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H.B. 208






Sponsor: Rebecca D. Lockhart

             6      This act modifies provisions related to the Health Policy Commission which was repealed last
             7      year. The act deletes references to the Health Policy Commission in the Health Code and the
             8      Insurance Code and makes technical changes.
             9      This act affects sections of Utah Code Annotated 1953 as follows:
             10      AMENDS:
             11          26-1-30, as last amended by Chapter 229, Laws of Utah 2000
             12          26-1-30.5, as enacted by Chapter 321, Laws of Utah 1995
             13          26-18-401, as last amended by Chapter 13, Laws of Utah 1998
             14          26-33a-106.5, as enacted by Chapter 201, Laws of Utah 1996
             15          26-40-103, as last amended by Chapter 351, Laws of Utah 2000
             16          26-40-104, as enacted by Chapter 360, Laws of Utah 1998
             17          26-40-109, as enacted by Chapter 360, Laws of Utah 1998
             18          26-40-110, as enacted by Chapter 360, Laws of Utah 1998
             19          31A-30-110, as last amended by Chapters 10 and 265, Laws of Utah 1997
             20          31A-32a-106, as enacted by Chapter 131, Laws of Utah 1999
             21      Be it enacted by the Legislature of the state of Utah:
             22          Section 1. Section 26-1-30 is amended to read:
             23           26-1-30. Powers and duties of department.
             24          (1) The department shall:
             25          (a) enter into cooperative agreements with the Department of Environmental Quality to
             26      delineate specific responsibilities to assure that assessment and management of risk to human
             27      health from the environment are properly administered; and

             28          (b) consult with the Department of Environmental Quality and enter into cooperative
             29      agreements, as needed, to ensure efficient use of resources and effective response to potential
             30      health and safety threats from the environment, and to prevent gaps in protection from potential
             31      risks from the environment to specific individuals or population groups.
             32          (2) In addition to all other powers and duties of the department, it shall have and exercise
             33      the following powers and duties:
             34          (a) promote and protect the health and wellness of the people within the state;
             35          (b) establish, maintain, and enforce rules necessary or desirable to carry out the provisions
             36      and purposes of this title to promote and protect the public health or to prevent disease and illness;
             37          (c) investigate and control the causes of epidemic, infectious, communicable, and other
             38      diseases affecting the public health;
             39          (d) provide for the detection, reporting, prevention, and control of communicable,
             40      infectious, acute, chronic, or any other disease or health hazard that the department considers to
             41      be dangerous, important, or likely to affect the public health;
             42          (e) collect and report information on causes of injury, sickness, death, and disability and
             43      the risk factors that contribute to the causes of injury, sickness, death, and disability within the
             44      state;
             45          (f) collect, prepare, publish, and disseminate information to inform the public concerning
             46      the health and wellness of the population, specific hazards, and risks that may affect the health and
             47      wellness of the population and specific activities which may promote and protect the health and
             48      wellness of the population;
             49          (g) establish and operate programs necessary or desirable for the promotion or protection
             50      of the public health and the control of disease or which may be necessary to ameliorate the major
             51      causes of injury, sickness, death, and disability in the state, except that the programs shall not be
             52      established if adequate programs exist in the private sector;
             53          (h) establish, maintain, and enforce isolation and quarantine, and for this purpose only,
             54      exercise physical control over property and individuals as the department finds necessary for the
             55      protection of the public health;
             56          (i) close theaters, schools, and other public places and forbid gatherings of people when
             57      necessary to protect the public health;
             58          (j) abate nuisances when necessary to eliminate sources of filth and infectious and

             59      communicable diseases affecting the public health;
             60          (k) make necessary sanitary and health investigations and inspections in cooperation with
             61      local health departments as to any matters affecting the public health;
             62          (l) establish laboratory services necessary to support public health programs and medical
             63      services in the state;
             64          (m) establish and enforce standards for laboratory services which are provided by any
             65      laboratory in the state when the purpose of the services is to protect the public health;
             66          (n) cooperate with the Labor Commission to conduct studies of occupational health
             67      hazards and occupational diseases arising in and out of employment in industry, and make
             68      recommendations for elimination or reduction of the hazards;
             69          (o) cooperate with the local health departments, the Department of Corrections, the
             70      Administrative Office of the Courts, the Division of Youth Corrections, and the Crime Victims
             71      Reparations Board to conduct testing for HIV infection of convicted sexual offenders and any
             72      victims of a sexual offense;
             73          (p) investigate the cause of maternal and infant mortality;
             74          (q) establish, maintain, and enforce a procedure requiring the blood of adult pedestrians
             75      and drivers of motor vehicles killed in highway accidents be examined for the presence and
             76      concentration of alcohol;
             77          (r) provide the commissioner of public safety with monthly statistics reflecting the results
             78      of the examinations provided for in Subsection (2)(q) and provide safeguards so that information
             79      derived from the examinations is not used for a purpose other than the compilation of statistics
             80      authorized in this Subsection (2)(r);
             81          (s) establish qualifications for individuals permitted to draw blood pursuant to Section
             82      41-6-44.10 , and to issue permits to individuals it finds qualified, which permits may be terminated
             83      or revoked by the department;
             84          (t) establish a uniform public health program throughout the state which includes
             85      continuous service, employment of qualified employees, and a basic program of disease control,
             86      vital and health statistics, sanitation, public health nursing, and other preventive health programs
             87      necessary or desirable for the protection of public health;
             88          (u) adopt rules and enforce minimum sanitary standards for the operation and maintenance
             89      of:

             90          (i) orphanages;
             91          (ii) boarding homes;
             92          (iii) summer camps for children;
             93          (iv) lodging houses;
             94          (v) hotels;
             95          (vi) restaurants and all other places where food is handled for commercial purposes, sold,
             96      or served to the public;
             97          (vii) tourist and trailer camps;
             98          (viii) service stations;
             99          (ix) public conveyances and stations;
             100          (x) public and private schools;
             101          (xi) factories;
             102          (xii) private sanatoria;
             103          (xiii) barber shops;
             104          (xiv) beauty shops;
             105          (xv) physicians' offices;
             106          (xvi) dentists' offices;
             107          (xvii) workshops;
             108          (xviii) industrial, labor, or construction camps;
             109          (xix) recreational resorts and camps;
             110          (xx) swimming pools, public baths, and bathing beaches;
             111          (xxi) state, county, or municipal institutions, including hospitals and other buildings,
             112      centers, and places used for public gatherings; and
             113          (xxii) of any other facilities in public buildings and on public grounds;
             114          (v) conduct health planning for the state;
             115          (w) monitor the costs of health care in the state and foster price competition in the health
             116      care delivery system;
             117          (x) adopt rules for the licensure of health facilities within the state pursuant to Title 26,
             118      Chapter 21, Health Care Facility Licensing and Inspection Act;
             119          (y) serve as the collecting agent, on behalf of the state, for the nursing facility assessment
             120      fee imposed under Title 26, Chapter 35, Nursing Facility Assessment Act, and the provider

             121      assessment imposed under Chapter 40, Utah Children's Health Insurance Act, and adopt rules for
             122      the enforcement and administration of the assessments consistent with Chapters 35 and 40; and
             123          [(z) monitor and report to the Health Policy Commission created in Title 63C, Chapter 3,
             124      Health Policy Commission, on the development of managed health care plans in rural areas of the
             125      state, including the effect of the managed health care plans on costs, access, and availability of
             126      providers located in the rural communities of the state; and]
             127          [(aa)] (z) license the provision of child care.
             128          Section 2. Section 26-1-30.5 is amended to read:
             129           26-1-30.5. Duty to establish pilot program for monitoring quality in health care.
             130          (1) The department shall develop a two year demonstration project to promote and monitor
             131      quality health care. Implementation and execution of the demonstration project is contingent upon
             132      appropriations from the Legislature.
             133          (2) The demonstration project shall include at least the following:
             134          (a) a collaborative, public-private effort to promote clinical quality and cost effectiveness
             135      in health care through community wide continuous quality improvement methods; and
             136          (b) a process for evaluating the effectiveness of health care continuous quality
             137      improvement efforts in the state.
             138          [(3) (a) Before issuing any requests for proposals, as defined in Section 63-56-5 , to
             139      implement the demonstration project described in this section, the department shall:]
             140          [(i) submit to the Utah Health Policy Commission a draft of the request for proposal to be
             141      issued for the demonstration project; and]
             142          [(ii) provide an opportunity for the commission to comment on the request for proposal.]
             143          [(b) Sixty days before issuing any requests for proposals as defined in Section 63-56-5 for
             144      acquisition of hardware and software and information technology systems for the collection,
             145      storage, and encoding of encounter level data, the department shall submit to the Information
             146      Technology Commission a detailed description of the pilot program's plan for information
             147      technology acquisition and funding.]
             148          Section 3. Section 26-18-401 is amended to read:
             149           26-18-401. Medicaid waiver.
             150          (1) (a) Before July 1, 1995, the division shall submit to the Secretary of the United States
             151      Department of Health and Human Services an application for a Medicaid Waiver under 42 U.S.C.

             152      Section 1315. The purpose of the waiver is to expand the coverage of the Medicaid program, and
             153      to the extent permissible under the waiver, private health insurance plans to low income, otherwise
             154      uninsured persons who are in eligibility categories not traditionally served by the Medicaid
             155      program.
             156          (b) Prior to submitting the application under Subsection (1)(a), the department shall submit
             157      to the Health and Human Services Interim Committee a summary of the application and proposal
             158      for implementing the waiver.
             159          (c) Prior to adopting any rules or policies to implement the waiver, the department shall
             160      submit to the Health and Human Services Interim Committee the proposed rules and policies.
             161          (2) Implementation and execution of this waiver by the department will be within
             162      appropriations from the Legislature.
             163          [(3) The Health Policy Commission may make recommendations to the department
             164      regarding implementation and execution of the waiver.]
             165          [(4)] (3) The department shall establish by rule the policies governing eligibility, income
             166      limitations, cost sharing, participating in private insurance plans, benefit plan, and voluntary
             167      employee enrollment by employers who volunteer to participate.
             168          [(5)] (4) The department shall provide [a periodic report to the Health Policy Committee
             169      and] an annual report to the Health and Human Services Interim Committee on the progress and
             170      results of the waiver implementation.
             171          Section 4. Section 26-33a-106.5 is amended to read:
             172           26-33a-106.5. Comparative analyses.
             173          (1) The committee may publish compilations or reports that compare and identify health
             174      care providers or data suppliers from the data it collects under this chapter or from any other
             175      source.
             176          [(2) Until June 30, 1998, the committee shall inform the Health Policy Commission
             177      created in Title 63C, Chapter 3, before publishing a compilation or report that compares and
             178      identifies health care providers or data suppliers.]
             179          [(3)] (2) The committee shall contract with a private, independent analyst to evaluate the
             180      standard comparative reports of the committee that identify, compare, or rank the performance of
             181      data suppliers by name. The evaluation shall include a validation of statistical methodologies,
             182      limitations, appropriateness of use, and comparisons using standard health services research

             183      practice. The analyst must be experienced in analyzing large databases from multiple data
             184      suppliers and in evaluating health care issues of cost, quality, and access. The results of the
             185      analyst's evaluation must be released to the public before the standard comparative analysis upon
             186      which it is based may be published by the committee.
             187          [(4)] (3) The committee shall adopt by rule a timetable for the collection and analysis of
             188      data from multiple types of data suppliers.
             189          Section 5. Section 26-40-103 is amended to read:
             190           26-40-103. Creation and administration of the Utah Children's Health Insurance
             191      Program.
             192          (1) There is created the Utah Children's Health Insurance Program to be administered by
             193      the department in accordance with the provisions of:
             194          (a) this chapter; and
             195          (b) the State Children's Health Insurance Program, 42 U.S.C. Sec. 1397aa et seq.
             196          (2) The department shall:
             197          (a) prepare and submit the state's children's health insurance plan before May 1, 1998, and
             198      any amendments to the federal Department of Health and Human Services in accordance with 42
             199      U.S.C. Sec. 1397ff; and
             200          (b) make rules in accordance with Title 63, Chapter 46a, Utah Administrative Rulemaking
             201      Act regarding:
             202          (i) eligibility requirements consistent with Subsection 26-18-3 (6);
             203          (ii) program benefits;
             204          (iii) the level of coverage for each program benefit;
             205          (iv) cost-sharing requirements for enrollees, which may not:
             206          (A) exceed the guidelines set forth in 42 U.S.C. Sec. 1397ee; or
             207          (B) impose deductible, copayment, or coinsurance requirements on an enrollee for
             208      well-child, well-baby, and immunizations; and
             209          (v) the administration of the program.
             210          (3) Before July 1, 2001, the Governor's Office of Planning and Budget shall study the
             211      effectiveness of the department's administration of the program and report any findings to:
             212          (a) the Health and Human Services Interim Committee of the Legislature; and
             213          [(b) the Health Policy Commission; and]

             214          [(c)] (b) the department.
             215          Section 6. Section 26-40-104 is amended to read:
             216           26-40-104. Utah Children's Health Insurance Program Advisory Council.
             217          (1) There is created a Utah Children's Health Insurance Program Advisory Council
             218      consisting of at least eight and no more than eleven members appointed by the executive director
             219      of the department. The term of each appointment shall be three years. The appointments shall be
             220      staggered at one-year intervals to ensure continuity of the advisory council.
             221          (2) The advisory council shall meet at least quarterly.
             222          (3) The membership of the advisory council shall include at least one representative from
             223      each of the following groups:
             224          (a) child health care providers;
             225          (b) parents and guardians of children enrolled in the program;
             226          (c) ethnic populations other than American Indians;
             227          (d) American Indians;
             228          [(e) the Health Policy Commission;]
             229          [(f)] (e) the Utah Association of Health Care Providers;
             230          [(g)] (f) health and disability insurance providers; and
             231          [(h)] (g) the general public.
             232          (4) The advisory council shall advise the department on:
             233          (a) benefits design;
             234          (b) eligibility criteria;
             235          (c) outreach;
             236          (d) evaluation; and
             237          (e) special strategies for under-served populations.
             238          (5) (a) (i) Members who are not government employees may not receive compensation or
             239      benefits for their services, but may receive per diem and expenses incurred in the performance of
             240      the member's official duties at the rates established by the Division of Finance under Sections
             241      63A-3-106 and 63A-3-107 .
             242          (ii) Members may decline to receive per diem and expenses for their service.
             243          (b) (i) State government officer and employee members who do not receive salary, per
             244      diem, or expenses from their agency for their service may receive per diem and expenses incurred

             245      in the performance of their official duties from the council at the rates established by the Division
             246      of Finance under Sections 63A-3-106 and 63A-3-107 .
             247          (ii) State government officer and employee members may decline to receive per diem and
             248      expenses for their service.
             249          Section 7. Section 26-40-109 is amended to read:
             250           26-40-109. Evaluation.
             251          (1) The department shall develop performance measures and annually evaluate the
             252      program's performance.
             253          (2) The department shall report annually on its evaluation to the Health and Human
             254      Services Interim Committee of the Legislature [and the Health Policy Commission] before
             255      November 1.
             256          Section 8. Section 26-40-110 is amended to read:
             257           26-40-110. Managed care -- Contracting for services.
             258          (1) Services provided to enrollees under the program shall be delivered in a managed care
             259      system if services are available within 30 paved road miles of where the enrollee lives or resides.
             260      Otherwise, the program may provide services to enrollees through fee for service plans.
             261          (2) Before awarding a contract to a managed care system or fee for service plan to provide
             262      services under Subsection (1) or determining that no bid or proposal received in response to such
             263      a request is acceptable, the executive director shall report that information to and seek
             264      recommendations from the Health [Policy Commission] Advisory Council created in Section
             265      26-1-7.5 .
             266          (3) If after seeking the recommendation of the Health [Policy Commission] Advisory
             267      Council under Subsection (2), the executive director determines that no bid or proposal received
             268      in response to such a request is acceptable or if no bid or proposal has been received in response
             269      to such a request, the department may contract with the Group Insurance Division within the Utah
             270      State Retirement Office to provide services under Subsection (1).
             271          (4) Title 63, Chapter 56, Utah Procurement Code, shall apply to this section.
             272          Section 9. Section 31A-30-110 is amended to read:
             273           31A-30-110. Individual enrollment cap.
             274          (1) The commissioner shall set the individual enrollment cap at .5% on July 1, 1997.
             275          (2) The commissioner shall raise the individual enrollment cap by .5% at the later of the

             276      following dates:
             277          (a) six months from the last increase in the individual enrollment cap; or
             278          (b) the date when CCI/TI is greater than .90, where:
             279          (i) "CCI" is the total individual coverage count for all carriers certifying that their
             280      uninsurable percentage has reached the individual enrollment cap; and
             281          (ii) "TI" is the total individual coverage count for all carriers.
             282          (3) The commissioner may establish a minimum number of uninsurable individuals that
             283      a carrier entering the market who is subject to this chapter must accept under the individual
             284      enrollment provisions of this chapter.
             285          (4) Beginning July 1, 1997, an individual carrier may decline to accept individuals
             286      applying for individual enrollment under Subsection 31A-30-108 (3), other than individuals
             287      applying for coverage as set forth in P.L. 104-191, 110 Stat. 1979, Sec. 2741 (a)-(b), if:
             288          (a) the uninsurable percentage for that carrier equals or exceeds the cap established in
             289      Subsection (1); and
             290          (b) the covered carrier has certified on forms provided by the commissioner that its
             291      uninsurable percentage equals or exceeds the individual enrollment cap.
             292          (5) The department may audit a carrier's records to verify whether the carrier's uninsurable
             293      classification meets industry standards for underwriting criteria as established by the commissioner
             294      in accordance with Subsection 31A-30-106 (1)(k).
             295          [(6) (a) On or before July 1, 1997, and each July 1 thereafter, the commissioner:]
             296          [(i) shall report to the Utah Health Policy Commission on the distribution of risks assumed
             297      by various carriers in the state under the individual enrollment provision of this part; and]
             298          [(ii) may make recommendations to the Utah Health Policy Commission and the
             299      Legislature regarding the adjustment of the .5% cap on individual enrollment or some other risk
             300      adjustment to maintain equitable distribution of risk among carriers.]
             301          [(b)] (6) (a) If the commissioner determines that individual enrollment is causing a
             302      substantial adverse effect on premiums, enrollment, or experience, the commissioner may suspend,
             303      limit, or delay further individual enrollment for up to 12 months.
             304          [(c)] (b) The commissioner shall adopt rules to establish a uniform methodology for
             305      calculating and reporting loss ratios for individual policies for determining whether the individual
             306      enrollment provisions of Section 31A-30-108 should be waived for an individual carrier

             307      experiencing significant and adverse financial impact as a result of complying with those
             308      provisions.
             309          [(7) (a) On or before November 30, 1995, the commissioner shall report to the Health
             310      Policy Commission and the Legislature on:]
             311          [(i) the impact of the Small Employer Health Insurance Act on availability of small
             312      employer insurance in the market;]
             313          [(ii) the number of carriers who have withdrawn from the market or ceased to issue new
             314      policies since the implementation of the Small Employer Health Insurance Act;]
             315          [(iii) the expected impact of the individual enrollment provisions on the factors described
             316      in Subsections (7)(i) and (ii); and]
             317          [(iv) the claims experience, costs, premiums, participation, and viability of the
             318      Comprehensive Health Insurance Pool created in Chapter 29.]
             319          [(b) The report to the Legislature shall be submitted in writing to each legislator.]
             320          Section 10. Section 31A-32a-106 is amended to read:
             321           31A-32a-106. Regulation of account administrators -- Administration of tax
             322      deductions.
             323          (1) The department shall regulate account administrators and may adopt rules necessary
             324      to administer this chapter.
             325          [(2) Before adopting rules to administer this chapter, the department shall report the
             326      proposed rules to the Utah Health Policy Commission.]
             327          [(3)] (2) The tax commission may adopt rules necessary to monitor and implement the tax
             328      deductions established by this chapter and Section 59-10-114 .

Legislative Review Note
    as of 11-28-00 1:45 PM

A limited legal review of this legislation raises no obvious constitutional or statutory concerns.

Office of Legislative Research and General Counsel

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