognized specialty or specialties for which the hospital
    is licensed.
        (23) "Substantial compliance" means in a department survey of a licensee, the department
    determines there is an absence of deficiencies which would harm the physical health, mental health,
    safety, or welfare of patients or residents of a licensee.
        Section 4. Section 26-21-2.1 is amended to read:
         26-21-2.1. Services.
        (1) General acute hospitals and specialty hospitals shall remain open and be continuously
    ready to receive patients 24 hours of every day in a year and have an attending medical staff
    consisting of one or more physicians licensed to practice medicine and surgery under Title 58,
    Chapter [12] 67, Utah Medical Practice Act, or Title 58, Chapter 68, Utah Osteopathic [Medicine
    Licensing] Medical Practice Act.
        (2) A specialty hospital shall provide on-site all basic services required of a general acute
    hospital that are needed for the diagnosis, therapy, or rehabilitation offered to or required by patients
    admitted to or cared for in the facility.
        (3) (a) A home health agency shall provide at least licensed nursing services or therapeutic
    services directly through the agency employees.
        (b) A home health agency may provide additional services itself or under arrangements with
    another agency, organization, facility, or individual.

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        Section 5. Section 26-21-3 is amended to read:
         26-21-3. Health Facility Committee -- Members -- Terms -- Organization -- Meetings.
        (1) The Health Facility Committee created by Section 26-1-7 [shall consist] consists of 13
    members appointed by the governor with the consent of the senate. No more than seven members
    [shall] may be from the same political party. The appointed members shall be knowledgeable about
    health care facilities and issues. The membership of the committee [shall be composed of] is:
        (a) one physician, licensed to practice medicine and surgery under Title 58, Chapter [12] 67,
    Utah Medical Practice Act, or Title 58, Chapter 68, Utah Osteopathic [Medicine Licensing] Medical
    Practice Act, who is a graduate of a regularly chartered medical school;
        (b) one hospital administrator;
        (c) one hospital trustee;
        (d) one representative of the nursing care facility industry;
        (e) one [licensed] registered nurse, licensed to practice under Title 58, Chapter 31, Nurse
    Practice Act;
        (f) one professional in the field of mental retardation not affiliated with a nursing care
        (g) one licensed architect or engineer with expertise in health care facilities;
        (h) two representatives of health care facilities, other than nursing care facilities or hospitals,
    licensed under this chapter; and
        (i) four consumers, one of whom [shall have] has an interest in or expertise in geriatric care.
        (2) (a) Except as required by Subsection (b), members shall be appointed for a term of four
        (b) Notwithstanding the requirements of Subsection (a), the governor shall, at the time of
    appointment or reappointment, adjust the length of terms to ensure that the terms of committee
    members are staggered so that approximately half of the committee is appointed every two years.
        (c) When a vacancy occurs in the membership for any reason, the replacement shall be
    appointed for the unexpired term by the governor, giving consideration to recommendations made
    by the committee, with the consent of the Senate.

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        (d) [No] A member [shall] may not serve more than two consecutive full terms or ten
    consecutive years, whichever is less. However, a member may continue to serve as a member until
    he is replaced.
        (e) The committee shall annually elect from its membership a chair and vice chair [during
    the second quarter of each year].
        (f) The committee shall meet at least quarterly, or more frequently as determined by the
    chair or five members of the committee.
        (g) Seven members constitute a quorum. A vote of the majority of the members present
    constitutes action of the committee.
        Section 6. Section 26-21-5 is amended to read:
         26-21-5. Duties of committee.
        [(1)] The committee shall:
        [(a)] (1) make rules in accordance with Title 63, Chapter 46a, Utah Administrative
    Rulemaking Act:
        [(i)] (a) for the licensing [and revoking licenses for] of health-care facilities; and
        [(ii) governing the entry of agents of the department into health-care facilities for
        [(iii) governing public hearings conducted under this chapter;]
        [(iv) governing appeals related to licensure decisions of the department; and]
        [(v)] (b) requiring the submission of architectural plans and specifications for any proposed
    new health-care facility or renovation to the department for review;
        [(b) define] (2) approve the information [that must be submitted to the department with an
    application] for applications for [a license] licensure pursuant to Section 26-21-9;
        [(c) establish fees for licenses issued to health-care facilities under this chapter in accordance
    with Section 63-38-3.2;]
        [(d)] (3) advise the department as requested concerning the interpretation and enforcement
    of the rules established under this chapter; and
        [(e) conduct hearings on appeals from enforcement actions of the department as provided

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    in this chapter;]
        [(f) compel the attendance of witnesses and the production of documents and evidence,
    administer oaths, and take testimony concerning appeals as provided in this chapter;]
        [(g) appoint a hearings officer who is empowered to act in its behalf in hearings and appeals
    as provided in this chapter; an appointed hearings officer has the same powers as the committee in
    the conduct of the hearings; and]
        [(h)] (4) advise, consult, cooperate with, and provide technical assistance to other agencies
    of the state and federal government, and other states and affected groups or persons in carrying out
    the purposes of this chapter.
        [(2) Rules made by the committee under Subsection (1)(a)(v) are subject to Utah Fire
    Prevention Board rules governing residential health-care facilities made under Section 53-7-204.]
        Section 7. Section 26-21-6 is amended to read:
         26-21-6. Duties of department.
        (1) The department shall:
        (a) enforce rules established [by the committee] pursuant to this chapter;
        (b) authorize an agent of the department to conduct inspections of health-care facilities
    pursuant to [rules of the committee] this chapter;
        (c) collect information authorized by the committee that may be necessary to ensure that
    adequate health-care facilities are available to the public;
        (d) collect and credit fees for licenses as free revenue;
        (e) collect and credit fees for conducting plan reviews as dedicated credits;
        (f) designate an executive secretary from within the department to assist the committee in
    carrying out its powers and responsibilities; and
        (g) provide necessary administrative and staff support to the committee[;].
        (2) The department may:
        [(h)] (a) exercise all incidental powers necessary to carry out the purposes of this chapter;
        [(i)] (b) review architectural plans and specifications of proposed health-care facilities or

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    renovations of health-care facilities to ensure that the plans and specifications conform to rules
    established by the committee[.]; and
        (c) make rules as necessary to implement the provisions of this chapter, except as authority
    is specifically delegated to the committee.
        [(2) The rules established by the committee under Subsection (1)(i) are subject to the rules
    of the Utah Fire Prevention Board made pursuant to Section 53-7-204.]
        Section 8. Section 26-21-8 is amended to read:
         26-21-8. License required -- Not assignable or transferable -- Posting -- Expiration and
     renewal -- Time for compliance by operating facilities.
        (1) (a) A person or governmental unit acting severally or jointly with any other person or
    governmental unit, may not establish, conduct, or maintain a health care facility in this state without
    receiving a license from the department as provided by this chapter and the rules of the committee.
        (b) This subsection does not apply to those facilities exempted under Section 26-21-7.
        (2) A license issued under this chapter is not assignable or transferable.
        (3) The current license shall at all times be posted in each health care facility in a place
    readily visible and accessible to the public.
        (4) (a) Each license expires at midnight on the last day of the month, 12 months from date
    of issuance, unless previously revoked by the department.
        (b) The license shall be renewed annually upon completion of the application requirements,
    unless the department finds the health care facility has not complied with the provisions of this
    chapter or the rules adopted pursuant to [Section 26-21-5] this chapter.
        (5) A license may be issued under this section only for the operation of a specific facility at
    a specific site by a specific person.
        (6) Any health care facility in operation at the time of adoption of any applicable rules as
    provided under this chapter shall be given a reasonable time for compliance as determined by the
        Section 9. Section 26-21-11 is amended to read:
         26-21-11. Violations -- Denial or revocation of license -- Restricting or prohibiting new

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     admissions -- Monitor.
        If the department finds a violation [is found under Section 26-21-10] of this chapter or any
    rules adopted pursuant to this chapter the department may take one or more of the following actions:
        (1) [Serve] serve a written statement of violation requiring corrective action, which shall
    include time frames for correction of all violations[.];
        (2) [Deny, suspend,] deny or revoke a license if it finds [that]:
        (a) there has been a failure to comply with the rules established [by the committee; or, it
    finds] pursuant to this chapter;
        (b) evidence of aiding, abetting, or permitting the commission of any illegal act[,]; or [it
        (c) conduct adverse to the public health, morals, welfare, and safety of the people of the
        (3) [Restrict] restrict or prohibit new admissions to a health care facility or revoke [or
    suspend] the license of a health care facility for:
        (a) violation of any rule adopted under this chapter; or
        (b) permitting, aiding, or abetting the commission of any illegal act in the health care
        (4) [Place] place a department representative as a monitor in the facility until [such time as]
    corrective action is completed[.];
        (5) [Assess] assess to the facility the cost incurred by the department in placing [the] a
        (6) assess an administrative penalty as allowed by Subsection 26-23-6(1)(a); or
        (7) issue a cease and desist order to the facility.
        Section 10. Section 26-21-12 is amended to read:
         26-21-12. Issuance of new license after revocation -- Restoration.
        (1) If a license is revoked, [a new license may be issued only after the department verifies
    by inspection that the conditions upon which revocation was based have been corrected] the
    department may issue a new license only after it determines by inspection that the facility has

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    corrected the conditions that were the basis of revocation and that the facility complies with all
    provisions of this chapter and applicable rules.
        [(2) Suspension of a license may be for a definite or indefinite period. The Department shall
    completely or partially restore a suspended license upon a determination that the conditions upon
    which suspension was based have been completely or partially corrected and that the interests of the
    public will not be jeopardized by restoration of the license. ]
        [(3) If a license is not renewed] (2) If the department does not renew a license because of
    noncompliance with the provisions of this chapter or the rules adopted under [Section 26-21-5, a new
    license may be issued] this chapter, the department may issue a new license only after the facility
    complies with all renewal requirements and the department determines that the interests of the public
    will not be jeopardized.
        Section 11. Section 26-21-16 is amended to read:
         26-21-16. Operating facility in violation of chapter or rules a misdemeanor.
        (1) Any person owning, establishing, conducting, maintaining, managing, or operating a
    health care facility in violation of this chapter or rules of the committee is guilty of a class [B] A
        (2) This section takes precedence over Section 26-23-6.
        Section 12. Section 26-21-20 is amended to read:
         26-21-20. Requirement for hospitals to provide statements of itemized charges to
        (1) Each hospital, as defined in [Subsections 26-21-2 (8) and (18)] Section 26-21-2, shall
    provide a statement of itemized charges to any patient receiving medical care or other services from
    that hospital.
        (2) The statement shall be provided to the patient or his personal representative or agent at
    the hospital's expense, either personally or by mail, at the time any statement is provided to any
    person or entity for billing purposes. If the statement is not provided to a third party, it shall be
    provided to the patient as soon as possible and practicable.
        (3) The statement shall itemize each of the charges actually provided by the hospital to the

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        (4) The statement may not include charges of physicians who bill separately.
        (5) The requirements of this section do not apply to patients who receive services from a
    hospital under Title XIX of the Social Security Act.
        (6) A statement of charges to be paid by a third party and related information provided to
    a patient pursuant to this section shall be marked in bold: "DUPLICATE: DO NOT PAY" or other
    appropriate language.
        Section 13. Section 26-35-103 is amended to read:
         26-35-103. Definitions.
        As used in this chapter:
        (1) (a) "Nursing facility" means a health care facility described in [Subsection 26-21-2(14)]
    Section 26-21-2 or an intermediate care facility for the mentally retarded that is licensed under
    Section 26-21-13.5.
        (b) "Nursing facility" does not include the Utah State Developmental Center or the Utah
    State Hospital.
        (2) "Patient day" means each calendar day in which an individual patient is admitted to the
    nursing facility during a calendar month, even if on a temporary leave of absence from the facility.
        Section 14. Section 26-36-104 is amended to read:
         26-36-104. Definitions.
        As used in this chapter:
        (1) "Adjusted inpatient days" for any hospital during a particular measuring period means
    the number of inpatient days for a hospital during a measuring period times a fraction, the numerator
    of which is the total patient revenue of the hospital during a measuring period and the denominator
    of which is the total inpatient revenue of the hospital during a measuring period.
        (2) "Assessment" means the Medicaid hospital provider temporary assessment established
    by this chapter.
        (3) "Federal act" means the Medicaid Voluntary Contribution and Provider-Specific Tax
    Amendments of 1991, Public Law 102-234, enacted December 12, 1991.

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        (4) "Freestanding ambulatory surgical facility" means an urban or rural nonhospital based
    or nonhospital affiliated licensed facility as defined in [Subsection 26-21-2(2)] Section 26-21-2 as
    an ambulatory surgical facility, with an organized professional staff that provides surgical services
    to patients who do not require an inpatient bed.
        (5) "Gross revenue" for any hospital during a particular measuring period means standard,
    nondiscounted charges for all services rendered to patients by the hospital during a measuring period.
        (6) "Hospital" means:
        (a) any general acute hospital operating in the state of Utah as defined in [Subsection
    26-21-2(9)] Section 26-21-2.
        (b) "Hospital" does not include residential care or treatment facilities as defined in
    Subsections 62A-2-101(17), (18), and (20), Health Maintenance Organization owned service
    facilities, the Utah State Hospital or any rural hospital that operates outside of a metropolitan
    statistical area, a metropolitan area, or an urbanized area as designated by the U.S. Bureau of Census,
    or any specialty hospital operating in this state as defined in [Subsection 26-21-2(19)] Section
    26-21-2 that may be engaged exclusively in rendering psychiatric or other mental health treatment.
        (7) "Hospital-based ambulatory surgical facility" means an urban or rural on hospital campus
    or hospital affiliated licensed facility with an organized professional staff that provides surgical
    services to patients who do not require an inpatient bed.
        (8) "Inpatient" means a patient of a hospital who is admitted on an overnight basis.
        (9) "Inpatient day" means, with respect to each hospital patient excluding patients in the
    nursery, skilled nursing and labor room, each 24-hour period during which a patient is an inpatient
    of the hospital.
        (10) "Inpatient services" means all services rendered by a hospital to an inpatient.
        (11) "Outpatient" means any patient of a hospital other than an inpatient.
        (12) "Outpatient services" means all services rendered by a hospital other than inpatient
        (13) "Patient encounter" as applied to any freestanding ambulatory surgical facility or
    hospital-based ambulatory surgical facility means one or more outpatient surgery procedures

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    performed on one outpatient during the course of one outpatient visit for which a charge is incurred.
    The patient encounter as defined in this act includes ancillary services incident to the surgical
    procedures performed during the surgical visit.
        (14) "Total inpatient revenue" for any hospital during a particular measuring period means
    total gross revenue derived by the hospital from inpatient services rendered during a measuring
        (15) "Total outpatient revenue" for any hospital during a particular measuring period means
    total gross revenue derived by the hospital from all outpatient services rendered, minus those
    revenues derived from a hospital-based ambulatory surgical facility, during a measuring period.
        (16) "Total patient revenue" means the sum of total inpatient revenue and total outpatient
        Section 15. Section 59-12-102 is amended to read:
         59-12-102. Definitions.
        As used in this chapter:
        (1) (a) "Admission or user fees" includes season passes.
        (b) "Admission or user fees" does not include annual membership dues to private
        (2) "Authorized carrier" means:
        (a) in the case of vehicles operated over public highways, the holder of credentials indicating
    that the vehicle is or will be operated pursuant to both the International Registration Plan (IRP) and
    the International Fuel Tax Agreement (IFTA);
        (b) in the case of aircraft, the holder of a Federal Aviation Administration (FAA) operating
    certificate or air carrier's operating certificate; or
        (c) in the case of locomotives, freight cars, railroad work equipment, or other rolling stock,
    the holder of a certificate issued by the United States Interstate Commerce Commission.
        (3) (a) For purposes of Subsection 59-12-104(44), "coin-operated amusement device" means:
        (i) a coin-operated amusement, skill, or ride device;
        (ii) that is not controlled through vendor-assisted, over-the-counter, sales of tokens; and

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        (iii) includes a music machine, pinball machine, billiard machine, video game machine,
    arcade machine, and a mechanical or electronic skill game or ride.
        (b) For purposes of Subsection 59-12-104(44), "coin-operated amusement device" does not
    mean a coin-operated amusement device possessing a coinage mechanism that:
        (i) accepts and registers multiple denominations of coins; and
        (ii) allows the vendor to collect the sales and use tax at the time an amusement device is
    activated and operated by a person inserting coins into the device.
        (4) "Commercial use" means the use of gas, electricity, heat, coal, fuel oil, or other fuels that
    does not constitute industrial use under Subsection (10) or residential use under Subsection (16).
        (5) "Common carrier" means a person engaged in or transacting the business of transporting
    passengers, freight, merchandise, or other property for hire within this state.
        (6) "Component part" includes:
        (a) poultry, dairy, and other livestock feed, and their components;
        (b) baling ties and twine used in the baling of hay and straw;
        (c) fuel used for providing temperature control of orchards and commercial greenhouses
    doing a majority of their business in wholesale sales, and for providing power for off-highway type
    farm machinery; and
        (d) feed, seeds, and seedlings.
        (7) "Construction materials" means any tangible personal property that will be converted into
    real property.
        (8) (a) "Fundraising sales" means sales:
        (i) (A) made by a public or private elementary or secondary school; or
        (B) made by a public or private elementary or secondary school student, grades kindergarten
    through 12;
        (ii) that are for the purpose of raising funds for the school to purchase equipment, materials,
    or provide transportation; and
        (iii) that are part of an officially sanctioned school activity.
        (b) For purposes of Subsection (8)(a)(iii), "officially sanctioned school activity" means a

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    school activity:
        (i) that is conducted in accordance with a formal policy adopted by the school or school
    district governing the authorization and supervision of fundraising activities;
        (ii) that does not directly or indirectly compensate an individual teacher or other educational
    personnel by direct payment, commissions, or payment in kind; and
        (iii) the net or gross revenues from which are deposited in a dedicated account controlled
    by the school or school district.
        (9) (a) "Home medical equipment and supplies" means equipment and supplies that:
        (i) a licensed physician prescribes or authorizes in writing as necessary for the treatment of
    a medical illness or injury or as necessary to mitigate an impairment resulting from illness or injury;
        (ii) are used exclusively by the person for whom they are prescribed to serve a medical
    purpose; and
        (iii) are listed as eligible for payment under Title 18 of the federal Social Security Act or
    under the state plan for medical assistance under Title 19 of the federal Social Security Act.
        (b) "Home medical equipment and supplies" does not include:
        (i) equipment and supplies purchased by, for, or on behalf of any health care facility, as
    defined in Subsection (9)(c), doctor, nurse, or other health care provider for use in their professional
        (ii) eyeglasses, contact lenses, or equipment to correct impaired vision; or
        (iii) hearing aids or hearing aid accessories.
        (c) For purposes of Subsection (9)(b)(i), "health care facility" includes:
        (i) a clinic;
        (ii) a doctor's office; and
        (iii) a health care facility as defined in [Subsection 26-21-2(11)(a)] Section 26-21-2.
        (10) "Industrial use" means the use of natural gas, electricity, heat, coal, fuel oil, or other
    fuels in:
        (a) mining or extraction of minerals;
        (b) agricultural operations to produce an agricultural product up to the time of harvest or

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    placing the agricultural product into a storage facility, including:
        (i) commercial greenhouses;
        (ii) irrigation pumps;
        (iii) farm machinery;
        (iv) implements of husbandry as defined in Subsection 41-1a-102(23) that are not registered
    under Title 41, Chapter 1a, Part 2, Registration; and
        (v) other farming activities; and
        (c) manufacturing tangible personal property at an establishment described in SIC Codes
    2000 to 3999 of the 1987 Standard Industrial Classification Manual of the federal Executive Office
    of the President, Office of Management and Budget.
        (11) "Manufactured home" means any manufactured home or mobile home as defined in
    Title 58, Chapter 56, Utah Uniform Building Standards Act.
        (12) (a) "Medicine" means:
        (i) insulin, syringes, and any medicine prescribed for the treatment of human ailments by
    a person authorized to prescribe treatments and dispensed on prescription filled by a registered
    pharmacist, or supplied to patients by a physician, surgeon, or podiatric physician;
        (ii) any medicine dispensed to patients in a county or other licensed hospital if prescribed
    for that patient and dispensed by a registered pharmacist or administered under the direction of a
    physician; and
        (iii) any oxygen or stoma supplies prescribed by a physician or administered under the
    direction of a physician or paramedic.
        (b) "Medicine" does not include:
        (i) any auditory, prosthetic, ophthalmic, or ocular device or appliance; or
        (ii) any alcoholic beverage.
        (13) (a) "Other fuels" means products that burn independently to produce heat or energy.
        (b) "Other fuels" includes oxygen when it is used in the manufacturing of tangible personal
        (14) "Person" includes any individual, firm, partnership, joint venture, association,

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    corporation, estate, trust, business trust, receiver, syndicate, this state, any county, city, municipality,
    district, or other local governmental entity of the state, or any group or combination acting as a unit.
        (15) "Purchase price" means the amount paid or charged for tangible personal property or
    any other taxable item or service under Subsection 59-12-103(1), excluding only cash discounts
    taken or any excise tax imposed on the purchase price by the federal government.
        (16) "Residential use" means the use in or around a home, apartment building, sleeping
    quarters, and similar facilities or accommodations.
        (17) (a) "Retail sale" means any sale within the state of tangible personal property or any
    other taxable item or service under Subsection 59-12-103(1), other than resale of such property, item,
    or service by a retailer or wholesaler to a user or consumer.
        (b) "Retail sale" includes sales by any farmer or other agricultural producer of poultry, eggs,
    or dairy products to consumers if the sales have an average monthly sales value of $125 or more.
        (c) "Retail sale" does not include, and no additional sales or use tax shall be assessed against,
    those transactions where a purchaser of tangible personal property pays applicable sales or use taxes
    on its initial nonexempt purchases of property and then enters into a sale-leaseback transaction by
    which title to such property is transferred by the purchaser-lessee to a lessor for consideration,
        (i) the transaction is intended as a form of financing for the property to the purchaser-lessee;
        (ii) pursuant to generally accepted accounting principles, the purchaser-lessee is required to
    capitalize the subject property for financial reporting purposes, and account for the lease payments
    as payments made under a financing arrangement.
        (18) (a) "Retailer" means any person engaged in a regularly organized retail business in
    tangible personal property or any other taxable item or service under Subsection 59-12-103(1), and
    who is selling to the user or consumer and not for resale.
        (b) "Retailer" includes commission merchants, auctioneers, and any person regularly
    engaged in the business of selling to users or consumers within the state.
        (c) "Retailer" includes any person who engages in regular or systematic solicitation of a

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    consumer market in this state by the distribution of catalogs, periodicals, advertising flyers, or other
    advertising, or by means of print, radio or television media, by mail, telegraphy, telephone, computer
    data base, cable, optic, microwave, or other communication system.
        (d) "Retailer" does not include farmers, gardeners, stockmen, poultrymen, or other growers
    or agricultural producers producing and doing business on their own premises, except those who are
    regularly engaged in the business of buying or selling for a profit.
        (e) For purposes of this chapter the commission may regard as retailers the following if they
    determine it is necessary for the efficient administration of this chapter: salesmen, representatives,
    peddlers, or canvassers as the agents of the dealers, distributors, supervisors, or employers under
    whom they operate or from whom they obtain the tangible personal property sold by them,
    irrespective of whether they are making sales on their own behalf or on behalf of these dealers,
    distributors, supervisors, or employers, except that:
        (i) a printer's facility with which a retailer has contracted for printing shall not be considered
    to be a salesman, representative, peddler, canvasser, or agent of the retailer; and
        (ii) the ownership of property that is located at the premises of a printer's facility with which
    the retailer has contracted for printing and that consists of the final printed product, property that
    becomes a part of the final printed product, or copy from which the printed product is produced, shall
    not result in the retailer being deemed to have or maintain an office, distribution house, sales house,
    warehouse, service enterprise, or other place of business, or to maintain a stock of goods, within this
        (19) "Sale" means any transfer of title, exchange, or barter, conditional or otherwise, in any
    manner, of tangible personal property or any other taxable item or service under Subsection
    59-12-103(1), for a consideration. It includes:
        (a) installment and credit sales;
        (b) any closed transaction constituting a sale;
        (c) any sale of electrical energy, gas, services, or entertainment taxable under this chapter;
        (d) any transaction if the possession of property is transferred but the seller retains the title
    as security for the payment of the price; and

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        (e) any transaction under which right to possession, operation, or use of any article of
    tangible personal property is granted under a lease or contract and the transfer of possession would
    be taxable if an outright sale were made.
        (20) (a) "Sales relating to schools" means sales by a public school district or public or private
    elementary or secondary school, grades kindergarten through 12, that are directly related to the
    school's or school district's educational functions or activities and include:
        (i) the sale of textbooks, textbook fees, laboratory fees, laboratory supplies, and safety
        (ii) the sale of clothing that:
        (A) a student is specifically required to wear as a condition of participation in a
    school-related event or activity; and
        (B) is not readily adaptable to general or continued usage to the extent that it takes the place
    of ordinary clothing;
        (iii) sales of food if the net or gross revenues generated by the food sales are deposited into
    a school district fund or school fund dedicated to school meals; and
        (iv) transportation charges for official school activities.
        (b) "Sales relating to schools" does not include:
        (i) gate receipts;
        (ii) special event admission fees;
        (iii) bookstore sales of items that are not educational materials or supplies; and
        (iv) except as provided in Subsection (20)(a)(ii), clothing.
        (21) "State" means the state of Utah, its departments, and agencies.
        (22) "Storage" means any keeping or retention of tangible personal property or any other
    taxable item or service under Subsection 59-12-103(1), in this state for any purpose except sale in
    the regular course of business.
        (23) (a) "Tangible personal property" means:
        (i) all goods, wares, merchandise, produce, and commodities;
        (ii) all tangible or corporeal things and substances which are dealt in or capable of being

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    possessed or exchanged;
        (iii) water in bottles, tanks, or other containers; and
        (iv) all other physically existing articles or things, including property severed from real
        (b) "Tangible personal property" does not include:
        (i) real estate or any interest or improvements in real estate;
        (ii) bank accounts, stocks, bonds, mortgages, notes, and other evidence of debt;
        (iii) insurance certificates or policies;
        (iv) personal or governmental licenses;
        (v) water in pipes, conduits, ditches, or reservoirs;
        (vi) currency and coinage constituting legal tender of the United States or of a foreign
    nation; and
        (vii) all gold, silver, or platinum ingots, bars, medallions, or decorative coins, not
    constituting legal tender of any nation, with a gold, silver, or platinum content of not less than 80%.
        (24) (a) "Use" means the exercise of any right or power over tangible personal property
    under Subsection 59-12-103(1), incident to the ownership or the leasing of that property, item, or
        (b) "Use" does not include the sale, display, demonstration, or trial of that property in the
    regular course of business and held for resale.
        (25) "Vehicle" means any aircraft, as defined in Section 2-1-1; any vehicle, as defined in
    Section 41-1a-102; any off-highway vehicle, as defined in Section 41-22-2; and any vessel, as
    defined in Section 41-1a-102; that is required to be titled, registered, or both. "Vehicle" for purposes
    of Subsection 59-12-104(37) only, also includes any locomotive, freight car, railroad work
    equipment, or other railroad rolling stock.
        (26) "Vehicle dealer" means a person engaged in the business of buying, selling, or
    exchanging vehicles as defined in Subsection (25).
        (27) (a) "Vendor" means:
        (i) any person receiving any payment or consideration upon a sale of tangible personal

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    property or any other taxable item or service under Subsection 59-12-103(1), or to whom such
    payment or consideration is payable; and
        (ii) any person who engages in regular or systematic solicitation of a consumer market in
    this state by the distribution of catalogs, periodicals, advertising flyers, or other advertising, or by
    means of print, radio or television media, by mail, telegraphy, telephone, computer data base, cable,
    optic, microwave, or other communication system.
        (b) "Vendor" does not mean a printer's facility described in Subsection (18)(e).
        Section 16. Section 62A-3-202 is amended to read:
         62A-3-202. Definitions.
        As used in this part:
        (1) "Elderly resident" means an adult 60 years of age or older who because of physical,
    economic, social, or emotional problems cannot function normally on an independent basis, and who
    resides in a long-term care facility.
        (2) "Government agency" means any department, division, office, bureau, board,
    commission, authority, or any other agency or instrumentality created by the state, or to which the
    state is a party, or created by any county or municipality, which is responsible for the regulation,
    visitation, inspection, or supervision of facilities, or which provides services to patients, residents,
    or clients of facilities.
        (3) "Long-term care facility" means any skilled nursing facility, intermediate care facility,
    nursing home, residential health care facility, assisted living facility, adult foster care home, or any
    living arrangement in the community through which room and personal care services are provided
    for elderly residents.
        (4) "Ombudsman" means the administrator of the long-term care ombudsman program,
    created pursuant to Section 62A-3-203.
        Section 17. Section 78-30-4.13 is amended to read:
         78-30-4.13. Notice of adoption proceedings.
        (1) An unmarried biological father, by virtue of the fact that he has engaged in a sexual
    relationship with a woman, is deemed to be on notice that a pregnancy and an adoption proceeding

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    regarding that child may occur, and has a duty to protect his own rights and interests. He is therefore
    entitled to actual notice of a birth or an adoption proceeding with regard to that child only as
    provided in this section.
        (2) Notice of an adoption proceeding shall be served on each of the following persons:
        (a) any person or agency whose consent or relinquishment is required under Section
    78-30-4.14 unless that right has been terminated by waiver, relinquishment, consent, or judicial
        (b) any person who has initiated a paternity proceeding and filed notice of that action with
    the state registrar of vital statistics within the Department of Health, in accordance with Subsection
        (c) any legally appointed custodian or guardian of the adoptee;
        (d) the petitioner's spouse, if any, only if he has not joined in the petition;
        (e) the adoptee's spouse, if any;
        (f) any person who is recorded on the birth certificate as the child's father, with the
    knowledge and consent of the mother;
        (g) any person who is openly living in the same household with the child at the time the
    consent is executed or relinquishment made, and who is holding himself out to be the child's father;
        (h) any person who is married to the child's mother at the time she executes her consent to
    the adoption or relinquishes the child for adoption.
        (3) (a) In order to preserve any right to notice and consent, an unmarried biological father
    may initiate proceedings to establish paternity under Title 78, Chapter 45a, Uniform Act on
    Paternity, and file a notice of the initiation of those proceedings with the state registrar of vital
    statistics within the Department of Health prior to the mother's execution of consent or her
    relinquishment to an agency. That action and notice may also be filed prior to the child's birth.
        (b) The Department of Health shall provide forms for the purpose of filing the notice
    described in Subsection (a), and make those forms available in the office of the county clerk in each
    county, every health care facility, as defined in [Subsection 26-21-2(11)] Section 26-21-2, and

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    licensed child-placing agency.
        (4) Notice provided in accordance with this section need not disclose the name of the mother
    of the child who is the subject of an adoption proceeding.
        (5) The notice required by this section may be served immediately after relinquishment or
    execution of consent, but shall be served at least 30 days prior to the final dispositional hearing. The
    notice shall specifically state that the person served must respond to the petition within 30 days of
    service if he intends to intervene in or contest the adoption.
        (6) (a) Any person who has been served with notice of an adoption proceeding and who
    wishes to contest the adoption shall file a motion in the adoption proceeding within 30 days after
    service. The motion shall set forth specific relief sought and be accompanied by a memorandum
    specifying the factual and legal grounds upon which the motion is based.
        (b) Any person who fails to file a motion for relief within 30 days after service of notice
    waives any right to further notice in connection with the adoption, forfeits all rights in relation to the
    adoptee, and is barred from thereafter bringing or maintaining any action to assert any interest in the
        (7) Service of notice under this section shall be made as follows:
        (a) With regard to a person whose consent is necessary under Section 78-30-4.14, service
    shall be in accordance with the provisions of the Utah Rules of Civil Procedure. If service is by
    publication, the court shall designate the content of the notice regarding the identity of the parties.
    The notice may not include the name of the person or persons seeking to adopt the adoptee.
        (b) As to any other person for whom notice is required under this section, service by certified
    mail, return receipt requested, is sufficient. If that service cannot be completed after two attempts,
    the court may issue an order providing for service by publication, posting, or by any other manner
    of service.
        (c) Notice to a person who has initiated a paternity proceeding and filed notice of that action
    with the state registrar of vital statistics in the Department of Health in accordance with the
    requirements of Subsection (3), shall be served by certified mail, return receipt requested, at the last
    address filed with the registrar.

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        (8) The notice required by this section may be waived in writing by the person entitled to
    receive notice.
        (9) Proof of service of notice on all persons for whom notice is required by this section shall
    be filed with the court before the final dispositional hearing on the adoption.
        (10) Notwithstanding any other provision of law, neither the notice of an adoption
    proceeding nor any process in that proceeding is required to contain the name of the person or
    persons seeking to adopt the adoptee.
        (11) Except as to those persons whose consent to an adoption is required under Section
    78-30-4.14, the sole purpose of notice under this section is to enable the person served to intervene
    in the adoption and present evidence to the court relevant to the best interest of the child.
        Section 18. Repealer.
        This act repeals:
        Section 26-21-10, Violations -- Committee review.

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