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H.B. 52






Chief Sponsor: Merlynn T. Newbold

Senate Sponsor: Peter C. Knudson

             8      LONG TITLE
             9      Committee Note:
             10          The Health System Reform Task Force recommended this bill.
             11      General Description:
             12          This bill amends provisions related to the use of uniform electronic standards for health
             13      insurance claims processing, insurance eligibility, and coordination of benefits.
             14      Highlighted Provisions:
             15          This bill:
             16          .    amends provisions related to uniform electronic standards for health insurance
             17      claims processing, electronic insurance eligibility information, and electronic
             18      information regarding the coordination of benefits;
             19          .    establishes a voluntary registry of software vendors who comply with electronic
             20      standards; and
             21          .    makes clarifying and technical amendments.
             22      Monies Appropriated in this Bill:
             23          None
             24      Other Special Clauses:
             25          None
             26      Utah Code Sections Affected:
             27      AMENDS:

             28          31A-22-614.5, as last amended by Laws of Utah 2008, Chapters 379 and 382
             30      Be it enacted by the Legislature of the state of Utah:
             31          Section 1. Section 31A-22-614.5 is amended to read:
             32           31A-22-614.5. Uniform claims processing -- Electronic exchange of health
             33      information.
             34          (1) (a) [Beginning July 1, 1993] Except as provided in Subsection (1)(c), all insurers
             35      offering health insurance shall use a uniform claim form and uniform billing and claim codes.
             36          (b) Beginning January 1, 2011, all health benefit plans, and dental and vision plans,
             37      shall provide for the electronic exchange of uniform:
             38          (i) eligibility and coverage information; and
             39          (ii) coordination of benefits information.
             40          (c) For purposes of Subsection (1)(a), "health insurance" does not include a policy or
             41      certificate that provides benefits solely for:
             42          (i) income replacement; or
             43          (ii) long-term care.
             44          (2) (a) The uniform [claim forms and billing codes] electronic standards and
             45      information required in Subsection (1) shall be adopted and approved by the commissioner in
             46      accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act. [The]
             47          (b) When adopting rules under this section the commissioner:
             48          (i) shall:
             49          (A) consult with [the director of the Division of Health Care Financing, the National
             50      Uniform Claim Form Task Force, and the National Uniform Billing Committee when adopting
             51      the uniform claims and billing codes.] national and state organizations involved with the
             52      standardized exchange of health data, and the electronic exchange of health data, to develop the
             53      standards for the use and electronic exchange of uniform:
             54          (I) claim forms;
             55          (II) billing and claim codes;
             56          (III) insurance eligibility and coverage information; and
             57          (IV) coordination of benefits information; and
             58          (B) meet federal mandatory minimum standards following the adoption of national

             59      requirements for transaction and data elements in the federal Health Insurance Portability and
             60      Accountability Act of 1996, Pub. L. 104-191, 110 Stat. 1936;
             61          (ii) may not require an insurer or administrator to use a specific software product or
             62      vendor; and
             63          (iii) may require an insurer who participates in the all payer database created under
             64      Section 26-33a-106.1 to allow data regarding demographic and insurance coverage information
             65      to be electronically shared with the state's designated secure health information master person
             66      index to be used:
             67          (A) in compliance with data security standards established by:
             68          (I) the federal Health Insurance Portability and Accountability Act of 1996, Pub. L.
             69      104-191, 110 Stat. 1936; and
             70          (II) the electronic commerce agreements established in a business associate agreement;
             71      and
             72          (B) for the purpose of coordination of health benefit plans.
             73          [(3) (a) (i) Beginning July 1, 1995, all insurers shall offer compatible systems of
             74      electronic billing approved by the commissioner in accordance with Title 63G, Chapter 3, Utah
             75      Administrative Rulemaking Act.]
             76          [(ii) The systems approved by the commissioner may include monitoring and
             77      disseminating information concerning eligibility and coverage of individuals.]
             78          [(iii)] (3) (a) The commissioner shall coordinate the administrative rules adopted under
             79      the provisions of this section with the administrative rules adopted by the Department of Health
             80      for the implementation of the standards for the electronic exchange of clinical health
             81      information under Section 26-1-37 . The department shall establish procedures for developing
             82      the rules adopted under this section, which ensure that the Department of Health is given the
             83      opportunity to comment on proposed rules.
             84          (b) (i) The commissioner may provide information to health care providers regarding
             85      resources available to a health care provider to verify whether a health care provider's practice
             86      management software system meets the uniform electronic standards for data exchange
             87      required by this section.
             88          (ii) The commissioner may provide the information described in Subsection (3)(b)(i)
             89      by partnering with:

             90          (A) a not-for-profit, broad based coalition of state health care insurers and health care
             91      providers who are involved in the electronic exchange of the data required by this section; or
             92          (B) some other person that the commissioner determines is appropriate to provide the
             93      information described in Subsection (3)(b)(i).
             94          [(b)] (c) The commissioner shall regulate any fees charged by insurers to the providers
             95      for:
             96          (i) uniform claim forms;
             97          (ii) electronic billing; or
             98          (iii) the electronic exchange of clinical health information permitted by Section
             99      26-1-37 .

Legislative Review Note
    as of 11-19-09 9:52 AM

Office of Legislative Research and General Counsel

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