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Third Substitute H.B. 106

Senator Curtis S. Bramble proposes the following substitute bill:


             1     
MEDICAID INSPECTOR GENERAL AMENDMENTS

             2     
2013 GENERAL SESSION

             3     
STATE OF UTAH

             4     
Chief Sponsor: Ryan D. Wilcox

             5     
Senate Sponsor: Stuart C. Reid

             6      Cosponsor:James A. Dunnigan              7     
             8      LONG TITLE
             9      General Description:
             10          This bill changes the Office of Inspector General of Medicaid Services from within the
             11      Governor's Office of Planning and Budget to an independent entity within the
             12      Department of Administrative Services.
             13      Highlighted Provisions:
             14          This bill:
             15          .    moves the Office of Inspector General of Medicaid Services into the Department of
             16      Administrative Services as an independent entity within the department;
             17          .    provides for the appointment of the inspector general of Medicaid services by the
             18      governor with the advice and consent of the Senate;
             19          .    permits the removal of the inspector general by the governor for cause;
             20          .    preserves the term of the existing inspector general until December 31, 2014;
             21          .    establishes a four-year term of office for the inspector general of Medicaid services;
             22          .    requires the inspector general of Medicaid services to make recommendations to the
             23      Legislature and the governor;
             24          .    amends the duties and powers of the inspector general of Medicaid services;


             25          .    amends the period of time in which the inspector general can review claims;
             26          .    amends the manner in which the inspector general accesses records;
             27          .    requires the Office of Inspector General of Medicaid Services to adopt
             28      administrative rules to develop audit and investigation procedures;
             29          .    requires the Office of Inspector General of Medicaid Services to educate health care
             30      providers about best practices for Medicaid compliance;
             31          .    makes technical and conforming amendments; and
             32          .    includes uncodified language to transition the Office of Inspector General of
             33      Medicaid Services out of the Governor's Office of Planning and Budget.
             34      Money Appropriated in this Bill:
             35          This bill appropriates for fiscal year 2013-14:
             36          .    to the Governor's Office of Planning and Budget - Inspector General of Medicaid
             37      Services:
             38              .    From the General Fund, (1,020,200)
             39              .    From Transfers, (1,962,600)
             40              .    From Pass-Through, 733,400
             41              .    From Beginning Nonlapsing Balances, (865,300)
             42              .    Schedule of Programs, Inspector General of Medicaid Services ($3,114,700)
             43          .    to the Department of Administrative Services - Office of Inspector General of
             44      Medicaid Services:
             45              .    From General Fund, 1,020,200
             46              .    From Transfers, 1,962,600
             47              .    From Pass-through (733,400)
             48              .    From Beginning Nonlapsing Balances, 865,300
             49              .    Schedule of Programs Inspector General of Medicaid Services $3,114,700.
             50      Other Special Clauses:
             51          This bill provides an immediate effective date.
             52      Utah Code Sections Affected:
             53      AMENDS:
             54          58-37f-301, as last amended by Laws of Utah 2012, Chapters 174 and 239
             55          63G-2-305, as last amended by Laws of Utah 2012, Chapters 331 and 377


             56          63J-4-202, as last amended by Laws of Utah 2011, Chapter 151
             57      RENUMBERS AND AMENDS:
             58          63A-13-101, (Renumbered from 63J-4a-101, as enacted by Laws of Utah 2011,
             59      Chapters 151 and 151)
             60          63A-13-102, (Renumbered from 63J-4a-102, as enacted by Laws of Utah 2011, Chapter
             61      151)
             62          63A-13-201, (Renumbered from 63J-4a-201, as enacted by Laws of Utah 2011, Chapter
             63      151)
             64          63A-13-202, (Renumbered from 63J-4a-202, as enacted by Laws of Utah 2011, Chapter
             65      151)
             66          63A-13-203, (Renumbered from 63J-4a-203, as enacted by Laws of Utah 2011, Chapter
             67      151)
             68          63A-13-204, (Renumbered from 63J-4a-204, as enacted by Laws of Utah 2011, Chapter
             69      151)
             70          63A-13-205, (Renumbered from 63J-4a-205, as enacted by Laws of Utah 2011, Chapter
             71      151)
             72          63A-13-301, (Renumbered from 63J-4a-301, as enacted by Laws of Utah 2011, Chapter
             73      151)
             74          63A-13-302, (Renumbered from 63J-4a-302, as enacted by Laws of Utah 2011, Chapter
             75      151)
             76          63A-13-303, (Renumbered from 63J-4a-303, as enacted by Laws of Utah 2011, Chapter
             77      151)
             78          63A-13-304, (Renumbered from 63J-4a-304, as enacted by Laws of Utah 2011, Chapter
             79      151)
             80          63A-13-401, (Renumbered from 63J-4a-401, as enacted by Laws of Utah 2011, Chapter
             81      151)
             82          63A-13-501, (Renumbered from 63J-4a-501, as enacted by Laws of Utah 2011, Chapter
             83      151)
             84          63A-13-502, (Renumbered from 63J-4a-502, as enacted by Laws of Utah 2011, Chapter
             85      151)
             86          63A-13-601, (Renumbered from 63J-4a-601, as enacted by Laws of Utah 2011, Chapter


             87      151)
             88          63A-13-602, (Renumbered from 63J-4a-602, as enacted by Laws of Utah 2011, Chapter
             89      151)
             90      ENACTS:
             91          63A-13-305, Utah Code Annotated 1953
             92      Uncodified Material Affected:
             93      ENACTS UNCODIFIED MATERIAL
             94     
             95      Be it enacted by the Legislature of the state of Utah:
             96          Section 1. Section 58-37f-301 is amended to read:
             97           58-37f-301. Access to database.
             98          (1) The division shall make rules, in accordance with Title 63G, Chapter 3, Utah
             99      Administrative Rulemaking Act, to:
             100          (a) effectively enforce the limitations on access to the database as described in this
             101      part; and
             102          (b) establish standards and procedures to ensure accurate identification of individuals
             103      requesting information or receiving information without request from the database.
             104          (2) The division shall make information in the database and information obtained from
             105      other state or federal prescription monitoring programs by means of the database available only
             106      to the following individuals, in accordance with the requirements of this chapter and division
             107      rules:
             108          (a) personnel of the division specifically assigned to conduct investigations related to
             109      controlled substance laws under the jurisdiction of the division;
             110          (b) authorized division personnel engaged in analysis of controlled substance
             111      prescription information as a part of the assigned duties and responsibilities of their
             112      employment;
             113          (c) in accordance with a written agreement entered into with the department,
             114      employees of the Department of Health:
             115          (i) whom the director of the Department of Health assigns to conduct scientific studies
             116      regarding the use or abuse of controlled substances, provided that the identity of the individuals
             117      and pharmacies in the database are confidential and are not disclosed in any manner to any


             118      individual who is not directly involved in the scientific studies; or
             119          (ii) when the information is requested by the Department of Health in relation to a
             120      person or provider whom the Department of Health suspects may be improperly obtaining or
             121      providing a controlled substance;
             122          (d) a licensed practitioner having authority to prescribe controlled substances, to the
             123      extent the information:
             124          (i) (A) relates specifically to a current or prospective patient of the practitioner; and
             125          (B) is sought by the practitioner for the purpose of:
             126          (I) prescribing or considering prescribing any controlled substance to the current or
             127      prospective patient;
             128          (II) diagnosing the current or prospective patient;
             129          (III) providing medical treatment or medical advice to the current or prospective
             130      patient; or
             131          (IV) determining whether the current or prospective patient:
             132          (Aa) is attempting to fraudulently obtain a controlled substance from the practitioner;
             133      or
             134          (Bb) has fraudulently obtained, or attempted to fraudulently obtain, a controlled
             135      substance from the practitioner;
             136          (ii) (A) relates specifically to a former patient of the practitioner; and
             137          (B) is sought by the practitioner for the purpose of determining whether the former
             138      patient has fraudulently obtained, or has attempted to fraudulently obtain, a controlled
             139      substance from the practitioner;
             140          (iii) relates specifically to an individual who has access to the practitioner's Drug
             141      Enforcement Administration identification number, and the practitioner suspects that the
             142      individual may have used the practitioner's Drug Enforcement Administration identification
             143      number to fraudulently acquire or prescribe a controlled substance;
             144          (iv) relates to the practitioner's own prescribing practices, except when specifically
             145      prohibited by the division by administrative rule;
             146          (v) relates to the use of the controlled substance database by an employee of the
             147      practitioner, described in Subsection (2)(e); or
             148          (vi) relates to any use of the practitioner's Drug Enforcement Administration


             149      identification number to obtain, attempt to obtain, prescribe, or attempt to prescribe, a
             150      controlled substance;
             151          (e) in accordance with Subsection (3)(a), an employee of a practitioner described in
             152      Subsection (2)(d), for a purpose described in Subsection (2)(d)(i) or (ii), if:
             153          (i) the employee is designated by the practitioner as an individual authorized to access
             154      the information on behalf of the practitioner;
             155          (ii) the practitioner provides written notice to the division of the identity of the
             156      employee; and
             157          (iii) the division:
             158          (A) grants the employee access to the database; and
             159          (B) provides the employee with a password that is unique to that employee to access
             160      the database in order to permit the division to comply with the requirements of Subsection
             161      58-37f-203 (3)(b) with respect to the employee;
             162          (f) an employee of the same business that employs a licensed practitioner under
             163      Subsection (2)(d) if:
             164          (i) the employee is designated by the practitioner as an individual authorized to access
             165      the information on behalf of the practitioner;
             166          (ii) the practitioner and the employing business provide written notice to the division of
             167      the identity of the designated employee; and
             168          (iii) the division:
             169          (A) grants the employee access to the database; and
             170          (B) provides the employee with a password that is unique to that employee to access
             171      the database in order to permit the division to comply with the requirements of Subsection
             172      58-37f-203 (3)(b) with respect to the employee;
             173          (g) a licensed pharmacist having authority to dispense a controlled substance to the
             174      extent the information is sought for the purpose of:
             175          (i) dispensing or considering dispensing any controlled substance; or
             176          (ii) determining whether a person:
             177          (A) is attempting to fraudulently obtain a controlled substance from the pharmacist; or
             178          (B) has fraudulently obtained, or attempted to fraudulently obtain, a controlled
             179      substance from the pharmacist;


             180          (h) federal, state, and local law enforcement authorities, and state and local
             181      prosecutors, engaged as a specified duty of their employment in enforcing laws:
             182          (i) regulating controlled substances;
             183          (ii) investigating insurance fraud, Medicaid fraud, or Medicare fraud; or
             184          (iii) providing information about a criminal defendant to defense counsel, upon request
             185      during the discovery process, for the purpose of establishing a defense in a criminal case;
             186          (i) employees of the Office of Internal Audit and Program Integrity within the
             187      Department of Health who are engaged in their specified duty of ensuring Medicaid program
             188      integrity under Section 26-18-2.3 ;
             189          (j) a mental health therapist, if:
             190          (i) the information relates to a patient who is:
             191          (A) enrolled in a licensed substance abuse treatment program; and
             192          (B) receiving treatment from, or under the direction of, the mental health therapist as
             193      part of the patient's participation in the licensed substance abuse treatment program described
             194      in Subsection (2)(j)(i)(A);
             195          (ii) the information is sought for the purpose of determining whether the patient is
             196      using a controlled substance while the patient is enrolled in the licensed substance abuse
             197      treatment program described in Subsection (2)(j)(i)(A); and
             198          (iii) the licensed substance abuse treatment program described in Subsection
             199      (2)(j)(i)(A) is associated with a practitioner who:
             200          (A) is a physician, a physician assistant, an advance practice registered nurse, or a
             201      pharmacist; and
             202          (B) is available to consult with the mental health therapist regarding the information
             203      obtained by the mental health therapist, under this Subsection (2)(j), from the database;
             204          (k) an individual who is the recipient of a controlled substance prescription entered into
             205      the database, upon providing evidence satisfactory to the division that the individual requesting
             206      the information is in fact the individual about whom the data entry was made;
             207          (l) the inspector general, or a designee of the inspector general, of the Office of
             208      Inspector General of Medicaid Services, for the purpose of fulfilling the duties described in
             209      Title [63J, Chapter 4a] 63A, Chapter 13, Part 2, Office Duties and Powers; and
             210          (m) the following licensed physicians for the purpose of reviewing and offering an


             211      opinion on an individual's request for workers' compensation benefits under Title 34A, Chapter
             212      2, Workers' Compensation Act, or Title 34A, Chapter 3, Utah Occupational Disease Act:
             213          (i) a member of the medical panel described in Section 34A-2-601 ; or
             214          (ii) a physician offering a second opinion regarding treatment.
             215          (3) (a) A practitioner described in Subsection (2)(d) may designate up to three
             216      employees to access information from the database under Subsection (2)(e), (2)(f), or (4)(c).
             217          (b) The division shall make rules, in accordance with Title 63G, Chapter 3, Utah
             218      Administrative Rulemaking Act, to:
             219          (i) establish background check procedures to determine whether an employee
             220      designated under Subsection (2)(e), (2)(f), or (4)(c) should be granted access to the database;
             221      and
             222          (ii) establish the information to be provided by an emergency room employee under
             223      Subsection (4).
             224          (c) The division shall grant an employee designated under Subsection (2)(e), (2)(f), or
             225      (4)(c) access to the database, unless the division determines, based on a background check, that
             226      the employee poses a security risk to the information contained in the database.
             227          (4) (a) An individual who is employed in the emergency room of a hospital may
             228      exercise access to the database under this Subsection (4) on behalf of a licensed practitioner if
             229      the individual is designated under Subsection (4)(c) and the licensed practitioner:
             230          (i) is employed in the emergency room;
             231          (ii) is treating an emergency room patient for an emergency medical condition; and
             232          (iii) requests that an individual employed in the emergency room and designated under
             233      Subsection (4)(c) obtain information regarding the patient from the database as needed in the
             234      course of treatment.
             235          (b) The emergency room employee obtaining information from the database shall,
             236      when gaining access to the database, provide to the database the name and any additional
             237      identifiers regarding the requesting practitioner as required by division administrative rule
             238      established under Subsection (3)(b).
             239          (c) An individual employed in the emergency room under this Subsection (4) may
             240      obtain information from the database as provided in Subsection (4)(a) if:
             241          (i) the employee is designated by the practitioner as an individual authorized to access


             242      the information on behalf of the practitioner;
             243          (ii) the practitioner and the hospital operating the emergency room provide written
             244      notice to the division of the identity of the designated employee; and
             245          (iii) the division:
             246          (A) grants the employee access to the database; and
             247          (B) provides the employee with a password that is unique to that employee to access
             248      the database in order to permit the division to comply with the requirements of Subsection
             249      58-37f-203 (3)(b) with respect to the employee.
             250          (d) The division may impose a fee, in accordance with Section 63J-1-504 , on a
             251      practitioner who designates an employee under Subsection (2)(e), (2)(f), or (4)(c) to pay for the
             252      costs incurred by the division to conduct the background check and make the determination
             253      described in Subsection (3)(b).
             254          (5) (a) An individual who is granted access to the database based on the fact that the
             255      individual is a licensed practitioner or a mental health therapist shall be denied access to the
             256      database when the individual is no longer licensed.
             257          (b) An individual who is granted access to the database based on the fact that the
             258      individual is a designated employee of a licensed practitioner shall be denied access to the
             259      database when the practitioner is no longer licensed.
             260          Section 2. Section 63A-13-101 , which is renumbered from Section 63J-4a-101 is
             261      renumbered and amended to read:
             262     
CHAPTER 13. OFFICE OF INSPECTOR GENERAL OF MEDICAID SERVICES

             263     
Part 1. General Provisions

             264           [63J-4a-101].     63A-13-101. Title.
             265          This chapter is known as "Office of Inspector General of Medicaid Services."
             266          Section 3. Section 63A-13-102 , which is renumbered from Section 63J-4a-102 is
             267      renumbered and amended to read:
             268           [63J-4a-102].     63A-13-102. Definitions.
             269          As used in this chapter:
             270          (1) "Abuse" means:
             271          (a) an action or practice that:
             272          (i) is inconsistent with sound fiscal, business, or medical practices; and


             273          (ii) results, or may result, in unnecessary Medicaid related costs; or
             274          (b) reckless or negligent upcoding.
             275          (2) "Claimant" means a person that:
             276          (a) provides a service; and
             277          (b) submits a claim for Medicaid reimbursement for the service.
             278          (3) "Department" means the Department of Health, created in Section 26-1-4 .
             279          (4) "Division" means the Division of Health Care Financing, created in Section
             280      26-18-2.1 .
             281          (5) "Fraud" means intentional or knowing:
             282          (a) deception, misrepresentation, or upcoding in relation to Medicaid funds, costs, a
             283      claim, reimbursement, or services; or
             284          (b) a violation of a provision of Subsections 26-20-3 through 26-20-7 .
             285          (6) "Fraud unit" means the Medicaid Fraud Control Unit of the attorney general's
             286      office.
             287          (7) "Health care professional" means a person licensed under:
             288          (a) Title 58, Chapter 5a, Podiatric Physician Licensing Act;
             289          (b) Title 58, Chapter 16a, Utah Optometry Practice Act;
             290          (c) Title 58, Chapter 17b, Pharmacy Practice Act;
             291          (d) Title 58, Chapter 24b, Physical Therapy Practice Act;
             292          (e) Title 58, Chapter 31b, Nurse Practice Act;
             293          (f) Title 58, Chapter 40, Recreational Therapy Practice Act;
             294          (g) Title 58, Chapter 41, Speech-language Pathology and Audiology Licensing Act;
             295          (h) Title 58, Chapter 42a, Occupational Therapy Practice Act;
             296          (i) Title 58, Chapter 44a, Nurse Midwife Practice Act;
             297          (j) Title 58, Chapter 49, Dietitian Certification Act;
             298          (k) Title 58, Chapter 60, Mental Health Professional Practice Act;
             299          (l) Title 58, Chapter 67, Utah Medical Practice Act;
             300          (m) Title 58, Chapter 68, Utah Osteopathic Medical Practice Act;
             301          (n) Title 58, Chapter 69, Dentist and Dental Hygienist Practice Act;
             302          (o) Title 58, Chapter 70a, Physician Assistant Act; and
             303          (p) Title 58, Chapter 73, Chiropractic Physician Practice Act.


             304          (8) "Inspector general" means the inspector general of the office, appointed under
             305      Section [ 63J-4a-201 ] 63A-13-201 .
             306          (9) "Office" means the Office of Inspector General of Medicaid Services, created in
             307      Section [ 63J-4a-201 ] 63A-13-201 .
             308          (10) "Provider" means a person that provides:
             309          (a) medical assistance, including supplies or services, in exchange, directly or
             310      indirectly, for Medicaid funds; or
             311          (b) billing or recordkeeping services relating to Medicaid funds.
             312          (11) "Upcoding" means assigning an inaccurate billing code for a service that is
             313      payable or reimbursable by Medicaid funds, if the correct billing code for the service, taking
             314      into account reasonable opinions derived from official published coding definitions, would
             315      result in a lower Medicaid payment or reimbursement.
             316          (12) "Waste" means overutilization of resources or inappropriate payment.
             317          Section 4. Section 63A-13-201 , which is renumbered from Section 63J-4a-201 is
             318      renumbered and amended to read:
             319     
Part 2. Office and Powers

             320           [63J-4a-201].     63A-13-201. Creation of office -- Inspector general --
             321      Appointment -- Term.
             322          (1) There is created[, within the Governor's Office of Planning and Budget, the] an
             323      independent entity within the Department of Administrative Services known as the "Office of
             324      Inspector General of Medicaid Services."
             325          (2) The governor shall:
             326          (a) appoint the inspector general[,] of Medicaid services in accordance with Subsection
             327      (5)(b), and with the advice and consent of the Senate[.]; and
             328          (b) establish the salary for the inspector general of Medicaid services based upon a
             329      recommendation from the Department of Human Resource Management which shall be based
             330      on a market salary survey conducted by the Department of Human Resource Management.
             331          (3) A person appointed as the inspector general shall:
             332          (a) be a certified public accountant or a certified internal auditor; and
             333          (b) have the following qualifications:
             334          (i) a general knowledge of the type of methodology and controls necessary to audit,


             335      investigate, and identify fraud, waste, and abuse;
             336          (ii) strong management skills;
             337          (iii) extensive knowledge of, and at least seven years experience with, performance
             338      audit methodology;
             339          (iv) the ability to oversee and execute an audit; and
             340          (v) strong interpersonal skills.
             341          (4) The inspector general of Medicaid services:
             342          (a) shall, except as provided in Subsection (5), serve a term of [two] four years; and
             343          (b) may be removed by the governor, for cause.
             344          (5) (a) If the inspector general is removed for cause, a new inspector general shall be
             345      appointed, with the advice and consent of the Senate, to serve [a two-year term.] the remainder
             346      of the term of the inspector general of Medicaid services who was removed for cause.
             347          (b) The term of office for the inspector general of Medicaid services in office on
             348      January 1, 2013, shall end on December 31, 2014. The governor may appoint an inspector
             349      general for a four-year term on January 1, 2015.
             350          (6) The office of the inspector general for Medicaid services:
             351          (a) is not under the supervision of, and does not take direction from, the executive
             352      director, except for administrative purposes;
             353          (b) shall use the legal services of the state attorney general's office;
             354          (c) shall submit a budget for the office directly to the governor;
             355          (d) except as prohibited by federal law, is subject to:
             356          (i) Title 51, Chapter 5, Funds Consolidation Act;
             357          (ii) Title 51, Chapter 7, State Money Management Act;
             358          (iii) Title 63A, Utah Administrative Services Code;
             359          (iv) Title 63G, Chapter 3, Utah Administrative Rulemaking Act;
             360          (v) Title 63G, Chapter 4, Administrative Procedures Act;
             361          (vi) Title 63G, Chapter 6a, Utah Procurement Code;
             362          (vii) Title 63J, Chapter 1, Budgetary Procedures Act;
             363          (viii) Title 63J, Chapter 2, Revenue Procedures and Control Act;
             364          (ix) Title 67, Chapter 19, Utah State Personnel Management Act;
             365          (x) Title 67, Chapter 16, Utah Public Officers' and Employees' Ethics Act;


             366          (xi) Title 52, Chapter 4, Open and Public Meetings Act;
             367          (xii) Title 63G, Chapter 2, Government Records Access and Management Act; and
             368          (xiii) coverage under the Risk Management Fund created under Section 63A-4-201 ;
             369          (e) when requested, shall provide reports to the governor, the president of the Senate,
             370      or the speaker of the House; and
             371          (f) shall adopt administrative rules to establish policies for employees that are
             372      substantially similar to the administrative rules adopted by the Department of Human Resource
             373      Management.
             374          Section 5. Section 63A-13-202 , which is renumbered from Section 63J-4a-202 is
             375      renumbered and amended to read:
             376           [63J-4a-202].     63A-13-202. Duties and powers of inspector general and
             377      office.
             378          (1) The inspector general of Medicaid services shall:
             379          (a) administer, direct, and manage the office;
             380          (b) inspect and monitor the following in relation to the state Medicaid program:
             381          (i) the use and expenditure of federal and state funds;
             382          (ii) the provision of health benefits and other services;
             383          (iii) implementation of, and compliance with, state and federal requirements; and
             384          (iv) records and recordkeeping procedures;
             385          (c) receive reports of potential fraud, waste, or abuse in the state Medicaid program;
             386          (d) investigate and identify potential or actual fraud, waste, or abuse in the state
             387      Medicaid program;
             388          (e) consult with the Centers for Medicaid and Medicare Services and other states to
             389      determine and implement best practices for:
             390          (i) educating and communicating with health care professionals and providers about
             391      program and audit policies and procedures;
             392          (ii) discovering and eliminating fraud, waste, and abuse of Medicaid funds; and
             393          (iii) differentiating between honest mistakes and intentional errors, or fraud, waste, and
             394      abuse, if the office enters into settlement negotiations with the provider or health care
             395      professional;
             396          (f) obtain, develop, and utilize computer algorithms to identify fraud, waste, or abuse


             397      in the state Medicaid program;
             398          (g) work closely with the fraud unit to identify and recover improperly or fraudulently
             399      expended Medicaid funds;
             400          (h) audit, inspect, and evaluate the functioning of the division for the purpose of
             401      making recommendations to the Legislature and the department to ensure that the state
             402      Medicaid program is managed:
             403          (i) in the most efficient and cost-effective manner possible; and
             404          (ii) in a manner that promotes adequate provider and health care professional
             405      participation and the provision of appropriate health benefits and services;
             406          (i) regularly advise the department and the division of an action that should be taken to
             407      ensure that the state Medicaid program is managed in the most efficient and cost-effective
             408      manner possible;
             409          (j) refer potential criminal conduct, relating to Medicaid funds or the state Medicaid
             410      program, to the fraud unit;
             411          (k) refer potential criminal conduct, including relevant data from the controlled
             412      substance database, relating to Medicaid fraud, to law enforcement in accordance with Title 58,
             413      Chapter 37f, Controlled Substance Database Act;
             414          [(k)] (l) determine ways to:
             415          (i) identify, prevent, and reduce fraud, waste, and abuse in the state Medicaid program;
             416      and
             417          (ii) [recoup costs,] balance efforts to reduce costs[,] and avoid or minimize increased
             418      costs of the state Medicaid program with the need to encourage robust health care professional
             419      and provider participation in the state Medicaid program;
             420          [(l) seek recovery of]
             421          (m) recover improperly paid Medicaid funds;
             422          [(m)] (n) track recovery of Medicaid funds by the state;
             423          [(n)] (o) in accordance with Section [ 63J-4a-501 ] 63A-13-502 :
             424          (i) report on the actions and findings of the inspector general; and
             425          (ii) make recommendations to the Legislature and the governor;
             426          [(o)] (p) provide training to:
             427          (i) agencies and employees on identifying potential fraud, waste, or abuse of Medicaid


             428      funds; and
             429          (ii) health care professionals and providers on program and audit policies and
             430      compliance; and
             431          [(p)] (q) develop and implement principles and standards for the fulfillment of the
             432      duties of the inspector general, based on principles and standards used by:
             433          (i) the Federal Offices of Inspector General;
             434          (ii) the Association of Inspectors General; and
             435          (iii) the United States Government Accountability Office.
             436          (2) (a) The office may, in fulfilling the duties under Subsection (1), conduct a
             437      performance or financial audit of:
             438          [(a)] (i) a state executive branch entity or a local government entity, including an entity
             439      described in [Subsection 63J-4a-301 (3)] Section 63A-13-301 , that:
             440          [(i)] (A) manages or oversees a state Medicaid program; or
             441          [(ii)] (B) manages or oversees the use or expenditure of state or federal Medicaid
             442      funds; or
             443          [(b)] (ii) Medicaid funds received by a person by a grant from, or under contract with, a
             444      state executive branch entity or a local government entity.
             445          (b) (i) The office may not, in fulfilling the duties under Subsection (1), amend the state
             446      Medicaid program or change the policies and procedures of the state Medicaid program.
             447          (ii) The office shall identify conflicts between the state Medicaid plan, department
             448      administrative rules, Medicaid provider manuals, and Medicaid information bulletins and
             449      recommend that the department reconcile inconsistencies. If the department does not reconcile
             450      the inconsistencies, the office shall report the inconsistencies to the Legislature's
             451      Administrative Rules Review Committee created in Section 63G-3-501 .
             452          (iii) Beginning July 1, 2013, the office shall review a Medicaid provider manual and a
             453      Medicaid information bulletin in accordance with Subsection (2)(b)(ii), prior to the department
             454      making the provider manual or Medicaid information bulletin available to the public.
             455          (c) Beginning July 1, 2013, the department shall submit a Medicaid provider manual
             456      and a Medicaid information bulletin to the office for the review required by Subsection
             457      (2)(b)(ii) prior to releasing the document to the public. The department and the office of the
             458      inspector general shall enter into a memorandum of understanding regarding the timing of the


             459      review process under Subsection (2)(b)(iii).
             460          (3) (a) The office shall, in fulfilling the duties under this section to investigate,
             461      discover, and recover fraud, waste, and abuse in the Medicaid program, apply the state
             462      Medicaid plan, department administrative rules, Medicaid provider manuals, and Medicaid
             463      information bulletins in effect at the time the medical services were provided.
             464          (b) A health care provider may rely on the policy interpretation included in a current
             465      Medicaid provider manual or a current Medicaid information bulletin that is available to the
             466      public.
             467          [(3)] (4) The inspector general of Medicaid services, or a designee of the inspector
             468      general of Medicaid services within the office, may take a sworn statement or administer an
             469      oath.
             470          Section 6. Section 63A-13-203 , which is renumbered from Section 63J-4a-203 is
             471      renumbered and amended to read:
             472           [63J-4a-203].     63A-13-203. Memorandum of understanding with fraud
             473      unit.
             474          The inspector general shall enter into a memorandum of understanding with the fraud
             475      unit to:
             476          (1) formalize communication, cooperation, coordination of efforts, and the sharing of
             477      information, on a regular basis, between the office and the fraud unit;
             478          (2) provide for reporting criminal activity discovered by the office to the fraud unit;
             479          (3) ensure that investigations and other actions by the office and the fraud unit do not
             480      conflict; and
             481          (4) provide for the sharing and classification of records between the office and the
             482      fraud unit under the Government Records Access and Management Act.
             483          Section 7. Section 63A-13-204 , which is renumbered from Section 63J-4a-204 is
             484      renumbered and amended to read:
             485           [63J-4a-204].     63A-13-204. Selection and review of claims.
             486          (1) (a) [On an annual basis, the] The office shall periodically select and review a
             487      representative sample of claims submitted for reimbursement under the state Medicaid program
             488      to determine whether fraud, waste, or abuse occurred.
             489          (b) The office shall limit its review for waste and abuse under Subsection (1)(a) to 36


             490      months prior to the date of the inception of the investigation or 72 months if there is a credible
             491      allegation of fraud. In the event the office or the fraud unit determines that there is fraud as
             492      defined in Subsection 63A-13-102 (5), then the statute of limitations defined in Subsection
             493      26-20-15 (1) shall apply.
             494          (2) The office may directly contact the recipient of record for a Medicaid reimbursed
             495      service to determine whether the service for which reimbursement was claimed was actually
             496      provided to the recipient of record.
             497          (3) The office shall generate statistics from the sample described in Subsection (1) to
             498      determine the type of fraud, waste, or abuse that is most advantageous to focus on in future
             499      audits or investigations.
             500          Section 8. Section 63A-13-205 , which is renumbered from Section 63J-4a-205 is
             501      renumbered and amended to read:
             502           [63J-4a-205].     63A-13-205. Placement of hold on claims for reimbursement
             503      -- Injunction.
             504          (1) The inspector general or the inspector general's designee may, without prior notice,
             505      order a hold on the payment of a claim for reimbursement submitted by a claimant if there is
             506      reasonable cause to believe that the claim, or payment of the claim, constitutes fraud, waste, or
             507      abuse, or is otherwise inaccurate.
             508          (2) The office shall, within seven days after the day on which a hold described in
             509      Subsection (1) is ordered, notify the claimant that the hold has been placed.
             510          (3) The inspector general or the inspector general's designee may not maintain a hold
             511      longer than is necessary to determine whether the claim, or payment of the claim, constitutes
             512      fraud, waste, or abuse, or is otherwise inaccurate.
             513          (4) A claimant may, at any time during which a hold is in place, appeal the hold under
             514      Title 63G, Chapter 4, Administrative Procedures Act.
             515          (5) If a claim is approved or denied before a hearing is held under Title 63G, Chapter 4,
             516      Administrative Procedures Act, the appeal shall be dismissed as moot.
             517          (6) The inspector general may request that the attorney general's office seek an
             518      injunction to prevent a person from disposing of an asset that is potentially subject to recovery
             519      by the state to recover funds due to a person's fraud or abuse.
             520          (7) The department and the division shall fully comply with a hold ordered under this


             521      section.
             522          Section 9. Section 63A-13-301 , which is renumbered from Section 63J-4a-301 is
             523      renumbered and amended to read:
             524     
Part 3. Investigation or Audit

             525           [63J-4a-301].     63A-13-301. Access to records -- Retention of designation
             526      under Government Records Access and Management Act.
             527          (1) In order to fulfill the duties described in Section [ 63J-4a-202 ,] 63A-13-202 , and in
             528      the manner provided in Subsection (4), the office shall have unrestricted access to all records of
             529      state executive branch entities, all local government entities, and all providers relating, directly
             530      or indirectly, to:
             531          (a) the state Medicaid program;
             532          (b) state or federal Medicaid funds;
             533          (c) the provision of Medicaid related services;
             534          (d) the regulation or management of any aspect of the state Medicaid program;
             535          (e) the use or expenditure of state or federal Medicaid funds;
             536          (f) suspected or proven fraud, waste, or abuse of state or federal Medicaid funds;
             537          (g) Medicaid program policies, practices, and procedures;
             538          (h) monitoring of Medicaid services or funds; or
             539          (i) a fatality review of a person who received Medicaid funded services.
             540          (2) The office shall have access to information in any database maintained by the state
             541      or a local government to verify identity, income, employment status, or other factors that affect
             542      eligibility for Medicaid services.
             543          (3) The records described in Subsections (1) and (2) include records held or maintained
             544      by the department, the division, the Department of Human Services, the Department of
             545      Workforce Services, a local health department, a local mental health authority, or a school
             546      district. The records described in Subsection (1) include records held or maintained by a
             547      provider. When conducting an audit of a provider, the office shall, to the extent possible, limit
             548      the records accessed to the scope of the audit.
             549          (4) A record, described in Subsection (1) or (2), that is accessed or copied by the
             550      office:
             551          (a) may be reviewed or copied by the office during normal business hours[; and],


             552      unless otherwise requested by the provider or health care professional under Subsection (4)(b);
             553          (b) unless there is a credible allegation of fraud, shall be accessed, reviewed, and
             554      copied in a manner, on a day, and at a time that is minimally disruptive to the health care
             555      professional's or provider's care of patients, as requested by the health care professional or
             556      provider;
             557          (c) may be submitted electronically;
             558          (d) may be submitted together with other records for multiple claims; and
             559          [(b)] (e) if it is a government record, shall retain the classification made by the entity
             560      responsible for the record, under Title 63G, Chapter 2, Government Records Access and
             561      Management Act.
             562          (5) Notwithstanding any provision of state law to the contrary, the office shall have the
             563      same access to all records, information, and databases [that] to which the department or the
             564      division have access [to].
             565          (6) The office shall comply with the requirements of federal law, including the Health
             566      Insurance Portability and Accountability Act of 1996 and 42 C.F.R., Part 2, relating to [the
             567      confidentiality of alcohol and drug abuse records, in] the office's:
             568          (a) access, review, retention, and use of records; and
             569          (b) use of information included in, or derived from, records.
             570          Section 10. Section 63A-13-302 , which is renumbered from Section 63J-4a-302 is
             571      renumbered and amended to read:
             572           [63J-4a-302].     63A-13-302. Access to employees -- Cooperating with
             573      investigation or audit.
             574          (1) The office shall have access to interview the following persons if the inspector
             575      general determines that the interview may assist the inspector general in fulfilling the duties
             576      described in Section [ 63J-4a-202 ] 63A-13-202 :
             577          (a) a state executive branch official, executive director, director, or employee;
             578          (b) a local government official or employee;
             579          (c) a consultant or contractor of a person described in Subsection (1)(a) or (b); or
             580          (d) a provider or a health care professional or an employee of a provider or a health
             581      care professional.
             582          (2) A person described in Subsection (1) and each supervisor of the person shall fully


             583      cooperate with the office by:
             584          (a) providing the office or the inspector general's designee with access to interview the
             585      person;
             586          (b) completely and truthfully answering questions asked by the office or the inspector
             587      general's designee;
             588          (c) providing the records, described in Subsection [ 63J-4a-301 (1),] 63A-13-301 (1), in
             589      the manner described in Subsection 63A-13-301 (4), requested by the office or the inspector
             590      general's designee; and
             591          (d) providing the office or the inspector general's designee with information relating to
             592      the office's investigation or audit.
             593          (3) A person described in Subsection (1)(a) or (b) and each supervisor of the person
             594      shall fully cooperate with the office by:
             595          (a) providing records requested by the office or the inspector general's designee in the
             596      manner described in Subsection 63A-13-301 (4); and
             597          (b) providing the office or the inspector general's designee with information relating to
             598      the office's investigation or audit, including information that is classified as private, controlled,
             599      or protected under Title 63G, Chapter 2, Government Records Access and Management Act.
             600          Section 11. Section 63A-13-303 , which is renumbered from Section 63J-4a-303 is
             601      renumbered and amended to read:
             602           [63J-4a-303].     63A-13-303. Cooperation and support.
             603          The department, the division, each consultant or contractor of the department or
             604      division, and each provider shall provide its full cooperation and support to the inspector
             605      general and the office in fulfilling the duties of the inspector general and the office.
             606          Section 12. Section 63A-13-304 , which is renumbered from Section 63J-4a-304 is
             607      renumbered and amended to read:
             608           [63J-4a-304].     63A-13-304. Interference with an investigation or audit
             609      prohibited.
             610          No person may:
             611          (1) interfere with or impede an investigation or audit of the office or fraud unit; or
             612          (2) interfere with the office relative to the content of a report, the conclusions reached
             613      in a report, or the manner of disclosing the results and findings of the office.


             614          Section 13. Section 63A-13-305 is enacted to read:
             615          63A-13-305. Audit and investigation procedures.
             616          (1) (a) The office shall, in accordance with Section 63A-13-602 , adopt administrative
             617      rules in consultation with providers and health care professionals subject to audit and
             618      investigation under this chapter to establish procedures for audits and investigations that are
             619      fair and consistent with the duties of the office under this chapter.
             620          (b) If the providers and health care professionals do not agree with the rules proposed
             621      or adopted by the office under Subsection (1)(a) or Section 63A-13-602 , the providers or health
             622      care professionals may:
             623          (i) request a hearing for the proposed administrative rule or seek any other remedies
             624      under the provisions of Title 63G, Chapter 3, Utah Administrative Rulemaking Act; and
             625          (ii) request a review of the rule by the Legislature's Administrative Rules Review
             626      Committee created in Section 63G-3-501 .
             627          (2) The office shall notify and educate providers and health care professionals subject
             628      to audit and investigation under this chapter of the providers' and health care professionals'
             629      responsibilities and rights under the administrative rules adopted by the office under the
             630      provisions of this section and Section 63A-13-602 .
             631          Section 14. Section 63A-13-401 , which is renumbered from Section 63J-4a-401 is
             632      renumbered and amended to read:
             633     
Part 4. Subpoena Power

             634           [63J-4a-401].     63A-13-401. Subpoena power -- Enforcement.
             635          (1) The inspector general has the power to issue a subpoena to obtain a record or
             636      interview a person that the office or inspector general has the right to access under Part 3,
             637      Investigation or Audit.
             638          (2) A person who fails to comply with a subpoena issued by the inspector general or
             639      who refuses to testify regarding a matter upon which the person may be lawfully interrogated:
             640          (a) is in contempt of the inspector general; and
             641          (b) upon request by the inspector general, the attorney general shall:
             642          (i) file a motion for an order to compel obedience to the subpoena with the district
             643      court;
             644          (ii) file, with the district court, a motion for an order to show cause why the penalties


             645      established in Title 78B, Chapter 6, Part 3, Contempt, should not be imposed upon the person
             646      named in the subpoena for contempt of the inspector general; or
             647          (iii) pursue other legal remedies against the person.
             648          (3) Upon receipt of a motion under Subsection (2), the court:
             649          (a) shall expedite the hearing and decision on the motion; and
             650          (b) may:
             651          (i) order the person named in the subpoena to comply with the subpoena; and
             652          (ii) impose any penalties authorized by Title 78B, Chapter 6, Part 3, Contempt, upon
             653      the person named in the subpoena for contempt of the inspector general.
             654          (4) (a) If a subpoena described in this section requires the production of accounts,
             655      books, papers, documents, or other tangible items, the person or entity to whom it is directed
             656      may petition a district court to quash or modify the subpoena at or before the time specified in
             657      the subpoena for compliance.
             658          (b) The inspector general may respond to a motion to quash or modify the subpoena by
             659      pursuing any remedy authorized by Subsection (3).
             660          (c) If the court finds that a subpoena requiring the production of accounts, books,
             661      papers, documents, or other tangible items is unreasonable or oppressive, the court may quash
             662      or modify the subpoena.
             663          (5) Nothing in this section prevents the inspector general from seeking an extraordinary
             664      writ to remedy contempt of the inspector general.
             665          (6) Any party aggrieved by a decision of a court under this section may appeal that
             666      decision directly to the Utah Supreme Court.
             667          Section 15. Section 63A-13-501 , which is renumbered from Section 63J-4a-501 is
             668      renumbered and amended to read:
             669     
Part 5. Reporting

             670           [63J-4a-501].     63A-13-501. Duty to report potential Medicaid fraud to the
             671      office or fraud unit.
             672          (1) [A] (a) Except as provided in Subsection (1)(b), a health care professional, a
             673      provider, or a state or local government official or employee who becomes aware of fraud,
             674      waste, or abuse shall report the fraud, waste, or abuse to the office or the fraud unit.
             675          (b) (i) The reporting exception in this Subsection (1)(b) does not apply to fraud and


             676      abuse. Suspected fraud and abuse shall be reported in accordance with Subsection (1).
             677          (ii) If a person described in Subsection (1)(a) reasonably believes that the suspected
             678      waste is a mistake, and is not intentional or knowing, the person may first report the suspected
             679      waste to the provider, health care professional, or compliance officer for the provider or health
             680      care professional.
             681          (iii) The person described in Subsection (1)(b) shall report the suspected waste to the
             682      office or the fraud unit unless, within 30 days after the day on which the person reported the
             683      suspected waste to the provider, health care professional, or compliance officer, the provider,
             684      health care professional, or compliance officer demonstrates to the person that the suspected
             685      waste has been corrected.
             686          (2) A person who makes a report under Subsection (1) may request that the person's
             687      name not be released in connection with the investigation.
             688          (3) If a request is made under Subsection (2), the person's identity may not be released
             689      to any person or entity other than the office, the fraud unit, or law enforcement, unless a court
             690      of competent jurisdiction orders that the person's identity be released.
             691          Section 16. Section 63A-13-502 , which is renumbered from Section 63J-4a-502 is
             692      renumbered and amended to read:
             693           [63J-4a-502].     63A-13-502. Report and recommendations to governor and
             694      Executive Appropriations Committee.
             695          (1) The inspector general of Medicaid services shall, on an annual basis, prepare a
             696      written report on the activities of the office for the preceding fiscal year.
             697          (2) The report shall include:
             698          (a) non-identifying information, including statistical information, on:
             699          (i) the items described in Subsection [ 63J-4a-202 (1)(b) and Section 63J-4a-204 ]
             700      63A-13-202(1)(b) and Section 63A-13-204 ;
             701          (ii) action taken by the office and the result of that action;
             702          (iii) fraud, waste, and abuse in the state Medicaid program;
             703          (iv) the recovery of fraudulent or improper use of state and federal Medicaid funds;
             704          (v) measures taken by the state to discover and reduce fraud, waste, and abuse in the
             705      state Medicaid program;
             706          (vi) audits conducted by the office; [and]


             707          (vii) investigations conducted by the office and the results of those investigations; and
             708          (viii) administrative and educational efforts made by the office and the division to
             709      improve compliance with Medicaid program policies and requirements;
             710          (b) recommendations on action that should be taken by the Legislature or the governor
             711      to:
             712          (i) improve the discovery and reduction of fraud, waste, and abuse in the state
             713      Medicaid program;
             714          (ii) improve the recovery of fraudulently or improperly used Medicaid funds; and
             715          (iii) reduce costs and avoid or minimize increased costs in the state Medicaid program;
             716          (c) recommendations relating to rules, policies, or procedures of a state or local
             717      government entity; and
             718          (d) services provided by the state Medicaid program that exceed industry standards.
             719          (3) The report described in Subsection (1) may not include any information that would
             720      interfere with or jeopardize an ongoing criminal investigation or other investigation.
             721          (4) [The inspector general] On or before October 1 of each year, the inspector general
             722      of Medicaid services shall provide the report described in Subsection (1) to the Executive
             723      Appropriations Committee of the Legislature and to the governor on or before October 1 of
             724      each year.
             725          (5) The inspector general of Medicaid services shall present the report described in
             726      Subsection (1) to the Executive Appropriations Committee of the Legislature before November
             727      30 of each year.
             728          Section 17. Section 63A-13-601 , which is renumbered from Section 63J-4a-601 is
             729      renumbered and amended to read:
             730     
Part 6. Miscellaneous Provisions

             731           [63J-4a-601].     63A-13-601. Provision of contract services to Office of
             732      Inspector General of Medicaid Services.
             733          (1) The division and the assistant attorneys general assigned to the division shall
             734      provide, without charge, contract review, contract enforcement, and other contract management
             735      services to the office.
             736          (2) The division shall ensure that the services described in Subsection (1) are provided
             737      in an expeditious manner.


             738          (3) The attorney general shall designate one of the assistant attorneys general assigned
             739      to the division to give first priority to providing the services described in Subsection (1) to the
             740      office.
             741          (4) The office and the division shall enter into a memorandum of understanding in
             742      order to execute the requirements of this section in an effective and efficient manner.
             743          Section 18. Section 63A-13-602 , which is renumbered from Section 63J-4a-602 is
             744      renumbered and amended to read:
             745           [63J-4a-602].     63A-13-602. Rulemaking authority.
             746          The office may make rules, pursuant to Title 63G, Chapter 3, Utah Administrative
             747      Rulemaking Act, and Section 63A-13-305 , that establish policies, procedures, and practices, in
             748      accordance with the provisions of this chapter, relating to:
             749          (1) inspecting and monitoring the state Medicaid Program;
             750          (2) discovering and investigating potential fraud, waste, or abuse in the State Medicaid
             751      program;
             752          (3) developing and implementing the principles and standards described in Subsection
             753      [ 63J-4a-202 (1)(p)] 63A-13-202 (1)(q);
             754          (4) auditing, inspecting, and evaluating the functioning of the division under
             755      Subsection [ 63J-4a-202 (1)(h)] 63A-13-202 (1)(h);
             756          (5) conducting an audit under Subsection [ 63J-4a-202 (1)(h)] 63A-13-202 (1)(h) or (2);
             757      or
             758          (6) ordering a hold on the payment of a claim for reimbursement under Section
             759      [ 63J-4a-205 ] 63A-13-205 .
             760          Section 19. Section 63G-2-305 is amended to read:
             761           63G-2-305. Protected records.
             762          The following records are protected if properly classified by a governmental entity:
             763          (1) trade secrets as defined in Section 13-24-2 if the person submitting the trade secret
             764      has provided the governmental entity with the information specified in Section 63G-2-309 ;
             765          (2) commercial information or nonindividual financial information obtained from a
             766      person if:
             767          (a) disclosure of the information could reasonably be expected to result in unfair
             768      competitive injury to the person submitting the information or would impair the ability of the


             769      governmental entity to obtain necessary information in the future;
             770          (b) the person submitting the information has a greater interest in prohibiting access
             771      than the public in obtaining access; and
             772          (c) the person submitting the information has provided the governmental entity with
             773      the information specified in Section 63G-2-309 ;
             774          (3) commercial or financial information acquired or prepared by a governmental entity
             775      to the extent that disclosure would lead to financial speculations in currencies, securities, or
             776      commodities that will interfere with a planned transaction by the governmental entity or cause
             777      substantial financial injury to the governmental entity or state economy;
             778          (4) records the disclosure of which could cause commercial injury to, or confer a
             779      competitive advantage upon a potential or actual competitor of, a commercial project entity as
             780      defined in Subsection 11-13-103 (4);
             781          (5) test questions and answers to be used in future license, certification, registration,
             782      employment, or academic examinations;
             783          (6) records the disclosure of which would impair governmental procurement
             784      proceedings or give an unfair advantage to any person proposing to enter into a contract or
             785      agreement with a governmental entity, except, subject to Subsections (1) and (2), that this
             786      Subsection (6) does not restrict the right of a person to have access to, once the contract or
             787      grant has been awarded, a bid, proposal, or application submitted to or by a governmental
             788      entity in response to:
             789          (a) a request for bids;
             790          (b) a request for proposals;
             791          (c) a grant; or
             792          (d) other similar document;
             793          (7) records that would identify real property or the appraisal or estimated value of real
             794      or personal property, including intellectual property, under consideration for public acquisition
             795      before any rights to the property are acquired unless:
             796          (a) public interest in obtaining access to the information is greater than or equal to the
             797      governmental entity's need to acquire the property on the best terms possible;
             798          (b) the information has already been disclosed to persons not employed by or under a
             799      duty of confidentiality to the entity;


             800          (c) in the case of records that would identify property, potential sellers of the described
             801      property have already learned of the governmental entity's plans to acquire the property;
             802          (d) in the case of records that would identify the appraisal or estimated value of
             803      property, the potential sellers have already learned of the governmental entity's estimated value
             804      of the property; or
             805          (e) the property under consideration for public acquisition is a single family residence
             806      and the governmental entity seeking to acquire the property has initiated negotiations to acquire
             807      the property as required under Section 78B-6-505 ;
             808          (8) records prepared in contemplation of sale, exchange, lease, rental, or other
             809      compensated transaction of real or personal property including intellectual property, which, if
             810      disclosed prior to completion of the transaction, would reveal the appraisal or estimated value
             811      of the subject property, unless:
             812          (a) the public interest in access is greater than or equal to the interests in restricting
             813      access, including the governmental entity's interest in maximizing the financial benefit of the
             814      transaction; or
             815          (b) when prepared by or on behalf of a governmental entity, appraisals or estimates of
             816      the value of the subject property have already been disclosed to persons not employed by or
             817      under a duty of confidentiality to the entity;
             818          (9) records created or maintained for civil, criminal, or administrative enforcement
             819      purposes or audit purposes, or for discipline, licensing, certification, or registration purposes, if
             820      release of the records:
             821          (a) reasonably could be expected to interfere with investigations undertaken for
             822      enforcement, discipline, licensing, certification, or registration purposes;
             823          (b) reasonably could be expected to interfere with audits, disciplinary, or enforcement
             824      proceedings;
             825          (c) would create a danger of depriving a person of a right to a fair trial or impartial
             826      hearing;
             827          (d) reasonably could be expected to disclose the identity of a source who is not
             828      generally known outside of government and, in the case of a record compiled in the course of
             829      an investigation, disclose information furnished by a source not generally known outside of
             830      government if disclosure would compromise the source; or


             831          (e) reasonably could be expected to disclose investigative or audit techniques,
             832      procedures, policies, or orders not generally known outside of government if disclosure would
             833      interfere with enforcement or audit efforts;
             834          (10) records the disclosure of which would jeopardize the life or safety of an
             835      individual;
             836          (11) records the disclosure of which would jeopardize the security of governmental
             837      property, governmental programs, or governmental recordkeeping systems from damage, theft,
             838      or other appropriation or use contrary to law or public policy;
             839          (12) records that, if disclosed, would jeopardize the security or safety of a correctional
             840      facility, or records relating to incarceration, treatment, probation, or parole, that would interfere
             841      with the control and supervision of an offender's incarceration, treatment, probation, or parole;
             842          (13) records that, if disclosed, would reveal recommendations made to the Board of
             843      Pardons and Parole by an employee of or contractor for the Department of Corrections, the
             844      Board of Pardons and Parole, or the Department of Human Services that are based on the
             845      employee's or contractor's supervision, diagnosis, or treatment of any person within the board's
             846      jurisdiction;
             847          (14) records and audit workpapers that identify audit, collection, and operational
             848      procedures and methods used by the State Tax Commission, if disclosure would interfere with
             849      audits or collections;
             850          (15) records of a governmental audit agency relating to an ongoing or planned audit
             851      until the final audit is released;
             852          (16) records that are subject to the attorney client privilege;
             853          (17) records prepared for or by an attorney, consultant, surety, indemnitor, insurer,
             854      employee, or agent of a governmental entity for, or in anticipation of, litigation or a judicial,
             855      quasi-judicial, or administrative proceeding;
             856          (18) (a) (i) personal files of a state legislator, including personal correspondence to or
             857      from a member of the Legislature; and
             858          (ii) notwithstanding Subsection (18)(a)(i), correspondence that gives notice of
             859      legislative action or policy may not be classified as protected under this section; and
             860          (b) (i) an internal communication that is part of the deliberative process in connection
             861      with the preparation of legislation between:


             862          (A) members of a legislative body;
             863          (B) a member of a legislative body and a member of the legislative body's staff; or
             864          (C) members of a legislative body's staff; and
             865          (ii) notwithstanding Subsection (18)(b)(i), a communication that gives notice of
             866      legislative action or policy may not be classified as protected under this section;
             867          (19) (a) records in the custody or control of the Office of Legislative Research and
             868      General Counsel, that, if disclosed, would reveal a particular legislator's contemplated
             869      legislation or contemplated course of action before the legislator has elected to support the
             870      legislation or course of action, or made the legislation or course of action public; and
             871          (b) notwithstanding Subsection (19)(a), the form to request legislation submitted to the
             872      Office of Legislative Research and General Counsel is a public document unless a legislator
             873      asks that the records requesting the legislation be maintained as protected records until such
             874      time as the legislator elects to make the legislation or course of action public;
             875          (20) research requests from legislators to the Office of Legislative Research and
             876      General Counsel or the Office of the Legislative Fiscal Analyst and research findings prepared
             877      in response to these requests;
             878          (21) drafts, unless otherwise classified as public;
             879          (22) records concerning a governmental entity's strategy about:
             880          (a) collective bargaining; or
             881          (b) imminent or pending litigation;
             882          (23) records of investigations of loss occurrences and analyses of loss occurrences that
             883      may be covered by the Risk Management Fund, the Employers' Reinsurance Fund, the
             884      Uninsured Employers' Fund, or similar divisions in other governmental entities;
             885          (24) records, other than personnel evaluations, that contain a personal recommendation
             886      concerning an individual if disclosure would constitute a clearly unwarranted invasion of
             887      personal privacy, or disclosure is not in the public interest;
             888          (25) records that reveal the location of historic, prehistoric, paleontological, or
             889      biological resources that if known would jeopardize the security of those resources or of
             890      valuable historic, scientific, educational, or cultural information;
             891          (26) records of independent state agencies if the disclosure of the records would
             892      conflict with the fiduciary obligations of the agency;


             893          (27) records of an institution within the state system of higher education defined in
             894      Section 53B-1-102 regarding tenure evaluations, appointments, applications for admissions,
             895      retention decisions, and promotions, which could be properly discussed in a meeting closed in
             896      accordance with Title 52, Chapter 4, Open and Public Meetings Act, provided that records of
             897      the final decisions about tenure, appointments, retention, promotions, or those students
             898      admitted, may not be classified as protected under this section;
             899          (28) records of the governor's office, including budget recommendations, legislative
             900      proposals, and policy statements, that if disclosed would reveal the governor's contemplated
             901      policies or contemplated courses of action before the governor has implemented or rejected
             902      those policies or courses of action or made them public;
             903          (29) records of the Office of the Legislative Fiscal Analyst relating to budget analysis,
             904      revenue estimates, and fiscal notes of proposed legislation before issuance of the final
             905      recommendations in these areas;
             906          (30) records provided by the United States or by a government entity outside the state
             907      that are given to the governmental entity with a requirement that they be managed as protected
             908      records if the providing entity certifies that the record would not be subject to public disclosure
             909      if retained by it;
             910          (31) transcripts, minutes, or reports of the closed portion of a meeting of a public body
             911      except as provided in Section 52-4-206 ;
             912          (32) records that would reveal the contents of settlement negotiations but not including
             913      final settlements or empirical data to the extent that they are not otherwise exempt from
             914      disclosure;
             915          (33) memoranda prepared by staff and used in the decision-making process by an
             916      administrative law judge, a member of the Board of Pardons and Parole, or a member of any
             917      other body charged by law with performing a quasi-judicial function;
             918          (34) records that would reveal negotiations regarding assistance or incentives offered
             919      by or requested from a governmental entity for the purpose of encouraging a person to expand
             920      or locate a business in Utah, but only if disclosure would result in actual economic harm to the
             921      person or place the governmental entity at a competitive disadvantage, but this section may not
             922      be used to restrict access to a record evidencing a final contract;
             923          (35) materials to which access must be limited for purposes of securing or maintaining


             924      the governmental entity's proprietary protection of intellectual property rights including patents,
             925      copyrights, and trade secrets;
             926          (36) the name of a donor or a prospective donor to a governmental entity, including an
             927      institution within the state system of higher education defined in Section 53B-1-102 , and other
             928      information concerning the donation that could reasonably be expected to reveal the identity of
             929      the donor, provided that:
             930          (a) the donor requests anonymity in writing;
             931          (b) any terms, conditions, restrictions, or privileges relating to the donation may not be
             932      classified protected by the governmental entity under this Subsection (36); and
             933          (c) except for an institution within the state system of higher education defined in
             934      Section 53B-1-102 , the governmental unit to which the donation is made is primarily engaged
             935      in educational, charitable, or artistic endeavors, and has no regulatory or legislative authority
             936      over the donor, a member of the donor's immediate family, or any entity owned or controlled
             937      by the donor or the donor's immediate family;
             938          (37) accident reports, except as provided in Sections 41-6a-404 , 41-12a-202 , and
             939      73-18-13 ;
             940          (38) a notification of workers' compensation insurance coverage described in Section
             941      34A-2-205 ;
             942          (39) (a) the following records of an institution within the state system of higher
             943      education defined in Section 53B-1-102 , which have been developed, discovered, disclosed to,
             944      or received by or on behalf of faculty, staff, employees, or students of the institution:
             945          (i) unpublished lecture notes;
             946          (ii) unpublished notes, data, and information:
             947          (A) relating to research; and
             948          (B) of:
             949          (I) the institution within the state system of higher education defined in Section
             950      53B-1-102 ; or
             951          (II) a sponsor of sponsored research;
             952          (iii) unpublished manuscripts;
             953          (iv) creative works in process;
             954          (v) scholarly correspondence; and


             955          (vi) confidential information contained in research proposals;
             956          (b) Subsection (39)(a) may not be construed to prohibit disclosure of public
             957      information required pursuant to Subsection 53B-16-302 (2)(a) or (b); and
             958          (c) Subsection (39)(a) may not be construed to affect the ownership of a record;
             959          (40) (a) records in the custody or control of the Office of Legislative Auditor General
             960      that would reveal the name of a particular legislator who requests a legislative audit prior to the
             961      date that audit is completed and made public; and
             962          (b) notwithstanding Subsection (40)(a), a request for a legislative audit submitted to the
             963      Office of the Legislative Auditor General is a public document unless the legislator asks that
             964      the records in the custody or control of the Office of Legislative Auditor General that would
             965      reveal the name of a particular legislator who requests a legislative audit be maintained as
             966      protected records until the audit is completed and made public;
             967          (41) records that provide detail as to the location of an explosive, including a map or
             968      other document that indicates the location of:
             969          (a) a production facility; or
             970          (b) a magazine;
             971          (42) information:
             972          (a) contained in the statewide database of the Division of Aging and Adult Services
             973      created by Section 62A-3-311.1 ; or
             974          (b) received or maintained in relation to the Identity Theft Reporting Information
             975      System (IRIS) established under Section 67-5-22 ;
             976          (43) information contained in the Management Information System and Licensing
             977      Information System described in Title 62A, Chapter 4a, Child and Family Services;
             978          (44) information regarding National Guard operations or activities in support of the
             979      National Guard's federal mission;
             980          (45) records provided by any pawn or secondhand business to a law enforcement
             981      agency or to the central database in compliance with Title 13, Chapter 32a, Pawnshop and
             982      Secondhand Merchandise Transaction Information Act;
             983          (46) information regarding food security, risk, and vulnerability assessments performed
             984      by the Department of Agriculture and Food;
             985          (47) except to the extent that the record is exempt from this chapter pursuant to Section


             986      63G-2-106 , records related to an emergency plan or program, a copy of which is provided to or
             987      prepared or maintained by the Division of Emergency Management, and the disclosure of
             988      which would jeopardize:
             989          (a) the safety of the general public; or
             990          (b) the security of:
             991          (i) governmental property;
             992          (ii) governmental programs; or
             993          (iii) the property of a private person who provides the Division of Emergency
             994      Management information;
             995          (48) records of the Department of Agriculture and Food that provides for the
             996      identification, tracing, or control of livestock diseases, including any program established under
             997      Title 4, Chapter 24, Utah Livestock Brand and Anti-theft Act or Title 4, Chapter 31, Control of
             998      Animal Disease;
             999          (49) as provided in Section 26-39-501 :
             1000          (a) information or records held by the Department of Health related to a complaint
             1001      regarding a child care program or residential child care which the department is unable to
             1002      substantiate; and
             1003          (b) information or records related to a complaint received by the Department of Health
             1004      from an anonymous complainant regarding a child care program or residential child care;
             1005          (50) unless otherwise classified as public under Section 63G-2-301 and except as
             1006      provided under Section 41-1a-116 , an individual's home address, home telephone number, or
             1007      personal mobile phone number, if:
             1008          (a) the individual is required to provide the information in order to comply with a law,
             1009      ordinance, rule, or order of a government entity; and
             1010          (b) the subject of the record has a reasonable expectation that this information will be
             1011      kept confidential due to:
             1012          (i) the nature of the law, ordinance, rule, or order; and
             1013          (ii) the individual complying with the law, ordinance, rule, or order;
             1014          (51) the name, home address, work addresses, and telephone numbers of an individual
             1015      that is engaged in, or that provides goods or services for, medical or scientific research that is:
             1016          (a) conducted within the state system of higher education, as defined in Section


             1017      53B-1-102 ; and
             1018          (b) conducted using animals;
             1019          (52) an initial proposal under Title 63M, Chapter 1, Part 26, Government Procurement
             1020      Private Proposal Program, to the extent not made public by rules made under that chapter;
             1021          (53) in accordance with Section 78A-12-203 , any record of the Judicial Performance
             1022      Evaluation Commission concerning an individual commissioner's vote on whether or not to
             1023      recommend that the voters retain a judge;
             1024          (54) information collected and a report prepared by the Judicial Performance
             1025      Evaluation Commission concerning a judge, unless Section 20A-7-702 or Title 78A, Chapter
             1026      12, Judicial Performance Evaluation Commission Act, requires disclosure of, or makes public,
             1027      the information or report;
             1028          (55) records contained in the Management Information System created in Section
             1029      62A-4a-1003 ;
             1030          (56) records provided or received by the Public Lands Policy Coordinating Office in
             1031      furtherance of any contract or other agreement made in accordance with Section 63J-4-603 ;
             1032          (57) information requested by and provided to the Utah State 911 Committee under
             1033      Section 53-10-602 ;
             1034          (58) recorded Children's Justice Center investigative interviews, both video and audio,
             1035      the release of which are governed by Section 77-37-4 ;
             1036          (59) in accordance with Section 73-10-33 :
             1037          (a) a management plan for a water conveyance facility in the possession of the Division
             1038      of Water Resources or the Board of Water Resources; or
             1039          (b) an outline of an emergency response plan in possession of the state or a county or
             1040      municipality;
             1041          (60) the following records in the custody or control of the Office of Inspector General
             1042      of Medicaid Services, created in Section [ 63J-4a-201 ] 63A-13-201 :
             1043          (a) records that would disclose information relating to allegations of personal
             1044      misconduct, gross mismanagement, or illegal activity of a person if the information or
             1045      allegation cannot be corroborated by the Office of Inspector General of Medicaid Services
             1046      through other documents or evidence, and the records relating to the allegation are not relied
             1047      upon by the Office of Inspector General of Medicaid Services in preparing a final investigation


             1048      report or final audit report;
             1049          (b) records and audit workpapers to the extent they would disclose the identity of a
             1050      person who, during the course of an investigation or audit, communicated the existence of any
             1051      Medicaid fraud, waste, or abuse, or a violation or suspected violation of a law, rule, or
             1052      regulation adopted under the laws of this state, a political subdivision of the state, or any
             1053      recognized entity of the United States, if the information was disclosed on the condition that
             1054      the identity of the person be protected;
             1055          (c) before the time that an investigation or audit is completed and the final
             1056      investigation or final audit report is released, records or drafts circulated to a person who is not
             1057      an employee or head of a governmental entity for the person's response or information;
             1058          (d) records that would disclose an outline or part of any investigation, audit survey
             1059      plan, or audit program; or
             1060          (e) requests for an investigation or audit, if disclosure would risk circumvention of an
             1061      investigation or audit;
             1062          (61) records that reveal methods used by the Office of Inspector General of Medicaid
             1063      Services, the fraud unit, or the Department of Health, to discover Medicaid fraud, waste, or
             1064      abuse;
             1065          (62) information provided to the Department of Health or the Division of Occupational
             1066      and Professional Licensing under Subsection 58-68-304 (3) or (4); and
             1067          (63) a record described in Section 63G-12-210 .
             1068          Section 20. Section 63J-4-202 is amended to read:
             1069           63J-4-202. Appointment of director and state planning coordinator.
             1070          (1) (a) The governor shall appoint, to serve at the governor's pleasure:
             1071          (i) a director of the Governor's Office of Planning and Budget; and
             1072          (ii) a state planning coordinator.
             1073          (b) The state planning coordinator is considered part of the office for purposes of
             1074      administration.
             1075          (2) The governor shall establish the director's salary within the salary range fixed by
             1076      the Legislature in Title 67, Chapter 22, State Officer Compensation.
             1077          [(3) (a) In accordance with Section 63J-4a-201 , the governor shall appoint, with the
             1078      advice and consent of the Senate, the inspector general of the Office of Inspector General of


             1079      Medicaid Services.]
             1080          [(b) The Office of Inspector General of Medicaid Services is considered part of the
             1081      office for purposes of administration.]
             1082          Section 21. Transition of Office of Inspector General of Medicaid Services to the
             1083      Department of Administrative Services.
             1084          (1) The inspector general for Medicaid services in office on January 1, 2013, shall
             1085      serve as the transition director for the transition of the office of the inspector general of
             1086      Medicaid services into the Department of Administrative Services and shall transition the
             1087      office of the inspector general of Medicaid services into the Department of Administrative
             1088      Services on or before July 1, 2013.
             1089          (2) Notwithstanding the provisions of Subsection 63J-1-206 , all records, personnel,
             1090      property, equipment, grants, unexpended and unexpired balances of appropriations, allocations,
             1091      and other funds used, held, employed, available, or to be made available to the office of the
             1092      inspector general within the Governor's Office of Planning and Budget for the activities,
             1093      powers, duties, functions, and responsibilities transferred to the office of the inspector general
             1094      of Medicaid Services within the Department of Administrative Services by this bill shall
             1095      transfer to the office of the inspector general of Medicaid Services within the Department of
             1096      Administrative Services.
             1097          (3) The transition director shall administer the functions of this bill in a manner that
             1098      promotes efficient administration and shall make internal organizational changes as necessary
             1099      to complete the realignment of responsibilities required by this bill.
             1100          (4) The governor and the governor's designee may request the assistance of any
             1101      executive branch agency with respect to personnel, budgeting, procurement, information
             1102      systems, and other management related functions, and the executive branch agency shall
             1103      provide the requested assistance.
             1104          (5) All rules, orders, contracts, grants, and agreements relating to the functions of the
             1105      office of the inspector general of Medicaid services lawfully adopted prior to the effective date
             1106      of this bill by the responsible state executive branch agency shall continue to be effective until
             1107      revised, amended, or rescinded.
             1108          (6) Any suit, action, or other proceeding lawfully commenced by, against, or before
             1109      any entity affected by this chapter shall not abate by reason of this bill.


             1110          (7) This uncodified section "Transition of Inspector General of Medicaid Services" is
             1111      repealed on July 1, 2014.
             1112          Section 22. Appropriation.
             1113          Under the terms and conditions of Title 63J, Chapter 1, Budgetary Procedures Act, for
             1114      the fiscal year beginning July 1, 2013, and ending June 30, 2014, the following sums of money
             1115      are appropriated from resources not otherwise appropriated, or reduced from amounts
             1116      previously appropriated, out of the funds or accounts indicated. These sums of money are in
             1117      addition to any amounts previously appropriated for fiscal year 2014.
             1118          To Governor's Office of Planning and Budget - Inspector General of Medicaid Services
             1119              From General Fund
(1,020,200)

             1120              From Transfers
(1,962,600)

             1121              From Pass-through
733,400

             1122              From Beginning Nonlapsing Balances
(865,300)

             1123              Schedule of Programs
             1124                  Inspector General of Medicaid Services        ($3,114,700)
             1125          The Legislature intends that the Division of Finance transfer unexpended appropriations
             1126      and balances of appropriations, up to the amounts shown above, from the Governor's Office of
             1127      Planning and Budget to the Department of Administrative Services for fiscal year 2014.
             1128          To Department of Administrative Services - Inspector General of Medicaid Services
             1129              From General Fund
1,020,200

             1130              From Transfers
1,962,600

             1131              From Pass-through
(733,400)

             1132              From Beginning Nonlapsing Balances
865,300

             1133              Schedule of Programs
             1134                  Inspector General of Medicaid Services         $3,114,700
             1135          The Legislature intends that the Division of Finance transfer unexpended appropriations
             1136      and balances of appropriations, up to the amounts shown above, from the Governor's Office of
             1137      Planning and Budget to the Department of Administrative Services for fiscal year 2014.
             1138          Section 23. Effective date.
             1139          If approved by two-thirds of all the members elected to each house, this bill takes effect
             1140      upon approval by the governor, or the day following the constitutional time limit of Utah


             1141      Constitution Article VII, Section 8, without the governor's signature, or in the case of a veto,
             1142      the date of veto override.


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