H.B. 82 Enrolled

1

NOTICE OF CHANGES TO THE STATE
2 MEDICAID PLAN
3 2008 GENERAL SESSION
4 STATE OF UTAH
5 Chief Sponsor: Merlynn T. Newbold
6 Senate Sponsor: Allen M. Christensen
7
8 LONG TITLE
9 General Description:
10 This bill amends the Department of Health's reporting requirements to the Legislature
11 when the department makes a change to the state Medicaid plan.
12 Highlighted Provisions:
13 This bill:
14 . clarifies the content of the Department of Health's notice to the Legislature when the
15 department makes a change to the state Medicaid plan; and
16 . makes technical and clarifying changes.
17 Monies Appropriated in this Bill:
18 None
19 Other Special Clauses:
20 None
21 Utah Code Sections Affected:
22 AMENDS:
23 26-18-3, as last amended by Laws of Utah 2006, Chapter 116
24 26-18-4, as last amended by Laws of Utah 1999, Chapter 61
25 26-18-10, as last amended by Laws of Utah 1999, Chapter 61
26 26-40-103, as last amended by Laws of Utah 2003, Chapter 16
27
28 Be it enacted by the Legislature of the state of Utah:
29 Section 1. Section 26-18-3 is amended to read:

30 26-18-3. Administration of Medicaid program by department -- Reporting to the
31 Legislature -- Disciplinary measures and sanctions -- Funds collected -- Eligibility
32 standards.
33 (1) The department shall be the single state agency responsible for the administration of
34 the Medicaid program in connection with the United States Department of Health and Human
35 Services pursuant to Title XIX of the Social Security Act.
36 (2) (a) The department shall implement the Medicaid program through administrative
37 rules in conformity with this chapter, Title 63, Chapter 46a, Utah Administrative Rulemaking
38 Act, the requirements of Title XIX, and applicable federal regulations.
39 (b) [(i)] The rules adopted under Subsection (2)(a) shall include, in addition to other
40 rules necessary to implement the program[,]:
41 (i) the standards used by the department for determining eligibility for Medicaid
42 services[,];
43 (ii) the services and benefits to be covered by the Medicaid program[,]; and
44 (iii) reimbursement methodologies for providers under the Medicaid program.
45 [(ii) If the department implements a change in the Medicaid State Plan, initiates a new
46 Medicaid waiver, initiates an amendment to an existing Medicaid waiver, or initiates a rate
47 change requiring public notice under state or federal law, the department shall, prior to adopting
48 the change,]
49 (3) (a) The department shall, in accordance with Subsection (3)(b), report to either the
50 Legislative Executive Appropriations Committee or the Legislative Health and Human Services
51 Appropriations Subcommittee [and include in the report:] when the department:
52 (i) implements a change in the Medicaid State Plan;
53 (ii) initiates a new Medicaid waiver;
54 (iii) initiates an amendment to an existing Medicaid waiver; or
55 (iv) initiates a rate change that requires public notice under state or federal law.
56 (b) The report required by Subsection (3)(a) shall:
57 (i) be submitted to the Legislature's Executive Appropriations Committee or the

58 legislative Health and Human Services Appropriations Subcommittee prior to the department
59 implementing the proposed change; and
60 (ii) shall include:
61 (A) a description of the department's current practice or policy that the department is
62 proposing to change;
63 (B) an explanation of why the department is proposing the change;
64 [(A)] (C) the proposed change in services or reimbursement, including a description of
65 the effect of the change;
66 [(B)] (D) the effect of an increase or decrease in services or benefits on individuals and
67 families;
68 [(C)] (E) the degree to which any proposed cut may result in cost-shifting to more
69 expensive services in health or human service programs; and
70 [(D) the effect of any proposed increase of benefits or reimbursement on current and
71 future appropriations from the Legislature to the department.]
72 (F) the fiscal impact of the proposed change, including:
73 (I) the effect of the proposed change on current or future appropriations from the
74 Legislature to the department;
75 (II) the effect the proposed change may have on federal matching dollars received by
76 the state Medicaid program;
77 (III) any cost shifting or cost savings within the department's budget that may result
78 from the proposed change; and
79 (IV) identification of the funds that will be used for the proposed change, including any
80 transfer of funds within the department's budget.
81 [(iii)] (4) Any rules adopted by the department under [this] Subsection (2) are subject to
82 review and reauthorization by the Legislature in accordance with Section 63-46a-11.5 .
83 [(3)] (5) The department may, in its discretion, contract with the Department of Human
84 Services or other qualified agencies for services in connection with the administration of the
85 Medicaid program, including [but not limited to]:

86 (a) the determination of the eligibility of individuals for the program[,];
87 (b) recovery of overpayments[,]; and
88 (c) consistent with Section 26-20-13 , and to the extent permitted by law and quality
89 control services, enforcement of fraud and abuse laws[, consistent with Section 26-20-13 , to the
90 extent permitted by law and quality control services].
91 [(4)] (6) The department shall provide, by rule, disciplinary measures and sanctions for
92 Medicaid providers who fail to comply with the rules and procedures of the program, provided
93 that sanctions imposed administratively may not extend beyond:
94 (a) termination from the program;
95 (b) recovery of claim reimbursements incorrectly paid; and
96 (c) those specified in Section 1919 of Title XIX of the federal Social Security Act.
97 [(5)] (7) Funds collected as a result of a sanction imposed under Section 1919 of Title
98 XIX of the federal Social Security Act shall be deposited in the General Fund as nonlapsing
99 dedicated credits to be used by the division in accordance with the requirements of [that
100 section] Section 1919 of Title XIX of the federal Social Security Act.
101 [(6)] (8) (a) In determining whether an applicant or recipient is eligible for a service or
102 benefit under this part or Chapter 40, Utah Children's Health Insurance Act, the department
103 shall, if Subsection [(6)] (8)(b) is satisfied, exclude from consideration one passenger vehicle
104 designated by the applicant or recipient.
105 (b) Before Subsection [(6)] (8)(a) may be applied:
106 (i) the federal government must:
107 (A) determine that Subsection [(6)] (8)(a) may be implemented within the state's
108 existing public assistance-related waivers as of January 1, 1999;
109 (B) extend a waiver to the state permitting the implementation of Subsection [(6)]
110 (8)(a); or
111 (C) determine that the state's waivers that permit dual eligibility determinations for cash
112 assistance and Medicaid are no longer valid; and
113 (ii) the department must determine that Subsection [(6)] (8)(a) can be implemented

114 within existing funding.
115 [(7)] (9) (a) For purposes of this Subsection [(7)] (9):
116 (i) "aged, blind, or disabled" shall be defined by administrative rule; and
117 (ii) "spend down" means an amount of income in excess of the allowable income
118 standard that must be paid in cash to the department or incurred through the medical services
119 not paid by Medicaid.
120 (b) In determining whether an applicant or recipient who is aged, blind, or disabled is
121 eligible for a service or benefit under this chapter, the department shall use 100% of the federal
122 poverty level as:
123 (i) the allowable income standard for eligibility for services or benefits; and
124 (ii) the allowable income standard for eligibility as a result of spend down.
125 Section 2. Section 26-18-4 is amended to read:
126 26-18-4. Department standards for eligibility under Medicaid -- Funds for
127 abortions.
128 (1) The department may develop standards and administer policies relating to eligibility
129 under the Medicaid program as long as they are consistent with Subsection 26-18-3 [(6)](8). An
130 applicant receiving Medicaid assistance may be limited to particular types of care or services or
131 to payment of part or all costs of care determined to be medically necessary.
132 (2) The department shall not provide any funds for medical, hospital, or other medical
133 expenditures or medical services to otherwise eligible persons where the purpose of the
134 assistance is to perform an abortion, unless the life of the mother would be endangered if an
135 abortion were not performed.
136 (3) Any employee of the department who authorizes payment for an abortion contrary
137 to the provisions of this section is guilty of a class B misdemeanor and subject to forfeiture of
138 office.
139 (4) Any person or organization that, under the guise of other medical treatment,
140 provides an abortion under auspices of the Medicaid program is guilty of a third degree felony
141 and subject to forfeiture of license to practice medicine or authority to provide medical services

142 and treatment.
143 Section 3. Section 26-18-10 is amended to read:
144 26-18-10. Utah Medical Assistance Program -- Policies and standards.
145 (1) The division shall develop a medical assistance program, which shall be known as
146 the Utah Medical Assistance Program, for low income persons who are not eligible under the
147 state plan for Medicaid under Title XIX of the Social Security Act or Medicare under Title
148 XVIII of that act.
149 (2) Persons in the custody of prisons, jails, halfway houses, and other nonmedical
150 government institutions are not eligible for services provided under this section.
151 (3) The department shall develop standards and administer policies relating to eligibility
152 requirements, consistent with Subsection 26-18-3 [(6)](8), for participation in the program, and
153 for payment of medical claims for eligible persons.
154 (4) The program shall be a payor of last resort. Before assistance is rendered the
155 division shall investigate the availability of the resources of the spouse, father, mother, and adult
156 children of the person making application.
157 (5) The department shall determine what medically necessary care or services are
158 covered under the program, including duration of care, and method of payment, which may be
159 partial or in full.
160 (6) The department shall not provide public assistance for medical, hospital, or other
161 medical expenditures or medical services to otherwise eligible persons where the purpose of the
162 assistance is for the performance of an abortion, unless the life of the mother would be
163 endangered if an abortion were not performed.
164 (7) The department may establish rules to carry out the provisions of this section.
165 Section 4. Section 26-40-103 is amended to read:
166 26-40-103. Creation and administration of the Utah Children's Health Insurance
167 Program.
168 (1) There is created the Utah Children's Health Insurance Program to be administered
169 by the department in accordance with the provisions of:

170 (a) this chapter; and
171 (b) the State Children's Health Insurance Program, 42 U.S.C. Sec. 1397aa et seq.
172 (2) The department shall:
173 (a) prepare and submit the state's children's health insurance plan before May 1, 1998,
174 and any amendments to the federal Department of Health and Human Services in accordance
175 with 42 U.S.C. Sec. 1397ff; and
176 (b) make rules in accordance with Title 63, Chapter 46a, Utah Administrative
177 Rulemaking Act regarding:
178 (i) eligibility requirements consistent with Subsection 26-18-3 [(6)](8);
179 (ii) program benefits;
180 (iii) the level of coverage for each program benefit;
181 (iv) cost-sharing requirements for enrollees, which may not:
182 (A) exceed the guidelines set forth in 42 U.S.C. Sec. 1397ee; or
183 (B) impose deductible, copayment, or coinsurance requirements on an enrollee for
184 well-child, well-baby, and immunizations; and
185 (v) the administration of the program.