1     
MEDICAL BENEFITS RECOVERY AMENDMENTS

2     
2018 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Daniel Hemmert

5     
House Sponsor: Michael S. Kennedy

6     

7     LONG TITLE
8     General Description:
9          This bill amends and enacts provisions related to state recovery of medical assistance
10     benefits.
11     Highlighted Provisions:
12          This bill:
13          ▸     defines terms;
14          ▸     amends and enacts provisions related to recovery of medical assistance from a
15     recipient's estate or trust;
16          ▸     provides for the imposition of a lien, authorized by the federal Tax Equity and
17     Fiscal Responsibility Act of 1982 (TEFRA) against the real property of an
18     individual who is an inpatient in a care facility, during the life of that individual;
19          ▸     establishes procedures, requirements, and exemptions, relating to imposing a
20     TEFRA lien; and
21          ▸     makes technical changes.
22     Money Appropriated in this Bill:
23          None
24     Other Special Clauses:
25          None
26     Utah Code Sections Affected:
27     AMENDS:
28          31A-4-107.5, as enacted by Laws of Utah 2007, Chapter 64
29          31A-22-610, as last amended by Laws of Utah 2007, Chapter 307

30          31A-22-610.5, as last amended by Laws of Utah 2017, Chapters 168 and 292
31          34A-2-417, as last amended by Laws of Utah 2010, Chapter 174
32          34A-2-422, as last amended by Laws of Utah 2007, Chapter 63
33          75-3-803, as last amended by Laws of Utah 2010, Chapter 223
34          75-3-805, as last amended by Laws of Utah 1998, Chapter 145
35          75-7-508, as last amended by Laws of Utah 2014, Chapter 142
36          75-7-511, as renumbered and amended by Laws of Utah 2004, Chapter 89
37     ENACTS:
38          26-19-404, Utah Code Annotated 1953
39          26-19-501, Utah Code Annotated 1953
40          26-19-502, Utah Code Annotated 1953
41          26-19-503, Utah Code Annotated 1953
42          26-19-504, Utah Code Annotated 1953
43          26-19-505, Utah Code Annotated 1953
44          26-19-506, Utah Code Annotated 1953
45          26-19-507, Utah Code Annotated 1953
46          26-19-508, Utah Code Annotated 1953
47          26-19-509, Utah Code Annotated 1953
48          75-3-104.5, Utah Code Annotated 1953
49     RENUMBERS AND AMENDS:
50          26-19-101, (Renumbered from 26-19-1, as enacted by Laws of Utah 1981, Chapter 126)
51          26-19-102, (Renumbered from 26-19-2, as last amended by Laws of Utah 2007,
52     Chapter 64)
53          26-19-103, (Renumbered from 26-19-3, as last amended by Laws of Utah 1984,
54     Chapter 34)
55          26-19-201, (Renumbered from 26-19-4.5, as last amended by Laws of Utah 1998,
56     Chapter 145)
57          26-19-301, (Renumbered from 26-19-4.7, as enacted by Laws of Utah 2007, Chapter

58     64)
59          26-19-302, (Renumbered from 26-19-14, as last amended by Laws of Utah 2017,
60     Chapter 292)
61          26-19-303, (Renumbered from 26-19-9.5, as enacted by Laws of Utah 2004, Chapter
62     72)
63          26-19-304, (Renumbered from 26-19-9, as enacted by Laws of Utah 1993, Chapter 145)
64          26-19-305, (Renumbered from 26-19-8, as last amended by Laws of Utah 2011,
65     Chapter 297)
66          26-19-401, (Renumbered from 26-19-5, as last amended by Laws of Utah 2005,
67     Chapter 103)
68          26-19-402, (Renumbered from 26-19-6, as last amended by Laws of Utah 2009,
69     Chapter 388)
70          26-19-403, (Renumbered from 26-19-7, as last amended by Laws of Utah 2011,
71     Chapter 297)
72          26-19-405, (Renumbered from 26-19-13.5, as last amended by Laws of Utah 2011,
73     Chapter 366)
74          26-19-406, (Renumbered from 26-19-13.7, as enacted by Laws of Utah 1998, Chapter
75     145)
76          26-19-601, (Renumbered from 26-19-9.7, as enacted by Laws of Utah 2004, Chapter
77     72)
78          26-19-602, (Renumbered from 26-19-19, as enacted by Laws of Utah 1998, Chapter
79     145)
80          26-19-603, (Renumbered from 26-19-15, as last amended by Laws of Utah 1984,
81     Chapter 34)
82          26-19-604, (Renumbered from 26-19-16, as enacted by Laws of Utah 1981, Chapter
83     126)
84          26-19-605, (Renumbered from 26-19-17, as last amended by Laws of Utah 1984,
85     Chapter 34)

86     

87     Be it enacted by the Legislature of the state of Utah:
88          Section 1. Section 26-19-101, which is renumbered from Section 26-19-1 is
89     renumbered and amended to read:
90     
Part 1. General Provisions

91          [26-19-1].      26-19-101. Title.
92          This chapter [shall be] is known [and may be cited] as the "Medical Benefits Recovery
93     Act."
94          Section 2. Section 26-19-102, which is renumbered from Section 26-19-2 is
95     renumbered and amended to read:
96          [26-19-2].      26-19-102. Definitions.
97          As used in this chapter:
98          (1) "Annuity" shall have the same meaning as provided in Section 31A-1-301.
99          (2) "Care facility" means:
100          (a) a nursing facility;
101          (b) an intermediate care facility for an individual with an intellectual disability; or
102          (c) any other medical institution.
103          [(2)] (3) "Claim" means:
104          (a) a request or demand for payment; or
105          (b) a cause of action for money or damages arising under any law.
106          [(3)] (4) "Employee welfare benefit plan" means a medical insurance plan developed
107     by an employer under 29 U.S.C. Section 1001, et seq., the Employee Retirement Income
108     Security Act of 1974 as amended.
109          (5) "Health insurance entity" means:
110          (a) an insurer;
111          (b) a person who administers, manages, provides, offers, sells, carries, or underwrites
112     health insurance, as defined in Section 31A-1-301;
113          (c) a self-insured plan;

114          (d) a group health plan, as defined in Subsection 607(1) of the federal Employee
115     Retirement Income Security Act of 1974;
116          (e) a service benefit plan;
117          (f) a managed care organization;
118          (g) a pharmacy benefit manager;
119          (h) an employee welfare benefit plan; or
120          (i) a person who is, by statute, contract, or agreement, legally responsible for payment
121     of a claim for a health care item or service.
122          (6) "Inpatient" means an individual who is a patient and a resident of a care facility.
123          [(6)] (7) "Insurer" includes:
124          (a) a group health plan as defined in Subsection 607(1) of the federal Employee
125     Retirement Income Security Act of 1974;
126          (b) a health maintenance organization; and
127          (c) any entity offering a health service benefit plan.
128          [(7)] (8) "Medical assistance" means:
129          (a) all funds expended for the benefit of a recipient under Title 26, Chapter 18, Medical
130     Assistance Act, or under Titles XVIII and XIX, federal Social Security Act; and
131          (b) any other services provided for the benefit of a recipient by a prepaid health care
132     delivery system under contract with the department.
133          [(8)] (9) "Office of Recovery Services" means the Office of Recovery Services within
134     the Department of Human Services.
135          [(9)] (10) "Provider" means a person or entity who provides services to a recipient.
136          [(10)] (11) "Recipient" means:
137          (a) [a person] an individual who has applied for or received medical assistance from
138     the state;
139          (b) the guardian, conservator, or other personal representative of [a person] an
140     individual under Subsection [(10)] (11)(a) if the [person] individual is a minor or an
141     incapacitated person; or

142          (c) the estate and survivors of [a person] an individual under Subsection [(10)] (11)(a),
143     if the [person] individual is deceased.
144          [(4)] (12) ["Estate] "Recovery estate" means, regarding a deceased recipient:
145          (a) all real and personal property or other assets included within a decedent's estate as
146     defined in Section 75-1-201;
147          (b) the decedent's augmented estate as defined in Section 75-2-203; and
148          (c) that part of other real or personal property in which the decedent had a legal interest
149     at the time of death including assets conveyed to a survivor, heir, or assign of the decedent
150     through joint tenancy, tenancy in common, survivorship, life estate, living trust, or other
151     arrangement.
152          [(11)] (13) "State plan" means the state Medicaid program as enacted in accordance
153     with Title XIX, federal Social Security Act.
154          (14) "TEFRA lien" means a lien, authorized under the Tax Equity and Fiscal
155     Responsibility Act of 1982, against the real property of an individual prior to the individual's
156     death, as described in 42 U.S.C. Sec. 1396p.
157          [(12)] (15) "Third party" includes:
158          (a) an individual, institution, corporation, public or private agency, trust, estate,
159     insurance carrier, employee welfare benefit plan, health maintenance organization, health
160     service organization, preferred provider organization, governmental program such as Medicare,
161     CHAMPUS, and workers' compensation, which may be obligated to pay all or part of the
162     medical costs of injury, disease, or disability of a recipient, unless any of these are excluded by
163     department rule; and
164          (b) a spouse or a parent who:
165          (i) may be obligated to pay all or part of the medical costs of a recipient under law or
166     by court or administrative order; or
167          (ii) has been ordered to maintain health, dental, or accident and health insurance to
168     cover medical expenses of a spouse or dependent child by court or administrative order.
169          [(13)] (16) "Trust" shall have the same meaning as provided in Section 75-1-201.

170          Section 3. Section 26-19-103, which is renumbered from Section 26-19-3 is
171     renumbered and amended to read:
172          [26-19-3].      26-19-103. Program established by department -- Promulgation of
173     rules.
174          (1) The department shall establish and maintain a program for the recoupment of
175     medical assistance.
176          (2) The department may promulgate rules to implement the purposes of this chapter.
177          Section 4. Section 26-19-201, which is renumbered from Section 26-19-4.5 is
178     renumbered and amended to read:
179     
Part 2. Assignment of Rights

180          [26-19-4.5].      26-19-201. Assignment of rights to benefits.
181          (1) (a) To the extent that medical assistance is actually provided to a recipient, all
182     benefits for medical services or payments from a third party otherwise payable to or on behalf
183     of a recipient are assigned by operation of law to the department if the department provides, or
184     becomes obligated to provide, medical assistance, regardless of who made application for the
185     benefits on behalf of the recipient.
186          (b) The assignment:
187          (i) authorizes the department to submit its claim to the third party and authorizes
188     payment of benefits directly to the department; and
189          (ii) is effective for all medical assistance.
190          (2) The department may recover the assigned benefits or payments in accordance with
191     Section [26-19-5] 26-19-401 and as otherwise provided by law.
192          (3) The assignment of benefits includes medical support and third party payments
193     ordered, decreed, or adjudged by any court of this state or any other state or territory of the
194     United States. That assignment is not in lieu of, and does not supersede or alter any other court
195     order, decree, or judgment.
196          (4) When an assignment takes effect, the recipient is entitled to receive medical
197     assistance, and the benefits paid to the department are a reimbursement to the department.

198          Section 5. Section 26-19-301, which is renumbered from Section 26-19-4.7 is
199     renumbered and amended to read:
200     
Part 3. Insurance Provisions

201          [26-19-4.7].      26-19-301. Health insurance entity -- Duties related to state claims
202     for Medicaid payment or recovery.
203          As a condition of doing business in the state, a health insurance entity shall:
204          (1) with respect to [a person] an individual who is eligible for, or is provided, medical
205     assistance under the state plan, upon the request of the Department of Health, provide
206     information to determine:
207          (a) during what period the [person] individual, or the spouse or dependent of the
208     [person] individual, may be or may have been, covered by the health insurance entity; and
209          (b) the nature of the coverage that is or was provided by the health insurance entity
210     described in Subsection (1)(a), including the name, address, and identifying number of the
211     plan;
212          (2) accept the state's right of recovery and the assignment to the state of any right of [a
213     person] an individual to payment from a party for an item or service for which payment has
214     been made under the state plan;
215          (3) respond to any inquiry by the Department of Health regarding a claim for payment
216     for any health care item or service that is submitted no later than three years after the day on
217     which the health care item or service is provided; and
218          (4) not deny a claim submitted by the Department of Health solely on the basis of the
219     date of submission of the claim, the type or format of the claim form, or failure to present
220     proper documentation at the point-of-sale that is the basis for the claim, if:
221          (a) the claim is submitted no later than three years after the day on which the item or
222     service is furnished; and
223          (b) any action by the Department of Health to enforce the rights of the state with
224     respect to the claim is commenced no later than six years after the day on which the claim is
225     submitted.

226          Section 6. Section 26-19-302, which is renumbered from Section 26-19-14 is
227     renumbered and amended to read:
228          [26-19-14].      26-19-302. Insurance policies not to deny or reduce benefits of
229     individuals eligible for state medical assistance -- Exemptions.
230          (1) A policy of accident or sickness insurance may not contain any provision denying
231     or reducing benefits because services are rendered to an insured or dependent who is eligible
232     for or receiving medical assistance from the state.
233          (2) An association, corporation, or organization may not deliver, issue for delivery, or
234     renew any subscriber's contract which contains any provisions denying or reducing benefits
235     because services are rendered to a subscriber or dependent who is eligible for or receiving
236     medical assistance from the state.
237          (3) An association, corporation, business, or organization authorized to do business in
238     this state and which provides or pays for any health care benefits may not deny or reduce
239     benefits because services are rendered to a beneficiary who is eligible for or receiving medical
240     assistance from the state.
241          (4) Notwithstanding Subsection (1), (2), or (3), the Utah State Public Employees
242     Health Program, administered by the Utah State Retirement Board, is not required to reimburse
243     any agency of state government for custodial care which the agency provides, through its staff
244     or facilities, to members of the Utah State Public Employees Health Program.
245          Section 7. Section 26-19-303, which is renumbered from Section 26-19-9.5 is
246     renumbered and amended to read:
247          [26-19-9.5].      26-19-303. Availability of insurance policy.
248          If the third party does not pay the department's claim or lien within 30 days from the
249     date the claim or lien is received, the third party shall:
250          (1) provide a written explanation if the claim is denied;
251          (2) specifically describe and request any additional information from the department
252     that is necessary to process the claim; and
253          (3) provide the department or its agent a copy of any relevant or applicable insurance

254     or benefit policy.
255          Section 8. Section 26-19-304, which is renumbered from Section 26-19-9 is
256     renumbered and amended to read:
257          [26-19-9].      26-19-304. Employee benefit plans.
258          As allowed pursuant to 29 U.S.C. Section 1144, an employee benefit plan may not
259     include any provision that has the effect of limiting or excluding coverage or payment for any
260     health care for an individual who would otherwise be covered or entitled to benefits or services
261     under the terms of the employee benefit plan based on the fact that the individual is eligible for
262     or is provided services under the state plan.
263          Section 9. Section 26-19-305, which is renumbered from Section 26-19-8 is
264     renumbered and amended to read:
265          [26-19-8].      26-19-305. Statute of limitations -- Survival of right of action --
266     Insurance policy not to limit time allowed for recovery.
267          (1) (a) Subject to Subsection (6), action commenced by the department under this
268     chapter against a health insurance entity shall be commenced within:
269          (i) subject to Subsection (7), six years after the day on which the department submits
270     the claim for recovery or payment for the health care item or service upon which the action is
271     based; or
272          (ii) six months after the date of the last payment for medical assistance, whichever is
273     later.
274          (b) An action against any other third party, the recipient, or anyone to whom the
275     proceeds are payable shall be commenced within:
276          (i) four years after the date of the injury or onset of the illness; or
277          (ii) six months after the date of the last payment for medical assistance, whichever is
278     later.
279          (2) The death of the recipient does not abate any right of action established by this
280     chapter.
281          (3) (a) No insurance policy issued or renewed after June 1, 1981, may contain any

282     provision that limits the time in which the department may submit its claim to recover medical
283     assistance benefits to a period of less than 24 months from the date the provider furnishes
284     services or goods to the recipient.
285          (b) No insurance policy issued or renewed after April 30, 2007, may contain any
286     provision that limits the time in which the department may submit its claim to recover medical
287     assistance benefits to a period of less than that described in Subsection (1)(a).
288          (4) The provisions of this section do not apply to Section [26-19-13.5] 26-19-405 or
289     Part 5, TEFRA Liens.
290          (5) The provisions of this section supercede any other sections regarding the time limit
291     in which an action shall be commenced, including Section 75-7-509.
292          (6) (a) Subsection (1)(a) extends the statute of limitations on a cause of action
293     described in Subsection (1)(a) that was not time-barred on or before April 30, 2007.
294          (b) Subsection (1)(a) does not revive a cause of action that was time-barred on or
295     before April 30, 2007.
296          (7) An action described in Subsection (1)(a) may not be commenced if the claim for
297     recovery or payment described in Subsection (1)(a)(i) is submitted later than three years after
298     the day on which the health care item or service upon which the claim is based was provided.
299          Section 10. Section 26-19-401, which is renumbered from Section 26-19-5 is
300     renumbered and amended to read:
301     
Part 4. General Recovery Provisions

302          [26-19-5].      26-19-401. Recovery of medical assistance from third party -- Lien
303     -- Notice -- Action -- Compromise or waiver -- Recipient's right to action protected.
304          (1) (a) When the department provides or becomes obligated to provide medical
305     assistance to a recipient that a third party is obligated to pay for, the department may recover
306     the medical assistance directly from that third party.
307          (b) Any claim arising under Subsection (1)(a) or Section [26-19-4.5] 26-19-201 to
308     recover medical assistance provided to a recipient is a lien against any proceeds payable to or
309     on behalf of the recipient by that third party. This lien has priority over all other claims to the

310     proceeds, except claims for [attorney's] attorney fees and costs authorized under Subsection
311     [26-19-7] 26-19-403(2)(c)(ii).
312          (2) (a) The department shall mail or deliver written notice of its claim or lien to the
313     third party at its principal place of business or last-known address.
314          (b) The notice shall include:
315          (i) the recipient's name;
316          (ii) the approximate date of illness or injury;
317          (iii) a general description of the type of illness or injury; and
318          (iv) if applicable, the general location where the injury is alleged to have occurred.
319          (3) The department may commence an action on its claim or lien in its own name, but
320     that claim or lien is not enforceable as to a third party unless:
321          (a) the third party receives written notice of the department's claim or lien before it
322     settles with the recipient; or
323          (b) the department has evidence that the third party had knowledge that the department
324     provided or was obligated to provide medical assistance.
325          (4) The department may:
326          (a) waive a claim or lien against a third party in whole or in part; or
327          (b) compromise, settle, or release a claim or lien.
328          (5) An action commenced under this section does not bar an action by a recipient or a
329     dependent of a recipient for loss or damage not included in the department's action.
330          (6) The department's claim or lien on proceeds under this section is not affected by the
331     transfer of the proceeds to a trust, annuity, financial account, or other financial instrument.
332          Section 11. Section 26-19-402, which is renumbered from Section 26-19-6 is
333     renumbered and amended to read:
334          [26-19-6].      26-19-402. Action by department -- Notice to recipient.
335          (1) (a) Within 30 days after commencing an action under Subsection [26-19-5]
336     26-19-401(3), the department shall give the recipient, [his] the recipient's guardian, personal
337     representative, trustee, estate, or survivor, whichever is appropriate, written notice of the action

338     by:
339          (i) personal service or certified mail to the last known address of the person receiving
340     the notice; or
341          (ii) if no last-known address is available, by publishing a notice:
342          (A) once a week for three successive weeks in a newspaper of general circulation in the
343     county where the recipient resides; and
344          (B) in accordance with Section 45-1-101 for three weeks.
345          (b) Proof of service shall be filed in the action.
346          (c) The recipient may intervene in the department's action at any time before trial.
347          (2) The notice required by Subsection (1) shall name the court in which the action is
348     commenced and advise the recipient of:
349          (a) the right to intervene in the proceeding;
350          (b) the right to obtain a private attorney; and
351          (c) the department's right to recover medical assistance directly from the third party.
352          Section 12. Section 26-19-403, which is renumbered from Section 26-19-7 is
353     renumbered and amended to read:
354          [26-19-7].      26-19-403. Notice of claim by recipient -- Department response --
355     Conditions for proceeding -- Collection agreements.
356          (1) (a) A recipient may not file a claim, commence an action, or settle, compromise,
357     release, or waive a claim against a third party for recovery of medical costs for an injury,
358     disease, or disability for which the department has provided or has become obligated to provide
359     medical assistance, without the department's written consent as provided in Subsection (2)(b)
360     or (4).
361          (b) For purposes of Subsection (1)(a), consent may be obtained if:
362          (i) a recipient who files a claim, or commences an action against a third party notifies
363     the department in accordance with Subsection (1)(d) within 10 days of the recipient making the
364     claim or commencing an action; or
365          (ii) an attorney, who has been retained by the recipient to file a claim, or commence an

366     action against a third party, notifies the department in accordance with Subsection (1)(d) of the
367     recipient's claim:
368          (A) within 30 days after being retained by the recipient for that purpose; or
369          (B) within 30 days from the date the attorney either knew or should have known that
370     the recipient received medical assistance from the department.
371          (c) Service of the notice of claim to the department shall be made by certified mail,
372     personal service, or by e-mail in accordance with Rule 5 of the Utah Rules of Civil Procedure,
373     to the director of the Office of Recovery Services.
374          (d) The notice of claim shall include the following information:
375          (i) the name of the recipient;
376          (ii) the recipient's Social Security number;
377          (iii) the recipient's date of birth;
378          (iv) the name of the recipient's attorney if applicable;
379          (v) the name or names of individuals or entities against whom the recipient is making
380     the claim, if known;
381          (vi) the name of the third party's insurance carrier, if known;
382          (vii) the date of the incident giving rise to the claim; and
383          (viii) a short statement identifying the nature of the recipient's claim.
384          (2) (a) Within 30 days of receipt of the notice of the claim required in Subsection (1),
385     the department shall acknowledge receipt of the notice of the claim to the recipient or the
386     recipient's attorney and shall notify the recipient or the recipient's attorney in writing of the
387     following:
388          (i) if the department has a claim or lien pursuant to Section [26-19-5] 26-19-401 or has
389     become obligated to provide medical assistance; and
390          (ii) whether the department is denying or granting written consent in accordance with
391     Subsection (1)(a).
392          (b) The department shall provide the recipient's attorney the opportunity to enter into a
393     collection agreement with the department, with the recipient's consent, unless:

394          (i) the department, prior to the receipt of the notice of the recipient's claim pursuant to
395     Subsection (1), filed a written claim with the third party, the third party agreed to make
396     payment to the department before the date the department received notice of the recipient's
397     claim, and the agreement is documented in the department's record; or
398          (ii) there has been a failure by the recipient's attorney to comply with any provision of
399     this section by:
400          (A) failing to comply with the notice provisions of this section;
401          (B) failing or refusing to enter into a collection agreement;
402          (C) failing to comply with the terms of a collection agreement with the department; or
403          (D) failing to disburse funds owed to the state in accordance with this section.
404          (c) (i) The collection agreement shall be:
405          (A) consistent with this section and the attorney's obligation to represent the recipient
406     and represent the state's claim; and
407          (B) state the terms under which the interests of the department may be represented in
408     an action commenced by the recipient.
409          (ii) If the recipient's attorney enters into a written collection agreement with the
410     department, or includes the department's claim in the recipient's claim or action pursuant to
411     Subsection (4), the department shall pay [attorney's] attorney fees at the rate of 33.3% of the
412     department's total recovery and shall pay a proportionate share of the litigation expenses
413     directly related to the action.
414          (d) The department is not required to enter into a collection agreement with the
415     recipient's attorney for collection of personal injury protection under Subsection
416     31A-22-302(2).
417          (3) (a) If the department receives notice pursuant to Subsection (1), and notifies the
418     recipient and the recipient's attorney that the department will not enter into a collection
419     agreement with the recipient's attorney, the recipient may proceed with the recipient's claim or
420     action against the third party if the recipient excludes from the claim:
421          (i) any medical expenses paid by the department; or

422          (ii) any medical costs for which the department is obligated to provide medical
423     assistance.
424          (b) When a recipient proceeds with a claim under Subsection (3)(a), the recipient shall
425     provide written notice to the third party of the exclusion of the department's claim for expenses
426     under Subsection (3)(a)(i) or (ii).
427          (4) If the department receives notice pursuant to Subsection (1), and does not respond
428     within 30 days to the recipient or the recipient's attorney, the recipient or the recipient's
429     attorney:
430          (a) may proceed with the recipient's claim or action against the third party;
431          (b) may include the state's claim in the recipient's claim or action; and
432          (c) may not negotiate, compromise, settle, or waive the department's claim without the
433     department's consent.
434          [(5) The department has an unconditional right to intervene in an action commenced by
435     a recipient against a third party for the purpose of recovering medical costs for which the
436     department has provided or has become obligated to provide medical assistance.]
437          [(6) (a) If the recipient proceeds without complying with the provisions of this section,
438     the department is not bound by any decision, judgment, agreement, settlement, or compromise
439     rendered or made on the claim or in the action.]
440          [(b) The department may recover in full from the recipient or any party to which the
441     proceeds were made payable all medical assistance which it has provided and retains its right to
442     commence an independent action against the third party, subject to Subsection 26-19-5(3).]
443          [(7) Any amounts assigned to and recoverable by the department pursuant to Sections
444     26-19-4.5 and 26-19-5 collected directly by the recipient shall be remitted to the Bureau of
445     Medical Collections within the Office of Recovery Services no later than five business days
446     after receipt.]
447          [(8) (a) Any amounts assigned to and recoverable by the department pursuant to
448     Sections 26-19-4.5 and 26-19-5 collected directly by the recipient's attorney shall be remitted to
449     the Bureau of Medical Collections within the Office of Recovery Services no later than 30 days

450     after the funds are placed in the attorney's trust account.]
451          [(b) The date by which the funds shall be remitted to the department may be modified
452     based on agreement between the department and the recipient's attorney.]
453          [(c) The department's consent to another date for remittance may not be unreasonably
454     withheld.]
455          [(d) If the funds are received by the recipient's attorney, no disbursements shall be
456     made to the recipient or the recipient's attorney until the department's claim has been paid.]
457          [(9) A recipient or recipient's attorney who knowingly and intentionally fails to comply
458     with this section is liable to the department for:]
459          [(a) the amount of the department's claim or lien pursuant to Subsection (5);]
460          [(b) a penalty equal to 10% of the amount of the department's claim; and]
461          [(c) attorney fees and litigation expenses related to recovering the department's claim.]
462          Section 13. Section 26-19-404 is enacted to read:
463          26-19-404. Department's right to intervene -- Department's interests protected --
464     Remitting funds -- Disbursements -- Liability and penalty for noncompliance.
465          (1) The department has an unconditional right to intervene in an action commenced by
466     a recipient against a third party for the purpose of recovering medical costs for which the
467     department has provided or has become obligated to provide medical assistance.
468          (2) (a) If the recipient proceeds without complying with the provisions of Section
469     26-19-403, the department is not bound by any decision, judgment, agreement, settlement, or
470     compromise rendered or made on the claim or in the action.
471          (b) The department:
472          (i) may recover in full from the recipient, or any party to which the proceeds were
473     made payable, all medical assistance that the department has provided; and
474          (ii) retains its right to commence an independent action against the third party, subject
475     to Subsection 26-19-401(3).
476          (3) Any amounts assigned to and recoverable by the department pursuant to Sections
477     26-19-201 and 26-19-401 collected directly by the recipient shall be remitted to the Bureau of

478     Medical Collections within the Office of Recovery Services no later than five business days
479     after receipt.
480          (4) (a) Any amounts assigned to and recoverable by the department pursuant to
481     Sections 26-19-201 and 26-19-401 collected directly by the recipient's attorney shall be
482     remitted to the Bureau of Medical Collections within the Office of Recovery Services no later
483     than 30 days after the funds are placed in the attorney's trust account.
484          (b) The date by which the funds shall be remitted to the department may be modified
485     based on agreement between the department and the recipient's attorney.
486          (c) The department's consent to another date for remittance may not be unreasonably
487     withheld.
488          (d) If the funds are received by the recipient's attorney, no disbursements shall be made
489     to the recipient or the recipient's attorney until the department's claim has been paid.
490          (5) A recipient or recipient's attorney who knowingly and intentionally fails to comply
491     with this section is liable to the department for:
492          (a) the amount of the department's claim or lien pursuant to Subsection (1);
493          (b) a penalty equal to 10% of the amount of the department's claim; and
494          (c) attorney fees and litigation expenses related to recovering the department's claim.
495          Section 14. Section 26-19-405, which is renumbered from Section 26-19-13.5 is
496     renumbered and amended to read:
497          [26-19-13.5].      26-19-405. Estate and trust recovery.
498          (1) [Upon] (a) Except as provided in Subsection (1)(b), upon a recipient's death, the
499     department may recover from the recipient's recovery estate and any trust, in which the
500     recipient is the grantor and a beneficiary, medical assistance correctly provided for the benefit
501     of the recipient when the recipient was 55 years of age or older [if, at the time of death, the
502     recipient has no:].
503          [(a) surviving spouse; or]
504          [(b) child:]
505          [(i) younger than 21 years of age; or]

506          [(ii) who is blind or has a permanent and total disability.]
507          (b) The department may not make an adjustment or a recovery under Subsection (1)(a):
508          (i) while the deceased recipient's spouse is still living; or
509          (ii) if the deceased recipient has a surviving child who is:
510          (A) under age 21; or
511          (B) blind or disabled, as defined in the state plan.
512          (2) (a) The amount of [medial] medical assistance correctly provided for the benefit of
513     a recipient and recoverable under this section is a lien against the deceased recipient's recovery
514     estate [of the deceased recipient] or any trust when the recipient is the grantor and a
515     beneficiary.
516          (b) The lien holds the same priority as reasonable and necessary medical expenses of
517     the last illness as provided in Section 75-3-805.
518          [(3) (a) The department shall perfect the lien by filing a notice in the court of
519     appropriate jurisdiction for the amount of the lien, in the same manner as a creditor's claim is
520     filed, prior to final distribution.]
521          [(b) The department may file an amended lien prior to the entry of the final order
522     closing the estate.]
523          (3) (a) For a lien described in Subsection (2), the department shall provide notice in
524     accordance with Section 38-12-102.
525          (b) Before final distribution, the department shall perfect the lien as follows:
526          (i) for an estate, by presenting the lien to the estate's personal representative in
527     accordance with Section 75-3-804; and
528          (ii) for a trust, by presenting the lien to the trustee in accordance with Section
529     75-7-510.
530          (c) The department may file an amended lien before the entry of the final order to close
531     the estate or trust.
532          (4) Claims against a deceased recipient's inter vivos trust shall be presented in
533     accordance with Sections 75-7-509 and 75-7-510.

534          (5) Any trust provision that denies recovery for medical assistance is void at the time of
535     its making.
536          (6) Nothing in this section affects the right of the department to recover Medicaid
537     assistance before a recipient's death under Section [26-19-4.5] 26-19-201 or Section
538     [26-19-13.7] 26-19-406.
539          (7) A lien imposed under this section is of indefinite duration.
540          Section 15. Section 26-19-406, which is renumbered from Section 26-19-13.7 is
541     renumbered and amended to read:
542          [26-19-13.7].      26-19-406. Recovery from recipient of incorrectly provided
543     medical assistance.
544          The department may:
545          (1) recover medical assistance incorrectly provided, whether due to administrative or
546     factual error or fraud, from the recipient or [his] the recipient's recovery estate; and
547          (2) pursuant to a judgment, impose a lien against real property of the recipient.
548          Section 16. Section 26-19-501 is enacted to read:
549     
Part 5. TEFRA Liens

550          26-19-501. TEFRA liens authorized -- Grounds for TEFRA liens -- Exemptions.
551          (1) Except as provided in Subsections (2) and (3), the department may impose a
552     TEFRA lien on the real property of an individual for the amount of medical assistance provided
553     for, or to, the individual while the individual is an inpatient in a care facility, if:
554          (a) the individual is an inpatient in a care facility;
555          (b) the individual is required, as a condition of receiving services under the state plan,
556     to spend for costs of medical care all but a minimal amount of the individual's income required
557     for personal needs; and
558          (c) the department determines that the individual cannot reasonably be expected to:
559          (i) be discharged from the care facility; and
560          (ii) return to the individual's home.
561          (2) The department may not impose a lien on the home of an individual described in

562     Subsection (1), if any of the following individuals are lawfully residing in the home:
563          (a) the spouse of the individual;
564          (b) a child of the individual, if the child is:
565          (i) under 21 years of age; or
566          (ii) blind or permanently and totally disabled, as defined in Title 42 U.S.C. Sec.
567     1382c(a)(3)(F); or
568          (c) a sibling of the individual, if the sibling:
569          (i) has an equity interest in the home; and
570          (ii) resided in the home for at least one year immediately preceding the day on which
571     the individual was admitted to the care facility.
572          (3) The department may not impose a TEFRA lien on the real property of an
573     individual, unless:
574          (a) the individual has been an inpatient in a care facility for the 180-day period
575     immediately preceding the day on which the lien is imposed;
576          (b) the department serves:
577          (i) a preliminary notice of intent to impose a TEFRA lien relating to the real property,
578     in accordance with Section 26-19-503; and
579          (ii) a final notice of intent to impose a TEFRA lien relating to the real property, in
580     accordance with Section 26-19-504; and
581          (c) (i) the individual does not file a timely request for review of the department's
582     decision under Title 63G, Chapter 4, Administrative Procedures Act; or
583          (ii) the department's decision is upheld upon final review or appeal under Title 63G,
584     Chapter 4, Administrative Procedures Act.
585          Section 17. Section 26-19-502 is enacted to read:
586          26-19-502. Presumption of permanency.
587          There is a rebuttable presumption that an individual who is an inpatient in a care facility
588     cannot reasonably be expected to be discharged from a care facility and return to the
589     individual's home, if the individual has been an inpatient in a care facility for a period of at

590     least 180 consecutive days.
591          Section 18. Section 26-19-503 is enacted to read:
592          26-19-503. Preliminary notice of intent to impose a TEFRA lien.
593          (1) Prior to imposing a TEFRA lien on real property, the department shall serve a
594     preliminary notice of intent to impose a TEFRA lien, on the individual described in Subsection
595     26-19-501(1), who owns the property.
596          (2) The preliminary notice of intent shall:
597          (a) be served in person, or by certified mail, on the individual described in Subsection
598     26-19-501(1), and, if the department is aware that the individual has a legally authorized
599     representative, on the representative;
600          (b) include a statement indicating that, according to the department's records, the
601     individual:
602          (i) meets the criteria described in Subsections 26-19-501(1)(a) and (b);
603          (ii) has been an inpatient in a care facility for a period of at least 180 days immediately
604     preceding the day on which the department provides the notice to the individual; and
605          (iii) is legally presumed to be in a condition where it cannot reasonably be expected
606     that the individual will be discharged from the care facility and return to the individual's home;
607          (c) indicate that the department intends to impose a TEFRA lien on real property
608     belonging to the individual;
609          (d) describe the real property that the TEFRA lien will apply to;
610          (e) describe the current amount of, and purpose of, the TEFRA lien;
611          (f) indicate that the amount of the lien may continue to increase as the individual
612     continues to receive medical assistance;
613          (g) indicate that the individual may seek to prevent the TEFRA lien from being
614     imposed on the real property by providing documentation to the department that:
615          (i) establishes that the individual does not meet the criteria described in Subsection
616     26-19-501(1)(a) or (b);
617          (ii) establishes that the individual has not been an inpatient in a care facility for a

618     period of at least 180 days;
619          (iii) rebuts the presumption described in Section 26-19-502; or
620          (iv) establishes that the real property is exempt from imposition of a TEFRA lien under
621     Subsection 26-19-501(2);
622          (h) indicate that if the owner fails to provide the documentation described in
623     Subsection (2)(g) within 30 days after the day on which the preliminary notice of intent is
624     served, the department will issue a final notice of intent to impose a TEFRA lien on the real
625     property and will proceed to impose the lien;
626          (i) identify the type of documentation that the owner may provide to comply with
627     Subsection (2)(g);
628          (j) describe the circumstances under which a TEFRA lien is required to be released;
629     and
630          (k) describe the circumstances under which the department may seek to recover the
631     lien.
632          Section 19. Section 26-19-504 is enacted to read:
633          26-19-504. Final notice of intent to impose a TEFRA lien.
634          (1) The department may issue a final notice of intent to impose a TEFRA lien on real
635     property if:
636          (a) a preliminary notice of intent relating to the property is served in accordance with
637     Section 26-19-503;
638          (b) it is at least 30 days after the day on which the preliminary notice of intent was
639     served; and
640          (c) the department has not received documentation or other evidence that adequately
641     establishes that a TEFRA lien may not be imposed on the real property.
642          (2) The final notice of intent to impose a TEFRA lien on real property shall:
643          (a) be served in person, or by certified mail, on the individual described in Subsection
644     26-19-501(1), who owns the property, and, if the department is aware that the individual has a
645     legally authorized representative, on the representative;

646          (b) indicate that the department has complied with the requirements for filing the final
647     notice of intent under Subsection (1);
648          (c) include a statement indicating that, according to the department's records, the
649     individual:
650          (i) meets the criteria described in Subsections 26-19-501(1)(a) and (b);
651          (ii) has been an inpatient in a care facility for a period of at least 180 days immediately
652     preceding the day on which the department provides the notice to the individual; and
653          (iii) is legally presumed to be in a condition where it cannot reasonably be expected
654     that the individual will be discharged from the care facility and return to the individual's home;
655          (d) indicate that the department intends to impose a TEFRA lien on real property
656     belonging to the individual;
657          (e) describe the real property that the TEFRA lien will apply to;
658          (f) describe the current amount of, and purpose of, the TEFRA lien;
659          (g) indicate that the amount of the lien may continue to increase as the individual
660     continues to receive medical assistance;
661          (h) describe the circumstances under which a TEFRA lien is required to be released;
662          (i) describe the circumstances under which the department may seek to recover the
663     lien;
664          (j) describe the right of the individual to challenge the decision of the department in an
665     adjudicative proceeding; and
666          (k) indicate that failure by the individual to successfully challenge the decision of the
667     department will result in the TEFRA lien being imposed.
668          Section 20. Section 26-19-505 is enacted to read:
669          26-19-505. Review of department decision.
670          An individual who has been served with a final notice of intent to impose a TEFRA lien
671     under Section 26-19-504 may seek agency or judicial review of that decision under Title 63G,
672     Chapter 4, Administrative Procedures Act.
673          Section 21. Section 26-19-506 is enacted to read:

674          26-19-506. Dissolution and removal of TEFRA lien.
675          (1) A TEFRA lien shall dissolve and be removed by the department if the individual
676     described in Subsection 26-19-501(1):
677          (a) (i) is discharged from the care facility; and
678          (ii) returns to the individual's home; or
679          (b) provides sufficient documentation to the department that:
680          (i) rebuts the presumption described in Section 26-19-502; or
681          (ii) any of the following individuals are lawfully residing in the individual's home:
682          (A) the spouse of the individual;
683          (B) a child of the individual, if the child is under 21 years of age or blind or
684     permanently and totally disabled, as defined in Title 42 U.S.C. Sec. 1382c(a)(3)(F); or
685          (C) a sibling of the individual, if the sibling has an equity interest in the home and
686     resided in the home for at least one year immediately preceding the day on which the individual
687     was admitted to the care facility.
688          (2) An individual described in Subsection 26-19-501(1)(a) may, at any time after the
689     department has imposed a lien under this part, file a request for the department to remove the
690     lien.
691          (3) A request filed under Subsection (2) shall be considered and reviewed pursuant to
692     Title 63G, Chapter 4, Administrative Procedures Act.
693          Section 22. Section 26-19-507 is enacted to read:
694          26-19-507. Expenditures included in lien -- Other proceedings.
695          (1) A TEFRA lien imposed on real property under this part includes all expenses
696     relating to medical assistance provided or paid for under the state plan from the first day that
697     the individual is placed in a care facility, regardless of when the lien is imposed or filed on the
698     property.
699          (2) Nothing in this part affects or prevents the department from bringing or pursuing
700     any other legally authorized action to recover medical assistance or to set aside a fraudulent or
701     improper conveyance.

702          Section 23. Section 26-19-508 is enacted to read:
703          26-19-508. Contract with another government agency.
704          If the department contracts with another government agency to recover funds paid for
705     medical assistance under this chapter, that government agency shall be the sole agency that
706     determines whether to impose or remove a TEFRA lien under this part.
707          Section 24. Section 26-19-509 is enacted to read:
708          26-19-509. Precedence of the Tax Equity and Fiscal Responsibility Act of 1982.
709          If any provision of this part conflicts with the requirements of the Tax Equity and Fiscal
710     Responsibility Act of 1982 for imposing a lien against the property of an individual prior to the
711     individual's death, under 42 U.S.C. Sec. 1396p, the provisions of the Tax Equity and Fiscal
712     Responsibility Act of 1982 take precedence and shall be complied with by the department.
713          Section 25. Section 26-19-601, which is renumbered from Section 26-19-9.7 is
714     renumbered and amended to read:
715     
Part 6. Miscellaneous Provisions

716          [26-19-9.7].      26-19-601. Legal recognition of electronic claims records.
717          Pursuant to Title 46, Chapter 4, Uniform Electronic Transactions Act:
718          (1) a claim submitted to the department for payment may not be denied legal effect,
719     enforceability, or admissibility as evidence in any court in any civil action because it is in
720     electronic form; and
721          (2) a third party shall accept an electronic record of payments by the department for
722     medical services on behalf of a recipient as evidence in support of the department's claim.
723          Section 26. Section 26-19-602, which is renumbered from Section 26-19-19 is
724     renumbered and amended to read:
725          [26-19-19].      26-19-602. Direct payment to the department by third party.
726          (1) Any third party required to make payment to the department pursuant to this
727     chapter shall make the payment directly to the department or its designee.
728          (2) The department may negotiate a payment or payment instrument it receives in
729     connection with Subsection (1) without the cosignature or other participation of the recipient or

730     any other party.
731          Section 27. Section 26-19-603, which is renumbered from Section 26-19-15 is
732     renumbered and amended to read:
733          [26-19-15].      26-19-603. Attorney general or county attorney to represent
734     department.
735          The attorney general or a county attorney shall represent the department in any action
736     commenced under this chapter.
737          Section 28. Section 26-19-604, which is renumbered from Section 26-19-16 is
738     renumbered and amended to read:
739          [26-19-16].      26-19-604. Department's right to attorney fees and costs.
740          In any action brought by the department under this chapter in which it prevails, the
741     department shall recover along with the principal sum and interest, a reasonable [attorney's]
742     attorney fee and costs incurred.
743          Section 29. Section 26-19-605, which is renumbered from Section 26-19-17 is
744     renumbered and amended to read:
745          [26-19-17].      26-19-605. Application of provisions contrary to federal law
746     prohibited.
747          In no event shall any provision contained in this chapter be applied contrary to existing
748     federal law.
749          Section 30. Section 31A-4-107.5 is amended to read:
750          31A-4-107.5. Penalty for failure of a regulated health insurance entity to fulfill
751     duties related to state claims for Medicaid payment or recovery.
752          (1) For purposes of this section, "regulated health insurance entity" means a health
753     insurance entity, as defined in Section [26-19-2] 26-19-102, that is subject to regulation by the
754     department.
755          (2) If a regulated health insurance entity fails to comply with the provisions of Section
756     [26-19-4.7] 26-19-301:
757          (a) the commissioner may revoke or suspend, in whole or in part, a license, certificate

758     of authority, registration, or other authority that is granted by the commissioner to the regulated
759     health insurance entity; and
760          (b) the regulated health insurance entity is subject to the penalties and procedures
761     provided for in Section 31A-2-308.
762          Section 31. Section 31A-22-610 is amended to read:
763          31A-22-610. Dependent coverage from moment of birth or adoption.
764          (1) As used in this section:
765          (a) "Child" means, in connection with any adoption, or placement for adoption of the
766     child, an individual who is younger than 18 years of age as of the date of the adoption or
767     placement for adoption.
768          (b) "Placement for adoption" means the assumption and retention by a person of a legal
769     obligation for total or partial support of a child in anticipation of the adoption of the child.
770          (2) (a) Except as provided in Subsection (5), if an accident and health insurance policy
771     provides coverage for any members of the policyholder's or certificate holder's family, the
772     policy shall provide that any health insurance benefits applicable to dependents of the insured
773     are applicable on the same basis to:
774          (i) a newly born child from the moment of birth; and
775          (ii) an adopted child:
776          (A) beginning from the moment of birth, if placement for adoption occurs within 30
777     days of the child's birth; or
778          (B) beginning from the date of placement, if placement for adoption occurs 30 days or
779     more after the child's birth.
780          (b) The coverage described in this Subsection (2):
781          (i) is not subject to any preexisting conditions; and
782          (ii) includes any injury or sickness, including the necessary care and treatment of
783     medically diagnosed:
784          (A) congenital defects;
785          (B) birth abnormalities; or

786          (C) prematurity.
787          (c) (i) Subject to Subsection (2)(c)(ii), a claim for services for a newly born child or an
788     adopted child may be denied until the child is enrolled.
789          (ii) Notwithstanding Subsection (2)(c)(i), an otherwise eligible claim denied under
790     Subsection (2)(c)(i) is eligible for payment and may be resubmitted or reprocessed once a child
791     is enrolled pursuant to Subsection (2)(d) or (e).
792          (d) If the payment of a specific premium is required to provide coverage for a child of a
793     policyholder or certificate holder, for there to be coverage for the child, the policyholder or
794     certificate holder shall enroll:
795          (i) a newly born child within 30 days after the date of birth of the child; or
796          (ii) an adopted child within 30 days after the day of placement of adoption.
797          (e) If the payment of a specific premium is not required to provide coverage for a child
798     of a policyholder or certificate holder, for the child to receive coverage the policyholder or
799     certificate holder shall enroll a newly born child or an adopted child no later than 30 days after
800     the first notification of denial of a claim for services for that child.
801          (3) (a) The coverage required by Subsection (2) as to children placed for the purpose of
802     adoption with a policyholder or certificate holder continues in the same manner as it would
803     with respect to a child of the policyholder or certificate holder unless:
804          (i) the placement is disrupted prior to legal adoption; and
805          (ii) the child is removed from placement.
806          (b) The coverage required by Subsection (2) ends if the child is removed from
807     placement prior to being legally adopted.
808          (4) The provisions of this section apply to employee welfare benefit plans as defined in
809     Section [26-19-2] 26-19-102.
810          (5) If an accident and health insurance policy that is not subject to the special
811     enrollment rights described in 45 C.F.R. Sec. 146.117(b) provides coverage for one individual,
812     the insurer may choose to:
813          (a) provide coverage according to this section; or

814          (b) allow application, subject to the insurer's underwriting criteria for:
815          (i) a newborn;
816          (ii) an adopted child; or
817          (iii) a child placed for adoption.
818          Section 32. Section 31A-22-610.5 is amended to read:
819          31A-22-610.5. Dependent coverage.
820          (1) As used in this section, "child" has the same meaning as defined in Section
821     78B-12-102.
822          (2) (a) Any individual or group accident and health insurance policy or managed care
823     organization contract that provides coverage for a policyholder's or certificate holder's
824     dependent may not terminate coverage of an unmarried dependent by reason of the dependent's
825     age before the dependent's 26th birthday and shall, upon application, provide coverage for all
826     unmarried dependents up to age 26.
827          (b) The cost of coverage for unmarried dependents 19 to 26 years of age shall be
828     included in the premium on the same basis as other dependent coverage.
829          (c) This section does not prohibit the employer from requiring the employee to pay all
830     or part of the cost of coverage for unmarried dependents.
831          (d) An individual or group health insurance policy or managed care organization shall
832     continue in force coverage for a dependent through the last day of the month in which the
833     dependent ceases to be a dependent:
834          (i) if premiums are paid; and
835          (ii) notwithstanding Sections 31A-22-618.6 and 31A-22-618.7.
836          (3) (a) When a parent is required by a court or administrative order to provide health
837     insurance coverage for a child, an accident and health insurer may not deny enrollment of a
838     child under the accident and health insurance plan of the child's parent on the grounds the
839     child:
840          (i) was born out of wedlock and is entitled to coverage under Subsection (4);
841          (ii) was born out of wedlock and the custodial parent seeks enrollment for the child

842     under the custodial parent's policy;
843          (iii) is not claimed as a dependent on the parent's federal tax return; or
844          (iv) does not reside with the parent or in the insurer's service area.
845          (b) A child enrolled as required under Subsection (3)(a)(iv) is subject to the terms of
846     the accident and health insurance plan contract pertaining to services received outside of an
847     insurer's service area.
848          (4) When a child has accident and health coverage through an insurer of a noncustodial
849     parent, and when requested by the noncustodial or custodial parent, the insurer shall:
850          (a) provide information to the custodial parent as necessary for the child to obtain
851     benefits through that coverage, but the insurer or employer, or the agents or employees of either
852     of them, are not civilly or criminally liable for providing information in compliance with this
853     Subsection (4)(a), whether the information is provided pursuant to a verbal or written request;
854          (b) permit the custodial parent or the service provider, with the custodial parent's
855     approval, to submit claims for covered services without the approval of the noncustodial
856     parent; and
857          (c) make payments on claims submitted in accordance with Subsection (4)(b) directly
858     to the custodial parent, the child who obtained benefits, the provider, or the state Medicaid
859     agency.
860          (5) When a parent is required by a court or administrative order to provide health
861     coverage for a child, and the parent is eligible for family health coverage, the insurer shall:
862          (a) permit the parent to enroll, under the family coverage, a child who is otherwise
863     eligible for the coverage without regard to an enrollment season restrictions;
864          (b) if the parent is enrolled but fails to make application to obtain coverage for the
865     child, enroll the child under family coverage upon application of the child's other parent, the
866     state agency administering the Medicaid program, or the state agency administering 42 U.S.C.
867     Sec. 651 through 669, the child support enforcement program; and
868          (c) (i) when the child is covered by an individual policy, not disenroll or eliminate
869     coverage of the child unless the insurer is provided satisfactory written evidence that:

870          (A) the court or administrative order is no longer in effect; or
871          (B) the child is or will be enrolled in comparable accident and health coverage through
872     another insurer which will take effect not later than the effective date of disenrollment; or
873          (ii) when the child is covered by a group policy, not disenroll or eliminate coverage of
874     the child unless the employer is provided with satisfactory written evidence, which evidence is
875     also provided to the insurer, that Subsection (8)(c)(i), (ii), or (iii) has happened.
876          (6) An insurer may not impose requirements on a state agency that has been assigned
877     the rights of an individual eligible for medical assistance under Medicaid and covered for
878     accident and health benefits from the insurer that are different from requirements applicable to
879     an agent or assignee of any other individual so covered.
880          (7) Insurers may not reduce their coverage of pediatric vaccines below the benefit level
881     in effect on May 1, 1993.
882          (8) When a parent is required by a court or administrative order to provide health
883     coverage, which is available through an employer doing business in this state, the employer
884     shall:
885          (a) permit the parent to enroll under family coverage any child who is otherwise
886     eligible for coverage without regard to any enrollment season restrictions;
887          (b) if the parent is enrolled but fails to make application to obtain coverage of the child,
888     enroll the child under family coverage upon application by the child's other parent, by the state
889     agency administering the Medicaid program, or the state agency administering 42 U.S.C. Sec.
890     651 through 669, the child support enforcement program;
891          (c) not disenroll or eliminate coverage of the child unless the employer is provided
892     satisfactory written evidence that:
893          (i) the court order is no longer in effect;
894          (ii) the child is or will be enrolled in comparable coverage which will take effect no
895     later than the effective date of disenrollment; or
896          (iii) the employer has eliminated family health coverage for all of its employees; and
897          (d) withhold from the employee's compensation the employee's share, if any, of

898     premiums for health coverage and to pay this amount to the insurer.
899          (9) An order issued under Section 62A-11-326.1 may be considered a "qualified
900     medical support order" for the purpose of enrolling a dependent child in a group accident and
901     health insurance plan as defined in Section 609(a), Federal Employee Retirement Income
902     Security Act of 1974.
903          (10) This section does not affect any insurer's ability to require as a precondition of any
904     child being covered under any policy of insurance that:
905          (a) the parent continues to be eligible for coverage;
906          (b) the child shall be identified to the insurer with adequate information to comply with
907     this section; and
908          (c) the premium shall be paid when due.
909          (11) This section applies to employee welfare benefit plans as defined in Section
910     [26-19-2] 26-19-102.
911          (12) (a) A policy that provides coverage to a child of a group member may not deny
912     eligibility for coverage to a child solely because:
913          (i) the child does not reside with the insured; or
914          (ii) the child is solely dependent on a former spouse of the insured rather than on the
915     insured.
916          (b) A child who does not reside with the insured may be excluded on the same basis as
917     a child who resides with the insured.
918          Section 33. Section 34A-2-417 is amended to read:
919          34A-2-417. Claims and benefits -- Time limits for filing -- Burden of proof.
920          (1) (a) Except with respect to prosthetic devices or in a permanent total disability case,
921     an employee is entitled to be compensated for a medical expense if:
922          (i) the medical expense is:
923          (A) reasonable in amount; and
924          (B) necessary to treat the industrial accident; and
925          (ii) the employee submits or makes a reasonable attempt to submit the medical

926     expense:
927          (A) to the employee's employer or insurance carrier for payment; and
928          (B) within one year from the later of:
929          (I) the day on which the medical expense is incurred; or
930          (II) the day on which the employee knows or in the exercise of reasonable diligence
931     should have known that the medical expense is related to the industrial accident.
932          (b) For an industrial accident that occurs on or after July 1, 1988, and is the basis of a
933     claim for a medical expense, an employee is entitled to be compensated for the medical
934     expense if the employee meets the requirements of Subsection (1)(a).
935          (2) (a) A claim described in Subsection (2)(b) is barred, unless the employee:
936          (i) files an application for hearing with the Division of Adjudication no later than six
937     years from the date of the accident; and
938          (ii) by no later than 12 years from the date of the accident, is able to meet the
939     employee's burden of proving that the employee is due the compensation claimed under this
940     chapter.
941          (b) Subsection (2)(a) applies to a claim for compensation for:
942          (i) temporary total disability benefits;
943          (ii) temporary partial disability benefits;
944          (iii) permanent partial disability benefits; or
945          (iv) permanent total disability benefits.
946          (c) The commission may enter an order awarding or denying an employee's claim for
947     compensation under this chapter within a reasonable time period beyond 12 years from the date
948     of the accident, if:
949          (i) the employee complies with Subsection (2)(a); and
950          (ii) 12 years from the date of the accident:
951          (A) (I) the employee is fully cooperating in a commission approved reemployment
952     plan; and
953          (II) the results of that commission approved reemployment plan are not known; or

954          (B) the employee is actively adjudicating issues of compensability before the
955     commission.
956          (3) A claim for death benefits is barred unless an application for hearing is filed within
957     one year of the date of death of the employee.
958          (4) (a) (i) Subject to Subsections (2)(c) and (4)(b), after an employee files an
959     application for hearing within six years from the date of the accident, the Division of
960     Adjudication may enter an order to show cause why the employee's claim should not be
961     dismissed because the employee has failed to meet the employee's burden of proof to establish
962     an entitlement to compensation claimed in the application for hearing.
963          (ii) The order described in Subsection (4)(a)(i) may be entered on the motion of the:
964          (A) Division of Adjudication;
965          (B) employee's employer; or
966          (C) employer's insurance carrier.
967          (b) Under Subsection (4)(a), the Division of Adjudication may dismiss a claim:
968          (i) without prejudice; or
969          (ii) with prejudice only if:
970          (A) the Division of Adjudication adjudicates the merits of the employee's entitlement
971     to the compensation claimed in the application for hearing; or
972          (B) the employee fails to comply with Subsection (2)(a)(ii).
973          (c) If a claim is dismissed without prejudice under Subsection (4)(b), the employee is
974     subject to the time limits under Subsection (2)(a) to claim compensation under this chapter.
975          (5) A claim for compensation under this chapter is subject to a claim or lien for
976     recovery under Section [26-19-5] 26-19-401.
977          Section 34. Section 34A-2-422 is amended to read:
978          34A-2-422. Compensation exempt from execution -- Transfer of payment rights.
979          (1) For purposes of this section:
980          (a) "Payment rights under workers' compensation" means the right to receive
981     compensation under this chapter or Chapter 3, Utah Occupational Disease Act, including the

982     payment of a workers' compensation claim, award, benefit, or settlement.
983          (b) (i) Subject to Subsection (1)(b)(ii), "transfer" means:
984          (A) a sale;
985          (B) an assignment;
986          (C) a pledge;
987          (D) an hypothecation; or
988          (E) other form of encumbrance or alienation for consideration.
989          (ii) "Transfer" does not include the creation or perfection of a security interest in a right
990     to receive a payment under a blanket security agreement entered into with an insured
991     depository institution, in the absence of any action to:
992          (A) redirect the payments to:
993          (I) the insured depository institution; or
994          (II) an agent or successor in interest to the insured depository institution; or
995          (B) otherwise enforce a blanket security interest against the payment rights.
996          (2) Compensation before payment:
997          (a) is exempt from:
998          (i) all claims of creditors; and
999          (ii) attachment or execution; and
1000          (b) shall be paid only to employees or their dependents, except as provided in Sections
1001     [26-19-5] 26-19-401 and 34A-2-417.
1002          (3) (a) Subject to Subsection (3)(b), beginning April 30, 2007, a person may not:
1003          (i) transfer payment rights under workers' compensation; or
1004          (ii) accept or take any action to provide for a transfer of payment rights under workers'
1005     compensation.
1006          (b) A person may take an action prohibited under Subsection (3)(a) if the commission
1007     approves the transfer of payment rights under workers' compensation:
1008          (i) before the transfer of payment rights under workers' compensation takes effect; and
1009          (ii) upon a determination by the commission that:

1010          (A) the person transferring the payment rights under workers' compensation received
1011     before executing an agreement to transfer those payment rights:
1012          (I) adequate notice that the transaction involving the transfer of payment rights under
1013     workers' compensation involves the transfer of those payment rights; and
1014          (II) an explanation of the financial consequences of and alternatives to the transfer of
1015     payment rights under workers' compensation in sufficient detail that the person transferring the
1016     payment rights under workers' compensation made an informed decision to transfer those
1017     payment rights; and
1018          (B) the transfer of payment rights under workers' compensation is in the best interest of
1019     the person transferring the payment rights under workers' compensation taking into account the
1020     welfare and support of that person's dependents.
1021          (c) The approval by the commission of the transfer of a person's payment rights under
1022     workers' compensation is a full and final resolution of the person's payment rights under
1023     workers' compensation that are transferred:
1024          (i) if the commission approves the transfer of the payment rights under workers'
1025     compensation in accordance with Subsection (3)(b); and
1026          (ii) once the person no longer has a right to appeal the decision in accordance with this
1027     title.
1028          Section 35. Section 75-3-104.5 is enacted to read:
1029          75-3-104.5. Notice to the state.
1030          (1) Within 30 days after the day on which a petitioner or personal representative files
1031     an action under this chapter for a decedent who was at least 55 years old, the petitioner or
1032     personal representative shall send a copy of the pleadings, by certified mail, to the Office of
1033     Recovery Services created in Section 62A-1-105.
1034          (2) Failure to provide notice as described in Subsection (1) tolls all limitations
1035     concerning the state's presentation or enforcement of a lien or claim under Section 26-19-405.
1036          Section 36. Section 75-3-803 is amended to read:
1037          75-3-803. Limitations on presentation of claims.

1038          (1) All claims against a decedent's estate which arose before the death of the decedent,
1039     including claims of the state and any subdivision of it, whether due or to become due, absolute
1040     or contingent, liquidated or unliquidated, founded on contract, tort, or other legal basis, if not
1041     barred earlier by other statute of limitations, are barred against the estate, the personal
1042     representative, and the heirs and devisees of the decedent, unless presented within the earlier of
1043     the following dates:
1044          (a) one year after the decedent's death; or
1045          (b) within the time provided by Subsection 75-3-801(2) for creditors who are given
1046     actual notice, and where notice is published, within the time provided in Subsection
1047     75-3-801(1) for all claims barred by publication.
1048          (2) In all events, claims barred by the nonclaim statute at the decedent's domicile are
1049     also barred in this state.
1050          (3) All claims against a decedent's estate which arise at or after the death of the
1051     decedent, including claims of the state and any of its subdivisions, whether due or to become
1052     due, absolute or contingent, liquidated or unliquidated, founded on contract, tort, or other legal
1053     basis are barred against the estate, the personal representative, and the heirs and devisees of the
1054     decedent, unless presented as follows:
1055          (a) a claim based on a contract with the personal representative within three months
1056     after performance by the personal representative is due; or
1057          (b) any other claim within the later of three months after it arises, or the time specified
1058     in Subsection (1)(a).
1059          (4) Nothing in this section affects or prevents:
1060          (a) any proceeding to enforce any mortgage, pledge, or other lien upon property of the
1061     estate;
1062          (b) to the limits of the insurance protection only, any proceeding to establish liability of
1063     the decedent or the personal representative for which [he] the decedent or the personal
1064     representative is protected by liability insurance; [or]
1065          (c) collection of compensation for services rendered and reimbursement for expenses

1066     advanced by the personal representative or by the attorney or accountant for the personal
1067     representative of the estate[.]; or
1068          (d) medical assistance recovery under Title 26, Chapter 19, Medical Benefits Recovery
1069     Act.
1070          (5) If a personal representative has not been timely appointed in accordance with this
1071     chapter, one may be appointed for the limited purposes of Subsection (4)(b) for any claim
1072     timely brought against the decedent.
1073          Section 37. Section 75-3-805 is amended to read:
1074          75-3-805. Classification of claims.
1075          (1) If the applicable assets of the estate are insufficient to pay all claims in full, the
1076     personal representative shall make payment in the following order:
1077          (a) reasonable funeral expenses;
1078          (b) costs and expenses of administration;
1079          (c) debts and taxes with preference under federal law;
1080          (d) reasonable and necessary medical and hospital expenses of the last illness of the
1081     decedent, including compensation of persons attending [him] the decedent, and medical
1082     assistance if Section [26-19-13.5] 26-19-405 applies;
1083          (e) debts and taxes with preference under other laws of this state; and
1084          (f) all other claims.
1085          (2) No preference shall be given in the payment of any claim over any other claim of
1086     the same class, and a claim due and payable shall not be entitled to a preference over claims not
1087     due.
1088          Section 38. Section 75-7-508 is amended to read:
1089          75-7-508. Notice to creditors.
1090          (1) (a) A trustee for an inter vivos revocable trust, upon the death of the settlor, may
1091     publish a notice to creditors:
1092          (i) once a week for three successive weeks in a newspaper of general circulation in the
1093     county where the settlor resided at the time of death; and

1094          (ii) in accordance with Section 45-1-101 for three weeks.
1095          (b) The notice required by Subsection (1)(a) shall:
1096          (i) provide the trustee's name and address; and
1097          (ii) notify creditors:
1098          (A) of the deceased settlor; and
1099          (B) to present their claims within three months after the date of the first publication of
1100     the notice or be forever barred from presenting the claim.
1101          (2) A trustee shall give written notice by mail or other delivery to any known creditor
1102     of the deceased settlor, notifying the creditor to present [his] the creditor's claim within 90 days
1103     from the published notice if given as provided in Subsection (1) or within 60 days from the
1104     mailing or other delivery of the notice, whichever is later, or be forever barred. Written notice
1105     shall be the notice described in Subsection (1) or a similar notice.
1106          (3) (a) If the deceased settlor received medical assistance, as defined in Section
1107     [26-19-2] 26-19-102, at any time after the age of 55, the trustee for an inter vivos revocable
1108     trust, upon the death of the settlor, shall mail or deliver written notice to the Director of the
1109     Office of Recovery Services, on behalf of the Department of Health, to present any claim under
1110     Section [26-19-13.5] 26-19-405 within 60 days from the mailing or other delivery of notice,
1111     whichever is later, or be forever barred.
1112          (b) If the trustee does not mail notice to the director of the Office of Recovery Services
1113     on behalf of the department in accordance with Subsection (3)(a), the department shall have
1114     one year from the death of the settlor to present its claim.
1115          (4) The trustee is not liable to any creditor or to any successor of the deceased settlor
1116     for giving or failing to give notice under this section.
1117          (5) The notice to creditors shall be valid against any creditor of the trust and also
1118     against any creditor of the estate of the deceased settlor.
1119          Section 39. Section 75-7-511 is amended to read:
1120          75-7-511. Classification of claims.
1121          (1) If the applicable assets of the deceased settlor's estate or trust estate are insufficient

1122     to pay all claims in full, the trustee shall make payment in the following order:
1123          (a) reasonable funeral expenses;
1124          (b) costs and expenses of administration;
1125          (c) debts and taxes with preference under federal law;
1126          (d) reasonable and necessary medical and hospital expenses of the last illness of the
1127     deceased settlor, including compensation of persons attending [him] the deceased settlor, and
1128     medical assistance if Section [26-19-13.5] 26-19-405 applies;
1129          (e) debts and taxes with preference under other laws of this state; and
1130          (f) all other claims.
1131          (2) No preference shall be given in the payment of any claim over any other claim of
1132     the same class, and a claim due and payable shall not be entitled to a preference over claims not
1133     due.