1     
HEALTH AND HUMAN SERVICES RECODIFICATION -

2     
HEALTH CARE ASSISTANCE AND DATA

3     
2023 GENERAL SESSION

4     
STATE OF UTAH

5     
Chief Sponsor: Jacob L. Anderegg

6     
House Sponsor: Raymond P. Ward

7     

8     LONG TITLE
9     General Description:
10          This bill recodifies portions of the Utah Health Code and Utah Human Services Code.
11     Highlighted Provisions:
12          This bill:
13          ▸     recodifies provisions regarding:
14               •     health care administration and assistance; and
15               •     vital statistics, health data, and the Utah Medical Examiner; and
16          ▸     makes technical and corresponding changes.
17     Money Appropriated in this Bill:
18          None
19     Other Special Clauses:
20          This bill provides a coordination clause.
21          This bill provides revisor instructions.
22     Utah Code Sections Affected:
23     AMENDS:
24          26B-3-101, as enacted by Laws of Utah 2022, Chapter 255
25          26B-8-101, as enacted by Laws of Utah 2022, Chapter 255
26     RENUMBERS AND AMENDS:
27          26B-3-102, (Renumbered from 26-18-2.1, as last amended by Laws of Utah 2019,
28     Chapter 393)

29          26B-3-103, (Renumbered from 26-18-2.2, as last amended by Laws of Utah 2019,
30     Chapter 393)
31          26B-3-104, (Renumbered from 26-18-2.3, as last amended by Laws of Utah 2020,
32     Chapter 225)
33          26B-3-105, (Renumbered from 26-18-2.4, as last amended by Laws of Utah 2022,
34     Chapter 255)
35          26B-3-106, (Renumbered from 26-18-2.5, as last amended by Laws of Utah 2019,
36     Chapter 393)
37          26B-3-107, (Renumbered from 26-18-2.6, as last amended by Laws of Utah 2021,
38     Chapter 234)
39          26B-3-108, (Renumbered from 26-18-3, as last amended by Laws of Utah 2021,
40     Chapter 422)
41          26B-3-109, (Renumbered from 26-18-3.1, as last amended by Laws of Utah 2020,
42     Chapter 225)
43          26B-3-110, (Renumbered from 26-18-3.5, as last amended by Laws of Utah 2019,
44     Chapter 393)
45          26B-3-111, (Renumbered from 26-18-3.6, as last amended by Laws of Utah 2019,
46     Chapter 393)
47          26B-3-112, (Renumbered from 26-18-3.8, as last amended by Laws of Utah 2020, Sixth
48     Special Session, Chapter 3)
49          26B-3-113, (Renumbered from 26-18-3.9, as last amended by Laws of Utah 2020, Fifth
50     Special Session, Chapter 4)
51          26B-3-114, (Renumbered from 26-18-4, as last amended by Laws of Utah 2013,
52     Chapter 167)
53          26B-3-115, (Renumbered from 26-18-5, as last amended by Laws of Utah 2020,
54     Chapter 225)
55          26B-3-116, (Renumbered from 26-18-5.5, as enacted by Laws of Utah 2022, Chapter

56     469)
57          26B-3-117, (Renumbered from 26-18-6, as enacted by Laws of Utah 1981, Chapter
58     126)
59          26B-3-118, (Renumbered from 26-18-7, as last amended by Laws of Utah 1988,
60     Chapter 21)
61          26B-3-119, (Renumbered from 26-18-8, as last amended by Laws of Utah 2020,
62     Chapter 225)
63          26B-3-120, (Renumbered from 26-18-9, as enacted by Laws of Utah 1981, Chapter
64     126)
65          26B-3-121, (Renumbered from 26-18-11, as last amended by Laws of Utah 2019,
66     Chapter 393)
67          26B-3-122, (Renumbered from 26-18-13, as last amended by Laws of Utah 2017,
68     Chapter 241)
69          26B-3-123, (Renumbered from 26-18-13.5, as last amended by Laws of Utah 2019,
70     Chapter 249)
71          26B-3-124, (Renumbered from 26-18-15, as last amended by Laws of Utah 2021,
72     Chapter 163)
73          26B-3-125, (Renumbered from 26-18-16, as enacted by Laws of Utah 2012, Chapter
74     155)
75          26B-3-126, (Renumbered from 26-18-17, as enacted by Laws of Utah 2013, Chapter
76     53)
77          26B-3-127, (Renumbered from 26-18-18, as last amended by Laws of Utah 2019,
78     Chapter 393)
79          26B-3-128, (Renumbered from 26-18-19, as last amended by Laws of Utah 2016,
80     Chapter 114)
81          26B-3-129, (Renumbered from 26-18-20, as last amended by Laws of Utah 2022,
82     Chapter 443)

83          26B-3-130, (Renumbered from 26-18-21, as last amended by Laws of Utah 2019,
84     Chapter 393)
85          26B-3-131, (Renumbered from 26-18-22, as enacted by Laws of Utah 2017, Chapter
86     180)
87          26B-3-132, (Renumbered from 26-18-23, as enacted by Laws of Utah 2017, Chapter
88     53)
89          26B-3-133, (Renumbered from 26-18-24, as enacted by Laws of Utah 2018, Chapter
90     180)
91          26B-3-134, (Renumbered from 26-18-25, as enacted by Laws of Utah 2019, Chapter
92     320)
93          26B-3-135, (Renumbered from 26-18-26, as enacted by Laws of Utah 2019, Chapter
94     265)
95          26B-3-136, (Renumbered from 26-18-27, as enacted by Laws of Utah 2021, Chapter
96     163)
97          26B-3-137, (Renumbered from 26-18-28, as enacted by Laws of Utah 2022, Chapter
98     206)
99          26B-3-138, (Renumbered from 26-18-427, as enacted by Laws of Utah 2022, Chapter
100     394)
101          26B-3-139, (Renumbered from 26-18-603, as last amended by Laws of Utah 2015,
102     Chapter 135)
103          26B-3-140, (Renumbered from 26-18-604, as last amended by Laws of Utah 2015,
104     Chapter 135)
105          26B-3-141, (Renumbered from 26-18-703, as renumbered and amended by Laws of
106     Utah 2022, Chapter 334)
107          26B-3-201, (Renumbered from 26-18-403, as enacted by Laws of Utah 2006, Chapter
108     110)
109          26B-3-202, (Renumbered from 26-18-405, as last amended by Laws of Utah 2020,

110     Chapter 275)
111          26B-3-203, (Renumbered from 26-18-405.5, as last amended by Laws of Utah 2022,
112     Chapter 149)
113          26B-3-204, (Renumbered from 26-18-408, as last amended by Laws of Utah 2020,
114     Fifth Special Session, Chapter 4)
115          26B-3-205, (Renumbered from 26-18-409, as enacted by Laws of Utah 2014, Chapter
116     174)
117          26B-3-206, (Renumbered from 26-18-410, as last amended by Laws of Utah 2022,
118     Chapter 226)
119          26B-3-207, (Renumbered from 26-18-411, as last amended by Laws of Utah 2022,
120     Chapter 394)
121          26B-3-208, (Renumbered from 26-18-413, as last amended by Laws of Utah 2020,
122     Chapter 225)
123          26B-3-209, (Renumbered from 26-18-414, as enacted by Laws of Utah 2017, Chapter
124     307)
125          26B-3-210, (Renumbered from 26-18-415, as last amended by Laws of Utah 2019,
126     Chapters 1 and 393)
127          26B-3-211, (Renumbered from 26-18-416, as last amended by Laws of Utah 2020,
128     Chapter 354)
129          26B-3-212, (Renumbered from 26-18-417, as last amended by Laws of Utah 2019,
130     Chapter 393)
131          26B-3-213, (Renumbered from 26-18-418, as last amended by Laws of Utah 2020,
132     Chapter 303)
133          26B-3-214, (Renumbered from 26-18-419, as enacted by Laws of Utah 2019, Chapter
134     172)
135          26B-3-215, (Renumbered from 26-18-420, as enacted by Laws of Utah 2020, Chapter
136     187)

137          26B-3-216, (Renumbered from 26-18-420.1, as enacted by Laws of Utah 2021, Chapter
138     133)
139          26B-3-217, (Renumbered from 26-18-421, as enacted by Laws of Utah 2020, Chapter
140     159)
141          26B-3-218, (Renumbered from 26-18-422, as enacted by Laws of Utah 2020, Chapter
142     188)
143          26B-3-219, (Renumbered from 26-18-423, as enacted by Laws of Utah 2020, Chapter
144     303)
145          26B-3-220, (Renumbered from 26-18-424, as enacted by Laws of Utah 2021, Chapter
146     76)
147          26B-3-221, (Renumbered from 26-18-425, as enacted by Laws of Utah 2021, Chapter
148     27)
149          26B-3-222, (Renumbered from 26-18-426, as enacted by Laws of Utah 2021, Chapter
150     212)
151          26B-3-223, (Renumbered from 26-18-428, as enacted by Laws of Utah 2022, Chapter
152     394)
153          26B-3-224, (Renumbered from 26-18-429, as enacted by Laws of Utah 2022, Chapter
154     253)
155          26B-3-301, (Renumbered from 26-18-101, as last amended by Laws of Utah 2004,
156     Chapter 280)
157          26B-3-302, (Renumbered from 26-18-102, as last amended by Laws of Utah 2010,
158     Chapters 286 and 324)
159          26B-3-303, (Renumbered from 26-18-103, as last amended by Laws of Utah 2020,
160     Chapter 225)
161          26B-3-304, (Renumbered from 26-18-104, as last amended by Laws of Utah 2008,
162     Chapter 382)
163          26B-3-305, (Renumbered from 26-18-105, as last amended by Laws of Utah 2010,

164     Chapter 205)
165          26B-3-306, (Renumbered from 26-18-106, as enacted by Laws of Utah 1992, Chapter
166     273)
167          26B-3-307, (Renumbered from 26-18-107, as last amended by Laws of Utah 2019,
168     Chapter 349)
169          26B-3-308, (Renumbered from 26-18-108, as enacted by Laws of Utah 1992, Chapter
170     273)
171          26B-3-309, (Renumbered from 26-18-109, as enacted by Laws of Utah 1992, Chapter
172     273)
173          26B-3-310, (Renumbered from 26-18-502, as last amended by Laws of Utah 2021,
174     Chapter 274)
175          26B-3-311, (Renumbered from 26-18-503, as last amended by Laws of Utah 2022,
176     Chapter 274)
177          26B-3-312, (Renumbered from 26-18-504, as last amended by Laws of Utah 2017,
178     Chapter 443)
179          26B-3-313, (Renumbered from 26-18-505, as last amended by Laws of Utah 2017,
180     Chapter 443)
181          26B-3-401, (Renumbered from 26-35a-103, as last amended by Laws of Utah 2018,
182     Chapter 39)
183          26B-3-402, (Renumbered from 26-35a-102, as last amended by Laws of Utah 2011,
184     Chapter 366)
185          26B-3-403, (Renumbered from 26-35a-104, as last amended by Laws of Utah 2017,
186     Chapter 443)
187          26B-3-404, (Renumbered from 26-35a-105, as enacted by Laws of Utah 2004, Chapter
188     284)
189          26B-3-405, (Renumbered from 26-35a-107, as last amended by Laws of Utah 2017,
190     Chapter 443)

191          26B-3-406, (Renumbered from 26-35a-108, as last amended by Laws of Utah 2011,
192     Chapter 366)
193          26B-3-501, (Renumbered from 26-36b-103, as last amended by Laws of Utah 2019,
194     Chapter 1)
195          26B-3-502, (Renumbered from 26-36b-102, as last amended by Laws of Utah 2018,
196     Chapter 384)
197          26B-3-503, (Renumbered from 26-36b-201, as last amended by Laws of Utah 2018,
198     Chapters 384 and 468)
199          26B-3-504, (Renumbered from 26-36b-202, as last amended by Laws of Utah 2019,
200     Chapter 393)
201          26B-3-505, (Renumbered from 26-36b-203, as last amended by Laws of Utah 2018,
202     Chapters 384 and 468)
203          26B-3-506, (Renumbered from 26-36b-204, as last amended by Laws of Utah 2020,
204     Chapter 225)
205          26B-3-507, (Renumbered from 26-36b-205, as last amended by Laws of Utah 2020,
206     Chapter 225)
207          26B-3-508, (Renumbered from 26-36b-206, as last amended by Laws of Utah 2018,
208     Chapters 384 and 468)
209          26B-3-509, (Renumbered from 26-36b-207, as last amended by Laws of Utah 2018,
210     Chapters 384 and 468)
211          26B-3-510, (Renumbered from 26-36b-209, as last amended by Laws of Utah 2018,
212     Chapters 384 and 468)
213          26B-3-511, (Renumbered from 26-36b-210, as last amended by Laws of Utah 2018,
214     Chapters 384 and 468)
215          26B-3-512, (Renumbered from 26-36b-211, as last amended by Laws of Utah 2018,
216     Chapters 384 and 468)
217          26B-3-601, (Renumbered from 26-36c-102, as last amended by Laws of Utah 2019,

218     Chapter 1)
219          26B-3-602, (Renumbered from 26-36c-103, as enacted by Laws of Utah 2018, Chapter
220     468)
221          26B-3-603, (Renumbered from 26-36c-201, as last amended by Laws of Utah 2019,
222     Chapter 1)
223          26B-3-604, (Renumbered from 26-36c-202, as last amended by Laws of Utah 2019,
224     Chapter 393)
225          26B-3-605, (Renumbered from 26-36c-203, as last amended by Laws of Utah 2019,
226     Chapter 1)
227          26B-3-606, (Renumbered from 26-36c-204, as last amended by Laws of Utah 2020,
228     Chapter 225)
229          26B-3-607, (Renumbered from 26-36c-205, as last amended by Laws of Utah 2019,
230     Chapter 136)
231          26B-3-608, (Renumbered from 26-36c-206, as last amended by Laws of Utah 2019,
232     Chapter 1)
233          26B-3-609, (Renumbered from 26-36c-207, as enacted by Laws of Utah 2018, Chapter
234     468)
235          26B-3-610, (Renumbered from 26-36c-208, as last amended by Laws of Utah 2019,
236     Chapter 1)
237          26B-3-611, (Renumbered from 26-36c-209, as last amended by Laws of Utah 2019,
238     Chapter 1)
239          26B-3-612, (Renumbered from 26-36c-210, as last amended by Laws of Utah 2019,
240     Chapter 136)
241          26B-3-701, (Renumbered from 26-36d-103, as repealed and reenacted by Laws of Utah
242     2019, Chapter 455)
243          26B-3-702, (Renumbered from 26-36d-102, as repealed and reenacted by Laws of Utah
244     2019, Chapter 455)

245          26B-3-703, (Renumbered from 26-36d-201, as repealed and reenacted by Laws of Utah
246     2019, Chapter 455)
247          26B-3-704, (Renumbered from 26-36d-202, as repealed and reenacted by Laws of Utah
248     2019, Chapter 455)
249          26B-3-705, (Renumbered from 26-36d-203, as repealed and reenacted by Laws of Utah
250     2019, Chapter 455)
251          26B-3-706, (Renumbered from 26-36d-204, as repealed and reenacted by Laws of Utah
252     2019, Chapter 455)
253          26B-3-707, (Renumbered from 26-36d-205, as repealed and reenacted by Laws of Utah
254     2019, Chapter 455)
255          26B-3-708, (Renumbered from 26-36d-206, as repealed and reenacted by Laws of Utah
256     2019, Chapter 455)
257          26B-3-709, (Renumbered from 26-36d-208, as repealed and reenacted by Laws of Utah
258     2019, Chapter 455)
259          26B-3-801, (Renumbered from 26-37a-102, as last amended by Laws of Utah 2016,
260     Chapter 348)
261          26B-3-802, (Renumbered from 26-37a-103, as enacted by Laws of Utah 2015, Chapter
262     440)
263          26B-3-803, (Renumbered from 26-37a-104, as enacted by Laws of Utah 2015, Chapter
264     440)
265          26B-3-804, (Renumbered from 26-37a-105, as enacted by Laws of Utah 2015, Chapter
266     440)
267          26B-3-805, (Renumbered from 26-37a-106, as enacted by Laws of Utah 2015, Chapter
268     440)
269          26B-3-806, (Renumbered from 26-37a-108, as enacted by Laws of Utah 2015, Chapter
270     440)
271          26B-3-901, (Renumbered from 26-40-102, as last amended by Laws of Utah 2019,

272     Chapter 393)
273          26B-3-902, (Renumbered from 26-40-103, as last amended by Laws of Utah 2019,
274     Chapter 393)
275          26B-3-903, (Renumbered from 26-40-105, as last amended by Laws of Utah 2019,
276     Chapter 393)
277          26B-3-904, (Renumbered from 26-40-106, as last amended by Laws of Utah 2021,
278     Chapter 175)
279          26B-3-905, (Renumbered from 26-40-107, as enacted by Laws of Utah 1998, Chapter
280     360)
281          26B-3-906, (Renumbered from 26-40-108, as last amended by Laws of Utah 2010,
282     Chapter 391)
283          26B-3-907, (Renumbered from 26-40-109, as last amended by Laws of Utah 2013,
284     Chapter 167)
285          26B-3-908, (Renumbered from 26-40-110, as last amended by Laws of Utah 2019,
286     Chapter 393)
287          26B-3-909, (Renumbered from 26-40-115, as last amended by Laws of Utah 2020,
288     Chapters 32 and 152)
289          26B-3-1001, (Renumbered from 26-19-102, as renumbered and amended by Laws of
290     Utah 2018, Chapter 443)
291          26B-3-1002, (Renumbered from 26-19-103, as renumbered and amended by Laws of
292     Utah 2018, Chapter 443)
293          26B-3-1003, (Renumbered from 26-19-201, as last amended by Laws of Utah 2021,
294     Chapter 300)
295          26B-3-1004, (Renumbered from 26-19-301, as renumbered and amended by Laws of
296     Utah 2018, Chapter 443)
297          26B-3-1005, (Renumbered from 26-19-302, as last amended by Laws of Utah 2020,
298     Chapter 354)

299          26B-3-1006, (Renumbered from 26-19-303, as renumbered and amended by Laws of
300     Utah 2018, Chapter 443)
301          26B-3-1007, (Renumbered from 26-19-304, as renumbered and amended by Laws of
302     Utah 2018, Chapter 443)
303          26B-3-1008, (Renumbered from 26-19-305, as renumbered and amended by Laws of
304     Utah 2018, Chapter 443)
305          26B-3-1009, (Renumbered from 26-19-401, as last amended by Laws of Utah 2021,
306     Chapter 300)
307          26B-3-1010, (Renumbered from 26-19-402, as renumbered and amended by Laws of
308     Utah 2018, Chapter 443)
309          26B-3-1011, (Renumbered from 26-19-403, as renumbered and amended by Laws of
310     Utah 2018, Chapter 443)
311          26B-3-1012, (Renumbered from 26-19-404, as enacted by Laws of Utah 2018, Chapter
312     443)
313          26B-3-1013, (Renumbered from 26-19-405, as renumbered and amended by Laws of
314     Utah 2018, Chapter 443)
315          26B-3-1014, (Renumbered from 26-19-406, as renumbered and amended by Laws of
316     Utah 2018, Chapter 443)
317          26B-3-1015, (Renumbered from 26-19-501, as enacted by Laws of Utah 2018, Chapter
318     443)
319          26B-3-1016, (Renumbered from 26-19-502, as enacted by Laws of Utah 2018, Chapter
320     443)
321          26B-3-1017, (Renumbered from 26-19-503, as enacted by Laws of Utah 2018, Chapter
322     443)
323          26B-3-1018, (Renumbered from 26-19-504, as enacted by Laws of Utah 2018, Chapter
324     443)
325          26B-3-1019, (Renumbered from 26-19-505, as enacted by Laws of Utah 2018, Chapter

326     443)
327          26B-3-1020, (Renumbered from 26-19-506, as enacted by Laws of Utah 2018, Chapter
328     443)
329          26B-3-1021, (Renumbered from 26-19-507, as enacted by Laws of Utah 2018, Chapter
330     443)
331          26B-3-1022, (Renumbered from 26-19-508, as enacted by Laws of Utah 2018, Chapter
332     443)
333          26B-3-1023, (Renumbered from 26-19-509, as enacted by Laws of Utah 2018, Chapter
334     443)
335          26B-3-1024, (Renumbered from 26-19-601, as renumbered and amended by Laws of
336     Utah 2018, Chapter 443)
337          26B-3-1025, (Renumbered from 26-19-602, as renumbered and amended by Laws of
338     Utah 2018, Chapter 443)
339          26B-3-1026, (Renumbered from 26-19-603, as renumbered and amended by Laws of
340     Utah 2018, Chapter 443)
341          26B-3-1027, (Renumbered from 26-19-604, as renumbered and amended by Laws of
342     Utah 2018, Chapter 443)
343          26B-3-1028, (Renumbered from 26-19-605, as renumbered and amended by Laws of
344     Utah 2018, Chapter 443)
345          26B-3-1101, (Renumbered from 26-20-2, as last amended by Laws of Utah 2007,
346     Chapter 48)
347          26B-3-1102, (Renumbered from 26-20-3, as last amended by Laws of Utah 2011,
348     Chapter 297)
349          26B-3-1103, (Renumbered from 26-20-4, as repealed and reenacted by Laws of Utah
350     2007, Chapter 48)
351          26B-3-1104, (Renumbered from 26-20-5, as last amended by Laws of Utah 2007,
352     Chapter 48)

353          26B-3-1105, (Renumbered from 26-20-6, as last amended by Laws of Utah 2011,
354     Chapter 297)
355          26B-3-1106, (Renumbered from 26-20-7, as last amended by Laws of Utah 2007,
356     Chapter 48)
357          26B-3-1107, (Renumbered from 26-20-8, as last amended by Laws of Utah 2011,
358     Chapter 297)
359          26B-3-1108, (Renumbered from 26-20-9, as last amended by Laws of Utah 2007,
360     Chapter 48)
361          26B-3-1109, (Renumbered from 26-20-9.5, as last amended by Laws of Utah 2011,
362     Chapter 297)
363          26B-3-1110, (Renumbered from 26-20-10, as last amended by Laws of Utah 1998,
364     Chapter 192)
365          26B-3-1111, (Renumbered from 26-20-11, as enacted by Laws of Utah 1986, Chapter
366     46)
367          26B-3-1112, (Renumbered from 26-20-12, as last amended by Laws of Utah 2011,
368     Chapter 297)
369          26B-3-1113, (Renumbered from 26-20-13, as last amended by Laws of Utah 2007,
370     Chapter 48)
371          26B-3-1114, (Renumbered from 26-20-14, as last amended by Laws of Utah 2011,
372     Chapter 297)
373          26B-3-1115, (Renumbered from 26-20-15, as enacted by Laws of Utah 2007, Chapter
374     48)
375          26B-8-102, (Renumbered from 26-2-3, as last amended by Laws of Utah 2017, Chapter
376     22)
377          26B-8-103, (Renumbered from 26-2-4, as last amended by Laws of Utah 2022,
378     Chapters 231 and 365)
379          26B-8-104, (Renumbered from 26-2-5, as last amended by Laws of Utah 2019, Chapter

380     349)
381          26B-8-105, (Renumbered from 26-2-5.5, as last amended by Laws of Utah 1995,
382     Chapter 202)
383          26B-8-106, (Renumbered from 26-2-6, as last amended by Laws of Utah 1995, Chapter
384     202)
385          26B-8-107, (Renumbered from 26-2-7, as last amended by Laws of Utah 2022, Chapter
386     231)
387          26B-8-108, (Renumbered from 26-2-8, as last amended by Laws of Utah 1995, Chapter
388     202)
389          26B-8-109, (Renumbered from 26-2-9, as last amended by Laws of Utah 1995, Chapter
390     202)
391          26B-8-110, (Renumbered from 26-2-10, as last amended by Laws of Utah 2021,
392     Chapter 65)
393          26B-8-111, (Renumbered from 26-2-11, as last amended by Laws of Utah 1995,
394     Chapter 202)
395          26B-8-112, (Renumbered from 26-2-12.5, as last amended by Laws of Utah 2022,
396     Chapters 255 and 335)
397          26B-8-113, (Renumbered from 26-2-12.6, as last amended by Laws of Utah 2022,
398     Chapters 255 and 365)
399          26B-8-114, (Renumbered from 26-2-13, as last amended by Laws of Utah 2021,
400     Chapters 11 and 297)
401          26B-8-115, (Renumbered from 26-2-14, as last amended by Laws of Utah 1995,
402     Chapter 202)
403          26B-8-116, (Renumbered from 26-2-14.1, as enacted by Laws of Utah 2002, Chapter
404     69)
405          26B-8-117, (Renumbered from 26-2-14.2, as enacted by Laws of Utah 2002, Chapter
406     69)

407          26B-8-118, (Renumbered from 26-2-14.3, as enacted by Laws of Utah 2015, Chapter
408     184)
409          26B-8-119, (Renumbered from 26-2-15, as last amended by Laws of Utah 2020,
410     Chapter 201)
411          26B-8-120, (Renumbered from 26-2-16, as last amended by Laws of Utah 2009,
412     Chapters 66 and 68)
413          26B-8-121, (Renumbered from 26-2-17, as last amended by Laws of Utah 2020,
414     Chapter 251)
415          26B-8-122, (Renumbered from 26-2-18, as last amended by Laws of Utah 2020,
416     Chapter 251)
417          26B-8-123, (Renumbered from 26-2-19, as last amended by Laws of Utah 1995,
418     Chapter 202)
419          26B-8-124, (Renumbered from 26-2-21, as last amended by Laws of Utah 1995,
420     Chapter 202)
421          26B-8-125, (Renumbered from 26-2-22, as last amended by Laws of Utah 2021,
422     Chapter 262)
423          26B-8-126, (Renumbered from 26-2-23, as last amended by Laws of Utah 2009,
424     Chapter 68)
425          26B-8-127, (Renumbered from 26-2-24, as last amended by Laws of Utah 1995,
426     Chapter 202)
427          26B-8-128, (Renumbered from 26-2-25, as last amended by Laws of Utah 2021,
428     Chapter 65)
429          26B-8-129, (Renumbered from 26-2-26, as last amended by Laws of Utah 1995,
430     Chapter 202)
431          26B-8-130, (Renumbered from 26-2-27, as last amended by Laws of Utah 2011,
432     Chapter 366)
433          26B-8-131, (Renumbered from 26-2-28, as last amended by Laws of Utah 2021,

434     Chapter 65)
435          26B-8-132, (Renumbered from 26-34-4, as enacted by Laws of Utah 2020, Chapter
436     353)
437          26B-8-133, (Renumbered from 26-23-5, as last amended by Laws of Utah 1995,
438     Chapter 202)
439          26B-8-134, (Renumbered from 26-23-5.5, as enacted by Laws of Utah 1995, Chapter
440     202)
441          26B-8-201, (Renumbered from 26-4-2, as last amended by Laws of Utah 2022, Chapter
442     277)
443          26B-8-202, (Renumbered from 26-4-4, as last amended by Laws of Utah 2015, Chapter
444     72)
445          26B-8-203, (Renumbered from 26-4-5, as last amended by Laws of Utah 1993, Chapter
446     227)
447          26B-8-204, (Renumbered from 26-4-6, as last amended by Laws of Utah 2009, Chapter
448     63)
449          26B-8-205, (Renumbered from 26-4-7, as last amended by Laws of Utah 2021, Chapter
450     25)
451          26B-8-206, (Renumbered from 26-4-8, as last amended by Laws of Utah 1993, Chapter
452     38)
453          26B-8-207, (Renumbered from 26-4-9, as last amended by Laws of Utah 2021, Chapter
454     297)
455          26B-8-208, (Renumbered from 26-2-18.5, as last amended by Laws of Utah 2019,
456     Chapter 189)
457          26B-8-209, (Renumbered from 26-4-10, as last amended by Laws of Utah 2021,
458     Chapter 25)
459          26B-8-210, (Renumbered from 26-4-10.5, as last amended by Laws of Utah 2022,
460     Chapter 415)

461          26B-8-211, (Renumbered from 26-4-11, as last amended by Laws of Utah 2018,
462     Chapter 414)
463          26B-8-212, (Renumbered from 26-4-12, as last amended by Laws of Utah 2011,
464     Chapter 297)
465          26B-8-213, (Renumbered from 26-4-13, as last amended by Laws of Utah 2001,
466     Chapter 278)
467          26B-8-214, (Renumbered from 26-4-14, as last amended by Laws of Utah 2021,
468     Chapter 297)
469          26B-8-215, (Renumbered from 26-4-15, as enacted by Laws of Utah 1981, Chapter
470     126)
471          26B-8-216, (Renumbered from 26-4-16, as last amended by Laws of Utah 2007,
472     Chapter 144)
473          26B-8-217, (Renumbered from 26-4-17, as last amended by Laws of Utah 2022,
474     Chapter 255)
475          26B-8-218, (Renumbered from 26-4-18, as enacted by Laws of Utah 1981, Chapter
476     126)
477          26B-8-219, (Renumbered from 26-4-19, as last amended by Laws of Utah 1993,
478     Chapter 38)
479          26B-8-220, (Renumbered from 26-4-20, as last amended by Laws of Utah 2011,
480     Chapter 297)
481          26B-8-221, (Renumbered from 26-4-21, as last amended by Laws of Utah 1997,
482     Chapter 372)
483          26B-8-222, (Renumbered from 26-4-22, as enacted by Laws of Utah 1981, Chapter
484     126)
485          26B-8-223, (Renumbered from 26-4-23, as enacted by Laws of Utah 1981, Chapter
486     126)
487          26B-8-224, (Renumbered from 26-4-24, as last amended by Laws of Utah 1997,

488     Chapter 375)
489          26B-8-225, (Renumbered from 26-4-25, as repealed and reenacted by Laws of Utah
490     2015, Chapter 72)
491          26B-8-226, (Renumbered from 26-4-26, as enacted by Laws of Utah 1997, Chapter
492     232)
493          26B-8-227, (Renumbered from 26-4-27, as enacted by Laws of Utah 1998, Chapter
494     153)
495          26B-8-228, (Renumbered from 26-4-28, as last amended by Laws of Utah 2013,
496     Chapter 167)
497          26B-8-229, (Renumbered from 26-4-28.5, as enacted by Laws of Utah 2017, Chapter
498     346)
499          26B-8-230, (Renumbered from 26-4-29, as last amended by Laws of Utah 2010,
500     Chapter 218)
501          26B-8-231, (Renumbered from 26-4-30, as enacted by Laws of Utah 2020, Chapter
502     201)
503          26B-8-232, (Renumbered from 26-23a-2, as last amended by Laws of Utah 1996,
504     Chapter 23)
505          26B-8-301, (Renumbered from 26-28-102, as enacted by Laws of Utah 2007, Chapter
506     60)
507          26B-8-302, (Renumbered from 26-28-103, as enacted by Laws of Utah 2007, Chapter
508     60)
509          26B-8-303, (Renumbered from 26-28-104, as enacted by Laws of Utah 2007, Chapter
510     60)
511          26B-8-304, (Renumbered from 26-28-105, as last amended by Laws of Utah 2011,
512     Chapter 297)
513          26B-8-305, (Renumbered from 26-28-106, as last amended by Laws of Utah 2011,
514     Chapter 297)

515          26B-8-306, (Renumbered from 26-28-107, as last amended by Laws of Utah 2011,
516     Chapter 297)
517          26B-8-307, (Renumbered from 26-28-108, as enacted by Laws of Utah 2007, Chapter
518     60)
519          26B-8-308, (Renumbered from 26-28-109, as last amended by Laws of Utah 2018,
520     Chapter 48)
521          26B-8-309, (Renumbered from 26-28-110, as enacted by Laws of Utah 2007, Chapter
522     60)
523          26B-8-310, (Renumbered from 26-28-111, as last amended by Laws of Utah 2011,
524     Chapter 297)
525          26B-8-311, (Renumbered from 26-28-112, as last amended by Laws of Utah 2014,
526     Chapter 189)
527          26B-8-312, (Renumbered from 26-28-113, as enacted by Laws of Utah 2007, Chapter
528     60)
529          26B-8-313, (Renumbered from 26-28-114, as last amended by Laws of Utah 2019,
530     Chapter 349)
531          26B-8-314, (Renumbered from 26-28-115, as enacted by Laws of Utah 2007, Chapter
532     60)
533          26B-8-315, (Renumbered from 26-28-116, as enacted by Laws of Utah 2007, Chapter
534     60)
535          26B-8-316, (Renumbered from 26-28-117, as enacted by Laws of Utah 2007, Chapter
536     60)
537          26B-8-317, (Renumbered from 26-28-118, as last amended by Laws of Utah 2018,
538     Chapter 48)
539          26B-8-318, (Renumbered from 26-28-119, as enacted by Laws of Utah 2007, Chapter
540     60)
541          26B-8-319, (Renumbered from 26-28-120, as last amended by Laws of Utah 2011,

542     Chapter 297)
543          26B-8-320, (Renumbered from 26-28-121, as last amended by Laws of Utah 2011,
544     Chapter 297)
545          26B-8-321, (Renumbered from 26-28-122, as enacted by Laws of Utah 2007, Chapter
546     60)
547          26B-8-322, (Renumbered from 26-28-123, as enacted by Laws of Utah 2007, Chapter
548     60)
549          26B-8-323, (Renumbered from 26-28-124, as last amended by Laws of Utah 2011,
550     Chapter 297)
551          26B-8-324, (Renumbered from 26-28-125, as enacted by Laws of Utah 2007, Chapter
552     60)
553          26B-8-401, (Renumbered from 26-3-1, as last amended by Laws of Utah 1995, Chapter
554     202)
555          26B-8-402, (Renumbered from 26-3-2, as enacted by Laws of Utah 1981, Chapter 126)
556          26B-8-403, (Renumbered from 26-3-4, as enacted by Laws of Utah 1981, Chapter 126)
557          26B-8-404, (Renumbered from 26-3-5, as last amended by Laws of Utah 1996, Chapter
558     201)
559          26B-8-405, (Renumbered from 26-3-6, as last amended by Laws of Utah 1996, Chapter
560     201)
561          26B-8-406, (Renumbered from 26-3-7, as last amended by Laws of Utah 2013, Chapter
562     278)
563          26B-8-407, (Renumbered from 26-3-8, as last amended by Laws of Utah 2011, Chapter
564     297)
565          26B-8-408, (Renumbered from 26-3-9, as last amended by Laws of Utah 1996, Chapter
566     201)
567          26B-8-409, (Renumbered from 26-3-10, as last amended by Laws of Utah 1996,
568     Chapter 201)

569          26B-8-410, (Renumbered from 26-3-11, as last amended by Laws of Utah 2005,
570     Chapter 243)
571          26B-8-411, (Renumbered from 26-1-37, as last amended by Laws of Utah 2019,
572     Chapter 105)
573          26B-8-501, (Renumbered from 26-33a-102, as last amended by Laws of Utah 2022,
574     Chapter 255)
575          26B-8-502, (Renumbered from 26-33a-105, as enacted by Laws of Utah 1990, Chapter
576     305)
577          26B-8-503, (Renumbered from 26-33a-106, as last amended by Laws of Utah 1996,
578     Chapter 201)
579          26B-8-504, (Renumbered from 26-33a-106.1, as last amended by Laws of Utah 2022,
580     Chapter 321)
581          26B-8-505, (Renumbered from 26-33a-106.5, as last amended by Laws of Utah 2019,
582     Chapter 370)
583          26B-8-506, (Renumbered from 26-33a-107, as last amended by Laws of Utah 2016,
584     Chapter 74)
585          26B-8-507, (Renumbered from 26-33a-108, as last amended by Laws of Utah 1996,
586     Chapter 201)
587          26B-8-508, (Renumbered from 26-33a-109, as last amended by Laws of Utah 2021,
588     Chapter 277)
589          26B-8-509, (Renumbered from 26-33a-110, as enacted by Laws of Utah 1990, Chapter
590     305)
591          26B-8-510, (Renumbered from 26-33a-111, as last amended by Laws of Utah 2011,
592     Chapter 297)
593          26B-8-511, (Renumbered from 26-33a-115, as enacted by Laws of Utah 2013, Chapter
594     102)
595          26B-8-512, (Renumbered from 26-33a-116, as enacted by Laws of Utah 2019, Chapter

596     287)
597          26B-8-513, (Renumbered from 26-33a-117, as enacted by Laws of Utah 2020, Chapter
598     181)
599          26B-8-514, (Renumbered from 26-70-102, as enacted by Laws of Utah 2022, Chapter
600     327)
601     Utah Code Sections Affected by Coordination Clause:
602          26-2-2, as last amended by Laws of Utah 2022, Chapter 415
603          26-2-11, as last amended by Laws of Utah 1995, Chapter 202
604          26B-8-101, as enacted by Laws of Utah 2022, Chapter 255
605          26B-8-111, Utah Code Annotated 1953
606     

607     Be it enacted by the Legislature of the state of Utah:
608          Section 1. Section 26B-3-101 is amended to read:
609     
CHAPTER 3. HEALTH CARE - ADMINISTRATION AND ASSISTANCE

610     
Part 1. Health Care Assistance

611          26B-3-101. Definitions.
612          [Reserved]
613          As used in this chapter:
614          (1) "Applicant" means any person who requests assistance under the medical programs
615     of the state.
616          (2) "CMS" means the Centers for Medicare and Medicaid Services within the United
617     States Department of Health and Human Services.
618          (3) "Division" means the Division of Integrated Healthcare within the department,
619     established under Section 26B-3-102.
620          (4) "Enrollee" or "member" means an individual whom the department has determined
621     to be eligible for assistance under the Medicaid program.
622          (5) "Medicaid program" means the state program for medical assistance for persons

623     who are eligible under the state plan adopted pursuant to Title XIX of the federal Social
624     Security Act.
625          (6) "Medical assistance" means services furnished or payments made to or on behalf of
626     a member.
627          (7) (a) "Passenger vehicle" means a self-propelled, two-axle vehicle intended primarily
628     for operation on highways and used by an applicant or recipient to meet basic transportation
629     needs and has a fair market value below 40% of the applicable amount of the federal luxury
630     passenger automobile tax established in 26 U.S.C. Sec. 4001 and adjusted annually for
631     inflation.
632          (b) "Passenger vehicle" does not include:
633          (i) a commercial vehicle, as defined in Section 41-1a-102;
634          (ii) an off-highway vehicle, as defined in Section 41-1a-102; or
635          (iii) a motor home, as defined in Section 13-14-102.
636          (8) "PPACA" means the same as that term is defined in Section 31A-1-301.
637          (9) "Recipient" means a person who has received medical assistance under the
638     Medicaid program.
639          Section 2. Section 26B-3-102, which is renumbered from Section 26-18-2.1 is
640     renumbered and amended to read:
641          [26-18-2.1].      26B-3-102. Division -- Creation.
642          There is created, within the department, the Division of [Medicaid and Health
643     Financing] Integrated Healthcare which shall be responsible for implementing, organizing, and
644     maintaining the Medicaid program and the Children's Health Insurance Program established in
645     Section [26-40-103] 26B-3-902, in accordance with the provisions of this chapter and
646     applicable federal law.
647          Section 3. Section 26B-3-103, which is renumbered from Section 26-18-2.2 is
648     renumbered and amended to read:
649          [26-18-2.2].      26B-3-103. State Medicaid director -- Appointment --

650     Responsibilities.
651          (1) The state Medicaid director shall be appointed by the governor, after consultation
652     with the executive director, with the advice and consent of the Senate.
653          (2) The state Medicaid director may employ other employees as necessary to
654     implement the provisions of this chapter, and shall:
655          [(1)] (a) administer the responsibilities of the division as set forth in this chapter;
656          [(2)] (b) administer the division's budget; and
657          [(3)] (c) establish and maintain a state plan for the Medicaid program in compliance
658     with federal law and regulations.
659          Section 4. Section 26B-3-104, which is renumbered from Section 26-18-2.3 is
660     renumbered and amended to read:
661          [26-18-2.3].      26B-3-104. Division responsibilities -- Emphasis -- Periodic
662     assessment.
663          (1) In accordance with the requirements of Title XIX of the Social Security Act and
664     applicable federal regulations, the division is responsible for the effective and impartial
665     administration of this chapter in an efficient, economical manner. The division shall:
666          (a) establish, on a statewide basis, a program to safeguard against unnecessary or
667     inappropriate use of Medicaid services, excessive payments, and unnecessary or inappropriate
668     hospital admissions or lengths of stay;
669          (b) deny any provider claim for services that fail to meet criteria established by the
670     division concerning medical necessity or appropriateness; and
671          (c) place its emphasis on high quality care to recipients in the most economical and
672     cost-effective manner possible, with regard to both publicly and privately provided services.
673          (2) The division shall implement and utilize cost-containment methods, where
674     possible, which may include:
675          (a) prepayment and postpayment review systems to determine if utilization is
676     reasonable and necessary;

677          (b) preadmission certification of nonemergency admissions;
678          (c) mandatory outpatient, rather than inpatient, surgery in appropriate cases;
679          (d) second surgical opinions;
680          (e) procedures for encouraging the use of outpatient services;
681          (f) consistent with Sections [26-18-2.4] 26B-3-105 and 58-17b-606, a Medicaid drug
682     program;
683          (g) coordination of benefits; and
684          (h) review and exclusion of providers who are not cost effective or who have abused
685     the Medicaid program, in accordance with the procedures and provisions of federal law and
686     regulation.
687          (3) The state Medicaid director shall periodically assess the cost effectiveness and
688     health implications of the existing Medicaid program, and consider alternative approaches to
689     the provision of covered health and medical services through the Medicaid program, in order to
690     reduce unnecessary or unreasonable utilization.
691          (4) (a) The department shall ensure Medicaid program integrity by conducting internal
692     audits of the Medicaid program for efficiencies, best practices, and cost avoidance.
693          (b) The department shall coordinate with the Office of the Inspector General for
694     Medicaid Services created in Section 63A-13-201 to implement Subsection (2) and to address
695     Medicaid fraud, waste, or abuse as described in Section 63A-13-202.
696          Section 5. Section 26B-3-105, which is renumbered from Section 26-18-2.4 is
697     renumbered and amended to read:
698          [26-18-2.4].      26B-3-105. Medicaid drug program -- Preferred drug list.
699          (1) A Medicaid drug program developed by the department under Subsection
700     [26-18-2.3] 26B-3-104(2)(f):
701          (a) shall, notwithstanding Subsection [26-18-2.3] 26B-3-104(1)(b), be based on clinical
702     and cost-related factors which include medical necessity as determined by a provider in
703     accordance with administrative rules established by the Drug Utilization Review Board;

704          (b) may include therapeutic categories of drugs that may be exempted from the drug
705     program;
706          (c) may include placing some drugs, except the drugs described in Subsection (2), on a
707     preferred drug list:
708          (i) to the extent determined appropriate by the department; and
709          (ii) in the manner described in Subsection (3) for psychotropic drugs;
710          (d) notwithstanding the requirements of [Part 2,] Sections 26B-3-302 through
711     26B-3-309 regarding the Drug Utilization Review Board, and except as provided in Subsection
712     (3), shall immediately implement the prior authorization requirements for a nonpreferred drug
713     that is in the same therapeutic class as a drug that is:
714          (i) on the preferred drug list on the date that this act takes effect; or
715          (ii) added to the preferred drug list after this act takes effect; and
716          (e) except as prohibited by Subsections 58-17b-606(4) and (5), shall establish the prior
717     authorization requirements established under Subsections (1)(c) and (d) which shall permit a
718     health care provider or the health care provider's agent to obtain a prior authorization override
719     of the preferred drug list through the department's pharmacy prior authorization review process,
720     and which shall:
721          (i) provide either telephone or fax approval or denial of the request within 24 hours of
722     the receipt of a request that is submitted during normal business hours of Monday through
723     Friday from 8 a.m. to 5 p.m.;
724          (ii) provide for the dispensing of a limited supply of a requested drug as determined
725     appropriate by the department in an emergency situation, if the request for an override is
726     received outside of the department's normal business hours; and
727          (iii) require the health care provider to provide the department with documentation of
728     the medical need for the preferred drug list override in accordance with criteria established by
729     the department in consultation with the Pharmacy and Therapeutics Committee.
730          (2) (a) [For purposes of] As used in this Subsection (2):

731          (i) "Immunosuppressive drug":
732          (A) means a drug that is used in immunosuppressive therapy to inhibit or prevent
733     activity of the immune system to aid the body in preventing the rejection of transplanted organs
734     and tissue; and
735          (B) does not include drugs used for the treatment of autoimmune disease or diseases
736     that are most likely of autoimmune origin.
737          (ii) "Stabilized" means a health care provider has documented in the patient's medical
738     chart that a patient has achieved a stable or steadfast medical state within the past 90 days using
739     a particular psychotropic drug.
740          (b) A preferred drug list developed under the provisions of this section may not include
741     an immunosuppressive drug.
742          (c) (i) The state Medicaid program shall reimburse for a prescription for an
743     immunosuppressive drug as written by the health care provider for a patient who has undergone
744     an organ transplant.
745          (ii) For purposes of Subsection 58-17b-606(4), and with respect to patients who have
746     undergone an organ transplant, the prescription for a particular immunosuppressive drug as
747     written by a health care provider meets the criteria of demonstrating to the department a
748     medical necessity for dispensing the prescribed immunosuppressive drug.
749          (d) Notwithstanding the requirements of [Part 2,] Sections 26B-3-302 through
750     26B-3-309 regarding the Drug Utilization Review Board, the state Medicaid drug program may
751     not require the use of step therapy for immunosuppressive drugs without the written or oral
752     consent of the health care provider and the patient.
753          (e) The department may include a sedative hypnotic on a preferred drug list in
754     accordance with Subsection (2)(f).
755          (f) The department shall grant a prior authorization for a sedative hypnotic that is not
756     on the preferred drug list under Subsection (2)(e), if the health care provider has documentation
757     related to one of the following conditions for the Medicaid client:

758          (i) a trial and failure of at least one preferred agent in the drug class, including the
759     name of the preferred drug that was tried, the length of therapy, and the reason for the
760     discontinuation;
761          (ii) detailed evidence of a potential drug interaction between current medication and
762     the preferred drug;
763          (iii) detailed evidence of a condition or contraindication that prevents the use of the
764     preferred drug;
765          (iv) objective clinical evidence that a patient is at high risk of adverse events due to a
766     therapeutic interchange with a preferred drug;
767          (v) the patient is a new or previous Medicaid client with an existing diagnosis
768     previously stabilized with a nonpreferred drug; or
769          (vi) other valid reasons as determined by the department.
770          (g) A prior authorization granted under Subsection (2)(f) is valid for one year from the
771     date the department grants the prior authorization and shall be renewed in accordance with
772     Subsection (2)(f).
773          (3) (a) [For purposes of] As used in this Subsection (3), "psychotropic drug" means the
774     following classes of drugs:
775          (i) atypical anti-psychotic;
776          (ii) anti-depressant;
777          (iii) anti-convulsant/mood stabilizer;
778          (iv) anti-anxiety; and
779          (v) attention deficit hyperactivity disorder stimulant.
780          (b) (i) The department shall develop a preferred drug list for psychotropic drugs.
781          (ii) Except as provided in Subsection (3)(d), a preferred drug list for psychotropic
782     drugs developed under this section shall allow a health care provider to override the preferred
783     drug list by writing "dispense as written" on the prescription for the psychotropic drug.
784          (iii) A health care provider may not override Section 58-17b-606 by writing "dispense

785     as written" on a prescription.
786          (c) The department, and a Medicaid accountable care organization that is responsible
787     for providing behavioral health, shall:
788          (i) establish a system to:
789          (A) track health care provider prescribing patterns for psychotropic drugs;
790          (B) educate health care providers who are not complying with the preferred drug list;
791     and
792          (C) implement peer to peer education for health care providers whose prescribing
793     practices continue to not comply with the preferred drug list; and
794          (ii) determine whether health care provider compliance with the preferred drug list is at
795     least:
796          (A) 55% of prescriptions by July 1, 2017;
797          (B) 65% of prescriptions by July 1, 2018; and
798          (C) 75% of prescriptions by July 1, 2019.
799          (d) Beginning October 1, 2019, the department shall eliminate the dispense as written
800     override for the preferred drug list, and shall implement a prior authorization system for
801     psychotropic drugs, in accordance with Subsection (2)(f), if by July 1, 2019, the department has
802     not realized annual savings from implementing the preferred drug list for psychotropic drugs of
803     at least $750,000 General Fund savings.
804          Section 6. Section 26B-3-106, which is renumbered from Section 26-18-2.5 is
805     renumbered and amended to read:
806          [26-18-2.5].      26B-3-106. Simplified enrollment and renewal process for Medicaid
807     and other state medical programs -- Financial institutions.
808          (1) The department may apply for grants and accept donations to make technology
809     system improvements necessary to implement a simplified enrollment and renewal process for
810     the Medicaid program, Utah Premium Partnership, and Primary Care Network Demonstration
811     Project programs.

812          (2) (a) The department may enter into an agreement with a financial institution doing
813     business in the state to develop and operate a data match system to identify an applicant's or
814     enrollee's assets that:
815          (i) uses automated data exchanges to the maximum extent feasible; and
816          (ii) requires a financial institution each month to provide the name, record address,
817     Social Security number, other taxpayer identification number, or other identifying information
818     for each applicant or enrollee who maintains an account at the financial institution.
819          (b) The department may pay a reasonable fee to a financial institution for compliance
820     with this Subsection (2), as provided in Section 7-1-1006.
821          (c) A financial institution may not be liable under any federal or state law to any person
822     for any disclosure of information or action taken in good faith under this Subsection (2).
823          (d) The department may disclose a financial record obtained from a financial institution
824     under this section only for the purpose of, and to the extent necessary in, verifying eligibility as
825     provided in this section and Section [26-40-105] 26B-3-903.
826          Section 7. Section 26B-3-107, which is renumbered from Section 26-18-2.6 is
827     renumbered and amended to read:
828          [26-18-2.6].      26B-3-107. Dental benefits.
829          (1) (a) Except as provided in Subsection (8), the division may establish a competitive
830     bid process to bid out Medicaid dental benefits under this chapter.
831          (b) The division may bid out the Medicaid dental benefits separately from other
832     program benefits.
833          (2) The division shall use the following criteria to evaluate dental bids:
834          (a) ability to manage dental expenses;
835          (b) proven ability to handle dental insurance;
836          (c) efficiency of claim paying procedures;
837          (d) provider contracting, discounts, and adequacy of network; and
838          (e) other criteria established by the department.

839          (3) The division shall request bids for the program's benefits at least once every five
840     years.
841          (4) The division's contract with dental plans for the program's benefits shall include
842     risk sharing provisions in which the dental plan must accept 100% of the risk for any difference
843     between the division's premium payments per client and actual dental expenditures.
844          (5) The division may not award contracts to:
845          (a) more than three responsive bidders under this section; or
846          (b) an insurer that does not have a current license in the state.
847          (6) (a) The division may cancel the request for proposals if:
848          (i) there are no responsive bidders; or
849          (ii) the division determines that accepting the bids would increase the program's costs.
850          (b) If the division cancels a request for proposal or a contract that results from a request
851     for proposal described in Subsection (6)(a), the division shall report to the Health and Human
852     Services Interim Committee regarding the reasons for the decision.
853          (7) Title 63G, Chapter 6a, Utah Procurement Code, shall apply to this section.
854          (8) (a) The division may:
855          (i) establish a dental health care delivery system and payment reform pilot program for
856     Medicaid dental benefits to increase access to cost effective and quality dental health care by
857     increasing the number of dentists available for Medicaid dental services; and
858          (ii) target specific Medicaid populations or geographic areas in the state.
859          (b) The pilot program shall establish compensation models for dentists and dental
860     hygienists that:
861          (i) increase access to quality, cost effective dental care; and
862          (ii) use funds from the Division of Family Health and Preparedness that are available to
863     reimburse dentists for educational loans in exchange for the dentist agreeing to serve Medicaid
864     and under-served populations.
865          (c) The division may amend the state plan and apply to the Secretary of the United

866     States Department of Health and Human Services for waivers or pilot programs if necessary to
867     establish the new dental care delivery and payment reform model.
868          (d) The division shall evaluate the pilot program's effect on the cost of dental care and
869     access to dental care for the targeted Medicaid populations.
870          (9) (a) As used in this Subsection (9), "dental hygienist" means an individual who is
871     licensed as a dental hygienist under Section 58-69-301.
872          (b) The department shall reimburse a dental hygienist for dental services performed in
873     a public health setting and in accordance with Subsection (9)(c) beginning on the earlier of:
874          (i) January 1, 2023; or
875          (ii) 30 days after the date on which the replacement of the department's Medicaid
876     Management Information System software is complete.
877          (c) The department shall reimburse a dental hygienist directly for a service provided
878     through the Medicaid program if:
879          (i) the dental hygienist requests to be reimbursed directly; and
880          (ii) the dental hygienist provides the service within the scope of practice described in
881     Section 58-69-801.
882          (d) Before November 30 of each year in which the department reimburses dental
883     hygienists in accordance with Subsection (9)(c), the department shall report to the Health and
884     Human Services Interim Committee, for the previous fiscal year:
885          (i) the number and geographic distribution of dental hygienists who requested to be
886     reimbursed directly;
887          (ii) the total number of Medicaid enrollees who were served by a dental hygienist who
888     were reimbursed under this Subsection (9);
889          (iii) the total amount reimbursed directly to dental hygienists under this Subsection (9);
890          (iv) the specific services and billing codes that are reimbursed under this Subsection
891     (9); and
892          (v) the aggregate amount reimbursed for each service and billing code described in

893     Subsection (9)(d)(iv).
894          (e) (i) Except as provided in this Subsection (9), nothing in this Subsection (9) shall be
895     interpreted as expanding or otherwise altering the limitations and scope of practice for a dental
896     hygienist.
897          (ii) A dental hygienist may only directly bill and receive compensation for billing codes
898     that fall within the scope of practice of a dental hygienist.
899          Section 8. Section 26B-3-108, which is renumbered from Section 26-18-3 is
900     renumbered and amended to read:
901          [26-18-3].      26B-3-108. Administration of Medicaid program by department --
902     Reporting to the Legislature -- Disciplinary measures and sanctions -- Funds collected --
903     Eligibility standards -- Internal audits -- Health opportunity accounts.
904          (1) The department shall be the single state agency responsible for the administration
905     of the Medicaid program in connection with the United States Department of Health and
906     Human Services pursuant to Title XIX of the Social Security Act.
907          (2) (a) The department shall implement the Medicaid program through administrative
908     rules in conformity with this chapter, Title 63G, Chapter 3, Utah Administrative Rulemaking
909     Act, the requirements of Title XIX, and applicable federal regulations.
910          (b) The rules adopted under Subsection (2)(a) shall include, in addition to other rules
911     necessary to implement the program:
912          (i) the standards used by the department for determining eligibility for Medicaid
913     services;
914          (ii) the services and benefits to be covered by the Medicaid program;
915          (iii) reimbursement methodologies for providers under the Medicaid program; and
916          (iv) a requirement that:
917          (A) a person receiving Medicaid services shall participate in the electronic exchange of
918     clinical health records established in accordance with Section [26-1-37] 26B-8-411 unless the
919     individual opts out of participation;

920          (B) prior to enrollment in the electronic exchange of clinical health records the enrollee
921     shall receive notice of enrollment in the electronic exchange of clinical health records and the
922     right to opt out of participation at any time; and
923          (C) beginning July 1, 2012, when the program sends enrollment or renewal information
924     to the enrollee and when the enrollee logs onto the program's website, the enrollee shall receive
925     notice of the right to opt out of the electronic exchange of clinical health records.
926          (3) (a) The department shall, in accordance with Subsection (3)(b), report to the Social
927     Services Appropriations Subcommittee when the department:
928          (i) implements a change in the Medicaid State Plan;
929          (ii) initiates a new Medicaid waiver;
930          (iii) initiates an amendment to an existing Medicaid waiver;
931          (iv) applies for an extension of an application for a waiver or an existing Medicaid
932     waiver;
933          (v) applies for or receives approval for a change in any capitation rate within the
934     Medicaid program; or
935          (vi) initiates a rate change that requires public notice under state or federal law.
936          (b) The report required by Subsection (3)(a) shall:
937          (i) be submitted to the Social Services Appropriations Subcommittee prior to the
938     department implementing the proposed change; and
939          (ii) include:
940          (A) a description of the department's current practice or policy that the department is
941     proposing to change;
942          (B) an explanation of why the department is proposing the change;
943          (C) the proposed change in services or reimbursement, including a description of the
944     effect of the change;
945          (D) the effect of an increase or decrease in services or benefits on individuals and
946     families;

947          (E) the degree to which any proposed cut may result in cost-shifting to more expensive
948     services in health or human service programs; and
949          (F) the fiscal impact of the proposed change, including:
950          (I) the effect of the proposed change on current or future appropriations from the
951     Legislature to the department;
952          (II) the effect the proposed change may have on federal matching dollars received by
953     the state Medicaid program;
954          (III) any cost shifting or cost savings within the department's budget that may result
955     from the proposed change; and
956          (IV) identification of the funds that will be used for the proposed change, including any
957     transfer of funds within the department's budget.
958          (4) Any rules adopted by the department under Subsection (2) are subject to review and
959     reauthorization by the Legislature in accordance with Section 63G-3-502.
960          (5) The department may, in its discretion, contract with [the Department of Human
961     Services or] other qualified agencies for services in connection with the administration of the
962     Medicaid program, including:
963          (a) the determination of the eligibility of individuals for the program;
964          (b) recovery of overpayments; and
965          (c) consistent with Section [26-20-13] 26B-3-1113, and to the extent permitted by law
966     and quality control services, enforcement of fraud and abuse laws.
967          (6) The department shall provide, by rule, disciplinary measures and sanctions for
968     Medicaid providers who fail to comply with the rules and procedures of the program, provided
969     that sanctions imposed administratively may not extend beyond:
970          (a) termination from the program;
971          (b) recovery of claim reimbursements incorrectly paid; and
972          (c) those specified in Section 1919 of Title XIX of the federal Social Security Act.
973          (7) (a) Funds collected as a result of a sanction imposed under Section 1919 of Title

974     XIX of the federal Social Security Act shall be deposited in the General Fund as dedicated
975     credits to be used by the division in accordance with the requirements of Section 1919 of Title
976     XIX of the federal Social Security Act.
977          (b) In accordance with Section 63J-1-602.2, sanctions collected under this Subsection
978     (7) are nonlapsing.
979          (8) (a) In determining whether an applicant or recipient is eligible for a service or
980     benefit under this part or [Chapter 40] Part 9, Utah Children's Health Insurance [Act] Program,
981     the department shall, if Subsection (8)(b) is satisfied, exclude from consideration one passenger
982     vehicle designated by the applicant or recipient.
983          (b) Before Subsection (8)(a) may be applied:
984          (i) the federal government shall:
985          (A) determine that Subsection (8)(a) may be implemented within the state's existing
986     public assistance-related waivers as of January 1, 1999;
987          (B) extend a waiver to the state permitting the implementation of Subsection (8)(a); or
988          (C) determine that the state's waivers that permit dual eligibility determinations for
989     cash assistance and Medicaid are no longer valid; and
990          (ii) the department shall determine that Subsection (8)(a) can be implemented within
991     existing funding.
992          (9) (a) [For purposes of] As used in this Subsection (9):
993          (i) "aged, blind, or has a disability" means an aged, blind, or disabled individual, as
994     defined in 42 U.S.C. Sec. 1382c(a)(1); and
995          (ii) "spend down" means an amount of income in excess of the allowable income
996     standard that shall be paid in cash to the department or incurred through the medical services
997     not paid by Medicaid.
998          (b) In determining whether an applicant or recipient who is aged, blind, or has a
999     disability is eligible for a service or benefit under this chapter, the department shall use 100%
1000     of the federal poverty level as:

1001          (i) the allowable income standard for eligibility for services or benefits; and
1002          (ii) the allowable income standard for eligibility as a result of spend down.
1003          (10) The department shall conduct internal audits of the Medicaid program.
1004          (11) (a) The department may apply for and, if approved, implement a demonstration
1005     program for health opportunity accounts, as provided for in 42 U.S.C. Sec. 1396u-8.
1006          (b) A health opportunity account established under Subsection (11)(a) shall be an
1007     alternative to the existing benefits received by an individual eligible to receive Medicaid under
1008     this chapter.
1009          (c) Subsection (11)(a) is not intended to expand the coverage of the Medicaid program.
1010          (12) (a) (i) The department shall apply for, and if approved, implement an amendment
1011     to the state plan under this Subsection (12) for benefits for:
1012          (A) medically needy pregnant women;
1013          (B) medically needy children; and
1014          (C) medically needy parents and caretaker relatives.
1015          (ii) The department may implement the eligibility standards of Subsection (12)(b) for
1016     eligibility determinations made on or after the date of the approval of the amendment to the
1017     state plan.
1018          (b) In determining whether an applicant is eligible for benefits described in Subsection
1019     (12)(a)(i), the department shall:
1020          (i) disregard resources held in an account in the savings plan created under Title 53B,
1021     Chapter 8a, Utah Educational Savings Plan, if the beneficiary of the account is:
1022          (A) under the age of 26; and
1023          (B) living with the account owner, as that term is defined in Section 53B-8a-102, or
1024     temporarily absent from the residence of the account owner; and
1025          (ii) include the withdrawals from an account in the Utah Educational Savings Plan as
1026     resources for a benefit determination, if the withdrawal was not used for qualified higher
1027     education costs as that term is defined in Section 53B-8a-102.5.

1028          (13) (a) The department may not deny or terminate eligibility for Medicaid solely
1029     because an individual is:
1030          (i) incarcerated; and
1031          (ii) not an inmate as defined in Section 64-13-1.
1032          (b) Subsection (13)(a) does not require the Medicaid program to provide coverage for
1033     any services for an individual while the individual is incarcerated.
1034          (14) The department is a party to, and may intervene at any time in, any judicial or
1035     administrative action:
1036          (a) to which the Department of Workforce Services is a party; and
1037          (b) that involves medical assistance under[:] this chapter.
1038          [(i) Title 26, Chapter 18, Medical Assistance Act; or]
1039          [(ii) Title 26, Chapter 40, Utah Children's Health Insurance Act.]
1040          Section 9. Section 26B-3-109, which is renumbered from Section 26-18-3.1 is
1041     renumbered and amended to read:
1042          [26-18-3.1].      26B-3-109. Medicaid expansion.
1043          (1) The purpose of this section is to expand the coverage of the Medicaid program to
1044     persons who are in categories traditionally not served by that program.
1045          (2) Within appropriations from the Legislature, the department may amend the state
1046     plan for medical assistance to provide for eligibility for Medicaid:
1047          (a) on or after July 1, 1994, for children 12 to 17 years old who live in households
1048     below the federal poverty income guideline; and
1049          (b) on or after July 1, 1995, for persons who have incomes below the federal poverty
1050     income guideline and who are aged, blind, or have a disability.
1051          (3) (a) Within appropriations from the Legislature, on or after July 1, 1996, the
1052     Medicaid program may provide for eligibility for persons who have incomes below the federal
1053     poverty income guideline.
1054          (b) In order to meet the provisions of this subsection, the department may seek

1055     approval for a demonstration project under 42 U.S.C. Sec. 1315 from the secretary of the
1056     United States Department of Health and Human Services.
1057          (4) The Medicaid program shall provide for eligibility for persons as required by
1058     Subsection [26-18-3.9] 26B-3-113(2).
1059          (5) Services available for persons described in this section shall include required
1060     Medicaid services and may include one or more optional Medicaid services if those services
1061     are funded by the Legislature. The department may also require persons described in
1062     Subsections (1) through (3) to meet an asset test.
1063          Section 10. Section 26B-3-110, which is renumbered from Section 26-18-3.5 is
1064     renumbered and amended to read:
1065          [26-18-3.5].      26B-3-110. Copayments by recipients -- Employer sponsored plans.
1066          (1) The department shall selectively provide for enrollment fees, premiums,
1067     deductions, cost sharing or other similar charges to be paid by recipients, their spouses, and
1068     parents, within the limitations of federal law and regulation.
1069          (2) Beginning May 1, 2006, within appropriations by the Legislature and as a means to
1070     increase health care coverage among the uninsured, the department shall take steps to promote
1071     increased participation in employer sponsored health insurance, including:
1072          (a) maximizing the health insurance premium subsidy provided under the state's 1115
1073     demonstration waiver by:
1074          (i) ensuring that state funds are matched by federal funds to the greatest extent
1075     allowable; and
1076          (ii) as the department determines appropriate, seeking federal approval to do one or
1077     more of the following:
1078          (A) eliminate or otherwise modify the annual enrollment fee;
1079          (B) eliminate or otherwise modify the schedule used to determine the level of subsidy
1080     provided to an enrollee each year;
1081          (C) reduce the maximum number of participants allowable under the subsidy program;

1082     or
1083          (D) otherwise modify the program in a manner that promotes enrollment in employer
1084     sponsored health insurance; and
1085          (b) exploring the use of other options, including the development of a waiver under the
1086     Medicaid Health Insurance Flexibility Demonstration Initiative or other federal authority.
1087          Section 11. Section 26B-3-111, which is renumbered from Section 26-18-3.6 is
1088     renumbered and amended to read:
1089          [26-18-3.6].      26B-3-111. Income and resources from institutionalized spouses.
1090          (1) As used in this section:
1091          (a) "Community spouse" means the spouse of an institutionalized spouse.
1092          (b) (i) "Community spouse monthly income allowance" means an amount by which the
1093     minimum monthly maintenance needs allowance for the spouse exceeds the amount of monthly
1094     income otherwise available to the community spouse, determined without regard to the
1095     allowance, except as provided in Subsection (1)(b)(ii).
1096          (ii) If a court has entered an order against an institutionalized spouse for monthly
1097     income for the support of the community spouse, the community spouse monthly income
1098     allowance for the spouse may not be less than the amount of the monthly income so ordered.
1099          (c) "Community spouse resource allowance" is the amount of combined resources that
1100     are protected for a community spouse living in the community, which the division shall
1101     establish by rule made in accordance with Title 63G, Chapter 3, Utah Administrative
1102     Rulemaking Act, based on the amounts established by the United States Department of Health
1103     and Human Services.
1104          (d) "Excess shelter allowance" for a community spouse means the amount by which the
1105     sum of the spouse's expense for rent or mortgage payment, taxes, and insurance, and in the case
1106     of condominium or cooperative, required maintenance charge, for the community spouse's
1107     principal residence and the spouse's actual expenses for electricity, natural gas, and water
1108     utilities or, at the discretion of the department, the federal standard utility allowance under

1109     SNAP as defined in Section 35A-1-102, exceeds 30% of the amount described in Subsection
1110     (9).
1111          (e) "Family member" means a minor dependent child, dependent parents, or dependent
1112     sibling of the institutionalized spouse or community spouse who are residing with the
1113     community spouse.
1114          (f) (i) "Institutionalized spouse" means a person who is residing in a nursing facility
1115     and is married to a spouse who is not in a nursing facility.
1116          (ii) An "institutionalized spouse" does not include a person who is not likely to reside
1117     in a nursing facility for at least 30 consecutive days.
1118          (g) "Nursing care facility" means the same as that term is defined in Section [26-21-2]
1119     26B-2-201.
1120          (2) The division shall comply with this section when determining eligibility for
1121     medical assistance for an institutionalized spouse.
1122          (3) For services furnished during a calendar year beginning on or after January 1, 1999,
1123     the community spouse resource allowance shall be increased by the division by an amount as
1124     determined annually by CMS.
1125          (4) The division shall compute, as of the beginning of the first continuous period of
1126     institutionalization of the institutionalized spouse:
1127          (a) the total value of the resources to the extent either the institutionalized spouse or
1128     the community spouse has an ownership interest; and
1129          (b) a spousal share, which is 1/2 of the resources described in Subsection (4)(a).
1130          (5) At the request of an institutionalized spouse or a community spouse, at the
1131     beginning of the first continuous period of institutionalization of the institutionalized spouse
1132     and upon the receipt of relevant documentation of resources, the division shall promptly assess
1133     and document the total value described in Subsection (4)(a) and shall provide a copy of that
1134     assessment and documentation to each spouse and shall retain a copy of the assessment. When
1135     the division provides a copy of the assessment, it shall include a notice stating that the spouse

1136     may request a hearing under Subsection (11).
1137          (6) When determining eligibility for medical assistance under this chapter:
1138          (a) Except as provided in Subsection (6)(b), all resources held by either the
1139     institutionalized spouse, community spouse, or both, are considered to be available to the
1140     institutionalized spouse.
1141          (b) Resources are considered to be available to the institutionalized spouse only to the
1142     extent that the amount of those resources exceeds the community spouse resource allowance at
1143     the time of application for medical assistance under this chapter.
1144          (7) (a) The division may not find an institutionalized spouse to be ineligible for
1145     medical assistance by reason of resources determined under Subsection (5) to be available for
1146     the cost of care when:
1147          (i) the institutionalized spouse has assigned to the state any rights to support from the
1148     community spouse;
1149          (ii) except as provided in Subsection (7)(b), the institutionalized spouse lacks the
1150     ability to execute an assignment due to physical or mental impairment; or
1151          (iii) the division determines that denial of medical assistance would cause an undue
1152     burden.
1153          (b) Subsection (7)(a)(ii) does not prevent the division from seeking a court order for an
1154     assignment of support.
1155          (8) During the continuous period in which an institutionalized spouse is in an
1156     institution and after the month in which an institutionalized spouse is eligible for medical
1157     assistance, the resources of the community spouse may not be considered to be available to the
1158     institutionalized spouse.
1159          (9) When an institutionalized spouse is determined to be eligible for medical
1160     assistance, in determining the amount of the spouse's income that is to be applied monthly for
1161     the cost of care in the nursing care facility, the division shall deduct from the spouse's monthly
1162     income the following amounts in the following order:

1163          (a) a personal needs allowance, the amount of which is determined by the division;
1164          (b) a community spouse monthly income allowance, but only to the extent that the
1165     income of the institutionalized spouse is made available to, or for the benefit of, the community
1166     spouse;
1167          (c) a family allowance for each family member, equal to at least 1/3 of the amount that
1168     the amount described in Subsection (10)(a) exceeds the amount of the family member's
1169     monthly income; and
1170          (d) amounts for incurred expenses for the medical or remedial care for the
1171     institutionalized spouse.
1172          (10) The division shall establish a minimum monthly maintenance needs allowance for
1173     each community spouse that includes:
1174          (a) an amount established by the division by rule made in accordance with Title 63G,
1175     Chapter 3, Utah Administrative Rulemaking Act, based on the amounts established by the
1176     United States Department of Health and Human Services; and
1177          (b) an excess shelter allowance.
1178          (11) (a) An institutionalized spouse or a community spouse may request a hearing with
1179     respect to the determinations described in Subsections (11)(e)(i) through (v) if an application
1180     for medical assistance has been made on behalf of the institutionalized spouse.
1181          (b) A hearing under this subsection regarding the community spouse resource
1182     allowance shall be held by the division within 90 days from the date of the request for the
1183     hearing.
1184          (c) If either spouse establishes that the community spouse needs income, above the
1185     level otherwise provided by the minimum monthly maintenance needs allowance, due to
1186     exceptional circumstances resulting in significant financial duress, there shall be substituted,
1187     for the minimum monthly maintenance needs allowance provided under Subsection (10), an
1188     amount adequate to provide additional income as is necessary.
1189          (d) If either spouse establishes that the community spouse resource allowance, in

1190     relation to the amount of income generated by the allowance is inadequate to raise the
1191     community spouse's income to the minimum monthly maintenance needs allowance, there shall
1192     be substituted, for the community spouse resource allowance, an amount adequate to provide a
1193     minimum monthly maintenance needs allowance.
1194          (e) A hearing may be held under this subsection if either the institutionalized spouse or
1195     community spouse is dissatisfied with a determination of:
1196          (i) the community spouse monthly income allowance;
1197          (ii) the amount of monthly income otherwise available to the community spouse;
1198          (iii) the computation of the spousal share of resources under Subsection (4);
1199          (iv) the attribution of resources under Subsection (6); or
1200          (v) the determination of the community spouse resource allocation.
1201          (12) (a) An institutionalized spouse may transfer an amount equal to the community
1202     spouse resource allowance, but only to the extent the resources of the institutionalized spouse
1203     are transferred to or for the sole benefit of the community spouse.
1204          (b) The transfer under Subsection (12)(a) shall be made as soon as practicable after the
1205     date of the initial determination of eligibility, taking into account the time necessary to obtain a
1206     court order under Subsection (12)(c).
1207          (c) [Chapter 19, Medical Benefits Recovery Act] Part 10, Medical Benefits Recovery,
1208     does not apply if a court has entered an order against an institutionalized spouse for the support
1209     of the community spouse.
1210          Section 12. Section 26B-3-112, which is renumbered from Section 26-18-3.8 is
1211     renumbered and amended to read:
1212          [26-18-3.8].      26B-3-112. Maximizing use of premium assistance programs --
1213     Utah's Premium Partnership for Health Insurance.
1214          (1) (a) The department shall seek to maximize the use of Medicaid and Children's
1215     Health Insurance Program funds for assistance in the purchase of private health insurance
1216     coverage for Medicaid-eligible and non-Medicaid-eligible individuals.

1217          (b) The department's efforts to expand the use of premium assistance shall:
1218          (i) include, as necessary, seeking federal approval under all Medicaid and Children's
1219     Health Insurance Program premium assistance provisions of federal law, including provisions
1220     of [the Patient Protection and Affordable Care Act, Public Law 111-148] PPACA;
1221          (ii) give priority to, but not be limited to, expanding the state's Utah Premium
1222     Partnership for Health Insurance Program, including as required under Subsection (2); and
1223          (iii) encourage the enrollment of all individuals within a household in the same plan,
1224     where possible, including enrollment in a plan that allows individuals within the household
1225     transitioning out of Medicaid to retain the same network and benefits they had while enrolled
1226     in Medicaid.
1227          (2) The department shall seek federal approval of an amendment to the state's Utah
1228     Premium Partnership for Health Insurance program to adjust the eligibility determination for
1229     single adults and parents who have an offer of employer sponsored insurance. The amendment
1230     shall:
1231          (a) be within existing appropriations for the Utah Premium Partnership for Health
1232     Insurance program; and
1233          (b) provide that adults who are up to 200% of the federal poverty level are eligible for
1234     premium subsidies in the Utah Premium Partnership for Health Insurance program.
1235          (3) For the fiscal year 2020-21, the department shall seek authority to increase the
1236     maximum premium subsidy per month for adults under the Utah Premium Partnership for
1237     Health Insurance program to $300.
1238          (4) Beginning with the fiscal year 2021-22, and in each subsequent fiscal year, the
1239     department may increase premium subsidies for single adults and parents who have an offer of
1240     employer-sponsored insurance to keep pace with the increase in insurance premium costs,
1241     subject to appropriation of additional funding.
1242          Section 13. Section 26B-3-113, which is renumbered from Section 26-18-3.9 is
1243     renumbered and amended to read:

1244          [26-18-3.9].      26B-3-113. Expanding the Medicaid program.
1245          (1) As used in this section:
1246          [(a) "CMS" means the Centers for Medicare and Medicaid Services in the United
1247     States Department of Health and Human Services.]
1248          [(b)] (a) "Federal poverty level" means the same as that term is defined in Section
1249     [26-18-411] 26B-3-207.
1250          [(c)] (b) "Medicaid expansion" means an expansion of the Medicaid program in
1251     accordance with this section.
1252          [(d)] (c) "Medicaid Expansion Fund" means the Medicaid Expansion Fund created in
1253     Section [26-36b-208] 26B-1-315.
1254          (2) (a) As set forth in Subsections (2) through (5), eligibility criteria for the Medicaid
1255     program shall be expanded to cover additional low-income individuals.
1256          (b) The department shall continue to seek approval from CMS to implement the
1257     Medicaid waiver expansion as defined in Section [26-18-415] 26B-1-112.
1258          (c) The department may implement any provision described in Subsections
1259     [26-18-415] 26B-3-112(2)(b)(iii) through (viii) in a Medicaid expansion if the department
1260     receives approval from CMS to implement that provision.
1261          (3) The department shall expand the Medicaid program in accordance with this
1262     Subsection (3) if the department:
1263          (a) receives approval from CMS to:
1264          (i) expand Medicaid coverage to eligible individuals whose income is below 95% of
1265     the federal poverty level;
1266          (ii) obtain maximum federal financial participation under 42 U.S.C. Sec. 1396d(b) for
1267     enrolling an individual in the Medicaid expansion under this Subsection (3); and
1268          (iii) permit the state to close enrollment in the Medicaid expansion under this
1269     Subsection (3) if the department has insufficient funds to provide services to new enrollment
1270     under the Medicaid expansion under this Subsection (3);

1271          (b) pays the state portion of costs for the Medicaid expansion under this Subsection (3)
1272     with funds from:
1273          (i) the Medicaid Expansion Fund;
1274          (ii) county contributions to the nonfederal share of Medicaid expenditures; or
1275          (iii) any other contributions, funds, or transfers from a nonstate agency for Medicaid
1276     expenditures; and
1277          (c) closes the Medicaid program to new enrollment under the Medicaid expansion
1278     under this Subsection (3) if the department projects that the cost of the Medicaid expansion
1279     under this Subsection (3) will exceed the appropriations for the fiscal year that are authorized
1280     by the Legislature through an appropriations act adopted in accordance with Title 63J, Chapter
1281     1, Budgetary Procedures Act.
1282          (4) (a) The department shall expand the Medicaid program in accordance with this
1283     Subsection (4) if the department:
1284          (i) receives approval from CMS to:
1285          (A) expand Medicaid coverage to eligible individuals whose income is below 95% of
1286     the federal poverty level;
1287          (B) obtain maximum federal financial participation under 42 U.S.C. Sec. 1396d(y) for
1288     enrolling an individual in the Medicaid expansion under this Subsection (4); and
1289          (C) permit the state to close enrollment in the Medicaid expansion under this
1290     Subsection (4) if the department has insufficient funds to provide services to new enrollment
1291     under the Medicaid expansion under this Subsection (4);
1292          (ii) pays the state portion of costs for the Medicaid expansion under this Subsection (4)
1293     with funds from:
1294          (A) the Medicaid Expansion Fund;
1295          (B) county contributions to the nonfederal share of Medicaid expenditures; or
1296          (C) any other contributions, funds, or transfers from a nonstate agency for Medicaid
1297     expenditures; and

1298          (iii) closes the Medicaid program to new enrollment under the Medicaid expansion
1299     under this Subsection (4) if the department projects that the cost of the Medicaid expansion
1300     under this Subsection (4) will exceed the appropriations for the fiscal year that are authorized
1301     by the Legislature through an appropriations act adopted in accordance with Title 63J, Chapter
1302     1, Budgetary Procedures Act.
1303          (b) The department shall submit a waiver, an amendment to an existing waiver, or a
1304     state plan amendment to CMS to:
1305          (i) administer federal funds for the Medicaid expansion under this Subsection (4)
1306     according to a per capita cap developed by the department that includes an annual inflationary
1307     adjustment, accounts for differences in cost among categories of Medicaid expansion enrollees,
1308     and provides greater flexibility to the state than the current Medicaid payment model;
1309          (ii) limit, in certain circumstances as defined by the department, the ability of a
1310     qualified entity to determine presumptive eligibility for Medicaid coverage for an individual
1311     enrolled in a Medicaid expansion under this Subsection (4);
1312          (iii) impose a lock-out period if an individual enrolled in a Medicaid expansion under
1313     this Subsection (4) violates certain program requirements as defined by the department;
1314          (iv) allow an individual enrolled in a Medicaid expansion under this Subsection (4) to
1315     remain in the Medicaid program for up to a 12-month certification period as defined by the
1316     department; and
1317          (v) allow federal Medicaid funds to be used for housing support for eligible enrollees
1318     in the Medicaid expansion under this Subsection (4).
1319          (5) (a) (i) If CMS does not approve a waiver to expand the Medicaid program in
1320     accordance with Subsection (4)(a) on or before January 1, 2020, the department shall develop
1321     proposals to implement additional flexibilities and cost controls, including cost sharing tools,
1322     within a Medicaid expansion under this Subsection (5) through a request to CMS for a waiver
1323     or state plan amendment.
1324          (ii) The request for a waiver or state plan amendment described in Subsection (5)(a)(i)

1325     shall include:
1326          (A) a path to self-sufficiency for qualified adults in the Medicaid expansion that
1327     includes employment and training as defined in 7 U.S.C. Sec. 2015(d)(4); and
1328          (B) a requirement that an individual who is offered a private health benefit plan by an
1329     employer to enroll in the employer's health plan.
1330          (iii) The department shall submit the request for a waiver or state plan amendment
1331     developed under Subsection (5)(a)(i) on or before March 15, 2020.
1332          (b) Notwithstanding Sections [26-18-18] 26B-3-127 and 63J-5-204, and in accordance
1333     with this Subsection (5), eligibility for the Medicaid program shall be expanded to include all
1334     persons in the optional Medicaid expansion population under [the Patient Protection and
1335     Affordable Care Act, Pub. L. No. 111-148] PPACA and the Health Care Education
1336     Reconciliation Act of 2010, Pub. L. No. 111-152, and related federal regulations and guidance,
1337     on the earlier of:
1338          (i) the day on which CMS approves a waiver to implement the provisions described in
1339     Subsections (5)(a)(ii)(A) and (B); or
1340          (ii) July 1, 2020.
1341          (c) The department shall seek a waiver, or an amendment to an existing waiver, from
1342     federal law to:
1343          (i) implement each provision described in Subsections [26-18-415]
1344     26B-3-210(2)(b)(iii) through (viii) in a Medicaid expansion under this Subsection (5);
1345          (ii) limit, in certain circumstances as defined by the department, the ability of a
1346     qualified entity to determine presumptive eligibility for Medicaid coverage for an individual
1347     enrolled in a Medicaid expansion under this Subsection (5); and
1348          (iii) impose a lock-out period if an individual enrolled in a Medicaid expansion under
1349     this Subsection (5) violates certain program requirements as defined by the department.
1350          (d) The eligibility criteria in this Subsection (5) shall be construed to include all
1351     individuals eligible for the health coverage improvement program under Section [26-18-411]

1352     26B-3-207.
1353          (e) The department shall pay the state portion of costs for a Medicaid expansion under
1354     this Subsection (5) entirely from:
1355          (i) the Medicaid Expansion Fund;
1356          (ii) county contributions to the nonfederal share of Medicaid expenditures; or
1357          (iii) any other contributions, funds, or transfers from a nonstate agency for Medicaid
1358     expenditures.
1359          (f) If the costs of the Medicaid expansion under this Subsection (5) exceed the funds
1360     available under Subsection (5)(e):
1361          (i) the department may reduce or eliminate optional Medicaid services under this
1362     chapter; [and]
1363          (ii) savings, as determined by the department, from the reduction or elimination of
1364     optional Medicaid services under Subsection (5)(f)(i) shall be deposited into the Medicaid
1365     Expansion Fund; and
1366          (iii) the department may submit to CMS a request for waivers, or an amendment of
1367     existing waivers, from federal law necessary to implement budget controls within the Medicaid
1368     program to address the deficiency.
1369          (g) If the costs of the Medicaid expansion under this Subsection (5) are projected by
1370     the department to exceed the funds available in the current fiscal year under Subsection (5)(e),
1371     including savings resulting from any action taken under Subsection (5)(f):
1372          (i) the governor shall direct the [Department of Health, Department of Human
1373     Services,] department and Department of Workforce Services to reduce commitments and
1374     expenditures by an amount sufficient to offset the deficiency:
1375          (A) proportionate to the share of total current fiscal year General Fund appropriations
1376     for each of those agencies; and
1377          (B) up to 10% of each agency's total current fiscal year General Fund appropriations;
1378          (ii) the Division of Finance shall reduce allotments to the [Department of Health,

1379     Department of Human Services,] department and Department of Workforce Services by a
1380     percentage:
1381          (A) proportionate to the amount of the deficiency; and
1382          (B) up to 10% of each agency's total current fiscal year General Fund appropriations;
1383     and
1384          (iii) the Division of Finance shall deposit the total amount from the reduced allotments
1385     described in Subsection (5)(g)(ii) into the Medicaid Expansion Fund.
1386          (6) The department shall maximize federal financial participation in implementing this
1387     section, including by seeking to obtain any necessary federal approvals or waivers.
1388          (7) Notwithstanding Sections 17-43-201 and 17-43-301, a county does not have to
1389     provide matching funds to the state for the cost of providing Medicaid services to newly
1390     enrolled individuals who qualify for Medicaid coverage under a Medicaid expansion.
1391          (8) The department shall report to the Social Services Appropriations Subcommittee on
1392     or before November 1 of each year that a Medicaid expansion is operational:
1393          (a) the number of individuals who enrolled in the Medicaid expansion;
1394          (b) costs to the state for the Medicaid expansion;
1395          (c) estimated costs to the state for the Medicaid expansion for the current and
1396     following fiscal years;
1397          (d) recommendations to control costs of the Medicaid expansion; and
1398          (e) as calculated in accordance with Subsections [26-36b-204] 26B-3-506(4) and
1399     [26-36c-204] 26B-3-606(2), the state's net cost of the qualified Medicaid expansion.
1400          Section 14. Section 26B-3-114, which is renumbered from Section 26-18-4 is
1401     renumbered and amended to read:
1402          [26-18-4].      26B-3-114. Department standards for eligibility under Medicaid --
1403     Funds for abortions.
1404          (1) (a) The department may develop standards and administer policies relating to
1405     eligibility under the Medicaid program as long as they are consistent with Subsection [26-18-3]

1406     26B-4-704(8).
1407          (b) An applicant receiving Medicaid assistance may be limited to particular types of
1408     care or services or to payment of part or all costs of care determined to be medically necessary.
1409          (2) The department may not provide any funds for medical, hospital, or other medical
1410     expenditures or medical services to otherwise eligible persons where the purpose of the
1411     assistance is to perform an abortion, unless the life of the mother would be endangered if an
1412     abortion were not performed.
1413          (3) Any employee of the department who authorizes payment for an abortion contrary
1414     to the provisions of this section is guilty of a class B misdemeanor and subject to forfeiture of
1415     office.
1416          (4) Any person or organization that, under the guise of other medical treatment,
1417     provides an abortion under auspices of the Medicaid program is guilty of a third degree felony
1418     and subject to forfeiture of license to practice medicine or authority to provide medical services
1419     and treatment.
1420          Section 15. Section 26B-3-115, which is renumbered from Section 26-18-5 is
1421     renumbered and amended to read:
1422          [26-18-5].      26B-3-115. Contracts for provision of medical services -- Federal
1423     provisions modifying department rules -- Compliance with Social Security Act.
1424          (1) The department may contract with other public or private agencies to purchase or
1425     provide medical services in connection with the programs of the division. Where these
1426     programs are used by other government entities, contracts shall provide that other government
1427     entities, in compliance with state and federal law regarding intergovernmental transfers,
1428     transfer the state matching funds to the department in amounts sufficient to satisfy needs of the
1429     specified program.
1430          (2) Contract terms shall include provisions for maintenance, administration, and
1431     service costs.
1432          (3) If a federal legislative or executive provision requires modifications or revisions in

1433     an eligibility factor established under this chapter as a condition for participation in medical
1434     assistance, the department may modify or change its rules as necessary to qualify for
1435     participation.
1436          (4) The provisions of this section do not apply to department rules governing abortion.
1437          (5) The department shall comply with all pertinent requirements of the Social Security
1438     Act and all orders, rules, and regulations adopted thereunder when required as a condition of
1439     participation in benefits under the Social Security Act.
1440          Section 16. Section 26B-3-116, which is renumbered from Section 26-18-5.5 is
1441     renumbered and amended to read:
1442          [26-18-5.5].      26B-3-116. Liability insurance required.
1443          The Medicaid program may not reimburse a home health agency, as defined in Section
1444     [26-21-2] 26B-2-201, for home health services provided to an enrollee unless the home health
1445     agency has liability coverage of:
1446          (1) at least $500,000 per incident; or
1447          (2) an amount established by department rule made in accordance with Title 63G,
1448     Chapter 3, Utah Administrative Rulemaking Act.
1449          Section 17. Section 26B-3-117, which is renumbered from Section 26-18-6 is
1450     renumbered and amended to read:
1451          [26-18-6].      26B-3-117. Federal aid -- Authority of executive director.
1452          (1) The executive director, with the approval of the governor, may bind the state to any
1453     executive or legislative provisions promulgated or enacted by the federal government which
1454     invite the state to participate in the distribution, disbursement or administration of any fund or
1455     service advanced, offered or contributed in whole or in part by the federal government for
1456     purposes consistent with the powers and duties of the department.
1457          (2) Such funds shall be used as provided in this chapter and be administered by the
1458     department for purposes related to medical assistance programs.
1459          Section 18. Section 26B-3-118, which is renumbered from Section 26-18-7 is

1460     renumbered and amended to read:
1461          [26-18-7].      26B-3-118. Medical vendor rates.
1462          (1) Medical vendor payments made to providers of services for and in behalf of
1463     recipient households shall be based upon predetermined rates from standards developed by the
1464     division in cooperation with providers of services for each type of service purchased by the
1465     division.
1466          (2) As far as possible, the rates paid for services shall be established in advance of the
1467     fiscal year for which funds are to be requested.
1468          Section 19. Section 26B-3-119, which is renumbered from Section 26-18-8 is
1469     renumbered and amended to read:
1470          [26-18-8].      26B-3-119. Enforcement of public assistance statutes.
1471          (1) The department shall enforce or contract for the enforcement of Sections
1472     35A-1-503, 35A-3-108, 35A-3-110, 35A-3-111, 35A-3-112, and 35A-3-603 to the extent that
1473     these sections pertain to benefits conferred or administered by the division under this chapter,
1474     to the extent allowed under federal law or regulation.
1475          (2) The department may contract for services covered in Section 35A-3-111 insofar as
1476     that section pertains to benefits conferred or administered by the division under this chapter.
1477          Section 20. Section 26B-3-120, which is renumbered from Section 26-18-9 is
1478     renumbered and amended to read:
1479          [26-18-9].      26B-3-120. Prohibited acts of state or local employees of Medicaid
1480     program -- Violation a misdemeanor.
1481          (1) Each state or local employee responsible for the expenditure of funds under the
1482     state Medicaid program, each individual who formerly was such an officer or employee, and
1483     each partner of such an officer or employee is prohibited for a period of one year after
1484     termination of such responsibility from committing any act, the commission of which by an
1485     officer or employee of the United States Government, an individual who was such an officer or
1486     employee, or a partner of such an officer or employee is prohibited by Section 207 or Section

1487     208 of Title 18, United States Code.
1488          (2) Violation of this section is a class A misdemeanor.
1489          Section 21. Section 26B-3-121, which is renumbered from Section 26-18-11 is
1490     renumbered and amended to read:
1491          [26-18-11].      26B-3-121. Rural hospitals.
1492          (1) [For purposes of] As used in this section "rural hospital" means a hospital located
1493     outside of a standard metropolitan statistical area, as designated by the United States Bureau of
1494     the Census.
1495          (2) For purposes of the Medicaid program, the [Division of Medicaid and Health
1496     Financing] division may not discriminate among rural hospitals on the basis of size.
1497          Section 22. Section 26B-3-122, which is renumbered from Section 26-18-13 is
1498     renumbered and amended to read:
1499          [26-18-13].      26B-3-122. Telemedicine -- Reimbursement -- Rulemaking.
1500          (1) (a) As used in this section, communication by telemedicine is considered
1501     face-to-face contact between a health care provider and a patient under the state's medical
1502     assistance program if:
1503          (i) the communication by telemedicine meets the requirements of administrative rules
1504     adopted in accordance with Subsection (3); and
1505          (ii) the health care services are eligible for reimbursement under the state's medical
1506     assistance program.
1507          (b) This Subsection (1) applies to any managed care organization that contracts with
1508     the state's medical assistance program.
1509          (2) The reimbursement rate for telemedicine services approved under this section:
1510          (a) shall be subject to reimbursement policies set by the state plan; and
1511          (b) may be based on:
1512          (i) a monthly reimbursement rate;
1513          (ii) a daily reimbursement rate; or

1514          (iii) an encounter rate.
1515          (3) The department shall adopt administrative rules in accordance with Title 63G,
1516     Chapter 3, Utah Administrative Rulemaking Act, which establish:
1517          (a) the particular telemedicine services that are considered face-to-face encounters for
1518     reimbursement purposes under the state's medical assistance program; and
1519          (b) the reimbursement methodology for the telemedicine services designated under
1520     Subsection (3)(a).
1521          Section 23. Section 26B-3-123, which is renumbered from Section 26-18-13.5 is
1522     renumbered and amended to read:
1523          [26-18-13.5].      26B-3-123. Reimbursement of telemedicine services and
1524     telepsychiatric consultations.
1525          (1) As used in this section:
1526          (a) "Telehealth services" means the same as that term is defined in Section [26-60-102]
1527     26B-4-704.
1528          (b) "Telemedicine services" means the same as that term is defined in Section
1529     [26-60-102] 26B-4-704.
1530          (c) "Telepsychiatric consultation" means a consultation between a physician and a
1531     board certified psychiatrist, both of whom are licensed to engage in the practice of medicine in
1532     the state, that utilizes:
1533          (i) the health records of the patient, provided from the patient or the referring
1534     physician;
1535          (ii) a written, evidence-based patient questionnaire; and
1536          (iii) telehealth services that meet industry security and privacy standards, including
1537     compliance with the:
1538          (A) Health Insurance Portability and Accountability Act; and
1539          (B) Health Information Technology for Economic and Clinical Health Act, Pub. L. No.
1540     111-5, 123 Stat. 226, 467, as amended.

1541          (2) This section applies to:
1542          (a) a managed care organization that contracts with the Medicaid program; and
1543          (b) a provider who is reimbursed for health care services under the Medicaid program.
1544          (3) The Medicaid program shall reimburse for telemedicine services at the same rate
1545     that the Medicaid program reimburses for other health care services.
1546          (4) The Medicaid program shall reimburse for telepsychiatric consultations at a rate set
1547     by the Medicaid program.
1548          Section 24. Section 26B-3-124, which is renumbered from Section 26-18-15 is
1549     renumbered and amended to read:
1550          [26-18-15].      26B-3-124. Process to promote health insurance coverage for
1551     children.
1552          (1) The department, in collaboration with the Department of Workforce Services and
1553     the State Board of Education, shall develop a process to promote health insurance coverage for
1554     a child in school when:
1555          (a) the child applies for free or reduced price school lunch;
1556          (b) a child enrolls in or registers in school; and
1557          (c) other appropriate school related opportunities.
1558          (2) The department, in collaboration with the Department of Workforce Services, shall
1559     promote and facilitate the enrollment of children identified under Subsection (1) without health
1560     insurance in the Utah Children's Health Insurance Program, the Medicaid program, or the Utah
1561     Premium Partnership for Health Insurance Program.
1562          Section 25. Section 26B-3-125, which is renumbered from Section 26-18-16 is
1563     renumbered and amended to read:
1564          [26-18-16].      26B-3-125. Medicaid -- Continuous eligibility -- Promoting payment
1565     and delivery reform.
1566          (1) In accordance with Subsection (2), and within appropriations from the Legislature,
1567     the department may amend the state Medicaid plan to:

1568          (a) create continuous eligibility for up to 12 months for an individual who has qualified
1569     for the state Medicaid program;
1570          (b) provide incentives in managed care contracts for an individual to obtain appropriate
1571     care in appropriate settings; and
1572          (c) require the managed care system to accept the risk of managing the Medicaid
1573     population assigned to the plan amendment in return for receiving the benefits of providing
1574     quality and cost effective care.
1575          (2) If the department amends the state Medicaid plan under Subsection (1)(a) or (b),
1576     the department:
1577          (a) shall ensure that the plan amendment:
1578          (i) is cost effective for the state Medicaid program;
1579          (ii) increases the quality and continuity of care for recipients; and
1580          (iii) calculates and transfers administrative savings from continuous enrollment from
1581     the Department of Workforce Services to the [Department of Health] department; and
1582          (b) may limit the plan amendment under Subsection (1)(a) or (b) to select geographic
1583     areas or specific Medicaid populations.
1584          (3) The department may seek approval for a state plan amendment, waiver, or a
1585     demonstration project from the Secretary of the United States Department of Health and
1586     Human Services if necessary to implement a plan amendment under Subsection (1)(a) or (b).
1587          Section 26. Section 26B-3-126, which is renumbered from Section 26-18-17 is
1588     renumbered and amended to read:
1589          [26-18-17].      26B-3-126. Patient notice of health care provider privacy practices.
1590          (1) (a) For purposes of this section:
1591          (i) "Health care provider" means a health care provider as defined in Section
1592     78B-3-403 who:
1593          (A) receives payment for medical services from the Medicaid program established in
1594     this chapter, or the Children's Health Insurance Program established in [Chapter 40, Utah

1595     Children's Health Insurance Act] Section 26B-3-902; and
1596          (B) submits a patient's personally identifiable information to the Medicaid eligibility
1597     database or the Children's Health Insurance Program eligibility database.
1598          (ii) "HIPAA" means 45 C.F.R. Parts 160, 162, and 164, Health Insurance Portability
1599     and Accountability Act of 1996, as amended.
1600          (b) Beginning July 1, 2013, this section applies to the Medicaid program, the
1601     Children's Health Insurance Program created in [Chapter 40, Utah Children's Health Insurance
1602     Act] Section 26B-3-902, and a health care provider.
1603          (2) A health care provider shall, as part of the notice of privacy practices required by
1604     HIPAA, provide notice to the patient or the patient's personal representative that the health care
1605     provider either has, or may submit, personally identifiable information about the patient to the
1606     Medicaid eligibility database and the Children's Health Insurance Program eligibility database.
1607          (3) The Medicaid program and the Children's Health Insurance Program may not give a
1608     health care provider access to the Medicaid eligibility database or the Children's Health
1609     Insurance Program eligibility database unless the health care provider's notice of privacy
1610     practices complies with Subsection (2).
1611          (4) The department may adopt an administrative rule to establish uniform language for
1612     the state requirement regarding notice of privacy practices to patients required under
1613     Subsection (2).
1614          Section 27. Section 26B-3-127, which is renumbered from Section 26-18-18 is
1615     renumbered and amended to read:
1616          [26-18-18].      26B-3-127. Optional Medicaid expansion.
1617          (1) The department and the governor may not expand the state's Medicaid program
1618     under PPACA unless:
1619          (a) the department expands Medicaid in accordance with Section [26-18-415]
1620     26B-3-210; or
1621          (b) (i) the governor or the governor's designee has reported the intention to expand the

1622     state Medicaid program under PPACA to the Legislature in compliance with the legislative
1623     review process in Section [26-18-3] 26B-3-108; and
1624          (ii) the governor submits the request for expansion of the Medicaid program for
1625     optional populations to the Legislature under the high impact federal funds request process
1626     required by Section 63J-5-204.
1627          (2) (a) The department shall request approval from CMS for waivers from federal
1628     statutory and regulatory law necessary to implement the health coverage improvement program
1629     under Section [26-18-411] 26B-3-207.
1630          (b) The health coverage improvement program under Section [26-18-411] 26B-3-207
1631     is not subject to the requirements in Subsection (1).
1632          Section 28. Section 26B-3-128, which is renumbered from Section 26-18-19 is
1633     renumbered and amended to read:
1634          [26-18-19].      26B-3-128. Medicaid vision services -- Request for proposals.
1635          The department may select one or more contractors, in accordance with Title 63G,
1636     Chapter 6a, Utah Procurement Code, to provide vision services to the Medicaid populations
1637     that are eligible for vision services, as described in department rules, without restricting
1638     provider participation, and within existing appropriations from the Legislature.
1639          Section 29. Section 26B-3-129, which is renumbered from Section 26-18-20 is
1640     renumbered and amended to read:
1641          [26-18-20].      26B-3-129. Review of claims -- Audit and investigation procedures.
1642          (1) (a) The department shall adopt administrative rules in accordance with Title 63G,
1643     Chapter 3, Utah Administrative Rulemaking Act, and in consultation with providers and health
1644     care professionals subject to audit and investigation under the state Medicaid program, to
1645     establish procedures for audits and investigations that are fair and consistent with the duties of
1646     the department as the single state agency responsible for the administration of the Medicaid
1647     program under Section [26-18-3] 26B-3-108 and Title XIX of the Social Security Act.
1648          (b) If the providers and health care professionals do not agree with the rules proposed

1649     or adopted by the department under Subsection (1)(a), the providers or health care
1650     professionals may:
1651          (i) request a hearing for the proposed administrative rule or seek any other remedies
1652     under the provisions of Title 63G, Chapter 3, Utah Administrative Rulemaking Act; and
1653          (ii) request a review of the rule by the Legislature's Administrative Rules Review and
1654     General Oversight Committee created in Section 63G-3-501.
1655          (2) The department shall:
1656          (a) notify and educate providers and health care professionals subject to audit and
1657     investigation under the Medicaid program of the providers' and health care professionals'
1658     responsibilities and rights under the administrative rules adopted by the department under the
1659     provisions of this section;
1660          (b) ensure that the department, or any entity that contracts with the department to
1661     conduct audits:
1662          (i) has on staff or contracts with a medical or dental professional who is experienced in
1663     the treatment, billing, and coding procedures used by the type of provider being audited; and
1664          (ii) uses the services of the appropriate professional described in Subsection (3)(b)(i) if
1665     the provider who is the subject of the audit disputes the findings of the audit;
1666          (c) ensure that a finding of overpayment or underpayment to a provider is not based on
1667     extrapolation, as defined in Section 63A-13-102, unless:
1668          (i) there is a determination that the level of payment error involving the provider
1669     exceeds a 10% error rate:
1670          (A) for a sample of claims for a particular service code; and
1671          (B) over a three year period of time;
1672          (ii) documented education intervention has failed to correct the level of payment error;
1673     and
1674          (iii) the value of the claims for the provider, in aggregate, exceeds $200,000 in
1675     reimbursement for a particular service code on an annual basis; and

1676          (d) require that any entity with which the office contracts, for the purpose of
1677     conducting an audit of a service provider, shall be paid on a flat fee basis for identifying both
1678     overpayments and underpayments.
1679          (3) (a) If the department, or a contractor on behalf of the department:
1680          (i) intends to implement the use of extrapolation as a method of auditing claims, the
1681     department shall, prior to adopting the extrapolation method of auditing, report its intent to use
1682     extrapolation to the Social Services Appropriations Subcommittee; and
1683          (ii) determines Subsections (2)(c)(i) through (iii) are applicable to a provider, the
1684     department or the contractor may use extrapolation only for the service code associated with
1685     the findings under Subsections (2)(c)(i) through (iii).
1686          (b) (i) If extrapolation is used under this section, a provider may, at the provider's
1687     option, appeal the results of the audit based on:
1688          (A) each individual claim; or
1689          (B) the extrapolation sample.
1690          (ii) Nothing in this section limits a provider's right to appeal the audit under Title 63G,
1691     General Government, Title 63G, Chapter 4, Administrative Procedures Act, the Medicaid
1692     program and its manual or rules, or other laws or rules that may provide remedies to providers.
1693          Section 30. Section 26B-3-130, which is renumbered from Section 26-18-21 is
1694     renumbered and amended to read:
1695          [26-18-21].      26B-3-130. Medicaid intergovernmental transfer report -- Approval
1696     requirements.
1697          (1) As used in this section:
1698          (a) (i) "Intergovernmental transfer" means the transfer of public funds from:
1699          (A) a local government entity to another nonfederal governmental entity; or
1700          (B) from a nonfederal, government owned health care facility regulated under [Chapter
1701     21, Health Care Facility Licensing and Inspection Act] Chapter 2, Part 2, Health Care Facility
1702     Licensing and Inspection, to another nonfederal governmental entity.

1703          (ii) "Intergovernmental transfer" does not include:
1704          (A) the transfer of public funds from one state agency to another state agency; or
1705          (B) a transfer of funds from the University of Utah Hospitals and Clinics.
1706          (b) (i) "Intergovernmental transfer program" means a federally approved
1707     reimbursement program or category that is authorized by the Medicaid state plan or waiver
1708     authority for intergovernmental transfers.
1709          (ii) "Intergovernmental transfer program" does not include the addition of a provider to
1710     an existing intergovernmental transfer program.
1711          (c) "Local government entity" means a county, city, town, special service district, local
1712     district, or local education agency as that term is defined in Section 63J-5-102.
1713          (d) "Non-state government entity" means a hospital authority, hospital district, health
1714     care district, special service district, county, or city.
1715          (2) (a) An entity that receives federal Medicaid dollars from the department as a result
1716     of an intergovernmental transfer shall, on or before August 1, 2017, and on or before August 1
1717     each year thereafter, provide the department with:
1718          (i) information regarding the payments funded with the intergovernmental transfer as
1719     authorized by and consistent with state and federal law;
1720          (ii) information regarding the entity's ability to repay federal funds, to the extent
1721     required by the department in the contract for the intergovernmental transfer; and
1722          (iii) other information reasonably related to the intergovernmental transfer that may be
1723     required by the department in the contract for the intergovernmental transfer.
1724          (b) On or before October 15, 2017, and on or before October 15 each subsequent year,
1725     the department shall prepare a report for the Executive Appropriations Committee that
1726     includes:
1727          (i) the amount of each intergovernmental transfer under Subsection (2)(a);
1728          (ii) a summary of changes to CMS regulations and practices that are known by the
1729     department regarding federal funds related to an intergovernmental transfer program; and

1730          (iii) other information the department gathers about the intergovernmental transfer
1731     under Subsection (2)(a).
1732          (3) The department shall not create a new intergovernmental transfer program after
1733     July 1, 2017, unless the department reports to the Executive Appropriations Committee, in
1734     accordance with Section 63J-5-206, before submitting the new intergovernmental transfer
1735     program for federal approval. The report shall include information required by Subsection
1736     63J-5-102(1)(d) and the analysis required in Subsections (2)(a) and (b).
1737          (4) (a) The department shall enter into new Nursing Care Facility Non-State
1738     Government-Owned Upper Payment Limit program contracts and contract amendments adding
1739     new nursing care facilities and new non-state government entity operators in accordance with
1740     this Subsection (4).
1741          (b) (i) If the nursing care facility expects to receive less than $1,000,000 in federal
1742     funds each year from the Nursing Care Facility Non-State Government-Owned Upper Payment
1743     Limit program, excluding seed funding and administrative fees paid by the non-state
1744     government entity, the department shall enter into a Nursing Care Facility Non-State
1745     Government-Owned Upper Payment Limit program contract with the non-state government
1746     entity operator of the nursing care facility.
1747          (ii) If the nursing care facility expects to receive between $1,000,000 and $10,000,000
1748     in federal funds each year from the Nursing Care Facility Non-State Government-Owned
1749     Upper Payment Limit program, excluding seed funding and administrative fees paid by the
1750     non-state government entity, the department shall enter into a Nursing Care Facility Non-State
1751     Government-Owned Upper Payment Limit program contract with the non-state government
1752     entity operator of the nursing care facility after receiving the approval of the Executive
1753     Appropriations Committee.
1754          (iii) If the nursing care facility expects to receive more than $10,000,000 in federal
1755     funds each year from the Nursing Care Facility Non-State Government-Owned Upper Payment
1756     Limit program, excluding seed funding and administrative fees paid by the non-state

1757     government entity, the department may not approve the application without obtaining approval
1758     from the Legislature and the governor.
1759          (c) A non-state government entity may not participate in the Nursing Care Facility
1760     Non-State Government-Owned Upper Payment Limit program unless the non-state government
1761     entity is a special service district, county, or city that operates a hospital or holds a license
1762     under [Chapter 21, Health Care Facility Licensing and Inspection Act] Chapter 2, Part 2,
1763     Health Care Facility Licensing and Inspection.
1764          (d) Each non-state government entity that participates in the Nursing Care Facility
1765     Non-State Government-Owned Upper Payment Limit program shall certify to the department
1766     that:
1767          (i) the non-state government entity is a local government entity that is able to make an
1768     intergovernmental transfer under applicable state and federal law;
1769          (ii) the non-state government entity has sufficient public funds or other permissible
1770     sources of seed funding that comply with the requirements in 42 C.F.R. Part 433, Subpart B;
1771          (iii) the funds received from the Nursing Care Facility Non-State Government-Owned
1772     Upper Payment Limit program are:
1773          (A) for each nursing care facility, available for patient care until the end of the
1774     non-state government entity's fiscal year; and
1775          (B) used exclusively for operating expenses for nursing care facility operations, patient
1776     care, capital expenses, rent, royalties, and other operating expenses; and
1777          (iv) the non-state government entity has completed all licensing, enrollment, and other
1778     forms and documents required by federal and state law to register a change of ownership with
1779     the department and with CMS.
1780          (5) The department shall add a nursing care facility to an existing Nursing Care Facility
1781     Non-State Government-Owned Upper Payment Limit program contract if:
1782          (a) the nursing care facility is managed by or affiliated with the same non-state
1783     government entity that also manages one or more nursing care facilities that are included in an

1784     existing Nursing Care Facility Non-State Government-Owned Upper Payment Limit program
1785     contract; and
1786          (b) the non-state government entity makes the certification described in Subsection
1787     (4)(d)(ii).
1788          (6) The department may not increase the percentage of the administrative fee paid by a
1789     non-state government entity to the department under the Nursing Care Facility Non-State
1790     Government-Owned Upper Payment Limit program.
1791          (7) The department may not condition participation in the Nursing Care Facility
1792     Non-State Government-Owned Upper Payment Limit program on:
1793          (a) a requirement that the department be allowed to direct or determine the types of
1794     patients that a non-state government entity will treat or the course of treatment for a patient in a
1795     non-state government nursing care facility; or
1796          (b) a requirement that a non-state government entity or nursing care facility post a
1797     bond, purchase insurance, or create a reserve account of any kind.
1798          (8) The non-state government entity shall have the primary responsibility for ensuring
1799     compliance with Subsection (4)(d)(ii).
1800          (9) (a) The department may not enter into a new Nursing Care Facility Non-State
1801     Government-Owned Upper Payment Limit program contract before January 1, 2019.
1802          (b) Subsection (9)(a) does not apply to:
1803          (i) a new Nursing Care Facility Non-State Government-Owned Upper Payment Limit
1804     program contract that was included in the federal funds request summary under Section
1805     63J-5-201 for fiscal year 2018; or
1806          (ii) a nursing care facility that is operated or managed by the same company as a
1807     nursing care facility that was included in the federal funds request summary under Section
1808     63J-5-201 for fiscal year 2018.
1809          Section 31. Section 26B-3-131, which is renumbered from Section 26-18-22 is
1810     renumbered and amended to read:

1811          [26-18-22].      26B-3-131. Screening, Brief Intervention, and Referral to
1812     Treatment Medicaid reimbursement.
1813          (1) As used in this section:
1814          (a) "Controlled substance prescriber" means a controlled substance prescriber, as that
1815     term is defined in Section 58-37-6.5, who:
1816          (i) has a record of having completed SBIRT training, in accordance with Subsection
1817     58-37-6.5(2), before providing the SBIRT services; and
1818          (ii) is a Medicaid enrolled health care provider.
1819          (b) "SBIRT" means the same as that term is defined in Section 58-37-6.5.
1820          (2) The department shall reimburse a controlled substance prescriber who provides
1821     SBIRT services to a Medicaid enrollee who is 13 years [of age] old or older for the SBIRT
1822     services.
1823          Section 32. Section 26B-3-132, which is renumbered from Section 26-18-23 is
1824     renumbered and amended to read:
1825          [26-18-23].      26B-3-132. Prescribing policies for opioid prescriptions.
1826          (1) The department may implement a prescribing policy for certain opioid prescriptions
1827     that is substantially similar to the prescribing policies required in Section 31A-22-615.5.
1828          (2) The department may amend the state program and apply for waivers for the state
1829     program, if necessary, to implement Subsection (1).
1830          Section 33. Section 26B-3-133, which is renumbered from Section 26-18-24 is
1831     renumbered and amended to read:
1832          [26-18-24].      26B-3-133. Reimbursement for long-acting reversible contraception
1833     immediately following childbirth.
1834          (1) As used in this section, "long-acting reversible contraception" means a
1835     contraception method that requires administration less than once per month, including:
1836          (a) an intrauterine device; and
1837          (b) a contraceptive implant.

1838          (2) The division shall separately identify and reimburse, from other labor and delivery
1839     services within the Medicaid program, the provision and insertion of long-acting reversible
1840     contraception immediately after childbirth.
1841          Section 34. Section 26B-3-134, which is renumbered from Section 26-18-25 is
1842     renumbered and amended to read:
1843          [26-18-25].      26B-3-134. Coverage of exome sequence testing.
1844          (1) As used in this section, "exome sequence testing" means a genomic technique for
1845     sequencing the genome of an individual for diagnostic purposes.
1846          (2) The Medicaid program shall reimburse for exome sequence testing:
1847          (a) for an enrollee who:
1848          (i) is younger than 21 years [of age] old; and
1849          (ii) who remains undiagnosed after exhausting all other appropriate diagnostic-related
1850     tests;
1851          (b) performed by a nationally recognized provider with significant experience in exome
1852     sequence testing;
1853          (c) that is medically necessary; and
1854          (d) at a rate set by the Medicaid program.
1855          Section 35. Section 26B-3-135, which is renumbered from Section 26-18-26 is
1856     renumbered and amended to read:
1857          [26-18-26].      26B-3-135. Reimbursement for nonemergency secured behavioral
1858     health transport providers.
1859          The department may not reimburse a nonemergency secured behavioral health transport
1860     provider that is designated under Section [26-8a-303] 26B-4-117.
1861          Section 36. Section 26B-3-136, which is renumbered from Section 26-18-27 is
1862     renumbered and amended to read:
1863          [26-18-27].      26B-3-136. Children's Health Care Coverage Program.
1864          (1) As used in this section:

1865          (a) "CHIP" means the Children's Health Insurance Program created in Section
1866     [26-40-103] 26B-3-902.
1867          (b) "Program" means the Children's Health Care Coverage Program created in
1868     Subsection (2).
1869          (2) (a) There is created the Children's Health Care Coverage Program within the
1870     department.
1871          (b) The purpose of the program is to:
1872          (i) promote health insurance coverage for children in accordance with Section
1873     [26-18-15] 26B-3-124;
1874          (ii) conduct research regarding families who are eligible for Medicaid and CHIP to
1875     determine awareness and understanding of available coverage;
1876          (iii) analyze trends in disenrollment and identify reasons that families may not be
1877     renewing enrollment, including any barriers in the process of renewing enrollment;
1878          (iv) administer surveys to recently enrolled CHIP and children's Medicaid enrollees to
1879     identify:
1880          (A) how the enrollees learned about coverage; and
1881          (B) any barriers during the application process;
1882          (v) develop promotional material regarding CHIP and children's Medicaid eligibility,
1883     including outreach through social media, video production, and other media platforms;
1884          (vi) identify ways that the eligibility website for enrollment in CHIP and children's
1885     Medicaid can be redesigned to increase accessibility and enhance the user experience;
1886          (vii) identify outreach opportunities, including partnerships with community
1887     organizations including:
1888          (A) schools;
1889          (B) small businesses;
1890          (C) unemployment centers;
1891          (D) parent-teacher associations; and

1892          (E) youth athlete clubs and associations; and
1893          (viii) develop messaging to increase awareness of coverage options that are available
1894     through the department.
1895          (3) (a) The department may not delegate implementation of the program to a private
1896     entity.
1897          (b) Notwithstanding Subsection (3)(a), the department may contract with a media
1898     agency to conduct the activities described in Subsection (2)(b)(iv) and (vii).
1899          Section 37. Section 26B-3-137, which is renumbered from Section 26-18-28 is
1900     renumbered and amended to read:
1901          [26-18-28].      26B-3-137. Reimbursement for diabetes prevention program.
1902          (1) As used in this section, "DPP" means the National Diabetes Prevention Program
1903     developed by the United States Centers for Disease Control and Prevention.
1904          (2) Beginning July 1, 2022, the Medicaid program shall reimburse a provider for an
1905     enrollee's participation in the DPP if the enrollee:
1906          (a) meets the DPP's eligibility requirements; and
1907          (b) has not previously participated in the DPP after July 1, 2022, while enrolled in the
1908     Medicaid program.
1909          (3) Subject to appropriation, the Medicaid program may set the rate for reimbursement.
1910          (4) The department may apply for a state plan amendment if necessary to implement
1911     this section.
1912          (5) (a) On or after July 1, 2025, but before October 1, 2025, the department shall
1913     provide a written report regarding the efficacy of the DPP and reimbursement under this
1914     section to the Health and Human Services Interim Committee.
1915          (b) The report described in Subsection (5)(a) shall include:
1916          (i) the total number of enrollees with a prediabetic condition as of July 1, 2022;
1917          (ii) the total number of enrollees as of July 1, 2022, with a diagnosis of type 2 diabetes;
1918          (iii) the total number of enrollees who participated in the DPP;

1919          (iv) the total cost incurred by the state to implement this section; and
1920          (v) any conclusions that can be drawn regarding the impact of the DPP on the rate of
1921     type 2 diabetes for enrollees.
1922          Section 38. Section 26B-3-138, which is renumbered from Section 26-18-427 is
1923     renumbered and amended to read:
1924          [26-18-427].      26B-3-138. Behavioral health delivery working group.
1925          (1) As used in this section, "targeted adult Medicaid program" means the same as that
1926     term is defined in Section [26-18-411] 26B-3-207.
1927          (2) On or before May 31, 2022, the department shall convene a working group to
1928     collaborate with the department on:
1929          (a) establishing specific and measurable metrics regarding:
1930          (i) compliance of managed care organizations in the state with federal Medicaid
1931     managed care requirements;
1932          (ii) timeliness and accuracy of authorization and claims processing in accordance with
1933     Medicaid policy and contract requirements;
1934          (iii) reimbursement by managed care organizations in the state to providers to maintain
1935     adequacy of access to care;
1936          (iv) availability of care management services to meet the needs of Medicaid-eligible
1937     individuals enrolled in the plans of managed care organizations in the state; and
1938          (v) timeliness of resolution for disputes between a managed care organization and the
1939     managed care organization's providers and enrollees;
1940          (b) improving the delivery of behavioral health services in the Medicaid program;
1941          (c) proposals to implement the delivery system adjustments authorized under
1942     Subsection [26-18-428] 26B-3-223(3); and
1943          (d) issues that are identified by managed care organizations, behavioral health service
1944     providers, and the department.
1945          (3) The working group convened under Subsection (2) shall:

1946          (a) meet quarterly; and
1947          (b) consist of at least the following individuals:
1948          (i) the executive director or the executive director's designee;
1949          (ii) for each Medicaid accountable care organization with which the department
1950     contracts, an individual selected by the accountable care organization;
1951          (iii) five individuals selected by the department to represent various types of behavioral
1952     health services providers, including, at a minimum, individuals who represent providers who
1953     provide the following types of services:
1954          (A) acute inpatient behavioral health treatment;
1955          (B) residential treatment;
1956          (C) intensive outpatient or partial hospitalization treatment; and
1957          (D) general outpatient treatment;
1958          (iv) a representative of an association that represents behavioral health treatment
1959     providers in the state, designated by the Utah Behavioral Healthcare Council convened by the
1960     Utah Association of Counties;
1961          (v) a representative of an organization representing behavioral health organizations;
1962          (vi) the chair of the Utah Substance Use and Mental Health Advisory Council created
1963     in Section 63M-7-301;
1964          (vii) a representative of an association that represents local authorities who provide
1965     public behavioral health care, designated by the department;
1966          (viii) one member of the Senate, appointed by the president of the Senate; and
1967          (ix) one member of the House of Representatives, appointed by the speaker of the
1968     House of Representatives.
1969          (4) The working group convened under this section shall recommend to the
1970     department:
1971          (a) specific and measurable metrics under Subsection (2)(a);
1972          (b) how physical and behavioral health services may be integrated for the targeted adult

1973     Medicaid program, including ways the department may address issues regarding:
1974          (i) filing of claims;
1975          (ii) authorization and reauthorization for treatment services;
1976          (iii) reimbursement rates; and
1977          (iv) other issues identified by the department, behavioral health services providers, or
1978     Medicaid managed care organizations;
1979          (c) ways to improve delivery of behavioral health services to enrollees, including
1980     changes to statute or administrative rule; and
1981          (d) wraparound service coverage for enrollees who need specific, nonclinical services
1982     to ensure a path to success.
1983          Section 39. Section 26B-3-139, which is renumbered from Section 26-18-603 is
1984     renumbered and amended to read:
1985          [26-18-603].      26B-3-139. Adjudicative proceedings related to Medicaid
1986     funds.
1987          (1) If a proceeding of the department, under Title 63G, Chapter 4, Administrative
1988     Procedures Act, relates in any way to recovery of Medicaid funds:
1989          (a) the presiding officer shall be designated by the executive director of the department
1990     and report directly to the executive director or, in the discretion of the executive director, report
1991     directly to the director of the Office of Internal Audit; and
1992          (b) the decision of the presiding officer is the recommended decision to the executive
1993     director of the department or a designee of the executive director who is not in the division.
1994          (2) Subsection (1) does not apply to hearings conducted by the Department of
1995     Workforce Services relating to medical assistance eligibility determinations.
1996          (3) If a proceeding of the department, under Title 63G, Chapter 4, Administrative
1997     Procedures Act, relates in any way to Medicaid or Medicaid funds, the following may attend
1998     and present evidence or testimony at the proceeding:
1999          (a) the director of the Office of Internal Audit, or the director's designee; and

2000          (b) the inspector general of Medicaid services or the inspector general's designee.
2001          (4) In relation to a proceeding of the department under Title 63G, Chapter 4,
2002     Administrative Procedures Act, a person may not, outside of the actual proceeding, attempt to
2003     influence the decision of the presiding officer.
2004          Section 40. Section 26B-3-140, which is renumbered from Section 26-18-604 is
2005     renumbered and amended to read:
2006          [26-18-604].      26B-3-140. Medical assistance accountability -- Division
2007     duties -- Reporting.
2008          (1) As used in this section:
2009          (a) "Abuse" means:
2010          (i) an action or practice that:
2011          (A) is inconsistent with sound fiscal, business, or medical practices; and
2012          (B) results, or may result, in unnecessary Medicaid related costs or other medical or
2013     hospital assistance costs; or
2014          (ii) reckless or negligent upcoding.
2015          (b) "Fraud" means intentional or knowing:
2016          (i) deception, misrepresentation, or upcoding in relation to Medicaid funds, costs,
2017     claims, reimbursement, or practice; or
2018          (ii) deception or misrepresentation in relation to medical or hospital assistance funds,
2019     costs, claims, reimbursement, or practice.
2020          (c) "Upcoding" means assigning an inaccurate billing code for a service that is payable
2021     or reimbursable by Medicaid funds, if the correct billing code for the service, taking into
2022     account reasonable opinions derived from official published coding definitions, would result in
2023     a lower Medicaid payment or reimbursement.
2024          (d) "Waste" means overutilization of resources or inappropriate payment.
2025          (2) The division shall:
2026          [(1)] (a) develop and implement procedures relating to Medicaid funds and medical or

2027     hospital assistance funds to ensure that providers do not receive:
2028          [(a)] (i) duplicate payments for the same goods or services;
2029          [(b)] (ii) payment for goods or services by resubmitting a claim for which:
2030          [(i)] (A) payment has been disallowed on the grounds that payment would be a
2031     violation of federal or state law, administrative rule, or the state plan; and
2032          [(ii)] (B) the decision to disallow the payment has become final;
2033          [(c)] (iii) payment for goods or services provided after a recipient's death, including
2034     payment for pharmaceuticals or long-term care; or
2035          [(d)] (iv) payment for transporting an unborn infant;
2036          [(2)] (b) consult with [the Centers for Medicaid and Medicare Services] CMS, other
2037     states, and the Office of Inspector General of Medicaid Services to determine and implement
2038     best practices for discovering and eliminating fraud, waste, and abuse of Medicaid funds and
2039     medical or hospital assistance funds;
2040          [(3)] (c) actively seek repayment from providers for improperly used or paid:
2041          [(a)] (i) Medicaid funds; and
2042          [(b)] (ii) medical or hospital assistance funds;
2043          [(4)] (d) coordinate, track, and keep records of all division efforts to obtain repayment
2044     of the funds described in Subsection [(3)] (2)(c), and the results of those efforts;
2045          [(5)] (e) keep Medicaid pharmaceutical costs as low as possible by actively seeking to
2046     obtain pharmaceuticals at the lowest price possible, including, on a quarterly basis for the
2047     pharmaceuticals that represent the highest 45% of state Medicaid expenditures for
2048     pharmaceuticals and on an annual basis for the remaining pharmaceuticals:
2049          [(a)] (i) tracking changes in the price of pharmaceuticals;
2050          [(b)] (ii) checking the availability and price of generic drugs;
2051          [(c)] (iii) reviewing and updating the state's maximum allowable cost list; and
2052          [(d)] (iv) comparing pharmaceutical costs of the state Medicaid program to available
2053     pharmacy price lists; and

2054          [(6)] (f) provide training, on an annual basis, to the employees of the division who
2055     make decisions on billing codes, or who are in the best position to observe and identify
2056     upcoding, in order to avoid and detect upcoding.
2057          Section 41. Section 26B-3-141, which is renumbered from Section 26-18-703 is
2058     renumbered and amended to read:
2059          [26-18-703].      26B-3-141. Medical assistance from division or Department
2060     of Workforce Services and compliance under adoption assistance interstate compact --
2061     Penalty for fraudulent claim.
2062          (1) As used in this section:
2063          (a) "Adoption assistance" means the same as that term is defined in Section 80-2-809.
2064          (b) "Adoption assistance agreement" means the same as that term is defined in Section
2065     80-2-809.
2066          (c) "Adoption assistance interstate compact" means an agreement executed by the
2067     Division of Child and Family Services with any other state in accordance with Section
2068     80-2-809.
2069          [(1)] (2) (a) A child who is a resident of this state and is the subject of an adoption
2070     assistance interstate compact is entitled to receive medical assistance from the division and the
2071     Department of Workforce Services by filing a certified copy of the child's adoption assistance
2072     agreement with the division or the Department of Workforce Services.
2073          (b) The adoptive parent of the child described in Subsection [(1)] (2)(a) shall annually
2074     provide the division or the Department of Workforce Services with evidence verifying that the
2075     adoption assistance agreement is still effective.
2076          [(2)] (3) The Department of Workforce Services shall consider the recipient of medical
2077     assistance under this section as the Department of Workforce Services does any other recipient
2078     of medical assistance under an adoption assistance agreement executed by the Division of
2079     Child and Family Services.
2080          [(3)] (4) (a) A person may not submit a claim for payment or reimbursement under this

2081     section that the person knows is false, misleading, or fraudulent.
2082          (b) A violation of Subsection [(3)] (4)(a) is a third degree felony.
2083          (5) The division and the Department of Workforce Services shall:
2084          (a) cooperate with the Division of Child and Family Services in regard to an adoption
2085     assistance interstate compact; and
2086          (b) comply with an adoption assistance interstate compact.
2087          Section 42. Section 26B-3-201, which is renumbered from Section 26-18-403 is
2088     renumbered and amended to read:
2089     
Part 2. Medicaid Waivers

2090          [26-18-403].      26B-3-201. Medicaid waiver for independent foster care
2091     adolescents.
2092          (1) [For purposes of] As used in this section, an "independent foster care adolescent"
2093     includes any individual who reached 18 years [of age] old while in the custody of the[ Division
2094     of Child and Family Services, or the Department of Human Services] department if the
2095     [Division of Child and Family Services] department was the primary case manager, or a
2096     federally recognized Indian tribe.
2097          (2) An independent foster care adolescent is eligible, when funds are available, for
2098     Medicaid coverage until the individual reaches 21 years [of age] old.
2099          (3) Before July 1, 2006, the division shall submit a state Medicaid Plan amendment to
2100     [the Center For Medicaid Services] CMS to provide medical coverage for independent foster
2101     care adolescents effective fiscal year 2006-07.
2102          Section 43. Section 26B-3-202, which is renumbered from Section 26-18-405 is
2103     renumbered and amended to read:
2104          [26-18-405].      26B-3-202. Waivers to maximize replacement of
2105     fee-for-service delivery model -- Cost of mandated program changes.
2106          (1) The department shall develop a waiver program in the Medicaid program to replace
2107     the fee-for-service delivery model with one or more risk-based delivery models.

2108          (2) The waiver program shall:
2109          (a) restructure the program's provider payment provisions to reward health care
2110     providers for delivering the most appropriate services at the lowest cost and in ways that,
2111     compared to services delivered before implementation of the waiver program, maintain or
2112     improve recipient health status;
2113          (b) restructure the program's cost sharing provisions and other incentives to reward
2114     recipients for personal efforts to:
2115          (i) maintain or improve their health status; and
2116          (ii) use providers that deliver the most appropriate services at the lowest cost;
2117          (c) identify the evidence-based practices and measures, risk adjustment methodologies,
2118     payment systems, funding sources, and other mechanisms necessary to reward providers for
2119     delivering the most appropriate services at the lowest cost, including mechanisms that:
2120          (i) pay providers for packages of services delivered over entire episodes of illness
2121     rather than for individual services delivered during each patient encounter; and
2122          (ii) reward providers for delivering services that make the most positive contribution to
2123     a recipient's health status;
2124          (d) limit total annual per-patient-per-month expenditures for services delivered through
2125     fee-for-service arrangements to total annual per-patient-per-month expenditures for services
2126     delivered through risk-based arrangements covering similar recipient populations and services;
2127     and
2128          (e) except as provided in Subsection (4), limit the rate of growth in
2129     per-patient-per-month General Fund expenditures for the program to the rate of growth in
2130     General Fund expenditures for all other programs, when the rate of growth in the General Fund
2131     expenditures for all other programs is greater than zero.
2132          (3) To the extent possible, the department shall operate the waiver program with the
2133     input of stakeholder groups representing those who will be affected by the waiver program.
2134          (4) (a) For purposes of this Subsection (4), "mandated program change" shall be

2135     determined by the department in consultation with the Medicaid accountable care
2136     organizations, and may include a change to the state Medicaid program that is required by state
2137     or federal law, state or federal guidance, policy, or the state Medicaid plan.
2138          (b) A mandated program change shall be included in the base budget for the Medicaid
2139     program for the fiscal year in which the Medicaid program adopted the mandated program
2140     change.
2141          (c) The mandated program change is not subject to the limit on the rate of growth in
2142     per-patient-per-month General Fund expenditures for the program established in Subsection
2143     (2)(e), until the fiscal year following the fiscal year in which the Medicaid program adopted the
2144     mandated program change.
2145          (5) A managed care organization or a pharmacy benefit manager that provides a
2146     pharmacy benefit to an enrollee shall establish a unique group number, payment classification
2147     number, or bank identification number for each Medicaid managed care organization plan for
2148     which the managed care organization or pharmacy benefit manager provides a pharmacy
2149     benefit.
2150          Section 44. Section 26B-3-203, which is renumbered from Section 26-18-405.5 is
2151     renumbered and amended to read:
2152          [26-18-405.5].      26B-3-203. Base budget appropriations for Medicaid
2153     accountable care organizations and behavioral health plans -- Forecast of behavioral
2154     health services cost.
2155          (1) As used in this section:
2156          (a) "ACO" means an accountable care organization that contracts with the state's
2157     Medicaid program for:
2158          (i) physical health services; or
2159          (ii) integrated physical and behavioral health services.
2160          (b) "Base budget" means the same as that term is defined in legislative rule.
2161          (c) "Behavioral health plan" means a managed care or fee for service delivery system

2162     that contracts with or is operated by the department to provide behavioral health services to
2163     Medicaid eligible individuals.
2164          (d) "Behavioral health services" means mental health or substance use treatment or
2165     services.
2166          (e) "General Fund growth factor" means the amount determined by dividing the next
2167     fiscal year ongoing General Fund revenue estimate by current fiscal year ongoing
2168     appropriations from the General Fund.
2169          (f) "Next fiscal year ongoing General Fund revenue estimate" means the next fiscal
2170     year ongoing General Fund revenue estimate identified by the Executive Appropriations
2171     Committee, in accordance with legislative rule, for use by the Office of the Legislative Fiscal
2172     Analyst in preparing budget recommendations.
2173          (g) "PMPM" means per-member-per-month funding.
2174          (2) If the General Fund growth factor is less than 100%, the next fiscal year base
2175     budget shall, subject to Subsection (5), include an appropriation to the department in an
2176     amount necessary to ensure that the next fiscal year PMPM for ACOs and behavioral health
2177     plans equals the current fiscal year PMPM for the ACOs and behavioral health plans multiplied
2178     by 100%.
2179          (3) If the General Fund growth factor is greater than or equal to 100%, but less than
2180     102%, the next fiscal year base budget shall, subject to Subsection (5), include an appropriation
2181     to the department in an amount necessary to ensure that the next fiscal year PMPM for ACOs
2182     and behavioral health plans equals the current fiscal year PMPM for the ACOs and behavioral
2183     health plans multiplied by the General Fund growth factor.
2184          (4) If the General Fund growth factor is greater than or equal to 102%, the next fiscal
2185     year base budget shall, subject to Subsection (5), include an appropriation to the department in
2186     an amount necessary to ensure that the next fiscal year PMPM for ACOs and behavioral health
2187     plans is greater than or equal to the current fiscal year PMPM for the ACOs and behavioral
2188     health plans multiplied by 102% and less than or equal to the current fiscal year PMPM for the

2189     ACOs and behavioral health plans multiplied by the General Fund growth factor.
2190          (5) The appropriations provided to the department for behavioral health plans under
2191     this section shall be reduced by the amount contributed by counties in the current fiscal year for
2192     behavioral health plans in accordance with Subsections 17-43-201(5)(k) and
2193     17-43-301(6)(a)(x).
2194          (6) In order for the department to estimate the impact of Subsections (2) through (4)
2195     before identification of the next fiscal year ongoing General Fund revenue estimate, the
2196     Governor's Office of Planning and Budget shall, in cooperation with the Office of the
2197     Legislative Fiscal Analyst, develop an estimate of ongoing General Fund revenue for the next
2198     fiscal year and provide the estimate to the department no later than November 1 of each year.
2199          (7) The Office of the Legislative Fiscal Analyst shall include an estimate of the cost of
2200     behavioral health services in any state Medicaid funding or savings forecast that is completed
2201     in coordination with the department and the Governor's Office of Planning and Budget.
2202          Section 45. Section 26B-3-204, which is renumbered from Section 26-18-408 is
2203     renumbered and amended to read:
2204          [26-18-408].      26B-3-204. Incentives to appropriately use emergency
2205     department services.
2206          (1) (a) This section applies to the Medicaid program and to the Utah Children's Health
2207     Insurance Program created in [Chapter 40, Utah Children's Health Insurance Act] Section
2208     26B-3-902.
2209          (b) As used in this section:
2210          (i) "Managed care organization" means a comprehensive full risk managed care
2211     delivery system that contracts with the Medicaid program or the Children's Health Insurance
2212     Program to deliver health care through a managed care plan.
2213          (ii) "Managed care plan" means a risk-based delivery service model authorized by
2214     Section [26-18-405] 26B-3-202 and administered by a managed care organization.
2215          (iii) "Non-emergent care":

2216          (A) means use of the emergency department to receive health care that is non-emergent
2217     as defined by the department by administrative rule adopted in accordance with Title 63G,
2218     Chapter 3, Utah Administrative Rulemaking Act, and the Emergency Medical Treatment and
2219     Active Labor Act; and
2220          (B) does not mean the medical services provided to an individual required by the
2221     Emergency Medical Treatment and Active Labor Act, including services to conduct a medical
2222     screening examination to determine if the recipient has an emergent or non-emergent condition.
2223          (iv) "Professional compensation" means payment made for services rendered to a
2224     Medicaid recipient by an individual licensed to provide health care services.
2225          (v) "Super-utilizer" means a Medicaid recipient who has been identified by the
2226     recipient's managed care organization as a person who uses the emergency department
2227     excessively, as defined by the managed care organization.
2228          (2) (a) A managed care organization may, in accordance with Subsections (2)(b) and
2229     (c):
2230          (i) audit emergency department services provided to a recipient enrolled in the
2231     managed care plan to determine if non-emergent care was provided to the recipient; and
2232          (ii) establish differential payment for emergent and non-emergent care provided in an
2233     emergency department.
2234          (b) (i) The differential payments under Subsection (2)(a)(ii) do not apply to
2235     professional compensation for services rendered in an emergency department.
2236          (ii) Except in cases of suspected fraud, waste, and abuse, a managed care organization's
2237     audit of payment under Subsection (2)(a)(i) is limited to the 18-month period of time after the
2238     date on which the medical services were provided to the recipient. If fraud, waste, or abuse is
2239     alleged, the managed care organization's audit of payment under Subsection (2)(a)(i) is limited
2240     to three years after the date on which the medical services were provided to the recipient.
2241          (c) The audits and differential payments under Subsections (2)(a) and (b) apply to
2242     services provided to a recipient on or after July 1, 2015.

2243          (3) A managed care organization shall:
2244          (a) use the savings under Subsection (2) to maintain and improve access to primary
2245     care and urgent care services for all Medicaid or CHIP recipients enrolled in the managed care
2246     plan;
2247          (b) provide viable alternatives for increasing primary care provider reimbursement
2248     rates to incentivize after hours primary care access for recipients; and
2249          (c) report to the department on how the managed care organization complied with this
2250     Subsection (3).
2251          (4) The department may:
2252          (a) through administrative rule adopted by the department, develop quality
2253     measurements that evaluate a managed care organization's delivery of:
2254          (i) appropriate emergency department services to recipients enrolled in the managed
2255     care plan;
2256          (ii) expanded primary care and urgent care for recipients enrolled in the managed care
2257     plan, with consideration of the managed care organization's:
2258          (A) delivery of primary care, urgent care, and after hours care through means other than
2259     the emergency department;
2260          (B) recipient access to primary care providers and community health centers including
2261     evening and weekend access; and
2262          (C) other innovations for expanding access to primary care; and
2263          (iii) quality of care for the managed care plan members;
2264          (b) compare the quality measures developed under Subsection (4)(a) for each managed
2265     care organization; and
2266          (c) develop, by administrative rule, an algorithm to determine assignment of new,
2267     unassigned recipients to specific managed care plans based on the plan's performance in
2268     relation to the quality measures developed pursuant to Subsection (4)(a).
2269          Section 46. Section 26B-3-205, which is renumbered from Section 26-18-409 is

2270     renumbered and amended to read:
2271          [26-18-409].      26B-3-205. Long-term care insurance partnership.
2272          (1) As used in this section:
2273          (a) "Qualified long-term care insurance contract" is as defined in 26 U.S.C. Sec.
2274     7702B(b).
2275          (b) "Qualified long-term care insurance partnership" is as defined in 42 U.S.C. Sec.
2276     1396p(b)(1)(C)(iii).
2277          (c) "State plan amendment" means an amendment to the state Medicaid plan drafted by
2278     the department in compliance with this section.
2279          (2) No later than July 1, 2014, the department shall seek federal approval of a state plan
2280     amendment that creates a qualified long-term care insurance partnership.
2281          (3) The department may make rules to comply with federal laws and regulations
2282     relating to qualified long-term care insurance partnerships and qualified long-term care
2283     insurance contracts.
2284          Section 47. Section 26B-3-206, which is renumbered from Section 26-18-410 is
2285     renumbered and amended to read:
2286          [26-18-410].      26B-3-206. Medicaid waiver for children with disabilities
2287     and complex medical needs.
2288          (1) As used in this section:
2289          (a) "Additional eligibility criteria" means the additional eligibility criteria set by the
2290     department under Subsection (4)(e).
2291          (b) "Complex medical condition" means a physical condition of an individual that:
2292          (i) results in severe functional limitations for the individual; and
2293          (ii) is likely to:
2294          (A) last at least 12 months; or
2295          (B) result in death.
2296          (c) "Program" means the program for children with complex medical conditions

2297     created in Subsection (3).
2298          (d) "Qualified child" means a child who:
2299          (i) is less than 19 years old;
2300          (ii) is diagnosed with a complex medical condition;
2301          (iii) has a condition that meets the definition of disability in 42 U.S.C. Sec. 12102; and
2302          (iv) meets the additional eligibility criteria.
2303          (2) The department shall apply for a Medicaid home and community-based waiver with
2304     CMS to implement, within the state Medicaid program, the program described in Subsection
2305     (3).
2306          (3) If the waiver described in Subsection (2) is approved, the department shall offer a
2307     program that:
2308          (a) as funding permits, provides treatment for qualified children;
2309          (b) if approved by CMS and as funding permits, beginning in fiscal year 2023 provides
2310     on an ongoing basis treatment for 130 more qualified children than the program provided
2311     treatment for during fiscal year 2022; [and]
2312          (c) accepts applications for the program on an ongoing basis[.];
2313          [(i)] (d) requires periodic reevaluations of an enrolled child's eligibility and other
2314     applicants or eligible children waiting for services in the program based on the additional
2315     eligibility criteria; and
2316          [(ii)] (e) at the time of reevaluation, allows the department to disenroll a child based on
2317     the prioritization described in Subsection (4)(a) and additional eligibility criteria.
2318          (4) The department shall:
2319          (a) establish by rule made in accordance with Title 63G, Chapter 3, Utah
2320     Administrative Rulemaking Act, criteria to prioritize qualified children's participation in the
2321     program based on the following factors, in the following priority order:
2322          (i) the complexity of a qualified child's medical condition; and
2323          (ii) the financial needs of the qualified child and the qualified child's family;

2324          (b) convene a public process to determine the benefits and services to offer a qualified
2325     child under the program;
2326          (c) evaluate, on an ongoing basis, the cost and effectiveness of the program;
2327          (d) if funding for the program is reduced, develop an evaluation process to reduce the
2328     number of children served based on the participation criteria established under Subsection
2329     (4)(a); and
2330          (e) establish, by rule made in accordance with Title 63G, Chapter 3, Utah
2331     Administrative Rulemaking Act, additional eligibility criteria based on the factors described in
2332     Subsections (4)(a)(i) and (ii).
2333          Section 48. Section 26B-3-207, which is renumbered from Section 26-18-411 is
2334     renumbered and amended to read:
2335          [26-18-411].      26B-3-207. Health coverage improvement program --
2336     Eligibility -- Annual report -- Expansion of eligibility for adults with dependent children.
2337          (1) As used in this section:
2338          (a) "Adult in the expansion population" means an individual who:
2339          (i) is described in 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII); and
2340          (ii) is not otherwise eligible for Medicaid as a mandatory categorically needy
2341     individual.
2342          (b) "Enhancement waiver program" means the Primary Care Network enhancement
2343     waiver program described in Section [26-18-416] 26B-3-211.
2344          (c) "Federal poverty level" means the poverty guidelines established by the Secretary of
2345     the United States Department of Health and Human Services under 42 U.S.C. Sec. 9909(2).
2346          (d) "Health coverage improvement program" means the health coverage improvement
2347     program described in Subsections (3) through [(10)] (9).
2348          (e) "Homeless":
2349          (i) means an individual who is chronically homeless, as determined by the department;
2350     and

2351          (ii) includes someone who was chronically homeless and is currently living in
2352     supported housing for the chronically homeless.
2353          (f) "Income eligibility ceiling" means the percent of federal poverty level:
2354          (i) established by the state in an appropriations act adopted pursuant to Title 63J,
2355     Chapter 1, Budgetary Procedures Act; and
2356          (ii) under which an individual may qualify for Medicaid coverage in accordance with
2357     this section.
2358          (g) "Targeted adult Medicaid program" means the program implemented by the
2359     department under Subsections (5) through (7).
2360          (2) Beginning July 1, 2016, the department shall amend the state Medicaid plan to
2361     allow temporary residential treatment for substance [abuse] use, for the traditional Medicaid
2362     population, in a short term, non-institutional, 24-hour facility, without a bed capacity limit that
2363     provides rehabilitation services that are medically necessary and in accordance with an
2364     individualized treatment plan, as approved by CMS and as long as the county makes the
2365     required match under Section 17-43-201.
2366          (3) Beginning July 1, 2016, the department shall amend the state Medicaid plan to
2367     increase the income eligibility ceiling to a percentage of the federal poverty level designated by
2368     the department, based on appropriations for the program, for an individual with a dependent
2369     child.
2370          (4) Before July 1, 2016, the division shall submit to CMS a request for waivers, or an
2371     amendment of existing waivers, from federal statutory and regulatory law necessary for the
2372     state to implement the health coverage improvement program in the Medicaid program in
2373     accordance with this section.
2374          (5) (a) An adult in the expansion population is eligible for Medicaid if the adult meets
2375     the income eligibility and other criteria established under Subsection (6).
2376          (b) An adult who qualifies under Subsection (6) shall receive Medicaid coverage:
2377          (i) through the traditional fee for service Medicaid model in counties without Medicaid

2378     accountable care organizations or the state's Medicaid accountable care organization delivery
2379     system, where implemented and subject to Section [26-18-428] 26B-3-223;
2380          (ii) except as provided in Subsection (5)(b)(iii), for behavioral health, through the
2381     counties in accordance with Sections 17-43-201 and 17-43-301;
2382          (iii) that, subject to Section [26-18-428] 26B-3-223, integrates behavioral health
2383     services and physical health services with Medicaid accountable care organizations in select
2384     geographic areas of the state that choose an integrated model; and
2385          (iv) that permits temporary residential treatment for substance [abuse] use in a short
2386     term, non-institutional, 24-hour facility, without a bed capacity limit, as approved by CMS, that
2387     provides rehabilitation services that are medically necessary and in accordance with an
2388     individualized treatment plan.
2389          (6) (a) An individual is eligible for the health coverage improvement program under
2390     Subsection (5) if:
2391          (i) at the time of enrollment, the individual's annual income is below the income
2392     eligibility ceiling established by the state under Subsection (1)(f); and
2393          (ii) the individual meets the eligibility criteria established by the department under
2394     Subsection (6)(b).
2395          (b) Based on available funding and approval from CMS, the department shall select the
2396     criteria for an individual to qualify for the Medicaid program under Subsection (6)(a)(ii), based
2397     on the following priority:
2398          (i) a chronically homeless individual;
2399          (ii) if funding is available, an individual:
2400          (A) involved in the justice system through probation, parole, or court ordered
2401     treatment; and
2402          (B) in need of substance [abuse] use treatment or mental health treatment, as
2403     determined by the department; or
2404          (iii) if funding is available, an individual in need of substance [abuse] use treatment or

2405     mental health treatment, as determined by the department.
2406          (c) An individual who qualifies for Medicaid coverage under Subsections (6)(a) and (b)
2407     may remain on the Medicaid program for a 12-month certification period as defined by the
2408     department. Eligibility changes made by the department under Subsection (1)(f) or (6)(b) shall
2409     not apply to an individual during the 12-month certification period.
2410          (7) The state may request a modification of the income eligibility ceiling and other
2411     eligibility criteria under Subsection (6) each fiscal year based on projected enrollment, costs to
2412     the state, and the state budget.
2413          (8) The current Medicaid program and the health coverage improvement program,
2414     when implemented, shall coordinate with a state prison or county jail to expedite Medicaid
2415     enrollment for an individual who is released from custody and was eligible for or enrolled in
2416     Medicaid before incarceration.
2417          (9) Notwithstanding Sections 17-43-201 and 17-43-301, a county does not have to
2418     provide matching funds to the state for the cost of providing Medicaid services to newly
2419     enrolled individuals who qualify for Medicaid coverage under the health coverage
2420     improvement program under Subsection (6).
2421          (10) If the enhancement waiver program is implemented, the department:
2422          (a) may not accept any new enrollees into the health coverage improvement program
2423     after the day on which the enhancement waiver program is implemented;
2424          (b) shall transition all individuals who are enrolled in the health coverage improvement
2425     program into the enhancement waiver program;
2426          (c) shall suspend the health coverage improvement program within one year after the
2427     day on which the enhancement waiver program is implemented;
2428          (d) shall, within one year after the day on which the enhancement waiver program is
2429     implemented, use all appropriations for the health coverage improvement program to
2430     implement the enhancement waiver program; and
2431          (e) shall work with CMS to maintain any waiver for the health coverage improvement

2432     program while the health coverage improvement program is suspended under Subsection [(11)]
2433     (10)(c).
2434          (11) If, after the enhancement waiver program takes effect, the enhancement waiver
2435     program is repealed or suspended by either the state or federal government, the department
2436     shall reinstate the health coverage improvement program and continue to accept new enrollees
2437     into the health coverage improvement program in accordance with the provisions of this
2438     section.
2439          Section 49. Section 26B-3-208, which is renumbered from Section 26-18-413 is
2440     renumbered and amended to read:
2441          [26-18-413].      26B-3-208. Medicaid waiver for delivery of adult dental
2442     services.
2443          (1) (a) Before June 30, 2016, the department shall ask CMS to grant waivers from
2444     federal statutory and regulatory law necessary for the Medicaid program to provide dental
2445     services in the manner described in Subsection (2)(a).
2446          (b) Before June 30, 2018, the department shall submit to CMS a request for waivers, or
2447     an amendment of existing waivers, from federal law necessary for the state to provide dental
2448     services, in accordance with Subsections (2)(b)(i) and (d) through (g), to an individual
2449     described in Subsection (2)(b)(i).
2450          (c) Before June 30, 2019, the department shall submit to the Centers for Medicare and
2451     Medicaid Services a request for waivers, or an amendment to existing waivers, from federal
2452     law necessary for the state to:
2453          (i) provide dental services, in accordance with Subsections (2)(b)(ii) and (d) through
2454     (g) to an individual described in Subsection (2)(b)(ii); and
2455          (ii) provide the services described in Subsection (2)(h).
2456          (2) (a) To the extent funded, the department shall provide services to only blind or
2457     disabled individuals, as defined in 42 U.S.C. Sec. 1382c(a)(1), who are 18 years old or older
2458     and eligible for the program.

2459          (b) Notwithstanding Subsection (2)(a):
2460          (i) if a waiver is approved under Subsection (1)(b), the department shall provide dental
2461     services to an individual who:
2462          (A) qualifies for the health coverage improvement program described in Section
2463     [26-18-411] 26B-3-207; and
2464          (B) is receiving treatment in a substance abuse treatment program, as defined in
2465     Section [62A-2-101] 26B-2-101, licensed under [Title 62A, Chapter 2, Licensure of Programs
2466     and Facilities] Chapter 2, Part 1, Human Services Programs and Facilities; and
2467          (ii) if a waiver is approved under Subsection (1)(c)(i), the department shall provide
2468     dental services to an individual who is an aged individual as defined in 42 U.S.C. Sec.
2469     1382c(a)(1).
2470          (c) To the extent possible, services to individuals described in Subsection (2)(a) shall
2471     be provided through the University of Utah School of Dentistry and the University of Utah
2472     School of Dentistry's associated statewide network.
2473          (d) The department shall provide the services to individuals described in Subsection
2474     (2)(b):
2475          (i) by contracting with an entity that:
2476          (A) has demonstrated experience working with individuals who are being treated for
2477     both a substance use disorder and a major oral health disease;
2478          (B) operates a program, targeted at the individuals described in Subsection (2)(b), that
2479     has demonstrated, through a peer-reviewed evaluation, the effectiveness of providing dental
2480     treatment to those individuals described in Subsection (2)(b);
2481          (C) is willing to pay for an amount equal to the program's non-federal share of the cost
2482     of providing dental services to the population described in Subsection (2)(b); and
2483          (D) is willing to pay all state costs associated with applying for the waiver described in
2484     Subsection (1)(b) and administering the program described in Subsection (2)(b); and
2485          (ii) through a fee-for-service payment model.

2486          (e) The entity that receives the contract under Subsection (2)(d)(i) shall cover all state
2487     costs of the program described in Subsection (2)(b).
2488          (f) Each fiscal year, the University of Utah School of Dentistry shall, in compliance
2489     with state and federal regulations regarding intergovernmental transfers, transfer funds to the
2490     program in an amount equal to the program's non-federal share of the cost of providing services
2491     under this section through the school during the fiscal year.
2492          (g) If a waiver is approved under Subsection (1)(c)(ii), the department shall provide
2493     coverage for porcelain and porcelain-to-metal crowns if the services are provided:
2494          (i) to an individual who qualifies for dental services under Subsection (2)(b); and
2495          (ii) by an entity that covers all state costs of:
2496          (A) providing the coverage described in this Subsection [(2)(h)] (2)(g); and
2497          (B) applying for the waiver described in Subsection (1)(c).
2498          (h) Where possible, the department shall ensure that services described in Subsection
2499     (2)(a) that are not provided by the University of Utah School of Dentistry or the University of
2500     Utah School of Dentistry's associated network are provided:
2501          (i) through fee for service reimbursement until July 1, 2018; and
2502          (ii) after July 1, 2018, through the method of reimbursement used by the division for
2503     Medicaid dental benefits.
2504          (i) Subject to appropriations by the Legislature, and as determined by the department,
2505     the scope, amount, duration, and frequency of services may be limited.
2506          (3) (a) If the waivers requested under Subsection (1)(a) are granted, the Medicaid
2507     program shall begin providing dental services in the manner described in Subsection (2) no
2508     later than July 1, 2017.
2509          (b) If the waivers requested under Subsection (1)(b) are granted, the Medicaid program
2510     shall begin providing dental services to the population described in Subsection (2)(b) within 90
2511     days from the day on which the waivers are granted.
2512          (c) If the waivers requested under Subsection (1)(c)(i) are granted, the Medicaid

2513     program shall begin providing dental services to the population described in Subsection
2514     (2)(b)(ii) within 90 days after the day on which the waivers are granted.
2515          (4) If the federal share of the cost of providing dental services under this section will be
2516     less than 65% during any portion of the next fiscal year, the Medicaid program shall cease
2517     providing dental services under this section no later than the end of the current fiscal year.
2518          Section 50. Section 26B-3-209, which is renumbered from Section 26-18-414 is
2519     renumbered and amended to read:
2520          [26-18-414].      26B-3-209. Medicaid long-term support services housing
2521     coordinator.
2522          (1) There is created within the Medicaid program a full-time-equivalent position of
2523     Medicaid long-term support services housing coordinator.
2524          (2) The coordinator shall help Medicaid recipients receive long-term support services
2525     in a home or other community-based setting rather than in a nursing home or other institutional
2526     setting by:
2527          (a) working with municipalities, counties, the Housing and Community Development
2528     Division within the Department of Workforce Services, and others to identify
2529     community-based settings available to recipients;
2530          (b) working with the same entities to promote the development, construction, and
2531     availability of additional community-based settings;
2532          (c) training Medicaid case managers and support coordinators on how to help Medicaid
2533     recipients move from an institutional setting to a community-based setting; and
2534          (d) performing other related duties.
2535          Section 51. Section 26B-3-210, which is renumbered from Section 26-18-415 is
2536     renumbered and amended to read:
2537          [26-18-415].      26B-3-210. Medicaid waiver expansion.
2538          (1) As used in this section:
2539          (a) "Federal poverty level" means the same as that term is defined in Section

2540     [26-18-411] 26B-3-207.
2541          (b) "Medicaid waiver expansion" means an expansion of the Medicaid program in
2542     accordance with this section.
2543          (2) (a) Before January 1, 2019, the department shall apply to CMS for approval of a
2544     waiver or state plan amendment to implement the Medicaid waiver expansion.
2545          (b) The Medicaid waiver expansion shall:
2546          (i) expand Medicaid coverage to eligible individuals whose income is below 95% of
2547     the federal poverty level;
2548          (ii) obtain maximum federal financial participation under 42 U.S.C. Sec. 1396d(y) for
2549     enrolling an individual in the Medicaid program;
2550          (iii) provide Medicaid benefits through the state's Medicaid accountable care
2551     organizations in areas where a Medicaid accountable care organization is implemented;
2552          (iv) integrate the delivery of behavioral health services and physical health services
2553     with Medicaid accountable care organizations in select geographic areas of the state that
2554     choose an integrated model;
2555          (v) include a path to self-sufficiency, including work activities as defined in 42 U.S.C.
2556     Sec. 607(d), for qualified adults;
2557          (vi) require an individual who is offered a private health benefit plan by an employer to
2558     enroll in the employer's health plan;
2559          (vii) sunset in accordance with Subsection (5)(a); and
2560          (viii) permit the state to close enrollment in the Medicaid waiver expansion if the
2561     department has insufficient funding to provide services to additional eligible individuals.
2562          (3) If the Medicaid waiver described in Subsection (2)(a) is approved, the department
2563     may only pay the state portion of costs for the Medicaid waiver expansion with appropriations
2564     from:
2565          (a) the Medicaid Expansion Fund, created in Section [26-36b-208] 26B-1-315;
2566          (b) county contributions to the non-federal share of Medicaid expenditures; and

2567          (c) any other contributions, funds, or transfers from a non-state agency for Medicaid
2568     expenditures.
2569          (4) (a) In consultation with the department, Medicaid accountable care organizations
2570     and counties that elect to integrate care under Subsection (2)(b)(iv) shall collaborate on
2571     enrollment, engagement of patients, and coordination of services.
2572          (b) As part of the provision described in Subsection (2)(b)(iv), the department shall
2573     apply for a waiver to permit the creation of an integrated delivery system:
2574          (i) for any geographic area that expresses interest in integrating the delivery of services
2575     under Subsection (2)(b)(iv); and
2576          (ii) in which the department:
2577          (A) may permit a local mental health authority to integrate the delivery of behavioral
2578     health services and physical health services;
2579          (B) may permit a county, local mental health authority, or Medicaid accountable care
2580     organization to integrate the delivery of behavioral health services and physical health services
2581     to select groups within the population that are newly eligible under the Medicaid waiver
2582     expansion; and
2583          (C) may make rules in accordance with Title 63G, Chapter 3, Utah Administrative
2584     Rulemaking Act, to integrate payments for behavioral health services and physical health
2585     services to plans or providers.
2586          (5) (a) If federal financial participation for the Medicaid waiver expansion is reduced
2587     below 90%, the authority of the department to implement the Medicaid waiver expansion shall
2588     sunset no later than the next July 1 after the date on which the federal financial participation is
2589     reduced.
2590          (b) The department shall close the program to new enrollment if the cost of the
2591     Medicaid waiver expansion is projected to exceed the appropriations for the fiscal year that are
2592     authorized by the Legislature through an appropriations act adopted in accordance with Title
2593     63J, Chapter 1, Budgetary Procedures Act.

2594          (6) If the Medicaid waiver expansion is approved by CMS, the department shall report
2595     to the Social Services Appropriations Subcommittee on or before November 1 of each year that
2596     the Medicaid waiver expansion is operational:
2597          (a) the number of individuals who enrolled in the Medicaid waiver program;
2598          (b) costs to the state for the Medicaid waiver program;
2599          (c) estimated costs for the current and following state fiscal year; and
2600          (d) recommendations to control costs of the Medicaid waiver expansion.
2601          Section 52. Section 26B-3-211, which is renumbered from Section 26-18-416 is
2602     renumbered and amended to read:
2603          [26-18-416].      26B-3-211. Primary Care Network enhancement waiver
2604     program.
2605          (1) As used in this section:
2606          (a) "Enhancement waiver program" means the Primary Care Network enhancement
2607     waiver program described in this section.
2608          (b) "Federal poverty level" means the poverty guidelines established by the secretary of
2609     the United States Department of Health and Human Services under 42 U.S.C. Sec. 9902(2).
2610          (c) "Health coverage improvement program" means the same as that term is defined in
2611     Section [26-18-411] 26B-3-207.
2612          (d) "Income eligibility ceiling" means the percentage of federal poverty level:
2613          (i) established by the Legislature in an appropriations act adopted pursuant to Title 63J,
2614     Chapter 1, Budgetary Procedures Act; and
2615          (ii) under which an individual may qualify for coverage in the enhancement waiver
2616     program in accordance with this section.
2617          (e) "Optional population" means the optional expansion population under PPACA if
2618     the expansion provides coverage for individuals at or above 95% of the federal poverty level.
2619          (f) "Primary Care Network" means the state Primary Care Network program created by
2620     the Medicaid primary care network demonstration waiver obtained under Section [26-18-3]

2621     26B-3-108.
2622          (2) The department shall continue to implement the Primary Care Network program for
2623     qualified individuals under the Primary Care Network program.
2624          (3) (a) The division shall apply for a Medicaid waiver or a state plan amendment with
2625     CMS to implement, within the state Medicaid program, the enhancement waiver program
2626     described in this section within six months after the day on which:
2627          (i) the division receives a notice from CMS that the waiver for the Medicaid waiver
2628     expansion submitted under Section [26-18-415] 26B-3-210, Medicaid waiver expansion, will
2629     not be approved; or
2630          (ii) the division withdraws the waiver for the Medicaid waiver expansion submitted
2631     under Section [26-18-415] 26B-3-210, Medicaid waiver expansion.
2632          (b) The division may not apply for a waiver under Subsection (3)(a) while a waiver
2633     request under Section [26-18-415] 26B-3-210, Medicaid waiver expansion, is pending with
2634     CMS.
2635          (4) An individual who is eligible for the enhancement waiver program may receive the
2636     following benefits under the enhancement waiver program:
2637          (a) the benefits offered under the Primary Care Network program;
2638          (b) diagnostic testing and procedures;
2639          (c) medical specialty care;
2640          (d) inpatient hospital services;
2641          (e) outpatient hospital services;
2642          (f) outpatient behavioral health care, including outpatient substance [abuse] use care;
2643     and
2644          (g) for an individual who qualifies for the health coverage improvement program, as
2645     approved by CMS, temporary residential treatment for substance [abuse] use in a short term,
2646     non-institutional, 24-hour facility, without a bed capacity limit, that provides rehabilitation
2647     services that are medically necessary and in accordance with an individualized treatment plan.

2648          (5) An individual is eligible for the enhancement waiver program if, at the time of
2649     enrollment:
2650          (a) the individual is qualified to enroll in the Primary Care Network or the health
2651     coverage improvement program;
2652          (b) the individual's annual income is below the income eligibility ceiling established by
2653     the Legislature under Subsection (1)(d); and
2654          (c) the individual meets the eligibility criteria established by the department under
2655     Subsection (6).
2656          (6) (a) Based on available funding and approval from CMS, the department shall
2657     determine the criteria for an individual to qualify for the enhancement waiver program, based
2658     on the following priority:
2659          (i) adults in the expansion population, as defined in Section [26-18-411] 26B-3-207,
2660     who qualify for the health coverage improvement program;
2661          (ii) adults with dependent children who qualify for the health coverage improvement
2662     program under Subsection [26-18-411] 26B-3-207(3) ;
2663          (iii) adults with dependent children who do not qualify for the health coverage
2664     improvement program; and
2665          (iv) if funding is available, adults without dependent children.
2666          (b) The number of individuals enrolled in the enhancement waiver program may not
2667     exceed 105% of the number of individuals who were enrolled in the Primary Care Network on
2668     December 31, 2017.
2669          (c) The department may only use appropriations from the Medicaid Expansion Fund
2670     created in Section [26-36b-208] 26B-1-315 to fund the state portion of the enhancement waiver
2671     program.
2672          (7) The department may request a modification of the income eligibility ceiling and the
2673     eligibility criteria under Subsection (6) from CMS each fiscal year based on enrollment in the
2674     enhancement waiver program, projected enrollment in the enhancement waiver program, costs

2675     to the state, and the state budget.
2676          (8) The department may implement the enhancement waiver program by contracting
2677     with Medicaid accountable care organizations to administer the enhancement waiver program.
2678          (9) In accordance with Subsections [26-18-411(11) and (12)] 26B-3-207(10) and (11),
2679     the department may use funds that have been appropriated for the health coverage
2680     improvement program to implement the enhancement waiver program.
2681          (10) If the department expands the state Medicaid program to the optional population,
2682     the department:
2683          (a) except as provided in Subsection (11), may not accept any new enrollees into the
2684     enhancement waiver program after the day on which the expansion to the optional population
2685     is effective;
2686          (b) shall suspend the enhancement waiver program within one year after the day on
2687     which the expansion to the optional population is effective; and
2688          (c) shall work with CMS to maintain the waiver for the enhancement waiver program
2689     submitted under Subsection (3) while the enhancement waiver program is suspended under
2690     Subsection (10)(b).
2691          (11) If, after the expansion to the optional population described in Subsection (10)
2692     takes effect, the expansion to the optional population is repealed by either the state or the
2693     federal government, the department shall reinstate the enhancement waiver program and
2694     continue to accept new enrollees into the enhancement waiver program in accordance with the
2695     provisions of this section.
2696          Section 53. Section 26B-3-212, which is renumbered from Section 26-18-417 is
2697     renumbered and amended to read:
2698          [26-18-417].      26B-3-212. Limited family planning services for low-income
2699     individuals.
2700          (1) As used in this section:
2701          (a) (i) "Family planning services" means family planning services that are provided

2702     under the state Medicaid program, including:
2703          (A) sexual health education and family planning counseling; and
2704          (B) other medical diagnosis, treatment, or preventative care routinely provided as part
2705     of a family planning service visit.
2706          (ii) "Family planning services" do not include an abortion, as that term is defined in
2707     Section 76-7-301.
2708          (b) "Low-income individual" means an individual who:
2709          (i) has an income level that is equal to or below 95% of the federal poverty level; and
2710          (ii) does not qualify for full coverage under the Medicaid program.
2711          (2) Before July 1, 2018, the division shall apply for a Medicaid waiver or a state plan
2712     amendment with CMS to:
2713          (a) offer a program that provides family planning services to low-income individuals;
2714     and
2715          (b) receive a federal match rate of 90% of state expenditures for family planning
2716     services provided under the waiver or state plan amendment.
2717          Section 54. Section 26B-3-213, which is renumbered from Section 26-18-418 is
2718     renumbered and amended to read:
2719          [26-18-418].      26B-3-213. Medicaid waiver for mental health crisis lines
2720     and mobile crisis outreach teams.
2721          (1) As used in this section:
2722          (a) "Local mental health crisis line" means the same as that term is defined in Section
2723     [62A-15-1301] 26B-5-610.
2724          (b) "Mental health crisis" means:
2725          (i) a mental health condition that manifests itself in an individual by symptoms of
2726     sufficient severity that a prudent layperson who possesses an average knowledge of mental
2727     health issues could reasonably expect the absence of immediate attention or intervention to
2728     result in:

2729          (A) serious danger to the individual's health or well-being; or
2730          (B) a danger to the health or well-being of others; or
2731          (ii) a mental health condition that, in the opinion of a mental health therapist or the
2732     therapist's designee, requires direct professional observation or the intervention of a mental
2733     health therapist.
2734          (c) (i) "Mental health crisis services" means direct mental health services and on-site
2735     intervention that a mobile crisis outreach team provides to an individual suffering from a
2736     mental health crisis, including the provision of safety and care plans, prolonged mental health
2737     services for up to 90 days, and referrals to other community resources.
2738          (ii) "Mental health crisis services" includes:
2739          (A) local mental health crisis lines; and
2740          (B) the statewide mental health crisis line.
2741          (d) "Mental health therapist" means the same as that term is defined in Section
2742     58-60-102.
2743          (e) "Mobile crisis outreach team" or "MCOT" means a mobile team of medical and
2744     mental health professionals that, in coordination with local law enforcement and emergency
2745     medical service personnel, provides mental health crisis services.
2746          (f) "Statewide mental health crisis line" means the same as that term is defined in
2747     Section [62A-15-1301] 26B-5-610.
2748          (2) In consultation with [the Department of Human Services and] the Behavioral
2749     Health Crisis Response Commission created in Section 63C-18-202, the department shall
2750     develop a proposal to amend the state Medicaid plan to include mental health crisis services,
2751     including the statewide mental health crisis line, local mental health crisis lines, and mobile
2752     crisis outreach teams.
2753          (3) By January 1, 2019, the department shall apply for a Medicaid waiver with CMS, if
2754     necessary to implement, within the state Medicaid program, the mental health crisis services
2755     described in Subsection (2).

2756          Section 55. Section 26B-3-214, which is renumbered from Section 26-18-419 is
2757     renumbered and amended to read:
2758          [26-18-419].      26B-3-214. Medicaid waiver for coverage of mental health
2759     services in schools.
2760          (1) As used in this section, "local education agency" means:
2761          (a) a school district;
2762          (b) a charter school; or
2763          (c) the Utah Schools for the Deaf and the Blind.
2764          (2) In consultation with [the Department of Human Services and] the State Board of
2765     Education, the department shall develop a proposal to allow the state Medicaid program to
2766     reimburse a local education agency, a local mental health authority, or a private provider for
2767     covered mental health services provided:
2768          (a) in accordance with Section 53E-9-203; and
2769          (b) (i) at a local education agency building or facility; or
2770          (ii) by an employee or contractor of a local education agency.
2771          (3) Before January 1, 2020, the department shall apply to CMS for a state plan
2772     amendment to implement the coverage described in Subsection (2).
2773          Section 56. Section 26B-3-215, which is renumbered from Section 26-18-420 is
2774     renumbered and amended to read:
2775          [26-18-420].      26B-3-215. Coverage for in vitro fertilization and genetic
2776     testing.
2777          (1) As used in this section:
2778          (a) "Qualified condition" means:
2779          (i) cystic fibrosis;
2780          (ii) spinal muscular atrophy;
2781          (iii) Morquio Syndrome;
2782          (iv) myotonic dystrophy; or

2783          (v) sickle cell anemia.
2784          (b) "Qualified enrollee" means an individual who:
2785          (i) is enrolled in the Medicaid program;
2786          (ii) has been diagnosed by a physician as having a genetic trait associated with a
2787     qualified condition; and
2788          (iii) intends to get pregnant with a partner who is diagnosed by a physician as having a
2789     genetic trait associated with the same qualified condition as the individual.
2790          (2) Before January 1, 2021, the department shall apply for a Medicaid waiver or a state
2791     plan amendment with the Centers for Medicare and Medicaid Services within the United States
2792     Department of Health and Human Services to implement the coverage described in Subsection
2793     (3).
2794          (3) If the waiver described in Subsection (2) is approved, the Medicaid program shall
2795     provide coverage to a qualified enrollee for:
2796          (a) in vitro fertilization services; and
2797          (b) genetic testing of a qualified enrollee who receives in vitro fertilization services
2798     under Subsection (3)(a).
2799          (4) The Medicaid program may not provide the coverage described in Subsection (3)
2800     before the later of:
2801          (a) the day on which the waiver described in Subsection (2) is approved; and
2802          (b) January 1, 2021.
2803          (5) Before November 1, 2022, and before November 1 of every third year thereafter,
2804     the department shall:
2805          (a) calculate the change in state spending attributable to the coverage under this
2806     section; and
2807          (b) report the amount described in Subsection [(4)(a)] (5)(a) to the Health and Human
2808     Services Interim Committee and the Social Services Appropriations Subcommittee.
2809          Section 57. Section 26B-3-216, which is renumbered from Section 26-18-420.1 is

2810     renumbered and amended to read:
2811          [26-18-420.1].      26B-3-216. Medicaid waiver for fertility preservation
2812     services.
2813          (1) As used in this section:
2814          (a) "Iatrogenic infertility" means an impairment of fertility or reproductive functioning
2815     caused by surgery, chemotherapy, radiation, or other medical treatment.
2816          (b) "Physician" means an individual licensed to practice under Title 58, Chapter 67,
2817     Utah Medical Practice Act, or Title 58, Chapter 68, Utah Osteopathic Medical Practice Act.
2818          (c) "Qualified enrollee" means an individual who:
2819          (i) is enrolled in the Medicaid program;
2820          (ii) has been diagnosed with a form of cancer by a physician; and
2821          (iii) needs treatment for that cancer that may cause a substantial risk of sterility or
2822     iatrogenic infertility, including surgery, radiation, or chemotherapy.
2823          (d) "Standard fertility preservation service" means a fertility preservation procedure
2824     and service that:
2825          (i) is not considered experimental or investigational by the American Society for
2826     Reproductive Medicine or the American Society of Clinical Oncology; and
2827          (ii) is consistent with established medical practices or professional guidelines
2828     published by the American Society for Reproductive Medicine or the American Society of
2829     Clinical Oncology, including:
2830          (A) sperm banking;
2831          (B) oocyte banking;
2832          (C) embryo banking;
2833          (D) banking of reproductive tissues; and
2834          (E) storage of reproductive cells and tissues.
2835          (2) Before January 1, 2022, the department shall apply for a Medicaid waiver or a state
2836     plan amendment with CMS to implement the coverage described in Subsection (3).

2837          (3) If the waiver or state plan amendment described in Subsection (2) is approved, the
2838     Medicaid program shall provide coverage to a qualified enrollee for standard fertility
2839     preservation services.
2840          (4) The Medicaid program may not provide the coverage described in Subsection (3)
2841     before the later of:
2842          (a) the day on which the waiver described in Subsection (2) is approved; and
2843          (b) January 1, 2023.
2844          (5) Before November 1, 2023, and before November 1 of each third year after 2023,
2845     the department shall:
2846          (a) calculate the change in state spending attributable to the coverage described in this
2847     section; and
2848          (b) report the amount described in Subsection (5)(a) to the Health and Human Services
2849     Interim Committee and the Social Services Appropriations Subcommittee.
2850          Section 58. Section 26B-3-217, which is renumbered from Section 26-18-421 is
2851     renumbered and amended to read:
2852          [26-18-421].      26B-3-217. Medicaid waiver for coverage of qualified
2853     inmates leaving prison or jail.
2854          (1) As used in this section:
2855          (a) "Correctional facility" means:
2856          (i) a county jail;
2857          (ii) the Department of Corrections, created in Section 64-13-2; or
2858          (iii) a prison, penitentiary, or other institution operated by or under contract with the
2859     Department of Corrections for the confinement of an offender, as defined in Section 64-13-1.
2860          (b) "Qualified inmate" means an individual who:
2861          (i) is incarcerated in a correctional facility; and
2862          (ii) has:
2863          (A) a chronic physical or behavioral health condition;

2864          (B) a mental illness, as defined in Section [62A-15-602] 26B-5-301; or
2865          (C) an opioid use disorder.
2866          (2) Before July 1, 2020, the division shall apply for a Medicaid waiver or a state plan
2867     amendment with CMS to offer a program to provide Medicaid coverage to a qualified inmate
2868     for up to 30 days immediately before the day on which the qualified inmate is released from a
2869     correctional facility.
2870          (3) If the waiver or state plan amendment described in Subsection (2) is approved, the
2871     department shall report to the Health and Human Services Interim Committee each year before
2872     November 30 while the waiver or state plan amendment is in effect regarding:
2873          (a) the number of qualified inmates served under the program;
2874          (b) the cost of the program; and
2875          (c) the effectiveness of the program, including:
2876          (i) any reduction in the number of emergency room visits or hospitalizations by
2877     inmates after release from a correctional facility;
2878          (ii) any reduction in the number of inmates undergoing inpatient treatment after release
2879     from a correctional facility;
2880          (iii) any reduction in overdose rates and deaths of inmates after release from a
2881     correctional facility; and
2882          (iv) any other costs or benefits as a result of the program.
2883          (4) If the waiver or state plan amendment described in Subsection (2) is approved, a
2884     county that is responsible for the cost of a qualified inmate's medical care shall provide the
2885     required matching funds to the state for:
2886          (a) any costs to enroll the qualified inmate for the Medicaid coverage described in
2887     Subsection (2);
2888          (b) any administrative fees for the Medicaid coverage described in Subsection (2); and
2889          (c) the Medicaid coverage that is provided to the qualified inmate under Subsection
2890     (2).

2891          Section 59. Section 26B-3-218, which is renumbered from Section 26-18-422 is
2892     renumbered and amended to read:
2893          [26-18-422].      26B-3-218. Medicaid waiver for inpatient care in an
2894     institution for mental diseases.
2895          (1) As used in this section, "institution for mental diseases" means the same as that
2896     term is defined in 42 C.F.R. Sec. 435.1010.
2897          (2) Before August 1, 2020, the division shall apply for a Medicaid waiver or a state
2898     plan amendment with CMS to offer a program that provides reimbursement for mental health
2899     services that are provided:
2900          (a) in an institution for mental diseases that includes more than 16 beds; and
2901          (b) to an individual who receives mental health services in an institution for mental
2902     diseases for a period of more than 15 days in a calendar month.
2903          (3) If the waiver or state plan amendment described in Subsection (2) is approved, the
2904     department shall:
2905          (a) [coordinate with the Department of Human Services to] develop and offer the
2906     program described in Subsection (2); and
2907          (b) submit to the Health and Human Services Interim Committee and the Social
2908     Services Appropriations Subcommittee any report that the department submits to CMS that
2909     relates to the budget neutrality, independent waiver evaluation, or performance metrics of the
2910     program described in Subsection (2), within 15 days after the day on which the report is
2911     submitted to CMS.
2912          (4) Notwithstanding Sections 17-43-201 and 17-43-301, if the waiver or state plan
2913     amendment described in Subsection (2) is approved, a county does not have to provide
2914     matching funds to the state for the mental health services described in Subsection (2) that are
2915     provided to an individual who qualifies for Medicaid coverage under Section [26-18-3.9 or
2916     Section 26-18-411] 26B-3-113 or 26B-3-207.
2917          Section 60. Section 26B-3-219, which is renumbered from Section 26-18-423 is

2918     renumbered and amended to read:
2919          [26-18-423].      26B-3-219. Reimbursement for crisis management services
2920     provided in a behavioral health receiving center -- Integration of payment for physical
2921     health services.
2922          (1) As used in this section:
2923          (a) "Accountable care organization" means the same as that term is defined in Section
2924     [26-18-408] 26B-3-204.
2925          (b) "Behavioral health receiving center" means the same as that term is defined in
2926     Section [62A-15-118] 26B-4-114.
2927          (c) "Crisis management services" means behavioral health services provided to an
2928     individual who is experiencing a mental health crisis.
2929          (d) "Managed care organization" means the same as that term is defined in 42 C.F.R.
2930     Sec. 438.2.
2931          (2) Before July 1, 2020, the division shall apply for a Medicaid waiver or state plan
2932     amendment with CMS to offer a program that provides reimbursement through a bundled daily
2933     rate for crisis management services that are delivered to an individual during the individual's
2934     stay at a behavioral health receiving center.
2935          (3) If the waiver or state plan amendment described in Subsection (2) is approved, the
2936     department shall:
2937          (a) implement the program described in Subsection (2); and
2938          (b) require a managed care organization that contracts with the state's Medicaid
2939     program for behavioral health services or integrated health services to provide coverage for
2940     crisis management services that are delivered to an individual during the individual's stay at a
2941     behavioral health receiving center.
2942          (4) (a) The department may elect to integrate payment for physical health services
2943     provided in a behavioral health receiving center.
2944          (b) In determining whether to integrate payment under Subsection (4)(a), the

2945     department shall consult with accountable care organizations and counties in the state.
2946          Section 61. Section 26B-3-220, which is renumbered from Section 26-18-424 is
2947     renumbered and amended to read:
2948          [26-18-424].      26B-3-220. Crisis services -- Reimbursement.
2949          The [Department] department shall submit a waiver or state plan amendment to allow
2950     for reimbursement for 988 services provided to an individual who is eligible and enrolled in
2951     Medicaid at the time this service is provided.
2952          Section 62. Section 26B-3-221, which is renumbered from Section 26-18-425 is
2953     renumbered and amended to read:
2954          [26-18-425].      26B-3-221. Medicaid waiver for respite care facility that
2955     provides services to homeless individuals.
2956          (1) As used in this section:
2957          (a) "Adult in the expansion population" means an adult:
2958          (i) described in 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII); and
2959          (ii) not otherwise eligible for Medicaid as a mandatory categorically needy individual.
2960          (b) "Homeless" means the same as that term is defined in Section [26-18-411]
2961     26B-3-207.
2962          (c) "Medical respite care" means short-term housing with supportive medical services.
2963          (d) "Medical respite facility" means a residential facility that provides medical respite
2964     care to homeless individuals.
2965          (2) Before January 1, 2022, the department shall apply for a Medicaid waiver or state
2966     plan amendment with CMS to choose a single medical respite facility to reimburse for services
2967     provided to an individual who is:
2968          (a) homeless; and
2969          (b) an adult in the expansion population.
2970          (3) The department shall choose a medical respite facility best able to serve homeless
2971     individuals who are adults in the expansion population.

2972          (4) If the waiver or state plan amendment described in Subsection (2) is approved,
2973     while the waiver or state plan amendment is in effect, the department shall submit a report to
2974     the Health and Human Services Interim Committee each year before November 30 detailing:
2975          (a) the number of homeless individuals served at the facility;
2976          (b) the cost of the program; and
2977          (c) the reduction of health care costs due to the program's implementation.
2978          (5) Through administrative rule made in accordance with Title 63G, Chapter 3, Utah
2979     Administrative Rulemaking Act, the department shall further define and limit the services,
2980     described in this section, provided to a homeless individual.
2981          Section 63. Section 26B-3-222, which is renumbered from Section 26-18-426 is
2982     renumbered and amended to read:
2983          [26-18-426].      26B-3-222. Medicaid waiver expansion for extraordinary
2984     care reimbursement.
2985          (1) As used in this section:
2986          (a) "Existing home and community-based services waiver" means an existing home
2987     and community-based services waiver in the state that serves an individual:
2988          (i) with an acquired brain injury;
2989          (ii) with an intellectual or physical disability; or
2990          (iii) who is 65 years old or older.
2991          (b) "Personal care services" means a service that:
2992          (i) is furnished to an individual who is not an inpatient nor a resident of a hospital,
2993     nursing facility, intermediate care facility, or institution for mental diseases;
2994          (ii) is authorized for an individual described in Subsection (1)(b)(i) in accordance with
2995     a plan of treatment;
2996          (iii) is provided by an individual who is qualified to provide the services; and
2997          (iv) is furnished in a home or another community-based setting.
2998          (c) "Waiver enrollee" means an individual who is enrolled in an existing home and

2999     community-based services waiver.
3000          (2) Before July 1, 2021, the department shall apply with CMS for an amendment to an
3001     existing home and community-based services waiver to implement a program to offer
3002     reimbursement to an individual who provides personal care services that constitute
3003     extraordinary care to a waiver enrollee who is the individual's spouse.
3004          (3) If CMS approves the amendment described in Subsection (2), the department shall
3005     implement the program described in Subsection (2).
3006          (4) The department shall by rule, made in accordance with Title 63G, Chapter 3, Utah
3007     Administrative Rulemaking Act, define "extraordinary care" for purposes of Subsection (2).
3008          Section 64. Section 26B-3-223, which is renumbered from Section 26-18-428 is
3009     renumbered and amended to read:
3010          [26-18-428].      26B-3-223. Delivery system adjustments for the targeted
3011     adult Medicaid program.
3012          (1) As used in this section, "targeted adult Medicaid program" means the same as that
3013     term is defined in Section [26-18-411] 26B-3-207.
3014          (2) The department may implement the delivery system adjustments authorized under
3015     Subsection (3) only on the later of:
3016          (a) July 1, 2023; and
3017          (b) the department determining that the Medicaid program, including providers and
3018     managed care organizations, are satisfying the metrics established in collaboration with the
3019     working group convened under Subsection [26-18-427] 26B-3-138(2).
3020          (3) The department may, for individuals who are enrolled in the targeted adult
3021     Medicaid program:
3022          (a) integrate the delivery of behavioral and physical health in certain counties; and
3023          (b) deliver behavioral health services through an accountable care organization where
3024     implemented.
3025          (4) Before implementing the delivery system adjustments described in Subsection (3)

3026     in a county, the department shall, at a minimum, seek input from:
3027          (a) individuals who qualify for the targeted adult Medicaid program who reside in the
3028     county;
3029          (b) the county's executive officer, legislative body, and other county officials who are
3030     involved in the delivery of behavioral health services;
3031          (c) the local mental health authority and local substance [use] abuse authority that
3032     serves the county;
3033          (d) Medicaid managed care organizations operating in the state, including Medicaid
3034     accountable care organizations;
3035          (e) providers of physical or behavioral health services in the county who provide
3036     services to enrollees in the targeted adult Medicaid program in the county; and
3037          (f) other individuals that the department deems necessary.
3038          (5) If the department provides Medicaid coverage through a managed care delivery
3039     system under this section, the department shall include language in the department's managed
3040     care contracts that require the managed care plan to:
3041          (a) be in compliance with federal Medicaid managed care requirements;
3042          (b) timely and accurately process authorizations and claims in accordance with
3043     Medicaid policy and contract requirements;
3044          (c) adequately reimburse providers to maintain adequacy of access to care;
3045          (d) provide care management services sufficient to meet the needs of Medicaid eligible
3046     individuals enrolled in the managed care plan's plan; and
3047          (e) timely resolve any disputes between a provider or enrollee with the managed care
3048     plan.
3049          (6) The department may take corrective action if the managed care organization fails to
3050     comply with the terms of the managed care organization's contract.
3051          Section 65. Section 26B-3-224, which is renumbered from Section 26-18-429 is
3052     renumbered and amended to read:

3053          [26-18-429].      26B-3-224. Medicaid waiver for increased integrated health
3054     care reimbursement.
3055          (1) As used in this section:
3056          (a) "Integrated health care setting" means a health care or behavioral health care setting
3057     that provides integrated physical and behavioral health care services.
3058          (b) "Local mental health authority" means a local mental health authority described in
3059     Section 17-43-301.
3060          (2) The department shall develop a proposal to allow the state Medicaid program to
3061     reimburse a local mental health authority for covered physical health care services provided in
3062     an integrated health care setting to Medicaid eligible individuals.
3063          (3) Before December 31, 2022, the department shall apply for a Medicaid waiver or a
3064     state plan amendment with CMS to implement the proposal described in Subsection (2).
3065          (4) If the waiver or state plan amendment described in Subsection (3) is approved, the
3066     department shall:
3067          (a) implement the proposal described in Subsection (2); and
3068          (b) while the waiver or state plan amendment is in effect, submit a report to the Health
3069     and Human Services Interim Committee each year before November 30 detailing:
3070          (i) the number of patients served under the waiver or state plan amendment;
3071          (ii) the cost of the waiver or state plan amendment; and
3072          (iii) any benefits of the waiver or state plan amendment.
3073          Section 66. Section 26B-3-301, which is renumbered from Section 26-18-101 is
3074     renumbered and amended to read:
3075     
Part 3. Administration of Medicaid Programs: Drug Utilization Review and

3076     
Long Term Care Facility Certification

3077          [26-18-101].      26B-3-301. Definitions.
3078          As used in this part:
3079          (1) "Appropriate and medically necessary" means, regarding drug prescribing,

3080     dispensing, and patient usage, that it is in conformity with the criteria and standards developed
3081     in accordance with this part.
3082          (2) "Board" means the Drug Utilization Review Board created in Section [26-18-102]
3083     26B-3-302.
3084          (3) "Certified program" means a nursing care facility program with Medicaid
3085     certification.
3086          [(3)] (4) "Compendia" means resources widely accepted by the medical profession in
3087     the efficacious use of drugs, including "American Hospital Formulary [Services] Service Drug
3088     Information," "U.S. Pharmacopeia - Drug Information," "A.M.A. Drug Evaluations,"
3089     peer-reviewed medical literature, and information provided by manufacturers of drug products.
3090          [(4)] (5) "Counseling" means the activities conducted by a pharmacist to inform
3091     Medicaid recipients about the proper use of drugs, as required by the board under this part.
3092          [(5)] (6) "Criteria" means those predetermined and explicitly accepted elements used to
3093     measure drug use on an ongoing basis in order to determine if the use is appropriate, medically
3094     necessary, and not likely to result in adverse medical outcomes.
3095          [(6)] (7) "Drug-disease contraindications" means that the therapeutic effect of a drug is
3096     adversely altered by the presence of another disease condition.
3097          [(7)] (8) "Drug-interactions" means that two or more drugs taken by a recipient lead to
3098     clinically significant toxicity that is characteristic of one or any of the drugs present, or that
3099     leads to interference with the effectiveness of one or any of the drugs.
3100          [(8)] (9) "Drug Utilization Review" or "DUR" means the program designed to measure
3101     and assess, on a retrospective and prospective basis, the proper use of outpatient drugs in the
3102     Medicaid program.
3103          [(9)] (10) "Intervention" means a form of communication utilized by the board with a
3104     prescriber or pharmacist to inform about or influence prescribing or dispensing practices.
3105          (11) "Medicaid certification" means the right of a nursing care facility, as a provider of
3106     a nursing care facility program, to receive Medicaid reimbursement for a specified number of

3107     beds within the facility.
3108          (12) (a) "Nursing care facility" means the following facilities licensed by the
3109     department under Chapter 2, Part 2, Health Care Facility Licensing and Inspection:
3110          (i) skilled nursing facilities;
3111          (ii) intermediate care facilities; and
3112          (iii) an intermediate care facility for people with an intellectual disability.
3113          (b) "Nursing care facility" does not mean a critical access hospital that meets the
3114     criteria of 42 U.S.C. Sec. 1395i-4(c)(2) (1998).
3115          (13) "Nursing care facility program" means the personnel, licenses, services, contracts,
3116     and all other requirements that shall be met for a nursing care facility to be eligible for
3117     Medicaid certification under this part and division rule.
3118          [(10)] (14) "Overutilization" or "underutilization" means the use of a drug in such
3119     quantities that the desired therapeutic goal is not achieved.
3120          [(11)] (15) "Pharmacist" means a person licensed in this state to engage in the practice
3121     of pharmacy under Title 58, Chapter 17b, Pharmacy Practice Act.
3122          (16) "Physical facility" means the buildings or other physical structures where a
3123     nursing care facility program is operated.
3124          [(12)] (17) "Physician" means a person licensed in this state to practice medicine and
3125     surgery under Section 58-67-301 or osteopathic medicine under Section 58-68-301.
3126          [(13)] (18) "Prospective DUR" means that part of the drug utilization review program
3127     that occurs before a drug is dispensed, and that is designed to screen for potential drug therapy
3128     problems based on explicit and predetermined criteria and standards.
3129          [(14)] (19) "Retrospective DUR" means that part of the drug utilization review
3130     program that assesses or measures drug use based on an historical review of drug use data
3131     against predetermined and explicit criteria and standards, on an ongoing basis with professional
3132     input.
3133          (20) "Rural county" means a county with a population of less than 50,000, as

3134     determined by:
3135          (a) the most recent official census or census estimate of the United States Bureau of the
3136     Census; or
3137          (b) the most recent population estimate for the county from the Utah Population
3138     Committee, if a population figure for the county is not available under Subsection (20)(a).
3139          (21) "Service area" means the boundaries of the distinct geographic area served by a
3140     certified program as determined by the division in accordance with this part and division rule.
3141          [(15)] (22) "Standards" means the acceptable range of deviation from the criteria that
3142     reflects local medical practice and that is tested on the Medicaid recipient database.
3143          [(16)] (23) "SURS" means the Surveillance Utilization Review System of the Medicaid
3144     program.
3145          [(17)] (24) "Therapeutic appropriateness" means drug prescribing and dispensing based
3146     on rational drug therapy that is consistent with criteria and standards.
3147          [(18)] (25) "Therapeutic duplication" means prescribing and dispensing the same drug
3148     or two or more drugs from the same therapeutic class where periods of drug administration
3149     overlap and where that practice is not medically indicated.
3150          (26) "Urban county" means a county that is not a rural county.
3151          Section 67. Section 26B-3-302, which is renumbered from Section 26-18-102 is
3152     renumbered and amended to read:
3153          [26-18-102].      26B-3-302. DUR Board -- Creation and membership --
3154     Expenses.
3155          (1) There is created a 12-member Drug Utilization Review Board responsible for
3156     implementation of a retrospective and prospective DUR program.
3157          (2) (a) Except as required by Subsection (2)(b), as terms of current board members
3158     expire, the executive director shall appoint each new member or reappointed member to a
3159     four-year term.
3160          (b) Notwithstanding the requirements of Subsection (2)(a), the executive director shall,

3161     at the time of appointment or reappointment, adjust the length of terms to ensure that the terms
3162     of board members are staggered so that approximately half of the board is appointed every two
3163     years.
3164          (c) Persons appointed to the board may be reappointed upon completion of their terms,
3165     but may not serve more than two consecutive terms.
3166          (d) The executive director shall provide for geographic balance in representation on the
3167     board.
3168          (3) When a vacancy occurs in the membership for any reason, the replacement shall be
3169     appointed for the unexpired term.
3170          (4) The membership shall be comprised of the following:
3171          (a) four physicians who are actively engaged in the practice of medicine or osteopathic
3172     medicine in this state, to be selected from a list of nominees provided by the Utah Medical
3173     Association;
3174          (b) one physician in this state who is actively engaged in academic medicine;
3175          (c) three pharmacists who are actively practicing in retail pharmacy in this state, to be
3176     selected from a list of nominees provided by the Utah Pharmaceutical Association;
3177          (d) one pharmacist who is actively engaged in academic pharmacy;
3178          (e) one person who shall represent consumers;
3179          (f) one person who shall represent pharmaceutical manufacturers, to be recommended
3180     by the Pharmaceutical Manufacturers Association; and
3181          (g) one dentist licensed to practice in this state under Title 58, Chapter 69, Dentist and
3182     Dental Hygienist Practice Act, who is actively engaged in the practice of dentistry, nominated
3183     by the Utah Dental Association.
3184          (5) Physician and pharmacist members of the board shall have expertise in clinically
3185     appropriate prescribing and dispensing of outpatient drugs.
3186          (6) The board shall elect a chair from among its members who shall serve a one-year
3187     term, and may serve consecutive terms.

3188          (7) A member may not receive compensation or benefits for the member's service, but
3189     may receive per diem and travel expenses in accordance with:
3190          (a) Section 63A-3-106;
3191          (b) Section 63A-3-107; and
3192          (c) rules made by the Division of Finance pursuant to Sections 63A-3-106 and
3193     63A-3-107.
3194          Section 68. Section 26B-3-303, which is renumbered from Section 26-18-103 is
3195     renumbered and amended to read:
3196          [26-18-103].      26B-3-303. DUR Board -- Responsibilities.
3197          The board shall:
3198          (1) develop rules necessary to carry out its responsibilities as defined in this part;
3199          (2) oversee the implementation of a Medicaid retrospective and prospective DUR
3200     program in accordance with this part, including responsibility for approving provisions of
3201     contractual agreements between the Medicaid program and any other entity that will process
3202     and review Medicaid drug claims and profiles for the DUR program in accordance with this
3203     part;
3204          (3) develop and apply predetermined criteria and standards to be used in retrospective
3205     and prospective DUR, ensuring that the criteria and standards are based on the compendia, and
3206     that they are developed with professional input, in a consensus fashion, with provisions for
3207     timely revision and assessment as necessary. The DUR standards developed by the board shall
3208     reflect the local practices of physicians in order to monitor:
3209          (a) therapeutic appropriateness;
3210          (b) overutilization or underutilization;
3211          (c) therapeutic duplication;
3212          (d) drug-disease contraindications;
3213          (e) drug-drug interactions;
3214          (f) incorrect drug dosage or duration of drug treatment; and

3215          (g) clinical abuse and misuse;
3216          (4) develop, select, apply, and assess interventions and remedial strategies for
3217     physicians, pharmacists, and recipients that are educational and not punitive in nature, in order
3218     to improve the quality of care;
3219          (5) disseminate information to physicians and pharmacists to ensure that they are aware
3220     of the board's duties and powers;
3221          (6) provide written, oral, or electronic reminders of patient-specific or drug-specific
3222     information, designed to ensure recipient, physician, and pharmacist confidentiality, and
3223     suggest changes in prescribing or dispensing practices designed to improve the quality of care;
3224          (7) utilize face-to-face discussions between experts in drug therapy and the prescriber
3225     or pharmacist who has been targeted for educational intervention;
3226          (8) conduct intensified reviews or monitoring of selected prescribers or pharmacists;
3227          (9) create an educational program using data provided through DUR to provide active
3228     and ongoing educational outreach programs to improve prescribing and dispensing practices,
3229     either directly or by contract with other governmental or private entities;
3230          (10) provide a timely evaluation of intervention to determine if those interventions
3231     have improved the quality of care;
3232          (11) publish the annual Drug Utilization Review report required under 42 C.F.R. Sec.
3233     712;
3234          (12) develop a working agreement with related boards or agencies, including the State
3235     Board of Pharmacy, Physicians' Licensing Board, and SURS staff within the division, in order
3236     to clarify areas of responsibility for each, where those areas may overlap;
3237          (13) establish a grievance process for physicians and pharmacists under this part, in
3238     accordance with Title 63G, Chapter 4, Administrative Procedures Act;
3239          (14) publish and disseminate educational information to physicians and pharmacists
3240     concerning the board and the DUR program, including information regarding:
3241          (a) identification and reduction of the frequency of patterns of fraud, abuse, gross

3242     overuse, inappropriate, or medically unnecessary care among physicians, pharmacists, and
3243     recipients;
3244          (b) potential or actual severe or adverse reactions to drugs;
3245          (c) therapeutic appropriateness;
3246          (d) overutilization or underutilization;
3247          (e) appropriate use of generics;
3248          (f) therapeutic duplication;
3249          (g) drug-disease contraindications;
3250          (h) drug-drug interactions;
3251          (i) incorrect drug dosage and duration of drug treatment;
3252          (j) drug allergy interactions; and
3253          (k) clinical abuse and misuse;
3254          (15) develop and publish, with the input of the State Board of Pharmacy, guidelines
3255     and standards to be used by pharmacists in counseling Medicaid recipients in accordance with
3256     this part. The guidelines shall ensure that the recipient may refuse counseling and that the
3257     refusal is to be documented by the pharmacist. Items to be discussed as part of that counseling
3258     include:
3259          (a) the name and description of the medication;
3260          (b) administration, form, and duration of therapy;
3261          (c) special directions and precautions for use;
3262          (d) common severe side effects or interactions, and therapeutic interactions, and how to
3263     avoid those occurrences;
3264          (e) techniques for self-monitoring drug therapy;
3265          (f) proper storage;
3266          (g) prescription refill information; and
3267          (h) action to be taken in the event of a missed dose; and
3268          (16) establish procedures in cooperation with the State Board of Pharmacy for

3269     pharmacists to record information to be collected under this part. The recorded information
3270     shall include:
3271          (a) the name, address, age, and gender of the recipient;
3272          (b) individual history of the recipient where significant, including disease state, known
3273     allergies and drug reactions, and a comprehensive list of medications and relevant devices;
3274          (c) the pharmacist's comments on the individual's drug therapy;
3275          (d) name of prescriber; and
3276          (e) name of drug, dose, duration of therapy, and directions for use.
3277          Section 69. Section 26B-3-304, which is renumbered from Section 26-18-104 is
3278     renumbered and amended to read:
3279          [26-18-104].      26B-3-304. Confidentiality of records.
3280          (1) Information obtained under this part shall be treated as confidential or controlled
3281     information under Title 63G, Chapter 2, Government Records Access and Management Act.
3282          (2) The board shall establish procedures [insuring] ensuring that the information
3283     described in Subsection [26-18-103] 26B-3-304(16) is held confidential by the pharmacist,
3284     being provided to the physician only upon request.
3285          (3) The board shall adopt and implement procedures designed to ensure the
3286     confidentiality of all information collected, stored, retrieved, assessed, or analyzed by the
3287     board, staff to the board, or contractors to the DUR program, that identifies individual
3288     physicians, pharmacists, or recipients. The board may have access to identifying information
3289     for purposes of carrying out intervention activities, but that identifying information may not be
3290     released to anyone other than a member of the board. The board may release cumulative
3291     nonidentifying information for research purposes.
3292          Section 70. Section 26B-3-305, which is renumbered from Section 26-18-105 is
3293     renumbered and amended to read:
3294          [26-18-105].      26B-3-305. Drug prior approval program.
3295          (1) A drug prior approval program approved or implemented by the board shall meet

3296     the following conditions:
3297          (a) except as provided in Subsection (2), a drug may not be placed on prior approval
3298     for other than medical reasons;
3299          (b) the board shall hold a public hearing at least 30 days prior to placing a drug on prior
3300     approval;
3301          (c) notwithstanding the provisions of Section 52-4-202, the board shall provide not less
3302     than 14 days' notice to the public before holding a public hearing under Subsection (1)(b);
3303          (d) the board shall consider written and oral comments submitted by interested parties
3304     prior to or during the hearing held in accordance with Subsection (1)(b);
3305          (e) the board shall provide evidence that placing a drug class on prior approval:
3306          (i) will not impede quality of recipient care; and
3307          (ii) that the drug class is subject to clinical abuse or misuse;
3308          (f) the board shall reconsider its decision to place a drug on prior approval:
3309          (i) no later than nine months after any drug class is placed on prior approval; and
3310          (ii) at a public hearing with notice as provided in Subsection (1)(b);
3311          (g) the program shall provide an approval or denial of a request for prior approval:
3312          (i) by either:
3313          (A) fax;
3314          (B) telephone; or
3315          (C) electronic transmission;
3316          (ii) at least Monday through Friday, except for state holidays; and
3317          (iii) within 24 hours after receipt of the prior approval request;
3318          (h) the program shall provide for the dispensing of at least a 72-hour supply of the drug
3319     on the prior approval program:
3320          (i) in an emergency situation; or
3321          (ii) on weekends or state holidays;
3322          (i) the program may be applied to allow acceptable medical use of a drug on prior

3323     approval for appropriate off-label indications; and
3324          (j) before placing a drug class on the prior approval program, the board shall:
3325          (i) determine that the requirements of Subsections (1)(a) through (i) have been met;
3326     and
3327          (ii) by majority vote, place the drug class on prior approval.
3328          (2) The board may, only after complying with Subsections (1)(b) through (j), consider
3329     the cost:
3330          (a) of a drug when placing a drug on the prior approval program; and
3331          (b) associated with including, or excluding a drug from the prior approval process,
3332     including:
3333          (i) potential side effects associated with a drug; or
3334          (ii) potential hospitalizations or other complications that may occur as a result of a
3335     drug's inclusion on the prior approval process.
3336          Section 71. Section 26B-3-306, which is renumbered from Section 26-18-106 is
3337     renumbered and amended to read:
3338          [26-18-106].      26B-3-306. Advisory committees.
3339          The board may establish advisory committees to assist it in carrying out its duties under
3340     [this part] Sections 26B-3-302 through 26B-3-309.
3341          Section 72. Section 26B-3-307, which is renumbered from Section 26-18-107 is
3342     renumbered and amended to read:
3343          [26-18-107].      26B-3-307. Retrospective and prospective DUR.
3344          (1) The board, in cooperation with the division, shall include in its state plan the
3345     creation and implementation of a retrospective and prospective DUR program for Medicaid
3346     outpatient drugs to ensure that prescriptions are appropriate, medically necessary, and not likely
3347     to result in adverse medical outcomes.
3348          (2) The retrospective and prospective DUR program shall be operated under guidelines
3349     established by the board under Subsections (3) and (4).

3350          (3) The retrospective DUR program shall be based on guidelines established by the
3351     board, using the mechanized drug claims processing and information retrieval system to
3352     analyze claims data in order to:
3353          (a) identify patterns of fraud, abuse, gross overuse, and inappropriate or medically
3354     unnecessary care; and
3355          (b) assess data on drug use against explicit predetermined standards that are based on
3356     the compendia and other sources for the purpose of monitoring:
3357          (i) therapeutic appropriateness;
3358          (ii) overutilization or underutilization;
3359          (iii) therapeutic duplication;
3360          (iv) drug-disease contraindications;
3361          (v) drug-drug interactions;
3362          (vi) incorrect drug dosage or duration of drug treatment; and
3363          (vii) clinical abuse and misuse.
3364          (4) The prospective DUR program shall be based on guidelines established by the
3365     board and shall provide that, before a prescription is filled or delivered, a review will be
3366     conducted by the pharmacist at the point of sale to screen for potential drug therapy problems
3367     resulting from:
3368          (a) therapeutic duplication;
3369          (b) drug-drug interactions;
3370          (c) incorrect dosage or duration of treatment;
3371          (d) drug-allergy interactions; and
3372          (e) clinical abuse or misuse.
3373          (5) In conducting the prospective DUR, a pharmacist may not alter the prescribed
3374     outpatient drug therapy without the consent of the prescribing physician or physician assistant.
3375     This section does not effect the ability of a pharmacist to substitute a generic equivalent.
3376          Section 73. Section 26B-3-308, which is renumbered from Section 26-18-108 is

3377     renumbered and amended to read:
3378          [26-18-108].      26B-3-308. Penalties.
3379          Any person who violates the confidentiality provisions of [this part] Sections
3380     26B-3-302 through 26B-3-307 is guilty of a class B misdemeanor.
3381          Section 74. Section 26B-3-309, which is renumbered from Section 26-18-109 is
3382     renumbered and amended to read:
3383          [26-18-109].      26B-3-309. Immunity.
3384          There is no liability on the part of, and no cause of action of any nature arises against
3385     any member of the board, its agents, or employees for any action or omission by them in
3386     effecting the provisions of [this part] Sections 26B-3-302 through 26B-3-307.
3387          Section 75. Section 26B-3-310, which is renumbered from Section 26-18-502 is
3388     renumbered and amended to read:
3389          [26-18-502].      26B-3-310. Purpose -- Medicaid certification of nursing care
3390     facilities.
3391          (1) The Legislature finds:
3392          (a) that an oversupply of nursing care facilities in the state adversely affects the state
3393     Medicaid program and the health of the people in the state;
3394          (b) it is in the best interest of the state to prohibit nursing care facilities from receiving
3395     Medicaid certification, except as provided by [this part] Sections 26B-3-311 through
3396     26B-3-313; and
3397          (c) it is in the best interest of the state to encourage aging nursing care facilities with
3398     Medicaid certification to renovate the nursing care facilities' physical facilities so that the
3399     quality of life and clinical services for Medicaid residents are preserved.
3400          (2) Medicaid reimbursement of nursing care facility programs is limited to:
3401          (a) the number of nursing care facility programs with Medicaid certification as of May
3402     9, 2016; and
3403          (b) additional nursing care facility programs approved for Medicaid certification under

3404     the provisions of Subsections [26-18-503] 26B-3-311(5) and (7).
3405          (3) The division may not:
3406          (a) except as authorized by Section [26-18-503] 26B-3-311:
3407          (i) process initial applications for Medicaid certification or execute provider
3408     agreements with nursing care facility programs; or
3409          (ii) reinstate Medicaid certification for a nursing care facility whose certification
3410     expired or was terminated by action of the federal or state government; or
3411          (b) execute a Medicaid provider agreement with a certified program that moves to a
3412     different physical facility, except as authorized by Subsection [26-18-503] 26B-3-311(3).
3413          (4) Notwithstanding Section [26-18-503] 26B-3-311, beginning May 4, 2021, the
3414     division may not approve a new or additional bed in an intermediate care facility for
3415     individuals with an intellectual disability for Medicaid certification, unless certification of the
3416     bed by the division does not increase the total number in the state of Medicaid-certified beds in
3417     intermediate care facilities for individuals with an intellectual disability.
3418          Section 76. Section 26B-3-311, which is renumbered from Section 26-18-503 is
3419     renumbered and amended to read:
3420          [26-18-503].      26B-3-311. Authorization to renew, transfer, or increase
3421     Medicaid certified programs -- Reimbursement methodology.
3422          (1) (a) The division may renew Medicaid certification of a certified program if the
3423     program, without lapse in service to Medicaid recipients, has its nursing care facility program
3424     certified by the division at the same physical facility as long as the licensed and certified bed
3425     capacity at the facility has not been expanded, unless the director has approved additional beds
3426     in accordance with Subsection (5).
3427          (b) The division may renew Medicaid certification of a nursing care facility program
3428     that is not currently certified if:
3429          (i) since the day on which the program last operated with Medicaid certification:
3430          (A) the physical facility where the program operated has functioned solely and

3431     continuously as a nursing care facility; and
3432          (B) the owner of the program has not, under this section or Section [26-18-505]
3433     26B-3-313, transferred to another nursing care facility program the license for any of the
3434     Medicaid beds in the program; and
3435          (ii) except as provided in Subsection [26-18-502] 26B-3-310(4), the number of beds
3436     granted renewed Medicaid certification does not exceed the number of beds certified at the
3437     time the program last operated with Medicaid certification, excluding a period of time where
3438     the program operated with temporary certification under Subsection [26-18-504] 26B-3-312(3).
3439          (2) (a) The division may issue a Medicaid certification for a new nursing care facility
3440     program if a current owner of the Medicaid certified program transfers its ownership of the
3441     Medicaid certification to the new nursing care facility program and the new nursing care
3442     facility program meets all of the following conditions:
3443          (i) the new nursing care facility program operates at the same physical facility as the
3444     previous Medicaid certified program;
3445          (ii) the new nursing care facility program gives a written assurance to the director in
3446     accordance with Subsection (4);
3447          (iii) the new nursing care facility program receives the Medicaid certification within
3448     one year of the date the previously certified program ceased to provide medical assistance to a
3449     Medicaid recipient; and
3450          (iv) the licensed and certified bed capacity at the facility has not been expanded, unless
3451     the director has approved additional beds in accordance with Subsection (5).
3452          (b) A nursing care facility program that receives Medicaid certification under the
3453     provisions of Subsection (2)(a) does not assume the Medicaid liabilities of the previous nursing
3454     care facility program if the new nursing care facility program:
3455          (i) is not owned in whole or in part by the previous nursing care facility program; or
3456          (ii) is not a successor in interest of the previous nursing care facility program.
3457          (3) The division may issue a Medicaid certification to a nursing care facility program

3458     that was previously a certified program but now resides in a new or renovated physical facility
3459     if the nursing care facility program meets all of the following:
3460          (a) the nursing care facility program met all applicable requirements for Medicaid
3461     certification at the time of closure;
3462          (b) the new or renovated physical facility is in the same county or within a five-mile
3463     radius of the original physical facility;
3464          (c) the time between which the certified program ceased to operate in the original
3465     facility and will begin to operate in the new physical facility is not more than three years,
3466     unless:
3467          (i) an emergency is declared by the president of the United States or the governor,
3468     affecting the building or renovation of the physical facility;
3469          (ii) the director approves an exception to the three-year requirement for any nursing
3470     care facility program within the three-year requirement;
3471          (iii) the provider submits documentation supporting a request for an extension to the
3472     director that demonstrates a need for an extension; and
3473          (iv) the exception does not extend for more than two years beyond the three-year
3474     requirement;
3475          (d) if Subsection (3)(c) applies, the certified program notifies the department within 90
3476     days after ceasing operations in its original facility, of its intent to retain its Medicaid
3477     certification;
3478          (e) the provider gives written assurance to the director in accordance with Subsection
3479     (4) that no third party has a legitimate claim to operate a certified program at the previous
3480     physical facility; and
3481          (f) the bed capacity in the physical facility has not been expanded unless the director
3482     has approved additional beds in accordance with Subsection (5).
3483          (4) (a) The entity requesting Medicaid certification under Subsections (2) and (3) shall
3484     give written assurances satisfactory to the director or the director's designee that:

3485          (i) no third party has a legitimate claim to operate the certified program;
3486          (ii) the requesting entity agrees to defend and indemnify the department against any
3487     claims by a third party who may assert a right to operate the certified program; and
3488          (iii) if a third party is found, by final agency action of the department after exhaustion
3489     of all administrative and judicial appeal rights, to be entitled to operate a certified program at
3490     the physical facility the certified program shall voluntarily comply with Subsection (4)(b).
3491          (b) If a finding is made under the provisions of Subsection (4)(a)(iii):
3492          (i) the certified program shall immediately surrender its Medicaid certification and
3493     comply with division rules regarding billing for Medicaid and the provision of services to
3494     Medicaid patients; and
3495          (ii) the department shall transfer the surrendered Medicaid certification to the third
3496     party who prevailed under Subsection (4)(a)(iii).
3497          (5) (a) The director may approve additional nursing care facility programs for Medicaid
3498     certification, or additional beds for Medicaid certification within an existing nursing care
3499     facility program, if a nursing care facility or other interested party requests Medicaid
3500     certification for a nursing care facility program or additional beds within an existing nursing
3501     care facility program, and the nursing care facility program or other interested party complies
3502     with this section.
3503          (b) The nursing care facility or other interested party requesting Medicaid certification
3504     for a nursing care facility program or additional beds within an existing nursing care facility
3505     program under Subsection (5)(a) shall submit to the director:
3506          (i) proof of the following as reasonable evidence that bed capacity provided by
3507     Medicaid certified programs within the county or group of counties impacted by the requested
3508     additional Medicaid certification is insufficient:
3509          (A) nursing care facility occupancy levels for all existing and proposed facilities will
3510     be at least 90% for the next three years;
3511          (B) current nursing care facility occupancy is 90% or more; or

3512          (C) there is no other nursing care facility within a 35-mile radius of the nursing care
3513     facility requesting the additional certification; and
3514          (ii) an independent analysis demonstrating that at projected occupancy rates the nursing
3515     care facility's after-tax net income is sufficient for the facility to be financially viable.
3516          (c) Any request for additional beds as part of a renovation project are limited to the
3517     maximum number of beds allowed in Subsection (7).
3518          (d) The director shall determine whether to issue additional Medicaid certification by
3519     considering:
3520          (i) whether bed capacity provided by certified programs within the county or group of
3521     counties impacted by the requested additional Medicaid certification is insufficient, based on
3522     the information submitted to the director under Subsection (5)(b);
3523          (ii) whether the county or group of counties impacted by the requested additional
3524     Medicaid certification is underserved by specialized or unique services that would be provided
3525     by the nursing care facility;
3526          (iii) whether any Medicaid certified beds are subject to a claim by a previous certified
3527     program that may reopen under the provisions of Subsections (2) and (3);
3528          (iv) how additional bed capacity should be added to the long-term care delivery system
3529     to best meet the needs of Medicaid recipients; and
3530          (v) (A) whether the existing certified programs within the county or group of counties
3531     have provided services of sufficient quality to merit at least a two-star rating in the Medicare
3532     Five-Star Quality Rating System over the previous three-year period; and
3533          (B) information obtained under Subsection (9).
3534          (6) The department shall adopt administrative rules in accordance with Title 63G,
3535     Chapter 3, Utah Administrative Rulemaking Act, to adjust the Medicaid nursing care facility
3536     property reimbursement methodology to:
3537          (a) only pay that portion of the property component of rates, representing actual bed
3538     usage by Medicaid clients as a percentage of the greater of:

3539          (i) actual occupancy; or
3540          (ii) (A) for a nursing care facility other than a facility described in Subsection
3541     (6)(a)(ii)(B), 85% of total bed capacity; or
3542          (B) for a rural nursing care facility, 65% of total bed capacity; and
3543          (b) not allow for increases in reimbursement for property values without major
3544     renovation or replacement projects as defined by the department by rule.
3545          (7) (a) Except as provided in Subsection [26-18-502(3)] 26B-3-310(3), if a nursing
3546     care facility does not seek Medicaid certification for a bed under Subsections (1) through (6),
3547     the department shall, notwithstanding Subsections [26-18-504] 26B-3-312(3)(a) and (b), grant
3548     Medicaid certification for additional beds in an existing Medicaid certified nursing care facility
3549     that has 90 or fewer licensed beds, including Medicaid certified beds, in the facility if:
3550          (i) the nursing care facility program was previously a certified program for all beds but
3551     now resides in a new facility or in a facility that underwent major renovations involving major
3552     structural changes, with 50% or greater facility square footage design changes, requiring review
3553     and approval by the department;
3554          (ii) the nursing care facility meets the quality of care regulations issued by CMS; and
3555          (iii) the total number of additional beds in the facility granted Medicaid certification
3556     under this section does not exceed 10% of the number of licensed beds in the facility.
3557          (b) The department may not revoke the Medicaid certification of a bed under this
3558     Subsection (7) as long as the provisions of Subsection (7)(a)(ii) are met.
3559          (8) (a) If a nursing care facility or other interested party indicates in its request for
3560     additional Medicaid certification under Subsection (5)(a) that the facility will offer specialized
3561     or unique services, but the facility does not offer those services after receiving additional
3562     Medicaid certification, the director shall revoke the additional Medicaid certification.
3563          (b) The nursing care facility program shall obtain Medicaid certification for any
3564     additional Medicaid beds approved under Subsection (5) or (7) within three years of the date of
3565     the director's approval, or the approval is void.

3566          (9) (a) If the director makes an initial determination that quality standards under
3567     Subsection (5)(d)(v) have not been met in a rural county or group of rural counties over the
3568     previous three-year period, the director shall, before approving certification of additional
3569     Medicaid beds in the rural county or group of counties:
3570          (i) notify the certified program that has not met the quality standards in Subsection
3571     (5)(d)(v) that the director intends to certify additional Medicaid beds under the provisions of
3572     Subsection (5)(d)(v); and
3573          (ii) consider additional information submitted to the director by the certified program
3574     in a rural county that has not met the quality standards under Subsection (5)(d)(v).
3575          (b) The notice under Subsection (9)(a) does not give the certified program that has not
3576     met the quality standards under Subsection (5)(d)(v), the right to legally challenge or appeal the
3577     director's decision to certify additional Medicaid beds under Subsection (5)(d)(v).
3578          Section 77. Section 26B-3-312, which is renumbered from Section 26-18-504 is
3579     renumbered and amended to read:
3580          [26-18-504].      26B-3-312. Appeals of division decision -- Rulemaking
3581     authority -- Application of act.
3582          (1) A decision by the director under this part to deny Medicaid certification for a
3583     nursing care facility program or to deny additional bed capacity for an existing certified
3584     program is subject to review under the procedures and requirements of Title 63G, Chapter 4,
3585     Administrative Procedures Act.
3586          (2) The department shall make rules to administer and enforce [this part] Sections
3587     26B-3-310 through 26B-3-313 in accordance with Title 63G, Chapter 3, Utah Administrative
3588     Rulemaking Act.
3589          (3) (a) In the event the department is at risk for a federal disallowance with regard to a
3590     Medicaid recipient being served in a nursing care facility program that is not Medicaid
3591     certified, the department may grant temporary Medicaid certification to that facility for up to 24
3592     months.

3593          (b) (i) The department may extend a temporary Medicaid certification granted to a
3594     facility under Subsection (3)(a):
3595          (A) for the number of beds in the nursing care facility occupied by a Medicaid
3596     recipient; and
3597          (B) for the period of time during which the Medicaid recipient resides at the facility.
3598          (ii) A temporary Medicaid certification granted under this Subsection (3) is revoked
3599     upon:
3600          (A) the discharge of the patient from the facility; or
3601          (B) the patient no longer residing at the facility for any reason.
3602          (c) The department may place conditions on the temporary certification granted under
3603     Subsections (3)(a) and (b), such as:
3604          (i) not allowing additional admissions of Medicaid recipients to the program; and
3605          (ii) not paying for the care of the patient after October 1, 2008, with state only dollars.
3606          Section 78. Section 26B-3-313, which is renumbered from Section 26-18-505 is
3607     renumbered and amended to read:
3608          [26-18-505].      26B-3-313. Authorization to sell or transfer licensed
3609     Medicaid beds -- Duties of transferor -- Duties of transferee -- Duties of division.
3610          (1) This section provides a method to transfer or sell the license for a Medicaid bed
3611     from a nursing care facility program to another entity that is in addition to the authorization to
3612     transfer under Section [26-18-503] 26B-3-311.
3613          (2) (a) A nursing care facility program may transfer or sell one or more of its licenses
3614     for Medicaid beds in accordance with Subsection (2)(b) if:
3615          (i) at the time of the transfer, and with respect to the license for the Medicaid bed that
3616     will be transferred, the nursing care facility program that will transfer the Medicaid license
3617     meets all applicable regulations for Medicaid certification;
3618          (ii) the nursing care facility program gives a written assurance, which is postmarked or
3619     has proof of delivery 30 days before the transfer, to the director and to the transferee in

3620     accordance with Subsection [26-18-503] 26B-3-311(4);
3621          (iii) the nursing care facility program that will transfer the license for a Medicaid bed
3622     notifies the division in writing, which is postmarked or has proof of delivery 30 days before the
3623     transfer, of:
3624          (A) the number of bed licenses that will be transferred;
3625          (B) the date of the transfer; and
3626          (C) the identity and location of the entity receiving the transferred licenses; and
3627          (iv) if the nursing care facility program for which the license will be transferred or
3628     purchased is located in an urban county with a nursing care facility average annual occupancy
3629     rate over the previous two years less than or equal to 75%, the nursing care facility program
3630     transferring or selling the license demonstrates to the satisfaction of the director that the sale or
3631     transfer:
3632          (A) will not result in an excessive number of Medicaid certified beds within the county
3633     or group of counties that would be impacted by the transfer or sale; and
3634          (B) best meets the needs of Medicaid recipients.
3635          (b) Except as provided in Subsection (2)(c), a nursing care facility program may
3636     transfer or sell one or more of its licenses for Medicaid beds to:
3637          (i) a nursing care facility program that has the same owner or successor in interest of
3638     the same owner;
3639          (ii) a nursing care facility program that has a different owner; or
3640          (iii) a related-party nonnursing-care-facility entity that wants to hold one or more of the
3641     licenses for a nursing care facility program not yet identified, as long as:
3642          (A) the licenses are subsequently transferred or sold to a nursing care facility program
3643     within three years; and
3644          (B) the nursing care facility program notifies the director of the transfer or sale in
3645     accordance with Subsection (2)(a)(iii).
3646          (c) A nursing care facility program may not transfer or sell one or more of its licenses

3647     for Medicaid beds to an entity under Subsection (2)(b)(i), (ii), or (iii) that is located in a rural
3648     county unless the entity requests, and the director issues, Medicaid certification for the beds
3649     under Subsection [26-18-503] 26B-3-311(5).
3650          (3) A nursing care facility program or entity under Subsection (2)(b)(i), (ii), or (iii) that
3651     receives or purchases a license for a Medicaid bed under Subsection (2)(b):
3652          (a) may receive a license for a Medicaid bed from more than one nursing care facility
3653     program;
3654          (b) shall give the division notice, which is postmarked or has proof of delivery within
3655     14 days of the nursing care facility program or entity seeking Medicaid certification of beds in
3656     the nursing care facility program or entity, of the total number of licenses for Medicaid beds
3657     that the entity received and who it received the licenses from;
3658          (c) may only seek Medicaid certification for the number of licensed beds in the nursing
3659     care facility program equal to the total number of licenses for Medicaid beds received by the
3660     entity;
3661          (d) does not have to demonstrate need or seek approval for the Medicaid licensed bed
3662     under Subsection [26-18-503] 26B-3-311(5), except as provided in Subsections (2)(a)(iv) and
3663     (2)(c) ;
3664          (e) shall meet the standards for Medicaid certification other than those in Subsection
3665     [26-18-503] 26B-3-311(5), including personnel, services, contracts, and licensing of facilities
3666     under [Chapter 21, Health Care Facility Licensing and Inspection Act] Chapter 2, Part 2,
3667     Health Care Facility Licensing and Inspection; and
3668          (f) shall obtain Medicaid certification for the licensed Medicaid beds within three years
3669     of the date of transfer as documented under Subsection (2)(a)(iii)(B).
3670          (4) (a) When the division receives notice of a transfer of a license for a Medicaid bed
3671     under Subsection (2)(a)(iii)(A), the department shall reduce the number of licenses for
3672     Medicaid beds at the transferring nursing care facility:
3673          (i) equal to the number of licenses transferred; and

3674          (ii) effective on the date of the transfer as reported under Subsection (2)(a)(iii)(B).
3675          (b) For purposes of Section [26-18-502] 26B-3-310, the division shall approve
3676     Medicaid certification for the receiving nursing care facility program or entity:
3677          (i) in accordance with the formula established in Subsection (3)(c); and
3678          (ii) if:
3679          (A) the nursing care facility seeks Medicaid certification for the transferred licenses
3680     within the time limit required by Subsection (3)(f); and
3681          (B) the nursing care facility program meets other requirements for Medicaid
3682     certification under Subsection (3)(e).
3683          (c) A license for a Medicaid bed may not be approved for Medicaid certification
3684     without meeting the requirements of Sections [26-18-502 and 26-18-503] 26B-3-310 and
3685     26B-3-311 if:
3686          (i) the license for a Medicaid bed is transferred under this section but the receiving
3687     entity does not obtain Medicaid certification for the licensed bed within the time required by
3688     Subsection (3)(f); or
3689          (ii) the license for a Medicaid bed is transferred under this section but the license is no
3690     longer eligible for Medicaid certification.
3691          Section 79. Section 26B-3-401, which is renumbered from Section 26-35a-103 is
3692     renumbered and amended to read:
3693     
Part 4. Nursing Care Facility Assessment

3694          [26-35a-103].      26B-3-401. Definitions.
3695          As used in this [chapter] part:
3696          (1) (a) "Nursing care facility" means:
3697          (i) a nursing care facility [described in Subsection 26-21-2(17)] as defined in Section
3698     26B-2-201;
3699          (ii) beginning January 1, 2006, a designated swing bed in:
3700          (A) a general acute hospital as defined in [Subsection 26-21-2(11)] Section 26B-2-201;

3701     and
3702          (B) a critical access hospital which meets the criteria of 42 U.S.C. Sec. 1395i-4(c)(2)
3703     (1998); and
3704          (iii) an intermediate care facility for people with an intellectual disability that is
3705     licensed under Section [26-21-13.5] 26B-2-212.
3706          (b) "Nursing care facility" does not include:
3707          (i) the Utah State Developmental Center;
3708          (ii) the Utah State Hospital;
3709          (iii) a general acute hospital, specialty hospital, or small health care facility as those
3710     terms are defined in Section [26-21-2] 26B-2-201; or
3711          (iv) a Utah State Veterans Home.
3712          (2) "Patient day" means each calendar day in which an individual patient is admitted to
3713     the nursing care facility during a calendar month, even if on a temporary leave of absence from
3714     the facility.
3715          Section 80. Section 26B-3-402, which is renumbered from Section 26-35a-102 is
3716     renumbered and amended to read:
3717          [26-35a-102].      26B-3-402. Legislative findings.
3718          (1) The Legislature finds that there is an important state purpose to improve the quality
3719     of care given to persons who are elderly and to people who have a disability, in long-term care
3720     nursing facilities.
3721          (2) The Legislature finds that in order to improve the quality of care to those persons
3722     described in Subsection (1), the rates paid to the nursing care facilities by the Medicaid
3723     program must be adequate to encourage and support quality care.
3724          (3) The Legislature finds that in order to meet the objectives in Subsections (1) and (2),
3725     adequate funding must be provided to increase the rates paid to nursing care facilities providing
3726     services pursuant to the Medicaid program.
3727          Section 81. Section 26B-3-403, which is renumbered from Section 26-35a-104 is

3728     renumbered and amended to read:
3729          [26-35a-104].      26B-3-403. Collection, remittance, and payment of nursing
3730     care facilities assessment.
3731          (1) (a) Beginning July 1, 2004, an assessment is imposed upon each nursing care
3732     facility in the amount designated in Subsection (1)(c).
3733          (b) (i) The department shall establish by rule, a uniform rate per non-Medicare patient
3734     day that may not exceed 6% of the total gross revenue for services provided to patients of all
3735     nursing care facilities licensed in this state.
3736          (ii) For purposes of Subsection (1)(b)(i), total revenue does not include charitable
3737     contribution received by a nursing care facility.
3738          (c) The department shall calculate the assessment imposed under Subsection (1)(a) by
3739     multiplying the total number of patient days of care provided to non-Medicare patients by the
3740     nursing care facility, as provided to the department pursuant to Subsection (3)(a), by the
3741     uniform rate established by the department pursuant to Subsection (1)(b).
3742          (2) (a) The assessment imposed by this [chapter] part is due and payable on a monthly
3743     basis on or before the last day of the month next succeeding each monthly period.
3744          (b) The collecting agent for this assessment shall be the department which is vested
3745     with the administration and enforcement of this [chapter] part, including the right to audit
3746     records of a nursing care facility related to patient days of care for the facility.
3747          (c) The department shall forward proceeds from the assessment imposed by this
3748     [chapter] part to the state treasurer for deposit in the expendable special revenue fund as
3749     specified in Section [26-35a-106] 26B-1-332.
3750          (3) Each nursing care facility shall, on or before the end of the month next succeeding
3751     each calendar monthly period, file with the department:
3752          (a) a report which includes:
3753          (i) the total number of patient days of care the facility provided to non-Medicare
3754     patients during the preceding month;

3755          (ii) the total gross revenue the facility earned as compensation for services provided to
3756     patients during the preceding month; and
3757          (iii) any other information required by the department; and
3758          (b) a return for the monthly period, and shall remit with the return the assessment
3759     required by this [chapter] part to be paid for the period covered by the return.
3760          (4) Each return shall contain information and be in the form the department prescribes
3761     by rule.
3762          (5) The assessment as computed in the return is an allowable cost for Medicaid
3763     reimbursement purposes.
3764          (6) The department may by rule, extend the time for making returns and paying the
3765     assessment.
3766          (7) Each nursing care facility that fails to pay any assessment required to be paid to the
3767     state, within the time required by this [chapter] part, or that fails to file a return as required by
3768     this [chapter] part, shall pay, in addition to the assessment, penalties and interest as provided in
3769     Section [26-35a-105] 26B-3-404.
3770          Section 82. Section 26B-3-404, which is renumbered from Section 26-35a-105 is
3771     renumbered and amended to read:
3772          [26-35a-105].      26B-3-404. Penalties and interest.
3773          (1) The penalty for failure to file a return or pay the assessment due within the time
3774     prescribed by this [chapter] part is the greater of $50, or 1% of the assessment due on the
3775     return.
3776          (2) For failure to pay within 30 days of a notice of deficiency of assessment required to
3777     be paid, the penalty is the greater of $50 or 5% of the assessment due.
3778          (3) The penalty for underpayment of the assessment is as follows:
3779          (a) If any underpayment of assessment is due to negligence, the penalty is 25% of the
3780     underpayment.
3781          (b) If the underpayment of the assessment is due to intentional disregard of law or rule,

3782     the penalty is 50% of the underpayment.
3783          (4) For intent to evade the assessment, the penalty is 100% of the underpayment.
3784          (5) The rate of interest applicable to an underpayment of an assessment under this
3785     [chapter] part or an unpaid penalty under this [chapter] part is 12% annually.
3786          (6) The department may waive the imposition of a penalty for good cause.
3787          Section 83. Section 26B-3-405, which is renumbered from Section 26-35a-107 is
3788     renumbered and amended to read:
3789          [26-35a-107].      26B-3-405. Adjustment to nursing care facility Medicaid
3790     reimbursement rates.
3791          If federal law or regulation prohibits the money in the Nursing Care Facilities Provider
3792     Assessment Fund from being used in the manner set forth in Subsection [26-35a-106]
3793     26B-1-332(1)(b), the rates paid to nursing care facilities for providing services pursuant to the
3794     Medicaid program shall be changed:
3795          (1) except as otherwise provided in Subsection (2), to the rates paid to nursing care
3796     facilities on June 30, 2004; or
3797          (2) if the Legislature or the department has on or after July 1, 2004, changed the rates
3798     paid to facilities through a manner other than the use of expenditures from the Nursing Care
3799     Facilities Provider Assessment Fund, to the rates provided for by the Legislature or the
3800     department.
3801          Section 84. Section 26B-3-406, which is renumbered from Section 26-35a-108 is
3802     renumbered and amended to read:
3803          [26-35a-108].      26B-3-406. Intermediate care facility for people with an
3804     intellectual disability -- Uniform rate.
3805          An intermediate care facility for people with an intellectual disability is subject to all
3806     the provisions of this [chapter] part, except that the department shall establish a uniform rate
3807     for an intermediate care facility for people with an intellectual disability that:
3808          (1) is based on the same formula specified for nursing care facilities under the

3809     provisions of Subsection [26-35a-104] 26B-3-403(1)(b); and
3810          (2) may be different than the uniform rate established for other nursing care facilities.
3811          Section 85. Section 26B-3-501, which is renumbered from Section 26-36b-103 is
3812     renumbered and amended to read:
3813     
Part 5. Inpatient Hospital Assessment

3814          [26-36b-103].      26B-3-501. Definitions.
3815          As used in this [chapter] part:
3816          (1) "Assessment" means the inpatient hospital assessment established by this [chapter]
3817     part.
3818          (2) "CMS" means the Centers for Medicare and Medicaid Services within the United
3819     States Department of Health and Human Services.
3820          (3) "Discharges" means the number of total hospital discharges reported on:
3821          (a) Worksheet S-3 Part I, column 15, lines 14, 16, and 17 of the 2552-10 Medicare cost
3822     report for the applicable assessment year; or
3823          (b) a similar report adopted by the department by administrative rule, if the report
3824     under Subsection (3)(a) is no longer available.
3825          (4) "Division" means the Division of [Health Care Financing] Integrated Healthcare
3826     within the department.
3827          (5) "Enhancement waiver program" means the program established by the Primary
3828     Care Network enhancement waiver program described in Section [26-18-416] 26B-3-211.
3829          (6) "Health coverage improvement program" means the health coverage improvement
3830     program described in Section [26-18-411] 26B-3-207.
3831          (7) "Hospital share" means the hospital share described in Section [26-36b-203]
3832     26B-3-505.
3833          (8) "Medicaid accountable care organization" means a managed care organization, as
3834     defined in 42 C.F.R. Sec. 438, that contracts with the department under the provisions of
3835     Section [26-18-405] 26B-3-202.

3836          (9) "Medicaid waiver expansion" means a Medicaid expansion in accordance with
3837     Section [26-18-3.9 or 26-18-415] 26B-3-113 or 26B-3-210.
3838          (10) "Medicare cost report" means CMS-2552-10, the cost report for electronic filing
3839     of hospitals.
3840          (11) (a) "Non-state government hospital" means a hospital owned by a non-state
3841     government entity.
3842          (b) "Non-state government hospital" does not include:
3843          (i) the Utah State Hospital; or
3844          (ii) a hospital owned by the federal government, including the Veterans Administration
3845     Hospital.
3846          (12) (a) "Private hospital" means:
3847          (i) a general acute hospital, as defined in Section [26-21-2] 26B-2-201, that is privately
3848     owned and operating in the state; and
3849          (ii) a privately owned specialty hospital operating in the state, including a privately
3850     owned hospital whose inpatient admissions are predominantly for:
3851          (A) rehabilitation;
3852          (B) psychiatric care;
3853          (C) chemical dependency services; or
3854          (D) long-term acute care services.
3855          (b) "Private hospital" does not include a facility for residential treatment as defined in
3856     Section [62A-2-101] 26B-2-101.
3857          (13) "State teaching hospital" means a state owned teaching hospital that is part of an
3858     institution of higher education.
3859          (14) "Upper payment limit gap" means the difference between the private hospital
3860     outpatient upper payment limit and the private hospital Medicaid outpatient payments, as
3861     determined in accordance with 42 C.F.R. Sec. 447.321.
3862          Section 86. Section 26B-3-502, which is renumbered from Section 26-36b-102 is

3863     renumbered and amended to read:
3864          [26-36b-102].      26B-3-502. Application.
3865          (1) Other than for the imposition of the assessment described in this [chapter] part,
3866     nothing in this [chapter] part shall affect the nonprofit or tax exempt status of any nonprofit
3867     charitable, religious, or educational health care provider under any:
3868          (a) state law;
3869          (b) ad valorem property taxes;
3870          (c) sales or use taxes; or
3871          (d) other taxes, fees, or assessments, whether imposed or sought to be imposed, by the
3872     state or any political subdivision of the state.
3873          (2) All assessments paid under this [chapter] part may be included as an allowable cost
3874     of a hospital for purposes of any applicable Medicaid reimbursement formula.
3875          (3) This [chapter] part does not authorize a political subdivision of the state to:
3876          (a) license a hospital for revenue;
3877          (b) impose a tax or assessment upon a hospital; or
3878          (c) impose a tax or assessment measured by the income or earnings of a hospital.
3879          Section 87. Section 26B-3-503, which is renumbered from Section 26-36b-201 is
3880     renumbered and amended to read:
3881          [26-36b-201].      26B-3-503. Assessment.
3882          (1) An assessment is imposed on each private hospital:
3883          (a) beginning upon the later of CMS approval of:
3884          (i) the health coverage improvement program waiver under Section [26-18-411]
3885     26B-3-207; and
3886          (ii) the assessment under this [chapter] part;
3887          (b) in the amount designated in Sections [26-36b-204 and 26-36b-205] 26B-3-506 and
3888     26B-3-507; and
3889          (c) in accordance with Section [26-36b-202] 26B-3-504.

3890          (2) Subject to Section [26-36b-203] 26B-3-505, the assessment imposed by this
3891     [chapter] part is due and payable on a quarterly basis, after payment of the outpatient upper
3892     payment limit supplemental payments under Section [26-36b-210] 26B-3-511 have been paid.
3893          (3) The first quarterly payment is not due until at least three months after the earlier of
3894     the effective dates of the coverage provided through:
3895          (a) the health coverage improvement program;
3896          (b) the enhancement waiver program; or
3897          (c) the Medicaid waiver expansion.
3898          Section 88. Section 26B-3-504, which is renumbered from Section 26-36b-202 is
3899     renumbered and amended to read:
3900          [26-36b-202].      26B-3-504. Collection of assessment -- Deposit of revenue --
3901     Rulemaking.
3902          (1) The collecting agent for the assessment imposed under Section [26-36b-201]
3903     26B-3-503 is the department.
3904          (2) The department is vested with the administration and enforcement of this [chapter]
3905     part, and may make rules in accordance with Title 63G, Chapter 3, Utah Administrative
3906     Rulemaking Act, necessary to:
3907          (a) collect the assessment, intergovernmental transfers, and penalties imposed under
3908     this [chapter] part;
3909          (b) audit records of a facility that:
3910          (i) is subject to the assessment imposed by this [chapter] part; and
3911          (ii) does not file a Medicare cost report; and
3912          (c) select a report similar to the Medicare cost report if Medicare no longer uses a
3913     Medicare cost report.
3914          (3) The department shall:
3915          (a) administer the assessment in this [chapter] part separately from the assessment in
3916     [Chapter 36d] Part 7, Hospital Provider Assessment [Act]; and

3917          (b) deposit assessments collected under this [chapter] part into the Medicaid Expansion
3918     Fund created by Section [26-36b-208] 26B-1-315.
3919          Section 89. Section 26B-3-505, which is renumbered from Section 26-36b-203 is
3920     renumbered and amended to read:
3921          [26-36b-203].      26B-3-505. Quarterly notice.
3922          (1) Quarterly assessments imposed by this [chapter] part shall be paid to the division
3923     within 15 business days after the original invoice date that appears on the invoice issued by the
3924     division.
3925          (2) The department may, by rule, extend the time for paying the assessment.
3926          Section 90. Section 26B-3-506, which is renumbered from Section 26-36b-204 is
3927     renumbered and amended to read:
3928          [26-36b-204].      26B-3-506. Hospital financing of health coverage
3929     improvement program Medicaid waiver expansion -- Hospital share.
3930          (1) The hospital share is:
3931          (a) 45% of the state's net cost of the health coverage improvement program, including
3932     Medicaid coverage for individuals with dependent children up to the federal poverty level
3933     designated under Section [26-18-411] 26B-3-207;
3934          (b) 45% of the state's net cost of the enhancement waiver program;
3935          (c) if the waiver for the Medicaid waiver expansion is approved, $11,900,000; and
3936          (d) 45% of the state's net cost of the upper payment limit gap.
3937          (2) (a) The hospital share is capped at no more than $13,600,000 annually, consisting
3938     of:
3939          (i) an $11,900,000 cap for the programs specified in Subsections (1)(a) through (c);
3940     and
3941          (ii) a $1,700,000 cap for the program specified in Subsection (1)(d).
3942          (b) The department shall prorate the cap described in Subsection (2)(a) in any year in
3943     which the programs specified in Subsections (1)(a) and (d) are not in effect for the full fiscal

3944     year.
3945          (3) Private hospitals shall be assessed under this [chapter] part for:
3946          (a) 69% of the portion of the hospital share for the programs specified in Subsections
3947     (1)(a) through (c); and
3948          (b) 100% of the portion of the hospital share specified in Subsection (1)(d).
3949          (4) (a) In the report described in Subsection [26-18-3.9] 26B-3-113(8), the department
3950     shall calculate the state's net cost of each of the programs described in Subsections (1)(a)
3951     through (c) that are in effect for that year.
3952          (b) If the assessment collected in the previous fiscal year is above or below the hospital
3953     share for private hospitals for the previous fiscal year, the underpayment or overpayment of the
3954     assessment by the private hospitals shall be applied to the fiscal year in which the report is
3955     issued.
3956          (5) A Medicaid accountable care organization shall, on or before October 15 of each
3957     year, report to the department the following data from the prior state fiscal year for each private
3958     hospital, state teaching hospital, and non-state government hospital provider that the Medicaid
3959     accountable care organization contracts with:
3960          (a) for the traditional Medicaid population:
3961          (i) hospital inpatient payments;
3962          (ii) hospital inpatient discharges;
3963          (iii) hospital inpatient days; and
3964          (iv) hospital outpatient payments; and
3965          (b) if the Medicaid accountable care organization enrolls any individuals in the health
3966     coverage improvement program, the enhancement waiver program, or the Medicaid waiver
3967     expansion, for the population newly eligible for any of those programs:
3968          (i) hospital inpatient payments;
3969          (ii) hospital inpatient discharges;
3970          (iii) hospital inpatient days; and

3971          (iv) hospital outpatient payments.
3972          (6) The department shall, by rule made in accordance with Title 63G, Chapter 3, Utah
3973     Administrative Rulemaking Act, provide details surrounding specific content and format for
3974     the reporting by the Medicaid accountable care organization.
3975          Section 91. Section 26B-3-507, which is renumbered from Section 26-36b-205 is
3976     renumbered and amended to read:
3977          [26-36b-205].      26B-3-507. Calculation of assessment.
3978          (1) (a) Except as provided in Subsection (1)(b), an annual assessment is payable on a
3979     quarterly basis for each private hospital in an amount calculated by the division at a uniform
3980     assessment rate for each hospital discharge, in accordance with this section.
3981          (b) A private teaching hospital with more than 425 beds and 60 residents shall pay an
3982     assessment rate 2.5 times the uniform rate established under Subsection (1)(c).
3983          (c) The division shall calculate the uniform assessment rate described in Subsection
3984     (1)(a) by dividing the hospital share for assessed private hospitals, described in Subsections
3985     [26-36b-204(1) and 26-36b-204(3)] 26B-3-506(1) and (3), by the sum of:
3986          (i) the total number of discharges for assessed private hospitals that are not a private
3987     teaching hospital; and
3988          (ii) 2.5 times the number of discharges for a private teaching hospital, described in
3989     Subsection (1)(b).
3990          (d) The division may, by rule made in accordance with Title 63G, Chapter 3, Utah
3991     Administrative Rulemaking Act, adjust the formula described in Subsection (1)(c) to address
3992     unforeseen circumstances in the administration of the assessment under this [chapter] part.
3993          (e) Any quarterly changes to the uniform assessment rate shall be applied uniformly to
3994     all assessed private hospitals.
3995          (2) Except as provided in Subsection (3), for each state fiscal year, the division shall
3996     determine a hospital's discharges as follows:
3997          (a) for state fiscal year 2017, the hospital's cost report data for the hospital's fiscal year

3998     ending between July 1, 2013, and June 30, 2014; and
3999          (b) for each subsequent state fiscal year, the hospital's cost report data for the hospital's
4000     fiscal year that ended in the state fiscal year two years before the assessment fiscal year.
4001          (3) (a) If a hospital's fiscal year Medicare cost report is not contained in the CMS
4002     Healthcare Cost Report Information System file:
4003          (i) the hospital shall submit to the division a copy of the hospital's Medicare cost report
4004     applicable to the assessment year; and
4005          (ii) the division shall determine the hospital's discharges.
4006          (b) If a hospital is not certified by the Medicare program and is not required to file a
4007     Medicare cost report:
4008          (i) the hospital shall submit to the division the hospital's applicable fiscal year
4009     discharges with supporting documentation;
4010          (ii) the division shall determine the hospital's discharges from the information
4011     submitted under Subsection (3)(b)(i); and
4012          (iii) failure to submit discharge information shall result in an audit of the hospital's
4013     records and a penalty equal to 5% of the calculated assessment.
4014          (4) Except as provided in Subsection (5), if a hospital is owned by an organization that
4015     owns more than one hospital in the state:
4016          (a) the assessment for each hospital shall be separately calculated by the department;
4017     and
4018          (b) each separate hospital shall pay the assessment imposed by this [chapter] part.
4019          (5) If multiple hospitals use the same Medicaid provider number:
4020          (a) the department shall calculate the assessment in the aggregate for the hospitals
4021     using the same Medicaid provider number; and
4022          (b) the hospitals may pay the assessment in the aggregate.
4023          Section 92. Section 26B-3-508, which is renumbered from Section 26-36b-206 is
4024     renumbered and amended to read:

4025          [26-36b-206].      26B-3-508. State teaching hospital and non-state government
4026     hospital mandatory intergovernmental transfer.
4027          (1) The state teaching hospital and a non-state government hospital shall make an
4028     intergovernmental transfer to the Medicaid Expansion Fund created in Section [26-36b-208]
4029     26B-1-315, in accordance with this section.
4030          (2) The hospitals described in Subsection (1) shall pay the intergovernmental transfer
4031     beginning on the later of CMS approval of:
4032          (a) the health improvement program waiver under Section [26-18-411] 26B-3-207; or
4033          (b) the assessment for private hospitals in this [chapter] part.
4034          (3) The intergovernmental transfer is apportioned as follows:
4035          (a) the state teaching hospital is responsible for:
4036          (i) 30% of the portion of the hospital share specified in Subsections [26-36b-204]
4037     26B-3-506(1)(a) through (c); and
4038          (ii) 0% of the hospital share specified in Subsection [26-36b-204] 26B-3-506(1)(d);
4039     and
4040          (b) non-state government hospitals are responsible for:
4041          (i) 1% of the portion of the hospital share specified in Subsections [26-36b-204]
4042     26B-3-506(1)(a) through (c); and
4043          (ii) 0% of the hospital share specified in Subsection [26-36b-204] 26B-3-506(1)(d).
4044          (4) The department shall, by rule made in accordance with Title 63G, Chapter 3, Utah
4045     Administrative Rulemaking Act, designate:
4046          (a) the method of calculating the amounts designated in Subsection (3); and
4047          (b) the schedule for the intergovernmental transfers.
4048          Section 93. Section 26B-3-509, which is renumbered from Section 26-36b-207 is
4049     renumbered and amended to read:
4050          [26-36b-207].      26B-3-509. Penalties and interest.
4051          (1) A hospital that fails to pay a quarterly assessment, make the mandated

4052     intergovernmental transfer, or file a return as required under this [chapter] part, within the time
4053     required by this [chapter] part, shall pay penalties described in this section, in addition to the
4054     assessment or intergovernmental transfer.
4055          (2) If a hospital fails to timely pay the full amount of a quarterly assessment or the
4056     mandated intergovernmental transfer, the department shall add to the assessment or
4057     intergovernmental transfer:
4058          (a) a penalty equal to 5% of the quarterly amount not paid on or before the due date;
4059     and
4060          (b) on the last day of each quarter after the due date until the assessed amount and the
4061     penalty imposed under Subsection (2)(a) are paid in full, an additional 5% penalty on:
4062          (i) any unpaid quarterly assessment or intergovernmental transfer; and
4063          (ii) any unpaid penalty assessment.
4064          (3) Upon making a record of the division's actions, and upon reasonable cause shown,
4065     the division may waive, reduce, or compromise any of the penalties imposed under this
4066     [chapter] part.
4067          Section 94. Section 26B-3-510, which is renumbered from Section 26-36b-209 is
4068     renumbered and amended to read:
4069          [26-36b-209].      26B-3-510. Hospital reimbursement.
4070          (1) If the health coverage improvement program, the enhancement waiver program, or
4071     the Medicaid waiver expansion is implemented by contracting with a Medicaid accountable
4072     care organization, the department shall, to the extent allowed by law, include, in a contract to
4073     provide benefits under the health coverage improvement program, the enhancement waiver
4074     program, or the Medicaid waiver expansion, a requirement that the Medicaid accountable care
4075     organization reimburse hospitals in the accountable care organization's provider network at no
4076     less than the Medicaid fee-for-service rate.
4077          (2) If the health coverage improvement program, the enhancement waiver program, or
4078     the Medicaid waiver expansion is implemented by the department as a fee-for-service program,

4079     the department shall reimburse hospitals at no less than the Medicaid fee-for-service rate.
4080          (3) Nothing in this section prohibits a Medicaid accountable care organization from
4081     paying a rate that exceeds the Medicaid fee-for-service rate.
4082          Section 95. Section 26B-3-511, which is renumbered from Section 26-36b-210 is
4083     renumbered and amended to read:
4084          [26-36b-210].      26B-3-511. Outpatient upper payment limit supplemental
4085     payments.
4086          (1) Beginning on the effective date of the assessment imposed under this [chapter] part,
4087     and for each subsequent fiscal year, the department shall implement an outpatient upper
4088     payment limit program for private hospitals that shall supplement the reimbursement to private
4089     hospitals in accordance with Subsection (2).
4090          (2) The division shall ensure that supplemental payment to Utah private hospitals
4091     under Subsection (1):
4092          (a) does not exceed the positive upper payment limit gap; and
4093          (b) is allocated based on the Medicaid state plan.
4094          (3) The department shall use the same outpatient data to allocate the payments under
4095     Subsection (2) and to calculate the upper payment limit gap.
4096          (4) The supplemental payments to private hospitals under Subsection (1) are payable
4097     for outpatient hospital services provided on or after the later of:
4098          (a) July 1, 2016;
4099          (b) the effective date of the Medicaid state plan amendment necessary to implement the
4100     payments under this section; or
4101          (c) the effective date of the coverage provided through the health coverage
4102     improvement program waiver.
4103          Section 96. Section 26B-3-512, which is renumbered from Section 26-36b-211 is
4104     renumbered and amended to read:
4105          [26-36b-211].      26B-3-512. Repeal of assessment.

4106          (1) The assessment imposed by this [chapter] part shall be repealed when:
4107          (a) the executive director certifies that:
4108          (i) action by Congress is in effect that disqualifies the assessment imposed by this
4109     [chapter] part from counting toward state Medicaid funds available to be used to determine the
4110     amount of federal financial participation;
4111          (ii) a decision, enactment, or other determination by the Legislature or by any court,
4112     officer, department, or agency of the state, or of the federal government, is in effect that:
4113          (A) disqualifies the assessment from counting toward state Medicaid funds available to
4114     be used to determine federal financial participation for Medicaid matching funds; or
4115          (B) creates for any reason a failure of the state to use the assessments for at least one of
4116     the Medicaid programs described in this [chapter] part; or
4117          (iii) a change is in effect that reduces the aggregate hospital inpatient and outpatient
4118     payment rate below the aggregate hospital inpatient and outpatient payment rate for July 1,
4119     2015; or
4120          (b) this [chapter] part is repealed in accordance with Section 63I-1-226.
4121          (2) If the assessment is repealed under Subsection (1):
4122          (a) the division may not collect any assessment or intergovernmental transfer under this
4123     [chapter] part;
4124          (b) the department shall disburse money in the special Medicaid Expansion Fund in
4125     accordance with the requirements in Subsection [26-36b-208] 26B-1-315(4), to the extent
4126     federal matching is not reduced by CMS due to the repeal of the assessment;
4127          (c) any money remaining in the Medicaid Expansion Fund after the disbursement
4128     described in Subsection (2)(b) that was derived from assessments imposed by this [chapter]
4129     part shall be refunded to the hospitals in proportion to the amount paid by each hospital for the
4130     last three fiscal years; and
4131          (d) any money remaining in the Medicaid Expansion Fund after the disbursements
4132     described in Subsections (2)(b) and (c) shall be deposited into the General Fund by the end of

4133     the fiscal year that the assessment is suspended.
4134          Section 97. Section 26B-3-601, which is renumbered from Section 26-36c-102 is
4135     renumbered and amended to read:
4136     
Part 6. Medicaid Expansion Hospital Assessment

4137          [26-36c-102].      26B-3-601. Definitions.
4138          As used in this [chapter] part:
4139          (1) "Assessment" means the Medicaid expansion hospital assessment established by
4140     this [chapter] part.
4141          (2) "CMS" means the Centers for Medicare and Medicaid Services within the United
4142     States Department of Health and Human Services.
4143          (3) "Discharges" means the number of total hospital discharges reported on:
4144          (a) Worksheet S-3 Part I, column 15, lines 14, 16, and 17 of the 2552-10 Medicare cost
4145     report for the applicable assessment year; or
4146          (b) a similar report adopted by the department by administrative rule, if the report
4147     under Subsection (3)(a) is no longer available.
4148          (4) "Division" means the Division of [Health Care Financing] Integrated Healthcare
4149     within the department.
4150          (5) "Hospital share" means the hospital share described in Section [26-36c-203]
4151     26B-3-605.
4152          (6) "Medicaid accountable care organization" means a managed care organization, as
4153     defined in 42 C.F.R. Sec. 438, that contracts with the department under the provisions of
4154     Section [26-18-405] 26B-3-202.
4155          (7) "Medicaid Expansion Fund" means the Medicaid Expansion Fund created in
4156     Section [26-36b-208] 26B-1-315.
4157          (8) "Medicaid waiver expansion" means the same as that term is defined in Section
4158     [26-18-415] 26B-3-210.
4159          (9) "Medicare cost report" means CMS-2552-10, the cost report for electronic filing of

4160     hospitals.
4161          (10) (a) "Non-state government hospital" means a hospital owned by a non-state
4162     government entity.
4163          (b) "Non-state government hospital" does not include:
4164          (i) the Utah State Hospital; or
4165          (ii) a hospital owned by the federal government, including the Veterans Administration
4166     Hospital.
4167          (11) (a) "Private hospital" means:
4168          (i) a privately owned general acute hospital operating in the state as defined in Section
4169     [26-21-2] 26B-2-201; or
4170          (ii) a privately owned specialty hospital operating in the state, including a privately
4171     owned hospital for which inpatient admissions are predominantly:
4172          (A) rehabilitation;
4173          (B) psychiatric;
4174          (C) chemical dependency; or
4175          (D) long-term acute care services.
4176          (b) "Private hospital" does not include a facility for residential treatment as defined in
4177     Section [62A-2-101] 26B-2-101.
4178          (12) "Qualified Medicaid expansion" means an expansion of the Medicaid program in
4179     accordance with Subsection [26-18-3.9] 26B-3-113(5).
4180          (13) "State teaching hospital" means a state owned teaching hospital that is part of an
4181     institution of higher education.
4182          Section 98. Section 26B-3-602, which is renumbered from Section 26-36c-103 is
4183     renumbered and amended to read:
4184          [26-36c-103].      26B-3-602. Application.
4185          (1) Other than for the imposition of the assessment described in this [chapter] part,
4186     nothing in this [chapter] part shall affect the nonprofit or tax exempt status of any nonprofit

4187     charitable, religious, or educational health care provider under any:
4188          (a) state law;
4189          (b) ad valorem property tax requirement;
4190          (c) sales or use tax requirement; or
4191          (d) other requirements imposed by taxes, fees, or assessments, whether imposed or
4192     sought to be imposed, by the state or any political subdivision of the state.
4193          (2) A hospital paying an assessment under this [chapter] part may include the
4194     assessment as an allowable cost of a hospital for purposes of any applicable Medicaid
4195     reimbursement formula.
4196          (3) This [chapter] part does not authorize a political subdivision of the state to:
4197          (a) license a hospital for revenue;
4198          (b) impose a tax or assessment upon a hospital; or
4199          (c) impose a tax or assessment measured by the income or earnings of a hospital.
4200          Section 99. Section 26B-3-603, which is renumbered from Section 26-36c-201 is
4201     renumbered and amended to read:
4202          [26-36c-201].      26B-3-603. Assessment.
4203          (1) An assessment is imposed on each private hospital:
4204          (a) beginning upon the later of:
4205          (i) April 1, 2019; and
4206          (ii) CMS approval of the assessment under this [chapter] part;
4207          (b) in the amount designated in Sections [26-36c-204 and 26-36c-205] 26B-3-606 and
4208     26B-3-607; and
4209          (c) in accordance with Section [26-36c-202] 26B-3-604.
4210          (2) The assessment imposed by this [chapter] part is due and payable in accordance
4211     with Subsection [26-36c-202] 26B-3-604(4).
4212          Section 100. Section 26B-3-604, which is renumbered from Section 26-36c-202 is
4213     renumbered and amended to read:

4214          [26-36c-202].      26B-3-604. Collection of assessment -- Deposit of revenue --
4215     Rulemaking.
4216          (1) The department shall act as the collecting agent for the assessment imposed under
4217     Section [26-36c-201] 26B-3-603.
4218          (2) The department shall administer and enforce the provisions of this [chapter] part,
4219     and may make rules, in accordance with Title 63G, Chapter 3, Utah Administrative
4220     Rulemaking Act, necessary to:
4221          (a) collect the assessment, intergovernmental transfers, and penalties imposed under
4222     this [chapter] part;
4223          (b) audit records of a facility that:
4224          (i) is subject to the assessment imposed under this [chapter] part; and
4225          (ii) does not file a Medicare cost report; and
4226          (c) select a report similar to the Medicare cost report if Medicare no longer uses a
4227     Medicare cost report.
4228          (3) The department shall:
4229          (a) administer the assessment in this part separately from the assessments in [Chapter
4230     36d] Part 7, Hospital Provider Assessment [Act, and Chapter 36b],and Part 5, Inpatient
4231     Hospital Assessment [Act]; and
4232          (b) deposit assessments collected under this [chapter] part into the Medicaid Expansion
4233     Fund.
4234          (4) (a) Hospitals shall pay the quarterly assessments imposed by this [chapter] part to
4235     the division within 15 business days after the original invoice date that appears on the invoice
4236     issued by the division.
4237          (b) The department may make rules creating requirements to allow the time for paying
4238     the assessment to be extended.
4239          Section 101. Section 26B-3-605, which is renumbered from Section 26-36c-203 is
4240     renumbered and amended to read:

4241          [26-36c-203].      26B-3-605. Hospital share.
4242          (1) The hospital share is:
4243          (a) for the period from April 1, 2019, through June 30, 2020, $15,000,000; and
4244          (b) beginning July 1, 2020, 100% of the state's net cost of the qualified Medicaid
4245     expansion, after deducting appropriate offsets and savings expected as a result of implementing
4246     the qualified Medicaid expansion, including:
4247          (i) savings from:
4248          (A) the Primary Care Network program;
4249          (B) the health coverage improvement program, as defined in Section [26-18-411]
4250     26B-3-207;
4251          (C) the state portion of inpatient prison medical coverage;
4252          (D) behavioral health coverage; and
4253          (E) county contributions to the non-federal share of Medicaid expenditures; and
4254          (ii) any funds appropriated to the Medicaid Expansion Fund.
4255          (2) (a) Beginning July 1, 2020, the hospital share is capped at no more than
4256     $15,000,000 annually.
4257          (b) Beginning July 1, 2020, the division shall prorate the cap specified in Subsection
4258     (2)(a) in any year in which the qualified Medicaid expansion is not in effect for the full fiscal
4259     year.
4260          Section 102. Section 26B-3-606, which is renumbered from Section 26-36c-204 is
4261     renumbered and amended to read:
4262          [26-36c-204].      26B-3-606. Hospital financing.
4263          (1) Private hospitals shall be assessed under this [chapter] part for the portion of the
4264     hospital share described in Section [26-36c-209] 26B-3-611.
4265          (2) In the report described in Subsection [26-18-3.9] 26B-3-113(8), the department
4266     shall calculate the state's net cost of the qualified Medicaid expansion.
4267          (3) If the assessment collected in the previous fiscal year is above or below the hospital

4268     share for private hospitals for the previous fiscal year, the division shall apply the
4269     underpayment or overpayment of the assessment by the private hospitals to the fiscal year in
4270     which the report is issued.
4271          Section 103. Section 26B-3-607, which is renumbered from Section 26-36c-205 is
4272     renumbered and amended to read:
4273          [26-36c-205].      26B-3-607. Calculation of assessment.
4274          (1) (a) Except as provided in Subsection (1)(b), each private hospital shall pay an
4275     annual assessment due on the last day of each quarter in an amount calculated by the division at
4276     a uniform assessment rate for each hospital discharge, in accordance with this section.
4277          (b) A private teaching hospital with more than 425 beds and more than 60 residents
4278     shall pay an assessment rate 2.5 times the uniform rate established under Subsection (1)(c).
4279          (c) The division shall calculate the uniform assessment rate described in Subsection
4280     (1)(a) by dividing the hospital share for assessed private hospitals, as described in Subsection
4281     [26-36c-204] 26B-3-606(1), by the sum of:
4282          (i) the total number of discharges for assessed private hospitals that are not a private
4283     teaching hospital; and
4284          (ii) 2.5 times the number of discharges for a private teaching hospital, described in
4285     Subsection (1)(b).
4286          (d) The division may make rules in accordance with Title 63G, Chapter 3, Utah
4287     Administrative Rulemaking Act, to adjust the formula described in Subsection (1)(c) to address
4288     unforeseen circumstances in the administration of the assessment under this [chapter] part.
4289          (e) The division shall apply any quarterly changes to the uniform assessment rate
4290     uniformly to all assessed private hospitals.
4291          (2) Except as provided in Subsection (3), for each state fiscal year, the division shall
4292     determine a hospital's discharges as follows:
4293          (a) for state fiscal year 2019, the hospital's cost report data for the hospital's fiscal year
4294     ending between July 1, 2015, and June 30, 2016; and

4295          (b) for each subsequent state fiscal year, the hospital's cost report data for the hospital's
4296     fiscal year that ended in the state fiscal year two years before the assessment fiscal year.
4297          (3) (a) If a hospital's fiscal year Medicare cost report is not contained in the Centers for
4298     Medicare and Medicaid Services' Healthcare Cost Report Information System file:
4299          (i) the hospital shall submit to the division a copy of the hospital's Medicare cost report
4300     applicable to the assessment year; and
4301          (ii) the division shall determine the hospital's discharges.
4302          (b) If a hospital is not certified by the Medicare program and is not required to file a
4303     Medicare cost report:
4304          (i) the hospital shall submit to the division the hospital's applicable fiscal year
4305     discharges with supporting documentation;
4306          (ii) the division shall determine the hospital's discharges from the information
4307     submitted under Subsection (3)(b)(i); and
4308          (iii) if the hospital fails to submit discharge information, the division shall audit the
4309     hospital's records and may impose a penalty equal to 5% of the calculated assessment.
4310          (4) Except as provided in Subsection (5), if a hospital is owned by an organization that
4311     owns more than one hospital in the state:
4312          (a) the division shall calculate the assessment for each hospital separately; and
4313          (b) each separate hospital shall pay the assessment imposed by this [chapter] part.
4314          (5) If multiple hospitals use the same Medicaid provider number:
4315          (a) the department shall calculate the assessment in the aggregate for the hospitals
4316     using the same Medicaid provider number; and
4317          (b) the hospitals may pay the assessment in the aggregate.
4318          Section 104. Section 26B-3-608, which is renumbered from Section 26-36c-206 is
4319     renumbered and amended to read:
4320          [26-36c-206].      26B-3-608. State teaching hospital and non-state government
4321     hospital mandatory intergovernmental transfer.

4322          (1) A state teaching hospital and a non-state government hospital shall make an
4323     intergovernmental transfer to the Medicaid Expansion Fund, in accordance with this section.
4324          (2) The hospitals described in Subsection (1) shall pay the intergovernmental transfer
4325     beginning on the later of:
4326          (a) April 1, 2019; or
4327          (b) CMS approval of the assessment for private hospitals in this [chapter] part.
4328          (3) The intergovernmental transfer is apportioned between the non-state government
4329     hospitals as follows:
4330          (a) the state teaching hospital shall pay for the portion of the hospital share described in
4331     Section [26-36c-209] 26B-3-611; and
4332          (b) non-state government hospitals shall pay for the portion of the hospital share
4333     described in Section [26-36c-209] 26B-3-611.
4334          (4) The department shall, by rule made in accordance with Title 63G, Chapter 3, Utah
4335     Administrative Rulemaking Act, designate:
4336          (a) the method of calculating the amounts designated in Subsection (3); and
4337          (b) the schedule for the intergovernmental transfers.
4338          Section 105. Section 26B-3-609, which is renumbered from Section 26-36c-207 is
4339     renumbered and amended to read:
4340          [26-36c-207].      26B-3-609. Penalties.
4341          (1) A hospital that fails to pay a quarterly assessment, make the mandated
4342     intergovernmental transfer, or file a return as required under this [chapter] part, within the time
4343     required by this [chapter] part, shall pay penalties described in this section, in addition to the
4344     assessment or intergovernmental transfer.
4345          (2) If a hospital fails to timely pay the full amount of a quarterly assessment or the
4346     mandated intergovernmental transfer, the department shall add to the assessment or
4347     intergovernmental transfer:
4348          (a) a penalty equal to 5% of the quarterly amount not paid on or before the due date;

4349     and
4350          (b) on the last day of each quarter after the due date until the assessed amount and the
4351     penalty imposed under Subsection (2)(a) are paid in full, an additional 5% penalty on:
4352          (i) any unpaid quarterly assessment or intergovernmental transfer; and
4353          (ii) any unpaid penalty assessment.
4354          (3) Upon making a record of the division's actions, and upon reasonable cause shown,
4355     the division may waive or reduce any of the penalties imposed under this [chapter] part.
4356          Section 106. Section 26B-3-610, which is renumbered from Section 26-36c-208 is
4357     renumbered and amended to read:
4358          [26-36c-208].      26B-3-610. Hospital reimbursement.
4359          (1) If the qualified Medicaid expansion is implemented by contracting with a Medicaid
4360     accountable care organization, the department shall, to the extent allowed by law, include in a
4361     contract to provide benefits under the qualified Medicaid expansion a requirement that the
4362     accountable care organization reimburse hospitals in the accountable care organization's
4363     provider network at no less than the Medicaid fee-for-service rate.
4364          (2) If the qualified Medicaid expansion is implemented by the department as a
4365     fee-for-service program, the department shall reimburse hospitals at no less than the Medicaid
4366     fee-for-service rate.
4367          (3) Nothing in this section prohibits the department or a Medicaid accountable care
4368     organization from paying a rate that exceeds the Medicaid fee-for-service rate.
4369          Section 107. Section 26B-3-611, which is renumbered from Section 26-36c-209 is
4370     renumbered and amended to read:
4371          [26-36c-209].      26B-3-611. Hospital financing of the hospital share.
4372          (1) For the first two full fiscal years that the assessment is in effect, the department
4373     shall:
4374          (a) assess private hospitals under this [chapter] part for 69% of the hospital share;
4375          (b) require the state teaching hospital to make an intergovernmental transfer under this

4376     [chapter] part for 30% of the hospital share; and
4377          (c) require non-state government hospitals to make an intergovernmental transfer under
4378     this [chapter] part for 1% of the hospital share.
4379          (2) (a) At the beginning of the third full fiscal year that the assessment is in effect, and
4380     at the beginning of each subsequent fiscal year, the department may set a different percentage
4381     share for private hospitals, the state teaching hospital, and non-state government hospitals by
4382     rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, with
4383     input from private hospitals and private teaching hospitals.
4384          (b) If the department does not set a different percentage share under Subsection (2)(a),
4385     the percentage shares in Subsection (1) shall apply.
4386          Section 108. Section 26B-3-612, which is renumbered from Section 26-36c-210 is
4387     renumbered and amended to read:
4388          [26-36c-210].      26B-3-612. Suspension of assessment.
4389          (1) The department shall suspend the assessment imposed by this [chapter] part when
4390     the executive director certifies that:
4391          (a) action by Congress is in effect that disqualifies the assessment imposed by this
4392     [chapter] part from counting toward state Medicaid funds available to be used to determine the
4393     amount of federal financial participation;
4394          (b) a decision, enactment, or other determination by the Legislature or by any court,
4395     officer, department, or agency of the state, or of the federal government, is in effect that:
4396          (i) disqualifies the assessment from counting toward state Medicaid funds available to
4397     be used to determine federal financial participation for Medicaid matching funds; or
4398          (ii) creates for any reason a failure of the state to use the assessments for at least one of
4399     the Medicaid programs described in this [chapter] part; or
4400          (c) a change is in effect that reduces the aggregate hospital inpatient and outpatient
4401     payment rate below the aggregate hospital inpatient and outpatient payment rate for July 1,
4402     2015.

4403          (2) If the assessment is suspended under Subsection (1):
4404          (a) the division may not collect any assessment or intergovernmental transfer under this
4405     [chapter] part;
4406          (b) the division shall disburse money in the Medicaid Expansion Fund that was derived
4407     from assessments imposed by this [chapter] part in accordance with the requirements in
4408     Subsection [26-36b-208] 26B-1-315(4), to the extent federal matching is not reduced by CMS
4409     due to the repeal of the assessment; and
4410          (c) the division shall refund any money remaining in the Medicaid Expansion Fund
4411     after the disbursement described in Subsection (2)(b) that was derived from assessments
4412     imposed by this [chapter] part to the hospitals in proportion to the amount paid by each hospital
4413     for the last three fiscal years.
4414          Section 109. Section 26B-3-701, which is renumbered from Section 26-36d-103 is
4415     renumbered and amended to read:
4416     
Part 7. Hospital Provider Assessment

4417          [26-36d-103].      26B-3-701. Definitions.
4418          As used in this [chapter] part:
4419          (1) "Accountable care organization" means a managed care organization, as defined in
4420     42 C.F.R. Sec. 438, that contracts with the department under the provisions of Section
4421     [26-18-405] 26B-3-202.
4422          (2) "Assessment" means the Medicaid hospital provider assessment established by this
4423     [chapter] part.
4424          (3) "Discharges" means the number of total hospital discharges reported on Worksheet
4425     S-3 Part I, column 15, lines 12, 14, and 14.01 of the 2552-96 Medicare Cost Report or on
4426     Worksheet S-3 Part I, column 15, lines 14, 16, and 17 of the 2552-10 Medicare Cost Report for
4427     the applicable assessment year.
4428          (4) "Division" means the Division of [Health Care Financing] Integrated Healthcare of
4429     the department.

4430          (5) "Hospital":
4431          (a) means a privately owned:
4432          (i) general acute hospital operating in the state as defined in Section [26-21-2]
4433     26B-2-201; and
4434          (ii) specialty hospital operating in the state, which shall include a privately owned
4435     hospital whose inpatient admissions are predominantly:
4436          (A) rehabilitation;
4437          (B) psychiatric;
4438          (C) chemical dependency; or
4439          (D) long-term acute care services; and
4440          (b) does not include:
4441          (i) a human services program, as defined in Section [62A-2-101] 26B-2-101;
4442          (ii) a hospital owned by the federal government, including the Veterans Administration
4443     Hospital; or
4444          (iii) a hospital that is owned by the state government, a state agency, or a political
4445     subdivision of the state, including:
4446          (A) a state-owned teaching hospital; and
4447          (B) the Utah State Hospital.
4448          (6) "Medicare Cost Report" means CMS-2552-96 or CMS-2552-10, the cost report for
4449     electronic filing of hospitals.
4450          (7) "State plan amendment" means a change or update to the state Medicaid plan.
4451          Section 110. Section 26B-3-702, which is renumbered from Section 26-36d-102 is
4452     renumbered and amended to read:
4453          [26-36d-102].      26B-3-702. Legislative findings.
4454          (1) The Legislature finds that there is an important state purpose to improve the access
4455     of Medicaid patients to quality care in Utah hospitals because of continuous decreases in state
4456     revenues and increases in enrollment under the Utah Medicaid program.

4457          (2) The Legislature finds that in order to improve this access to those persons described
4458     in Subsection (1):
4459          (a) the rates paid to Utah hospitals shall be adequate to encourage and support
4460     improved access; and
4461          (b) adequate funding shall be provided to increase the rates paid to Utah hospitals
4462     providing services pursuant to the Utah Medicaid program.
4463          Section 111. Section 26B-3-703, which is renumbered from Section 26-36d-201 is
4464     renumbered and amended to read:
4465          [26-36d-201].      26B-3-703. Application of part.
4466          (1) Other than for the imposition of the assessment described in this [chapter] part,
4467     nothing in this [chapter] part shall affect the nonprofit or tax exempt status of any nonprofit
4468     charitable, religious, or educational health care provider under:
4469          (a) Section 501(c), as amended, of the Internal Revenue Code;
4470          (b) other applicable federal law;
4471          (c) any state law;
4472          (d) any ad valorem property taxes;
4473          (e) any sales or use taxes; or
4474          (f) any other taxes, fees, or assessments, whether imposed or sought to be imposed by
4475     the state or any political subdivision, county, municipality, district, authority, or any agency or
4476     department thereof.
4477          (2) All assessments paid under this [chapter] part may be included as an allowable cost
4478     of a hospital for purposes of any applicable Medicaid reimbursement formula.
4479          (3) This [chapter] part does not authorize a political subdivision of the state to:
4480          (a) license a hospital for revenue;
4481          (b) impose a tax or assessment upon hospitals; or
4482          (c) impose a tax or assessment measured by the income or earnings of a hospital.
4483          Section 112. Section 26B-3-704, which is renumbered from Section 26-36d-202 is

4484     renumbered and amended to read:
4485          [26-36d-202].      26B-3-704. Assessment, collection, and payment of hospital
4486     provider assessment.
4487          (1) A uniform, broad based, assessment is imposed on each hospital as defined in
4488     Subsection [26-36d-103] 26B-3-701(5)(a):
4489          (a) in the amount designated in Section [26-36d-203] 26B-3-705; and
4490          (b) in accordance with Section [26-36d-204] 26B-3-706.
4491          (2) (a) The assessment imposed by this [chapter] part is due and payable on a quarterly
4492     basis in accordance with Section [26-36d-204] 26B-3-706.
4493          (b) The collecting agent for this assessment is the department which is vested with the
4494     administration and enforcement of this [chapter] part, including the right to adopt
4495     administrative rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking
4496     Act, necessary to:
4497          (i) implement and enforce the provisions of this act; and
4498          (ii) audit records of a facility:
4499          (A) that is subject to the assessment imposed by this [chapter] part; and
4500          (B) does not file a Medicare Cost Report.
4501          (c) The department shall forward proceeds from the assessment imposed by this
4502     [chapter] part to the state treasurer for deposit in the expendable special revenue fund as
4503     specified in Section [26-36d-207] 26B-1-316.
4504          (3) The department may, by rule, extend the time for paying the assessment.
4505          Section 113. Section 26B-3-705, which is renumbered from Section 26-36d-203 is
4506     renumbered and amended to read:
4507          [26-36d-203].      26B-3-705. Calculation of assessment.
4508          (1) (a) An annual assessment is payable on a quarterly basis for each hospital in an
4509     amount calculated at a uniform assessment rate for each hospital discharge, in accordance with
4510     this section.

4511          (b) The uniform assessment rate shall be determined using the total number of hospital
4512     discharges for assessed hospitals divided into the total non-federal portion in an amount
4513     consistent with Section [26-36d-205] 26B-3-707 that is needed to support capitated rates for
4514     accountable care organizations for purposes of hospital services provided to Medicaid
4515     enrollees.
4516          (c) Any quarterly changes to the uniform assessment rate shall be applied uniformly to
4517     all assessed hospitals.
4518          (d) The annual uniform assessment rate may not generate more than:
4519          (i) $1,000,000 to offset Medicaid mandatory expenditures; and
4520          (ii) the non-federal share to seed amounts needed to support capitated rates for
4521     accountable care organizations as provided for in Subsection (1)(b).
4522          (2) (a) For each state fiscal year, discharges shall be determined using the data from
4523     each hospital's Medicare Cost Report contained in the Centers for Medicare and Medicaid
4524     Services' Healthcare Cost Report Information System file. The hospital's discharge data will be
4525     derived as follows:
4526          (i) for state fiscal year 2013, the hospital's cost report data for the hospital's fiscal year
4527     ending between July 1, 2009, and June 30, 2010;
4528          (ii) for state fiscal year 2014, the hospital's cost report data for the hospital's fiscal year
4529     ending between July 1, 2010, and June 30, 2011;
4530          (iii) for state fiscal year 2015, the hospital's cost report data for the hospital's fiscal year
4531     ending between July 1, 2011, and June 30, 2012;
4532          (iv) for state fiscal year 2016, the hospital's cost report data for the hospital's fiscal year
4533     ending between July 1, 2012, and June 30, 2013; and
4534          (v) for each subsequent state fiscal year, the hospital's cost report data for the hospital's
4535     fiscal year that ended in the state fiscal year two years prior to the assessment fiscal year.
4536          (b) If a hospital's fiscal year Medicare Cost Report is not contained in the Centers for
4537     Medicare and Medicaid Services' Healthcare Cost Report Information System file:

4538          (i) the hospital shall submit to the division a copy of the hospital's Medicare Cost
4539     Report applicable to the assessment year; and
4540          (ii) the division shall determine the hospital's discharges.
4541          (c) If a hospital is not certified by the Medicare program and is not required to file a
4542     Medicare Cost Report:
4543          (i) the hospital shall submit to the division its applicable fiscal year discharges with
4544     supporting documentation;
4545          (ii) the division shall determine the hospital's discharges from the information
4546     submitted under Subsection (2)(c)(i); and
4547          (iii) the failure to submit discharge information shall result in an audit of the hospital's
4548     records and a penalty equal to 5% of the calculated assessment.
4549          (3) Except as provided in Subsection (4), if a hospital is owned by an organization that
4550     owns more than one hospital in the state:
4551          (a) the assessment for each hospital shall be separately calculated by the department;
4552     and
4553          (b) each separate hospital shall pay the assessment imposed by this [chapter] part.
4554          (4) Notwithstanding the requirement of Subsection (3), if multiple hospitals use the
4555     same Medicaid provider number:
4556          (a) the department shall calculate the assessment in the aggregate for the hospitals
4557     using the same Medicaid provider number; and
4558          (b) the hospitals may pay the assessment in the aggregate.
4559          Section 114. Section 26B-3-706, which is renumbered from Section 26-36d-204 is
4560     renumbered and amended to read:
4561          [26-36d-204].      26B-3-706. Quarterly notice -- Collection.
4562          Quarterly assessments imposed by this [chapter] part shall be paid to the division within
4563     15 business days after the original invoice date that appears on the invoice issued by the
4564     division.

4565          Section 115. Section 26B-3-707, which is renumbered from Section 26-36d-205 is
4566     renumbered and amended to read:
4567          [26-36d-205].      26B-3-707. Medicaid hospital adjustment under accountable
4568     care organization rates.
4569          To preserve and improve access to hospital services, the division shall, for accountable
4570     care organization rates effective on or after April 1, 2013, incorporate into the accountable care
4571     organization rate structure calculation consistent with the certified actuarial rate range:
4572          (1) $154,000,000 to be allocated toward the hospital inpatient directed payments for
4573     the Medicaid eligibility categories covered in Utah before January 1, 2019; and
4574          (2) an amount equal to the difference between payments made to hospitals by
4575     accountable care organizations for the Medicaid eligibility categories covered in Utah before
4576     January 1, 2019, based on submitted encounter data and the maximum amount that could be
4577     paid for those services using Medicare payment principles to be used for directed payments to
4578     hospitals for outpatient services.
4579          Section 116. Section 26B-3-708, which is renumbered from Section 26-36d-206 is
4580     renumbered and amended to read:
4581          [26-36d-206].      26B-3-708. Penalties and interest.
4582          (1) A facility that fails to pay any assessment or file a return as required under this
4583     [chapter] part, within the time required by this [chapter] part, shall pay, in addition to the
4584     assessment, penalties and interest established by the department.
4585          (2) (a) Consistent with Subsection (2)(b), the department shall adopt rules in
4586     accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, which establish
4587     reasonable penalties and interest for the violations described in Subsection (1).
4588          (b) If a hospital fails to timely pay the full amount of a quarterly assessment, the
4589     department shall add to the assessment:
4590          (i) a penalty equal to 5% of the quarterly amount not paid on or before the due date;
4591     and

4592          (ii) on the last day of each quarter after the due date until the assessed amount and the
4593     penalty imposed under Subsection (2)(b)(i) are paid in full, an additional 5% penalty on:
4594          (A) any unpaid quarterly assessment; and
4595          (B) any unpaid penalty assessment.
4596          (c) Upon making a record of its actions, and upon reasonable cause shown, the division
4597     may waive, reduce, or compromise any of the penalties imposed under this part.
4598          Section 117. Section 26B-3-709, which is renumbered from Section 26-36d-208 is
4599     renumbered and amended to read:
4600          [26-36d-208].      26B-3-709. Repeal of assessment.
4601          (1) The repeal of the assessment imposed by this [chapter] part shall occur upon the
4602     certification by the executive director of the department that the sooner of the following has
4603     occurred:
4604          (a) the effective date of any action by Congress that would disqualify the assessment
4605     imposed by this [chapter] part from counting toward state Medicaid funds available to be used
4606     to determine the federal financial participation;
4607          (b) the effective date of any decision, enactment, or other determination by the
4608     Legislature or by any court, officer, department, or agency of the state, or of the federal
4609     government that has the effect of:
4610          (i) disqualifying the assessment from counting towards state Medicaid funds available
4611     to be used to determine federal financial participation for Medicaid matching funds; or
4612          (ii) creating for any reason a failure of the state to use the assessments for the Medicaid
4613     program as described in this [chapter] part;
4614          (c) the effective date of:
4615          (i) an appropriation for any state fiscal year from the General Fund for hospital
4616     payments under the state Medicaid program that is less than the amount appropriated for state
4617     fiscal year 2012;
4618          (ii) the annual revenues of the state General Fund budget return to the level that was

4619     appropriated for fiscal year 2008;
4620          (iii) a division change in rules that reduces any of the following below July 1, 2011,
4621     payments:
4622          (A) aggregate hospital inpatient payments;
4623          (B) adjustment payment rates; or
4624          (C) any cost settlement protocol; or
4625          (iv) a division change in rules that reduces the aggregate outpatient payments below
4626     July 1, 2011, payments; and
4627          (d) the sunset of this [chapter] part in accordance with Section 63I-1-226.
4628          (2) If the assessment is repealed under Subsection (1), money in the fund that was
4629     derived from assessments imposed by this [chapter] part, before the determination made under
4630     Subsection (1), shall be disbursed under Section [26-36d-205] 26B-3-707 to the extent federal
4631     matching is not reduced due to the impermissibility of the assessments. Any funds remaining in
4632     the special revenue fund shall be refunded to the hospitals in proportion to the amount paid by
4633     each hospital.
4634          Section 118. Section 26B-3-801, which is renumbered from Section 26-37a-102 is
4635     renumbered and amended to read:
4636     
Part 8. Ambulance Service Provider Assessment

4637          [26-37a-102].      26B-3-801. Definitions.
4638          As used in this [chapter] part:
4639          (1) "Ambulance service provider" means:
4640          (a) an ambulance provider as defined in Section [26-8a-102] 26B-4-101; or
4641          (b) a non-911 service provider as defined in Section [26-8a-102] 26B-4-101.
4642          (2) "Assessment" means the Medicaid ambulance service provider assessment
4643     established by this [chapter] part.
4644          (3) "Division" means the Division of [Health Care Financing] Integrated Healthcare
4645     within the department.

4646          (4) "Non-federal portion" means the non-federal share the division needs to seed
4647     amounts that will support fee-for-service ambulance service provider rates, as described in
4648     Section [26-37a-105] 26B-3-804.
4649          (5) "Total transports" means the number of total ambulance transports applicable to a
4650     given fiscal year, as determined under Subsection [26-37a-104] 26B-3-803(5).
4651          Section 119. Section 26B-3-802, which is renumbered from Section 26-37a-103 is
4652     renumbered and amended to read:
4653          [26-37a-103].      26B-3-802. Assessment, collection, and payment of
4654     ambulance service provider assessment.
4655          (1) An ambulance service provider shall pay an assessment to the division:
4656          (a) in the amount designated in Section [26-37a-104] 26B-3-803;
4657          (b) in accordance with this [chapter] part;
4658          (c) quarterly, on a day determined by the division by rule made under Subsection
4659     (2)(b); and
4660          (d) no more than 15 business days after the day on which the division issues the
4661     ambulance service provider notice of the assessment.
4662          (2) The division shall:
4663          (a) collect the assessment described in Subsection (1);
4664          (b) determine, by rule made in accordance with Title 63G, Chapter 3, Utah
4665     Administrative Rulemaking Act, standards and procedures for implementing and enforcing the
4666     provisions of this [chapter] part; and
4667          (c) transfer assessment proceeds to the state treasurer for deposit into the Ambulance
4668     Service Provider Assessment Expendable Revenue Fund created in Section [26-37a-107]
4669     26B-1-317.
4670          Section 120. Section 26B-3-803, which is renumbered from Section 26-37a-104 is
4671     renumbered and amended to read:
4672          [26-37a-104].      26B-3-803. Calculation of assessment.

4673          (1) The division shall calculate a uniform assessment per transport as described in this
4674     section.
4675          (2) The assessment due from a given ambulance service provider equals the
4676     non-federal portion divided by total transports, multiplied by the number of transports for the
4677     ambulance service provider.
4678          (3) The division shall apply any quarterly changes to the assessment rate, calculated as
4679     described in Subsection (2), uniformly to all assessed ambulance service providers.
4680          (4) The assessment may not generate more than the total of:
4681          (a) an annual amount of $20,000 to offset Medicaid administration expenses; and
4682          (b) the non-federal portion.
4683          (5) (a) For each state fiscal year, the division shall calculate total transports using data
4684     from the Emergency Medical System as follows:
4685          (i) for state fiscal year 2016, the division shall use ambulance service provider
4686     transports during the 2014 calendar year; and
4687          (ii) for a fiscal year after 2016, the division shall use ambulance service provider
4688     transports during the calendar year ending 18 months before the end of the fiscal year.
4689          (b) If an ambulance service provider fails to submit transport information to the
4690     Emergency Medical System, the division may audit the ambulance service provider to
4691     determine the ambulance service provider's transports for a given fiscal year.
4692          Section 121. Section 26B-3-804, which is renumbered from Section 26-37a-105 is
4693     renumbered and amended to read:
4694          [26-37a-105].      26B-3-804. Medicaid ambulance service provider adjustment
4695     under fee-for-service rates.
4696          The division shall, if the assessment imposed by this [chapter] part is approved by the
4697     Centers for Medicare and Medicaid Services, for fee-for-service rates effective on or after July
4698     1, 2015, reimburse an ambulance service provider in an amount up to the Emergency Medical
4699     Services Ambulance Rates adopted annually by the department.

4700          Section 122. Section 26B-3-805, which is renumbered from Section 26-37a-106 is
4701     renumbered and amended to read:
4702          [26-37a-106].      26B-3-805. Penalties.
4703          The division shall require an ambulance service provider that fails to pay an assessment
4704     due under this [chapter] part to pay the division, in addition to the assessment, a penalty
4705     determined by the division by rule made in accordance with Title 63G, Chapter 3, Utah
4706     Administrative Rulemaking Act.
4707          Section 123. Section 26B-3-806, which is renumbered from Section 26-37a-108 is
4708     renumbered and amended to read:
4709          [26-37a-108].      26B-3-806. Repeal of assessment.
4710          (1) This [chapter] part is repealed when, as certified by the executive director of the
4711     department, any of the following occurs:
4712          (a) an action by Congress that disqualifies the assessment imposed by this [chapter]
4713     part from state Medicaid funds available to be used to determine the federal financial
4714     participation takes legal effect; or
4715          (b) an action, decision, enactment, or other determination by the Legislature or by any
4716     court, officer, department, or agency of the state or federal government takes effect that:
4717          (i) disqualifies the assessment from counting toward state Medicaid funds available to
4718     be used to determine federal financial participation for Medicaid matching funds; or
4719          (ii) creates for any reason a failure of the state to use the assessments for the Medicaid
4720     program as described in this [chapter] part.
4721          (2) If this [chapter] part is repealed under Subsection (1):
4722          (a) money in the Ambulance Service Provider Assessment Expendable Revenue Fund
4723     that was derived from assessments imposed by this [chapter] part, deposited before the
4724     determination made under Subsection (1), shall be disbursed under Section [26-37a-107]
4725     26B-1-317 to the extent federal matching is not reduced due to the impermissibility of the
4726     assessments; and

4727          (b) any funds remaining in the special revenue fund shall be refunded to each
4728     ambulance service provider in proportion to the amount paid by the ambulance service
4729     provider.
4730          Section 124. Section 26B-3-901, which is renumbered from Section 26-40-102 is
4731     renumbered and amended to read:
4732     
Part 9. Utah Children's Health Insurance Program

4733          [26-40-102].      26B-3-901. Definitions.
4734          As used in this [chapter] part:
4735          (1) "Child" means [a person who is under 19 years of age] an individual who is
4736     younger than 19 years old.
4737          (2) "Eligible child" means a child who qualifies for enrollment in the program as
4738     provided in Section [26-40-105] 26B-3-903.
4739          (3) "Member" means a child enrolled in the program.
4740          (4) "Plan" means the department's plan submitted to the United States Department of
4741     Health and Human Services pursuant to 42 U.S.C. Sec. 1397ff.
4742          (5) "Program" means the Utah Children's Health Insurance Program created by this
4743     [chapter] part.
4744          Section 125. Section 26B-3-902, which is renumbered from Section 26-40-103 is
4745     renumbered and amended to read:
4746          [26-40-103].      26B-3-902. Creation and administration of the Utah
4747     Children's Health Insurance Program.
4748          (1) There is created the Utah Children's Health Insurance Program to be administered
4749     by the department in accordance with the provisions of:
4750          (a) this [chapter] part; and
4751          (b) the State Children's Health Insurance Program, 42 U.S.C. Sec. 1397aa et seq.
4752          (2) The department shall:
4753          (a) prepare and submit the state's children's health insurance plan before May 1, 1998,

4754     and any amendments to the [federal] United States Department of Health and Human Services
4755     in accordance with 42 U.S.C. Sec. 1397ff; and
4756          (b) make rules in accordance with Title 63G, Chapter 3, Utah Administrative
4757     Rulemaking Act, regarding:
4758          (i) eligibility requirements consistent with Section [26-18-3] 26B-3-108;
4759          (ii) program benefits;
4760          (iii) the level of coverage for each program benefit;
4761          (iv) cost-sharing requirements for members, which may not:
4762          (A) exceed the guidelines set forth in 42 U.S.C. Sec. 1397ee; or
4763          (B) impose deductible, copayment, or coinsurance requirements on a member for
4764     well-child, well-baby, and immunizations;
4765          (v) the administration of the program; and
4766          (vi) a requirement that:
4767          (A) members in the program shall participate in the electronic exchange of clinical
4768     health records established in accordance with Section [26-1-37] 26B-8-411 unless the member
4769     opts out of participation;
4770          (B) prior to enrollment in the electronic exchange of clinical health records the member
4771     shall receive notice of the enrollment in the electronic exchange of clinical health records and
4772     the right to opt out of participation at any time; and
4773          (C) beginning July 1, 2012, when the program sends enrollment or renewal information
4774     to the member and when the member logs onto the program's website, the member shall
4775     receive notice of the right to opt out of the electronic exchange of clinical health records.
4776          Section 126. Section 26B-3-903, which is renumbered from Section 26-40-105 is
4777     renumbered and amended to read:
4778          [26-40-105].      26B-3-903. Eligibility.
4779          (1) A child is eligible to enroll in the program if the child:
4780          (a) is a bona fide Utah resident;

4781          (b) is a citizen or legal resident of the United States;
4782          (c) is under 19 years of age;
4783          (d) does not have access to or coverage under other health insurance, including any
4784     coverage available through a parent or legal guardian's employer;
4785          (e) is ineligible for Medicaid benefits;
4786          (f) resides in a household whose gross family income, as defined by rule, is at or below
4787     200% of the federal poverty level; and
4788          (g) is not an inmate of a public institution or a patient in an institution for mental
4789     diseases.
4790          (2) A child who qualifies for enrollment in the program under Subsection (1) may not
4791     be denied enrollment due to a diagnosis or pre-existing condition.
4792          (3) (a) The department shall determine eligibility and send notification of the eligibility
4793     decision within 30 days after receiving the application for coverage.
4794          (b) If the department cannot reach a decision because the applicant fails to take a
4795     required action, or because there is an administrative or other emergency beyond the
4796     department's control, the department shall:
4797          (i) document the reason for the delay in the applicant's case record; and
4798          (ii) inform the applicant of the status of the application and time frame for completion.
4799          (4) The department may not close enrollment in the program for a child who is eligible
4800     to enroll in the program under the provisions of Subsection (1).
4801          (5) The program shall:
4802          (a) apply for grants to make technology system improvements necessary to implement
4803     a simplified enrollment and renewal process in accordance with Subsection (5)(b); and
4804          (b) if funding is available, implement a simplified enrollment and renewal process.
4805          Section 127. Section 26B-3-904, which is renumbered from Section 26-40-106 is
4806     renumbered and amended to read:
4807          [26-40-106].      26B-3-904. Program benefits.

4808          (1) Except as provided in Subsection (3), medical and dental program benefits shall be
4809     benchmarked, in accordance with 42 U.S.C. Sec. 1397cc, as follows:
4810          (a) medical program benefits, including behavioral health care benefits, shall be
4811     benchmarked effective July 1, 2019, and on July 1 every third year thereafter, to:
4812          (i) be substantially equal to a health benefit plan with the largest insured commercial
4813     enrollment offered by a health maintenance organization in the state; and
4814          (ii) comply with the Mental Health Parity and Addiction Equity Act, Pub. L. No.
4815     110-343; and
4816          (b) dental program benefits shall be benchmarked effective July 1, 2019, and on July 1
4817     every third year thereafter in accordance with the Children's Health Insurance Program
4818     Reauthorization Act of 2009, to be substantially equal to a dental benefit plan that has the
4819     largest insured, commercial, non-Medicaid enrollment of covered lives that is offered in the
4820     state, except that the utilization review mechanism for orthodontia shall be based on medical
4821     necessity.
4822          (2) On or before July 1 of each year, the department shall publish the benchmark for
4823     dental program benefits established under Subsection (1)(b).
4824          (3) The program benefits:
4825          (a) for enrollees who are at or below 100% of the federal poverty level are exempt
4826     from the benchmark requirements of Subsections (1) and (2); and
4827          (b) shall include treatment for autism spectrum disorder as defined in Section
4828     31A-22-642, which:
4829          (i) shall include coverage for applied behavioral analysis; and
4830          (ii) if the benchmark described in Subsection (1)(a) does not include the coverage
4831     described in this Subsection (3)(b), the department shall exclude from the benchmark described
4832     in Subsection (1)(a) for any purpose other than providing benefits under the program.
4833          Section 128. Section 26B-3-905, which is renumbered from Section 26-40-107 is
4834     renumbered and amended to read:

4835          [26-40-107].      26B-3-905. Limitation of benefits.
4836          Abortion is not a covered benefit, except as provided in 42 U.S.C. Sec. 1397ee.
4837          Section 129. Section 26B-3-906, which is renumbered from Section 26-40-108 is
4838     renumbered and amended to read:
4839          [26-40-108].      26B-3-906. Funding.
4840          (1) The program shall be funded by federal matching funds received under, together
4841     with state matching funds required by, 42 U.S.C. Sec. 1397ee.
4842          (2) Program expenditures in the following categories may not exceed 10% in the
4843     aggregate of all federal payments pursuant to 42 U.S.C. Sec. 1397ee:
4844          (a) other forms of child health assistance for children with gross family incomes below
4845     200% of the federal poverty level;
4846          (b) other health services initiatives to improve low-income children's health;
4847          (c) outreach program expenditures; and
4848          (d) administrative costs.
4849          Section 130. Section 26B-3-907, which is renumbered from Section 26-40-109 is
4850     renumbered and amended to read:
4851          [26-40-109].      26B-3-907. Evaluation.
4852          The department shall develop performance measures and annually evaluate the
4853     program's performance.
4854          Section 131. Section 26B-3-908, which is renumbered from Section 26-40-110 is
4855     renumbered and amended to read:
4856          [26-40-110].      26B-3-908. Managed care -- Contracting for services.
4857          (1) Program benefits provided to a member under the program, as described in Section
4858     [26-40-106] 26B-3-904, shall be delivered by a managed care organization if the department
4859     determines that adequate services are available where the member lives or resides.
4860          (2) The department may contract with a managed care organization to provide program
4861     benefits. The department shall evaluate a potential contract with a managed care organization

4862     based on:
4863          (a) the managed care organization's:
4864          (i) ability to manage medical expenses, including mental health costs;
4865          (ii) proven ability to handle accident and health insurance;
4866          (iii) efficiency of claim paying procedures;
4867          (iv) proven ability for managed care and quality assurance;
4868          (v) provider contracting and discounts;
4869          (vi) pharmacy benefit management;
4870          (vii) estimated total charges for administering the pool;
4871          (viii) ability to administer the pool in a cost-efficient manner;
4872          (ix) ability to provide adequate providers and services in the state; and
4873          (x) ability to meet quality measures for emergency room use and access to primary care
4874     established by the department under Subsection [26-18-408] 26B-3-204(4); and
4875          (b) other factors established by the department.
4876          (3) The department may enter into separate managed care organization contracts to
4877     provide dental benefits required by Section [26-40-106] 26B-3-904.
4878          (4) The department's contract with a managed care organization for the program's
4879     benefits shall include risk sharing provisions in which the plan shall accept at least 75% of the
4880     risk for any difference between the department's premium payments per member and actual
4881     medical expenditures.
4882          (5) (a) The department may contract with the Group Insurance Division within the
4883     Utah State Retirement Office to provide services under Subsection (1) if no managed care
4884     organization is willing to contract with the department or the department determines no
4885     managed care organization meets the criteria established under Subsection (2).
4886          (b) In accordance with Section 49-20-201, a contract awarded under Subsection (5)(a)
4887     is not subject to the risk sharing required by Subsection (4).
4888          Section 132. Section 26B-3-909, which is renumbered from Section 26-40-115 is

4889     renumbered and amended to read:
4890          [26-40-115].      26B-3-909. State contractor -- Employee and dependent
4891     health benefit plan coverage.
4892          (1) For purposes of Sections 17B-2a-818.5, 19-1-206, 63A-5b-607, 63C-9-403,
4893     72-6-107.5, and 79-2-404, "qualified health coverage" means, at the time the contract is entered
4894     into or renewed:
4895          (a) a health benefit plan and employer contribution level with a combined actuarial
4896     value at least actuarially equivalent to the combined actuarial value of:
4897          (i) the benchmark plan determined by the program under Subsection [26-40-106]
4898     26B-3-904(1)(a); and
4899          (ii) a contribution level at which the employer pays at least 50% of the premium or
4900     contribution amounts for the employee and the dependents of the employee who reside or work
4901     in the state; or
4902          (b) a federally qualified high deductible health plan that, at a minimum:
4903          (i) has a deductible that is:
4904          (A) the lowest deductible permitted for a federally qualified high deductible health
4905     plan; or
4906          (B) a deductible that is higher than the lowest deductible permitted for a federally
4907     qualified high deductible health plan, but includes an employer contribution to a health savings
4908     account in a dollar amount at least equal to the dollar amount difference between the lowest
4909     deductible permitted for a federally qualified high deductible plan and the deductible for the
4910     employer offered federally qualified high deductible plan;
4911          (ii) has an out-of-pocket maximum that does not exceed three times the amount of the
4912     annual deductible; and
4913          (iii) provides that the employer pays 60% of the premium or contribution amounts for
4914     the employee and the dependents of the employee who work or reside in the state.
4915          (2) The department shall:

4916          (a) on or before July 1, 2016:
4917          (i) determine the commercial equivalent of the benchmark plan described in Subsection
4918     (1)(a); and
4919          (ii) post the commercially equivalent benchmark plan described in Subsection (2)(a)(i)
4920     on the department's website, noting the date posted; and
4921          (b) update the posted commercially equivalent benchmark plan annually and at the
4922     time of any change in the benchmark.
4923          Section 133. Section 26B-3-1001, which is renumbered from Section 26-19-102 is
4924     renumbered and amended to read:
4925     
Part 10. Medical Benefits Recovery

4926          [26-19-102].      26B-3-1001. Definitions.
4927          As used in this [chapter] part:
4928          (1) "Annuity" shall have the same meaning as provided in Section 31A-1-301.
4929          (2) "Care facility" means:
4930          (a) a nursing facility;
4931          (b) an intermediate care facility for an individual with an intellectual disability; or
4932          (c) any other medical institution.
4933          (3) "Claim" means:
4934          (a) a request or demand for payment; or
4935          (b) a cause of action for money or damages arising under any law.
4936          (4) "Employee welfare benefit plan" means a medical insurance plan developed by an
4937     employer under 29 U.S.C. [Section] Sec. 1001, et seq., the Employee Retirement Income
4938     Security Act of 1974 as amended.
4939          (5) "Health insurance entity" means:
4940          (a) an insurer;
4941          (b) a person who administers, manages, provides, offers, sells, carries, or underwrites
4942     health insurance, as defined in Section 31A-1-301;

4943          (c) a self-insured plan;
4944          (d) a group health plan, as defined in Subsection 607(1) of the federal Employee
4945     Retirement Income Security Act of 1974;
4946          (e) a service benefit plan;
4947          (f) a managed care organization;
4948          (g) a pharmacy benefit manager;
4949          (h) an employee welfare benefit plan; or
4950          (i) a person who is, by statute, contract, or agreement, legally responsible for payment
4951     of a claim for a health care item or service.
4952          (6) "Inpatient" means an individual who is a patient and a resident of a care facility.
4953          (7) "Insurer" includes:
4954          (a) a group health plan as defined in Subsection 607(1) of the federal Employee
4955     Retirement Income Security Act of 1974;
4956          (b) a health maintenance organization; and
4957          (c) any entity offering a health service benefit plan.
4958          (8) "Medical assistance" means:
4959          (a) all funds expended for the benefit of a recipient under [Title 26, Chapter 18,
4960     Medical Assistance Act, or under] this chapter or Titles XVIII and XIX, federal Social Security
4961     Act; and
4962          (b) any other services provided for the benefit of a recipient by a prepaid health care
4963     delivery system under contract with the department.
4964          (9) "Office of Recovery Services" means the Office of Recovery Services within the
4965     [Department of Human Services] department.
4966          (10) "Provider" means a person or entity who provides services to a recipient.
4967          (11) "Recipient" means:
4968          (a) an individual who has applied for or received medical assistance from the state;
4969          (b) the guardian, conservator, or other personal representative of an individual under

4970     Subsection (11)(a) if the individual is a minor or an incapacitated person; or
4971          (c) the estate and survivors of an individual under Subsection (11)(a), if the individual
4972     is deceased.
4973          (12) "Recovery estate" means, regarding a deceased recipient:
4974          (a) all real and personal property or other assets included within a decedent's estate as
4975     defined in Section 75-1-201;
4976          (b) the decedent's augmented estate as defined in Section 75-2-203; and
4977          (c) that part of other real or personal property in which the decedent had a legal interest
4978     at the time of death including assets conveyed to a survivor, heir, or assign of the decedent
4979     through joint tenancy, tenancy in common, survivorship, life estate, living trust, or other
4980     arrangement.
4981          (13) "State plan" means the state Medicaid program as enacted in accordance with Title
4982     XIX, federal Social Security Act.
4983          (14) "TEFRA lien" means a lien, authorized under the Tax Equity and Fiscal
4984     Responsibility Act of 1982, against the real property of an individual prior to the individual's
4985     death, as described in 42 U.S.C. Sec. 1396p.
4986          (15) "Third party" includes:
4987          (a) an individual, institution, corporation, public or private agency, trust, estate,
4988     insurance carrier, employee welfare benefit plan, health maintenance organization, health
4989     service organization, preferred provider organization, governmental program such as Medicare,
4990     CHAMPUS, and workers' compensation, which may be obligated to pay all or part of the
4991     medical costs of injury, disease, or disability of a recipient, unless any of these are excluded by
4992     department rule; and
4993          (b) a spouse or a parent who:
4994          (i) may be obligated to pay all or part of the medical costs of a recipient under law or
4995     by court or administrative order; or
4996          (ii) has been ordered to maintain health, dental, or accident and health insurance to

4997     cover medical expenses of a spouse or dependent child by court or administrative order.
4998          (16) "Trust" shall have the same meaning as provided in Section 75-1-201.
4999          Section 134. Section 26B-3-1002, which is renumbered from Section 26-19-103 is
5000     renumbered and amended to read:
5001          [26-19-103].      26B-3-1002. Program established by department --
5002     Promulgation of rules.
5003          (1) The department shall establish and maintain a program for the recoupment of
5004     medical assistance.
5005          (2) The department may promulgate rules to implement the purposes of this [chapter]
5006     part.
5007          Section 135. Section 26B-3-1003, which is renumbered from Section 26-19-201 is
5008     renumbered and amended to read:
5009          [26-19-201].      26B-3-1003. Assignment of rights to benefits.
5010          (1) (a) Except as provided in Subsection [26-19-401] 26B-3-1009(1), to the extent that
5011     medical assistance is actually provided to a recipient, all benefits for medical services or
5012     payments from a third-party otherwise payable to or on behalf of a recipient are assigned by
5013     operation of law to the department if the department provides, or becomes obligated to provide,
5014     medical assistance, regardless of who made application for the benefits on behalf of the
5015     recipient.
5016          (b) The assignment:
5017          (i) authorizes the department to submit its claim to the third-party and authorizes
5018     payment of benefits directly to the department; and
5019          (ii) is effective for all medical assistance.
5020          (2) The department may recover the assigned benefits or payments in accordance with
5021     Section [26-19-401] 26B-3-1009 and as otherwise provided by law.
5022          (3) (a) The assignment of benefits includes medical support and third-party payments
5023     ordered, decreed, or adjudged by any court of this state or any other state or territory of the

5024     United States.
5025          (b) The assignment is not in lieu of, and does not supersede or alter any other court
5026     order, decree, or judgment.
5027          (4) When an assignment takes effect, the recipient is entitled to receive medical
5028     assistance, and the benefits paid to the department are a reimbursement to the department.
5029          Section 136. Section 26B-3-1004, which is renumbered from Section 26-19-301 is
5030     renumbered and amended to read:
5031          [26-19-301].      26B-3-1004. Health insurance entity -- Duties related to state
5032     claims for Medicaid payment or recovery.
5033          As a condition of doing business in the state, a health insurance entity shall:
5034          (1) with respect to an individual who is eligible for, or is provided, medical assistance
5035     under the state plan, upon the request of the [Department of Health] department, provide
5036     information to determine:
5037          (a) during what period the individual, or the spouse or dependent of the individual, may
5038     be or may have been, covered by the health insurance entity; and
5039          (b) the nature of the coverage that is or was provided by the health insurance entity
5040     described in Subsection (1)(a), including the name, address, and identifying number of the
5041     plan;
5042          (2) accept the state's right of recovery and the assignment to the state of any right of an
5043     individual to payment from a party for an item or service for which payment has been made
5044     under the state plan;
5045          (3) respond to any inquiry by the [Department of Health] department regarding a claim
5046     for payment for any health care item or service that is submitted no later than three years after
5047     the day on which the health care item or service is provided; and
5048          (4) not deny a claim submitted by the [Department of Health] department solely on the
5049     basis of the date of submission of the claim, the type or format of the claim form, or failure to
5050     present proper documentation at the point-of-sale that is the basis for the claim, if:

5051          (a) the claim is submitted no later than three years after the day on which the item or
5052     service is furnished; and
5053          (b) any action by the [Department of Health] department to enforce the rights of the
5054     state with respect to the claim is commenced no later than six years after the day on which the
5055     claim is submitted.
5056          Section 137. Section 26B-3-1005, which is renumbered from Section 26-19-302 is
5057     renumbered and amended to read:
5058          [26-19-302].      26B-3-1005. Insurance policies not to deny or reduce benefits
5059     of individuals eligible for state medical assistance -- Exemptions.
5060          (1) A policy of accident or sickness insurance may not contain any provision denying
5061     or reducing benefits because services are rendered to an insured or dependent who is eligible
5062     for or receiving medical assistance from the state.
5063          (2) An association, corporation, or organization may not deliver, issue for delivery, or
5064     renew any subscriber's contract which contains any provisions denying or reducing benefits
5065     because services are rendered to a subscriber or dependent who is eligible for or receiving
5066     medical assistance from the state.
5067          (3) An association, corporation, business, or organization authorized to do business in
5068     this state and which provides or pays for any health care benefits may not deny or reduce
5069     benefits because services are rendered to a beneficiary who is eligible for or receiving medical
5070     assistance from the state.
5071          (4) Notwithstanding Subsection (1), (2), or (3), the Utah State Public Employees'
5072     Health Program, administered by the Utah State Retirement Board, is not required to reimburse
5073     any agency of state government for custodial care which the agency provides, through its staff
5074     or facilities, to members of the Utah State Public Employees' Health Program.
5075          Section 138. Section 26B-3-1006, which is renumbered from Section 26-19-303 is
5076     renumbered and amended to read:
5077          [26-19-303].      26B-3-1006. Availability of insurance policy.

5078          If the third party does not pay the department's claim or lien within 30 days from the
5079     date the claim or lien is received, the third party shall:
5080          (1) provide a written explanation if the claim is denied;
5081          (2) specifically describe and request any additional information from the department
5082     that is necessary to process the claim; and
5083          (3) provide the department or its agent a copy of any relevant or applicable insurance
5084     or benefit policy.
5085          Section 139. Section 26B-3-1007, which is renumbered from Section 26-19-304 is
5086     renumbered and amended to read:
5087          [26-19-304].      26B-3-1007. Employee benefit plans.
5088          As allowed pursuant to 29 U.S.C. [Section] Sec. 1144, an employee benefit plan may
5089     not include any provision that has the effect of limiting or excluding coverage or payment for
5090     any health care for an individual who would otherwise be covered or entitled to benefits or
5091     services under the terms of the employee benefit plan based on the fact that the individual is
5092     eligible for or is provided services under the state plan.
5093          Section 140. Section 26B-3-1008, which is renumbered from Section 26-19-305 is
5094     renumbered and amended to read:
5095          [26-19-305].      26B-3-1008. Statute of limitations -- Survival of right of
5096     action -- Insurance policy not to limit time allowed for recovery.
5097          (1) (a) Subject to Subsection (6), action commenced by the department under this
5098     [chapter] part against a health insurance entity shall be commenced within:
5099          (i) subject to Subsection (7), six years after the day on which the department submits
5100     the claim for recovery or payment for the health care item or service upon which the action is
5101     based; or
5102          (ii) six months after the date of the last payment for medical assistance, whichever is
5103     later.
5104          (b) An action against any other third party, the recipient, or anyone to whom the

5105     proceeds are payable shall be commenced within:
5106          (i) four years after the date of the injury or onset of the illness; or
5107          (ii) six months after the date of the last payment for medical assistance, whichever is
5108     later.
5109          (2) The death of the recipient does not abate any right of action established by this
5110     [chapter] part.
5111          (3) (a) No insurance policy issued or renewed after June 1, 1981, may contain any
5112     provision that limits the time in which the department may submit its claim to recover medical
5113     assistance benefits to a period of less than 24 months from the date the provider furnishes
5114     services or goods to the recipient.
5115          (b) No insurance policy issued or renewed after April 30, 2007, may contain any
5116     provision that limits the time in which the department may submit its claim to recover medical
5117     assistance benefits to a period of less than that described in Subsection (1)(a).
5118          (4) The provisions of this section do not apply to Section [26-19-405 or Part 5, TEFRA
5119     Liens] 26B-3-1013 or Sections 26B-3-1015 through 26B-3-1023.
5120          (5) The provisions of this section [supercede] supersede any other sections regarding
5121     the time limit in which an action shall be commenced, including Section 75-7-509.
5122          (6) (a) Subsection (1)(a) extends the statute of limitations on a cause of action
5123     described in Subsection (1)(a) that was not time-barred on or before April 30, 2007.
5124          (b) Subsection (1)(a) does not revive a cause of action that was time-barred on or
5125     before April 30, 2007.
5126          (7) An action described in Subsection (1)(a) may not be commenced if the claim for
5127     recovery or payment described in Subsection (1)(a)(i) is submitted later than three years after
5128     the day on which the health care item or service upon which the claim is based was provided.
5129          Section 141. Section 26B-3-1009, which is renumbered from Section 26-19-401 is
5130     renumbered and amended to read:
5131          [26-19-401].      26B-3-1009. Recovery of medical assistance from third party

5132     -- Lien -- Notice -- Action -- Compromise or waiver -- Recipient's right to action
5133     protected.
5134          (1) (a) Except as provided in Subsection (1)(c), if the department provides or becomes
5135     obligated to provide medical assistance to a recipient that a third-party is obligated to pay for,
5136     the department may recover the medical assistance directly from the third-party.
5137          (b) (i) A claim under Subsection (1)(a) or Section [26-19-201] 26B-3-1003 to recover
5138     medical assistance provided to a recipient is a lien against any proceeds payable to or on behalf
5139     of the recipient by the third-party.
5140          (ii) The lien described in Subsection (1)(b)(i) has priority over all other claims to the
5141     proceeds, except claims for attorney fees and costs authorized under Subsection [26-19-403]
5142     26B-3-1011(2)(c)(ii).
5143          (c) (i) The department may not recover medical assistance under Subsection (1)(a) if:
5144          (A) the third-party is obligated to pay the recipient for an injury to the recipient's child
5145     that occurred while the child was in the physical custody of the child's foster parent;
5146          (B) the child's injury is a physical or mental impairment that requires ongoing medical
5147     attention, or limits activities of daily living, for at least one year;
5148          (C) the third-party's payment to the recipient is placed in a trust, annuity, financial
5149     account, or other financial instrument for the benefit of the child; and
5150          (D) the recipient makes reasonable efforts to mitigate any other medical assistance
5151     costs for the recipient to the state.
5152          (ii) The department is responsible for any repayment to the federal government related
5153     to the medical assistance the department is prohibited from recovering under Subsection
5154     (1)(c)(i).
5155          (2) (a) The department shall mail or deliver written notice of the department's claim or
5156     lien to the third-party at the third-party's principal place of business or last-known address.
5157          (b) The notice shall include:
5158          (i) the recipient's name;

5159          (ii) the approximate date of illness or injury;
5160          (iii) a general description of the type of illness or injury; and
5161          (iv) if applicable, the general location where the injury is alleged to have occurred.
5162          (3) The department may commence an action on the department's claim or lien in the
5163     department's name, but the claim or lien is not enforceable as to a third-party unless:
5164          (a) the third-party receives written notice of the department's claim or lien before the
5165     third-party settles with the recipient; or
5166          (b) the department has evidence that the third party had knowledge that the department
5167     provided or was obligated to provide medical assistance.
5168          (4) The department may:
5169          (a) waive a claim or lien against a third party in whole or in part; or
5170          (b) compromise, settle, or release a claim or lien.
5171          (5) An action commenced under this section does not bar an action by a recipient or a
5172     dependent of a recipient for loss or damage not included in the department's action.
5173          (6) Except as provided in Subsection (1)(c), the department's claim or lien on proceeds
5174     under this section is not affected by the transfer of the proceeds to a trust, annuity, financial
5175     account, or other financial instrument.
5176          Section 142. Section 26B-3-1010, which is renumbered from Section 26-19-402 is
5177     renumbered and amended to read:
5178          [26-19-402].      26B-3-1010. Action by department -- Notice to recipient.
5179          (1) (a) Within 30 days after commencing an action under Subsection [26-19-401]
5180     26B-3-1009(3), the department shall give the recipient, the recipient's guardian, personal
5181     representative, trustee, estate, or survivor, whichever is appropriate, written notice of the action
5182     by:
5183          (i) personal service or certified mail to the last known address of the person receiving
5184     the notice; or
5185          (ii) if no last-known address is available, by publishing a notice:

5186          (A) once a week for three successive weeks in a newspaper of general circulation in the
5187     county where the recipient resides; and
5188          (B) in accordance with Section 45-1-101 for three weeks.
5189          (b) Proof of service shall be filed in the action.
5190          (c) The recipient may intervene in the department's action at any time before trial.
5191          (2) The notice required by Subsection (1) shall name the court in which the action is
5192     commenced and advise the recipient of:
5193          (a) the right to intervene in the proceeding;
5194          (b) the right to obtain a private attorney; and
5195          (c) the department's right to recover medical assistance directly from the third party.
5196          Section 143. Section 26B-3-1011, which is renumbered from Section 26-19-403 is
5197     renumbered and amended to read:
5198          [26-19-403].      26B-3-1011. Notice of claim by recipient -- Department
5199     response -- Conditions for proceeding -- Collection agreements.
5200          (1) (a) A recipient may not file a claim, commence an action, or settle, compromise,
5201     release, or waive a claim against a third party for recovery of medical costs for an injury,
5202     disease, or disability for which the department has provided or has become obligated to provide
5203     medical assistance, without the department's written consent as provided in Subsection (2)(b)
5204     or (4).
5205          (b) For purposes of Subsection (1)(a), consent may be obtained if:
5206          (i) a recipient who files a claim, or commences an action against a third party notifies
5207     the department in accordance with Subsection (1)(d) within 10 days of the recipient making the
5208     claim or commencing an action; or
5209          (ii) an attorney, who has been retained by the recipient to file a claim, or commence an
5210     action against a third party, notifies the department in accordance with Subsection (1)(d) of the
5211     recipient's claim:
5212          (A) within 30 days after being retained by the recipient for that purpose; or

5213          (B) within 30 days from the date the attorney either knew or should have known that
5214     the recipient received medical assistance from the department.
5215          (c) Service of the notice of claim to the department shall be made by certified mail,
5216     personal service, or by e-mail in accordance with Rule 5 of the Utah Rules of Civil Procedure,
5217     to the director of the Office of Recovery Services.
5218          (d) The notice of claim shall include the following information:
5219          (i) the name of the recipient;
5220          (ii) the recipient's Social Security number;
5221          (iii) the recipient's date of birth;
5222          (iv) the name of the recipient's attorney if applicable;
5223          (v) the name or names of individuals or entities against whom the recipient is making
5224     the claim, if known;
5225          (vi) the name of the third party's insurance carrier, if known;
5226          (vii) the date of the incident giving rise to the claim; and
5227          (viii) a short statement identifying the nature of the recipient's claim.
5228          (2) (a) Within 30 days of receipt of the notice of the claim required in Subsection (1),
5229     the department shall acknowledge receipt of the notice of the claim to the recipient or the
5230     recipient's attorney and shall notify the recipient or the recipient's attorney in writing of the
5231     following:
5232          (i) if the department has a claim or lien pursuant to Section [26-19-401] 26B-3-1009 or
5233     has become obligated to provide medical assistance; and
5234          (ii) whether the department is denying or granting written consent in accordance with
5235     Subsection (1)(a).
5236          (b) The department shall provide the recipient's attorney the opportunity to enter into a
5237     collection agreement with the department, with the recipient's consent, unless:
5238          (i) the department, prior to the receipt of the notice of the recipient's claim pursuant to
5239     Subsection (1), filed a written claim with the third party, the third party agreed to make

5240     payment to the department before the date the department received notice of the recipient's
5241     claim, and the agreement is documented in the department's record; or
5242          (ii) there has been a failure by the recipient's attorney to comply with any provision of
5243     this section by:
5244          (A) failing to comply with the notice provisions of this section;
5245          (B) failing or refusing to enter into a collection agreement;
5246          (C) failing to comply with the terms of a collection agreement with the department; or
5247          (D) failing to disburse funds owed to the state in accordance with this section.
5248          (c) (i) The collection agreement shall be:
5249          (A) consistent with this section and the attorney's obligation to represent the recipient
5250     and represent the state's claim; and
5251          (B) state the terms under which the interests of the department may be represented in
5252     an action commenced by the recipient.
5253          (ii) If the recipient's attorney enters into a written collection agreement with the
5254     department, or includes the department's claim in the recipient's claim or action pursuant to
5255     Subsection (4), the department shall pay attorney fees at the rate of 33.3% of the department's
5256     total recovery and shall pay a proportionate share of the litigation expenses directly related to
5257     the action.
5258          (d) The department is not required to enter into a collection agreement with the
5259     recipient's attorney for collection of personal injury protection under Subsection
5260     31A-22-302(2).
5261          (3) (a) If the department receives notice pursuant to Subsection (1), and notifies the
5262     recipient and the recipient's attorney that the department will not enter into a collection
5263     agreement with the recipient's attorney, the recipient may proceed with the recipient's claim or
5264     action against the third party if the recipient excludes from the claim:
5265          (i) any medical expenses paid by the department; or
5266          (ii) any medical costs for which the department is obligated to provide medical

5267     assistance.
5268          (b) When a recipient proceeds with a claim under Subsection (3)(a), the recipient shall
5269     provide written notice to the third party of the exclusion of the department's claim for expenses
5270     under Subsection (3)(a)(i) or (ii).
5271          (4) If the department receives notice pursuant to Subsection (1), and does not respond
5272     within 30 days to the recipient or the recipient's attorney, the recipient or the recipient's
5273     attorney:
5274          (a) may proceed with the recipient's claim or action against the third party;
5275          (b) may include the state's claim in the recipient's claim or action; and
5276          (c) may not negotiate, compromise, settle, or waive the department's claim without the
5277     department's consent.
5278          Section 144. Section 26B-3-1012, which is renumbered from Section 26-19-404 is
5279     renumbered and amended to read:
5280          [26-19-404].      26B-3-1012. Department's right to intervene -- Department's
5281     interests protected -- Remitting funds -- Disbursements -- Liability and penalty for
5282     noncompliance.
5283          (1) The department has an unconditional right to intervene in an action commenced by
5284     a recipient against a third party for the purpose of recovering medical costs for which the
5285     department has provided or has become obligated to provide medical assistance.
5286          (2) (a) If the recipient proceeds without complying with the provisions of Section
5287     [26-19-403] 26B-3-1011, the department is not bound by any decision, judgment, agreement,
5288     settlement, or compromise rendered or made on the claim or in the action.
5289          (b) The department:
5290          (i) may recover in full from the recipient, or any party to which the proceeds were
5291     made payable, all medical assistance that the department has provided; and
5292          (ii) retains its right to commence an independent action against the third party, subject
5293     to Subsection [26-19-401] 26B-3-1009(3).

5294          (3) Any amounts assigned to and recoverable by the department pursuant to Sections
5295     [26-19-201 and 26-19-401] 26B-3-1003 and 26B-3-1009 collected directly by the recipient
5296     shall be remitted to the Bureau of Medical Collections within the Office of Recovery Services
5297     no later than five business days after receipt.
5298          (4) (a) Any amounts assigned to and recoverable by the department pursuant to
5299     Sections [26-19-201 and 26-19-401] 26B-3-1003 and 26B-3-1009 collected directly by the
5300     recipient's attorney shall be remitted to the Bureau of Medical Collections within the Office of
5301     Recovery Services no later than 30 days after the funds are placed in the attorney's trust
5302     account.
5303          (b) The date by which the funds shall be remitted to the department may be modified
5304     based on agreement between the department and the recipient's attorney.
5305          (c) The department's consent to another date for remittance may not be unreasonably
5306     withheld.
5307          (d) If the funds are received by the recipient's attorney, no disbursements shall be made
5308     to the recipient or the recipient's attorney until the department's claim has been paid.
5309          (5) A recipient or recipient's attorney who knowingly and intentionally fails to comply
5310     with this section is liable to the department for:
5311          (a) the amount of the department's claim or lien pursuant to Subsection (1);
5312          (b) a penalty equal to 10% of the amount of the department's claim; and
5313          (c) attorney fees and litigation expenses related to recovering the department's claim.
5314          Section 145. Section 26B-3-1013, which is renumbered from Section 26-19-405 is
5315     renumbered and amended to read:
5316          [26-19-405].      26B-3-1013. Estate and trust recovery.
5317          (1) (a) Except as provided in Subsection (1)(b), upon a recipient's death, the
5318     department may recover from the recipient's recovery estate and any trust, in which the
5319     recipient is the grantor and a beneficiary, medical assistance correctly provided for the benefit
5320     of the recipient when the recipient was 55 years [of age] old or older.

5321          (b) The department may not make an adjustment or a recovery under Subsection (1)(a):
5322          (i) while the deceased recipient's spouse is still living; or
5323          (ii) if the deceased recipient has a surviving child who is:
5324          (A) under [age] 21 years old; or
5325          (B) blind or disabled, as defined in the state plan.
5326          (2) (a) The amount of medical assistance correctly provided for the benefit of a
5327     recipient and recoverable under this section is a lien against the deceased recipient's recovery
5328     estate or any trust when the recipient is the grantor and a beneficiary.
5329          (b) The lien holds the same priority as reasonable and necessary medical expenses of
5330     the last illness as provided in Section 75-3-805.
5331          (3) (a) For a lien described in Subsection (2), the department shall provide notice in
5332     accordance with Section 38-12-102.
5333          (b) Before final distribution, the department shall perfect the lien as follows:
5334          (i) for an estate, by presenting the lien to the estate's personal representative in
5335     accordance with Section 75-3-804; and
5336          (ii) for a trust, by presenting the lien to the trustee in accordance with Section
5337     75-7-510.
5338          (c) The department may file an amended lien before the entry of the final order to close
5339     the estate or trust.
5340          (4) Claims against a deceased recipient's inter vivos trust shall be presented in
5341     accordance with Sections 75-7-509 and 75-7-510.
5342          (5) Any trust provision that denies recovery for medical assistance is void at the time of
5343     its making.
5344          (6) Nothing in this section affects the right of the department to recover Medicaid
5345     assistance before a recipient's death under Section [26-19-201 or Section 26-19-406]
5346     26B-3-1003 or 26B-3-1014.
5347          (7) A lien imposed under this section is of indefinite duration.

5348          Section 146. Section 26B-3-1014, which is renumbered from Section 26-19-406 is
5349     renumbered and amended to read:
5350          [26-19-406].      26B-3-1014. Recovery from recipient of incorrectly provided
5351     medical assistance.
5352          The department may:
5353          (1) recover medical assistance incorrectly provided, whether due to administrative or
5354     factual error or fraud, from the recipient or the recipient's recovery estate; and
5355          (2) pursuant to a judgment, impose a lien against real property of the recipient.
5356          Section 147. Section 26B-3-1015, which is renumbered from Section 26-19-501 is
5357     renumbered and amended to read:
5358          [26-19-501].      26B-3-1015. TEFRA liens authorized -- Grounds for TEFRA
5359     liens -- Exemptions.
5360          (1) Except as provided in Subsections (2) and (3), the department may impose a
5361     TEFRA lien on the real property of an individual for the amount of medical assistance provided
5362     for, or to, the individual while the individual is an inpatient in a care facility, if:
5363          (a) the individual is an inpatient in a care facility;
5364          (b) the individual is required, as a condition of receiving services under the state plan,
5365     to spend for costs of medical care all but a minimal amount of the individual's income required
5366     for personal needs; and
5367          (c) the department determines that the individual cannot reasonably be expected to:
5368          (i) be discharged from the care facility; and
5369          (ii) return to the individual's home.
5370          (2) The department may not impose a lien on the home of an individual described in
5371     Subsection (1), if any of the following individuals are lawfully residing in the home:
5372          (a) the spouse of the individual;
5373          (b) a child of the individual, if the child is:
5374          (i) under 21 years [of age] old; or

5375          (ii) blind or permanently and totally disabled, as defined in Title 42 U.S.C. Sec.
5376     1382c(a)(3)(F); or
5377          (c) a sibling of the individual, if the sibling:
5378          (i) has an equity interest in the home; and
5379          (ii) resided in the home for at least one year immediately preceding the day on which
5380     the individual was admitted to the care facility.
5381          (3) The department may not impose a TEFRA lien on the real property of an
5382     individual, unless:
5383          (a) the individual has been an inpatient in a care facility for the 180-day period
5384     immediately preceding the day on which the lien is imposed;
5385          (b) the department serves:
5386          (i) a preliminary notice of intent to impose a TEFRA lien relating to the real property,
5387     in accordance with Section [26-19-503] 26B-3-1017; and
5388          (ii) a final notice of intent to impose a TEFRA lien relating to the real property, in
5389     accordance with Section [26-19-504] 26B-3-1018; and
5390          (c) (i) the individual does not file a timely request for review of the department's
5391     decision under Title 63G, Chapter 4, Administrative Procedures Act; or
5392          (ii) the department's decision is upheld upon final review or appeal under Title 63G,
5393     Chapter 4, Administrative Procedures Act.
5394          Section 148. Section 26B-3-1016, which is renumbered from Section 26-19-502 is
5395     renumbered and amended to read:
5396          [26-19-502].      26B-3-1016. Presumption of permanency.
5397          There is a rebuttable presumption that an individual who is an inpatient in a care facility
5398     cannot reasonably be expected to be discharged from a care facility and return to the
5399     individual's home, if the individual has been an inpatient in a care facility for a period of at
5400     least 180 consecutive days.
5401          Section 149. Section 26B-3-1017, which is renumbered from Section 26-19-503 is

5402     renumbered and amended to read:
5403          [26-19-503].      26B-3-1017. Preliminary notice of intent to impose a TEFRA
5404     lien.
5405          (1) Prior to imposing a TEFRA lien on real property, the department shall serve a
5406     preliminary notice of intent to impose a TEFRA lien, on the individual described in Subsection
5407     [26-19-501] 26B-3-1015(1), who owns the property.
5408          (2) The preliminary notice of intent shall:
5409          (a) be served in person, or by certified mail, on the individual described in Subsection
5410     [26-19-501] 26B-3-1015(1), and, if the department is aware that the individual has a legally
5411     authorized representative, on the representative;
5412          (b) include a statement indicating that, according to the department's records, the
5413     individual:
5414          (i) meets the criteria described in Subsections [26-19-501] 26B-3-1015(1)(a) and (b);
5415          (ii) has been an inpatient in a care facility for a period of at least 180 days immediately
5416     preceding the day on which the department provides the notice to the individual; and
5417          (iii) is legally presumed to be in a condition where it cannot reasonably be expected
5418     that the individual will be discharged from the care facility and return to the individual's home;
5419          (c) indicate that the department intends to impose a TEFRA lien on real property
5420     belonging to the individual;
5421          (d) describe the real property that the TEFRA lien will apply to;
5422          (e) describe the current amount of, and purpose of, the TEFRA lien;
5423          (f) indicate that the amount of the lien may continue to increase as the individual
5424     continues to receive medical assistance;
5425          (g) indicate that the individual may seek to prevent the TEFRA lien from being
5426     imposed on the real property by providing documentation to the department that:
5427          (i) establishes that the individual does not meet the criteria described in Subsection
5428     [26-19-501] 26B-3-1015(1)(a) or (b);

5429          (ii) establishes that the individual has not been an inpatient in a care facility for a
5430     period of at least 180 days;
5431          (iii) rebuts the presumption described in Section [26-19-502] 26B-3-1016; or
5432          (iv) establishes that the real property is exempt from imposition of a TEFRA lien under
5433     Subsection [26-19-501] 26B-3-1015(2);
5434          (h) indicate that if the owner fails to provide the documentation described in
5435     Subsection (2)(g) within 30 days after the day on which the preliminary notice of intent is
5436     served, the department will issue a final notice of intent to impose a TEFRA lien on the real
5437     property and will proceed to impose the lien;
5438          (i) identify the type of documentation that the owner may provide to comply with
5439     Subsection (2)(g);
5440          (j) describe the circumstances under which a TEFRA lien is required to be released;
5441     and
5442          (k) describe the circumstances under which the department may seek to recover the
5443     lien.
5444          Section 150. Section 26B-3-1018, which is renumbered from Section 26-19-504 is
5445     renumbered and amended to read:
5446          [26-19-504].      26B-3-1018. Final notice of intent to impose a TEFRA lien.
5447          (1) The department may issue a final notice of intent to impose a TEFRA lien on real
5448     property if:
5449          (a) a preliminary notice of intent relating to the property is served in accordance with
5450     Section [26-19-503] 26B-3-1017;
5451          (b) it is at least 30 days after the day on which the preliminary notice of intent was
5452     served; and
5453          (c) the department has not received documentation or other evidence that adequately
5454     establishes that a TEFRA lien may not be imposed on the real property.
5455          (2) The final notice of intent to impose a TEFRA lien on real property shall:

5456          (a) be served in person, or by certified mail, on the individual described in Subsection
5457     [26-19-501] 26B-3-1015(1), who owns the property, and, if the department is aware that the
5458     individual has a legally authorized representative, on the representative;
5459          (b) indicate that the department has complied with the requirements for filing the final
5460     notice of intent under Subsection (1);
5461          (c) include a statement indicating that, according to the department's records, the
5462     individual:
5463          (i) meets the criteria described in Subsections [26-19-501] 26B-3-1015(1)(a) and (b);
5464          (ii) has been an inpatient in a care facility for a period of at least 180 days immediately
5465     preceding the day on which the department provides the notice to the individual; and
5466          (iii) is legally presumed to be in a condition where it cannot reasonably be expected
5467     that the individual will be discharged from the care facility and return to the individual's home;
5468          (d) indicate that the department intends to impose a TEFRA lien on real property
5469     belonging to the individual;
5470          (e) describe the real property that the TEFRA lien will apply to;
5471          (f) describe the current amount of, and purpose of, the TEFRA lien;
5472          (g) indicate that the amount of the lien may continue to increase as the individual
5473     continues to receive medical assistance;
5474          (h) describe the circumstances under which a TEFRA lien is required to be released;
5475          (i) describe the circumstances under which the department may seek to recover the
5476     lien;
5477          (j) describe the right of the individual to challenge the decision of the department in an
5478     adjudicative proceeding; and
5479          (k) indicate that failure by the individual to successfully challenge the decision of the
5480     department will result in the TEFRA lien being imposed.
5481          Section 151. Section 26B-3-1019, which is renumbered from Section 26-19-505 is
5482     renumbered and amended to read:

5483          [26-19-505].      26B-3-1019. Review of department decision.
5484          An individual who has been served with a final notice of intent to impose a TEFRA lien
5485     under Section [26-19-504] 26B-3-1018 may seek agency or judicial review of that decision
5486     under Title 63G, Chapter 4, Administrative Procedures Act.
5487          Section 152. Section 26B-3-1020, which is renumbered from Section 26-19-506 is
5488     renumbered and amended to read:
5489          [26-19-506].      26B-3-1020. Dissolution and removal of TEFRA lien.
5490          (1) A TEFRA lien shall dissolve and be removed by the department if the individual
5491     described in Subsection [26-19-501] 26B-3-1015(1):
5492          (a) (i) is discharged from the care facility; and
5493          (ii) returns to the individual's home; or
5494          (b) provides sufficient documentation to the department that:
5495          (i) rebuts the presumption described in Section [26-19-502] 26B-3-1016; or
5496          (ii) any of the following individuals are lawfully residing in the individual's home:
5497          (A) the spouse of the individual;
5498          (B) a child of the individual, if the child is under 21 years [of age] old or blind or
5499     permanently and totally disabled, as defined in Title 42 U.S.C. Sec. 1382c(a)(3)(F); or
5500          (C) a sibling of the individual, if the sibling has an equity interest in the home and
5501     resided in the home for at least one year immediately preceding the day on which the individual
5502     was admitted to the care facility.
5503          (2) An individual described in Subsection [26-19-501] 26B-3-1015(1)(a) may, at any
5504     time after the department has imposed a lien under [this part] Sections 26B-3-1015 through
5505     26B-3-1023, file a request for the department to remove the lien.
5506          (3) A request filed under Subsection (2) shall be considered and reviewed pursuant to
5507     Title 63G, Chapter 4, Administrative Procedures Act.
5508          Section 153. Section 26B-3-1021, which is renumbered from Section 26-19-507 is
5509     renumbered and amended to read:

5510          [26-19-507].      26B-3-1021. Expenditures included in lien -- Other
5511     proceedings.
5512          (1) A TEFRA lien imposed on real property under [this part] Sections 26B-3-1015
5513     through 26B-3-1023 includes all expenses relating to medical assistance provided or paid for
5514     under the state plan from the first day that the individual is placed in a care facility, regardless
5515     of when the lien is imposed or filed on the property.
5516          (2) Nothing in [this part affects or prevents] Sections 26B-3-1015 through 26B-3-1023
5517     affect
or prevent the department from bringing or pursuing any other legally authorized action
5518     to recover medical assistance or to set aside a fraudulent or improper conveyance.
5519          Section 154. Section 26B-3-1022, which is renumbered from Section 26-19-508 is
5520     renumbered and amended to read:
5521          [26-19-508].      26B-3-1022. Contract with another government agency.
5522          If the department contracts with another government agency to recover funds paid for
5523     medical assistance under this [chapter] part, that government agency shall be the sole agency
5524     that determines whether to impose or remove a TEFRA lien under [this part] Sections
5525     26B-3-1015 through 26B-3-1023.
5526          Section 155. Section 26B-3-1023, which is renumbered from Section 26-19-509 is
5527     renumbered and amended to read:
5528          [26-19-509].      26B-3-1023. Precedence of the Tax Equity and Fiscal
5529     Responsibility Act of 1982.
5530          If any provision of [this part conflicts] Sections 26B-3-1015 through 26B-3-1023
5531     
conflict with the requirements of the Tax Equity and Fiscal Responsibility Act of 1982 for
5532     imposing a lien against the property of an individual prior to the individual's death, under 42
5533     U.S.C. Sec. 1396p, the provisions of the Tax Equity and Fiscal Responsibility Act of 1982 take
5534     precedence and shall be complied with by the department.
5535          Section 156. Section 26B-3-1024, which is renumbered from Section 26-19-601 is
5536     renumbered and amended to read:

5537          [26-19-601].      26B-3-1024. Legal recognition of electronic claims records.
5538          Pursuant to Title 46, Chapter 4, Uniform Electronic Transactions Act:
5539          (1) a claim submitted to the department for payment may not be denied legal effect,
5540     enforceability, or admissibility as evidence in any court in any civil action because it is in
5541     electronic form; and
5542          (2) a third party shall accept an electronic record of payments by the department for
5543     medical services on behalf of a recipient as evidence in support of the department's claim.
5544          Section 157. Section 26B-3-1025, which is renumbered from Section 26-19-602 is
5545     renumbered and amended to read:
5546          [26-19-602].      26B-3-1025. Direct payment to the department by third
5547     party.
5548          (1) Any third party required to make payment to the department pursuant to this
5549     [chapter] part shall make the payment directly to the department or its designee.
5550          (2) The department may negotiate a payment or payment instrument it receives in
5551     connection with Subsection (1) without the cosignature or other participation of the recipient or
5552     any other party.
5553          Section 158. Section 26B-3-1026, which is renumbered from Section 26-19-603 is
5554     renumbered and amended to read:
5555          [26-19-603].      26B-3-1026. Attorney general or county attorney to
5556     represent department.
5557          The attorney general or a county attorney shall represent the department in any action
5558     commenced under this [chapter] part.
5559          Section 159. Section 26B-3-1027, which is renumbered from Section 26-19-604 is
5560     renumbered and amended to read:
5561          [26-19-604].      26B-3-1027. Department's right to attorney fees and costs.
5562          In any action brought by the department under this [chapter] part in which it prevails,
5563     the department shall recover along with the principal sum and interest, a reasonable attorney

5564     fee and costs incurred.
5565          Section 160. Section 26B-3-1028, which is renumbered from Section 26-19-605 is
5566     renumbered and amended to read:
5567          [26-19-605].      26B-3-1028. Application of provisions contrary to federal
5568     law prohibited.
5569          In no event shall any provision contained in this [chapter] part be applied contrary to
5570     existing federal law.
5571          Section 161. Section 26B-3-1101, which is renumbered from Section 26-20-2 is
5572     renumbered and amended to read:
5573     
Part 11. Utah False Claims Act

5574          [26-20-2].      26B-3-1101. Definitions.
5575          As used in this [chapter] part:
5576          (1) "Benefit" means the receipt of money, goods, or any other thing of pecuniary value.
5577          (2) "Claim" means any request or demand for money or property:
5578          (a) made to any:
5579          (i) employee, officer, or agent of the state;
5580          (ii) contractor with the state; or
5581          (iii) grantee or other recipient, whether or not under contract with the state; and
5582          (b) if:
5583          (i) any portion of the money or property requested or demanded was issued from or
5584     provided by the state; or
5585          (ii) the state will reimburse the contractor, grantee, or other recipient for any portion of
5586     the money or property.
5587          (3) "False statement" or "false representation" means a wholly or partially untrue
5588     statement or representation which is:
5589          (a) knowingly made; and
5590          (b) a material fact with respect to the claim.

5591          (4) "Knowing" and "knowingly":
5592          (a) for purposes of criminal prosecutions for violations of this [chapter] part, is one of
5593     the culpable mental states described in Subsection [26-20-9] 26B-3-1108(1); and
5594          (b) for purposes of civil prosecutions for violations of this [chapter] part, is the
5595     required culpable mental state as defined in Subsection [26-20-9.5] 26B-3-1109(1).
5596          (5) "Medical benefit" means a benefit paid or payable to a recipient or a provider under
5597     a program administered by the state under:
5598          (a) Titles V and XIX of the federal Social Security Act;
5599          (b) Title X of the federal Public Health Services Act;
5600          (c) the federal Child Nutrition Act of 1966 as amended by [P.L.] Pub. L. No. 94-105;
5601     and
5602          (d) any programs for medical assistance of the state.
5603          (6) "Person" means an individual, corporation, unincorporated association, professional
5604     corporation, partnership, or other form of business association.
5605          Section 162. Section 26B-3-1102, which is renumbered from Section 26-20-3 is
5606     renumbered and amended to read:
5607          [26-20-3].      26B-3-1102. False statement or representation relating to medical
5608     benefits.
5609          (1) A person may not make or cause to be made a false statement or false representation
5610     of a material fact in an application for medical benefits.
5611          (2) A person may not make or cause to be made a false statement or false
5612     representation of a material fact for use in determining rights to a medical benefit.
5613          (3) A person, who having knowledge of the occurrence of an event affecting the
5614     person's initial or continued right to receive a medical benefit or the initial or continued right of
5615     any other person on whose behalf the person has applied for or is receiving a medical benefit,
5616     may not conceal or fail to disclose that event with intent to obtain a medical benefit to which
5617     the person or any other person is not entitled or in an amount greater than that to which the

5618     person or any other person is entitled.
5619          Section 163. Section 26B-3-1103, which is renumbered from Section 26-20-4 is
5620     renumbered and amended to read:
5621          [26-20-4].      26B-3-1103. Kickbacks or bribes prohibited.
5622          (1) For purposes of this section, kickback or bribe:
5623          (a) includes rebates, compensation, or any other form of remuneration which is:
5624          (i) direct or indirect;
5625          (ii) overt or covert; or
5626          (iii) in cash or in kind; and
5627          (b) does not include a rebate paid to the state under 42 U.S.C. Sec. 1396r-8 or any state
5628     supplemental rebates.
5629          (2) A person may not solicit, offer, pay, or receive a kickback or bribe in return for or
5630     to induce:
5631          (a) the purchasing, leasing, or ordering of any goods or services for which payment is
5632     or may be made in whole or in part pursuant to a medical benefit program; or
5633          (b) the referral of an individual to another person for the furnishing of any goods or
5634     services for which payment is or may be made in whole or in part pursuant to a medical benefit
5635     program.
5636          Section 164. Section 26B-3-1104, which is renumbered from Section 26-20-5 is
5637     renumbered and amended to read:
5638          [26-20-5].      26B-3-1104. False statements or false representations relating to
5639     qualification of health institution or facility prohibited -- Felony.
5640          (1) A person may not knowingly, intentionally, or recklessly make, induce, or seek to
5641     induce, the making of a false statement or false representation of a material fact with respect to
5642     the conditions or operation of an institution or facility in order that the institution or facility
5643     may qualify, upon initial certification or upon recertification, as a hospital, skilled nursing
5644     facility, intermediate care facility, or home health agency.

5645          (2) A person who violates this section is guilty of a second degree felony.
5646          Section 165. Section 26B-3-1105, which is renumbered from Section 26-20-6 is
5647     renumbered and amended to read:
5648          [26-20-6].      26B-3-1105. Conspiracy to defraud prohibited.
5649          A person may not enter into an agreement, combination, or conspiracy to defraud the
5650     state by obtaining or aiding another to obtain the payment or allowance of a false, fictitious, or
5651     fraudulent claim for a medical benefit.
5652          Section 166. Section 26B-3-1106, which is renumbered from Section 26-20-7 is
5653     renumbered and amended to read:
5654          [26-20-7].      26B-3-1106. False claims for medical benefits prohibited.
5655          (1) A person may not make or present or cause to be made or presented to an employee
5656     or officer of the state a claim for a medical benefit:
5657          (a) which is wholly or partially false, fictitious, or fraudulent;
5658          (b) for services which were not rendered or for items or materials which were not
5659     delivered;
5660          (c) which misrepresents the type, quality, or quantity of items or services rendered;
5661          (d) representing charges at a higher rate than those charged by the provider to the
5662     general public;
5663          (e) for items or services which the person or the provider knew were not medically
5664     necessary in accordance with professionally recognized standards;
5665          (f) which has previously been paid;
5666          (g) for services also covered by one or more private sources when the person or
5667     provider knew of the private sources without disclosing those sources on the claim; or
5668          (h) where a provider:
5669          (i) unbundles a product, procedure, or group of procedures usually and customarily
5670     provided or performed as a single billable product or procedure into artificial components or
5671     separate procedures; and

5672          (ii) bills for each component of the product, procedure, or group of procedures:
5673          (A) as if they had been provided or performed independently and at separate times; and
5674          (B) the aggregate billing for the components exceeds the amount otherwise billable for
5675     the usual and customary single product or procedure.
5676          (2) In addition to the prohibitions in Subsection (1), a person may not:
5677          (a) fail to credit the state for payments received from other sources;
5678          (b) recover or attempt to recover payment in violation of the provider agreement from:
5679          (i) a recipient under a medical benefit program; or
5680          (ii) the recipient's family;
5681          (c) falsify or alter with intent to deceive, any report or document required by state or
5682     federal law, rule, or Medicaid provider agreement;
5683          (d) retain any unauthorized payment as a result of acts described by this section; or
5684          (e) aid or abet the commission of any act prohibited by this section.
5685          Section 167. Section 26B-3-1107, which is renumbered from Section 26-20-8 is
5686     renumbered and amended to read:
5687          [26-20-8].      26B-3-1107. Knowledge of past acts not necessary to establish fact
5688     that false statement or representation knowingly made.
5689          In prosecution under this [chapter] part, it is not necessary to show that the person had
5690     knowledge of similar acts having been performed in the past on the part of persons acting on
5691     his behalf nor to show that the person had actual notice that the acts by the persons acting on
5692     his behalf occurred to establish the fact that a false statement or representation was knowingly
5693     made.
5694          Section 168. Section 26B-3-1108, which is renumbered from Section 26-20-9 is
5695     renumbered and amended to read:
5696          [26-20-9].      26B-3-1108. Criminal penalties.
5697          (1) (a) Except as provided in Subsection (1)(b) the culpable mental state required for a
5698     criminal violation of this [chapter] part is knowingly, intentionally, or recklessly as defined in

5699     Section 76-2-103.
5700          (b) The culpable mental state required for a criminal violation of this [chapter] part for
5701     kickbacks and bribes under Section [26-20-4] 26B-3-1103 is knowingly and intentionally as
5702     defined in Section 76-2-103.
5703          (2) The punishment for a criminal violation of any provision of this [chapter] part,
5704     except as provided under Section [26-20-5] 26B-3-1104, is determined by the cumulative value
5705     of the funds or other benefits received or claimed in the commission of all violations of a
5706     similar nature, and not by each separate violation.
5707          (3) Punishment for criminal violation of this [chapter] part, except as provided under
5708     Section [26-20-5] 26B-3-1104, is a felony of the second degree, felony of the third degree,
5709     class A misdemeanor, or class B misdemeanor based on the dollar amounts as prescribed by
5710     Subsection 76-6-412(1) for theft of property and services.
5711          Section 169. Section 26B-3-1109, which is renumbered from Section 26-20-9.5 is
5712     renumbered and amended to read:
5713          [26-20-9.5].      26B-3-1109. Civil penalties.
5714          (1) The culpable mental state required for a civil violation of this [chapter] part is
5715     "knowing" or "knowingly" which:
5716          (a) means that person, with respect to information:
5717          (i) has actual knowledge of the information;
5718          (ii) acts in deliberate ignorance of the truth or falsity of the information; or
5719          (iii) acts in reckless disregard of the truth or falsity of the information; and
5720          (b) does not require a specific intent to defraud.
5721          (2) Any person who violates this [chapter] part shall, in all cases, in addition to other
5722     penalties provided by law, be required to:
5723          (a) make full and complete restitution to the state of all damages that the state sustains
5724     because of the person's violation of this [chapter] part;
5725          (b) pay to the state its costs of enforcement of this [chapter] part in that case, including

5726     the cost of investigators, attorneys, and other public employees, as determined by the state; and
5727          (c) pay to the state a civil penalty equal to:
5728          (i) three times the amount of damages that the state sustains because of the person's
5729     violation of this [chapter] part; and
5730          (ii) not less than $5,000 or more than $10,000 for each claim filed or act done in
5731     violation of this [chapter] part.
5732          (3) Any civil penalties assessed under Subsection (2) shall be awarded by the court as
5733     part of its judgment in both criminal and civil actions.
5734          (4) A criminal action need not be brought against a person in order for that person to be
5735     civilly liable under this section.
5736          Section 170. Section 26B-3-1110, which is renumbered from Section 26-20-10 is
5737     renumbered and amended to read:
5738          [26-20-10].      26B-3-1110. Revocation of license of assisted living facility --
5739     Appointment of receiver.
5740          (1) If the license of an assisted living facility is revoked for violation of this [chapter]
5741     part, the county attorney may file a petition with the district court for the county in which the
5742     facility is located for the appointment of a receiver.
5743          (2) The district court shall issue an order to show cause why a receiver should not be
5744     appointed returnable within five days after the filing of the petition.
5745          (3) (a) If the court finds that the facts warrant the granting of the petition, the court
5746     shall appoint a receiver to take charge of the facility.
5747          (b) The court may determine fair compensation for the receiver.
5748          (4) A receiver appointed pursuant to this section shall have the powers and duties
5749     prescribed by the court.
5750          Section 171. Section 26B-3-1111, which is renumbered from Section 26-20-11 is
5751     renumbered and amended to read:
5752          [26-20-11].      26B-3-1111. Presumption based on paid state warrant -- Value of

5753     medical benefits -- Repayment of benefits.
5754          (1) In any civil or criminal action brought under this [chapter] part, a paid state
5755     warrant, made payable to the order of a party, creates a presumption that the party received
5756     funds from the state.
5757          (2) In any civil or criminal action brought under this [chapter] part, the value of the
5758     benefits received shall be the ordinary or usual charge for similar benefits in the private sector.
5759          (3) In any criminal action under this [chapter] part, the repayment of funds or other
5760     benefits obtained in violation of the provisions of this [chapter] part does not constitute a
5761     defense to, or grounds for dismissal of that action.
5762          Section 172. Section 26B-3-1112, which is renumbered from Section 26-20-12 is
5763     renumbered and amended to read:
5764          [26-20-12].      26B-3-1112. Violation of other laws.
5765          (1) The provisions of this [chapter] part are:
5766          (a) not exclusive, and the remedies provided for in this [chapter] part are in addition to
5767     any other remedies provided for under:
5768          (i) any other applicable law; or
5769          (ii) common law; and
5770          (b) to be liberally construed and applied to:
5771          (i) effectuate the chapter's remedial and deterrent purposes; and
5772          (ii) serve the public interest.
5773          (2) If any provision of this [chapter] part or the application of this [chapter] part to any
5774     person or circumstance is held unconstitutional:
5775          (a) the remaining provisions of this [chapter] part are not affected; and
5776          (b) the application of this [chapter] part to other persons or circumstances are not
5777     affected.
5778          Section 173. Section 26B-3-1113, which is renumbered from Section 26-20-13 is
5779     renumbered and amended to read:

5780          [26-20-13].      26B-3-1113. Medicaid fraud enforcement.
5781          (1) This [chapter] part shall be enforced in accordance with this section.
5782          (2) The department is responsible for:
5783          (a) (i) investigating and prosecuting suspected civil violations of this [chapter] part; or
5784          (ii) referring suspected civil violations of this [chapter] part to the attorney general for
5785     investigation and prosecution; and
5786          (b) promptly referring suspected criminal violations of this [chapter] part to the
5787     attorney general for criminal investigation and prosecution.
5788          (3) The attorney general has:
5789          (a) concurrent jurisdiction with the department for investigating and prosecuting
5790     suspected civil violations of this [chapter] part; and
5791          (b) exclusive jurisdiction to investigate and prosecute all suspected criminal violations
5792     of this [chapter] part.
5793          (4) The department and the attorney general share concurrent civil enforcement
5794     authority under this [chapter] part and may enter into an interagency agreement regarding the
5795     investigation and prosecution of violations of this [chapter] part in accordance with this
5796     section, the requirements of Title XIX of the federal Social Security Act, and applicable federal
5797     regulations.
5798          (5) (a) Any violation of this [chapter] part which comes to the attention of any state
5799     government officer or agency shall be reported to the attorney general or the department.
5800          (b) All state government officers and agencies shall cooperate with and assist in any
5801     prosecution for violation of this [chapter] part.
5802          Section 174. Section 26B-3-1114, which is renumbered from Section 26-20-14 is
5803     renumbered and amended to read:
5804          [26-20-14].      26B-3-1114. Investigations -- Civil investigative demands.
5805          (1) The attorney general may take investigative action under Subsection (2) if the
5806     attorney general has reason to believe that:

5807          (a) a person has information or custody or control of documentary material relevant to
5808     the subject matter of an investigation of an alleged violation of this [chapter] part;
5809          (b) a person is committing, has committed, or is about to commit a violation of this
5810     [chapter] part; or
5811          (c) it is in the public interest to conduct an investigation to ascertain whether or not a
5812     person is committing, has committed, or is about to commit a violation of this [chapter] part.
5813          (2) In taking investigative action, the attorney general may:
5814          (a) require the person to file on a prescribed form a statement in writing, under oath or
5815     affirmation describing:
5816          (i) the facts and circumstances concerning the alleged violation of this [chapter] part;
5817     and
5818          (ii) other information considered necessary by the attorney general;
5819          (b) examine under oath a person in connection with the alleged violation of this
5820     [chapter] part; and
5821          (c) in accordance with Subsections (7) through (18), execute in writing, and serve on
5822     the person, a civil investigative demand requiring the person to produce the documentary
5823     material and permit inspection and copying of the material.
5824          (3) The attorney general may not release or disclose information that is obtained under
5825     Subsection (2)(a) or (b), or any documentary material or other record derived from the
5826     information obtained under Subsection (2)(a) or (b), except:
5827          (a) by court order for good cause shown;
5828          (b) with the consent of the person who provided the information;
5829          (c) to an employee of the attorney general or the department;
5830          (d) to an agency of this state, the United States, or another state;
5831          (e) to a special assistant attorney general representing the state in a civil action;
5832          (f) to a political subdivision of this state; or
5833          (g) to a person authorized by the attorney general to receive the information.

5834          (4) The attorney general may use documentary material derived from information
5835     obtained under Subsection (2)(a) or (b), or copies of that material, as the attorney general
5836     determines necessary in the enforcement of this [chapter] part, including presentation before a
5837     court.
5838          (5) (a) If a person fails to file a statement as required by Subsection (2)(a) or fails to
5839     submit to an examination as required by Subsection (2)(b), the attorney general may file in
5840     district court a complaint for an order to compel the person to within a period stated by court
5841     order:
5842          (i) file the statement required by Subsection (2)(a); or
5843          (ii) submit to the examination required by Subsection (2)(b).
5844          (b) Failure to comply with an order entered under Subsection (5)(a) is punishable as
5845     contempt.
5846          (6) A civil investigative demand shall:
5847          (a) state the rule or statute under which the alleged violation of this [chapter] part is
5848     being investigated;
5849          (b) describe the:
5850          (i) general subject matter of the investigation; and
5851          (ii) class or classes of documentary material to be produced with reasonable specificity
5852     to fairly indicate the documentary material demanded;
5853          (c) designate a date within which the documentary material is to be produced; and
5854          (d) identify an authorized employee of the attorney general to whom the documentary
5855     material is to be made available for inspection and copying.
5856          (7) A civil investigative demand may require disclosure of any documentary material
5857     that is discoverable under the Utah Rules of Civil Procedure.
5858          (8) Service of a civil investigative demand may be made by:
5859          (a) delivering an executed copy of the demand to the person to be served or to a
5860     partner, an officer, or an agent authorized by appointment or by law to receive service of

5861     process on behalf of that person;
5862          (b) delivering an executed copy of the demand to the principal place of business in this
5863     state of the person to be served; or
5864          (c) mailing by registered or certified mail an executed copy of the demand addressed to
5865     the person to be served:
5866          (i) at the person's principal place of business in this state; or
5867          (ii) if the person has no place of business in this state, to the person's principal office or
5868     place of business.
5869          (9) Documentary material demanded in a civil investigative demand shall be produced
5870     for inspection and copying during normal business hours at the office of the attorney general or
5871     as agreed by the person served and the attorney general.
5872          (10) The attorney general may not produce for inspection or copying or otherwise
5873     disclose the contents of documentary material obtained pursuant to a civil investigative demand
5874     except:
5875          (a) by court order for good cause shown;
5876          (b) with the consent of the person who produced the information;
5877          (c) to an employee of the attorney general or the department;
5878          (d) to an agency of this state, the United States, or another state;
5879          (e) to a special assistant attorney general representing the state in a civil action;
5880          (f) to a political subdivision of this state; or
5881          (g) to a person authorized by the attorney general to receive the information.
5882          (11) (a) With respect to documentary material obtained pursuant to a civil investigative
5883     demand, the attorney general shall prescribe reasonable terms and conditions allowing such
5884     documentary material to be available for inspection and copying by the person who produced
5885     the material or by an authorized representative of that person.
5886          (b) The attorney general may use such documentary material or copies of it as the
5887     attorney general determines necessary in the enforcement of this [chapter] part, including

5888     presentation before a court.
5889          (12) (a) A person may file a complaint, stating good cause, to extend the return date for
5890     the demand or to modify or set aside the demand.
5891          (b) A complaint under this Subsection (12) shall be filed in district court before the
5892     earlier of:
5893          [(a)] (i) the return date specified in the demand; or
5894          [(b)] (ii) the 20th day after the date the demand is served.
5895          (13) Except as provided by court order, a person who has been served with a civil
5896     investigative demand shall comply with the terms of the demand.
5897          (14) (a) A person who has committed a violation of this [chapter] part in relation to the
5898     Medicaid program in this state or to any other medical benefit program administered by the
5899     state has submitted to the jurisdiction of this state.
5900          (b) Personal service of a civil investigative demand under this section may be made on
5901     the person described in Subsection (14)(a) outside of this state.
5902          (15) This section does not limit the authority of the attorney general to conduct
5903     investigations or to access a person's documentary materials or other information under another
5904     state or federal law, the Utah Rules of Civil Procedure, or the Federal Rules of Civil Procedure.
5905          (16) The attorney general may file a complaint in district court for an order to enforce
5906     the civil investigative demand if:
5907          (a) a person fails to comply with a civil investigative demand; or
5908          (b) copying and reproduction of the documentary material demanded:
5909          (i) cannot be satisfactorily accomplished; and
5910          (ii) the person refuses to surrender the documentary material.
5911          (17) If a complaint is filed under Subsection (16), the court may determine the matter
5912     presented and may enter an order to enforce the civil investigative demand.
5913          (18) Failure to comply with a final order entered under Subsection (17) is punishable
5914     by contempt.

5915          Section 175. Section 26B-3-1115, which is renumbered from Section 26-20-15 is
5916     renumbered and amended to read:
5917          [26-20-15].      26B-3-1115. Limitation of actions -- Civil acts antedating this
5918     section -- Civil burden of proof -- Estoppel -- Joint civil liability -- Venue.
5919          (1) An action under this [chapter] part may not be brought after the later of:
5920          (a) six years after the date on which the violation was committed; or
5921          (b) three years after the date an official of the state charged with responsibility to act in
5922     the circumstances discovers the violation, but in no event more than 10 years after the date on
5923     which the violation was committed.
5924          (2) A civil action brought under this [chapter] part may be brought for acts occurring
5925     prior to the effective date of this section if the limitations period set forth in Subsection (1) has
5926     not lapsed.
5927          (3) In any civil action brought under this [chapter] part the state shall be required to
5928     prove by a preponderance of evidence, all essential elements of the cause of action including
5929     damages.
5930          (4) Notwithstanding any other provision of law, a final judgment rendered in favor of
5931     the state in any criminal proceeding under this [chapter] part, whether upon a verdict after trial
5932     or upon a plea of guilty or nolo contendere, shall estop the defendant from denying the essential
5933     elements of the offense in any civil action under this [chapter] part which involves the same
5934     transaction.
5935          (5) Civil liability under this [chapter] part shall be joint and several for a violation
5936     committed by two or more persons.
5937          (6) Any action brought by the state under this [chapter] part shall be brought in district
5938     court in Salt Lake County or in any county where the defendant resides or does business.
5939          Section 176. Section 26B-8-101 is amended to read:
5940     
CHAPTER 8. HEALTH DATA, VITAL STATISTICS, AND UTAH MEDICAL

5941     
EXAMINER


5942     
Part 1. Vital Statistics

5943          26B-8-101. Definitions.
5944          [Reserved]
5945          As used in this part:
5946          (1) "Adoption document" means an adoption-related document filed with the office, a
5947     petition for adoption, a decree of adoption, an original birth certificate, or evidence submitted
5948     in support of a supplementary birth certificate.
5949          (2) "Certified nurse midwife" means an individual who:
5950          (a) is licensed to practice as a certified nurse midwife under Title 58, Chapter 44a,
5951     Nurse Midwife Practice Act; and
5952          (b) has completed an education program regarding the completion of a certificate of
5953     death developed by the department by rule made in accordance with Title 63G, Chapter 3, Utah
5954     Administrative Rulemaking Act.
5955          (3) "Custodial funeral service director" means a funeral service director who:
5956          (a) is employed by a licensed funeral establishment; and
5957          (b) has custody of a dead body.
5958          (4) "Dead body" means a human body or parts of a human body from the condition of
5959     which it reasonably may be concluded that death occurred.
5960          (5) "Decedent" means the same as a dead body.
5961          (6) "Dead fetus" means a product of human conception, other than those circumstances
5962     described in Subsection 76-7-301(1):
5963          (a) of 20 weeks' gestation or more, calculated from the date the last normal menstrual
5964     period began to the date of delivery; and
5965          (b) that was not born alive.
5966          (7) "Declarant father" means a male who claims to be the genetic father of a child, and,
5967     along with the biological mother, signs a voluntary declaration of paternity to establish the
5968     child's paternity.

5969          (8) "Dispositioner" means:
5970          (a) a person designated in a written instrument, under Subsection 58-9-602(1), as
5971     having the right and duty to control the disposition of the decedent, if the person voluntarily
5972     acts as the dispositioner; or
5973          (b) the next of kin of the decedent, if:
5974          (i) (A) a person has not been designated as described in Subsection (8)(a); or
5975          (B) the person described in Subsection (8)(a) is unable or unwilling to exercise the
5976     right and duty described in Subsection (8)(a); and
5977          (ii) the next of kin voluntarily acts as the dispositioner.
5978          (9) "Fetal remains" means:
5979          (a) an aborted fetus as that term is defined in Section 26B-2-232; or
5980          (b) a miscarried fetus as that term is defined in Section 26B-2-233.
5981          (10) "File" means the submission of a completed certificate or other similar document,
5982     record, or report as provided under this part for registration by the state registrar or a local
5983     registrar.
5984          (11) "Funeral service director" means the same as that term is defined in Section
5985     58-9-102.
5986          (12) "Health care facility" means the same as that term is defined in Section
5987     26B-2-201.
5988          (13) "Health care professional" means a physician, physician assistant, nurse
5989     practitioner, or certified nurse midwife.
5990          (14) "Licensed funeral establishment" means:
5991          (a) if located in Utah, a funeral service establishment, as that term is defined in Section
5992     58-9-102, that is licensed under Title 58, Chapter 9, Funeral Services Licensing Act; or
5993          (b) if located in a state, district, or territory of the United States other than Utah, a
5994     funeral service establishment that complies with the licensing laws of the jurisdiction where the
5995     establishment is located.

5996          (15) "Live birth" means the birth of a child who shows evidence of life after the child is
5997     entirely outside of the mother.
5998          (16) "Local registrar" means a person appointed under Subsection 26B-8-102(3)(b).
5999          (17) "Nurse practitioner" means an individual who:
6000          (a) is licensed to practice as an advanced practice registered nurse under Title 58,
6001     Chapter 31b, Nurse Practice Act; and
6002          (b) has completed an education program regarding the completion of a certificate of
6003     death developed by the department by administrative rule made in accordance with Title 63G,
6004     Chapter 3, Utah Administrative Rulemaking Act.
6005          (18) "Office" means the Office of Vital Records and Statistics within the department.
6006          (19) "Physician" means a person licensed to practice as a physician or osteopath in this
6007     state under Title 58, Chapter 67, Utah Medical Practice Act, or Title 58, Chapter 68, Utah
6008     Osteopathic Medical Practice Act.
6009          (20) "Physician assistant" means an individual who:
6010          (a) is licensed to practice as a physician assistant under Title 58, Chapter 70a, Utah
6011     Physician Assistant Act; and
6012          (b) has completed an education program regarding the completion of a certificate of
6013     death developed by the department by administrative rule made in accordance with Title 63G,
6014     Chapter 3, Utah Administrative Rulemaking Act.
6015          (21) "Presumed father" means the father of a child conceived or born during a marriage
6016     as defined in Section 30-1-17.2.
6017          (22) "Registration" or "register" means acceptance by the local or state registrar of a
6018     certificate and incorporation of the certificate into the permanent records of the state.
6019          (23) "State registrar" means the state registrar of vital records appointed under Section
6020     26B-8-102.
6021          (24) "Vital records" means:
6022          (a) registered certificates or reports of birth, death, fetal death, marriage, divorce,

6023     dissolution of marriage, or annulment;
6024          (b) amendments to any of the registered certificates or reports described in Subsection
6025     (24)(a);
6026          (c) an adoption document; and
6027          (d) other similar documents.
6028          (25) "Vital statistics" means the data derived from registered certificates and reports of
6029     birth, death, fetal death, induced termination of pregnancy, marriage, divorce, dissolution of
6030     marriage, or annulment.
6031          Section 177. Section 26B-8-102, which is renumbered from Section 26-2-3 is
6032     renumbered and amended to read:
6033          [26-2-3].      26B-8-102. Department duties and authority.
6034          (1) As used in this section:
6035          (a) "Compact" means the Compact for Interstate Sharing of Putative Father Registry
6036     Information created in Section 78B-6-121.5, effective on May 10, 2016.
6037          (b) "Putative father":
6038          (i) means the same as that term is as defined in Section 78B-6-121.5; and
6039          (ii) includes an unmarried biological father.
6040          (c) "State registrar" means the state registrar of vital records appointed under
6041     Subsection (2)(e).
6042          (d) "Unmarried biological father" means the same as that term is defined in Section
6043     78B-6-103.
6044          (2) The department shall:
6045          (a) provide offices properly equipped for the preservation of vital records made or
6046     received under this [chapter] part;
6047          (b) establish a statewide vital records system for the registration, collection,
6048     preservation, amendment, and certification of vital records and other similar documents
6049     required by this [chapter] part and activities related to them, including the tabulation, analysis,

6050     and publication of vital statistics;
6051          (c) prescribe forms for certificates, certification, reports, and other documents and
6052     records necessary to establish and maintain a statewide system of vital records;
6053          (d) prepare an annual compilation, analysis, and publication of statistics derived from
6054     vital records; and
6055          (e) appoint a state registrar to direct the statewide system of vital records.
6056          (3) The department may:
6057          (a) divide the state from time to time into registration districts; and
6058          (b) appoint local registrars for registration districts who under the direction and
6059     supervision of the state registrar shall perform all duties required of them by this [chapter] part
6060     and department rules.
6061          (4) The state registrar appointed under Subsection (2)(e) shall, with the input of Utah
6062     stakeholders and the Uniform Law Commission, study the following items for the state's
6063     implementation of the compact:
6064          (a) the feasibility of using systems developed by the National Association for Public
6065     Health Statistics and Information Systems, including the State and Territorial Exchange of
6066     Vital Events (STEVE) system and the Electronic Verification of Vital Events (EVVE) system,
6067     or similar systems, to exchange putative father registry information with states that are parties
6068     to the compact;
6069          (b) procedures necessary to share putative father information, located in the
6070     confidential registry maintained by the state registrar, upon request from the state registrar of
6071     another state that is a party to the compact;
6072          (c) procedures necessary for the state registrar to access putative father information
6073     located in a state that is a party to the compact, and share that information with persons who
6074     request a certificate from the state registrar;
6075          (d) procedures necessary to ensure that the name of the mother of the child who is the
6076     subject of a putative father's notice of commencement, filed pursuant to Section 78B-6-121, is

6077     kept confidential when a state that is a party to the compact accesses this state's confidential
6078     registry through the state registrar; and
6079          (e) procedures necessary to ensure that a putative father's registration with a state that
6080     is a party to the compact is given the same effect as a putative father's notice of commencement
6081     filed pursuant to Section 78B-6-121.
6082          Section 178. Section 26B-8-103, which is renumbered from Section 26-2-4 is
6083     renumbered and amended to read:
6084          [26-2-4].      26B-8-103. Content and form of certificates and reports.
6085          (1) As used in this section:
6086          (a) "Additional information" means information that is beyond the information
6087     necessary to comply with federal standards or state law for registering a birth.
6088          (b) "Diacritical mark" means a mark on a letter from the ISO basic Latin alphabet used
6089     to indicate a special pronunciation.
6090          (c) "Diacritical mark" includes accents, tildes, graves, umlauts, and cedillas.
6091          (2) Except as provided in Subsection (8), to promote and maintain nationwide
6092     uniformity in the vital records system, the forms of certificates, certification, reports, and other
6093     documents and records required by this [chapter] part or the rules implementing this [chapter]
6094     part shall include as a minimum the items recommended by the federal agency responsible for
6095     national vital statistics, subject to approval, additions, and modifications by the department.
6096          (3) Certificates, certifications, forms, reports, other documents and records, and the
6097     form of communications between persons required by this [chapter] part shall be prepared in
6098     the format prescribed by department rule.
6099          (4) All vital records shall include the date of filing.
6100          (5) Certificates, certifications, forms, reports, other documents and records, and
6101     communications between persons required by this [chapter] part may be signed, filed, verified,
6102     registered, and stored by photographic, electronic, or other means as prescribed by department
6103     rule.

6104          (6) (a) An individual may use a diacritical mark in an application for a vital record.
6105          (b) The office shall record a diacritical mark on a vital record as indicated on the
6106     application for the vital record.
6107          (7) The absence of a diacritical mark on a vital record does not render the document
6108     invalid or affect any constructive notice imparted by proper recordation of the document.
6109          (8) (a) The state:
6110          (i) may collect the Social Security number of a deceased individual; and
6111          (ii) may not include the Social Security number of an individual on a certificate of
6112     death.
6113          (b) For registering a birth, the department may not require an individual to provide
6114     additional information.
6115          (c) The department may request additional information if the department provides a
6116     written statement that:
6117          (i) discloses that providing the additional information is voluntary;
6118          (ii) discloses how the additional information will be used and the duration of use;
6119          (iii) describes how the department prevents the additional information from being used
6120     in a manner different from the disclosure given under Subsection [(6)(c)(ii)] (8)(c)(ii); and
6121          (iv) includes a notice that the individual is consenting to the department's use of the
6122     additional information by providing the additional information.
6123          (d) (i) Beginning July 1, 2022, an individual may submit a written request to the
6124     department to de-identify the individual's additional information contained in the department's
6125     databases.
6126          (ii) Upon receiving the written request, the department shall de-identify the additional
6127     information.
6128          (e) The department shall de-identify additional information contained in the
6129     department's databases before the additional information is held by the department for longer
6130     than six years.

6131          Section 179. Section 26B-8-104, which is renumbered from Section 26-2-5 is
6132     renumbered and amended to read:
6133          [26-2-5].      26B-8-104. Birth certificates -- Execution and registration
6134     requirements.
6135          (1) As used in this section, "birthing facility" means a general acute hospital or birthing
6136     center as defined in Section [26-21-2] 26B-2-201.
6137          (2) For each live birth occurring in the state, a certificate shall be filed with the local
6138     registrar for the district in which the birth occurred within 10 days following the birth. The
6139     certificate shall be registered if it is completed and filed in accordance with this [chapter] part.
6140          (3) (a) For each live birth that occurs in a birthing facility, the administrator of the
6141     birthing facility, or his designee, shall obtain and enter the information required under this
6142     [chapter] part on the certificate, securing the required signatures, and filing the certificate.
6143          (b) (i) The date, time, place of birth, and required medical information shall be certified
6144     by the birthing facility administrator or his designee.
6145          (ii) The attending physician or nurse midwife may sign the certificate, but if the
6146     attending physician or nurse midwife has not signed the certificate within seven days of the
6147     date of birth, the birthing facility administrator or his designee shall enter the attending
6148     physician's or nurse midwife's name and transmit the certificate to the local registrar.
6149          (iii) The information on the certificate about the parents shall be provided and certified
6150     by the mother or father or, in their incapacity or absence, by a person with knowledge of the
6151     facts.
6152          (4) (a) For live births that occur outside a birthing facility, the birth certificate shall be
6153     completed and filed by the physician, physician assistant, nurse, midwife, or other person
6154     primarily responsible for providing assistance to the mother at the birth. If there is no such
6155     person, either the presumed or declarant father shall complete and file the certificate. In his
6156     absence, the mother shall complete and file the certificate, and in the event of her death or
6157     disability, the owner or operator of the premises where the birth occurred shall do so.

6158          (b) The certificate shall be completed as fully as possible and shall include the date,
6159     time, and place of birth, the mother's name, and the signature of the person completing the
6160     certificate.
6161          (5) (a) For each live birth to an unmarried mother that occurs in a birthing facility, the
6162     administrator or director of that facility, or his designee, shall:
6163          (i) provide the birth mother and declarant father, if present, with:
6164          (A) a voluntary declaration of paternity form published by the state registrar;
6165          (B) oral and written notice to the birth mother and declarant father of the alternatives
6166     to, the legal consequences of, and the rights and responsibilities that arise from signing the
6167     declaration; and
6168          (C) the opportunity to sign the declaration;
6169          (ii) witness the signature of a birth mother or declarant father in accordance with
6170     Section 78B-15-302 if the signature occurs at the facility;
6171          (iii) enter the declarant father's information on the original birth certificate, but only if
6172     the mother and declarant father have signed a voluntary declaration of paternity or a court or
6173     administrative agency has issued an adjudication of paternity; and
6174          (iv) file the completed declaration with the original birth certificate.
6175          (b) If there is a presumed father, the voluntary declaration will only be valid if the
6176     presumed father also signs the voluntary declaration.
6177          (c) The state registrar shall file the information provided on the voluntary declaration
6178     of paternity form with the original birth certificate and may provide certified copies of the
6179     declaration of paternity as otherwise provided under Title 78B, Chapter 15, Utah Uniform
6180     Parentage Act.
6181          (6) (a) The state registrar shall publish a form for the voluntary declaration of paternity,
6182     a description of the process for filing a voluntary declaration of paternity, and of the rights and
6183     responsibilities established or effected by that filing, in accordance with Title 78B, Chapter 15,
6184     Utah Uniform Parentage Act.

6185          (b) Information regarding the form and services related to voluntary paternity
6186     establishment shall be made available to birthing facilities and to any other entity or individual
6187     upon request.
6188          (7) The name of a declarant father may only be included on the birth certificate of a
6189     child of unmarried parents if:
6190          (a) the mother and declarant father have signed a voluntary declaration of paternity; or
6191          (b) a court or administrative agency has issued an adjudication of paternity.
6192          (8) Voluntary declarations of paternity, adjudications of paternity by judicial or
6193     administrative agencies, and voluntary rescissions of paternity shall be filed with and
6194     maintained by the state registrar for the purpose of comparing information with the state case
6195     registry maintained by the Office of Recovery Services pursuant to Section [62A-11-104]
6196     26B-9-104.
6197          Section 180. Section 26B-8-105, which is renumbered from Section 26-2-5.5 is
6198     renumbered and amended to read:
6199          [26-2-5.5].      26B-8-105. Requirement to obtain parents' social security numbers.
6200          (1) For each live birth that occurs in this state, the administrator of the birthing facility,
6201     as defined in Section [26-2-5] 26B-8-104, or other person responsible for completing and filing
6202     the birth certificate under Section [26-2-5] 26B-8-104 shall obtain the social security numbers
6203     of each parent and provide those numbers to the state registrar.
6204          (2) Each parent shall furnish his or her social security number to the person authorized
6205     to obtain the numbers under Subsection (1) unless a court or administrative agency has
6206     determined there is good cause for not furnishing a number under Subsection (1).
6207          (3) The state registrar shall, as soon as practicable, supply those social security
6208     numbers to the Office of Recovery Services within the [Department of Human Services]
6209     department.
6210          (4) The social security numbers obtained under this section may not be recorded on the
6211     child's birth certificate.

6212          (5) The state may not use any social security number obtained under this section for
6213     any reason other than enforcement of child support orders in accordance with the federal
6214     Family Support Act of 1988, [Public Law] Pub. L. No. 100-485.
6215          Section 181. Section 26B-8-106, which is renumbered from Section 26-2-6 is
6216     renumbered and amended to read:
6217          [26-2-6].      26B-8-106. Foundling certificates.
6218          (1) A foundling certificate shall be filed for each infant of unknown parentage found in
6219     the state. The certificate shall be prepared and filed with the local registrar of the district in
6220     which the infant was found by the person assuming custody.
6221          (2) The certificate shall be filed within 10 days after the infant is found and is
6222     acceptable for all purposes in lieu of a certificate of birth.
6223          Section 182. Section 26B-8-107, which is renumbered from Section 26-2-7 is
6224     renumbered and amended to read:
6225          [26-2-7].      26B-8-107. Correction of errors or omissions in vital records --
6226     Conflicting birth and foundling certificates -- Rulemaking.
6227          In accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, the
6228     department may make rules:
6229          (1) governing applications to correct alleged errors or omissions on any vital record;
6230          (2) establishing procedures to resolve conflicting birth and foundling certificates; and
6231          (3) allowing for the correction and reissuance of a vital record that was originally
6232     created omitting a diacritical mark.
6233          Section 183. Section 26B-8-108, which is renumbered from Section 26-2-8 is
6234     renumbered and amended to read:
6235          [26-2-8].      26B-8-108. Birth certificates -- Delayed registration.
6236          (1) When a certificate of birth of a person born in this state has not been filed within
6237     the time provided in Subsection [26-2-5] 26B-8-104(2), a certificate of birth may be filed in
6238     accordance with department rules and subject to this section.

6239          (2) (a) The registrar shall mark a certificate of birth as "delayed" and show the date of
6240     registration if the certificate is registered one year or more after the date of birth.
6241          (b) The registrar shall abstract a summary statement of the evidence submitted in
6242     support of delayed registration onto the certificate.
6243          (3) When the minimum evidence required for delayed registration is not submitted or
6244     when the state registrar has reasonable cause to question the validity or adequacy of the
6245     evidence supporting the application, and the deficiencies are not corrected, the state registrar:
6246          (a) may not register the certificate; and
6247          (b) shall provide the applicant with a written statement indicating the reasons for denial
6248     of registration.
6249          (4) The state registrar has no duty to take further action regarding an application which
6250     is not actively pursued.
6251          Section 184. Section 26B-8-109, which is renumbered from Section 26-2-9 is
6252     renumbered and amended to read:
6253          [26-2-9].      26B-8-109. Birth certificates -- Petition for issuance of delayed
6254     certificate -- Court procedure.
6255          (1) (a) If registration of a certificate of birth under Section [26-2-8] 26B-8-108 is
6256     denied, the person seeking registration may bring an action by a verified petition in the Utah
6257     [district] court encompassing where the petitioner resides or in the district encompassing Salt
6258     Lake City.
6259          (b) The petition shall request an order establishing a record of the date and place of the
6260     birth and the parentage of the person whose birth is to be registered.
6261          (2) The petition shall be on a form furnished by the state registrar and shall allege:
6262          (a) the person for whom registration of a delayed certificate is sought was born in this
6263     state and is still living;
6264          (b) no registered certificate of birth of the person can be found in the state office of
6265     vital statistics or the office of any local registrar;

6266          (c) diligent efforts by the petitioner have failed to obtain the evidence required by
6267     department rule; and
6268          (d) the state registrar has denied the petitioner's request to register a delayed certificate
6269     of birth.
6270          (3) The petition shall be accompanied by a written statement of the state registrar
6271     indicating the reasons for denial of registration and all documentary evidence which was
6272     submitted in support of registration.
6273          (4) The court shall fix a time and place for hearing the petition and shall give the state
6274     registrar 15 [days] days' notice of the hearing. The state registrar or his authorized
6275     representative may appear and testify at the hearing.
6276          (5) (a) If the court finds the person for whom registration of a certificate of birth is
6277     sought under Section [26-2-8] 26B-8-108 was born in this state, it shall make findings as to the
6278     place and date of birth, parentage, and other findings as may be required and shall issue an
6279     order, on a form prescribed and furnished by the state registrar, to establish a court-ordered
6280     delayed certificate of birth.
6281          (b) The order shall include the birth data to be registered, a description of the evidence
6282     presented, and the date of the court's action.
6283          [(b)] (c) The clerk of the court shall forward each order to the state registrar not later
6284     than the tenth day of the calendar month following the month in which the order was entered.
6285          (d) The order described in Subsection (5)(a) shall be registered by the state registrar
6286     and constitutes the certificate of birth.
6287          Section 185. Section 26B-8-110, which is renumbered from Section 26-2-10 is
6288     renumbered and amended to read:
6289          [26-2-10].      26B-8-110. Supplementary certificate of birth.
6290          (1) An individual born in this state may request the state registrar to register a
6291     supplementary birth certificate for the individual if:
6292          (a) the individual is legally recognized as a child of the individual's natural parents

6293     when the individual's natural parents are subsequently married;
6294          (b) the individual's parentage has been determined by a state court of the United States
6295     or a Canadian provincial court with jurisdiction; or
6296          (c) the individual has been legally adopted, as a child or as an adult, under the law of
6297     this state, any other state, or any province of Canada.
6298          (2) The application for registration of a supplementary birth certificate may be made
6299     by:
6300          (a) the individual requesting registration under Subsection (1) if the individual is of
6301     legal age;
6302          (b) a legal representative; or
6303          (c) any agency authorized to receive children for placement or adoption under the laws
6304     of this or any other state.
6305          (3) (a) The state registrar shall require that an applicant submit identification and proof
6306     according to department rules.
6307          (b) In the case of an adopted individual, that proof may be established by order of the
6308     court in which the adoption proceedings were held.
6309          (4) (a) After the supplementary birth certificate is registered, any information disclosed
6310     from the record shall be from the supplementary birth certificate.
6311          (b) Access to the original birth certificate and to the evidence submitted in support of
6312     the supplementary birth certificate are not open to inspection except upon the order of a Utah
6313     district court or as described in Section 78B-6-141 or Section 78B-6-144.
6314          Section 186. Section 26B-8-111, which is renumbered from Section 26-2-11 is
6315     renumbered and amended to read:
6316          [26-2-11].      26B-8-111. Name or sex change -- Registration of court order and
6317     amendment of birth certificate.
6318          (1) When a person born in this state has a name change or sex change approved by an
6319     order of a Utah [district] court or a court of competent jurisdiction of another state or a

6320     province of Canada, a certified copy of the order may be filed with the state registrar with an
6321     application form provided by the registrar.
6322          (2) (a) Upon receipt of the application, a certified copy of the order, and payment of the
6323     required fee, the state registrar shall review the application, and if complete, register it and note
6324     the fact of the amendment on the otherwise unaltered original certificate.
6325          (b) The amendment shall be registered with and become a part of the original
6326     certificate and a certified copy shall be issued to the applicant without additional cost.
6327          Section 187. Section 26B-8-112, which is renumbered from Section 26-2-12.5 is
6328     renumbered and amended to read:
6329          [26-2-12.5].      26B-8-112. Certified copies of birth certificates -- Fees credited to
6330     Children's Account.
6331          (1) In addition to the fees provided for in Section 26B-1-209, the department and local
6332     registrars authorized to issue certified copies shall charge an additional $3 fee for each certified
6333     copy of a birth certificate, including certified copies of supplementary and amended birth
6334     certificates, under Sections [26-2-8 through 26-2-11] 26B-8-108 through 26B-8-111. [This]
6335          (2) The additional fee described in Subsection (1) may be charged only for the first
6336     copy requested at any one time.
6337          [(2)] (3) The fee shall be transmitted monthly to the state treasurer and credited to the
6338     Children's Account [established] created in Section 80-2-501.
6339          Section 188. Section 26B-8-113, which is renumbered from Section 26-2-12.6 is
6340     renumbered and amended to read:
6341          [26-2-12.6].      26B-8-113. Fee waived for certified copy of birth certificate.
6342          (1) Notwithstanding [Section] Sections 26B-1-209 and [Section 26-2-12.5] 26B-6-112,
6343     the department shall waive a fee that would otherwise be charged for a certified copy of a birth
6344     certificate, if the individual whose birth is confirmed by the birth certificate is:
6345          (a) the individual requesting the certified copy of the birth certificate; and
6346          (b) (i) homeless, as defined in Section [26-18-411] 26B-3-207;

6347          (ii) a person who is homeless, as defined in Section 35A-5-302;
6348          (iii) an individual whose primary nighttime residence is a location that is not designed
6349     for or ordinarily used as a sleeping accommodation for an individual;
6350          (iv) a homeless service provider as verified by the Department of Workforce Services;
6351     or
6352          (v) a homeless child or youth, as defined in 42 U.S.C. Sec. 11434a.
6353          (2) To satisfy the requirement in Subsection (1)(b), the department shall accept written
6354     verification that the individual is homeless or a person, child, or youth who is homeless from:
6355          (a) a homeless shelter;
6356          (b) a permanent housing, permanent, supportive, or transitional facility, as defined in
6357     Section 35A-5-302;
6358          (c) the Department of Workforce Services;
6359          (d) a homeless service provider as verified by the Department of Workforce Services;
6360     or
6361          (e) a local educational agency liaison for homeless children and youth designated under
6362     42 U.S.C. Sec. 11432(g)(1)(J)(ii).
6363          Section 189. Section 26B-8-114, which is renumbered from Section 26-2-13 is
6364     renumbered and amended to read:
6365          [26-2-13].      26B-8-114. Certificate of death -- Execution and registration
6366     requirements -- Information provided to lieutenant governor.
6367          (1) (a) A certificate of death for each death that occurs in this state shall be filed with
6368     the local registrar of the district in which the death occurs, or as otherwise directed by the state
6369     registrar, within five days after death and prior to the decedent's interment, any other disposal,
6370     or removal from the registration district where the death occurred.
6371          (b) A certificate of death shall be registered if the certificate of death is completed and
6372     filed in accordance with this [chapter] part.
6373          (2) (a) If the place of death is unknown but the dead body is found in this state:

6374          (i) the certificate of death shall be completed and filed in accordance with this section;
6375     and
6376          (ii) the place where the dead body is found shall be shown as the place of death.
6377          (b) If the date of death is unknown, the date shall be determined by approximation.
6378          (3) (a) When death occurs in a moving conveyance in the United States and the
6379     decedent is first removed from the conveyance in this state:
6380          (i) the certificate of death shall be filed with:
6381          (A) the local registrar of the district where the decedent is removed; or
6382          (B) a person designated by the state registrar; and
6383          (ii) the place where the decedent is removed shall be considered the place of death.
6384          (b) When a death occurs on a moving conveyance outside the United States and the
6385     decedent is first removed from the conveyance in this state:
6386          (i) the certificate of death shall be filed with:
6387          (A) the local registrar of the district where the decedent is removed; or
6388          (B) a person designated by the state registrar; and
6389          (ii) the certificate of death shall show the actual place of death to the extent it can be
6390     determined.
6391          (4) (a) Subject to Subsections (4)(d) and (10), a custodial funeral service director or, if a
6392     funeral service director is not retained, a dispositioner shall sign the certificate of death.
6393          (b) The custodial funeral service director, an agent of the custodial funeral service
6394     director, or, if a funeral service director is not retained, a dispositioner shall:
6395          (i) file the certificate of death prior to any disposition of a dead body or fetus; and
6396          (ii) obtain the decedent's personal data from the next of kin or the best qualified person
6397     or source available, including the decedent's social security number, if known.
6398          (c) The certificate of death may not include the decedent's social security number.
6399          (d) A dispositioner may not sign a certificate of death, unless the signature is witnessed
6400     by the state registrar or a local registrar.

6401          (5) (a) Except as provided in Section [26-2-14] 26B-8-115, fetal death certificates, the
6402     medical section of the certificate of death shall be completed, signed, and returned to the
6403     funeral service director, or, if a funeral service director is not retained, a dispositioner, within
6404     72 hours after death by the health care professional who was in charge of the decedent's care
6405     for the illness or condition which resulted in death, except when inquiry is required by [Title
6406     26, Chapter 4, Utah Medical Examiner Act] Part 2, Utah Medical Examiner.
6407          (b) In the absence of the health care professional or with the health care professional's
6408     approval, the certificate of death may be completed and signed by an associate physician, the
6409     chief medical officer of the institution in which death occurred, or a physician who performed
6410     an autopsy upon the decedent, if:
6411          (i) the person has access to the medical history of the case;
6412          (ii) the person views the decedent at or after death; and
6413          (iii) the death is not due to causes required to be investigated by the medical examiner.
6414          (6) When death occurs more than 365 days after the day on which the decedent was last
6415     treated by a health care professional, the case shall be referred to the medical examiner for
6416     investigation to determine and certify the cause, date, and place of death.
6417          (7) When inquiry is required by [Title 26, Chapter 4, Utah Medical Examiner Act] Part
6418     2, Utah Medical Examiner, the medical examiner shall make an investigation and complete and
6419     sign the medical section of the certificate of death within 72 hours after taking charge of the
6420     case.
6421          (8) If the cause of death cannot be determined within 72 hours after death:
6422          (a) the medical section of the certificate of death shall be completed as provided by
6423     department rule;
6424          (b) the attending health care professional or medical examiner shall give the funeral
6425     service director, or, if a funeral service director is not retained, a dispositioner, notice of the
6426     reason for the delay; and
6427          (c) final disposition of the decedent may not be made until authorized by the attending

6428     health care professional or medical examiner.
6429          (9) (a) When a death is presumed to have occurred within this state but the dead body
6430     cannot be located, a certificate of death may be prepared by the state registrar upon receipt of
6431     an order of a Utah [district] court.
6432          (b) The order described in Subsection (9)(a) shall include a finding of fact stating the
6433     name of the decedent, the date of death, and the place of death.
6434          (c) A certificate of death prepared under Subsection (9)(a) shall:
6435          (i) show the date of registration; and
6436          (ii) identify the court and the date of the order.
6437          (10) It is unlawful for a dispositioner to charge for or accept any remuneration for:
6438          (a) signing a certificate of death; or
6439          (b) performing any other duty of a dispositioner, as described in this section.
6440          (11) The state registrar shall, within five business days after the day on which the state
6441     registrar or local registrar registers a certificate of death for a Utah resident, inform the
6442     lieutenant governor of:
6443          (a) the decedent's name, last known residential address, date of birth, and date of death;
6444     and
6445          (b) any other information requested by the lieutenant governor to assist the county
6446     clerk in identifying the decedent for the purpose of removing the decedent from the official
6447     register of voters.
6448          (12) The lieutenant governor shall, within one business day after the day on which the
6449     lieutenant governor receives the information described in Subsection (11), provide the
6450     information to the county clerks.
6451          Section 190. Section 26B-8-115, which is renumbered from Section 26-2-14 is
6452     renumbered and amended to read:
6453          [26-2-14].      26B-8-115. Fetal death certificate -- Filing and registration
6454     requirements.

6455          (1) A fetal death certificate shall be filed for each fetal death which occurs in this state.
6456     The certificate shall be filed within five days after delivery with the local registrar or as
6457     otherwise directed by the state registrar. The certificate shall be registered if it is completed and
6458     filed in accordance with this [chapter] part.
6459          (2) When a dead fetus is delivered in an institution, the institution administrator or his
6460     designated representative shall prepare and file the fetal death certificate. The attending
6461     physician shall state in the certificate the cause of death and sign the certificate.
6462          (3) When a dead fetus is delivered outside an institution, the physician in attendance at
6463     or immediately after delivery shall complete, sign, and file the fetal death certificate.
6464          (4) When a fetal death occurs without medical attendance at or immediately after the
6465     delivery or when inquiry is required by [Title 26, Chapter 4, Utah Medical Examiner Act] Part
6466     2, Utah Medical Examiner, the medical examiner shall investigate the cause of death and
6467     prepare and file the certificate of fetal death within five days after taking charge of the case.
6468          (5) When a fetal death occurs in a moving conveyance and the dead fetus is first
6469     removed from the conveyance in this state or when a dead fetus is found in this state and the
6470     place of death is unknown, the death shall be registered in this state. The place where the dead
6471     fetus was first removed from the conveyance or found shall be considered the place of death.
6472          (6) Final disposition of the dead fetus may not be made until the fetal death certificate
6473     has been registered.
6474          Section 191. Section 26B-8-116, which is renumbered from Section 26-2-14.1 is
6475     renumbered and amended to read:
6476          [26-2-14.1].      26B-8-116. Certificate of birth resulting in stillbirth.
6477          (1) [For purposes of this section and Section 26-2-14.2] As used in this section,
6478     "stillbirth" and "stillborn child" [shall have the same meaning] mean the same as "dead fetus"
6479     as defined in Section [26-2-2] 26B-8-101.
6480          (2) (a) In addition to the requirements of Section [26-2-14] 26B-8-115, the state
6481     registrar shall establish a certificate of birth resulting in stillbirth on a form approved by the

6482     state registrar for each stillbirth occurring in this state.
6483          (b) This certificate shall be offered to the parent or parents of a stillborn child.
6484          (3) The certificate of birth resulting in stillbirth shall meet all of the format and filing
6485     requirements of Sections [26-2-4 and 26-2-5] 26B-8-103 and 26B-8-104, relating to a live
6486     birth.
6487          (4) The person who prepares a certificate pursuant to this section shall leave blank any
6488     references to the stillborn child's name if the stillborn child's parent or parents do not wish to
6489     provide a name for the stillborn child.
6490          (5) Notwithstanding Subsections (2) and (3), the certificate of birth resulting in
6491     stillbirth shall be filed with the designated registrar within 10 days following the delivery and
6492     prior to cremation or removal of the fetus from the registration district.
6493          Section 192. Section 26B-8-117, which is renumbered from Section 26-2-14.2 is
6494     renumbered and amended to read:
6495          [26-2-14.2].      26B-8-117. Delayed registration of birth resulting in stillbirth.
6496          When a birth resulting in stillbirth occurring in this state has not been registered within
6497     one year after the date of delivery, a certificate marked "delayed" may be filed and registered in
6498     accordance with department rule relating to evidentiary and other requirements sufficient to
6499     substantiate the alleged facts of birth resulting in stillbirth.
6500          Section 193. Section 26B-8-118, which is renumbered from Section 26-2-14.3 is
6501     renumbered and amended to read:
6502          [26-2-14.3].      26B-8-118. Certificate of early term stillbirth.
6503          (1) As used in this section, "early term stillborn child" means a product of human
6504     conception, other than in the circumstances described in Subsection 76-7-301(1), that:
6505          (a) is of at least 16 weeks' gestation but less than 20 weeks' gestation, calculated from
6506     the day on which the mother's last normal menstrual period began to the day of delivery; and
6507          (b) is not born alive.
6508          (2) The state registrar shall issue a certificate of early term stillbirth to a parent of an

6509     early term stillborn child if:
6510          (a) the parent requests, on a form created by the state registrar, that the state registrar
6511     register and issue a certificate of early term stillbirth for the early term stillborn child; and
6512          (b) the parent files with the state registrar:
6513          (i) (A) a signed statement from a physician confirming the delivery of the early term
6514     stillborn child; or
6515          (B) an accurate copy of the parent's medical records related to the early term stillborn
6516     child; and
6517          (ii) any other record the state registrar determines, by rule made in accordance with
6518     Title 63G, Chapter 3, Utah Administrative Rulemaking Act, is necessary for accurate
6519     recordkeeping.
6520          (3) The certificate of early term stillbirth described in Subsection (2) shall meet all of
6521     the format and filing requirements of Section [26-2-4] 26B-8-103.
6522          (4) A person who prepares a certificate of early term stillbirth under this section shall
6523     leave blank any references to an early term stillborn child's name if the early term stillborn
6524     child's parent does not wish to provide a name for the early term stillborn child.
6525          Section 194. Section 26B-8-119, which is renumbered from Section 26-2-15 is
6526     renumbered and amended to read:
6527          [26-2-15].      26B-8-119. Petition for establishment of unregistered birth or death
6528     -- Court procedure.
6529          (1) A person holding a direct, tangible, and legitimate interest as described in
6530     Subsection [26-2-22] 26B-8-125(3)(a) or (b) may petition for a court order establishing the
6531     fact, time, and place of a birth or death that is not registered or for which a certified copy of the
6532     registered birth or death certificate is not obtainable. The person shall verify the petition and
6533     file the petition in the Utah [district] court for the county where:
6534          (a) the birth or death is alleged to have occurred;
6535          (b) the person resides whose birth is to be established; or

6536          (c) the decedent named in the petition resided at the date of death.
6537          (2) In order for the court to have jurisdiction, the petition shall:
6538          (a) allege the date, time, and place of the birth or death; and
6539          (b) state either that no certificate of birth or death has been registered or that a copy of
6540     the registered certificate cannot be obtained.
6541          (3) The court shall set a hearing for five to 10 days after the day on which the petition
6542     is filed.
6543          (4) (a) If the time and place of birth or death are in question, the court shall hear
6544     available evidence and determine the time and place of the birth or death.
6545          (b) If the time and place of birth or death are not in question, the court shall determine
6546     the time and place of birth or death to be those alleged in the petition.
6547          (5) A court order under this section shall be made on a form prescribed and furnished
6548     by the department and is effective upon the filing of a certified copy of the order with the state
6549     registrar.
6550          (6) (a) For purposes of this section, the birth certificate of an adopted alien child, as
6551     defined in Section 78B-6-108, is considered to be unobtainable if the child was born in a
6552     country that is not recognized by department rule as having an established vital records
6553     registration system.
6554          (b) If the adopted child was born in a country recognized by department rule, but a
6555     person described in Subsection (1) is unable to obtain a certified copy of the birth certificate,
6556     the state registrar shall authorize the preparation of a birth certificate if the state registrar
6557     receives a written statement signed by the registrar of the child's birth country stating a certified
6558     copy of the birth certificate is not available.
6559          Section 195. Section 26B-8-120, which is renumbered from Section 26-2-16 is
6560     renumbered and amended to read:
6561          [26-2-16].      26B-8-120. Certificate of death -- Duties of a custodial funeral
6562     service director, an agent of a funeral service director, or a dispositioner -- Medical

6563     certification -- Records of funeral service director or dispositioner -- Information filed
6564     with local registrar -- Unlawful signing of certificate of death.
6565          (1) The custodial funeral service director or, if a funeral service director is not retained,
6566     a dispositioner shall sign the certificate of death prior to any disposition of a dead body or dead
6567     fetus.
6568          (2) The custodial funeral service director, an agent of the custodial funeral service
6569     director, or, if a funeral service director is not retained, a dispositioner shall:
6570          (a) obtain personal and statistical information regarding the decedent from the
6571     available persons best qualified to provide the information;
6572          (b) present the certificate of death to the attending health care professional, if any, or to
6573     the medical examiner who shall certify the cause of death and other information required on the
6574     certificate of death;
6575          (c) provide the address of the custodial funeral service director or, if a funeral service
6576     director is not retained, a dispositioner;
6577          (d) certify the date and place of burial; and
6578          (e) file the certificate of death with the state or local registrar.
6579          (3) A funeral service director, dispositioner, embalmer, or other person who removes a
6580     dead body or dead fetus from the place of death or transports or is in charge of final disposal of
6581     a dead body or dead fetus, shall keep a record identifying the dead body or dead fetus, and
6582     containing information pertaining to receipt, removal, and delivery of the dead body or dead
6583     fetus as prescribed by department rule.
6584          (4) (a) Not later than the tenth day of each month, every licensed funeral service
6585     establishment shall send to the local registrar and the department a list of the information
6586     required in Subsection (3) for each casket furnished and for funerals performed when no casket
6587     was furnished, during the preceding month.
6588          (b) The list described in Subsection (4)(a) shall be in the form prescribed by the state
6589     registrar.

6590          (5) Any person who intentionally signs the portion of a certificate of death that is
6591     required to be signed by a funeral service director or a dispositioner under Subsection (1) is
6592     guilty of a class B misdemeanor, unless the person:
6593          (a) (i) is a funeral service director; and
6594          (ii) is employed by a licensed funeral establishment; or
6595          (b) is a dispositioner, if a funeral service director is not retained.
6596          (6) The state registrar shall post information on the state registrar's website, providing
6597     instructions to a dispositioner for complying with the requirements of law relating to the
6598     dispositioner's responsibilities for:
6599          (a) completing and filing a certificate of death; and
6600          (b) possessing, transporting, and disposing of a dead body or dead fetus.
6601          (7) The provisions of this [chapter] part shall be construed to avoid interference, to the
6602     fullest extent possible, with the ceremonies, customs, rites, or beliefs of the decedent and the
6603     decedent's next of kin for disposing of a dead body or dead fetus.
6604          Section 196. Section 26B-8-121, which is renumbered from Section 26-2-17 is
6605     renumbered and amended to read:
6606          [26-2-17].      26B-8-121. Certificate of death -- Registration prerequisite to
6607     interment -- Burial-transit permits -- Procedure where body donated under anatomical
6608     gift law -- Permit for disinterment.
6609          (1) (a) A dead body or dead fetus may not be interred or otherwise disposed of or
6610     removed from the registration district in which death or fetal death occurred or the remains are
6611     found until a certificate of death is registered.
6612          (b) Subsection (1)(a) does not apply to fetal remains for a fetus that is less than 20
6613     weeks in gestational age.
6614          (2) (a) For deaths or fetal deaths which occur in this state, no burial-transit permit is
6615     required for final disposition of the remains if:
6616          (i) disposition occurs in the state and is performed by a funeral service director; or

6617           (ii) the disposition takes place with authorization of the next of kin and in:
6618          (A) a general acute hospital as [that term is] defined in Section [26-21-2] 26B-2-201,
6619     that is licensed by the department; or
6620          (B) in a pathology laboratory operated under contract with a general acute hospital
6621     licensed by the department.
6622          (b) For an abortion or miscarriage that occurs at a health care facility, no burial-transit
6623     permit is required for final disposition of the fetal remains if:
6624          (i) disposition occurs in the state and is performed by a funeral service director; or
6625          (ii) the disposition takes place:
6626          (A) with authorization of the parent of a miscarried fetus or the pregnant woman for an
6627     aborted fetus; and
6628          (B) in a general acute hospital as [that term is] defined in Section [26-21-2] 26B-2-201,
6629     or a pathology laboratory operated under contract with a general acute hospital.
6630          (3) (a) A burial-transit permit shall be issued by the local registrar of the district where
6631     the certificate of death or fetal death is registered:
6632          (i) for a dead body or a dead fetus to be transported out of the state for final
6633     disposition; or
6634          (ii) when disposition of the dead body or dead fetus is made by a person other than a
6635     funeral service director.
6636          (b) For fetal remains that are less than 20 weeks in gestational age, a burial-transit
6637     permit shall be issued by the local registrar of the district where the health care facility that is in
6638     possession of the fetal remains is located:
6639          (i) for the fetal remains to be transported out of the state for final disposition; or
6640          (ii) when disposition of the fetal remains is made by a person other than a funeral
6641     service director.
6642          (c) A local registrar issuing a burial-transit permit issued under Subsection (3)(b):
6643          (i) may not require an individual to designate a name for the fetal remains; and

6644          (ii) may leave the space for a name on the burial-transit permit blank; and
6645          (d) shall redact from any public records maintained under this [chapter] part any
6646     information:
6647          (i) that is submitted under Subsection (3)(c); and
6648          (ii) that may be used to identify the parent or pregnant woman.
6649          (4) A burial-transit permit issued under the law of another state which accompanies a
6650     dead body, dead fetus, or fetal remains brought into this state is authority for final disposition
6651     of the dead body, dead fetus, or fetal remains in this state.
6652          (5) When a dead body or dead fetus or any part of the dead body or dead fetus has been
6653     donated under [the] Part 3, Revised Uniform Anatomical Gift Act, or similar laws of another
6654     state and the preservation of the gift requires the immediate transportation of the dead body,
6655     dead fetus, or any part of the body or fetus outside of the registration district in which death
6656     occurs or the remains are found, or into this state from another state, the dead body or dead
6657     fetus or any part of the body or fetus may be transported and the burial-transit permit required
6658     by this section obtained within a reasonable time after transportation.
6659          (6) A permit for disinterment and reinterment is required prior to disinterment of a
6660     dead body, dead fetus, or fetal remains, except as otherwise provided by statute or department
6661     rule.
6662          Section 197. Section 26B-8-122, which is renumbered from Section 26-2-18 is
6663     renumbered and amended to read:
6664          [26-2-18].      26B-8-122. Interments -- Duties of sexton or person in charge --
6665     Record of interments -- Information filed with local registrar.
6666          (1) (a) A sexton or person in charge of any premises in which interments are made may
6667     not inter or permit the interment of any dead body, dead fetus, or fetal remains unless the
6668     interment is made by a funeral service director or by a person holding a burial-transit permit.
6669          (b) The right and duty to control the disposition of a deceased person shall be governed
6670     by Sections 58-9-601 through 58-9-604.

6671          (2) (a) The sexton or the person in charge of any premises where interments are made
6672     shall keep a record of all interments made in the premises under their charge, stating the name
6673     of the decedent, place of death, date of burial, and name and address of the funeral service
6674     director or other person making the interment.
6675          (b) The record described in this Subsection (2) shall be open to public inspection.
6676          (c) A city or county clerk may, at the clerk's option, maintain the interment records
6677     described in this Subsection (2) on behalf of the sexton or person in charge of any premises in
6678     which interments are made.
6679          (3) (a) Not later than the tenth day of each month, the sexton, person in charge of the
6680     premises, or city or county clerk who maintains the interment records shall send to the local
6681     registrar and the department a list of all interments made in the premises during the preceding
6682     month.
6683          (b) The list described in Subsection (3)(a) shall be in the form prescribed by the state
6684     registrar.
6685          Section 198. Section 26B-8-123, which is renumbered from Section 26-2-19 is
6686     renumbered and amended to read:
6687          [26-2-19].      26B-8-123. Rules of department for transmittal of certificates and
6688     keeping of records by local registrar.
6689          Each local registrar shall transmit all records registered by him to the department in
6690     accordance with department rules. The manner of keeping local copies of vital records and the
6691     uses of them shall be prescribed by department rules.
6692          Section 199. Section 26B-8-124, which is renumbered from Section 26-2-21 is
6693     renumbered and amended to read:
6694          [26-2-21].      26B-8-124. Local registrars authorized to issue certified copies of
6695     records.
6696          The state registrar may authorize local registrars to issue certified copies of vital
6697     records.

6698          Section 200. Section 26B-8-125, which is renumbered from Section 26-2-22 is
6699     renumbered and amended to read:
6700          [26-2-22].      26B-8-125. Inspection of vital records.
6701          (1) As used in this section:
6702          (a) "Designated legal representative" means an attorney, physician, funeral service
6703     director, genealogist, or other agent of the subject, or an immediate family member of the
6704     subject, who has been delegated the authority to access vital records.
6705          (b) "Drug use intervention or suicide prevention effort" means a program that studies
6706     or promotes the prevention of drug overdose deaths or suicides in the state.
6707          (c) "Immediate family member" means a spouse, child, parent, sibling, grandparent, or
6708     grandchild.
6709          (2) (a) The vital records shall be open to inspection, but only in compliance with the
6710     provisions of this [chapter] part, department rules, and Sections 78B-6-141 and 78B-6-144.
6711          (b) It is unlawful for any state or local officer or employee to disclose data contained in
6712     vital records contrary to this [chapter] part, department rule, Section 78B-6-141, or Section
6713     78B-6-144.
6714          (c) (i) An adoption document is open to inspection as provided in Section 78B-6-141
6715     or Section 78B-6-144.
6716          (ii) A birth parent may not access an adoption document under Subsection
6717     78B-6-141(3).
6718          (d) A custodian of vital records may permit inspection of a vital record or issue a
6719     certified copy of a record or a part of a record when the custodian is satisfied that the applicant
6720     has demonstrated a direct, tangible, and legitimate interest.
6721          (3) Except as provided in Subsection (4), a direct, tangible, and legitimate interest in a
6722     vital record is present only if:
6723          (a) the request is from:
6724          (i) the subject;

6725          (ii) an immediate family member of the subject;
6726          (iii) the guardian of the subject;
6727          (iv) a designated legal representative of the subject; or
6728          (v) a person, including a child-placing agency as defined in Section 78B-6-103, with
6729     whom a child has been placed pending finalization of an adoption of the child;
6730          (b) the request involves a personal or property right of the subject of the record;
6731          (c) the request is for official purposes of a public health authority or a state, local, or
6732     federal governmental agency;
6733          (d) the request is for a drug use intervention or suicide prevention effort or a statistical
6734     or medical research program and prior consent has been obtained from the state registrar; or
6735          (e) the request is a certified copy of an order of a court of record specifying the record
6736     to be examined or copied.
6737          (4) (a) Except as provided in Title 78B, Chapter 6, Part 1, Utah Adoption Act, a parent,
6738     or an immediate family member of a parent, who does not have legal or physical custody of or
6739     visitation or parent-time rights for a child because of the termination of parental rights under
6740     Title 80, Chapter 4, Termination and Restoration of Parental Rights, or by virtue of consenting
6741     to or relinquishing a child for adoption pursuant to Title 78B, Chapter 6, Part 1, Utah Adoption
6742     Act, may not be considered as having a direct, tangible, and legitimate interest under this
6743     section.
6744          (b) Except as provided in Subsection (2)(d), a commercial firm or agency requesting
6745     names, addresses, or similar information may not be considered as having a direct, tangible,
6746     and legitimate interest under this section.
6747          (5) Upon payment of a fee established in accordance with Section 63J-1-504, the office
6748     shall make the following records available to the public:
6749          (a) except as provided in Subsection [26-2-10] 26B-8-110(4)(b), a birth record,
6750     excluding confidential information collected for medical and health use, if 100 years or more
6751     have passed since the date of birth;

6752          (b) a death record if 50 years or more have passed since the date of death; and
6753          (c) a vital record not subject to Subsection (5)(a) or (b) if 75 years or more have passed
6754     since the date of the event upon which the record is based.
6755          (6) Upon payment of a fee established in accordance with Section 63J-1-504, the office
6756     shall make an adoption document available as provided in Sections 78B-6-141 and 78B-6-144.
6757          (7) The office shall make rules in accordance with Title 63G, Chapter 3, Utah
6758     Administrative Rulemaking Act, establishing procedures and the content of forms as follows:
6759          (a) for the inspection of adoption documents under Subsection 78B-6-141(4);
6760          (b) for a birth parent's election to permit identifying information about the birth parent
6761     to be made available, under Section 78B-6-141;
6762          (c) for the release of information by the mutual-consent, voluntary adoption registry,
6763     under Section 78B-6-144;
6764          (d) for collecting fees and donations under Section 78B-6-144.5; and
6765          (e) for the review and approval of a request described in Subsection (3)(d).
6766          Section 201. Section 26B-8-126, which is renumbered from Section 26-2-23 is
6767     renumbered and amended to read:
6768          [26-2-23].      26B-8-126. Records required to be kept by health care institutions
6769     -- Information filed with local registrar and department.
6770          (1) (a) All administrators or other persons in charge of hospitals, nursing homes, or
6771     other institutions, public or private, to which persons resort for treatment of diseases,
6772     confinements, or are committed by law, shall record all the personal and statistical information
6773     about patients of their institutions as required in certificates prescribed by this [chapter] part.
6774          (b) The information described in Subsection (1)(a) shall:
6775          (i) be recorded for collection at the time of admission of a patient;
6776          (ii) be obtained from the patient, if possible; and
6777          (iii) if the information cannot be obtained from the patient, the information shall be
6778     secured in as complete a manner as possible from other persons acquainted with the facts.

6779          (2) (a) When a dead body or dead fetus is released or disposed of by an institution, the
6780     person in charge of the institution shall keep a record showing:
6781          (i) the name of the deceased;
6782          (ii) the date of death of the deceased;
6783          (iii) the name and address of the person to whom the dead body or dead fetus is
6784     released; and
6785          (iv) the date that the dead body or dead fetus is removed from the institution.
6786          (b) If final disposal is by the institution, the date, place, manner of disposition, and the
6787     name of the person authorizing disposition shall be recorded by the person in charge of the
6788     institution.
6789          (3) Not later than the tenth day of each month, the administrator of each institution
6790     shall cause to be sent to the local registrar and the department a list of all births, deaths, fetal
6791     deaths, and induced abortions occurring in the institution during the preceding month. The list
6792     shall be in the form prescribed by the state registrar.
6793          (4) A person or institution who, in good faith, releases a dead body or dead fetus, under
6794     this section, to a funeral service director or a dispositioner is immune from civil liability
6795     connected, directly or indirectly, with release of the dead body or dead fetus.
6796          Section 202. Section 26B-8-127, which is renumbered from Section 26-2-24 is
6797     renumbered and amended to read:
6798          [26-2-24].      26B-8-127. Marriage licenses -- Execution and filing requirements.
6799          (1) The state registrar shall supply county clerks with application forms for marriage
6800     licenses.
6801          (2) Completed applications shall be transmitted by the clerks to the state registrar
6802     monthly.
6803          (3) The personal identification information contained on each application for a
6804     marriage license filed with the county clerk shall be entered on a form supplied by the state
6805     registrar.

6806          (4) The person performing the marriage shall furnish the date and place of marriage
6807     and his name and address.
6808          (5) The form described in Subsection (1) shall be completed and certified by the county
6809     clerk before it is filed with the state registrar.
6810          Section 203. Section 26B-8-128, which is renumbered from Section 26-2-25 is
6811     renumbered and amended to read:
6812          [26-2-25].      26B-8-128. Divorce or adoption -- Duty of court clerk to file
6813     certificates or reports.
6814          (1) For each adoption, annulment of adoption, divorce, and annulment of marriage
6815     ordered or decreed in this state, the clerk of the court shall prepare a divorce certificate or
6816     report of adoption on a form furnished by the state registrar.
6817          (2) The petitioner shall provide the information necessary to prepare the certificate or
6818     report under Subsection (1).
6819          (3) The clerk shall:
6820          (a) prepare the certificate or report under Subsection (1); and
6821          (b) complete the remaining entries for the certificate or report immediately after the
6822     decree or order becomes final.
6823          (4) On or before the 15th day of each month, the clerk shall forward the divorce
6824     certificates and reports of adoption under Subsection (1) completed by the clerk during the
6825     preceding month to the state registrar.
6826          (5) (a) A report of adoption under Subsection (1) may be provided to the attorney who
6827     is providing representation of a party to the adoption or the child-placing agency, as defined in
6828     Section 78B-6-103, that is placing the child.
6829          (b) If a report of adoption is provided to the attorney or the child-placing agency, as
6830     defined in Section 78B-6-103, the attorney or the child-placing agency shall immediately
6831     provide the report of adoption to the state registrar.
6832          Section 204. Section 26B-8-129, which is renumbered from Section 26-2-26 is

6833     renumbered and amended to read:
6834          [26-2-26].      26B-8-129. Certified copies of vital records -- Preparation by state
6835     and local registrars -- Evidentiary value.
6836          (1) The state registrar and local registrars authorized by the department under Section
6837     [26-2-21] 26B-8-124 may prepare typewritten, photographic, electronic, or other reproductions
6838     of vital records and certify their correctness.
6839          (2) Certified copies of the vital record, or authorized reproductions of the original,
6840     issued by either the state registrar or a designated local registrar are prima facie evidence in all
6841     courts of the state with like effect as the vital record.
6842          Section 205. Section 26B-8-130, which is renumbered from Section 26-2-27 is
6843     renumbered and amended to read:
6844          [26-2-27].      26B-8-130. Identifying birth certificates of missing persons --
6845     Procedures.
6846          (1) As used in this section:
6847          (a) "Division" means the Criminal Investigations and Technical Services Division,
6848     Department of Public Safety, in Title 53, Chapter 10, Criminal Investigations and Technical
6849     Services Act.
6850          (b) "Missing child" means a person younger than 18 years [of age] old who is missing
6851     from the person's home environment or a temporary placement facility for any reason, and
6852     whose whereabouts cannot be determined by the person responsible for the child's care.
6853          (c) "Missing person" means a person who:
6854          (i) is missing from the person's home environment; and
6855          (ii) (A) has a physical or mental disability;
6856          (B) is missing under circumstances that indicate that the person is endangered, missing
6857     involuntarily, or a victim of a catastrophe; or
6858          (C) is a missing child.
6859          (2) (a) In accordance with Section 53-10-203, upon the state registrar's notification by

6860     the division that a person who was born in this state is missing, the state and local registrars
6861     shall flag the registered birth certificate of that person so that when a copy of the registered
6862     birth certificate or information regarding the birth record is requested, the state and local
6863     registrars are alerted to the fact the registered birth certificate is that of a missing person.
6864          (b) Upon notification by the division the missing person has been recovered, the state
6865     and local registrars shall remove the flag from that person's registered birth certificate.
6866          (3) The state and local registrars may not provide a copy of a registered birth certificate
6867     of any person whose record is flagged under Subsection (2), except as approved by the
6868     division.
6869          (4) (a) When a copy of the registered birth certificate of a person whose record has
6870     been flagged is requested in person, the state or local registrar shall require that person to
6871     complete a form supplying that person's name, address, telephone number, and relationship to
6872     the missing person, and the name and birth date of the missing person.
6873          (b) The state or local registrar shall inform the requester that a copy of the registered
6874     birth certificate will be mailed to the requester.
6875          (c) The state or local registrar shall note the physical description of the person making
6876     the request, and shall immediately notify the division of the request and the information
6877     obtained pursuant to this Subsection (4).
6878          (5) When a copy of the registered birth certificate of a person whose record has been
6879     flagged is requested in writing, the state or local registrar or personnel of the state or local
6880     registrar shall immediately notify the division, and provide it with a copy of the written request.
6881          Section 206. Section 26B-8-131, which is renumbered from Section 26-2-28 is
6882     renumbered and amended to read:
6883          [26-2-28].      26B-8-131. Birth certificate for foreign adoptees.
6884          Upon presentation of a court order of adoption and an order establishing the fact, time,
6885     and place of birth under Section [26-2-15] 26B-6-119, the department shall prepare a birth
6886     certificate for an individual who:

6887          (1) was adopted under the laws of this state; and
6888          (2) was at the time of adoption, as a child or as an adult, considered an alien child or
6889     adult for whom the court received documentary evidence of lawful admission under Section
6890     78B-6-108.
6891          Section 207. Section 26B-8-132, which is renumbered from Section 26-34-4 is
6892     renumbered and amended to read:
6893          [26-34-4].      26B-8-132. Determination of death made by registered nurse.
6894          (1) As used in this section[: (a) "Health care facility" means the same as that term is
6895     defined in Section 26-21-2. (b) "Physician" means a physician licensed under: (i) Title 58,
6896     Chapter 67, Utah Medical Practice Act; or (ii) Title 58, Chapter 68, Utah Osteopathic Medical
6897     Practice Act. (c) "Registered], "registered nurse" means a registered nurse licensed under Title
6898     58, Chapter 31b, Nurse Practice Act.
6899          (2) (a) An individual is dead if the individual has sustained either:
6900          (i) irreversible cessation of circulatory and respiratory functions; or
6901          (ii) irreversible cessation of all functions of the entire brain, including the brain stem.
6902          (b) A determination of death shall be made in accordance with this part and accepted
6903     medical standards.
6904          [(2)] (3) A registered nurse may make a determination of death of an individual if:
6905          (a) an attending physician has:
6906          (i) documented in the individual's medical or clinical record that the individual's death
6907     is anticipated due to illness, infirmity, or disease no later than 180 days after the day on which
6908     the physician makes the documentation; and
6909          (ii) established clear assessment procedures for determining death;
6910          (b) the death actually occurs within the 180-day period described in Subsection [(2)]
6911     (3)(a); and
6912          (c) at the time of the documentation described in Subsection [(2)] (3)(a), the physician
6913     authorized the following, in writing, to make the determination of death:

6914          (i) one or more specific registered nurses; or
6915          (ii) if the individual is in a health care facility that has complied with Subsection [(5)]
6916     (6), all registered nurses that the facility employs.
6917          [(3)] (4) A registered nurse who has determined death under this section shall:
6918          (a) document the clinical criteria for the determination in the individual's medical or
6919     clinical record;
6920          (b) notify the physician described in Subsection [(2)] (3); and
6921          (c) ensure that the death certificate includes:
6922          (i) the name of the deceased;
6923          (ii) the presence of a contagious disease, if known; and
6924          (iii) the date and time of death.
6925          [(4)] (5) Except as otherwise provided by law or rule, a physician [licensed under Title
6926     58, Chapter 67, Utah Medical Practice Act, or Title 58, Chapter 68, Utah Osteopathic Medical
6927     Practice Act,] shall certify a determination of death described in Subsection [(3)] (4) within 24
6928     hours after the registered nurse makes the determination of death.
6929          [(5)] (6) (a) For a health care facility to be eligible for a general authorization described
6930     in Subsection [(2)] (3)(c), the facility shall adopt written policies and procedures that provide
6931     for the determination of death by a registered nurse under this section.
6932          (b) A registered nurse that a health care facility employs may not make a determination
6933     of death under this section unless the facility has adopted the written policies and procedures
6934     described in Subsection [(5)] (6)(a).
6935          [(6)] (7) The department may make rules, in accordance with Title 63G, Chapter 3,
6936     Utah Administrative Rulemaking Act, to ensure the appropriate determination of death under
6937     this section.
6938          Section 208. Section 26B-8-133, which is renumbered from Section 26-23-5 is
6939     renumbered and amended to read:
6940          [26-23-5].      26B-8-133. Unlawful acts concerning certificates, records, and

6941     reports -- Unlawful transportation or acceptance of dead human body.
6942          It is unlawful for any person, association, or corporation and the officers of any of them:
6943          (1) to willfully and knowingly make any false statement in a certificate, record, or
6944     report required to be filed with the department, or in an application for a certified copy of a
6945     vital record, or to willfully and knowingly supply false information intending that the
6946     information be used in the preparation of any report, record, or certificate, or an amendment to
6947     any of these;
6948          (2) to make, counterfeit, alter, amend, or mutilate any certificate, record, or report
6949     required to be filed under this code or a certified copy of the certificate, record, or report
6950     without lawful authority and with the intent to deceive;
6951          (3) to willfully and knowingly obtain, possess, use, sell, furnish, or attempt to obtain,
6952     possess, use, sell, or furnish to another, for any purpose of deception, any certificate, record,
6953     report, or certified copy of any of them, including any that are counterfeited, altered, amended,
6954     or mutilated;
6955          (4) without lawful authority, to possess any certificate, record, or report, required by
6956     the department or a copy or certified copy of the certificate, record, or report, knowing it to
6957     have been stolen or otherwise unlawfully obtained; or
6958          (5) to willfully and knowingly transport or accept for transportation, interment, or other
6959     disposition a dead human body without a permit required by law.
6960          Section 209. Section 26B-8-134, which is renumbered from Section 26-23-5.5 is
6961     renumbered and amended to read:
6962          [26-23-5.5].      26B-8-134. Illegal use of birth certificate -- Penalties.
6963          (1) It is a third degree felony for any person to willfully and knowingly:
6964          (a) and with the intent to deceive, obtain, possess, use, sell, furnish, or attempt to
6965     obtain, possess, use, sell, or furnish to another any certificate of birth or certified copy of a
6966     certificate of birth knowing that the certificate or certified copy was issued upon information
6967     which is false in whole or in part or which relates to the birth of another person, whether living

6968     or deceased; or
6969          (b) furnish or process a certificate of birth or certified copy of a certificate of birth with
6970     the knowledge or intention that it be used for the purpose of deception by a person other than
6971     the person to whom the certificate of birth relates.
6972          (2) The specific criminal violations and the criminal penalty under this section take
6973     precedence over any more general criminal offense as described in Section [26-23-5]
6974     26B-8-133.
6975          Section 210. Section 26B-8-201, which is renumbered from Section 26-4-2 is
6976     renumbered and amended to read:
6977     
Part 2. Utah Medical Examiner

6978          [26-4-2].      26B-8-201. Definitions.
6979          As used in this [chapter] part:
6980          (1) "Dead body" means the same as that term is defined in Section [26-2-2] 26B-8-101.
6981          (2) (a) "Death by violence" means death that resulted by the decedent's exposure to
6982     physical, mechanical, or chemical forces.
6983          (b) "Death by violence" includes death that appears to have been due to homicide,
6984     death that occurred during or in an attempt to commit rape, mayhem, kidnapping, robbery,
6985     burglary, housebreaking, extortion, or blackmail accompanied by threats of violence, assault
6986     with a dangerous weapon, assault with intent to commit any offense punishable by
6987     imprisonment for more than one year, arson punishable by imprisonment for more than one
6988     year, or any attempt to commit any of the foregoing offenses.
6989          (3) "Immediate relative" means an individual's spouse, child, parent, sibling,
6990     grandparent, or grandchild.
6991          (4) "Health care professional" means any of the following while acting in a
6992     professional capacity:
6993          (a) a physician licensed under Title 58, Chapter 67, Utah Medical Practice Act, or Title
6994     58, Chapter 68, Utah Osteopathic Medical Practice Act;

6995          (b) a physician assistant licensed under Title 58, Chapter 70a, Utah Physician Assistant
6996     Act; or
6997          (c) an advance practice registered nurse licensed under Subsection 58-31b-301(2)(e).
6998          (5) "Medical examiner" means the state medical examiner appointed pursuant to
6999     Section [26-4-4] 26B-8-202 or a deputy appointed by the medical examiner.
7000          (6) "Medical examiner record" means:
7001          (a) all information that the medical examiner obtains regarding a decedent; and
7002          (b) reports that the medical examiner makes regarding a decedent.
7003          (7) "Regional pathologist" means a trained pathologist licensed to practice medicine
7004     and surgery in the state, appointed by the medical examiner pursuant to Subsection [26-4-4]
7005     26B-8-202(3).
7006          (8) "Sudden death while in apparent good health" means apparently instantaneous
7007     death without obvious natural cause, death during or following an unexplained syncope or
7008     coma, or death during an acute or unexplained rapidly fatal illness.
7009          (9) "Sudden infant death syndrome" means the death of a child who was thought to be
7010     in good health or whose terminal illness appeared to be so mild that the possibility of a fatal
7011     outcome was not anticipated.
7012          (10) "Suicide" means death caused by an intentional and voluntary act of an individual
7013     who understands the physical nature of the act and intends by such act to accomplish
7014     self-destruction.
7015          (11) "Unattended death" means a death that occurs more than 365 days after the day on
7016     which a health care professional examined or treated the deceased individual for any purpose,
7017     including writing a prescription.
7018          (12) (a) "Unavailable for postmortem investigation" means that a dead body is:
7019          (i) transported out of state;
7020          (ii) buried at sea;
7021          (iii) cremated;

7022          (iv) processed by alkaline hydrolysis; or
7023          (v) otherwise made unavailable to the medical examiner for postmortem investigation
7024     or autopsy.
7025          (b) "Unavailable for postmortem investigation" does not include embalming or burial
7026     of a dead body pursuant to the requirements of law.
7027          (13) "Within the scope of the decedent's employment" means all acts reasonably
7028     necessary or incident to the performance of work, including matters of personal convenience
7029     and comfort not in conflict with specific instructions.
7030          Section 211. Section 26B-8-202, which is renumbered from Section 26-4-4 is
7031     renumbered and amended to read:
7032          [26-4-4].      26B-8-202. Chief medical examiner -- Appointment -- Qualifications
7033     -- Authority.
7034          (1) The executive director, with the advice of an advisory board consisting of the
7035     chairman of the Department of Pathology at the University of Utah medical school and the
7036     dean of the law school at the University of Utah, shall appoint a chief medical examiner who
7037     shall be licensed to practice medicine in the state and shall meet the qualifications of a forensic
7038     pathologist, certified by the American Board of [Pathologists] Pathology.
7039          (2) (a) The medical examiner shall serve at the will of the executive director.
7040          (b) The medical examiner has authority to:
7041          (i) employ medical, technical and clerical personnel as may be required to effectively
7042     administer this chapter, subject to the rules of the department and the state merit system;
7043          (ii) conduct investigations and pathological examinations;
7044          (iii) perform autopsies authorized in this title;
7045          (iv) conduct or authorize necessary examinations on dead bodies; and
7046          (v) notwithstanding the provisions of Subsection [26-28-122] 26B-8-321(3), retain
7047     tissues and biological samples:
7048          (A) for scientific purposes;

7049          (B) where necessary to accurately certify the cause and manner of death; or
7050          (C) for tissue from an unclaimed body, subject to Section [26-4-25] 26B-8-225, in
7051     order to donate the tissue or biological sample to an individual who is affiliated with an
7052     established search and rescue dog organization, for the purpose of training a dog to search for
7053     human remains.
7054          (c) In the case of an unidentified body, the medical examiner shall authorize or conduct
7055     investigations, tests and processes in order to determine its identity as well as the cause of
7056     death.
7057          (3) The medical examiner may appoint regional pathologists, each of whom shall be
7058     approved by the executive director.
7059          Section 212. Section 26B-8-203, which is renumbered from Section 26-4-5 is
7060     renumbered and amended to read:
7061          [26-4-5].      26B-8-203. County medical examiners.
7062          The county executive, with the advice and consent of the county legislative body, may
7063     appoint medical examiners for their respective counties.
7064          Section 213. Section 26B-8-204, which is renumbered from Section 26-4-6 is
7065     renumbered and amended to read:
7066          [26-4-6].      26B-8-204. Investigation of deaths -- Requests for autopsies.
7067          (1) The following have authority to investigate a death described in Section [26-4-7]
7068     26B-8-205 and any other case which may be within their jurisdiction:
7069          (a) the attorney general or an assistant attorney general;
7070          (b) the district attorney or county attorney who has criminal jurisdiction over the death
7071     or case;
7072          (c) a deputy of the district attorney or county attorney described in Subsection (1)(b);
7073     or
7074          (d) a peace officer within the jurisdiction described in Subsection (1)(b).
7075          (2) If, in the opinion of the medical examiner, an autopsy should be performed or if an

7076     autopsy is requested by the district attorney or county attorney having criminal jurisdiction, or
7077     by the attorney general, the autopsy shall be performed by the medical examiner or a regional
7078     pathologist.
7079          Section 214. Section 26B-8-205, which is renumbered from Section 26-4-7 is
7080     renumbered and amended to read:
7081          [26-4-7].      26B-8-205. Custody by medical examiner.
7082          Upon notification under Section [26-4-8] 26B-8-206 or investigation by the medical
7083     examiner's office, the medical examiner shall assume custody of a deceased body if it appears
7084     that death:
7085          (1) was by violence, gunshot, suicide, or accident;
7086          (2) was sudden death while in apparent good health;
7087          (3) occurred unattended, except that an autopsy may only be performed in accordance
7088     with the provisions of Subsection [26-4-9] 26B-8-207(3);
7089          (4) occurred under suspicious or unusual circumstances;
7090          (5) resulted from poisoning or overdose of drugs;
7091          (6) resulted from a disease that may constitute a threat to the public health;
7092          (7) resulted from disease, injury, toxic effect, or unusual exertion incurred within the
7093     scope of the decedent's employment;
7094          (8) was due to sudden infant death syndrome;
7095          (9) occurred while the decedent was in prison, jail, police custody, the state hospital, or
7096     in a detention or medical facility operated for the treatment of persons with a mental illness,
7097     persons who are emotionally disturbed, or delinquent persons;
7098          (10) resulted directly from the actions of a law enforcement officer, as defined in
7099     Section 53-13-103;
7100          (11) was associated with diagnostic or therapeutic procedures; or
7101          (12) was described in this section when request is made to assume custody by a county
7102     or district attorney or law enforcement agency in connection with a potential homicide

7103     investigation or prosecution.
7104          Section 215. Section 26B-8-206, which is renumbered from Section 26-4-8 is
7105     renumbered and amended to read:
7106          [26-4-8].      26B-8-206. Discovery of dead body -- Notice requirements --
7107     Procedure.
7108          (1) When death occurs under circumstances listed in Section [26-4-7] 26B-8-205, the
7109     person or persons finding or having custody of the body shall immediately notify the nearest
7110     law enforcement agency. The law enforcement agency having jurisdiction over the case shall
7111     then proceed to the place where the body is and conduct an investigation concerning the cause
7112     and circumstances of death for the purpose of determining whether there exists any criminal
7113     responsibility for the death.
7114          (2) On a determination by the law enforcement agency that death may have occurred in
7115     any of the ways described in Section [26-4-7] 26B-8-205, the death shall be reported to the
7116     district attorney or county attorney having criminal jurisdiction and to the medical examiner by
7117     the law enforcement agency having jurisdiction over the investigation.
7118          (3) The report shall be made by the most expeditious means available. Failure to give
7119     notification or report to the district attorney or county attorney having criminal jurisdiction and
7120     medical examiner is a class B misdemeanor.
7121          Section 216. Section 26B-8-207, which is renumbered from Section 26-4-9 is
7122     renumbered and amended to read:
7123          [26-4-9].      26B-8-207. Custody of dead body and personal effects --
7124     Examination of scene of death -- Preservation of body -- Autopsies.
7125          (1) (a) Upon notification of a death under Section [26-4-8] 26B-8-206, the medical
7126     examiner shall assume custody of the deceased body, clothing on the body, biological samples
7127     taken, and any article on or near the body which may aid the medical examiner in determining
7128     the cause of death except those articles which will assist the investigative agency to proceed
7129     without delay with the investigation.

7130          (b) In all cases the scene of the event may not be disturbed until authorization is given
7131     by the senior ranking peace officer from the law enforcement agency having jurisdiction of the
7132     case and conducting the investigation.
7133          (c) Where death appears to have occurred under circumstances listed in Section
7134     [26-4-7] 26B-8-205, the person or persons finding or having custody of the body, or
7135     jurisdiction over the investigation of the death, shall take reasonable precautions to preserve the
7136     body and body fluids so that minimum deterioration takes place.
7137          (d) A person may not move a body in the custody of the medical examiner unless:
7138          (i) the medical examiner, or district attorney or county attorney that has criminal
7139     jurisdiction, authorizes the person to move the body;
7140          (ii) a designee of an individual listed in this Subsection (1)(d) authorizes the person to
7141     move the body;
7142          (iii) not moving the body would be an affront to public decency or impractical; or
7143          (iv) the medical examiner determines the cause of death is likely due to natural causes.
7144          (e) The body can under direction of the medical examiner or the medical examiner's
7145     designee be moved to a place specified by the medical examiner or the medical examiner's
7146     designee.
7147          (2) (a) If the medical examiner has custody of a body, a person may not clean or
7148     embalm the body without first obtaining the medical examiner's permission.
7149          (b) An intentional or knowing violation of Subsection (2)(a) is a class B misdemeanor.
7150          (3) (a) When the medical examiner assumes lawful custody of a body under Subsection
7151     [26-4-7] 26B-8-205(3) solely because the death was unattended, an autopsy may not be
7152     performed unless requested by the district attorney, county attorney having criminal
7153     jurisdiction, or law enforcement agency having jurisdiction of the place where the body is
7154     found.
7155          (b) The county attorney or district attorney and law enforcement agency having
7156     jurisdiction shall consult with the medical examiner to determine the need for an autopsy.

7157          (c) If the deceased chose not to be seen or treated by a health care professional for a
7158     spiritual or religious reason, a district attorney, county attorney, or law enforcement agency,
7159     may not request an autopsy or inquest under Subsection (3)(a) solely because of the deceased's
7160     choice.
7161          (d) The medical examiner or medical examiner's designee may not conduct a requested
7162     autopsy described in Subsection (3)(a) if the medical examiner or medical examiner's designee
7163     determines:
7164          (i) the request violates Subsection (3)(c); or
7165          (ii) the cause of death can be determined without performing an autopsy.
7166          Section 217. Section 26B-8-208, which is renumbered from Section 26-2-18.5 is
7167     renumbered and amended to read:
7168          [26-2-18.5].      26B-8-208. Rendering a dead body unavailable for postmortem
7169     investigation.
7170          (1) As used in this section:
7171          (a) "Medical examiner" means the same as that term is defined in Section [26-4-2]
7172     26B-8-201.
7173          (b) "Unavailable for postmortem investigation" means the same as that term is defined
7174     in Section [26-4-2] 26B-8-201.
7175          (2) It is unlawful for a person to engage in any conduct that makes a dead body
7176     unavailable for postmortem investigation, unless, before engaging in that conduct, the person
7177     obtains a permit from the medical examiner to render the dead body unavailable for
7178     postmortem investigation, under Section [26-4-29] 26B-8-230, if the person intends to make
7179     the body unavailable for postmortem investigation.
7180          (3) A person who violates Subsection (2) is guilty of a third degree felony.
7181          (4) If a person engages in conduct that constitutes both a violation of this section and a
7182     violation of Section 76-9-704, the provisions and penalties of Section 76-9-704 supersede the
7183     provisions and penalties of this section.

7184          Section 218. Section 26B-8-209, which is renumbered from Section 26-4-10 is
7185     renumbered and amended to read:
7186          [26-4-10].      26B-8-209. Certification of cause of death.
7187          (1) (a) For a death under any of the circumstances described in Section [26-4-7]
7188     26B-8-205, only the medical examiner or the medical examiner's designee may certify the
7189     cause of death.
7190          (b) An individual who knowingly certifies the cause of death in violation of Subsection
7191     (1)(a) is guilty of a class B misdemeanor.
7192          (2) (a) For a death described in Section [26-4-7] 26B-8-205, an individual may not
7193     knowingly give false information, with the intent to mislead, to the medical examiner or the
7194     medical examiner's designee.
7195          (b) A violation of Subsection (2)(a) is a class B misdemeanor.
7196          Section 219. Section 26B-8-210, which is renumbered from Section 26-4-10.5 is
7197     renumbered and amended to read:
7198          [26-4-10.5].      26B-8-210. Medical examiner to report death caused by prescribed
7199     controlled substance poisoning or overdose.
7200          (1) If a medical examiner determines that the death of a person who is 12 years old or
7201     older at the time of death resulted from poisoning or overdose involving a prescribed controlled
7202     substance, the medical examiner shall, within three business days after the day on which the
7203     medical examiner determines the cause of death, send a written report to the Division of
7204     Professional Licensing, created in Section 58-1-103, that includes:
7205          (a) the decedent's name;
7206          (b) each drug or other substance found in the decedent's system that may have
7207     contributed to the poisoning or overdose, if known; and
7208          (c) the name of each person the medical examiner has reason to believe may have
7209     prescribed a controlled substance described in Subsection (1)(b) to the decedent.
7210          (2) This section does not create a new cause of action.

7211          Section 220. Section 26B-8-211, which is renumbered from Section 26-4-11 is
7212     renumbered and amended to read:
7213          [26-4-11].      26B-8-211. Records and reports of investigations.
7214          (1) A complete copy of all written records and reports of investigations and facts
7215     resulting from medical care treatment, autopsies conducted by any person on the body of the
7216     deceased who died in any manner listed in Section [26-4-7] 26B-8-205 and the written reports
7217     of any investigative agency making inquiry into the incident shall be promptly made and filed
7218     with the medical examiner.
7219          (2) The judiciary or a state or local government entity that retains a record, other than a
7220     document described in Subsection (1), of the decedent shall provide a copy of the record to the
7221     medical examiner:
7222          (a) in accordance with federal law; and
7223          (b) upon receipt of the medical examiner's written request for the record.
7224          (3) Failure to submit reports or records described in Subsection (1) or (2), other than
7225     reports of a county attorney, district attorney, or law enforcement agency, within 10 days after
7226     the day on which the person in possession of the report or record receives the medical
7227     examiner's written request for the report or record is a class B misdemeanor.
7228          Section 221. Section 26B-8-212, which is renumbered from Section 26-4-12 is
7229     renumbered and amended to read:
7230          [26-4-12].      26B-8-212. Order to exhume body -- Procedure.
7231          (1) In case of any death described in Section [26-4-7] 26B-8-205, when a body is
7232     buried without an investigation by the medical examiner as to the cause and manner of death, it
7233     shall be the duty of the medical examiner, upon being advised of the fact, to notify the district
7234     attorney or county attorney having criminal jurisdiction where the body is buried or death
7235     occurred. Upon notification, the district attorney or county attorney having criminal
7236     jurisdiction may file an action in the district court to obtain an order to exhume the body. A
7237     district judge may order the body exhumed upon an ex parte hearing.

7238          (2) (a) A body may not be exhumed until notice of the order has been served upon the
7239     executor or administrator of the deceased's estate, or if no executor or administrator has been
7240     appointed, upon the nearest heir of the deceased, determined as if the deceased had died
7241     intestate. If the nearest heir of the deceased cannot be located within the jurisdiction, then the
7242     next heir in succession within the jurisdiction may be served.
7243          (b) The executor, administrator, or heir shall have 24 hours to notify the issuing court
7244     of any objection to the order prior to the time the body is exhumed. If no heirs can be located
7245     within the jurisdiction within 24 hours, the facts shall be reported to the issuing court which
7246     may order that the body be exhumed forthwith.
7247          (c) Notification to the executor, administrator, or heir shall specifically state the nature
7248     of the action and the fact that any objection shall be filed with the issuing court within 24 hours
7249     of the time of service.
7250          (d) In the event an heir files an objection, the court shall set hearing on the matter at the
7251     earliest possible time and issue an order on the matter immediately at the conclusion of the
7252     hearing. Upon the receipt of notice of objection, the court shall immediately notify the county
7253     attorney who requested the order, so that the interest of the state may be represented at the
7254     hearing.
7255          (e) When there is reason to believe that death occurred in a manner described in
7256     Section [26-4-7] 26B-8-205, the district attorney or county attorney having criminal
7257     jurisdiction may make a motion that the court, upon ex parte hearing, order the body exhumed
7258     forthwith and without notice. Upon a showing of exigent circumstances the court may order
7259     the body exhumed forthwith and without notice. In any event, upon motion of the district
7260     attorney or county attorney having criminal jurisdiction and upon the personal appearance of
7261     the medical examiner, the court for good cause may order the body exhumed forthwith and
7262     without notice.
7263          (3) An order to exhume a body shall be directed to the medical examiner, commanding
7264     the medical examiner to cause the body to be exhumed, perform the required autopsy, and

7265     properly cause the body to be reburied upon completion of the examination.
7266          (4) The examination shall be completed and the complete autopsy report shall be made
7267     to the district attorney or county attorney having criminal jurisdiction for any action the
7268     attorney considers appropriate. The district attorney or county attorney shall submit the return
7269     of the order to exhume within 10 days in the manner prescribed by the issuing court.
7270          Section 222. Section 26B-8-213, which is renumbered from Section 26-4-13 is
7271     renumbered and amended to read:
7272          [26-4-13].      26B-8-213. Autopsies -- When authorized.
7273          (1) The medical examiner shall perform an autopsy to:
7274          (a) aid in the discovery and prosecution of a crime;
7275          (b) protect an innocent person accused of a crime; and
7276          (c) disclose hazards to public health.
7277          (2) The medical examiner may perform an autopsy:
7278          (a) to aid in the administration of civil justice in life and accident insurance problems
7279     in accordance with Title 34A, Chapter 2, Workers' Compensation Act; and
7280          (b) in other cases involving questions of civil liability.
7281          Section 223. Section 26B-8-214, which is renumbered from Section 26-4-14 is
7282     renumbered and amended to read:
7283          [26-4-14].      26B-8-214. Certification of death by attending health care
7284     professional -- Deaths without medical attendance -- Cause of death uncertain -- Notice
7285     requirements.
7286          (1) (a) A health care professional who treats or examines an individual within 365 days
7287     from the day on which the individual dies, shall certify the individual's cause of death to the
7288     best of the health care professional's knowledge and belief unless the health care professional
7289     determines the individual may have died in a manner described in Section [26-4-7] 26B-8-205.
7290          (b) If a health care professional is unable to determine an individual's cause of death in
7291     accordance with Subsection (1)(a), the health care professional shall notify the medical

7292     examiner.
7293          (2) For an unattended death, the person with custody of the body shall notify the
7294     medical examiner of the death.
7295          (3) If the medical examiner determines there may be criminal responsibility for a death,
7296     the medical examiner shall notify:
7297          (a) the district attorney or county attorney that has criminal jurisdiction; or
7298          (b) the head of the law enforcement agency that has jurisdiction to investigate the
7299     death.
7300          Section 224. Section 26B-8-215, which is renumbered from Section 26-4-15 is
7301     renumbered and amended to read:
7302          [26-4-15].      26B-8-215. Deaths in medical centers and federal facilities.
7303          All death certificates of any decedent who died in a teaching medical center or a federal
7304     medical facility unattended or in the care of an unlicensed physician or other medical personnel
7305     shall be signed by the licensed supervisory physician, attending physician or licensed resident
7306     physician of the medical center or facility.
7307          Section 225. Section 26B-8-216, which is renumbered from Section 26-4-16 is
7308     renumbered and amended to read:
7309          [26-4-16].      26B-8-216. Release of body for funeral preparations.
7310          (1) (a) Where a body is held for investigation or autopsy under this chapter or for a
7311     medical investigation permitted by law, the body shall, if requested by the person given priority
7312     under Section 58-9-602, be released for funeral preparations no later than 24 hours after the
7313     arrival at the office of the medical examiner or regional medical facility.
7314          (b) An extension may be ordered only by a district court.
7315          (2) The right and duty to control the disposition of a deceased person is governed by
7316     Sections 58-9-601 through 58-9-606.
7317          Section 226. Section 26B-8-217, which is renumbered from Section 26-4-17 is
7318     renumbered and amended to read:

7319          [26-4-17].      26B-8-217. Records of medical examiner -- Confidentiality.
7320          (1) The medical examiner shall maintain complete, original records for the medical
7321     examiner record, which shall:
7322          (a) be properly indexed, giving the name, if known, or otherwise identifying every
7323     individual whose death is investigated;
7324          (b) indicate the place where the body was found;
7325          (c) indicate the date of death;
7326          (d) indicate the cause and manner of death;
7327          (e) indicate the occupation of the decedent, if available;
7328          (f) include all other relevant information concerning the death; and
7329          (g) include a full report and detailed findings of the autopsy or report of the
7330     investigation.
7331          (2) (a) Upon written request from an individual described in Subsections (2)(a)(i)
7332     through (iv), the medical examiner shall provide a copy of the medical examiner's final report
7333     of examination for the decedent, including the autopsy report, toxicology report, lab reports,
7334     and investigative reports to any of the following:
7335          (i) a decedent's immediate relative;
7336          (ii) a decedent's legal representative;
7337          (iii) a physician or physician assistant who attended the decedent during the year before
7338     the decedent's death; or
7339          (iv) a county attorney, a district attorney, a criminal defense attorney, or other law
7340     enforcement official with jurisdiction, as necessary for the performance of the attorney or
7341     official's professional duties.
7342          (b) Upon written request from the director or a designee of the director of an entity
7343     described in Subsections (2)(b)(i) through (iv), the medical examiner may provide a copy of the
7344     of the medical examiner's final report of examination for the decedent, including any other
7345     reports described in Subsection (2)(a), to any of the following entities as necessary for

7346     performance of the entity's official purposes:
7347          (i) a local health department;
7348          (ii) a local mental health authority;
7349          (iii) a public health authority; or
7350          (iv) another state or federal governmental agency.
7351          (c) The medical examiner may provide a copy of the medical examiner's final report of
7352     examination, including any other reports described in Subsection (2)(a), if the final report
7353     relates to an issue of public health or safety, as further defined by rule made by the department
7354     in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.
7355          (3) Reports provided under Subsection (2) may not include records that the medical
7356     examiner obtains from a third party in the course of investigating the decedent's death.
7357          (4) The medical examiner may provide a medical examiner record to a researcher who:
7358          (a) has an advanced degree;
7359          (b) (i) is affiliated with an accredited college or university, a hospital, or another
7360     system of care, including an emergency medical response or a local health agency; or
7361          (ii) is part of a research firm contracted with an accredited college or university, a
7362     hospital, or another system of care;
7363          (c) requests a medical examiner record for a research project or a quality improvement
7364     initiative that will have a public health benefit, as determined by the department; and
7365          (d) provides to the medical examiner an approval from:
7366          (i) the researcher's sponsoring organization; and
7367          (ii) the Utah Department of Health and Human Services Institutional Review Board.
7368          (5) Records provided under Subsection (4) may not include a third party record, unless:
7369          (a) a court has ordered disclosure of the third party record; and
7370          (b) disclosure is conducted in compliance with state and federal law.
7371          (6) A person who obtains a medical examiner record under Subsection (4) shall:
7372          (a) maintain the confidentiality of the medical examiner record by removing personally

7373     identifying information about a decedent or the decedent's family and any other information
7374     that may be used to identify a decedent before using the medical examiner record in research;
7375          (b) conduct any research within and under the supervision of the Office of the Medical
7376     Examiner, if the medical examiner record contains a third party record with personally
7377     identifiable information;
7378          (c) limit the use of a medical examiner record to the purpose for which the person
7379     requested the medical examiner record;
7380          (d) destroy a medical examiner record and the data abstracted from the medical
7381     examiner record at the conclusion of the research for which the person requested the medical
7382     examiner record;
7383          (e) reimburse the medical examiner, as provided in Section 26B-1-209, for any costs
7384     incurred by the medical examiner in providing a medical examiner record;
7385          (f) allow the medical examiner to review, before public release, a publication in which
7386     data from a medical examiner record is referenced or analyzed; and
7387          (g) provide the medical examiner access to the researcher's database containing data
7388     from a medical examiner record, until the day on which the researcher permanently destroys
7389     the medical examiner record and all data obtained from the medical examiner record.
7390          (7) The department may make rules, in accordance with Title 63G, Chapter 3, Utah
7391     Administrative Rulemaking Act, and in consideration of applicable state and federal law, to
7392     establish permissible uses and disclosures of a medical examiner record or other record
7393     obtained under this section.
7394          (8) Except as provided in this chapter or ordered by a court, the medical examiner may
7395     not disclose any part of a medical examiner record.
7396          (9) A person who obtains a medical examiner record under Subsection (4) is guilty of a
7397     class B misdemeanor, if the person fails to comply with the requirements of Subsections (6)(a)
7398     through (d).
7399          Section 227. Section 26B-8-218, which is renumbered from Section 26-4-18 is

7400     renumbered and amended to read:
7401          [26-4-18].      26B-8-218. Records of medical examiner -- Admissibility as
7402     evidence -- Subpoena of person who prepared record.
7403          The records of the medical examiner or transcripts thereof certified by the medical
7404     examiner are admissible as evidence in any civil action in any court in this state except that
7405     statements by witnesses or other persons, unless taken pursuant to Section [26-4-21]
7406     26B-8-221, as conclusions upon extraneous matters are not hereby made admissible. The
7407     person who prepared a report or record offered in evidence hereunder may be subpoenaed as a
7408     witness in the case by any party.
7409          Section 228. Section 26B-8-219, which is renumbered from Section 26-4-19 is
7410     renumbered and amended to read:
7411          [26-4-19].      26B-8-219. Personal property of deceased -- Disposition.
7412          (1) Personal property of the deceased not held as evidence shall be turned over to the
7413     legal representative of the deceased within 30 days after completion of the investigation of the
7414     death of the deceased. If no legal representative is known, the county attorney, district attorney,
7415     or the medical examiner shall, within 30 days after the investigation, turn the personal property
7416     over to the county treasurer to be handled pursuant to the escheat laws.
7417          (2) An affidavit shall be filed with the county treasurer by the county attorney, district
7418     attorney, or the medical examiner within 30 days after investigation of the death of the
7419     deceased showing the money or other property belonging to the estate of the deceased person
7420     which has come into his possession and the disposition made of the property.
7421          (3) Property required to be turned over to the legal representative of the deceased may
7422     be held longer than 30 days if, in the opinion of the county attorney, district attorney, or
7423     attorney general, the property is necessary evidence in a court proceeding. Upon conclusion of
7424     the court proceedings, the personal property shall be turned over as described in this section
7425     and in accordance with the rules of the court.
7426          Section 229. Section 26B-8-220, which is renumbered from Section 26-4-20 is

7427     renumbered and amended to read:
7428          [26-4-20].      26B-8-220. Officials not liable for authorized acts.
7429          Except as provided in this [chapter] part, a criminal or civil action may not arise against
7430     the county attorney, district attorney, or his deputies, the medical examiner or his deputies, or
7431     regional pathologists for authorizing or performing autopsies authorized by this [chapter] part
7432     or for any other act authorized by this [chapter] part.
7433          Section 230. Section 26B-8-221, which is renumbered from Section 26-4-21 is
7434     renumbered and amended to read:
7435          [26-4-21].      26B-8-221. Authority of county attorney or district attorney to
7436     subpoena witnesses and compel testimony -- Determination if decedent died by unlawful
7437     means.
7438          (1) The district attorney or county attorney having criminal jurisdiction may subpoena
7439     witnesses and compel testimony concerning the death of any person and have such testimony
7440     reduced to writing under his direction and may employ a shorthand reporter for that purpose at
7441     the same compensation as is allowed to reporters in the district courts. When the testimony has
7442     been taken down by the shorthand reporter, a transcript thereof, duly certified, shall constitute
7443     the deposition of the witness.
7444          (2) Upon review of all facts and testimony taken concerning the death of a person, the
7445     district attorney or county attorney having criminal jurisdiction shall determine if the decedent
7446     died by unlawful means and shall also determine if criminal prosecution shall be instituted.
7447          Section 231. Section 26B-8-222, which is renumbered from Section 26-4-22 is
7448     renumbered and amended to read:
7449          [26-4-22].      26B-8-222. Additional powers and duties of department.
7450          The department may:
7451          (1) establish rules to carry out the provisions of this [chapter] part;
7452          (2) arrange for the state health laboratory to perform toxicologic analysis for public or
7453     private institutions and fix fees for the services;

7454          (3) cooperate and train law enforcement personnel in the techniques of criminal
7455     investigation as related to medical and pathological matters; and
7456          (4) pay to private parties, institutions or funeral directors the reasonable value of
7457     services performed for the medical examiner's office.
7458          Section 232. Section 26B-8-223, which is renumbered from Section 26-4-23 is
7459     renumbered and amended to read:
7460          [26-4-23].      26B-8-223. Authority of examiner to provide organ or other tissue
7461     for transplant purposes.
7462          (1) When requested by the licensed physician of a patient who is in need of an organ or
7463     other tissue for transplant purpose, by a legally created Utah eye bank, organ bank or medical
7464     facility, the medical examiner may provide an organ or other tissue if:
7465          (a) a decedent who may provide a suitable organ or other tissue for the transplant is in
7466     the custody of the medical examiner;
7467          (b) the medical examiner is assured that the requesting party has made reasonable
7468     search for and inquiry of next of kin of the decedent and that no objection by the next of kin is
7469     known by the requesting party; and
7470          (c) the removal of the organ or other tissue will not interfere with the investigation or
7471     autopsy or alter the post-mortem facial appearance.
7472          (2) When the medical examiner is in custody of a decedent who may provide a suitable
7473     organ or other tissue for transplant purposes, he may contact the appropriate eye bank, organ
7474     bank or medical facility and notify them concerning the suitability of the organ or other tissue.
7475     In such contact the medical examiner may disclose the name of the decedent so that necessary
7476     clearances can be obtained.
7477          (3) No person shall be held civilly or criminally liable for any acts performed pursuant
7478     to this section.
7479          Section 233. Section 26B-8-224, which is renumbered from Section 26-4-24 is
7480     renumbered and amended to read:

7481          [26-4-24].      26B-8-224. Autopsies -- Persons eligible to authorize.
7482          (1) Autopsies may be authorized:
7483          (a) by the commissioner of the Labor Commission or the commissioner's designee as
7484     provided in Section 34A-2-603;
7485          (b) by individuals by will or other written document;
7486          (c) upon a decedent by the next of kin in the following order and as known: surviving
7487     spouse, child, if 18 years old or older, otherwise the legal guardian of the child, parent, sibling,
7488     uncle or aunt, nephew or niece, cousin, others charged by law with the duty of burial, or friend
7489     assuming the obligation of burial;
7490          (d) by the county attorney, district attorney, or the district attorney's deputy, or a district
7491     judge; and
7492          (e) by the medical examiner as provided in this [chapter] part.
7493          (2) Autopsies authorized under Subsections (1)(a) and (1)(d) shall be performed by a
7494     certified pathologist.
7495          (3) No criminal or civil action arises against a pathologist or a physician who proceeds
7496     in good faith and performs an autopsy authorized by this section.
7497          Section 234. Section 26B-8-225, which is renumbered from Section 26-4-25 is
7498     renumbered and amended to read:
7499          [26-4-25].      26B-8-225. Burial of an unclaimed body -- Request by the school of
7500     medicine at the University of Utah -- Medical examiner may retain tissue for dog
7501     training.
7502          (1) Except as described in Subsection (2) or (3), a county shall provide, at the county's
7503     expense, decent burial for an unclaimed body found in the county.
7504          (2) A county is not responsible for decent burial of an unclaimed body found in the
7505     county if the body is requested by the dean of the school of medicine at the University of Utah
7506     under Section 53B-17-301.
7507          (3) For an unclaimed body that is temporarily in the medical examiner's custody before

7508     burial under Subsection (1), the medical examiner may retain tissue from the unclaimed body
7509     in order to donate the tissue to an individual who is affiliated with an established search and
7510     rescue dog organization, for the purpose of training a dog to search for human remains.
7511          Section 235. Section 26B-8-226, which is renumbered from Section 26-4-26 is
7512     renumbered and amended to read:
7513          [26-4-26].      26B-8-226. Social security number in certification of death.
7514          A certification of death shall include, if known, the social security number of the
7515     deceased person, and a copy of the certification shall be sent to the Office of Recovery Services
7516     within the [Department of Human Services] department upon request.
7517          Section 236. Section 26B-8-227, which is renumbered from Section 26-4-27 is
7518     renumbered and amended to read:
7519          [26-4-27].      26B-8-227. Registry of unidentified deceased persons.
7520          (1) If the identity of a deceased person over which the medical examiner has
7521     jurisdiction under Section [26-4-7] 26B-8-205 is unknown, the medical examiner shall do the
7522     following before releasing the body to the county in which the body was found as provided in
7523     Section [26-4-25] 26B-8-225:
7524          (a) assign a unique identifying number to the body;
7525          (b) create and maintain a file under the assigned number;
7526          (c) examine the body, take samples, and perform other related tasks for the purpose of
7527     deriving information that may be useful in ascertaining the identity of the deceased person;
7528          (d) use the identifying number in all records created by the medical examiner that
7529     pertains to the body;
7530          (e) record all information pertaining to the body in the file created and maintained
7531     under Subsection (1)(b);
7532          (f) communicate the unique identifying number to the county in which the body was
7533     found; and
7534          (g) access information from available government sources and databases in an attempt

7535     to ascertain the identity of the deceased person.
7536          (2) A county which has received a body to which Subsection (1) applies:
7537          (a) shall adopt and use the same identifying number assigned by Subsection (1) in all
7538     records created by the county that pertain to the body;
7539          (b) require any funeral director or sexton who is involved in the disposition of the body
7540     to adopt and use the same identifying number assigned by Subsection (1) in all records created
7541     by the funeral director or sexton pertaining to the body; and
7542          (c) shall provide a decent burial for the body.
7543          (3) Within 30 days of receiving a body to which Subsection (1) applies, the county
7544     shall inform the medical examiner of the disposition of the body including the burial plot. The
7545     medical examiner shall record this information in the file created and maintained under
7546     Subsection (1)(b).
7547          (4) The requirements of Subsections (1) and (6) apply to a county examiner appointed
7548     under Section [26-4-5] 26B-8-203, with the additional requirements that the county examiner:
7549          (a) obtain a unique identifying number from the medical examiner for the body; and
7550          (b) send to the medical examiner a copy of the file created and maintained in
7551     accordance with Subsection (1)(b), including the disposition of the body and burial plot, within
7552     30 days of releasing the body.
7553          (5) The medical examiner shall maintain a file received under Subsection (4) in the
7554     same way that it maintains a file created and maintained by the medical examiner in accordance
7555     with Subsection (1)(b).
7556          (6) The medical examiner shall cooperate and share information generated and
7557     maintained under this section with a person who demonstrates:
7558          (a) a legitimate personal or governmental interest in determining the identity of a
7559     deceased person; and
7560          (b) a reasonable belief that the body of that deceased person may have come into the
7561     custody of the medical examiner.

7562          Section 237. Section 26B-8-228, which is renumbered from Section 26-4-28 is
7563     renumbered and amended to read:
7564          [26-4-28].      26B-8-228. Testing for suspected suicides -- Maintaining
7565     information -- Compensation to deputy medical examiners.
7566          (1) In all cases where it is suspected that a death resulted from suicide, including
7567     assisted suicide, the medical examiner shall endeavor to have the following tests conducted
7568     upon samples taken from the body of the deceased:
7569          (a) a test that detects all of the substances included in the volatiles panel of the Bureau
7570     of Forensic Toxicology within the [Department of Health] department;
7571          (b) a test that detects all of the substances included in the drugs of abuse panel of the
7572     Bureau of Forensic Toxicology within the [Department of Health] department; and
7573          (c) a test that detects all of the substances included in the prescription drug panel of the
7574     Bureau of Forensic Toxicology within the [Department of Health] department.
7575          (2) The medical examiner shall maintain information regarding the types of substances
7576     found present in the samples taken from the body of a person who is suspected to have died as
7577     a result of suicide or assisted suicide.
7578          (3) Within funds appropriated by the Legislature for this purpose, the medical
7579     examiner shall provide compensation, at a standard rate determined by the medical examiner,
7580     to a deputy medical examiner who collects samples for the purposes described in Subsection
7581     (1).
7582          Section 238. Section 26B-8-229, which is renumbered from Section 26-4-28.5 is
7583     renumbered and amended to read:
7584          [26-4-28.5].      26B-8-229. Psychological autopsy examiner.
7585          (1) With funds appropriated by the Legislature for this purpose, the department shall
7586     provide compensation, at a standard rate determined by the department, to a psychological
7587     autopsy examiner.
7588          (2) The psychological autopsy examiner shall:

7589          (a) work with the medical examiner to compile data regarding suicide related deaths;
7590          (b) as relatives of the deceased are willing, gather information from relatives of the
7591     deceased regarding the psychological reasons for the decedent's death;
7592          (c) maintain a database of information described in Subsections (2)(a) and (b);
7593          (d) in accordance with all applicable privacy laws subject to approval by the
7594     department, share the database described in Subsection (2)(c) with the University of Utah
7595     Department of Psychiatry or other university-based departments conducting research on
7596     suicide;
7597          (e) coordinate no less than monthly with the suicide prevention coordinator described
7598     in Subsection [62A-15-1101] 26B-5-611(2); and
7599          (f) coordinate no less than quarterly with the state suicide prevention coalition.
7600          Section 239. Section 26B-8-230, which is renumbered from Section 26-4-29 is
7601     renumbered and amended to read:
7602          [26-4-29].      26B-8-230. Application for permit to render a dead body
7603     unavailable for postmortem examination -- Fees.
7604          (1) Upon receiving an application by a person for a permit to render a dead body
7605     unavailable for postmortem investigation, the medical examiner shall review the application to
7606     determine whether:
7607          (a) the person is authorized by law to render the dead body unavailable for postmortem
7608     investigation in the manner specified in the application; and
7609          (b) there is a need to delay any action that will render the dead body unavailable for
7610     postmortem investigation until a postmortem investigation or an autopsy of the dead body is
7611     performed by the medical examiner.
7612          (2) Except as provided in Subsection (4), within three days after receiving an
7613     application described in Subsection (1), the medical examiner shall:
7614          (a) make the determinations described in Subsection (1); and
7615          (b) (i) issue a permit to render the dead body unavailable for postmortem investigation

7616     in the manner specified in the application; or
7617          (ii) deny the permit.
7618          (3) The medical examiner may deny a permit to render a dead body unavailable for
7619     postmortem investigation only if:
7620          (a) the applicant is not authorized by law to render the dead body unavailable for
7621     postmortem investigation in the manner specified in the application;
7622          (b) the medical examiner determines that there is a need to delay any action that will
7623     render the dead body unavailable for postmortem investigation; or
7624          (c) the applicant fails to pay the fee described in Subsection (5).
7625          (4) If the medical examiner cannot in good faith make the determinations described in
7626     Subsection (1) within three days after receiving an application described in Subsection (1), the
7627     medical examiner shall notify the applicant:
7628          (a) that more time is needed to make the determinations described in Subsection (1);
7629     and
7630          (b) of the estimated amount of time needed before the determinations described in
7631     Subsection (1) can be made.
7632          (5) The medical examiner may charge a fee, pursuant to Section 63J-1-504, to recover
7633     the costs of fulfilling the duties of the medical examiner described in this section.
7634          Section 240. Section 26B-8-231, which is renumbered from Section 26-4-30 is
7635     renumbered and amended to read:
7636          [26-4-30].      26B-8-231. Overdose fatality examiner.
7637          (1) Within funds appropriated by the Legislature, the department shall provide
7638     compensation, at a standard rate determined by the department, to an overdose fatality
7639     examiner.
7640          (2) The overdose fatality examiner shall:
7641          (a) work with the medical examiner to compile data regarding overdose and opioid
7642     related deaths, including:

7643          (i) toxicology information;
7644          (ii) demographics; and
7645          (iii) the source of opioids or drugs;
7646          (b) as relatives of the deceased are willing, gather information from relatives of the
7647     deceased regarding the circumstances of the decedent's death;
7648          (c) maintain a database of information described in Subsections (2)(a) and (b);
7649          (d) coordinate no less than monthly with the suicide prevention coordinator described
7650     in Section [62A-15-1101] 26B-5-611; and
7651          (e) coordinate no less than quarterly with the Opioid and Overdose Fatality Review
7652     Committee created in Section [26-7-13] 26B-1-403.
7653          Section 241. Section 26B-8-232, which is renumbered from Section 26-23a-2 is
7654     renumbered and amended to read:
7655          [26-23a-2].      26B-8-232. Injury reporting requirements by health care provider
7656     -- Contents of report -- Penalties.
7657          (1) As used in this section:
7658          (a) "Health care provider" means any person, firm, corporation, or association which
7659     furnishes treatment or care to persons who have suffered bodily injury, and includes hospitals,
7660     clinics, podiatrists, dentists and dental hygienists, nurses, nurse practitioners, physicians and
7661     physicians' assistants, osteopathic physicians, naturopathic practitioners, chiropractors,
7662     acupuncturists, paramedics, and emergency medical technicians.
7663          (b) "Injury" does not include any psychological or physical condition brought about
7664     solely through the voluntary administration of prescribed controlled substances.
7665          (c) "Law enforcement agency" means the municipal or county law enforcement agency:
7666          (i) having jurisdiction over the location where the injury occurred; or
7667          (ii) if the reporting health care provider is unable to identify or contact the law
7668     enforcement agency with jurisdiction over the injury, "law enforcement agency" means the
7669     agency nearest to the location of the reporting health care provider.

7670          (d) "Report to a law enforcement agency" means to report, by telephone or other
7671     spoken communication, the facts known regarding an injury subject to reporting under Section
7672     26-23a-2 to the dispatch desk or other staff person designated by the law enforcement agency
7673     to receive reports from the public.
7674          [(1)] (2) (a) Any health care provider who treats or cares for any person who suffers
7675     from any wound or other injury inflicted by the person's own act or by the act of another by
7676     means of a knife, gun, pistol, explosive, infernal device, or deadly weapon, or by violation of
7677     any criminal statute of this state, shall immediately report to a law enforcement agency the facts
7678     regarding the injury.
7679          (b) The report shall state the name and address of the injured person, if known, the
7680     person's whereabouts, the character and extent of the person's injuries, and the name, address,
7681     and telephone number of the person making the report.
7682          [(2)] (3) A health care provider may not be discharged, suspended, disciplined, or
7683     harassed for making a report pursuant to this section.
7684          [(3)] (4) A person may not incur any civil or criminal liability as a result of making any
7685     report required by this section.
7686          [(4)] (5) A health care provider who has personal knowledge that the report of a wound
7687     or injury has been made in compliance with this section is under no further obligation to make
7688     a report regarding that wound or injury under this section.
7689          (6) Any health care provider who intentionally or knowingly violates any provision of
7690     this section is guilty of a class B misdemeanor.
7691          Section 242. Section 26B-8-301, which is renumbered from Section 26-28-102 is
7692     renumbered and amended to read:
7693     
Part 3. Revised Uniform Anatomical Gift Act

7694          [26-28-102].      26B-8-301. Definitions.
7695          As used in this [chapter] part:
7696          (1) "Adult" means an individual who is at least 18 years [of age] old.

7697          (2) "Agent" means an individual:
7698          (a) authorized to make health care decisions on the principal's behalf by a power of
7699     attorney for health care; or
7700          (b) expressly authorized to make an anatomical gift on the principal's behalf by any
7701     other record signed by the principal.
7702          (3) "Anatomical gift" means a donation of all or part of a human body to take effect
7703     after the donor's death for the purpose of transplantation, therapy, research, or education.
7704          (4) "Decedent" means:
7705          (a) a deceased individual whose body or part is or may be the source of an anatomical
7706     gift; and
7707          (b) includes:
7708          (i) a stillborn infant; and
7709          (ii) subject to restrictions imposed by law other than this [chapter] part, a fetus.
7710          (5) (a) "Disinterested witness" means:
7711          (i) a witness other than the spouse, child, parent, sibling, grandchild, grandparent, or
7712     guardian of the individual who makes, amends, revokes, or refuses to make an anatomical gift;
7713     or
7714          (ii) another adult who exhibited special care and concern for the individual.
7715          (b) "Disinterested witness" does not include a person to which an anatomical gift could
7716     pass under Section [26-28-111] 26B-8-310.
7717          (6) "Document of gift" means a donor card or other record used to make an anatomical
7718     gift. The term includes a statement or symbol on a driver license, identification card, or donor
7719     registry.
7720          (7) "Donor" means an individual whose body or part is the subject of an anatomical
7721     gift.
7722          (8) "Donor registry" means a database that contains records of anatomical gifts and
7723     amendments to or revocations of anatomical gifts.

7724          (9) "Driver license" means a license or permit issued by the Driver License Division of
7725     the Department of Public Safety, to operate a vehicle, whether or not conditions are attached to
7726     the license or permit.
7727          (10) "Eye bank" means a person that is licensed, accredited, or regulated under federal
7728     or state law to engage in the recovery, screening, testing, processing, storage, or distribution of
7729     human eyes or portions of human eyes.
7730          (11) "Guardian":
7731          (a) means a person appointed by a court to make decisions regarding the support, care,
7732     education, health, or welfare of an individual; and
7733          (b) does not include a guardian ad litem.
7734          (12) "Hospital" means a facility licensed as a hospital under the law of any state or a
7735     facility operated as a hospital by the United States, a state, or a subdivision of a state.
7736          (13) "Identification card" means an identification card issued by the Driver License
7737     Division of the Department of Public Safety.
7738          (14) "Know" means to have actual knowledge.
7739          (15) "Minor" means an individual who is under 18 years of age.
7740          (16) "Organ procurement organization" means a person designated by the Secretary of
7741     the United States Department of Health and Human Services as an organ procurement
7742     organization.
7743          (17) "Parent" means a parent whose parental rights have not been terminated.
7744          (18) "Part" means an organ, an eye, or tissue of a human being. The term does not
7745     include the whole body.
7746          (19) "Person" means an individual, corporation, business trust, estate, trust,
7747     partnership, limited liability company, association, joint venture, public corporation,
7748     government or governmental subdivision, agency, or instrumentality, or any other legal or
7749     commercial entity.
7750          (20) "Physician" means an individual authorized to practice medicine or osteopathy

7751     under the law of any state.
7752          (21) "Procurement organization" means an eye bank, organ procurement organization,
7753     or tissue bank.
7754          (22) "Prospective donor":
7755          (a) means an individual who is dead or near death and has been determined by a
7756     procurement organization to have a part that could be medically suitable for transplantation,
7757     therapy, research, or education; and
7758          (b) does not include an individual who has made a refusal.
7759          (23) "Reasonably available" means able to be contacted by a procurement organization
7760     without undue effort and willing and able to act in a timely manner consistent with existing
7761     medical criteria necessary for the making of an anatomical gift.
7762          (24) "Recipient" means an individual into whose body a decedent's part has been or is
7763     intended to be transplanted.
7764          (25) "Record" means information that is inscribed on a tangible medium or that is
7765     stored in an electronic or other medium and is retrievable in perceivable form.
7766          (26) "Refusal" means a record created under Section [26-28-107] 26B-8-306 that
7767     expressly states an intent to bar other persons from making an anatomical gift of an individual's
7768     body or part.
7769          (27) "Sign" means, with the present intent to authenticate or adopt a record:
7770          (a) to execute or adopt a tangible symbol; or
7771          (b) to attach to or logically associate with the record an electronic symbol, sound, or
7772     process.
7773          (28) "State" means a state of the United States, the District of Columbia, Puerto Rico,
7774     the United States Virgin Islands, or any territory or insular possession subject to the jurisdiction
7775     of the United States.
7776          (29) "Technician":
7777          (a) means an individual determined to be qualified to remove or process parts by an

7778     appropriate organization that is licensed, accredited, or regulated under federal or state law; and
7779          (b) includes an enucleator.
7780          (30) "Tissue" means a portion of the human body other than an organ or an eye. The
7781     term does not include blood unless the blood is donated for the purpose of research or
7782     education.
7783          (31) "Tissue bank" means a person that is licensed, accredited, or regulated under
7784     federal or state law to engage in the recovery, screening, testing, processing, storage, or
7785     distribution of tissue.
7786          (32) "Transplant hospital" means a hospital that furnishes organ transplants and other
7787     medical and surgical specialty services required for the care of transplant patients.
7788          Section 243. Section 26B-8-302, which is renumbered from Section 26-28-103 is
7789     renumbered and amended to read:
7790          [26-28-103].      26B-8-302. Applicability.
7791          This [chapter] part applies to an anatomical gift or amendment to, revocation of, or
7792     refusal to make an anatomical gift, whenever made.
7793          Section 244. Section 26B-8-303, which is renumbered from Section 26-28-104 is
7794     renumbered and amended to read:
7795          [26-28-104].      26B-8-303. Who may make anatomical gift before donor's
7796     death.
7797          Subject to Section [26-28-108] 26B-8-307, an anatomical gift of a donor's body or part
7798     may be made during the life of the donor for the purpose of transplantation, therapy, research,
7799     or education in the manner provided in Section [26-28-105] 26B-8-304 by:
7800          (1) the donor, if the donor is an adult or if the donor is a minor and is:
7801          (a) emancipated; or
7802          (b) authorized under state law to apply for a driver license because the donor is at least
7803     15 years [of age] old;
7804          (2) an agent of the donor, unless the power of attorney for health care or other record

7805     prohibits the agent from making an anatomical gift;
7806          (3) a parent of the donor, if the donor is an unemancipated minor; or
7807          (4) the donor's guardian.
7808          Section 245. Section 26B-8-304, which is renumbered from Section 26-28-105 is
7809     renumbered and amended to read:
7810          [26-28-105].      26B-8-304. Manner of making anatomical gift before donor's
7811     death.
7812          (1) A donor may make an anatomical gift:
7813          (a) by authorizing a statement or symbol indicating that the donor has made an
7814     anatomical gift to be imprinted on the donor's driver license or identification card;
7815          (b) in a will;
7816          (c) during a terminal illness or injury of the donor, by any form of communication
7817     addressed to at least two adults, at least one of whom is a disinterested witness; or
7818          (d) as provided in Subsection (2).
7819          (2) A donor or other person authorized to make an anatomical gift under Section
7820     [26-28-104] 26B-8-303 may make a gift by a donor card or other record signed by the donor or
7821     other person making the gift or by authorizing that a statement or symbol indicating that the
7822     donor has made an anatomical gift be included on a donor registry. If the donor or other person
7823     is physically unable to sign a record, the record may be signed by another individual at the
7824     direction of the donor or other person and shall:
7825          (a) be witnessed by at least two adults, at least one of whom is a disinterested witness,
7826     who have signed at the request of the donor or the other person; and
7827          (b) state that it has been signed and witnessed as provided in Subsection (2)(a).
7828          (3) Revocation, suspension, expiration, or cancellation of a driver license or
7829     identification card upon which an anatomical gift is indicated does not invalidate the gift.
7830          (4) An anatomical gift made by will takes effect upon the donor's death whether or not
7831     the will is probated. Invalidation of the will after the donor's death does not invalidate the gift.

7832          Section 246. Section 26B-8-305, which is renumbered from Section 26-28-106 is
7833     renumbered and amended to read:
7834          [26-28-106].      26B-8-305. Amending or revoking anatomical gift before
7835     donor's death.
7836          (1) Subject to Section [26-28-108] 26B-8-307, a donor or other person authorized to
7837     make an anatomical gift under Section [26-28-104] 26B-8-303 may amend or revoke an
7838     anatomical gift by:
7839          (a) a record signed by:
7840          (i) the donor;
7841          (ii) the other person; or
7842          (iii) subject to Subsection (2), another individual acting at the direction of the donor or
7843     the other person if the donor or other person is physically unable to sign; or
7844          (b) a later-executed document of gift that amends or revokes a previous anatomical gift
7845     or portion of an anatomical gift, either expressly or by inconsistency.
7846          (2) A record signed pursuant to Subsection (1)(a)(iii) shall:
7847          (a) be witnessed by at least two adults, at least one of whom is a disinterested witness,
7848     who have signed at the request of the donor or the other person; and
7849          (b) state that it has been signed and witnessed as provided in Subsection (1)(a).
7850          (3) Subject to Section [26-28-108] 26B-8-307, a donor or other person authorized to
7851     make an anatomical gift under Section [26-28-104] 26B-8-303 may revoke an anatomical gift
7852     by the destruction or cancellation of the document of gift, or the portion of the document of gift
7853     used to make the gift, with the intent to revoke the gift.
7854          (4) A donor may amend or revoke an anatomical gift that was not made in a will by any
7855     form of communication during a terminal illness or injury addressed to at least two adults, at
7856     least one of whom is a disinterested witness.
7857          (5) A donor who makes an anatomical gift in a will may amend or revoke the gift in the
7858     manner provided for amendment or revocation of wills or as provided in Subsection (1).

7859          Section 247. Section 26B-8-306, which is renumbered from Section 26-28-107 is
7860     renumbered and amended to read:
7861          [26-28-107].      26B-8-306. Refusal to make anatomical gift -- Effect of
7862     refusal.
7863          (1) An individual may refuse to make an anatomical gift of the individual's body or part
7864     by:
7865          (a) a record signed by:
7866          (i) the individual; or
7867          (ii) subject to Subsection (2), another individual acting at the direction of the individual
7868     if the individual is physically unable to sign;
7869          (b) the individual's will, whether or not the will is admitted to probate or invalidated
7870     after the individual's death; or
7871          (c) any form of communication made by the individual during the individual's terminal
7872     illness or injury addressed to at least two adults, at least one of whom is a disinterested witness.
7873          (2) A record signed pursuant to Subsection (1)(a)(ii) shall:
7874          (a) be witnessed by at least two adults, at least one of whom is a disinterested witness,
7875     who have signed at the request of the individual; and
7876          (b) state that it has been signed and witnessed as provided in Subsection (1)(a).
7877          (3) An individual who has made a refusal may amend or revoke the refusal:
7878          (a) in the manner provided in Subsection (1) for making a refusal;
7879          (b) by subsequently making an anatomical gift pursuant to Section [26-28-105]
7880     26B-8-304 that is inconsistent with the refusal; or
7881          (c) by destroying or canceling the record evidencing the refusal, or the portion of the
7882     record used to make the refusal, with the intent to revoke the refusal.
7883          (4) Except as otherwise provided in Subsection [26-28-108] 26B-8-307(8), in the
7884     absence of an express, contrary indication by the individual set forth in the refusal, an
7885     individual's unrevoked refusal to make an anatomical gift of the individual's body or part bars

7886     all other persons from making an anatomical gift of the individual's body or part.
7887          Section 248. Section 26B-8-307, which is renumbered from Section 26-28-108 is
7888     renumbered and amended to read:
7889          [26-28-108].      26B-8-307. Preclusive effect of anatomical gift, amendment,
7890     or revocation.
7891          (1) Except as otherwise provided in Subsection (7) and subject to Subsection (6), in the
7892     absence of an express, contrary indication by the donor, a person other than the donor is barred
7893     from making, amending, or revoking an anatomical gift of a donor's body or part if the donor
7894     made an anatomical gift of the donor's body or part under Section [26-28-105] 26B-8-304 or an
7895     amendment to an anatomical gift of the donor's body or part under Section [26-28-106]
7896     26B-8-305.
7897          (2) A donor's revocation of an anatomical gift of the donor's body or part under Section
7898     [26-28-106] 26B-8-305 is not a refusal and does not bar another person specified in Section
7899     [26-28-104 or 26-28-109] 26B-8-303 or 26B-8-308 from making an anatomical gift of the
7900     donor's body or part under Section [26-28-105 or 26-28-110] 26B-8-304 or 26B-8-309.
7901          (3) If a person other than the donor makes an unrevoked anatomical gift of the donor's
7902     body or part under Section [26-28-105] 26B-8-304 or an amendment to an anatomical gift of
7903     the donor's body or part under Section [26-28-106] 26B-8-305, another person may not make,
7904     amend, or revoke the gift of the donor's body or part under Section [26-28-110] 26B-8-309.
7905          (4) A revocation of an anatomical gift of a donor's body or part under Section
7906     [26-28-106] 26B-8-305 by a person other than the donor does not bar another person from
7907     making an anatomical gift of the body or part under Section [26-28-105 or 26-28-110]
7908     26B-8-304 or 26B-8-309.
7909          (5) In the absence of an express, contrary indication by the donor or other person
7910     authorized to make an anatomical gift under Section [26-28-104] 26B-8-303, an anatomical
7911     gift of a part is neither a refusal to give another part nor a limitation on the making of an
7912     anatomical gift of another part at a later time by the donor or another person.

7913          (6) In the absence of an express, contrary indication by the donor or other person
7914     authorized to make an anatomical gift under Section [26-28-104] 26B-8-303, an anatomical
7915     gift of a part for one or more of the purposes set forth in Section [26-28-104] 26B-8-303 is not
7916     a limitation on the making of an anatomical gift of the part for any of the other purposes by the
7917     donor or any other person under Section [26-28-105 or 26-28-110] 26B-8-304 or 26B-8-309.
7918          (7) If a donor who is an unemancipated minor dies, a parent of the donor who is
7919     reasonably available may revoke or amend an anatomical gift of the donor's body or part.
7920          (8) If an unemancipated minor who signed a refusal dies, a parent of the minor who is
7921     reasonably available may revoke the minor's refusal.
7922          Section 249. Section 26B-8-308, which is renumbered from Section 26-28-109 is
7923     renumbered and amended to read:
7924          [26-28-109].      26B-8-308. Who may make anatomical gift of decedent's
7925     body or part.
7926          (1) Subject to Subsections (2) and (3) and unless barred by Section [26-28-107 or
7927     26-28-108] 26B-8-306 or 26B-8-307, an anatomical gift of a decedent's body or part for
7928     purpose of transplantation, therapy, research, or education may be made by any member of the
7929     following classes of persons who is reasonably available, in the order of priority listed:
7930          (a) an agent of the decedent at the time of death who could have made an anatomical
7931     gift under Subsection [26-28-104] 26B-8-303(2) immediately before the decedent's death;
7932          (b) the spouse of the decedent;
7933          (c) adult children of the decedent;
7934          (d) parents of the decedent;
7935          (e) adult siblings of the decedent;
7936          (f) adult grandchildren of the decedent;
7937          (g) grandparents of the decedent;
7938          (h) the persons who were acting as the guardians of the person of the decedent at the
7939     time of death;

7940          (i) an adult who exhibited special care and concern for the decedent; and
7941          (j) any other person having the authority to dispose of the decedent's body.
7942          (2) If there is more than one member of a class listed in Subsection (1)(a), (c), (d), (e),
7943     (f), (g), or (j) entitled to make an anatomical gift, an anatomical gift may be made by a member
7944     of the class unless that member or a person to which the gift may pass under Section
7945     [26-28-111] 26B-8-310 knows of an objection by another member of the class. If an objection
7946     is known, the gift may be made only by a majority of the members of the class who are
7947     reasonably available.
7948          (3) A person may not make an anatomical gift if, at the time of the decedent's death, a
7949     person in a prior class under Subsection (1) is reasonably available to make or to object to the
7950     making of an anatomical gift.
7951          Section 250. Section 26B-8-309, which is renumbered from Section 26-28-110 is
7952     renumbered and amended to read:
7953          [26-28-110].      26B-8-309. Manner of making, amending, or revoking
7954     anatomical gift of decedent's body or part.
7955          (1) A person authorized to make an anatomical gift under Section [26-28-109]
7956     26B-8-308 may make an anatomical gift by a document of gift signed by the person making the
7957 &