1     
MEDICAID SANCTIONS AMENDMENTS

2     
2018 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Raymond P. Ward

5     
Senate Sponsor: Brian Zehnder

6     

7     LONG TITLE
8     General Description:
9          This bill adds Medicaid sanctions to the list of programs with nonlapsing authority.
10     Highlighted Provisions:
11          This bill:
12          ▸     adds Medicaid sanctions to the list of programs with nonlapsing authority.
13     Money Appropriated in this Bill:
14          None
15     Other Special Clauses:
16          This bill provides a special effective date.
17     Utah Code Sections Affected:
18     AMENDS:
19          26-18-3, as last amended by Laws of Utah 2017, Chapter 74
20          63J-1-602.1 (Effective 09/30/18), as last amended by Laws of Utah 2017, Chapters 88,
21     107, 194, and 383
22          63J-1-602.1 (Superseded 09/30/18), as last amended by Laws of Utah 2017, Chapters
23     88, 194, and 383
24     

25     Be it enacted by the Legislature of the state of Utah:
26          Section 1. Section 26-18-3 is amended to read:
27          26-18-3. Administration of Medicaid program by department -- Reporting to the
28     Legislature -- Disciplinary measures and sanctions -- Funds collected -- Eligibility
29     standards -- Internal audits -- Health opportunity accounts.

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

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

86     Medicaid program, including:
87          (a) the determination of the eligibility of individuals for the program;
88          (b) recovery of overpayments; and
89          (c) consistent with Section 26-20-13, and to the extent permitted by law and quality
90     control services, enforcement of fraud and abuse laws.
91          (6) The department shall provide, by rule, disciplinary measures and sanctions for
92     Medicaid providers who fail to comply with the rules and procedures of the program, provided
93     that sanctions imposed administratively may not extend beyond:
94          (a) termination from the program;
95          (b) recovery of claim reimbursements incorrectly paid; and
96          (c) those specified in Section 1919 of Title XIX of the federal Social Security Act.
97          (7) (a) Funds collected as a result of a sanction imposed under Section 1919 of Title
98     XIX of the federal Social Security Act shall be deposited in the General Fund as dedicated
99     credits to be used by the division in accordance with the requirements of Section 1919 of Title
100     XIX of the federal Social Security Act.
101          (b) In accordance with Section 63J-1-602.1, sanctions collected under this Subsection
102     (7) are nonlapsing.
103          (8) (a) In determining whether an applicant or recipient is eligible for a service or
104     benefit under this part or Chapter 40, Utah Children's Health Insurance Act, the department
105     shall, if Subsection (8)(b) is satisfied, exclude from consideration one passenger vehicle
106     designated by the applicant or recipient.
107          (b) Before Subsection (8)(a) may be applied:
108          (i) the federal government shall:
109          (A) determine that Subsection (8)(a) may be implemented within the state's existing
110     public assistance-related waivers as of January 1, 1999;
111          (B) extend a waiver to the state permitting the implementation of Subsection (8)(a); or
112          (C) determine that the state's waivers that permit dual eligibility determinations for
113     cash assistance and Medicaid are no longer valid; and

114          (ii) the department shall determine that Subsection (8)(a) can be implemented within
115     existing funding.
116          (9) (a) For purposes of this Subsection (9):
117          (i) "aged, blind, or has a disability" means an aged, blind, or disabled individual, as
118     defined in 42 U.S.C. Sec. 1382c(a)(1); and
119          (ii) "spend down" means an amount of income in excess of the allowable income
120     standard that shall be paid in cash to the department or incurred through the medical services
121     not paid by Medicaid.
122          (b) In determining whether an applicant or recipient who is aged, blind, or has a
123     disability is eligible for a service or benefit under this chapter, the department shall use 100%
124     of the federal poverty level as:
125          (i) the allowable income standard for eligibility for services or benefits; and
126          (ii) the allowable income standard for eligibility as a result of spend down.
127          (10) The department shall conduct internal audits of the Medicaid program.
128          (11) (a) The department may apply for and, if approved, implement a demonstration
129     program for health opportunity accounts, as provided for in 42 U.S.C. Sec. 1396u-8.
130          (b) A health opportunity account established under Subsection (11)(a) shall be an
131     alternative to the existing benefits received by an individual eligible to receive Medicaid under
132     this chapter.
133          (c) Subsection (11)(a) is not intended to expand the coverage of the Medicaid program.
134          (12) (a) (i) The department shall apply for, and if approved, implement an amendment
135     to the state plan under this Subsection (12) for benefits for:
136          (A) medically needy pregnant women;
137          (B) medically needy children; and
138          (C) medically needy parents and caretaker relatives.
139          (ii) The department may implement the eligibility standards of Subsection (12)(b) for
140     eligibility determinations made on or after the date of the approval of the amendment to the
141     state plan.

142          (b) In determining whether an applicant is eligible for benefits described in Subsection
143     (12)(a)(i), the department shall:
144          (i) disregard resources held in an account in the savings plan created under Title 53B,
145     Chapter 8a, Utah Educational Savings Plan, if the beneficiary of the account is:
146          (A) under the age of 26; and
147          (B) living with the account owner, as that term is defined in Section 53B-8a-102, or
148     temporarily absent from the residence of the account owner; and
149          (ii) include the withdrawals from an account in the Utah Educational Savings Plan as
150     resources for a benefit determination, if the withdrawal was not used for qualified higher
151     education costs as that term is defined in Section [53B-8a-102] 53B-8a-102.5.
152          Section 2. Section 63J-1-602.1 (Superseded 09/30/18) is amended to read:
153          63J-1-602.1 (Superseded 09/30/18). List of nonlapsing accounts and funds --
154     General authority and Title 1 through Title 30.
155          (1) Appropriations made to the Legislature and its committees.
156          (2) The Utah Intracurricular Student Organization Support for Agricultural Education
157     and Leadership Restricted Account created in Section 4-42-102.
158          (3) The Percent-for-Art Program created in Section 9-6-404.
159          (4) The Native American Repatriation Restricted Account created in Section 9-9-407.
160          (5) The Martin Luther King, Jr. Civil Rights Support Restricted Account created in
161     Section 9-18-102.
162          (6) The National Professional Men's Soccer Team Support of Building Communities
163     Restricted Account created in Section 9-19-102.
164          (7) The LeRay McAllister Critical Land Conservation Program created in Section
165     11-38-301.
166          (8) The Support for State-Owned Shooting Ranges Restricted Account created in
167     Section 23-14-13.5.
168          (9) An appropriation made to the Division of Wildlife Resources for the appraisal and
169     purchase of lands under the Pelican Management Act, as provided in Section 23-21a-6.

170          (10) Award money under the State Asset Forfeiture Grant Program, as provided under
171     Section 24-4-117.
172          (11) Funds collected from the program fund for local health department expenses
173     incurred in responding to a local health emergency under Section 26-1-38.
174          (12) Funds collected from the emergency medical services grant program, as provided
175     in Section 26-8a-207.
176          (13) The primary care grant program created in Section 26-10b-102.
177          (14) Sanctions collected from Medicaid providers under Subsection 26-18-3(7).
178          [(14)] (15) The Prostate Cancer Support Restricted Account created in Section
179     26-21a-303.
180          [(15)] (16) The Children with Cancer Support Restricted Account created in Section
181     26-21a-304.
182          [(16)] (17) State funds appropriated for matching federal funds in the Children's Health
183     Insurance Program as provided in Section 26-40-108.
184          [(17)] (18) The Utah Health Care Workforce Financial Assistance Program created in
185     Section 26-46-102.
186          [(18)] (19) The Rural Physician Loan Repayment Program created in Section
187     26-46a-103.
188          [(19)] (20) The Opiate Overdose Outreach Pilot Program created in Section 26-55-107.
189          [(20)] (21) The Children with Heart Disease Support Restricted Account created in
190     Section 26-58-102.
191          Section 3. Section 63J-1-602.1 (Effective 09/30/18) is amended to read:
192          63J-1-602.1 (Effective 09/30/18). List of nonlapsing accounts and funds -- General
193     authority and Title 1 through Title 30.
194          (1) Appropriations made to the Legislature and its committees.
195          (2) The Utah Intracurricular Student Organization Support for Agricultural Education
196     and Leadership Restricted Account created in Section 4-42-102.
197          (3) The Percent-for-Art Program created in Section 9-6-404.

198          (4) The Native American Repatriation Restricted Account created in Section 9-9-407.
199          (5) The Martin Luther King, Jr. Civil Rights Support Restricted Account created in
200     Section 9-18-102.
201          (6) The National Professional Men's Soccer Team Support of Building Communities
202     Restricted Account created in Section 9-19-102.
203          (7) The LeRay McAllister Critical Land Conservation Program created in Section
204     11-38-301.
205          (8) The Support for State-Owned Shooting Ranges Restricted Account created in
206     Section 23-14-13.5.
207          (9) An appropriation made to the Division of Wildlife Resources for the appraisal and
208     purchase of lands under the Pelican Management Act, as provided in Section 23-21a-6.
209          (10) Award money under the State Asset Forfeiture Grant Program, as provided under
210     Section 24-4-117.
211          (11) Funds collected from the program fund for local health department expenses
212     incurred in responding to a local health emergency under Section 26-1-38.
213          (12) Funds collected from the emergency medical services grant program, as provided
214     in Section 26-8a-207.
215          (13) The primary care grant program created in Section 26-10b-102.
216          (14) Sanctions collected from Medicaid providers under Subsection 26-18-3(7).
217          [(14)] (15) The Children with Cancer Support Restricted Account created in Section
218     26-21a-304.
219          [(15)] (16) State funds appropriated for matching federal funds in the Children's Health
220     Insurance Program as provided in Section 26-40-108.
221          [(16)] (17) The Utah Health Care Workforce Financial Assistance Program created in
222     Section 26-46-102.
223          [(17)] (18) The Rural Physician Loan Repayment Program created in Section
224     26-46a-103.
225          [(18)] (19) The Opiate Overdose Outreach Pilot Program created in Section 26-55-107.

226          [(19)] (20) The Children with Heart Disease Support Restricted Account created in
227     Section 26-58-102.
228          Section 4. Effective date.
229          This bill takes effect on May 8, 2018, except that the amendments to Section
230     63J-1-602.1 (Effective 09/30/18) take effect on September 30, 2018.