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First Substitute H.B. 117

Representative Trisha S. Beck proposes the following substitute bill:




Sponsor: Trisha S. Beck

             5      This act modifies the Medicaid spend down requirements. The act amends the Medical
             6      Assistance Act. The act defines terms and directs the Health Department to use 100% of the
             7      federal poverty level as the income standard when determining if the aged, blind, or disabled
             8      have spent down enough excess income to be eligible for Medicaid benefits.
             9      This act affects sections of Utah Code Annotated 1953 as follows:
             10      AMENDS:
             11          26-18-3, as last amended by Chapter 316, Laws of Utah 2000
             12      Be it enacted by the Legislature of the state of Utah:
             13          Section 1. Section 26-18-3 is amended to read:
             14           26-18-3. Administration of Medicaid program by department -- Disciplinary
             15      measures and sanctions -- Funds collected.
             16          (1) The department shall be the single state agency responsible for the administration of
             17      the Medicaid program in connection with the United States Department of Health and Human
             18      Services pursuant to Title XIX of the Social Security Act.
             19          (2) The department shall develop implementing policy in conformity with this chapter, the
             20      requirements of Title XIX, and applicable federal regulations.
             21          (3) The department may, in its discretion, contract with the Department of Human Services
             22      or other qualified agencies for services in connection with the administration of the Medicaid
             23      program, including but not limited to the determination of the eligibility of individuals for the
             24      program, recovery of overpayments, and enforcement of fraud and abuse laws, consistent with
             25      Section 26-20-13 , to the extent permitted by law and quality control services.

             26          (4) The department shall provide, by rule, disciplinary measures and sanctions for
             27      Medicaid providers who fail to comply with the rules and procedures of the program, provided that
             28      sanctions imposed administratively may not extend beyond:
             29          (a) termination from the program;
             30          (b) recovery of claim reimbursements incorrectly paid; and
             31          (c) those specified in Section 1919 of Title XIX of the federal Social Security Act.
             32          (5) Funds collected as a result of a sanction imposed under Section 1919 of Title XIX of
             33      the federal Social Security Act shall be deposited in the General Fund as nonlapsing dedicated
             34      credits to be used by the division in accordance with the requirements of that section.
             35          (6) (a) In determining whether an applicant or recipient is eligible for a service or benefit
             36      under this part or Chapter 40, Utah Children's Health Insurance [Program] Act, the department
             37      shall, if Subsection (6)(b) is satisfied, exclude from consideration one passenger vehicle designated
             38      by the applicant or recipient.
             39          (b) Before Subsection (6)(a) may be applied:
             40          (i) the federal government must:
             41          (A) determine that Subsection (6)(a) may be implemented within the state's existing public
             42      assistance-related waivers as of January 1, 1999;
             43          (B) extend a waiver to the state permitting the implementation of Subsection (6)(a); or
             44          (C) determine that the state's waivers that permit dual eligibility determinations for cash
             45      assistance and Medicaid are no longer valid; and
             46          (ii) the department must determine that Subsection (6)(a) can be implemented within
             47      existing funding.
             48          (7) (a) For purposes of this Subsection (7):
             49          (i) "aged, blind, or disabled" shall be defined by administrative rule; and
             50          (ii) "spend down" means an amount of income in excess of the allowable income standard
             51      that must be paid in cash to the department or incurred through the medical services not paid by
             52      Medicaid.
             53          (b) In determining whether an applicant or recipient who is aged, blind, or disabled is
             54      eligible for a service or benefit under this chapter as a result of a spend down, the department shall
             55      use 100% of the federal poverty level as the income standard for the spend down.

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