Chief Sponsor: Bruce R. Cutler

Senate Sponsor: Brian E. Shiozawa


9     General Description:
10          This bill amends the Medical Assistance Act in the Utah Health Code.
11     Highlighted Provisions:
12          This bill:
13          ▸     instructs the state Medicaid program to:
14               •     seek a plan amendment to disregard resources held by an applicant in a Utah
15     Educational Savings Plan account when determining eligibility for certain
16     benefits in the Medicaid program; and
17               •     implement the plan amendment for benefit determinations made on or after the
18     date of the approval of the state plan amendment; and
19          ▸     makes technical amendments.
20     Money Appropriated in this Bill:
21          None
22     Other Special Clauses:
23          None
24     Utah Code Sections Affected:
25     AMENDS:
26          26-18-3, as last amended by Laws of Utah 2016, Chapter 168
27          26-18-10, as last amended by Laws of Utah 2013, Chapter 167

28          26-40-103, as last amended by Laws of Utah 2013, Chapter 167

30     Be it enacted by the Legislature of the state of Utah:
31          Section 1. Section 26-18-3 is amended to read:
32          26-18-3. Administration of Medicaid program by department -- Reporting to the
33     Legislature -- Disciplinary measures and sanctions -- Funds collected -- Eligibility
34     standards -- Internal audits -- Health opportunity accounts.
35          (1) The department shall be the single state agency responsible for the administration
36     of the Medicaid program in connection with the United States Department of Health and
37     Human Services pursuant to Title XIX of the Social Security Act.
38          (2) (a) The department shall implement the Medicaid program through administrative
39     rules in conformity with this chapter, Title 63G, Chapter 3, Utah Administrative Rulemaking
40     Act, the requirements of Title XIX, and applicable federal regulations.
41          (b) The rules adopted under Subsection (2)(a) shall include, in addition to other rules
42     necessary to implement the program:
43          (i) the standards used by the department for determining eligibility for Medicaid
44     services;
45          (ii) the services and benefits to be covered by the Medicaid program;
46          (iii) reimbursement methodologies for providers under the Medicaid program; and
47          (iv) a requirement that:
48          (A) a person receiving Medicaid services shall participate in the electronic exchange of
49     clinical health records established in accordance with Section 26-1-37 unless the individual
50     opts out of participation;
51          (B) prior to enrollment in the electronic exchange of clinical health records the enrollee
52     shall receive notice of enrollment in the electronic exchange of clinical health records and the
53     right to opt out of participation at any time; and
54          (C) beginning July 1, 2012, when the program sends enrollment or renewal information
55     to the enrollee and when the enrollee logs onto the program's website, the enrollee shall receive
56     notice of the right to opt out of the electronic exchange of clinical health records.
57          (3) (a) The department shall, in accordance with Subsection (3)(b), report to the Social
58     Services Appropriations Subcommittee when the department:

59          (i) implements a change in the Medicaid State Plan;
60          (ii) initiates a new Medicaid waiver;
61          (iii) initiates an amendment to an existing Medicaid waiver;
62          (iv) applies for an extension of an application for a waiver or an existing Medicaid
63     waiver; or
64          (v) initiates a rate change that requires public notice under state or federal law.
65          (b) The report required by Subsection (3)(a) shall:
66          (i) be submitted to the Social Services Appropriations Subcommittee prior to the
67     department implementing the proposed change; and
68          (ii) include:
69          (A) a description of the department's current practice or policy that the department is
70     proposing to change;
71          (B) an explanation of why the department is proposing the change;
72          (C) the proposed change in services or reimbursement, including a description of the
73     effect of the change;
74          (D) the effect of an increase or decrease in services or benefits on individuals and
75     families;
76          (E) the degree to which any proposed cut may result in cost-shifting to more expensive
77     services in health or human service programs; and
78          (F) the fiscal impact of the proposed change, including:
79          (I) the effect of the proposed change on current or future appropriations from the
80     Legislature to the department;
81          (II) the effect the proposed change may have on federal matching dollars received by
82     the state Medicaid program;
83          (III) any cost shifting or cost savings within the department's budget that may result
84     from the proposed change; and
85          (IV) identification of the funds that will be used for the proposed change, including any
86     transfer of funds within the department's budget.
87          (4) Any rules adopted by the department under Subsection (2) are subject to review and
88     reauthorization by the Legislature in accordance with Section 63G-3-502.
89          (5) The department may, in its discretion, contract with the Department of Human

90     Services or other qualified agencies for services in connection with the administration of the
91     Medicaid program, including:
92          (a) the determination of the eligibility of individuals for the program;
93          (b) recovery of overpayments; and
94          (c) consistent with Section 26-20-13, and to the extent permitted by law and quality
95     control services, enforcement of fraud and abuse laws.
96          (6) The department shall provide, by rule, disciplinary measures and sanctions for
97     Medicaid providers who fail to comply with the rules and procedures of the program, provided
98     that sanctions imposed administratively may not extend beyond:
99          (a) termination from the program;
100          (b) recovery of claim reimbursements incorrectly paid; and
101          (c) those specified in Section 1919 of Title XIX of the federal Social Security Act.
102          (7) Funds collected as a result of a sanction imposed under Section 1919 of Title XIX
103     of the federal Social Security Act shall be deposited in the General Fund as dedicated credits to
104     be used by the division in accordance with the requirements of Section 1919 of Title XIX of
105     the federal Social Security Act.
106          (8) (a) In determining whether an applicant or recipient is eligible for a service or
107     benefit under this part or Chapter 40, Utah Children's Health Insurance Act, the department
108     shall, if Subsection (8)(b) is satisfied, exclude from consideration one passenger vehicle
109     designated by the applicant or recipient.
110          (b) Before Subsection (8)(a) may be applied:
111          (i) the federal government shall:
112          (A) determine that Subsection (8)(a) may be implemented within the state's existing
113     public assistance-related waivers as of January 1, 1999;
114          (B) extend a waiver to the state permitting the implementation of Subsection (8)(a); or
115          (C) determine that the state's waivers that permit dual eligibility determinations for
116     cash assistance and Medicaid are no longer valid; and
117          (ii) the department shall determine that Subsection (8)(a) can be implemented within
118     existing funding.
119          (9) (a) For purposes of this Subsection (9):
120          (i) "aged, blind, or has a disability" means an aged, blind, or disabled individual, as

121     defined in 42 U.S.C. Sec. 1382c(a)(1); and
122          (ii) "spend down" means an amount of income in excess of the allowable income
123     standard that shall be paid in cash to the department or incurred through the medical services
124     not paid by Medicaid.
125          (b) In determining whether an applicant or recipient who is aged, blind, or has a
126     disability is eligible for a service or benefit under this chapter, the department shall use 100%
127     of the federal poverty level as:
128          (i) the allowable income standard for eligibility for services or benefits; and
129          (ii) the allowable income standard for eligibility as a result of spend down.
130          (10) The department shall conduct internal audits of the Medicaid program.
131          (11) (a) The department may apply for and, if approved, implement a demonstration
132     program for health opportunity accounts, as provided for in 42 U.S.C. Sec. 1396u-8.
133          (b) A health opportunity account established under Subsection (11)(a) shall be an
134     alternative to the existing benefits received by an individual eligible to receive Medicaid under
135     this chapter.
136          (c) Subsection (11)(a) is not intended to expand the coverage of the Medicaid program.
137          (12) (a) (i) The department shall apply for, and if approved, implement an amendment
138     to the state plan under this Subsection (12) for benefits for:
139          (A) medically needy pregnant women;
140          (B) medically needy children; and
141          (C) medically needy parents and caretaker relatives.
142          (ii) The department may implement the eligibility standards of Subsection (12)(b) for
143     eligibility determinations made on or after the date of the approval of the amendment to the
144     state plan.
145          (b) In determining whether an applicant is eligible for benefits described in Subsection
146     (12)(a)(i), the department shall:
147          (i) disregard resources held in an account in the savings plan created under Title 53B,
148     Chapter 8a, Utah Educational Savings Plan, if the beneficiary of the account is:
149          (A) under the age of 26; and
150          (B) living with the account owner, as that term is defined in Section 53B-8a-102, or
151     temporarily absent from the residence of the account owner; and

152          (ii) include the withdrawals from an account in the Utah Educational Savings Plan as
153     resources for a benefit determination, if the withdrawal was not used for qualified higher
154     education costs as that term is defined in Section 53B-8a-102.
155          Section 2. Section 26-18-10 is amended to read:
156          26-18-10. Utah Medical Assistance Program -- Policies and standards.
157          (1) The division shall develop a medical assistance program, which shall be known as
158     the Utah Medical Assistance Program, for low income persons who are not eligible under the
159     state plan for Medicaid under Title XIX of the Social Security Act or Medicare under Title
160     XVIII of that act.
161          (2) Persons in the custody of prisons, jails, halfway houses, and other nonmedical
162     government institutions are not eligible for services provided under this section.
163          (3) The department shall develop standards and administer policies relating to
164     eligibility requirements, consistent with [Subsection] Section 26-18-3[(8)], for participation in
165     the program, and for payment of medical claims for eligible persons.
166          (4) The program shall be a payor of last resort. Before assistance is rendered the
167     division shall investigate the availability of the resources of the spouse, father, mother, and
168     adult children of the person making application.
169          (5) The department shall determine what medically necessary care or services are
170     covered under the program, including duration of care, and method of payment, which may be
171     partial or in full.
172          (6) The department may not provide public assistance for medical, hospital, or other
173     medical expenditures or medical services to otherwise eligible persons where the purpose of
174     the assistance is for the performance of an abortion, unless the life of the mother would be
175     endangered if an abortion were not performed.
176          (7) The department may establish rules to carry out the provisions of this section.
177          Section 3. Section 26-40-103 is amended to read:
178          26-40-103. Creation and administration of the Utah Children's Health Insurance
179     Program.
180          (1) There is created the Utah Children's Health Insurance Program to be administered
181     by the department in accordance with the provisions of:
182          (a) this chapter; and

183          (b) the State Children's Health Insurance Program, 42 U.S.C. Sec. 1397aa et seq.
184          (2) The department shall:
185          (a) prepare and submit the state's children's health insurance plan before May 1, 1998,
186     and any amendments to the federal Department of Health and Human Services in accordance
187     with 42 U.S.C. Sec. 1397ff; and
188          (b) make rules in accordance with Title 63G, Chapter 3, Utah Administrative
189     Rulemaking Act regarding:
190          (i) eligibility requirements consistent with [Subsection] Section 26-18-3[(8)];
191          (ii) program benefits;
192          (iii) the level of coverage for each program benefit;
193          (iv) cost-sharing requirements for enrollees, which may not:
194          (A) exceed the guidelines set forth in 42 U.S.C. Sec. 1397ee; or
195          (B) impose deductible, copayment, or coinsurance requirements on an enrollee for
196     well-child, well-baby, and immunizations;
197          (v) the administration of the program; and
198          (vi) a requirement that:
199          (A) enrollees in the program shall participate in the electronic exchange of clinical
200     health records established in accordance with Section 26-1-37 unless the enrollee opts out of
201     participation;
202          (B) prior to enrollment in the electronic exchange of clinical health records the enrollee
203     shall receive notice of the enrollment in the electronic exchange of clinical health records and
204     the right to opt out of participation at any time; and
205          (C) beginning July 1, 2012, when the program sends enrollment or renewal information
206     to the enrollee and when the enrollee logs onto the program's website, the enrollee shall receive
207     notice of the right to opt out of the electronic exchange of clinical health records.

Legislative Review Note
Office of Legislative Research and General Counsel