Chief Sponsor: Timothy D. Hawkes

Senate Sponsor: Brian E. Shiozawa


8     General Description:
9          This bill amends provisions related to the Medicaid program.
10     Highlighted Provisions:
11          This bill:
12          ▸     amends provisions related to the Medicaid Inspector General's access to records
13     held by the Department of Health.
14     Money Appropriated in this Bill:
15          None
16     Other Special Clauses:
17          None
18     Utah Code Sections Affected:
19     AMENDS:
20          63A-13-301, as last amended by Laws of Utah 2013, Chapter 359 and renumbered and
21     amended by Laws of Utah 2013, Chapter 12

23     Be it enacted by the Legislature of the state of Utah:
24          Section 1. Section 63A-13-301 is amended to read:
25          63A-13-301. Access to records -- Retention of designation under Government
26     Records Access and Management Act.
27          (1) In order to fulfill the duties described in Section 63A-13-202, and in the manner
28     provided in Subsection (4), the office shall have unrestricted access to all records of state
29     executive branch entities, all local government entities, and all providers relating, directly or

30     indirectly, to:
31          (a) the state Medicaid program;
32          (b) state or federal Medicaid funds;
33          (c) the provision of Medicaid related services;
34          (d) the regulation or management of any aspect of the state Medicaid program;
35          (e) the use or expenditure of state or federal Medicaid funds;
36          (f) suspected or proven fraud, waste, or abuse of state or federal Medicaid funds;
37          (g) Medicaid program policies, practices, and procedures;
38          (h) monitoring of Medicaid services or funds; or
39          (i) a fatality review of a person who received Medicaid funded services.
40          (2) The office shall have access to information in any database maintained by the state
41     or a local government to verify identity, income, employment status, or other factors that affect
42     eligibility for Medicaid services.
43          (3) The records described in Subsections (1) and (2) include records held or maintained
44     by the department, the division, the Department of Human Services, the Department of
45     Workforce Services, a local health department, a local mental health authority, or a school
46     district. The records described in Subsection (1) include records held or maintained by a
47     provider. When conducting an audit of a provider, the office shall, to the extent possible, limit
48     the records accessed to the scope of the audit.
49          (4) A record, described in Subsection (1) or (2), that is accessed or copied by the
50     office:
51          (a) may be reviewed or copied by the office during normal business hours, unless
52     otherwise requested by the provider or health care professional under Subsection (4)(b);
53          (b) unless there is a credible allegation of fraud, shall be accessed, reviewed, and
54     copied in a manner, on a day, and at a time that is minimally disruptive to the health care
55     professional's or provider's care of patients, as requested by the health care professional or
56     provider;
57          (c) may be submitted electronically;

58          (d) may be submitted together with other records for multiple claims; and
59          (e) if it is a government record, shall retain the classification made by the entity
60     responsible for the record, under Title 63G, Chapter 2, Government Records Access and
61     Management Act.
62          (5) [Notwithstanding] Except as provided in Subsection (7), notwithstanding any
63     provision of state law to the contrary, the office shall have the same access to all records,
64     information, and databases to which the department or the division [have] has access.
65          (6) The office shall comply with the requirements of federal law, including the Health
66     Insurance Portability and Accountability Act of 1996 and 42 C.F.R., Part 2, relating to the
67     office's:
68          (a) access, review, retention, and use of records; and
69          (b) use of information included in, or derived from, records.
70          (7) The office's access to data held by the Health Data Committee:
71          (a) is not subject to this section; and
72          (b) is subject to Title 26, Chapter 33a, Utah Health Data Authority Act.