This document includes House Committee Amendments incorporated into the bill on Thu, Feb 27, 2020 at 8:25 AM by pflowers.



Chief Sponsor: Suzanne Harrison

Senate Sponsor: Curtis S. Bramble


8     General Description:
9          This bill amends the Public Employees' Health Program.
10     Highlighted Provisions:
11          This bill:
12          ▸     authorizes the Public Employees' Health Program to establish an out-of-state
13     provider network through requests for proposals;
14          ▸     authorizes the Public Employees' Health Program to partner with public entities in
15     other states in certain circumstances; and
16          ▸     makes technical changes.
17     Money Appropriated in this Bill:
18          None
19     Other Special Clauses:
20          None
21     Utah Code Sections Affected:
22     AMENDS:
23          49-20-401, as last amended by Laws of Utah 2019, Chapter 393

25     Be it enacted by the Legislature of the state of Utah:
26          Section 1. Section 49-20-401 is amended to read:
27          49-20-401. Program -- Powers and duties.

28          (1) The program shall:
29          (a) act as a self-insurer of employee benefit plans and administer those plans;
30          (b) enter into contracts with private insurers or carriers to underwrite employee benefit
31     plans as considered appropriate by the program;
32          (c) indemnify employee benefit plans or purchase commercial reinsurance as
33     considered appropriate by the program;
34          (d) provide descriptions of all employee benefit plans under this chapter in cooperation
35     with covered employers;
36          (e) process claims for all employee benefit plans under this chapter or enter into
37     contracts, after competitive bids are taken, with other benefit administrators to provide for the
38     administration of the claims process;
39          (f) obtain an annual actuarial review of all health and dental benefit plans and a
40     periodic review of all other employee benefit plans;
41          (g) consult with the covered employers to evaluate employee benefit plans and develop
42     recommendations for benefit changes;
43          (h) annually submit a budget and audited financial statements to the governor and
44     Legislature which includes total projected benefit costs and administrative costs;
45          (i) maintain reserves sufficient to liquidate the unrevealed claims liability and other
46     liabilities of the employee benefit plans as certified by the program's consulting actuary;
47          (j) submit, in advance, its recommended benefit adjustments for state employees to:
48          (i) the Legislature; and
49          (ii) the executive director of the state Department of Human Resource Management;
50          (k) determine benefits and rates, upon approval of the board, for multi-employer risk
51     pools, retiree coverage, and conversion coverage;
52          (l) determine benefits and rates based on the total estimated costs and the employee
53     premium share established by the Legislature, upon approval of the board, for state employees;
54          (m) administer benefits and rates, upon ratification of the board, for single-employer
55     risk pools;
56          (n) request proposals for [provider networks or health and dental benefit plans
57     administered by third-party carriers] one or more out-of-state provider networks, and a dental
58     health plan administered by a third-party carrier at least once every three years for the purposes

59     of:
60          (i) stimulating competition for the benefit of covered individuals;
61          (ii) establishing better geographical [distribution] coverage of medical care services;
62     and
63          (iii) providing coverage for both active and retired covered individuals;
64          (o) offer proposals which meet the criteria specified in a request for proposals and
65     accepted by the program to active and retired state covered individuals and which may be
66     offered to active and retired covered individuals of other covered employers at the option of the
67     covered employer;
68          (p) perform the same functions established in Subsections (1)(a), (b), (e), and (h) for
69     the Department of Health if the program provides program benefits to children enrolled in the
70     Utah Children's Health Insurance Program created in Title 26, Chapter 40, Utah Children's
71     Health Insurance Act;
72          (q) establish rules and procedures governing the admission of political subdivisions or
73     educational institutions and their employees to the program;
74          (r) contract directly with medical providers to provide services for covered individuals;
75          (s) take additional actions necessary or appropriate to carry out the purposes of this
76     chapter;
77          (t) (i) require state employees and their dependents to participate in the electronic
78     exchange of clinical health records in accordance with Section 26-1-37 unless the enrollee opts
79     out of participation; and
80          (ii) prior to enrolling the state employee, each time the state employee logs onto the
81     program's website, and each time the enrollee receives written enrollment information from the
82     program, provide notice to the enrollee of the enrollee's participation in the electronic exchange
83     of clinical health records and the option to opt out of participation at any time; and
84          (u) at the request of a procurement unit, as that term is defined in Section 63G-6a-103,
85     that administers benefits to program recipients who are not covered by Title 26, Utah Health
86     Code, provide services for:
87          (i) drugs;
88          (ii) medical devices; or
89          (iii) other types of medical care.

90          (2) (a) Funds budgeted and expended shall accrue from rates paid by the covered
91     employers and covered individuals.
92          (b) Administrative costs shall be approved by the board and reported to the governor
93     and the Legislature.
94          (3) The Department of Human Resource Management shall include the benefit
95     adjustments described in Subsection (1)(j) in the total compensation plan recommended to the
96     governor required under Subsection 67-19-12(5)(a).
97          (4) The program may establish a partnership with a public entity in a different state to
98     purchase or share services related to the administration of medical benefits if:
99          (a) the program receives approval for the partnership from the board; and
100          (b) the partnership:
101          (i) creates cost savings for Utah;
102          (ii) does not comingle state funds with funds of the public entity in the other state; and
103          (iii) does not pose a Ĥ→ [
financial] greater actuarial ←Ĥ risk to Utah Ĥ→ than the
103a     program has already assumed ←Ĥ .