Chief Sponsor: Paul Ray

Senate Sponsor: ____________


8     General Description:
9          This bill amends provisions related to the scope of services that the Public Employees'
10     Health Program can provide.
11     Highlighted Provisions:
12          This bill:
13          ▸     expands the scope of services that certain state entities can request from the Public
14     Employees' Health Program; and
15          ▸     makes technical changes.
16     Money Appropriated in this Bill:
17          None
18     Other Special Clauses:
19          None
20     Utah Code Sections Affected:
21     AMENDS:
22          26-36b-208, as last amended by Laws of Utah 2018, Chapters 384 and 468
23          49-20-401, as last amended by Laws of Utah 2018, Chapter 281

25     Be it enacted by the Legislature of the state of Utah:
26          Section 1. Section 26-36b-208 is amended to read:
27          26-36b-208. Medicaid Expansion Fund.

28          (1) There is created an expendable special revenue fund known as the Medicaid
29     Expansion Fund.
30          (2) The fund consists of:
31          (a) assessments collected under this chapter;
32          (b) intergovernmental transfers under Section 26-36b-206;
33          (c) savings attributable to the health coverage improvement program as determined by
34     the department;
35          (d) savings attributable to the enhancement waiver program as determined by the
36     department;
37          (e) savings attributable to the Medicaid waiver expansion as determined by the
38     department;
39          (f) savings attributable to the inclusion of psychotropic drugs on the preferred drug list
40     under Subsection 26-18-2.4(3) as determined by the department;
41          (g) savings attributable to the services provided by the Public Employees' Health Plan
42     under Subsection 49-20-401(1)(u)(i) or (ii);
43          (h) gifts, grants, donations, or any other conveyance of money that may be made to the
44     fund from private sources;
45          (i) interest earned on money in the fund; and
46          (j) additional amounts as appropriated by the Legislature.
47          (3) (a) The fund shall earn interest.
48          (b) All interest earned on fund money shall be deposited into the fund.
49          (4) (a) A state agency administering the provisions of this chapter may use money from
50     the fund to pay the costs, not otherwise paid for with federal funds or other revenue sources, of:
51          (i) the health coverage improvement program;
52          (ii) the enhancement waiver program;
53          (iii) the Medicaid waiver expansion; and
54          (iv) the outpatient upper payment limit supplemental payments under Section
55     26-36b-210.
56          (b) A state agency administering the provisions of this chapter may not use:
57          (i) funds described in Subsection (2)(b) to pay the cost of private outpatient upper
58     payment limit supplemental payments; or

59          (ii) money in the fund for any purpose not described in Subsection (4)(a).
60          Section 2. Section 49-20-401 is amended to read:
61          49-20-401. Program -- Powers and duties.
62          (1) The program shall:
63          (a) act as a self-insurer of employee benefit plans and administer those plans;
64          (b) enter into contracts with private insurers or carriers to underwrite employee benefit
65     plans as considered appropriate by the program;
66          (c) indemnify employee benefit plans or purchase commercial reinsurance as
67     considered appropriate by the program;
68          (d) provide descriptions of all employee benefit plans under this chapter in cooperation
69     with covered employers;
70          (e) process claims for all employee benefit plans under this chapter or enter into
71     contracts, after competitive bids are taken, with other benefit administrators to provide for the
72     administration of the claims process;
73          (f) obtain an annual actuarial review of all health and dental benefit plans and a
74     periodic review of all other employee benefit plans;
75          (g) consult with the covered employers to evaluate employee benefit plans and develop
76     recommendations for benefit changes;
77          (h) annually submit a budget and audited financial statements to the governor and
78     Legislature which includes total projected benefit costs and administrative costs;
79          (i) maintain reserves sufficient to liquidate the unrevealed claims liability and other
80     liabilities of the employee benefit plans as certified by the program's consulting actuary;
81          (j) submit, in advance, its recommended benefit adjustments for state employees to:
82          (i) the Legislature; and
83          (ii) the executive director of the state Department of Human Resource Management;
84          (k) determine benefits and rates, upon approval of the board, for [multiemployer]
85     multi-employer risk pools, retiree coverage, and conversion coverage;
86          (l) determine benefits and rates based on the total estimated costs and the employee
87     premium share established by the Legislature, upon approval of the board, for state employees;
88          (m) administer benefits and rates, upon ratification of the board, for [single employer]
89     single-employer risk pools;

90          (n) request proposals for provider networks or health and dental benefit plans
91     administered by [third party] third-party carriers at least once every three years for the purposes
92     of:
93          (i) stimulating competition for the benefit of covered individuals;
94          (ii) establishing better geographical distribution of medical care services; and
95          (iii) providing coverage for both active and retired covered individuals;
96          (o) offer proposals which meet the criteria specified in a request for proposals and
97     accepted by the program to active and retired state covered individuals and which may be
98     offered to active and retired covered individuals of other covered employers at the option of the
99     covered employer;
100          (p) perform the same functions established in Subsections (1)(a), (b), (e), and (h) for
101     the Department of Health if the program provides program benefits to children enrolled in the
102     Utah Children's Health Insurance Program created in Title 26, Chapter 40, Utah Children's
103     Health Insurance Act;
104          (q) establish rules and procedures governing the admission of political subdivisions or
105     educational institutions and their employees to the program;
106          (r) contract directly with medical providers to provide services for covered individuals;
107          (s) take additional actions necessary or appropriate to carry out the purposes of this
108     chapter;
109          (t) (i) require state employees and their dependents to participate in the electronic
110     exchange of clinical health records in accordance with Section 26-1-37 unless the enrollee opts
111     out of participation; and
112          (ii) prior to enrolling the state employee, each time the state employee logs onto the
113     program's website, and each time the enrollee receives written enrollment information from the
114     program, provide notice to the enrollee of the enrollee's participation in the electronic exchange
115     of clinical health records and the option to opt out of participation at any time; and
116          (u) [provide services for drugs or medical devices] at the request of a procurement unit,
117     as that term is defined in Section 63G-6a-103, that administers benefits to program recipients
118     who are not covered by Title 26, Utah Health Code[.], provide services for:
119          (i) drugs;
120          (ii) medical devices; or

121          (iii) other types of medical care.
122          (2) (a) Funds budgeted and expended shall accrue from rates paid by the covered
123     employers and covered individuals.
124          (b) Administrative costs shall be approved by the board and reported to the governor
125     and the Legislature.
126          (3) The Department of Human Resource Management shall include the benefit
127     adjustments described in Subsection (1)(j) in the total compensation plan recommended to the
128     governor required under Subsection 67-19-12(5)(a).