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H.B. 46 Enrolled

             1     

ELECTRONIC PERSONAL MEDICAL RECORDS

             2     
2012 GENERAL SESSION

             3     
STATE OF UTAH

             4     
Chief Sponsor: Ronda Rudd Menlove

             5     
Senate Sponsor: Curtis S. Bramble

             6     
             7      LONG TITLE
             8      General Description:
             9          This bill facilitates the enrollment of Medicaid beneficiaries, Children's Health
             10      Insurance Program enrollees, and state employees and their dependents into the
             11      electronic exchange of clinical health records.
             12      Highlighted Provisions:
             13          This bill:
             14          .    amends the duties of the state Medicaid plan to enroll Medicaid beneficiaries in the
             15      electronic exchange of clinical health records unless the individual opts out;
             16          .    amends the duties of the Children's Health Insurance Program to enroll the members
             17      of the Children's Health Insurance Program in the electronic exchange of clinical
             18      health records unless the individual opts out;
             19          .    amends the duties of the Public Employees Health Program to enroll state
             20      employees and their dependents in the electronic exchange of clinical health records
             21      unless the individual opts out; and
             22          .    provides notice to individuals regarding the enrollment in the electronic exchange of
             23      clinical health records and the option to opt out of enrollment at any time.
             24      Money Appropriated in this Bill:
             25          None
             26      Other Special Clauses:
             27          None
             28      Utah Code Sections Affected:
             29      AMENDS:


             30          26-18-3, as last amended by Laws of Utah 2011, Chapters 151, 297, and 366
             31          26-40-103, as last amended by Laws of Utah 2008, Chapters 62 and 382
             32          49-20-401, as last amended by Laws of Utah 2008, Chapter 176
             33     
             34      Be it enacted by the Legislature of the state of Utah:
             35          Section 1. Section 26-18-3 is amended to read:
             36           26-18-3. Administration of Medicaid program by department -- Reporting to the
             37      Legislature -- Disciplinary measures and sanctions -- Funds collected -- Eligibility
             38      standards -- Internal audits -- Studies -- Health opportunity accounts.
             39          (1) The department shall be the single state agency responsible for the administration
             40      of the Medicaid program in connection with the United States Department of Health and
             41      Human Services pursuant to Title XIX of the Social Security Act.
             42          (2) (a) The department shall implement the Medicaid program through administrative
             43      rules in conformity with this chapter, Title 63G, Chapter 3, Utah Administrative Rulemaking
             44      Act, the requirements of Title XIX, and applicable federal regulations.
             45          (b) The rules adopted under Subsection (2)(a) shall include, in addition to other rules
             46      necessary to implement the program:
             47          (i) the standards used by the department for determining eligibility for Medicaid
             48      services;
             49          (ii) the services and benefits to be covered by the Medicaid program; [and]
             50          (iii) reimbursement methodologies for providers under the Medicaid program[.]; and
             51          (iv) a requirement that:
             52          (A) a person receiving Medicaid services shall participate in the electronic exchange of
             53      clinical health records established in accordance with Section 26-1-37 unless the individual
             54      opts out of participation;
             55          (B) prior to enrollment in the electronic exchange of clinical health records the enrollee
             56      shall receive notice of enrollment in the electronic exchange of clinical health records and the
             57      right to opt out of participation at any time; and


             58          (C) beginning July 1, 2012, when the program sends enrollment or renewal information
             59      to the enrollee and when the enrollee logs onto the program's website, the enrollee shall receive
             60      notice of the right to opt out of the electronic exchange of clinical health records.
             61          (3) (a) The department shall, in accordance with Subsection (3)(b), report to the Health
             62      and Human Services Appropriations Subcommittee when the department:
             63          (i) implements a change in the Medicaid State Plan;
             64          (ii) initiates a new Medicaid waiver;
             65          (iii) initiates an amendment to an existing Medicaid waiver;
             66          (iv) applies for an extension of an application for a waiver or an existing Medicaid
             67      waiver; or
             68          (v) initiates a rate change that requires public notice under state or federal law.
             69          (b) The report required by Subsection (3)(a) shall:
             70          (i) be submitted to the Health and Human Services Appropriations Subcommittee prior
             71      to the department implementing the proposed change; and
             72          (ii) include:
             73          (A) a description of the department's current practice or policy that the department is
             74      proposing to change;
             75          (B) an explanation of why the department is proposing the change;
             76          (C) the proposed change in services or reimbursement, including a description of the
             77      effect of the change;
             78          (D) the effect of an increase or decrease in services or benefits on individuals and
             79      families;
             80          (E) the degree to which any proposed cut may result in cost-shifting to more expensive
             81      services in health or human service programs; and
             82          (F) the fiscal impact of the proposed change, including:
             83          (I) the effect of the proposed change on current or future appropriations from the
             84      Legislature to the department;
             85          (II) the effect the proposed change may have on federal matching dollars received by


             86      the state Medicaid program;
             87          (III) any cost shifting or cost savings within the department's budget that may result
             88      from the proposed change; and
             89          (IV) identification of the funds that will be used for the proposed change, including any
             90      transfer of funds within the department's budget.
             91          (4) (a) The Department of Human Services shall report to the Legislative Health and
             92      Human Services Appropriations Subcommittee no later than December 31, 2010 in accordance
             93      with Subsection (4)(b).
             94          (b) The report required by Subsection (4)(a) shall include:
             95          (i) changes made by the division or the department beginning July 1, 2010, that effect
             96      the Medicaid program, a waiver under the Medicaid program, or an interpretation of Medicaid
             97      services or funding, that relate to care for children and youth in the custody of the Division of
             98      Child and Family Services or the Division of Juvenile Justice Services;
             99          (ii) the history and impact of the changes under Subsection (4)(b)(i);
             100          (iii) the Department of Human Service's plans for addressing the impact of the changes
             101      under Subsection (4)(b)(i); and
             102          (iv) ways to consolidate administrative functions within the Department of Human
             103      Services, the Department of Health, the Division of Child and Family Services, and the
             104      Division of Juvenile Justice Services to more efficiently meet the needs of children and youth
             105      with mental health and substance disorder treatment needs.
             106          (5) Any rules adopted by the department under Subsection (2) are subject to review and
             107      reauthorization by the Legislature in accordance with Section 63G-3-502 .
             108          (6) The department may, in its discretion, contract with the Department of Human
             109      Services or other qualified agencies for services in connection with the administration of the
             110      Medicaid program, including:
             111          (a) the determination of the eligibility of individuals for the program;
             112          (b) recovery of overpayments; and
             113          (c) consistent with Section 26-20-13 , and to the extent permitted by law and quality


             114      control services, enforcement of fraud and abuse laws.
             115          (7) The department shall provide, by rule, disciplinary measures and sanctions for
             116      Medicaid providers who fail to comply with the rules and procedures of the program, provided
             117      that sanctions imposed administratively may not extend beyond:
             118          (a) termination from the program;
             119          (b) recovery of claim reimbursements incorrectly paid; and
             120          (c) those specified in Section 1919 of Title XIX of the federal Social Security Act.
             121          (8) Funds collected as a result of a sanction imposed under Section 1919 of Title XIX
             122      of the federal Social Security Act shall be deposited in the General Fund as dedicated credits to
             123      be used by the division in accordance with the requirements of Section 1919 of Title XIX of
             124      the federal Social Security Act.
             125          (9) (a) In determining whether an applicant or recipient is eligible for a service or
             126      benefit under this part or Chapter 40, Utah Children's Health Insurance Act, the department
             127      shall, if Subsection (9)(b) is satisfied, exclude from consideration one passenger vehicle
             128      designated by the applicant or recipient.
             129          (b) Before Subsection (9)(a) may be applied:
             130          (i) the federal government shall:
             131          (A) determine that Subsection (9)(a) may be implemented within the state's existing
             132      public assistance-related waivers as of January 1, 1999;
             133          (B) extend a waiver to the state permitting the implementation of Subsection (9)(a); or
             134          (C) determine that the state's waivers that permit dual eligibility determinations for
             135      cash assistance and Medicaid are no longer valid; and
             136          (ii) the department shall determine that Subsection (9)(a) can be implemented within
             137      existing funding.
             138          (10) (a) For purposes of this Subsection (10):
             139          (i) "aged, blind, or has a disability" means an aged, blind, or disabled individual, as
             140      defined in 42 U.S.C. 1382c(a)(1); and
             141          (ii) "spend down" means an amount of income in excess of the allowable income


             142      standard that shall be paid in cash to the department or incurred through the medical services
             143      not paid by Medicaid.
             144          (b) In determining whether an applicant or recipient who is aged, blind, or has a
             145      disability is eligible for a service or benefit under this chapter, the department shall use 100%
             146      of the federal poverty level as:
             147          (i) the allowable income standard for eligibility for services or benefits; and
             148          (ii) the allowable income standard for eligibility as a result of spend down.
             149          (11) The department shall conduct internal audits of the Medicaid program.
             150          (12) In order to determine the feasibility of contracting for direct Medicaid providers
             151      for primary care services, the department shall:
             152          (a) issue a request for information for direct contracting for primary services that shall
             153      provide that a provider shall exclusively serve all Medicaid clients:
             154          (i) in a geographic area;
             155          (ii) for a defined range of primary care services; and
             156          (iii) for a predetermined total contracted amount; and
             157          (b) by February 1, 2011, report to the Health and Human Services Appropriations
             158      Subcommittee on the response to the request for information under Subsection (12)(a).
             159          (13) (a) By December 31, 2010, the department shall:
             160          (i) determine the feasibility of implementing a three year patient-centered medical
             161      home demonstration project in an area of the state using existing budget funds; and
             162          (ii) report the department's findings and recommendations under Subsection (13)(a)(i)
             163      to the Health and Human Services Appropriations Subcommittee.
             164          (b) If the department determines that the medical home demonstration project
             165      described in Subsection (13)(a) is feasible, and the Health and Human Services Appropriations
             166      Subcommittee recommends that the demonstration project be implemented, the department
             167      shall:
             168          (i) implement the demonstration project; and
             169          (ii) by December 1, 2012, make recommendations to the Health and Human Services


             170      Appropriations Subcommittee regarding the:
             171          (A) continuation of the demonstration project;
             172          (B) expansion of the demonstration project to other areas of the state; and
             173          (C) cost savings incurred by the implementation of the demonstration project.
             174          (14) (a) The department may apply for and, if approved, implement a demonstration
             175      program for health opportunity accounts, as provided for in 42 U.S.C. Sec. 1396u-8.
             176          (b) A health opportunity account established under Subsection (14)(a) shall be an
             177      alternative to the existing benefits received by an individual eligible to receive Medicaid under
             178      this chapter.
             179          (c) Subsection (14)(a) is not intended to expand the coverage of the Medicaid program.
             180          Section 2. Section 26-40-103 is amended to read:
             181           26-40-103. Creation and administration of the Utah Children's Health Insurance
             182      Program.
             183          (1) There is created the Utah Children's Health Insurance Program to be administered
             184      by the department in accordance with the provisions of:
             185          (a) this chapter; and
             186          (b) the State Children's Health Insurance Program, 42 U.S.C. Sec. 1397aa et seq.
             187          (2) The department shall:
             188          (a) prepare and submit the state's children's health insurance plan before May 1, 1998,
             189      and any amendments to the federal Department of Health and Human Services in accordance
             190      with 42 U.S.C. Sec. 1397ff; and
             191          (b) make rules in accordance with Title 63G, Chapter 3, Utah Administrative
             192      Rulemaking Act regarding:
             193          (i) eligibility requirements consistent with Subsection 26-18-3 [(8)](9);
             194          (ii) program benefits;
             195          (iii) the level of coverage for each program benefit;
             196          (iv) cost-sharing requirements for enrollees, which may not:
             197          (A) exceed the guidelines set forth in 42 U.S.C. Sec. 1397ee; or


             198          (B) impose deductible, copayment, or coinsurance requirements on an enrollee for
             199      well-child, well-baby, and immunizations; [and]
             200          (v) the administration of the program[.]; and
             201          (vi) a requirement that:
             202          (A) enrollees in the program shall participate in the electronic exchange of clinical
             203      health records established in accordance with Section 26-1-37 unless the enrollee opts out of
             204      participation;
             205          (B) prior to enrollment in the electronic exchange of clinical health records the enrollee
             206      shall receive notice of the enrollment in the electronic exchange of clinical health records and
             207      the right to opt out of participation at any time; and
             208          (C) beginning July 1, 2012, when the program sends enrollment or renewal information
             209      to the enrollee and when the enrollee logs onto the program's website, the enrollee shall receive
             210      notice of the right to opt out of the electronic exchange of clinical health records.
             211          Section 3. Section 49-20-401 is amended to read:
             212           49-20-401. Program -- Powers and duties.
             213          (1) The program shall:
             214          (a) act as a self-insurer of employee benefit plans and administer those plans;
             215          (b) enter into contracts with private insurers or carriers to underwrite employee benefit
             216      plans as considered appropriate by the program;
             217          (c) indemnify employee benefit plans or purchase commercial reinsurance as
             218      considered appropriate by the program;
             219          (d) provide descriptions of all employee benefit plans under this chapter in cooperation
             220      with covered employers;
             221          (e) process claims for all employee benefit plans under this chapter or enter into
             222      contracts, after competitive bids are taken, with other benefit administrators to provide for the
             223      administration of the claims process;
             224          (f) obtain an annual actuarial review of all health and dental benefit plans and a
             225      periodic review of all other employee benefit plans;


             226          (g) consult with the covered employers to evaluate employee benefit plans and develop
             227      recommendations for benefit changes;
             228          (h) annually submit a budget and audited financial statements to the governor and
             229      Legislature which includes total projected benefit costs and administrative costs;
             230          (i) maintain reserves sufficient to liquidate the unrevealed claims liability and other
             231      liabilities of the employee benefit plans as certified by the program's consulting actuary;
             232          (j) submit, in advance, its recommended benefit adjustments for state employees to:
             233          (i) the Legislature; and
             234          (ii) the executive director of the state Department of Human Resource Management;
             235          (k) determine benefits and rates, upon approval of the board, for multiemployer risk
             236      pools, retiree coverage, and conversion coverage;
             237          (l) determine benefits and rates based on the total estimated costs and the employee
             238      premium share established by the Legislature, upon approval of the board, for state employees;
             239          (m) administer benefits and rates, upon ratification of the board, for single employer
             240      risk pools;
             241          (n) request proposals for provider networks or health and dental benefit plans
             242      administered by third party carriers at least once every three years for the purposes of:
             243          (i) stimulating competition for the benefit of covered individuals;
             244          (ii) establishing better geographical distribution of medical care services; and
             245          (iii) providing coverage for both active and retired covered individuals;
             246          (o) offer proposals which meet the criteria specified in a request for proposals and
             247      accepted by the program to active and retired state covered individuals and which may be
             248      offered to active and retired covered individuals of other covered employers at the option of the
             249      covered employer;
             250          (p) perform the same functions established in Subsections (1)(a), (b), (e), and (h) for
             251      the Department of Health if the program provides program benefits to children enrolled in the
             252      Utah Children's Health Insurance Program created in Title 26, Chapter 40, Utah Children's
             253      Health Insurance Act;


             254          (q) establish rules and procedures governing the admission of political subdivisions or
             255      educational institutions and their employees to the program;
             256          (r) contract directly with medical providers to provide services for covered individuals;
             257      [and]
             258          (s) take additional actions necessary or appropriate to carry out the purposes of this
             259      chapter[.]; and
             260          (t) (i) require state employees and their dependents to participate in the electronic
             261      exchange of clinical health records in accordance with Section 26-1-37 unless the enrollee opts
             262      out of participation; and
             263          (ii) prior to enrolling the state employee, each time the state employee logs onto the
             264      program's website, and each time the enrollee receives written enrollment information from the
             265      program, provide notice to the enrollee of the enrollee's participation in the electronic exchange
             266      of clinical health records and the option to opt out of participation at any time.
             267          (2) (a) Funds budgeted and expended shall accrue from rates paid by the covered
             268      employers and covered individuals.
             269          (b) Administrative costs shall be approved by the board and reported to the governor
             270      and the Legislature.
             271          (3) The Department of Human Resource Management shall include the benefit
             272      adjustments described in Subsection (1)(j) in the total compensation plan recommended to the
             273      governor required under Subsection 67-19-12 (6)(a).


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