H.B. 401





Chief Sponsor: James A. Dunnigan

Senate Sponsor: ____________

             7      LONG TITLE
             8      General Description:
             9          This bill establishes the Access Utah program to provide access to health care to certain
             10      individuals below the federal poverty level.
             11      Highlighted Provisions:
             12          This bill:
             13          .    updates language regarding the prohibition against Medicaid expansion to reflect
             14      current federal regulations;
             15          .    creates a two-year pilot program known as Access Utah to provide a defined
             16      contribution health benefit to individuals who are below the federal poverty level
             17      and who meet other need based requirements;
             18          .    establishes a coordinated care model for providing care in Access Utah; and
             19          .    instructs the Department of Health to:
             20              *    work with the Legislature's Health Reform Task Force to develop a     
             21      Section 1332 Medicaid waiver; and
             22              *    submit an amendment of the Utah Premium Partnership and Primary Care
             23      Network waiver to the Centers for Medicare and Medicaid Services to
             24      incorporate the Access Utah program.
             25      Money Appropriated in this Bill:
             26          None
             27      Other Special Clauses:

             28          None
             29      Utah Code Sections Affected:
             30      AMENDS:
             31           26-18-18 , as enacted by Laws of Utah 2013, Chapter 477
             32      ENACTS:
             33           26-18-20 , Utah Code Annotated 1953
             35      Be it enacted by the Legislature of the state of Utah:
             36          Section 1. Section 26-18-18 is amended to read:
             37           26-18-18. Optional Medicaid expansion.
             38          (1) For purposes of this section:
             39          (a) "Optional expansion population" means individuals who:
             40          (i) do not qualify for the state's Medicaid program; and
             41          (ii) the Centers for Medicare and Medicaid Services within the United States
             42      Department of Health and Human Services would otherwise determine are eligible for funding
             43      at the enhanced federal medical assistance percentage available under PPACA beginning
             44      January 1, 2014.
             45          (b) PPACA is as defined in Section 31A-1-301 .
             46          (2) The department and the governor shall not expand the [state's] Medicaid program to
             47      the optional expansion population under PPACA unless:
             48          [(a) the Health Reform Task Force has completed a thorough analysis of a statewide
             49      charity care system;]
             50          [(b) the department and its contractors have:]
             51          [(i) completed a thorough analysis of the impact to the state of expanding the state's
             52      Medicaid program to optional populations under PPACA; and]
             53          [(ii) made the analysis conducted under Subsection (2)(b)(i) available to the public;]
             54          [(c)] (a) the governor or the governor's designee has reported the intention to expand
             55      the state Medicaid program under PPACA to the Legislature in compliance with the legislative
             56      review process in Sections 63M-1-2505.5 and 26-18-3 ; and
             57          [(d)] (b) notwithstanding Subsection 63J-5-103 (2), the governor submits the request
             58      for expansion of the Medicaid program for optional populations to the Legislature under the

             59      high impact federal funds request process required by Section 63J-5-204 , Legislative review
             60      and approval of certain federal funds request.
             61          Section 2. Section 26-18-20 is enacted to read:
             62          26-18-20. Access Utah -- Eligibility -- Defined contribution.
             63          (1) For purposes of this section:
             64          (a) "Access Utah" means the defined contribution program created in this section.
             65          (b) "Medically frail" means an individual who meets the criteria of 42 C.F.R. 440.315
             66      as determined by the department based on methodology administered by the department or
             67      another entity selected by the department.
             68          (c) "Optional expansion population" is as defined in Section 26-18-18 .
             69          (2) (a) The department shall establish a two-year pilot program known as "Access
             70      Utah," which shall:
             71          (i) begin on January 1, 2015, and end on January 1, 2017; and
             72          (ii) provide a defined contribution to eligible individuals in accordance with this
             73      section.
             74          (b) The department shall work with the Legislature's Health Reform Task Force to
             75      develop a Medicaid waiver proposal under Section 1332 of the Social Security Act to submit to
             76      the Centers for Medicare and Medicaid Services within the United States Department of Health
             77      and Human Services.
             78          (3) An individual is eligible for Access Utah if the individual:
             79          (a) (i) is in the optional expansion population and below 100% of the federal poverty
             80      level; and
             81          (ii) (A) is medically frail; or
             82          (B) is an adult with a dependent child; and
             83          (b) if funding permits, is an individual described in Subsection (3)(a)(i), but not in
             84      Subsection (3)(a)(ii).
             85          (4) (a) Within appropriations from the Legislature, the department shall offer to an
             86      eligible individual a defined contribution in an amount determined by the department.
             87          (b) An eligible individual shall use the defined contribution to purchase employer
             88      sponsored health insurance coverage if the individual is offered employer sponsored health
             89      insurance coverage.

             90          (c) If an eligible individual is not offered employer sponsored coverage, the individual
             91      may use the defined contribution to purchase:
             92          (i) a commercial health insurance policy; or
             93          (ii) access to a coordinated care model described in Subsection (5).
             94          (5) (a) The department may contract with public and private entities to provide or
             95      manage the delivery of a coordinated care model to an individual described in Subsection
             96      (4)(c)(ii).
             97          (b) The coordinated care model shall combine state and federal funding with charity
             98      care resources to:
             99          (i) provide, as funding permits, preventive care, outpatient care, pharmacy benefits,
             100      urgent and emergency care, and limited hospital benefits; and
             101          (ii) integrate physical health and behavioral health services.
             102          (6) The department shall evaluate and report to the Legislature's Health Reform Task
             103      Force on or before November 1, 2016, regarding:
             104          (a) the methods used to determine a medically frail individual and the number of
             105      medically frail individuals who enrolled in Access Utah;
             106          (b) access to and quality of care in Access Utah; and
             107          (c) whether Access Utah helped to facilitate enrollee self-sufficiency.
             108          (7) (a) Notwithstanding Section 26-18-18 , the department shall seek an extension of
             109      Utah's Primary Care Network and the Utah Premium Partnership 1115 Waiver from the
             110      Centers for Medicare and Medicaid Services within the United States Department of Health
             111      and Human Services in accordance with Subsection (7)(b).
             112          (b) The department may modify the Primary Care Network and The Utah Premium
             113      Partnership scope of benefits and eligibility criteria as part of the waiver request under
             114      Subsection (7)(a) if:
             115          (i) the department develops the waiver request in coordination with the Legislature's
             116      Health Reform Task Force and reports to the Legislature's Executive Appropriations
             117      Committee regarding the waiver request; and
             118          (ii) the modification of benefits will:
             119          (A) not increase the state's expenditure for the Access Utah program beyond the
             120      Legislature's appropriation for the program; and

             121          (B) further the state's goal to reduce health care costs, improve access to health care,
             122      and improve health outcomes of Utah citizens.

Legislative Review Note
    as of 2-24-14 11:01 AM

Office of Legislative Research and General Counsel

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