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8 LONG TITLE
9 Committee Note:
10 The Health and Human Services Interim Committee recommended this bill.
11 Legislative Vote: 14 voting for 0 voting against 4 absent
12 General Description:
13 This bill recodifies portions of the Utah Health Code and Utah Human Services Code.
14 Highlighted Provisions:
15 This bill:
16 ▸ recodifies provisions regarding:
17 • health care administration and assistance; and
18 • vital statistics, health data, and the Utah Medical Examiner; and
19 ▸ makes technical and corresponding changes.
20 Money Appropriated in this Bill:
21 None
22 Other Special Clauses:
23 This bill provides revisor instructions.
24 Utah Code Sections Affected:
25 AMENDS:
26 26B-3-101, as enacted by Laws of Utah 2022, Chapter 255
27 26B-8-101, as enacted by Laws of Utah 2022, Chapter 255
28 RENUMBERS AND AMENDS:
29 26B-3-102, (Renumbered from 26-18-2.1, as last amended by Laws of Utah 2019,
30 Chapter 393)
31 26B-3-103, (Renumbered from 26-18-2.2, as last amended by Laws of Utah 2019,
32 Chapter 393)
33 26B-3-104, (Renumbered from 26-18-2.3, as last amended by Laws of Utah 2020,
34 Chapter 225)
35 26B-3-105, (Renumbered from 26-18-2.4, as last amended by Laws of Utah 2022,
36 Chapter 255)
37 26B-3-106, (Renumbered from 26-18-2.5, as last amended by Laws of Utah 2019,
38 Chapter 393)
39 26B-3-107, (Renumbered from 26-18-2.6, as last amended by Laws of Utah 2021,
40 Chapter 234)
41 26B-3-108, (Renumbered from 26-18-3, as last amended by Laws of Utah 2021,
42 Chapter 422)
43 26B-3-109, (Renumbered from 26-18-3.1, as last amended by Laws of Utah 2020,
44 Chapter 225)
45 26B-3-110, (Renumbered from 26-18-3.5, as last amended by Laws of Utah 2019,
46 Chapter 393)
47 26B-3-111, (Renumbered from 26-18-3.6, as last amended by Laws of Utah 2019,
48 Chapter 393)
49 26B-3-112, (Renumbered from 26-18-3.8, as last amended by Laws of Utah 2020, Sixth
50 Special Session, Chapter 3)
51 26B-3-113, (Renumbered from 26-18-3.9, as last amended by Laws of Utah 2020, Fifth
52 Special Session, Chapter 4)
53 26B-3-114, (Renumbered from 26-18-4, as last amended by Laws of Utah 2013,
54 Chapter 167)
55 26B-3-115, (Renumbered from 26-18-5, as last amended by Laws of Utah 2020,
56 Chapter 225)
57 26B-3-116, (Renumbered from 26-18-5.5, as enacted by Laws of Utah 2022, Chapter
58 469)
59 26B-3-117, (Renumbered from 26-18-6, as enacted by Laws of Utah 1981, Chapter
60 126)
61 26B-3-118, (Renumbered from 26-18-7, as last amended by Laws of Utah 1988,
62 Chapter 21)
63 26B-3-119, (Renumbered from 26-18-8, as last amended by Laws of Utah 2020,
64 Chapter 225)
65 26B-3-120, (Renumbered from 26-18-9, as enacted by Laws of Utah 1981, Chapter
66 126)
67 26B-3-121, (Renumbered from 26-18-11, as last amended by Laws of Utah 2019,
68 Chapter 393)
69 26B-3-122, (Renumbered from 26-18-13, as last amended by Laws of Utah 2017,
70 Chapter 241)
71 26B-3-123, (Renumbered from 26-18-13.5, as last amended by Laws of Utah 2019,
72 Chapter 249)
73 26B-3-124, (Renumbered from 26-18-15, as last amended by Laws of Utah 2021,
74 Chapter 163)
75 26B-3-125, (Renumbered from 26-18-16, as enacted by Laws of Utah 2012, Chapter
76 155)
77 26B-3-126, (Renumbered from 26-18-17, as enacted by Laws of Utah 2013, Chapter
78 53)
79 26B-3-127, (Renumbered from 26-18-18, as last amended by Laws of Utah 2019,
80 Chapter 393)
81 26B-3-128, (Renumbered from 26-18-19, as last amended by Laws of Utah 2016,
82 Chapter 114)
83 26B-3-129, (Renumbered from 26-18-20, as last amended by Laws of Utah 2022,
84 Chapter 443)
85 26B-3-130, (Renumbered from 26-18-21, as last amended by Laws of Utah 2019,
86 Chapter 393)
87 26B-3-131, (Renumbered from 26-18-22, as enacted by Laws of Utah 2017, Chapter
88 180)
89 26B-3-132, (Renumbered from 26-18-23, as enacted by Laws of Utah 2017, Chapter
90 53)
91 26B-3-133, (Renumbered from 26-18-24, as enacted by Laws of Utah 2018, Chapter
92 180)
93 26B-3-134, (Renumbered from 26-18-25, as enacted by Laws of Utah 2019, Chapter
94 320)
95 26B-3-135, (Renumbered from 26-18-26, as enacted by Laws of Utah 2019, Chapter
96 265)
97 26B-3-136, (Renumbered from 26-18-27, as enacted by Laws of Utah 2021, Chapter
98 163)
99 26B-3-137, (Renumbered from 26-18-28, as enacted by Laws of Utah 2022, Chapter
100 206)
101 26B-3-138, (Renumbered from 26-18-427, as enacted by Laws of Utah 2022, Chapter
102 394)
103 26B-3-139, (Renumbered from 26-18-603, as last amended by Laws of Utah 2015,
104 Chapter 135)
105 26B-3-140, (Renumbered from 26-18-604, as last amended by Laws of Utah 2015,
106 Chapter 135)
107 26B-3-141, (Renumbered from 26-18-703, as renumbered and amended by Laws of
108 Utah 2022, Chapter 334)
109 26B-3-201, (Renumbered from 26-18-403, as enacted by Laws of Utah 2006, Chapter
110 110)
111 26B-3-202, (Renumbered from 26-18-405, as last amended by Laws of Utah 2020,
112 Chapter 275)
113 26B-3-203, (Renumbered from 26-18-405.5, as last amended by Laws of Utah 2022,
114 Chapter 149)
115 26B-3-204, (Renumbered from 26-18-408, as last amended by Laws of Utah 2020,
116 Fifth Special Session, Chapter 4)
117 26B-3-205, (Renumbered from 26-18-409, as enacted by Laws of Utah 2014, Chapter
118 174)
119 26B-3-206, (Renumbered from 26-18-410, as last amended by Laws of Utah 2022,
120 Chapter 226)
121 26B-3-207, (Renumbered from 26-18-411, as last amended by Laws of Utah 2022,
122 Chapter 394)
123 26B-3-208, (Renumbered from 26-18-413, as last amended by Laws of Utah 2020,
124 Chapter 225)
125 26B-3-209, (Renumbered from 26-18-414, as enacted by Laws of Utah 2017, Chapter
126 307)
127 26B-3-210, (Renumbered from 26-18-415, as last amended by Laws of Utah 2019,
128 Chapters 1 and 393)
129 26B-3-211, (Renumbered from 26-18-416, as last amended by Laws of Utah 2020,
130 Chapter 354)
131 26B-3-212, (Renumbered from 26-18-417, as last amended by Laws of Utah 2019,
132 Chapter 393)
133 26B-3-213, (Renumbered from 26-18-418, as last amended by Laws of Utah 2020,
134 Chapter 303)
135 26B-3-214, (Renumbered from 26-18-419, as enacted by Laws of Utah 2019, Chapter
136 172)
137 26B-3-215, (Renumbered from 26-18-420, as enacted by Laws of Utah 2020, Chapter
138 187)
139 26B-3-216, (Renumbered from 26-18-420.1, as enacted by Laws of Utah 2021, Chapter
140 133)
141 26B-3-217, (Renumbered from 26-18-421, as enacted by Laws of Utah 2020, Chapter
142 159)
143 26B-3-218, (Renumbered from 26-18-422, as enacted by Laws of Utah 2020, Chapter
144 188)
145 26B-3-219, (Renumbered from 26-18-423, as enacted by Laws of Utah 2020, Chapter
146 303)
147 26B-3-220, (Renumbered from 26-18-424, as enacted by Laws of Utah 2021, Chapter
148 76)
149 26B-3-221, (Renumbered from 26-18-425, as enacted by Laws of Utah 2021, Chapter
150 27)
151 26B-3-222, (Renumbered from 26-18-426, as enacted by Laws of Utah 2021, Chapter
152 212)
153 26B-3-223, (Renumbered from 26-18-428, as enacted by Laws of Utah 2022, Chapter
154 394)
155 26B-3-224, (Renumbered from 26-18-429, as enacted by Laws of Utah 2022, Chapter
156 253)
157 26B-3-301, (Renumbered from 26-18-101, as last amended by Laws of Utah 2004,
158 Chapter 280)
159 26B-3-302, (Renumbered from 26-18-102, as last amended by Laws of Utah 2010,
160 Chapters 286 and 324)
161 26B-3-303, (Renumbered from 26-18-103, as last amended by Laws of Utah 2020,
162 Chapter 225)
163 26B-3-304, (Renumbered from 26-18-104, as last amended by Laws of Utah 2008,
164 Chapter 382)
165 26B-3-305, (Renumbered from 26-18-105, as last amended by Laws of Utah 2010,
166 Chapter 205)
167 26B-3-306, (Renumbered from 26-18-106, as enacted by Laws of Utah 1992, Chapter
168 273)
169 26B-3-307, (Renumbered from 26-18-107, as last amended by Laws of Utah 2019,
170 Chapter 349)
171 26B-3-308, (Renumbered from 26-18-108, as enacted by Laws of Utah 1992, Chapter
172 273)
173 26B-3-309, (Renumbered from 26-18-109, as enacted by Laws of Utah 1992, Chapter
174 273)
175 26B-3-310, (Renumbered from 26-18-502, as last amended by Laws of Utah 2021,
176 Chapter 274)
177 26B-3-311, (Renumbered from 26-18-503, as last amended by Laws of Utah 2022,
178 Chapter 274)
179 26B-3-312, (Renumbered from 26-18-504, as last amended by Laws of Utah 2017,
180 Chapter 443)
181 26B-3-313, (Renumbered from 26-18-505, as last amended by Laws of Utah 2017,
182 Chapter 443)
183 26B-3-401, (Renumbered from 26-35a-103, as last amended by Laws of Utah 2018,
184 Chapter 39)
185 26B-3-402, (Renumbered from 26-35a-102, as last amended by Laws of Utah 2011,
186 Chapter 366)
187 26B-3-403, (Renumbered from 26-35a-104, as last amended by Laws of Utah 2017,
188 Chapter 443)
189 26B-3-404, (Renumbered from 26-35a-105, as enacted by Laws of Utah 2004, Chapter
190 284)
191 26B-3-405, (Renumbered from 26-35a-107, as last amended by Laws of Utah 2017,
192 Chapter 443)
193 26B-3-406, (Renumbered from 26-35a-108, as last amended by Laws of Utah 2011,
194 Chapter 366)
195 26B-3-501, (Renumbered from 26-36b-103, as last amended by Laws of Utah 2019,
196 Chapter 1)
197 26B-3-502, (Renumbered from 26-36b-102, as last amended by Laws of Utah 2018,
198 Chapter 384)
199 26B-3-503, (Renumbered from 26-36b-201, as last amended by Laws of Utah 2018,
200 Chapters 384 and 468)
201 26B-3-504, (Renumbered from 26-36b-202, as last amended by Laws of Utah 2019,
202 Chapter 393)
203 26B-3-505, (Renumbered from 26-36b-203, as last amended by Laws of Utah 2018,
204 Chapters 384 and 468)
205 26B-3-506, (Renumbered from 26-36b-204, as last amended by Laws of Utah 2020,
206 Chapter 225)
207 26B-3-507, (Renumbered from 26-36b-205, as last amended by Laws of Utah 2020,
208 Chapter 225)
209 26B-3-508, (Renumbered from 26-36b-206, as last amended by Laws of Utah 2018,
210 Chapters 384 and 468)
211 26B-3-509, (Renumbered from 26-36b-207, as last amended by Laws of Utah 2018,
212 Chapters 384 and 468)
213 26B-3-510, (Renumbered from 26-36b-209, as last amended by Laws of Utah 2018,
214 Chapters 384 and 468)
215 26B-3-511, (Renumbered from 26-36b-210, as last amended by Laws of Utah 2018,
216 Chapters 384 and 468)
217 26B-3-512, (Renumbered from 26-36b-211, as last amended by Laws of Utah 2018,
218 Chapters 384 and 468)
219 26B-3-601, (Renumbered from 26-36c-102, as last amended by Laws of Utah 2019,
220 Chapter 1)
221 26B-3-602, (Renumbered from 26-36c-103, as enacted by Laws of Utah 2018, Chapter
222 468)
223 26B-3-603, (Renumbered from 26-36c-201, as last amended by Laws of Utah 2019,
224 Chapter 1)
225 26B-3-604, (Renumbered from 26-36c-202, as last amended by Laws of Utah 2019,
226 Chapter 393)
227 26B-3-605, (Renumbered from 26-36c-203, as last amended by Laws of Utah 2019,
228 Chapter 1)
229 26B-3-606, (Renumbered from 26-36c-204, as last amended by Laws of Utah 2020,
230 Chapter 225)
231 26B-3-607, (Renumbered from 26-36c-205, as last amended by Laws of Utah 2019,
232 Chapter 136)
233 26B-3-608, (Renumbered from 26-36c-206, as last amended by Laws of Utah 2019,
234 Chapter 1)
235 26B-3-609, (Renumbered from 26-36c-207, as enacted by Laws of Utah 2018, Chapter
236 468)
237 26B-3-610, (Renumbered from 26-36c-208, as last amended by Laws of Utah 2019,
238 Chapter 1)
239 26B-3-611, (Renumbered from 26-36c-209, as last amended by Laws of Utah 2019,
240 Chapter 1)
241 26B-3-612, (Renumbered from 26-36c-210, as last amended by Laws of Utah 2019,
242 Chapter 136)
243 26B-3-701, (Renumbered from 26-36d-103, as repealed and reenacted by Laws of Utah
244 2019, Chapter 455)
245 26B-3-702, (Renumbered from 26-36d-102, as repealed and reenacted by Laws of Utah
246 2019, Chapter 455)
247 26B-3-703, (Renumbered from 26-36d-201, as repealed and reenacted by Laws of Utah
248 2019, Chapter 455)
249 26B-3-704, (Renumbered from 26-36d-202, as repealed and reenacted by Laws of Utah
250 2019, Chapter 455)
251 26B-3-705, (Renumbered from 26-36d-203, as repealed and reenacted by Laws of Utah
252 2019, Chapter 455)
253 26B-3-706, (Renumbered from 26-36d-204, as repealed and reenacted by Laws of Utah
254 2019, Chapter 455)
255 26B-3-707, (Renumbered from 26-36d-205, as repealed and reenacted by Laws of Utah
256 2019, Chapter 455)
257 26B-3-708, (Renumbered from 26-36d-206, as repealed and reenacted by Laws of Utah
258 2019, Chapter 455)
259 26B-3-709, (Renumbered from 26-36d-208, as repealed and reenacted by Laws of Utah
260 2019, Chapter 455)
261 26B-3-801, (Renumbered from 26-37a-102, as last amended by Laws of Utah 2016,
262 Chapter 348)
263 26B-3-802, (Renumbered from 26-37a-103, as enacted by Laws of Utah 2015, Chapter
264 440)
265 26B-3-803, (Renumbered from 26-37a-104, as enacted by Laws of Utah 2015, Chapter
266 440)
267 26B-3-804, (Renumbered from 26-37a-105, as enacted by Laws of Utah 2015, Chapter
268 440)
269 26B-3-805, (Renumbered from 26-37a-106, as enacted by Laws of Utah 2015, Chapter
270 440)
271 26B-3-806, (Renumbered from 26-37a-108, as enacted by Laws of Utah 2015, Chapter
272 440)
273 26B-3-901, (Renumbered from 26-40-102, as last amended by Laws of Utah 2019,
274 Chapter 393)
275 26B-3-902, (Renumbered from 26-40-103, as last amended by Laws of Utah 2019,
276 Chapter 393)
277 26B-3-903, (Renumbered from 26-40-105, as last amended by Laws of Utah 2019,
278 Chapter 393)
279 26B-3-904, (Renumbered from 26-40-106, as last amended by Laws of Utah 2021,
280 Chapter 175)
281 26B-3-905, (Renumbered from 26-40-107, as enacted by Laws of Utah 1998, Chapter
282 360)
283 26B-3-906, (Renumbered from 26-40-108, as last amended by Laws of Utah 2010,
284 Chapter 391)
285 26B-3-907, (Renumbered from 26-40-109, as last amended by Laws of Utah 2013,
286 Chapter 167)
287 26B-3-908, (Renumbered from 26-40-110, as last amended by Laws of Utah 2019,
288 Chapter 393)
289 26B-3-909, (Renumbered from 26-40-115, as last amended by Laws of Utah 2020,
290 Chapters 32 and 152)
291 26B-3-1001, (Renumbered from 26-19-102, as renumbered and amended by Laws of
292 Utah 2018, Chapter 443)
293 26B-3-1002, (Renumbered from 26-19-103, as renumbered and amended by Laws of
294 Utah 2018, Chapter 443)
295 26B-3-1003, (Renumbered from 26-19-201, as last amended by Laws of Utah 2021,
296 Chapter 300)
297 26B-3-1004, (Renumbered from 26-19-301, as renumbered and amended by Laws of
298 Utah 2018, Chapter 443)
299 26B-3-1005, (Renumbered from 26-19-302, as last amended by Laws of Utah 2020,
300 Chapter 354)
301 26B-3-1006, (Renumbered from 26-19-303, as renumbered and amended by Laws of
302 Utah 2018, Chapter 443)
303 26B-3-1007, (Renumbered from 26-19-304, as renumbered and amended by Laws of
304 Utah 2018, Chapter 443)
305 26B-3-1008, (Renumbered from 26-19-305, as renumbered and amended by Laws of
306 Utah 2018, Chapter 443)
307 26B-3-1009, (Renumbered from 26-19-401, as last amended by Laws of Utah 2021,
308 Chapter 300)
309 26B-3-1010, (Renumbered from 26-19-402, as renumbered and amended by Laws of
310 Utah 2018, Chapter 443)
311 26B-3-1011, (Renumbered from 26-19-403, as renumbered and amended by Laws of
312 Utah 2018, Chapter 443)
313 26B-3-1012, (Renumbered from 26-19-404, as enacted by Laws of Utah 2018, Chapter
314 443)
315 26B-3-1013, (Renumbered from 26-19-405, as renumbered and amended by Laws of
316 Utah 2018, Chapter 443)
317 26B-3-1014, (Renumbered from 26-19-406, as renumbered and amended by Laws of
318 Utah 2018, Chapter 443)
319 26B-3-1015, (Renumbered from 26-19-501, as enacted by Laws of Utah 2018, Chapter
320 443)
321 26B-3-1016, (Renumbered from 26-19-502, as enacted by Laws of Utah 2018, Chapter
322 443)
323 26B-3-1017, (Renumbered from 26-19-503, as enacted by Laws of Utah 2018, Chapter
324 443)
325 26B-3-1018, (Renumbered from 26-19-504, as enacted by Laws of Utah 2018, Chapter
326 443)
327 26B-3-1019, (Renumbered from 26-19-505, as enacted by Laws of Utah 2018, Chapter
328 443)
329 26B-3-1020, (Renumbered from 26-19-506, as enacted by Laws of Utah 2018, Chapter
330 443)
331 26B-3-1021, (Renumbered from 26-19-507, as enacted by Laws of Utah 2018, Chapter
332 443)
333 26B-3-1022, (Renumbered from 26-19-508, as enacted by Laws of Utah 2018, Chapter
334 443)
335 26B-3-1023, (Renumbered from 26-19-509, as enacted by Laws of Utah 2018, Chapter
336 443)
337 26B-3-1024, (Renumbered from 26-19-601, as renumbered and amended by Laws of
338 Utah 2018, Chapter 443)
339 26B-3-1025, (Renumbered from 26-19-602, as renumbered and amended by Laws of
340 Utah 2018, Chapter 443)
341 26B-3-1026, (Renumbered from 26-19-603, as renumbered and amended by Laws of
342 Utah 2018, Chapter 443)
343 26B-3-1027, (Renumbered from 26-19-604, as renumbered and amended by Laws of
344 Utah 2018, Chapter 443)
345 26B-3-1028, (Renumbered from 26-19-605, as renumbered and amended by Laws of
346 Utah 2018, Chapter 443)
347 26B-3-1101, (Renumbered from 26-20-2, as last amended by Laws of Utah 2007,
348 Chapter 48)
349 26B-3-1102, (Renumbered from 26-20-3, as last amended by Laws of Utah 2011,
350 Chapter 297)
351 26B-3-1103, (Renumbered from 26-20-4, as repealed and reenacted by Laws of Utah
352 2007, Chapter 48)
353 26B-3-1104, (Renumbered from 26-20-5, as last amended by Laws of Utah 2007,
354 Chapter 48)
355 26B-3-1105, (Renumbered from 26-20-6, as last amended by Laws of Utah 2011,
356 Chapter 297)
357 26B-3-1106, (Renumbered from 26-20-7, as last amended by Laws of Utah 2007,
358 Chapter 48)
359 26B-3-1107, (Renumbered from 26-20-8, as last amended by Laws of Utah 2011,
360 Chapter 297)
361 26B-3-1108, (Renumbered from 26-20-9, as last amended by Laws of Utah 2007,
362 Chapter 48)
363 26B-3-1109, (Renumbered from 26-20-9.5, as last amended by Laws of Utah 2011,
364 Chapter 297)
365 26B-3-1110, (Renumbered from 26-20-10, as last amended by Laws of Utah 1998,
366 Chapter 192)
367 26B-3-1111, (Renumbered from 26-20-11, as enacted by Laws of Utah 1986, Chapter
368 46)
369 26B-3-1112, (Renumbered from 26-20-12, as last amended by Laws of Utah 2011,
370 Chapter 297)
371 26B-3-1113, (Renumbered from 26-20-13, as last amended by Laws of Utah 2007,
372 Chapter 48)
373 26B-3-1114, (Renumbered from 26-20-14, as last amended by Laws of Utah 2011,
374 Chapter 297)
375 26B-3-1115, (Renumbered from 26-20-15, as enacted by Laws of Utah 2007, Chapter
376 48)
377 26B-8-102, (Renumbered from 26-2-3, as last amended by Laws of Utah 2017, Chapter
378 22)
379 26B-8-103, (Renumbered from 26-2-4, as last amended by Laws of Utah 2022,
380 Chapters 231 and 365)
381 26B-8-104, (Renumbered from 26-2-5, as last amended by Laws of Utah 2019, Chapter
382 349)
383 26B-8-105, (Renumbered from 26-2-5.5, as last amended by Laws of Utah 1995,
384 Chapter 202)
385 26B-8-106, (Renumbered from 26-2-6, as last amended by Laws of Utah 1995, Chapter
386 202)
387 26B-8-107, (Renumbered from 26-2-7, as last amended by Laws of Utah 2022, Chapter
388 231)
389 26B-8-108, (Renumbered from 26-2-8, as last amended by Laws of Utah 1995, Chapter
390 202)
391 26B-8-109, (Renumbered from 26-2-9, as last amended by Laws of Utah 1995, Chapter
392 202)
393 26B-8-110, (Renumbered from 26-2-10, as last amended by Laws of Utah 2021,
394 Chapter 65)
395 26B-8-111, (Renumbered from 26-2-11, as last amended by Laws of Utah 1995,
396 Chapter 202)
397 26B-8-112, (Renumbered from 26-2-12.5, as last amended by Laws of Utah 2022,
398 Chapters 255 and 335)
399 26B-8-113, (Renumbered from 26-2-12.6, as last amended by Laws of Utah 2022,
400 Chapters 255 and 365)
401 26B-8-114, (Renumbered from 26-2-13, as last amended by Laws of Utah 2021,
402 Chapters 11 and 297)
403 26B-8-115, (Renumbered from 26-2-14, as last amended by Laws of Utah 1995,
404 Chapter 202)
405 26B-8-116, (Renumbered from 26-2-14.1, as enacted by Laws of Utah 2002, Chapter
406 69)
407 26B-8-117, (Renumbered from 26-2-14.2, as enacted by Laws of Utah 2002, Chapter
408 69)
409 26B-8-118, (Renumbered from 26-2-14.3, as enacted by Laws of Utah 2015, Chapter
410 184)
411 26B-8-119, (Renumbered from 26-2-15, as last amended by Laws of Utah 2020,
412 Chapter 201)
413 26B-8-120, (Renumbered from 26-2-16, as last amended by Laws of Utah 2009,
414 Chapters 66 and 68)
415 26B-8-121, (Renumbered from 26-2-17, as last amended by Laws of Utah 2020,
416 Chapter 251)
417 26B-8-122, (Renumbered from 26-2-18, as last amended by Laws of Utah 2020,
418 Chapter 251)
419 26B-8-123, (Renumbered from 26-2-19, as last amended by Laws of Utah 1995,
420 Chapter 202)
421 26B-8-124, (Renumbered from 26-2-21, as last amended by Laws of Utah 1995,
422 Chapter 202)
423 26B-8-125, (Renumbered from 26-2-22, as last amended by Laws of Utah 2021,
424 Chapter 262)
425 26B-8-126, (Renumbered from 26-2-23, as last amended by Laws of Utah 2009,
426 Chapter 68)
427 26B-8-127, (Renumbered from 26-2-24, as last amended by Laws of Utah 1995,
428 Chapter 202)
429 26B-8-128, (Renumbered from 26-2-25, as last amended by Laws of Utah 2021,
430 Chapter 65)
431 26B-8-129, (Renumbered from 26-2-26, as last amended by Laws of Utah 1995,
432 Chapter 202)
433 26B-8-130, (Renumbered from 26-2-27, as last amended by Laws of Utah 2011,
434 Chapter 366)
435 26B-8-131, (Renumbered from 26-2-28, as last amended by Laws of Utah 2021,
436 Chapter 65)
437 26B-8-132, (Renumbered from 26-34-4, as enacted by Laws of Utah 2020, Chapter
438 353)
439 26B-8-133, (Renumbered from 26-23-5, as last amended by Laws of Utah 1995,
440 Chapter 202)
441 26B-8-134, (Renumbered from 26-23-5.5, as enacted by Laws of Utah 1995, Chapter
442 202)
443 26B-8-201, (Renumbered from 26-4-2, as last amended by Laws of Utah 2022, Chapter
444 277)
445 26B-8-202, (Renumbered from 26-4-4, as last amended by Laws of Utah 2015, Chapter
446 72)
447 26B-8-203, (Renumbered from 26-4-5, as last amended by Laws of Utah 1993, Chapter
448 227)
449 26B-8-204, (Renumbered from 26-4-6, as last amended by Laws of Utah 2009, Chapter
450 63)
451 26B-8-205, (Renumbered from 26-4-7, as last amended by Laws of Utah 2021, Chapter
452 25)
453 26B-8-206, (Renumbered from 26-4-8, as last amended by Laws of Utah 1993, Chapter
454 38)
455 26B-8-207, (Renumbered from 26-4-9, as last amended by Laws of Utah 2021, Chapter
456 297)
457 26B-8-208, (Renumbered from 26-2-18.5, as last amended by Laws of Utah 2019,
458 Chapter 189)
459 26B-8-209, (Renumbered from 26-4-10, as last amended by Laws of Utah 2021,
460 Chapter 25)
461 26B-8-210, (Renumbered from 26-4-10.5, as last amended by Laws of Utah 2022,
462 Chapter 415)
463 26B-8-211, (Renumbered from 26-4-11, as last amended by Laws of Utah 2018,
464 Chapter 414)
465 26B-8-212, (Renumbered from 26-4-12, as last amended by Laws of Utah 2011,
466 Chapter 297)
467 26B-8-213, (Renumbered from 26-4-13, as last amended by Laws of Utah 2001,
468 Chapter 278)
469 26B-8-214, (Renumbered from 26-4-14, as last amended by Laws of Utah 2021,
470 Chapter 297)
471 26B-8-215, (Renumbered from 26-4-15, as enacted by Laws of Utah 1981, Chapter
472 126)
473 26B-8-216, (Renumbered from 26-4-16, as last amended by Laws of Utah 2007,
474 Chapter 144)
475 26B-8-217, (Renumbered from 26-4-17, as last amended by Laws of Utah 2022,
476 Chapter 255)
477 26B-8-218, (Renumbered from 26-4-18, as enacted by Laws of Utah 1981, Chapter
478 126)
479 26B-8-219, (Renumbered from 26-4-19, as last amended by Laws of Utah 1993,
480 Chapter 38)
481 26B-8-220, (Renumbered from 26-4-20, as last amended by Laws of Utah 2011,
482 Chapter 297)
483 26B-8-221, (Renumbered from 26-4-21, as last amended by Laws of Utah 1997,
484 Chapter 372)
485 26B-8-222, (Renumbered from 26-4-22, as enacted by Laws of Utah 1981, Chapter
486 126)
487 26B-8-223, (Renumbered from 26-4-23, as enacted by Laws of Utah 1981, Chapter
488 126)
489 26B-8-224, (Renumbered from 26-4-24, as last amended by Laws of Utah 1997,
490 Chapter 375)
491 26B-8-225, (Renumbered from 26-4-25, as repealed and reenacted by Laws of Utah
492 2015, Chapter 72)
493 26B-8-226, (Renumbered from 26-4-26, as enacted by Laws of Utah 1997, Chapter
494 232)
495 26B-8-227, (Renumbered from 26-4-27, as enacted by Laws of Utah 1998, Chapter
496 153)
497 26B-8-228, (Renumbered from 26-4-28, as last amended by Laws of Utah 2013,
498 Chapter 167)
499 26B-8-229, (Renumbered from 26-4-28.5, as enacted by Laws of Utah 2017, Chapter
500 346)
501 26B-8-230, (Renumbered from 26-4-29, as last amended by Laws of Utah 2010,
502 Chapter 218)
503 26B-8-231, (Renumbered from 26-4-30, as enacted by Laws of Utah 2020, Chapter
504 201)
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
602 Be it enacted by the Legislature of the state of Utah:
603 Section 1. Section 26B-3-101 is amended to read:
604
605
606 26B-3-101. Definitions.
607 [
608 As used in this chapter:
609 (1) "Applicant" means any person who requests assistance under the medical programs
610 of the state.
611 (2) "CMS" means the Centers for Medicare and Medicaid Services within the United
612 States Department of Health and Human Services.
613 (3) "Division" means the Division of Integrated Healthcare within the department,
614 established under Section 26B-3-102.
615 (4) "Enrollee" or "member" means an individual whom the department has determined
616 to be eligible for assistance under the Medicaid program.
617 (5) "Medicaid program" means the state program for medical assistance for persons
618 who are eligible under the state plan adopted pursuant to Title XIX of the federal Social
619 Security Act.
620 (6) "Medical assistance" means services furnished or payments made to or on behalf of
621 a member.
622 (7) (a) "Passenger vehicle" means a self-propelled, two-axle vehicle intended primarily
623 for operation on highways and used by an applicant or recipient to meet basic transportation
624 needs and has a fair market value below 40% of the applicable amount of the federal luxury
625 passenger automobile tax established in 26 U.S.C. Sec. 4001 and adjusted annually for
626 inflation.
627 (b) "Passenger vehicle" does not include:
628 (i) a commercial vehicle, as defined in Section 41-1a-102;
629 (ii) an off-highway vehicle, as defined in Section 41-1a-102; or
630 (iii) a motor home, as defined in Section 13-14-102.
631 (8) "PPACA" means the same as that term is defined in Section 31A-1-301.
632 (9) "Recipient" means a person who has received medical assistance under the
633 Medicaid program.
634 Section 2. Section 26B-3-102, which is renumbered from Section 26-18-2.1 is
635 renumbered and amended to read:
636 [
637 There is created, within the department, the Division of [
638
639 maintaining the Medicaid program and the Children's Health Insurance Program established in
640 Section [
641 applicable federal law.
642 Section 3. Section 26B-3-103, which is renumbered from Section 26-18-2.2 is
643 renumbered and amended to read:
644 [
645 Responsibilities.
646 (1) The state Medicaid director shall be appointed by the governor, after consultation
647 with the executive director, with the advice and consent of the Senate.
648 (2) The state Medicaid director may employ other employees as necessary to
649 implement the provisions of this chapter, and shall:
650 [
651 [
652 [
653 with federal law and regulations.
654 Section 4. Section 26B-3-104, which is renumbered from Section 26-18-2.3 is
655 renumbered and amended to read:
656 [
657 assessment.
658 (1) In accordance with the requirements of Title XIX of the Social Security Act and
659 applicable federal regulations, the division is responsible for the effective and impartial
660 administration of this chapter in an efficient, economical manner. The division shall:
661 (a) establish, on a statewide basis, a program to safeguard against unnecessary or
662 inappropriate use of Medicaid services, excessive payments, and unnecessary or inappropriate
663 hospital admissions or lengths of stay;
664 (b) deny any provider claim for services that fail to meet criteria established by the
665 division concerning medical necessity or appropriateness; and
666 (c) place its emphasis on high quality care to recipients in the most economical and
667 cost-effective manner possible, with regard to both publicly and privately provided services.
668 (2) The division shall implement and utilize cost-containment methods, where
669 possible, which may include:
670 (a) prepayment and postpayment review systems to determine if utilization is
671 reasonable and necessary;
672 (b) preadmission certification of nonemergency admissions;
673 (c) mandatory outpatient, rather than inpatient, surgery in appropriate cases;
674 (d) second surgical opinions;
675 (e) procedures for encouraging the use of outpatient services;
676 (f) consistent with Sections [
677 program;
678 (g) coordination of benefits; and
679 (h) review and exclusion of providers who are not cost effective or who have abused
680 the Medicaid program, in accordance with the procedures and provisions of federal law and
681 regulation.
682 (3) The state Medicaid director shall periodically assess the cost effectiveness and
683 health implications of the existing Medicaid program, and consider alternative approaches to
684 the provision of covered health and medical services through the Medicaid program, in order to
685 reduce unnecessary or unreasonable utilization.
686 (4) (a) The department shall ensure Medicaid program integrity by conducting internal
687 audits of the Medicaid program for efficiencies, best practices, and cost avoidance.
688 (b) The department shall coordinate with the Office of the Inspector General for
689 Medicaid Services created in Section 63A-13-201 to implement Subsection (2) and to address
690 Medicaid fraud, waste, or abuse as described in Section 63A-13-202.
691 Section 5. Section 26B-3-105, which is renumbered from Section 26-18-2.4 is
692 renumbered and amended to read:
693 [
694 (1) A Medicaid drug program developed by the department under Subsection
695 [
696 (a) shall, notwithstanding Subsection [
697 and cost-related factors which include medical necessity as determined by a provider in
698 accordance with administrative rules established by the Drug Utilization Review Board;
699 (b) may include therapeutic categories of drugs that may be exempted from the drug
700 program;
701 (c) may include placing some drugs, except the drugs described in Subsection (2), on a
702 preferred drug list:
703 (i) to the extent determined appropriate by the department; and
704 (ii) in the manner described in Subsection (3) for psychotropic drugs;
705 (d) notwithstanding the requirements of [
706 26B-3-309 regarding the, Drug Utilization Review Board, and except as provided in
707 Subsection (3), shall immediately implement the prior authorization requirements for a
708 nonpreferred drug that is in the same therapeutic class as a drug that is:
709 (i) on the preferred drug list on the date that this act takes effect; or
710 (ii) added to the preferred drug list after this act takes effect; and
711 (e) except as prohibited by Subsections 58-17b-606(4) and (5), shall establish the prior
712 authorization requirements established under Subsections (1)(c) and (d) which shall permit a
713 health care provider or the health care provider's agent to obtain a prior authorization override
714 of the preferred drug list through the department's pharmacy prior authorization review process,
715 and which shall:
716 (i) provide either telephone or fax approval or denial of the request within 24 hours of
717 the receipt of a request that is submitted during normal business hours of Monday through
718 Friday from 8 a.m. to 5 p.m.;
719 (ii) provide for the dispensing of a limited supply of a requested drug as determined
720 appropriate by the department in an emergency situation, if the request for an override is
721 received outside of the department's normal business hours; and
722 (iii) require the health care provider to provide the department with documentation of
723 the medical need for the preferred drug list override in accordance with criteria established by
724 the department in consultation with the Pharmacy and Therapeutics Committee.
725 (2) (a) [
726 (i) "Immunosuppressive drug":
727 (A) means a drug that is used in immunosuppressive therapy to inhibit or prevent
728 activity of the immune system to aid the body in preventing the rejection of transplanted organs
729 and tissue; and
730 (B) does not include drugs used for the treatment of autoimmune disease or diseases
731 that are most likely of autoimmune origin.
732 (ii) "Stabilized" means a health care provider has documented in the patient's medical
733 chart that a patient has achieved a stable or steadfast medical state within the past 90 days using
734 a particular psychotropic drug.
735 (b) A preferred drug list developed under the provisions of this section may not include
736 an immunosuppressive drug.
737 (c) (i) The state Medicaid program shall reimburse for a prescription for an
738 immunosuppressive drug as written by the health care provider for a patient who has undergone
739 an organ transplant.
740 (ii) For purposes of Subsection 58-17b-606(4), and with respect to patients who have
741 undergone an organ transplant, the prescription for a particular immunosuppressive drug as
742 written by a health care provider meets the criteria of demonstrating to the department a
743 medical necessity for dispensing the prescribed immunosuppressive drug.
744 (d) Notwithstanding the requirements of [
745 26B-3-309 regarding the, Drug Utilization Review Board, the state Medicaid drug program
746 may not require the use of step therapy for immunosuppressive drugs without the written or
747 oral consent of the health care provider and the patient.
748 (e) The department may include a sedative hypnotic on a preferred drug list in
749 accordance with Subsection (2)(f).
750 (f) The department shall grant a prior authorization for a sedative hypnotic that is not
751 on the preferred drug list under Subsection (2)(e), if the health care provider has documentation
752 related to one of the following conditions for the Medicaid client:
753 (i) a trial and failure of at least one preferred agent in the drug class, including the
754 name of the preferred drug that was tried, the length of therapy, and the reason for the
755 discontinuation;
756 (ii) detailed evidence of a potential drug interaction between current medication and
757 the preferred drug;
758 (iii) detailed evidence of a condition or contraindication that prevents the use of the
759 preferred drug;
760 (iv) objective clinical evidence that a patient is at high risk of adverse events due to a
761 therapeutic interchange with a preferred drug;
762 (v) the patient is a new or previous Medicaid client with an existing diagnosis
763 previously stabilized with a nonpreferred drug; or
764 (vi) other valid reasons as determined by the department.
765 (g) A prior authorization granted under Subsection (2)(f) is valid for one year from the
766 date the department grants the prior authorization and shall be renewed in accordance with
767 Subsection (2)(f).
768 (3) (a) [
769 following classes of drugs:
770 (i) atypical anti-psychotic;
771 (ii) anti-depressant;
772 (iii) anti-convulsant/mood stabilizer;
773 (iv) anti-anxiety; and
774 (v) attention deficit hyperactivity disorder stimulant.
775 (b) (i) The department shall develop a preferred drug list for psychotropic drugs.
776 (ii) Except as provided in Subsection (3)(d), a preferred drug list for psychotropic
777 drugs developed under this section shall allow a health care provider to override the preferred
778 drug list by writing "dispense as written" on the prescription for the psychotropic drug.
779 (iii) A health care provider may not override Section 58-17b-606 by writing "dispense
780 as written" on a prescription.
781 (c) The department, and a Medicaid accountable care organization that is responsible
782 for providing behavioral health, shall:
783 (i) establish a system to:
784 (A) track health care provider prescribing patterns for psychotropic drugs;
785 (B) educate health care providers who are not complying with the preferred drug list;
786 and
787 (C) implement peer to peer education for health care providers whose prescribing
788 practices continue to not comply with the preferred drug list; and
789 (ii) determine whether health care provider compliance with the preferred drug list is at
790 least:
791 (A) 55% of prescriptions by July 1, 2017;
792 (B) 65% of prescriptions by July 1, 2018; and
793 (C) 75% of prescriptions by July 1, 2019.
794 (d) Beginning October 1, 2019, the department shall eliminate the dispense as written
795 override for the preferred drug list, and shall implement a prior authorization system for
796 psychotropic drugs, in accordance with Subsection (2)(f), if by July 1, 2019, the department has
797 not realized annual savings from implementing the preferred drug list for psychotropic drugs of
798 at least $750,000 General Fund savings.
799 Section 6. Section 26B-3-106, which is renumbered from Section 26-18-2.5 is
800 renumbered and amended to read:
801 [
802 and other state medical programs -- Financial institutions.
803 (1) The department may apply for grants and accept donations to make technology
804 system improvements necessary to implement a simplified enrollment and renewal process for
805 the Medicaid program, Utah Premium Partnership, and Primary Care Network Demonstration
806 Project programs.
807 (2) (a) The department may enter into an agreement with a financial institution doing
808 business in the state to develop and operate a data match system to identify an applicant's or
809 enrollee's assets that:
810 (i) uses automated data exchanges to the maximum extent feasible; and
811 (ii) requires a financial institution each month to provide the name, record address,
812 Social Security number, other taxpayer identification number, or other identifying information
813 for each applicant or enrollee who maintains an account at the financial institution.
814 (b) The department may pay a reasonable fee to a financial institution for compliance
815 with this Subsection (2), as provided in Section 7-1-1006.
816 (c) A financial institution may not be liable under any federal or state law to any person
817 for any disclosure of information or action taken in good faith under this Subsection (2).
818 (d) The department may disclose a financial record obtained from a financial institution
819 under this section only for the purpose of, and to the extent necessary in, verifying eligibility as
820 provided in this section and Section [
821 Section 7. Section 26B-3-107, which is renumbered from Section 26-18-2.6 is
822 renumbered and amended to read:
823 [
824 (1) (a) Except as provided in Subsection (8), the division may establish a competitive
825 bid process to bid out Medicaid dental benefits under this chapter.
826 (b) The division may bid out the Medicaid dental benefits separately from other
827 program benefits.
828 (2) The division shall use the following criteria to evaluate dental bids:
829 (a) ability to manage dental expenses;
830 (b) proven ability to handle dental insurance;
831 (c) efficiency of claim paying procedures;
832 (d) provider contracting, discounts, and adequacy of network; and
833 (e) other criteria established by the department.
834 (3) The division shall request bids for the program's benefits at least once every five
835 years.
836 (4) The division's contract with dental plans for the program's benefits shall include
837 risk sharing provisions in which the dental plan must accept 100% of the risk for any difference
838 between the division's premium payments per client and actual dental expenditures.
839 (5) The division may not award contracts to:
840 (a) more than three responsive bidders under this section; or
841 (b) an insurer that does not have a current license in the state.
842 (6) (a) The division may cancel the request for proposals if:
843 (i) there are no responsive bidders; or
844 (ii) the division determines that accepting the bids would increase the program's costs.
845 (b) If the division cancels a request for proposal or a contract that results from a request
846 for proposal described in Subsection (6)(a), the division shall report to the Health and Human
847 Services Interim Committee regarding the reasons for the decision.
848 (7) Title 63G, Chapter 6a, Utah Procurement Code, shall apply to this section.
849 (8) (a) The division may:
850 (i) establish a dental health care delivery system and payment reform pilot program for
851 Medicaid dental benefits to increase access to cost effective and quality dental health care by
852 increasing the number of dentists available for Medicaid dental services; and
853 (ii) target specific Medicaid populations or geographic areas in the state.
854 (b) The pilot program shall establish compensation models for dentists and dental
855 hygienists that:
856 (i) increase access to quality, cost effective dental care; and
857 (ii) use funds from the Division of Family Health and Preparedness that are available to
858 reimburse dentists for educational loans in exchange for the dentist agreeing to serve Medicaid
859 and under-served populations.
860 (c) The division may amend the state plan and apply to the Secretary of the United
861 States Department of Health and Human Services for waivers or pilot programs if necessary to
862 establish the new dental care delivery and payment reform model.
863 (d) The division shall evaluate the pilot program's effect on the cost of dental care and
864 access to dental care for the targeted Medicaid populations.
865 (9) (a) As used in this Subsection (9), "dental hygienist" means an individual who is
866 licensed as a dental hygienist under Section 58-69-301.
867 (b) The department shall reimburse a dental hygienist for dental services performed in
868 a public health setting and in accordance with Subsection (9)(c) beginning on the earlier of:
869 (i) January 1, 2023; or
870 (ii) 30 days after the date on which the replacement of the department's Medicaid
871 Management Information System software is complete.
872 (c) The department shall reimburse a dental hygienist directly for a service provided
873 through the Medicaid program if:
874 (i) the dental hygienist requests to be reimbursed directly; and
875 (ii) the dental hygienist provides the service within the scope of practice described in
876 Section 58-69-801.
877 (d) Before November 30 of each year in which the department reimburses dental
878 hygienists in accordance with Subsection (9)(c), the department shall report to the Health and
879 Human Services Interim Committee, for the previous fiscal year:
880 (i) the number and geographic distribution of dental hygienists who requested to be
881 reimbursed directly;
882 (ii) the total number of Medicaid enrollees who were served by a dental hygienist who
883 were reimbursed under this Subsection (9);
884 (iii) the total amount reimbursed directly to dental hygienists under this Subsection (9);
885 (iv) the specific services and billing codes that are reimbursed under this Subsection
886 (9); and
887 (v) the aggregate amount reimbursed for each service and billing code described in
888 Subsection (9)(d)(iv).
889 (e) (i) Except as provided in this Subsection (9), nothing in this Subsection (9) shall be
890 interpreted as expanding or otherwise altering the limitations and scope of practice for a dental
891 hygienist.
892 (ii) A dental hygienist may only directly bill and receive compensation for billing codes
893 that fall within the scope of practice of a dental hygienist.
894 Section 8. Section 26B-3-108, which is renumbered from Section 26-18-3 is
895 renumbered and amended to read:
896 [
897 Reporting to the Legislature -- Disciplinary measures and sanctions -- Funds collected --
898 Eligibility standards -- Internal audits -- Health opportunity accounts.
899 (1) The department shall be the single state agency responsible for the administration
900 of the Medicaid program in connection with the United States Department of Health and
901 Human Services pursuant to Title XIX of the Social Security Act.
902 (2) (a) The department shall implement the Medicaid program through administrative
903 rules in conformity with this chapter, Title 63G, Chapter 3, Utah Administrative Rulemaking
904 Act, the requirements of Title XIX, and applicable federal regulations.
905 (b) The rules adopted under Subsection (2)(a) shall include, in addition to other rules
906 necessary to implement the program:
907 (i) the standards used by the department for determining eligibility for Medicaid
908 services;
909 (ii) the services and benefits to be covered by the Medicaid program;
910 (iii) reimbursement methodologies for providers under the Medicaid program; and
911 (iv) a requirement that:
912 (A) a person receiving Medicaid services shall participate in the electronic exchange of
913 clinical health records established in accordance with Section [
914 individual opts out of participation;
915 (B) prior to enrollment in the electronic exchange of clinical health records the enrollee
916 shall receive notice of enrollment in the electronic exchange of clinical health records and the
917 right to opt out of participation at any time; and
918 (C) beginning July 1, 2012, when the program sends enrollment or renewal information
919 to the enrollee and when the enrollee logs onto the program's website, the enrollee shall receive
920 notice of the right to opt out of the electronic exchange of clinical health records.
921 (3) (a) The department shall, in accordance with Subsection (3)(b), report to the Social
922 Services Appropriations Subcommittee when the department:
923 (i) implements a change in the Medicaid State Plan;
924 (ii) initiates a new Medicaid waiver;
925 (iii) initiates an amendment to an existing Medicaid waiver;
926 (iv) applies for an extension of an application for a waiver or an existing Medicaid
927 waiver;
928 (v) applies for or receives approval for a change in any capitation rate within the
929 Medicaid program; or
930 (vi) initiates a rate change that requires public notice under state or federal law.
931 (b) The report required by Subsection (3)(a) shall:
932 (i) be submitted to the Social Services Appropriations Subcommittee prior to the
933 department implementing the proposed change; and
934 (ii) include:
935 (A) a description of the department's current practice or policy that the department is
936 proposing to change;
937 (B) an explanation of why the department is proposing the change;
938 (C) the proposed change in services or reimbursement, including a description of the
939 effect of the change;
940 (D) the effect of an increase or decrease in services or benefits on individuals and
941 families;
942 (E) the degree to which any proposed cut may result in cost-shifting to more expensive
943 services in health or human service programs; and
944 (F) the fiscal impact of the proposed change, including:
945 (I) the effect of the proposed change on current or future appropriations from the
946 Legislature to the department;
947 (II) the effect the proposed change may have on federal matching dollars received by
948 the state Medicaid program;
949 (III) any cost shifting or cost savings within the department's budget that may result
950 from the proposed change; and
951 (IV) identification of the funds that will be used for the proposed change, including any
952 transfer of funds within the department's budget.
953 (4) Any rules adopted by the department under Subsection (2) are subject to review and
954 reauthorization by the Legislature in accordance with Section 63G-3-502.
955 (5) The department may, in its discretion, contract with [
956
957 Medicaid program, including:
958 (a) the determination of the eligibility of individuals for the program;
959 (b) recovery of overpayments; and
960 (c) consistent with Section [
961 and quality control services, enforcement of fraud and abuse laws.
962 (6) The department shall provide, by rule, disciplinary measures and sanctions for
963 Medicaid providers who fail to comply with the rules and procedures of the program, provided
964 that sanctions imposed administratively may not extend beyond:
965 (a) termination from the program;
966 (b) recovery of claim reimbursements incorrectly paid; and
967 (c) those specified in Section 1919 of Title XIX of the federal Social Security Act.
968 (7) (a) Funds collected as a result of a sanction imposed under Section 1919 of Title
969 XIX of the federal Social Security Act shall be deposited in the General Fund as dedicated
970 credits to be used by the division in accordance with the requirements of Section 1919 of Title
971 XIX of the federal Social Security Act.
972 (b) In accordance with Section 63J-1-602.2, sanctions collected under this Subsection
973 (7) are nonlapsing.
974 (8) (a) In determining whether an applicant or recipient is eligible for a service or
975 benefit under this part or [
976 the department shall, if Subsection (8)(b) is satisfied, exclude from consideration one passenger
977 vehicle designated by the applicant or recipient.
978 (b) Before Subsection (8)(a) may be applied:
979 (i) the federal government shall:
980 (A) determine that Subsection (8)(a) may be implemented within the state's existing
981 public assistance-related waivers as of January 1, 1999;
982 (B) extend a waiver to the state permitting the implementation of Subsection (8)(a); or
983 (C) determine that the state's waivers that permit dual eligibility determinations for
984 cash assistance and Medicaid are no longer valid; and
985 (ii) the department shall determine that Subsection (8)(a) can be implemented within
986 existing funding.
987 (9) (a) [
988 (i) "aged, blind, or has a disability" means an aged, blind, or disabled individual, as
989 defined in 42 U.S.C. Sec. 1382c(a)(1); and
990 (ii) "spend down" means an amount of income in excess of the allowable income
991 standard that shall be paid in cash to the department or incurred through the medical services
992 not paid by Medicaid.
993 (b) In determining whether an applicant or recipient who is aged, blind, or has a
994 disability is eligible for a service or benefit under this chapter, the department shall use 100%
995 of the federal poverty level as:
996 (i) the allowable income standard for eligibility for services or benefits; and
997 (ii) the allowable income standard for eligibility as a result of spend down.
998 (10) The department shall conduct internal audits of the Medicaid program.
999 (11) (a) The department may apply for and, if approved, implement a demonstration
1000 program for health opportunity accounts, as provided for in 42 U.S.C. Sec. 1396u-8.
1001 (b) A health opportunity account established under Subsection (11)(a) shall be an
1002 alternative to the existing benefits received by an individual eligible to receive Medicaid under
1003 this chapter.
1004 (c) Subsection (11)(a) is not intended to expand the coverage of the Medicaid program.
1005 (12) (a) (i) The department shall apply for, and if approved, implement an amendment
1006 to the state plan under this Subsection (12) for benefits for:
1007 (A) medically needy pregnant women;
1008 (B) medically needy children; and
1009 (C) medically needy parents and caretaker relatives.
1010 (ii) The department may implement the eligibility standards of Subsection (12)(b) for
1011 eligibility determinations made on or after the date of the approval of the amendment to the
1012 state plan.
1013 (b) In determining whether an applicant is eligible for benefits described in Subsection
1014 (12)(a)(i), the department shall:
1015 (i) disregard resources held in an account in the savings plan created under Title 53B,
1016 Chapter 8a, Utah Educational Savings Plan, if the beneficiary of the account is:
1017 (A) under the age of 26; and
1018 (B) living with the account owner, as that term is defined in Section 53B-8a-102, or
1019 temporarily absent from the residence of the account owner; and
1020 (ii) include the withdrawals from an account in the Utah Educational Savings Plan as
1021 resources for a benefit determination, if the withdrawal was not used for qualified higher
1022 education costs as that term is defined in Section 53B-8a-102.5.
1023 (13) (a) The department may not deny or terminate eligibility for Medicaid solely
1024 because an individual is:
1025 (i) incarcerated; and
1026 (ii) not an inmate as defined in Section 64-13-1.
1027 (b) Subsection (13)(a) does not require the Medicaid program to provide coverage for
1028 any services for an individual while the individual is incarcerated.
1029 (14) The department is a party to, and may intervene at any time in, any judicial or
1030 administrative action:
1031 (a) to which the Department of Workforce Services is a party; and
1032 (b) that involves medical assistance under[
1033 [
1034 [
1035 Section 9. Section 26B-3-109, which is renumbered from Section 26-18-3.1 is
1036 renumbered and amended to read:
1037 [
1038 (1) The purpose of this section is to expand the coverage of the Medicaid program to
1039 persons who are in categories traditionally not served by that program.
1040 (2) Within appropriations from the Legislature, the department may amend the state
1041 plan for medical assistance to provide for eligibility for Medicaid:
1042 (a) on or after July 1, 1994, for children 12 to 17 years old who live in households
1043 below the federal poverty income guideline; and
1044 (b) on or after July 1, 1995, for persons who have incomes below the federal poverty
1045 income guideline and who are aged, blind, or have a disability.
1046 (3) (a) Within appropriations from the Legislature, on or after July 1, 1996, the
1047 Medicaid program may provide for eligibility for persons who have incomes below the federal
1048 poverty income guideline.
1049 (b) In order to meet the provisions of this subsection, the department may seek
1050 approval for a demonstration project under 42 U.S.C. Sec. 1315 from the secretary of the
1051 United States Department of Health and Human Services.
1052 (4) The Medicaid program shall provide for eligibility for persons as required by
1053 Subsection [
1054 (5) Services available for persons described in this section shall include required
1055 Medicaid services and may include one or more optional Medicaid services if those services
1056 are funded by the Legislature. The department may also require persons described in
1057 Subsections (1) through (3) to meet an asset test.
1058 Section 10. Section 26B-3-110, which is renumbered from Section 26-18-3.5 is
1059 renumbered and amended to read:
1060 [
1061 (1) The department shall selectively provide for enrollment fees, premiums,
1062 deductions, cost sharing or other similar charges to be paid by recipients, their spouses, and
1063 parents, within the limitations of federal law and regulation.
1064 (2) Beginning May 1, 2006, within appropriations by the Legislature and as a means to
1065 increase health care coverage among the uninsured, the department shall take steps to promote
1066 increased participation in employer sponsored health insurance, including:
1067 (a) maximizing the health insurance premium subsidy provided under the state's 1115
1068 demonstration waiver by:
1069 (i) ensuring that state funds are matched by federal funds to the greatest extent
1070 allowable; and
1071 (ii) as the department determines appropriate, seeking federal approval to do one or
1072 more of the following:
1073 (A) eliminate or otherwise modify the annual enrollment fee;
1074 (B) eliminate or otherwise modify the schedule used to determine the level of subsidy
1075 provided to an enrollee each year;
1076 (C) reduce the maximum number of participants allowable under the subsidy program;
1077 or
1078 (D) otherwise modify the program in a manner that promotes enrollment in employer
1079 sponsored health insurance; and
1080 (b) exploring the use of other options, including the development of a waiver under the
1081 Medicaid Health Insurance Flexibility Demonstration Initiative or other federal authority.
1082 Section 11. Section 26B-3-111, which is renumbered from Section 26-18-3.6 is
1083 renumbered and amended to read:
1084 [
1085 (1) As used in this section:
1086 (a) "Community spouse" means the spouse of an institutionalized spouse.
1087 (b) (i) "Community spouse monthly income allowance" means an amount by which the
1088 minimum monthly maintenance needs allowance for the spouse exceeds the amount of monthly
1089 income otherwise available to the community spouse, determined without regard to the
1090 allowance, except as provided in Subsection (1)(b)(ii).
1091 (ii) If a court has entered an order against an institutionalized spouse for monthly
1092 income for the support of the community spouse, the community spouse monthly income
1093 allowance for the spouse may not be less than the amount of the monthly income so ordered.
1094 (c) "Community spouse resource allowance" is the amount of combined resources that
1095 are protected for a community spouse living in the community, which the division shall
1096 establish by rule made in accordance with Title 63G, Chapter 3, Utah Administrative
1097 Rulemaking Act, based on the amounts established by the United States Department of Health
1098 and Human Services.
1099 (d) "Excess shelter allowance" for a community spouse means the amount by which the
1100 sum of the spouse's expense for rent or mortgage payment, taxes, and insurance, and in the case
1101 of condominium or cooperative, required maintenance charge, for the community spouse's
1102 principal residence and the spouse's actual expenses for electricity, natural gas, and water
1103 utilities or, at the discretion of the department, the federal standard utility allowance under
1104 SNAP as defined in Section 35A-1-102, exceeds 30% of the amount described in Subsection
1105 (9).
1106 (e) "Family member" means a minor dependent child, dependent parents, or dependent
1107 sibling of the institutionalized spouse or community spouse who are residing with the
1108 community spouse.
1109 (f) (i) "Institutionalized spouse" means a person who is residing in a nursing facility
1110 and is married to a spouse who is not in a nursing facility.
1111 (ii) An "institutionalized spouse" does not include a person who is not likely to reside
1112 in a nursing facility for at least 30 consecutive days.
1113 (g) "Nursing care facility" means the same as that term is defined in Section [
1114 26B-2-201.
1115 (2) The division shall comply with this section when determining eligibility for
1116 medical assistance for an institutionalized spouse.
1117 (3) For services furnished during a calendar year beginning on or after January 1, 1999,
1118 the community spouse resource allowance shall be increased by the division by an amount as
1119 determined annually by CMS.
1120 (4) The division shall compute, as of the beginning of the first continuous period of
1121 institutionalization of the institutionalized spouse:
1122 (a) the total value of the resources to the extent either the institutionalized spouse or
1123 the community spouse has an ownership interest; and
1124 (b) a spousal share, which is 1/2 of the resources described in Subsection (4)(a).
1125 (5) At the request of an institutionalized spouse or a community spouse, at the
1126 beginning of the first continuous period of institutionalization of the institutionalized spouse
1127 and upon the receipt of relevant documentation of resources, the division shall promptly assess
1128 and document the total value described in Subsection (4)(a) and shall provide a copy of that
1129 assessment and documentation to each spouse and shall retain a copy of the assessment. When
1130 the division provides a copy of the assessment, it shall include a notice stating that the spouse
1131 may request a hearing under Subsection (11).
1132 (6) When determining eligibility for medical assistance under this chapter:
1133 (a) Except as provided in Subsection (6)(b), all resources held by either the
1134 institutionalized spouse, community spouse, or both, are considered to be available to the
1135 institutionalized spouse.
1136 (b) Resources are considered to be available to the institutionalized spouse only to the
1137 extent that the amount of those resources exceeds the community spouse resource allowance at
1138 the time of application for medical assistance under this chapter.
1139 (7) (a) The division may not find an institutionalized spouse to be ineligible for
1140 medical assistance by reason of resources determined under Subsection (5) to be available for
1141 the cost of care when:
1142 (i) the institutionalized spouse has assigned to the state any rights to support from the
1143 community spouse;
1144 (ii) except as provided in Subsection (7)(b), the institutionalized spouse lacks the
1145 ability to execute an assignment due to physical or mental impairment; or
1146 (iii) the division determines that denial of medical assistance would cause an undue
1147 burden.
1148 (b) Subsection (7)(a)(ii) does not prevent the division from seeking a court order for an
1149 assignment of support.
1150 (8) During the continuous period in which an institutionalized spouse is in an
1151 institution and after the month in which an institutionalized spouse is eligible for medical
1152 assistance, the resources of the community spouse may not be considered to be available to the
1153 institutionalized spouse.
1154 (9) When an institutionalized spouse is determined to be eligible for medical
1155 assistance, in determining the amount of the spouse's income that is to be applied monthly for
1156 the cost of care in the nursing care facility, the division shall deduct from the spouse's monthly
1157 income the following amounts in the following order:
1158 (a) a personal needs allowance, the amount of which is determined by the division;
1159 (b) a community spouse monthly income allowance, but only to the extent that the
1160 income of the institutionalized spouse is made available to, or for the benefit of, the community
1161 spouse;
1162 (c) a family allowance for each family member, equal to at least 1/3 of the amount that
1163 the amount described in Subsection (10)(a) exceeds the amount of the family member's
1164 monthly income; and
1165 (d) amounts for incurred expenses for the medical or remedial care for the
1166 institutionalized spouse.
1167 (10) The division shall establish a minimum monthly maintenance needs allowance for
1168 each community spouse that includes:
1169 (a) an amount established by the division by rule made in accordance with Title 63G,
1170 Chapter 3, Utah Administrative Rulemaking Act, based on the amounts established by the
1171 United States Department of Health and Human Services; and
1172 (b) an excess shelter allowance.
1173 (11) (a) An institutionalized spouse or a community spouse may request a hearing with
1174 respect to the determinations described in Subsections (11)(e)(i) through (v) if an application
1175 for medical assistance has been made on behalf of the institutionalized spouse.
1176 (b) A hearing under this subsection regarding the community spouse resource
1177 allowance shall be held by the division within 90 days from the date of the request for the
1178 hearing.
1179 (c) If either spouse establishes that the community spouse needs income, above the
1180 level otherwise provided by the minimum monthly maintenance needs allowance, due to
1181 exceptional circumstances resulting in significant financial duress, there shall be substituted,
1182 for the minimum monthly maintenance needs allowance provided under Subsection (10), an
1183 amount adequate to provide additional income as is necessary.
1184 (d) If either spouse establishes that the community spouse resource allowance, in
1185 relation to the amount of income generated by the allowance is inadequate to raise the
1186 community spouse's income to the minimum monthly maintenance needs allowance, there shall
1187 be substituted, for the community spouse resource allowance, an amount adequate to provide a
1188 minimum monthly maintenance needs allowance.
1189 (e) A hearing may be held under this subsection if either the institutionalized spouse or
1190 community spouse is dissatisfied with a determination of:
1191 (i) the community spouse monthly income allowance;
1192 (ii) the amount of monthly income otherwise available to the community spouse;
1193 (iii) the computation of the spousal share of resources under Subsection (4);
1194 (iv) the attribution of resources under Subsection (6); or
1195 (v) the determination of the community spouse resource allocation.
1196 (12) (a) An institutionalized spouse may transfer an amount equal to the community
1197 spouse resource allowance, but only to the extent the resources of the institutionalized spouse
1198 are transferred to or for the sole benefit of the community spouse.
1199 (b) The transfer under Subsection (12)(a) shall be made as soon as practicable after the
1200 date of the initial determination of eligibility, taking into account the time necessary to obtain a
1201 court order under Subsection (12)(c).
1202 (c) [
1203 does not apply if a court has entered an order against an institutionalized spouse for the support
1204 of the community spouse.
1205 Section 12. Section 26B-3-112, which is renumbered from Section 26-18-3.8 is
1206 renumbered and amended to read:
1207 [
1208 Utah's Premium Partnership for Health Insurance.
1209 (1) (a) The department shall seek to maximize the use of Medicaid and Children's
1210 Health Insurance Program funds for assistance in the purchase of private health insurance
1211 coverage for Medicaid-eligible and non-Medicaid-eligible individuals.
1212 (b) The department's efforts to expand the use of premium assistance shall:
1213 (i) include, as necessary, seeking federal approval under all Medicaid and Children's
1214 Health Insurance Program premium assistance provisions of federal law, including provisions
1215 of [
1216 (ii) give priority to, but not be limited to, expanding the state's Utah Premium
1217 Partnership for Health Insurance Program, including as required under Subsection (2); and
1218 (iii) encourage the enrollment of all individuals within a household in the same plan,
1219 where possible, including enrollment in a plan that allows individuals within the household
1220 transitioning out of Medicaid to retain the same network and benefits they had while enrolled
1221 in Medicaid.
1222 (2) The department shall seek federal approval of an amendment to the state's Utah
1223 Premium Partnership for Health Insurance program to adjust the eligibility determination for
1224 single adults and parents who have an offer of employer sponsored insurance. The amendment
1225 shall:
1226 (a) be within existing appropriations for the Utah Premium Partnership for Health
1227 Insurance program; and
1228 (b) provide that adults who are up to 200% of the federal poverty level are eligible for
1229 premium subsidies in the Utah Premium Partnership for Health Insurance program.
1230 (3) For the fiscal year 2020-21, the department shall seek authority to increase the
1231 maximum premium subsidy per month for adults under the Utah Premium Partnership for
1232 Health Insurance program to $300.
1233 (4) Beginning with the fiscal year 2021-22, and in each subsequent fiscal year, the
1234 department may increase premium subsidies for single adults and parents who have an offer of
1235 employer-sponsored insurance to keep pace with the increase in insurance premium costs,
1236 subject to appropriation of additional funding.
1237 Section 13. Section 26B-3-113, which is renumbered from Section 26-18-3.9 is
1238 renumbered and amended to read:
1239 [
1240 (1) As used in this section:
1241 [
1242
1243 [
1244 [
1245 [
1246 accordance with this section.
1247 [
1248 Section [
1249 (2) (a) As set forth in Subsections (2) through (5), eligibility criteria for the Medicaid
1250 program shall be expanded to cover additional low-income individuals.
1251 (b) The department shall continue to seek approval from CMS to implement the
1252 Medicaid waiver expansion as defined in Section [
1253 (c) The department may implement any provision described in Subsections
1254 [
1255 receives approval from CMS to implement that provision.
1256 (3) The department shall expand the Medicaid program in accordance with this
1257 Subsection (3) if the department:
1258 (a) receives approval from CMS to:
1259 (i) expand Medicaid coverage to eligible individuals whose income is below 95% of
1260 the federal poverty level;
1261 (ii) obtain maximum federal financial participation under 42 U.S.C. Sec. 1396d(b) for
1262 enrolling an individual in the Medicaid expansion under this Subsection (3); and
1263 (iii) permit the state to close enrollment in the Medicaid expansion under this
1264 Subsection (3) if the department has insufficient funds to provide services to new enrollment
1265 under the Medicaid expansion under this Subsection (3);
1266 (b) pays the state portion of costs for the Medicaid expansion under this Subsection (3)
1267 with funds from:
1268 (i) the Medicaid Expansion Fund;
1269 (ii) county contributions to the nonfederal share of Medicaid expenditures; or
1270 (iii) any other contributions, funds, or transfers from a nonstate agency for Medicaid
1271 expenditures; and
1272 (c) closes the Medicaid program to new enrollment under the Medicaid expansion
1273 under this Subsection (3) if the department projects that the cost of the Medicaid expansion
1274 under this Subsection (3) will exceed the appropriations for the fiscal year that are authorized
1275 by the Legislature through an appropriations act adopted in accordance with Title 63J, Chapter
1276 1, Budgetary Procedures Act.
1277 (4) (a) The department shall expand the Medicaid program in accordance with this
1278 Subsection (4) if the department:
1279 (i) receives approval from CMS to:
1280 (A) expand Medicaid coverage to eligible individuals whose income is below 95% of
1281 the federal poverty level;
1282 (B) obtain maximum federal financial participation under 42 U.S.C. Sec. 1396d(y) for
1283 enrolling an individual in the Medicaid expansion under this Subsection (4); and
1284 (C) permit the state to close enrollment in the Medicaid expansion under this
1285 Subsection (4) if the department has insufficient funds to provide services to new enrollment
1286 under the Medicaid expansion under this Subsection (4);
1287 (ii) pays the state portion of costs for the Medicaid expansion under this Subsection (4)
1288 with funds from:
1289 (A) the Medicaid Expansion Fund;
1290 (B) county contributions to the nonfederal share of Medicaid expenditures; or
1291 (C) any other contributions, funds, or transfers from a nonstate agency for Medicaid
1292 expenditures; and
1293 (iii) closes the Medicaid program to new enrollment under the Medicaid expansion
1294 under this Subsection (4) if the department projects that the cost of the Medicaid expansion
1295 under this Subsection (4) will exceed the appropriations for the fiscal year that are authorized
1296 by the Legislature through an appropriations act adopted in accordance with Title 63J, Chapter
1297 1, Budgetary Procedures Act.
1298 (b) The department shall submit a waiver, an amendment to an existing waiver, or a
1299 state plan amendment to CMS to:
1300 (i) administer federal funds for the Medicaid expansion under this Subsection (4)
1301 according to a per capita cap developed by the department that includes an annual inflationary
1302 adjustment, accounts for differences in cost among categories of Medicaid expansion enrollees,
1303 and provides greater flexibility to the state than the current Medicaid payment model;
1304 (ii) limit, in certain circumstances as defined by the department, the ability of a
1305 qualified entity to determine presumptive eligibility for Medicaid coverage for an individual
1306 enrolled in a Medicaid expansion under this Subsection (4);
1307 (iii) impose a lock-out period if an individual enrolled in a Medicaid expansion under
1308 this Subsection (4) violates certain program requirements as defined by the department;
1309 (iv) allow an individual enrolled in a Medicaid expansion under this Subsection (4) to
1310 remain in the Medicaid program for up to a 12-month certification period as defined by the
1311 department; and
1312 (v) allow federal Medicaid funds to be used for housing support for eligible enrollees
1313 in the Medicaid expansion under this Subsection (4).
1314 (5) (a) (i) If CMS does not approve a waiver to expand the Medicaid program in
1315 accordance with Subsection (4)(a) on or before January 1, 2020, the department shall develop
1316 proposals to implement additional flexibilities and cost controls, including cost sharing tools,
1317 within a Medicaid expansion under this Subsection (5) through a request to CMS for a waiver
1318 or state plan amendment.
1319 (ii) The request for a waiver or state plan amendment described in Subsection (5)(a)(i)
1320 shall include:
1321 (A) a path to self-sufficiency for qualified adults in the Medicaid expansion that
1322 includes employment and training as defined in 7 U.S.C. Sec. 2015(d)(4); and
1323 (B) a requirement that an individual who is offered a private health benefit plan by an
1324 employer to enroll in the employer's health plan.
1325 (iii) The department shall submit the request for a waiver or state plan amendment
1326 developed under Subsection (5)(a)(i) on or before March 15, 2020.
1327 (b) Notwithstanding Sections [
1328 with this Subsection (5), eligibility for the Medicaid program shall be expanded to include all
1329 persons in the optional Medicaid expansion population under [
1330
1331 Reconciliation Act of 2010, Pub. L. No. 111-152, and related federal regulations and guidance,
1332 on the earlier of:
1333 (i) the day on which CMS approves a waiver to implement the provisions described in
1334 Subsections (5)(a)(ii)(A) and (B); or
1335 (ii) July 1, 2020.
1336 (c) The department shall seek a waiver, or an amendment to an existing waiver, from
1337 federal law to:
1338 (i) implement each provision described in Subsections [
1339 26B-3-210(2)(b)(iii) through (viii) in a Medicaid expansion under this Subsection (5);
1340 (ii) limit, in certain circumstances as defined by the department, the ability of a
1341 qualified entity to determine presumptive eligibility for Medicaid coverage for an individual
1342 enrolled in a Medicaid expansion under this Subsection (5); and
1343 (iii) impose a lock-out period if an individual enrolled in a Medicaid expansion under
1344 this Subsection (5) violates certain program requirements as defined by the department.
1345 (d) The eligibility criteria in this Subsection (5) shall be construed to include all
1346 individuals eligible for the health coverage improvement program under Section [
1347 26B-3-207.
1348 (e) The department shall pay the state portion of costs for a Medicaid expansion under
1349 this Subsection (5) entirely from:
1350 (i) the Medicaid Expansion Fund;
1351 (ii) county contributions to the nonfederal share of Medicaid expenditures; or
1352 (iii) any other contributions, funds, or transfers from a nonstate agency for Medicaid
1353 expenditures.
1354 (f) If the costs of the Medicaid expansion under this Subsection (5) exceed the funds
1355 available under Subsection (5)(e):
1356 (i) the department may reduce or eliminate optional Medicaid services under this
1357 chapter; and
1358 (ii) savings, as determined by the department, from the reduction or elimination of
1359 optional Medicaid services under Subsection (5)(f)(i) shall be deposited into the Medicaid
1360 Expansion Fund; and
1361 (iii) the department may submit to CMS a request for waivers, or an amendment of
1362 existing waivers, from federal law necessary to implement budget controls within the Medicaid
1363 program to address the deficiency.
1364 (g) If the costs of the Medicaid expansion under this Subsection (5) are projected by
1365 the department to exceed the funds available in the current fiscal year under Subsection (5)(e),
1366 including savings resulting from any action taken under Subsection (5)(f):
1367 (i) the governor shall direct the [
1368
1369 expenditures by an amount sufficient to offset the deficiency:
1370 (A) proportionate to the share of total current fiscal year General Fund appropriations
1371 for each of those agencies; and
1372 (B) up to 10% of each agency's total current fiscal year General Fund appropriations;
1373 (ii) the Division of Finance shall reduce allotments to the [
1374
1375 percentage:
1376 (A) proportionate to the amount of the deficiency; and
1377 (B) up to 10% of each agency's total current fiscal year General Fund appropriations;
1378 and
1379 (iii) the Division of Finance shall deposit the total amount from the reduced allotments
1380 described in Subsection (5)(g)(ii) into the Medicaid Expansion Fund.
1381 (6) The department shall maximize federal financial participation in implementing this
1382 section, including by seeking to obtain any necessary federal approvals or waivers.
1383 (7) Notwithstanding Sections 17-43-201 and 17-43-301, a county does not have to
1384 provide matching funds to the state for the cost of providing Medicaid services to newly
1385 enrolled individuals who qualify for Medicaid coverage under a Medicaid expansion.
1386 (8) The department shall report to the Social Services Appropriations Subcommittee on
1387 or before November 1 of each year that a Medicaid expansion is operational:
1388 (a) the number of individuals who enrolled in the Medicaid expansion;
1389 (b) costs to the state for the Medicaid expansion;
1390 (c) estimated costs to the state for the Medicaid expansion for the current and
1391 following fiscal years;
1392 (d) recommendations to control costs of the Medicaid expansion; and
1393 (e) as calculated in accordance with Subsections [
1394 [
1395 Section 14. Section 26B-3-114, which is renumbered from Section 26-18-4 is
1396 renumbered and amended to read:
1397 [
1398 Funds for abortions.
1399 (1) (a) The department may develop standards and administer policies relating to
1400 eligibility under the Medicaid program as long as they are consistent with Subsection [
1401 26B-4-704(8).
1402 (b) An applicant receiving Medicaid assistance may be limited to particular types of
1403 care or services or to payment of part or all costs of care determined to be medically necessary.
1404 (2) The department may not provide any funds for medical, hospital, or other medical
1405 expenditures or medical services to otherwise eligible persons where the purpose of the
1406 assistance is to perform an abortion, unless the life of the mother would be endangered if an
1407 abortion were not performed.
1408 (3) Any employee of the department who authorizes payment for an abortion contrary
1409 to the provisions of this section is guilty of a class B misdemeanor and subject to forfeiture of
1410 office.
1411 (4) Any person or organization that, under the guise of other medical treatment,
1412 provides an abortion under auspices of the Medicaid program is guilty of a third degree felony
1413 and subject to forfeiture of license to practice medicine or authority to provide medical services
1414 and treatment.
1415 Section 15. Section 26B-3-115, which is renumbered from Section 26-18-5 is
1416 renumbered and amended to read:
1417 [
1418 provisions modifying department rules -- Compliance with Social Security Act.
1419 (1) The department may contract with other public or private agencies to purchase or
1420 provide medical services in connection with the programs of the division. Where these
1421 programs are used by other government entities, contracts shall provide that other government
1422 entities, in compliance with state and federal law regarding intergovernmental transfers,
1423 transfer the state matching funds to the department in amounts sufficient to satisfy needs of the
1424 specified program.
1425 (2) Contract terms shall include provisions for maintenance, administration, and
1426 service costs.
1427 (3) If a federal legislative or executive provision requires modifications or revisions in
1428 an eligibility factor established under this chapter as a condition for participation in medical
1429 assistance, the department may modify or change its rules as necessary to qualify for
1430 participation.
1431 (4) The provisions of this section do not apply to department rules governing abortion.
1432 (5) The department shall comply with all pertinent requirements of the Social Security
1433 Act and all orders, rules, and regulations adopted thereunder when required as a condition of
1434 participation in benefits under the Social Security Act.
1435 Section 16. Section 26B-3-116, which is renumbered from Section 26-18-5.5 is
1436 renumbered and amended to read:
1437 [
1438 The Medicaid program may not reimburse a home health agency, as defined in Section
1439 [
1440 agency has liability coverage of:
1441 (1) at least $500,000 per incident; or
1442 (2) an amount established by department rule made in accordance with Title 63G,
1443 Chapter 3, Utah Administrative Rulemaking Act.
1444 Section 17. Section 26B-3-117, which is renumbered from Section 26-18-6 is
1445 renumbered and amended to read:
1446 [
1447 (1) The executive director, with the approval of the governor, may bind the state to any
1448 executive or legislative provisions promulgated or enacted by the federal government which
1449 invite the state to participate in the distribution, disbursement or administration of any fund or
1450 service advanced, offered or contributed in whole or in part by the federal government for
1451 purposes consistent with the powers and duties of the department.
1452 (2) Such funds shall be used as provided in this chapter and be administered by the
1453 department for purposes related to medical assistance programs.
1454 Section 18. Section 26B-3-118, which is renumbered from Section 26-18-7 is
1455 renumbered and amended to read:
1456 [
1457 (1) Medical vendor payments made to providers of services for and in behalf of
1458 recipient households shall be based upon predetermined rates from standards developed by the
1459 division in cooperation with providers of services for each type of service purchased by the
1460 division.
1461 (2) As far as possible, the rates paid for services shall be established in advance of the
1462 fiscal year for which funds are to be requested.
1463 Section 19. Section 26B-3-119, which is renumbered from Section 26-18-8 is
1464 renumbered and amended to read:
1465 [
1466 (1) The department shall enforce or contract for the enforcement of Sections
1467 35A-1-503, 35A-3-108, 35A-3-110, 35A-3-111, 35A-3-112, and 35A-3-603 to the extent that
1468 these sections pertain to benefits conferred or administered by the division under this chapter,
1469 to the extent allowed under federal law or regulation.
1470 (2) The department may contract for services covered in Section 35A-3-111 insofar as
1471 that section pertains to benefits conferred or administered by the division under this chapter.
1472 Section 20. Section 26B-3-120, which is renumbered from Section 26-18-9 is
1473 renumbered and amended to read:
1474 [
1475 program -- Violation a misdemeanor.
1476 (1) Each state or local employee responsible for the expenditure of funds under the
1477 state Medicaid program, each individual who formerly was such an officer or employee, and
1478 each partner of such an officer or employee is prohibited for a period of one year after
1479 termination of such responsibility from committing any act, the commission of which by an
1480 officer or employee of the United States Government, an individual who was such an officer or
1481 employee, or a partner of such an officer or employee is prohibited by Section 207 or Section
1482 208 of Title 18, United States Code.
1483 (2) Violation of this section is a class A misdemeanor.
1484 Section 21. Section 26B-3-121, which is renumbered from Section 26-18-11 is
1485 renumbered and amended to read:
1486 [
1487 (1) [
1488 outside of a standard metropolitan statistical area, as designated by the United States Bureau of
1489 the Census.
1490 (2) For purposes of the Medicaid program, the [
1491
1492 Section 22. Section 26B-3-122, which is renumbered from Section 26-18-13 is
1493 renumbered and amended to read:
1494 [
1495 (1) (a) As used in this section, communication by telemedicine is considered
1496 face-to-face contact between a health care provider and a patient under the state's medical
1497 assistance program if:
1498 (i) the communication by telemedicine meets the requirements of administrative rules
1499 adopted in accordance with Subsection (3); and
1500 (ii) the health care services are eligible for reimbursement under the state's medical
1501 assistance program.
1502 (b) This Subsection (1) applies to any managed care organization that contracts with
1503 the state's medical assistance program.
1504 (2) The reimbursement rate for telemedicine services approved under this section:
1505 (a) shall be subject to reimbursement policies set by the state plan; and
1506 (b) may be based on:
1507 (i) a monthly reimbursement rate;
1508 (ii) a daily reimbursement rate; or
1509 (iii) an encounter rate.
1510 (3) The department shall adopt administrative rules in accordance with Title 63G,
1511 Chapter 3, Utah Administrative Rulemaking Act, which establish:
1512 (a) the particular telemedicine services that are considered face-to-face encounters for
1513 reimbursement purposes under the state's medical assistance program; and
1514 (b) the reimbursement methodology for the telemedicine services designated under
1515 Subsection (3)(a).
1516 Section 23. Section 26B-3-123, which is renumbered from Section 26-18-13.5 is
1517 renumbered and amended to read:
1518 [
1519 telepsychiatric consultations.
1520 (1) As used in this section:
1521 (a) "Telehealth services" means the same as that term is defined in Section [
1522 26B-4-704.
1523 (b) "Telemedicine services" means the same as that term is defined in Section
1524 [
1525 (c) "Telepsychiatric consultation" means a consultation between a physician and a
1526 board certified psychiatrist, both of whom are licensed to engage in the practice of medicine in
1527 the state, that utilizes:
1528 (i) the health records of the patient, provided from the patient or the referring
1529 physician;
1530 (ii) a written, evidence-based patient questionnaire; and
1531 (iii) telehealth services that meet industry security and privacy standards, including
1532 compliance with the:
1533 (A) Health Insurance Portability and Accountability Act; and
1534 (B) Health Information Technology for Economic and Clinical Health Act, Pub. L. No.
1535 111-5, 123 Stat. 226, 467, as amended.
1536 (2) This section applies to:
1537 (a) a managed care organization that contracts with the Medicaid program; and
1538 (b) a provider who is reimbursed for health care services under the Medicaid program.
1539 (3) The Medicaid program shall reimburse for telemedicine services at the same rate
1540 that the Medicaid program reimburses for other health care services.
1541 (4) The Medicaid program shall reimburse for telepsychiatric consultations at a rate set
1542 by the Medicaid program.
1543 Section 24. Section 26B-3-124, which is renumbered from Section 26-18-15 is
1544 renumbered and amended to read:
1545 [
1546 children.
1547 (1) The department, in collaboration with the Department of Workforce Services and
1548 the State Board of Education, shall develop a process to promote health insurance coverage for
1549 a child in school when:
1550 (a) the child applies for free or reduced price school lunch;
1551 (b) a child enrolls in or registers in school; and
1552 (c) other appropriate school related opportunities.
1553 (2) The department, in collaboration with the Department of Workforce Services, shall
1554 promote and facilitate the enrollment of children identified under Subsection (1) without health
1555 insurance in the Utah Children's Health Insurance Program, the Medicaid program, or the Utah
1556 Premium Partnership for Health Insurance Program.
1557 Section 25. Section 26B-3-125, which is renumbered from Section 26-18-16 is
1558 renumbered and amended to read:
1559 [
1560 and delivery reform.
1561 (1) In accordance with Subsection (2), and within appropriations from the Legislature,
1562 the department may amend the state Medicaid plan to:
1563 (a) create continuous eligibility for up to 12 months for an individual who has qualified
1564 for the state Medicaid program;
1565 (b) provide incentives in managed care contracts for an individual to obtain appropriate
1566 care in appropriate settings; and
1567 (c) require the managed care system to accept the risk of managing the Medicaid
1568 population assigned to the plan amendment in return for receiving the benefits of providing
1569 quality and cost effective care.
1570 (2) If the department amends the state Medicaid plan under Subsection (1)(a) or (b),
1571 the department:
1572 (a) shall ensure that the plan amendment:
1573 (i) is cost effective for the state Medicaid program;
1574 (ii) increases the quality and continuity of care for recipients; and
1575 (iii) calculates and transfers administrative savings from continuous enrollment from
1576 the Department of Workforce Services to the [
1577 (b) may limit the plan amendment under Subsection (1)(a) or (b) to select geographic
1578 areas or specific Medicaid populations.
1579 (3) The department may seek approval for a state plan amendment, waiver, or a
1580 demonstration project from the Secretary of the United States Department of Health and
1581 Human Services if necessary to implement a plan amendment under Subsection (1)(a) or (b).
1582 Section 26. Section 26B-3-126, which is renumbered from Section 26-18-17 is
1583 renumbered and amended to read:
1584 [
1585 (1) (a) For purposes of this section:
1586 (i) "Health care provider" means a health care provider as defined in Section
1587 78B-3-403 who:
1588 (A) receives payment for medical services from the Medicaid program established in
1589 this chapter, or the Children's Health Insurance Program established in [
1590
1591 (B) submits a patient's personally identifiable information to the Medicaid eligibility
1592 database or the Children's Health Insurance Program eligibility database.
1593 (ii) "HIPAA" means 45 C.F.R. Parts 160, 162, and 164, Health Insurance Portability
1594 and Accountability Act of 1996, as amended.
1595 (b) Beginning July 1, 2013, this section applies to the Medicaid program, the
1596 Children's Health Insurance Program created in [
1597
1598 (2) A health care provider shall, as part of the notice of privacy practices required by
1599 HIPAA, provide notice to the patient or the patient's personal representative that the health care
1600 provider either has, or may submit, personally identifiable information about the patient to the
1601 Medicaid eligibility database and the Children's Health Insurance Program eligibility database.
1602 (3) The Medicaid program and the Children's Health Insurance Program may not give a
1603 health care provider access to the Medicaid eligibility database or the Children's Health
1604 Insurance Program eligibility database unless the health care provider's notice of privacy
1605 practices complies with Subsection (2).
1606 (4) The department may adopt an administrative rule to establish uniform language for
1607 the state requirement regarding notice of privacy practices to patients required under
1608 Subsection (2).
1609 Section 27. Section 26B-3-127, which is renumbered from Section 26-18-18 is
1610 renumbered and amended to read:
1611 [
1612 (1) The department and the governor may not expand the state's Medicaid program
1613 under PPACA unless:
1614 (a) the department expands Medicaid in accordance with Section [
1615 26B-3-210; or
1616 (b) (i) the governor or the governor's designee has reported the intention to expand the
1617 state Medicaid program under PPACA to the Legislature in compliance with the legislative
1618 review process in Section [
1619 (ii) the governor submits the request for expansion of the Medicaid program for
1620 optional populations to the Legislature under the high impact federal funds request process
1621 required by Section 63J-5-204.
1622 (2) (a) The department shall request approval from CMS for waivers from federal
1623 statutory and regulatory law necessary to implement the health coverage improvement program
1624 under Section [
1625 (b) The health coverage improvement program under Section [
1626 is not subject to the requirements in Subsection (1).
1627 Section 28. Section 26B-3-128, which is renumbered from Section 26-18-19 is
1628 renumbered and amended to read:
1629 [
1630 The department may select one or more contractors, in accordance with Title 63G,
1631 Chapter 6a, Utah Procurement Code, to provide vision services to the Medicaid populations
1632 that are eligible for vision services, as described in department rules, without restricting
1633 provider participation, and within existing appropriations from the Legislature.
1634 Section 29. Section 26B-3-129, which is renumbered from Section 26-18-20 is
1635 renumbered and amended to read:
1636 [
1637 (1) (a) The department shall adopt administrative rules in accordance with Title 63G,
1638 Chapter 3, Utah Administrative Rulemaking Act, and in consultation with providers and health
1639 care professionals subject to audit and investigation under the state Medicaid program, to
1640 establish procedures for audits and investigations that are fair and consistent with the duties of
1641 the department as the single state agency responsible for the administration of the Medicaid
1642 program under Section [
1643 (b) If the providers and health care professionals do not agree with the rules proposed
1644 or adopted by the department under Subsection (1)(a), the providers or health care
1645 professionals may:
1646 (i) request a hearing for the proposed administrative rule or seek any other remedies
1647 under the provisions of Title 63G, Chapter 3, Utah Administrative Rulemaking Act; and
1648 (ii) request a review of the rule by the Legislature's Administrative Rules Review and
1649 General Oversight Committee created in Section 63G-3-501.
1650 (2) The department shall:
1651 (a) notify and educate providers and health care professionals subject to audit and
1652 investigation under the Medicaid program of the providers' and health care professionals'
1653 responsibilities and rights under the administrative rules adopted by the department under the
1654 provisions of this section;
1655 (b) ensure that the department, or any entity that contracts with the department to
1656 conduct audits:
1657 (i) has on staff or contracts with a medical or dental professional who is experienced in
1658 the treatment, billing, and coding procedures used by the type of provider being audited; and
1659 (ii) uses the services of the appropriate professional described in Subsection (3)(b)(i) if
1660 the provider who is the subject of the audit disputes the findings of the audit;
1661 (c) ensure that a finding of overpayment or underpayment to a provider is not based on
1662 extrapolation, as defined in Section 63A-13-102, unless:
1663 (i) there is a determination that the level of payment error involving the provider
1664 exceeds a 10% error rate:
1665 (A) for a sample of claims for a particular service code; and
1666 (B) over a three year period of time;
1667 (ii) documented education intervention has failed to correct the level of payment error;
1668 and
1669 (iii) the value of the claims for the provider, in aggregate, exceeds $200,000 in
1670 reimbursement for a particular service code on an annual basis; and
1671 (d) require that any entity with which the office contracts, for the purpose of
1672 conducting an audit of a service provider, shall be paid on a flat fee basis for identifying both
1673 overpayments and underpayments.
1674 (3) (a) If the department, or a contractor on behalf of the department:
1675 (i) intends to implement the use of extrapolation as a method of auditing claims, the
1676 department shall, prior to adopting the extrapolation method of auditing, report its intent to use
1677 extrapolation to the Social Services Appropriations Subcommittee; and
1678 (ii) determines Subsections (2)(c)(i) through (iii) are applicable to a provider, the
1679 department or the contractor may use extrapolation only for the service code associated with
1680 the findings under Subsections (2)(c)(i) through (iii).
1681 (b) (i) If extrapolation is used under this section, a provider may, at the provider's
1682 option, appeal the results of the audit based on:
1683 (A) each individual claim; or
1684 (B) the extrapolation sample.
1685 (ii) Nothing in this section limits a provider's right to appeal the audit under Title 63G,
1686 General Government, Title 63G, Chapter 4, Administrative Procedures Act, the Medicaid
1687 program and its manual or rules, or other laws or rules that may provide remedies to providers.
1688 Section 30. Section 26B-3-130, which is renumbered from Section 26-18-21 is
1689 renumbered and amended to read:
1690 [
1691 requirements.
1692 (1) As used in this section:
1693 (a) (i) "Intergovernmental transfer" means the transfer of public funds from:
1694 (A) a local government entity to another nonfederal governmental entity; or
1695 (B) from a nonfederal, government owned health care facility regulated under [
1696
1697 Licensing and Inspection, to another nonfederal governmental entity.
1698 (ii) "Intergovernmental transfer" does not include:
1699 (A) the transfer of public funds from one state agency to another state agency; or
1700 (B) a transfer of funds from the University of Utah Hospitals and Clinics.
1701 (b) (i) "Intergovernmental transfer program" means a federally approved
1702 reimbursement program or category that is authorized by the Medicaid state plan or waiver
1703 authority for intergovernmental transfers.
1704 (ii) "Intergovernmental transfer program" does not include the addition of a provider to
1705 an existing intergovernmental transfer program.
1706 (c) "Local government entity" means a county, city, town, special service district, local
1707 district, or local education agency as that term is defined in Section 63J-5-102.
1708 (d) "Non-state government entity" means a hospital authority, hospital district, health
1709 care district, special service district, county, or city.
1710 (2) (a) An entity that receives federal Medicaid dollars from the department as a result
1711 of an intergovernmental transfer shall, on or before August 1, 2017, and on or before August 1
1712 each year thereafter, provide the department with:
1713 (i) information regarding the payments funded with the intergovernmental transfer as
1714 authorized by and consistent with state and federal law;
1715 (ii) information regarding the entity's ability to repay federal funds, to the extent
1716 required by the department in the contract for the intergovernmental transfer; and
1717 (iii) other information reasonably related to the intergovernmental transfer that may be
1718 required by the department in the contract for the intergovernmental transfer.
1719 (b) On or before October 15, 2017, and on or before October 15 each subsequent year,
1720 the department shall prepare a report for the Executive Appropriations Committee that
1721 includes:
1722 (i) the amount of each intergovernmental transfer under Subsection (2)(a);
1723 (ii) a summary of changes to CMS regulations and practices that are known by the
1724 department regarding federal funds related to an intergovernmental transfer program; and
1725 (iii) other information the department gathers about the intergovernmental transfer
1726 under Subsection (2)(a).
1727 (3) The department shall not create a new intergovernmental transfer program after
1728 July 1, 2017, unless the department reports to the Executive Appropriations Committee, in
1729 accordance with Section 63J-5-206, before submitting the new intergovernmental transfer
1730 program for federal approval. The report shall include information required by Subsection
1731 63J-5-102(1)(d) and the analysis required in Subsections (2)(a) and (b).
1732 (4) (a) The department shall enter into new Nursing Care Facility Non-State
1733 Government-Owned Upper Payment Limit program contracts and contract amendments adding
1734 new nursing care facilities and new non-state government entity operators in accordance with
1735 this Subsection (4).
1736 (b) (i) If the nursing care facility expects to receive less than $1,000,000 in federal
1737 funds each year from the Nursing Care Facility Non-State Government-Owned Upper Payment
1738 Limit program, excluding seed funding and administrative fees paid by the non-state
1739 government entity, the department shall enter into a Nursing Care Facility Non-State
1740 Government-Owned Upper Payment Limit program contract with the non-state government
1741 entity operator of the nursing care facility.
1742 (ii) If the nursing care facility expects to receive between $1,000,000 and $10,000,000
1743 in federal funds each year from the Nursing Care Facility Non-State Government-Owned
1744 Upper Payment Limit program, excluding seed funding and administrative fees paid by the
1745 non-state government entity, the department shall enter into a Nursing Care Facility Non-State
1746 Government-Owned Upper Payment Limit program contract with the non-state government
1747 entity operator of the nursing care facility after receiving the approval of the Executive
1748 Appropriations Committee.
1749 (iii) If the nursing care facility expects to receive more than $10,000,000 in federal
1750 funds each year from the Nursing Care Facility Non-State Government-Owned Upper Payment
1751 Limit program, excluding seed funding and administrative fees paid by the non-state
1752 government entity, the department may not approve the application without obtaining approval
1753 from the Legislature and the governor.
1754 (c) A non-state government entity may not participate in the Nursing Care Facility
1755 Non-State Government-Owned Upper Payment Limit program unless the non-state government
1756 entity is a special service district, county, or city that operates a hospital or holds a license
1757 under [
1758 Health Care Facility Licensing and Inspection.
1759 (d) Each non-state government entity that participates in the Nursing Care Facility
1760 Non-State Government-Owned Upper Payment Limit program shall certify to the department
1761 that:
1762 (i) the non-state government entity is a local government entity that is able to make an
1763 intergovernmental transfer under applicable state and federal law;
1764 (ii) the non-state government entity has sufficient public funds or other permissible
1765 sources of seed funding that comply with the requirements in 42 C.F.R. Part 433, Subpart B;
1766 (iii) the funds received from the Nursing Care Facility Non-State Government-Owned
1767 Upper Payment Limit program are:
1768 (A) for each nursing care facility, available for patient care until the end of the
1769 non-state government entity's fiscal year; and
1770 (B) used exclusively for operating expenses for nursing care facility operations, patient
1771 care, capital expenses, rent, royalties, and other operating expenses; and
1772 (iv) the non-state government entity has completed all licensing, enrollment, and other
1773 forms and documents required by federal and state law to register a change of ownership with
1774 the department and with CMS.
1775 (5) The department shall add a nursing care facility to an existing Nursing Care Facility
1776 Non-State Government-Owned Upper Payment Limit program contract if:
1777 (a) the nursing care facility is managed by or affiliated with the same non-state
1778 government entity that also manages one or more nursing care facilities that are included in an
1779 existing Nursing Care Facility Non-State Government-Owned Upper Payment Limit program
1780 contract; and
1781 (b) the non-state government entity makes the certification described in Subsection
1782 (4)(d)(ii).
1783 (6) The department may not increase the percentage of the administrative fee paid by a
1784 non-state government entity to the department under the Nursing Care Facility Non-State
1785 Government-Owned Upper Payment Limit program.
1786 (7) The department may not condition participation in the Nursing Care Facility
1787 Non-State Government-Owned Upper Payment Limit program on:
1788 (a) a requirement that the department be allowed to direct or determine the types of
1789 patients that a non-state government entity will treat or the course of treatment for a patient in a
1790 non-state government nursing care facility; or
1791 (b) a requirement that a non-state government entity or nursing care facility post a
1792 bond, purchase insurance, or create a reserve account of any kind.
1793 (8) The non-state government entity shall have the primary responsibility for ensuring
1794 compliance with Subsection (4)(d)(ii).
1795 (9) (a) The department may not enter into a new Nursing Care Facility Non-State
1796 Government-Owned Upper Payment Limit program contract before January 1, 2019.
1797 (b) Subsection (9)(a) does not apply to:
1798 (i) a new Nursing Care Facility Non-State Government-Owned Upper Payment Limit
1799 program contract that was included in the federal funds request summary under Section
1800 63J-5-201 for fiscal year 2018; or
1801 (ii) a nursing care facility that is operated or managed by the same company as a
1802 nursing care facility that was included in the federal funds request summary under Section
1803 63J-5-201 for fiscal year 2018.
1804 Section 31. Section 26B-3-131, which is renumbered from Section 26-18-22 is
1805 renumbered and amended to read:
1806 [
1807 Treatment Medicaid reimbursement.
1808 (1) As used in this section:
1809 (a) "Controlled substance prescriber" means a controlled substance prescriber, as that
1810 term is defined in Section 58-37-6.5, who:
1811 (i) has a record of having completed SBIRT training, in accordance with Subsection
1812 58-37-6.5(2), before providing the SBIRT services; and
1813 (ii) is a Medicaid enrolled health care provider.
1814 (b) "SBIRT" means the same as that term is defined in Section 58-37-6.5.
1815 (2) The department shall reimburse a controlled substance prescriber who provides
1816 SBIRT services to a Medicaid enrollee who is 13 years of age or older for the SBIRT services.
1817 Section 32. Section 26B-3-132, which is renumbered from Section 26-18-23 is
1818 renumbered and amended to read:
1819 [
1820 (1) The department may implement a prescribing policy for certain opioid prescriptions
1821 that is substantially similar to the prescribing policies required in Section 31A-22-615.5.
1822 (2) The department may amend the state program and apply for waivers for the state
1823 program, if necessary, to implement Subsection (1).
1824 Section 33. Section 26B-3-133, which is renumbered from Section 26-18-24 is
1825 renumbered and amended to read:
1826 [
1827 immediately following childbirth.
1828 (1) As used in this section, "long-acting reversible contraception" means a
1829 contraception method that requires administration less than once per month, including:
1830 (a) an intrauterine device; and
1831 (b) a contraceptive implant.
1832 (2) The division shall separately identify and reimburse, from other labor and delivery
1833 services within the Medicaid program, the provision and insertion of long-acting reversible
1834 contraception immediately after childbirth.
1835 Section 34. Section 26B-3-134, which is renumbered from Section 26-18-25 is
1836 renumbered and amended to read:
1837 [
1838 (1) As used in this section, "exome sequence testing" means a genomic technique for
1839 sequencing the genome of an individual for diagnostic purposes.
1840 (2) The Medicaid program shall reimburse for exome sequence testing:
1841 (a) for an enrollee who:
1842 (i) is younger than 21 years of age; and
1843 (ii) who remains undiagnosed after exhausting all other appropriate diagnostic-related
1844 tests;
1845 (b) performed by a nationally recognized provider with significant experience in exome
1846 sequence testing;
1847 (c) that is medically necessary; and
1848 (d) at a rate set by the Medicaid program.
1849 Section 35. Section 26B-3-135, which is renumbered from Section 26-18-26 is
1850 renumbered and amended to read:
1851 [
1852 health transport providers.
1853 The department may not reimburse a nonemergency secured behavioral health transport
1854 provider that is designated under Section [
1855 Section 36. Section 26B-3-136, which is renumbered from Section 26-18-27 is
1856 renumbered and amended to read:
1857 [
1858 (1) As used in this section:
1859 (a) "CHIP" means the Children's Health Insurance Program created in Section
1860 [
1861 (b) "Program" means the Children's Health Care Coverage Program created in
1862 Subsection (2).
1863 (2) (a) There is created the Children's Health Care Coverage Program within the
1864 department.
1865 (b) The purpose of the program is to:
1866 (i) promote health insurance coverage for children in accordance with Section
1867 [
1868 (ii) conduct research regarding families who are eligible for Medicaid and CHIP to
1869 determine awareness and understanding of available coverage;
1870 (iii) analyze trends in disenrollment and identify reasons that families may not be
1871 renewing enrollment, including any barriers in the process of renewing enrollment;
1872 (iv) administer surveys to recently enrolled CHIP and children's Medicaid enrollees to
1873 identify:
1874 (A) how the enrollees learned about coverage; and
1875 (B) any barriers during the application process;
1876 (v) develop promotional material regarding CHIP and children's Medicaid eligibility,
1877 including outreach through social media, video production, and other media platforms;
1878 (vi) identify ways that the eligibility website for enrollment in CHIP and children's
1879 Medicaid can be redesigned to increase accessibility and enhance the user experience;
1880 (vii) identify outreach opportunities, including partnerships with community
1881 organizations including:
1882 (A) schools;
1883 (B) small businesses;
1884 (C) unemployment centers;
1885 (D) parent-teacher associations; and
1886 (E) youth athlete clubs and associations; and
1887 (viii) develop messaging to increase awareness of coverage options that are available
1888 through the department.
1889 (3) (a) The department may not delegate implementation of the program to a private
1890 entity.
1891 (b) Notwithstanding Subsection (3)(a), the department may contract with a media
1892 agency to conduct the activities described in Subsection (2)(b)(iv) and (vii).
1893 Section 37. Section 26B-3-137, which is renumbered from Section 26-18-28 is
1894 renumbered and amended to read:
1895 [
1896 (1) As used in this section, "DPP" means the National Diabetes Prevention Program
1897 developed by the United States Centers for Disease Control and Prevention.
1898 (2) Beginning July 1, 2022, the Medicaid program shall reimburse a provider for an
1899 enrollee's participation in the DPP if the enrollee:
1900 (a) meets the DPP's eligibility requirements; and
1901 (b) has not previously participated in the DPP after July 1, 2022, while enrolled in the
1902 Medicaid program.
1903 (3) Subject to appropriation, the Medicaid program may set the rate for reimbursement.
1904 (4) The department may apply for a state plan amendment if necessary to implement
1905 this section.
1906 (5) (a) On or after July 1, 2025, but before October 1, 2025, the department shall
1907 provide a written report regarding the efficacy of the DPP and reimbursement under this
1908 section to the Health and Human Services Interim Committee.
1909 (b) The report described in Subsection (5)(a) shall include:
1910 (i) the total number of enrollees with a prediabetic condition as of July 1, 2022;
1911 (ii) the total number of enrollees as of July 1, 2022, with a diagnosis of type 2 diabetes;
1912 (iii) the total number of enrollees who participated in the DPP;
1913 (iv) the total cost incurred by the state to implement this section; and
1914 (v) any conclusions that can be drawn regarding the impact of the DPP on the rate of
1915 type 2 diabetes for enrollees.
1916 Section 38. Section 26B-3-138, which is renumbered from Section 26-18-427 is
1917 renumbered and amended to read:
1918 [
1919 (1) As used in this section, "targeted adult Medicaid program" means the same as that
1920 term is defined in Section [
1921 (2) On or before May 31, 2022, the department shall convene a working group to
1922 collaborate with the department on:
1923 (a) establishing specific and measurable metrics regarding:
1924 (i) compliance of managed care organizations in the state with federal Medicaid
1925 managed care requirements;
1926 (ii) timeliness and accuracy of authorization and claims processing in accordance with
1927 Medicaid policy and contract requirements;
1928 (iii) reimbursement by managed care organizations in the state to providers to maintain
1929 adequacy of access to care;
1930 (iv) availability of care management services to meet the needs of Medicaid-eligible
1931 individuals enrolled in the plans of managed care organizations in the state; and
1932 (v) timeliness of resolution for disputes between a managed care organization and the
1933 managed care organization's providers and enrollees;
1934 (b) improving the delivery of behavioral health services in the Medicaid program;
1935 (c) proposals to implement the delivery system adjustments authorized under
1936 Subsection [
1937 (d) issues that are identified by managed care organizations, behavioral health service
1938 providers, and the department.
1939 (3) The working group convened under Subsection (2) shall:
1940 (a) meet quarterly; and
1941 (b) consist of at least the following individuals:
1942 (i) the executive director or the executive director's designee;
1943 (ii) for each Medicaid accountable care organization with which the department
1944 contracts, an individual selected by the accountable care organization;
1945 (iii) five individuals selected by the department to represent various types of behavioral
1946 health services providers, including, at a minimum, individuals who represent providers who
1947 provide the following types of services:
1948 (A) acute inpatient behavioral health treatment;
1949 (B) residential treatment;
1950 (C) intensive outpatient or partial hospitalization treatment; and
1951 (D) general outpatient treatment;
1952 (iv) a representative of an association that represents behavioral health treatment
1953 providers in the state, designated by the Utah Behavioral Healthcare Council convened by the
1954 Utah Association of Counties;
1955 (v) a representative of an organization representing behavioral health organizations;
1956 (vi) the chair of the Utah Substance Use and Mental Health Advisory Council created
1957 in Section 63M-7-301;
1958 (vii) a representative of an association that represents local authorities who provide
1959 public behavioral health care, designated by the department;
1960 (viii) one member of the Senate, appointed by the president of the Senate; and
1961 (ix) one member of the House of Representatives, appointed by the speaker of the
1962 House of Representatives.
1963 (4) The working group convened under this section shall recommend to the
1964 department:
1965 (a) specific and measurable metrics under Subsection (2)(a);
1966 (b) how physical and behavioral health services may be integrated for the targeted adult
1967 Medicaid program, including ways the department may address issues regarding:
1968 (i) filing of claims;
1969 (ii) authorization and reauthorization for treatment services;
1970 (iii) reimbursement rates; and
1971 (iv) other issues identified by the department, behavioral health services providers, or
1972 Medicaid managed care organizations;
1973 (c) ways to improve delivery of behavioral health services to enrollees, including
1974 changes to statute or administrative rule; and
1975 (d) wraparound service coverage for enrollees who need specific, nonclinical services
1976 to ensure a path to success.
1977 Section 39. Section 26B-3-139, which is renumbered from Section 26-18-603 is
1978 renumbered and amended to read:
1979 [
1980 funds.
1981 (1) If a proceeding of the department, under Title 63G, Chapter 4, Administrative
1982 Procedures Act, relates in any way to recovery of Medicaid funds:
1983 (a) the presiding officer shall be designated by the executive director of the department
1984 and report directly to the executive director or, in the discretion of the executive director, report
1985 directly to the director of the Office of Internal Audit; and
1986 (b) the decision of the presiding officer is the recommended decision to the executive
1987 director of the department or a designee of the executive director who is not in the division.
1988 (2) Subsection (1) does not apply to hearings conducted by the Department of
1989 Workforce Services relating to medical assistance eligibility determinations.
1990 (3) If a proceeding of the department, under Title 63G, Chapter 4, Administrative
1991 Procedures Act, relates in any way to Medicaid or Medicaid funds, the following may attend
1992 and present evidence or testimony at the proceeding:
1993 (a) the director of the Office of Internal Audit, or the director's designee; and
1994 (b) the inspector general of Medicaid services or the inspector general's designee.
1995 (4) In relation to a proceeding of the department under Title 63G, Chapter 4,
1996 Administrative Procedures Act, a person may not, outside of the actual proceeding, attempt to
1997 influence the decision of the presiding officer.
1998 Section 40. Section 26B-3-140, which is renumbered from Section 26-18-604 is
1999 renumbered and amended to read:
2000 [
2001 duties -- Reporting.
2002 (1) As used in this section:
2003 (a) "Abuse" means:
2004 (i) an action or practice that:
2005 (A) is inconsistent with sound fiscal, business, or medical practices; and
2006 (B) results, or may result, in unnecessary Medicaid related costs or other medical or
2007 hospital assistance costs; or
2008 (ii) reckless or negligent upcoding.
2009 (b) "Fraud" means intentional or knowing:
2010 (i) deception, misrepresentation, or upcoding in relation to Medicaid funds, costs,
2011 claims, reimbursement, or practice; or
2012 (ii) deception or misrepresentation in relation to medical or hospital assistance funds,
2013 costs, claims, reimbursement, or practice.
2014 (c) "Upcoding" means assigning an inaccurate billing code for a service that is payable
2015 or reimbursable by Medicaid funds, if the correct billing code for the service, taking into
2016 account reasonable opinions derived from official published coding definitions, would result in
2017 a lower Medicaid payment or reimbursement.
2018 (d) "Waste" means overutilization of resources or inappropriate payment.
2019 (2) The division shall:
2020 [
2021 hospital assistance funds to ensure that providers do not receive:
2022 [
2023 [
2024 [
2025 violation of federal or state law, administrative rule, or the state plan; and
2026 [
2027 [
2028 payment for pharmaceuticals or long-term care; or
2029 [
2030 [
2031 states, and the Office of Inspector General of Medicaid Services to determine and implement
2032 best practices for discovering and eliminating fraud, waste, and abuse of Medicaid funds and
2033 medical or hospital assistance funds;
2034 [
2035 [
2036 [
2037 [
2038 of the funds described in Subsection [
2039 [
2040 obtain pharmaceuticals at the lowest price possible, including, on a quarterly basis for the
2041 pharmaceuticals that represent the highest 45% of state Medicaid expenditures for
2042 pharmaceuticals and on an annual basis for the remaining pharmaceuticals:
2043 [
2044 [
2045 [
2046 [
2047 pharmacy price lists; and
2048 [
2049 make decisions on billing codes, or who are in the best position to observe and identify
2050 upcoding, in order to avoid and detect upcoding.
2051 Section 41. Section 26B-3-141, which is renumbered from Section 26-18-703 is
2052 renumbered and amended to read:
2053 [
2054 of Workforce Services and compliance under adoption assistance interstate compact --
2055 Penalty for fraudulent claim.
2056 (1) As used in this section:
2057 (a) "Adoption assistance" means the same as that term is defined in Section 80-2-809.
2058 (b) "Adoption assistance agreement" means the same as that term is defined in Section
2059 80-2-809.
2060 (c) "Adoption assistance interstate compact" means an agreement executed by the
2061 Division of Child and Family Services with any other state in accordance with Section
2062 80-2-809.
2063 [
2064 assistance interstate compact is entitled to receive medical assistance from the division and the
2065 Department of Workforce Services by filing a certified copy of the child's adoption assistance
2066 agreement with the division or the Department of Workforce Services.
2067 (b) The adoptive parent of the child described in Subsection [
2068 provide the division or the Department of Workforce Services with evidence verifying that the
2069 adoption assistance agreement is still effective.
2070 [
2071 assistance under this section as the Department of Workforce Services does any other recipient
2072 of medical assistance under an adoption assistance agreement executed by the Division of
2073 Child and Family Services.
2074 [
2075 section that the person knows is false, misleading, or fraudulent.
2076 (b) A violation of Subsection [
2077 (5) The division and the Department of Workforce Services shall:
2078 (a) cooperate with the Division of Child and Family Services in regards to an adoption
2079 assistance interstate compact; and
2080 (b) comply with an adoption assistance interstate compact.
2081 Section 42. Section 26B-3-201, which is renumbered from Section 26-18-403 is
2082 renumbered and amended to read:
2083
2084 [
2085 adolescents.
2086 (1) [
2087 includes any individual who reached 18 years of age while in the custody of the[
2088
2089
2090 recognized Indian tribe.
2091 (2) An independent foster care adolescent is eligible, when funds are available, for
2092 Medicaid coverage until the individual reaches 21 years of age.
2093 (3) Before July 1, 2006, the division shall submit a state Medicaid Plan amendment to
2094 [
2095 care adolescents effective fiscal year 2006-07.
2096 Section 43. Section 26B-3-202, which is renumbered from Section 26-18-405 is
2097 renumbered and amended to read:
2098 [
2099 fee-for-service delivery model -- Cost of mandated program changes.
2100 (1) The department shall develop a waiver program in the Medicaid program to replace
2101 the fee-for-service delivery model with one or more risk-based delivery models.
2102 (2) The waiver program shall:
2103 (a) restructure the program's provider payment provisions to reward health care
2104 providers for delivering the most appropriate services at the lowest cost and in ways that,
2105 compared to services delivered before implementation of the waiver program, maintain or
2106 improve recipient health status;
2107 (b) restructure the program's cost sharing provisions and other incentives to reward
2108 recipients for personal efforts to:
2109 (i) maintain or improve their health status; and
2110 (ii) use providers that deliver the most appropriate services at the lowest cost;
2111 (c) identify the evidence-based practices and measures, risk adjustment methodologies,
2112 payment systems, funding sources, and other mechanisms necessary to reward providers for
2113 delivering the most appropriate services at the lowest cost, including mechanisms that:
2114 (i) pay providers for packages of services delivered over entire episodes of illness
2115 rather than for individual services delivered during each patient encounter; and
2116 (ii) reward providers for delivering services that make the most positive contribution to
2117 a recipient's health status;
2118 (d) limit total annual per-patient-per-month expenditures for services delivered through
2119 fee-for-service arrangements to total annual per-patient-per-month expenditures for services
2120 delivered through risk-based arrangements covering similar recipient populations and services;
2121 and
2122 (e) except as provided in Subsection (4), limit the rate of growth in
2123 per-patient-per-month General Fund expenditures for the program to the rate of growth in
2124 General Fund expenditures for all other programs, when the rate of growth in the General Fund
2125 expenditures for all other programs is greater than zero.
2126 (3) To the extent possible, the department shall operate the waiver program with the
2127 input of stakeholder groups representing those who will be affected by the waiver program.
2128 (4) (a) For purposes of this Subsection (4), "mandated program change" shall be
2129 determined by the department in consultation with the Medicaid accountable care
2130 organizations, and may include a change to the state Medicaid program that is required by state
2131 or federal law, state or federal guidance, policy, or the state Medicaid plan.
2132 (b) A mandated program change shall be included in the base budget for the Medicaid
2133 program for the fiscal year in which the Medicaid program adopted the mandated program
2134 change.
2135 (c) The mandated program change is not subject to the limit on the rate of growth in
2136 per-patient-per-month General Fund expenditures for the program established in Subsection
2137 (2)(e), until the fiscal year following the fiscal year in which the Medicaid program adopted the
2138 mandated program change.
2139 (5) A managed care organization or a pharmacy benefit manager that provides a
2140 pharmacy benefit to an enrollee shall establish a unique group number, payment classification
2141 number, or bank identification number for each Medicaid managed care organization plan for
2142 which the managed care organization or pharmacy benefit manager provides a pharmacy
2143 benefit.
2144 Section 44. Section 26B-3-203, which is renumbered from Section 26-18-405.5 is
2145 renumbered and amended to read:
2146 [
2147 accountable care organizations and behavioral health plans -- Forecast of behavioral
2148 health services cost.
2149 (1) As used in this section:
2150 (a) "ACO" means an accountable care organization that contracts with the state's
2151 Medicaid program for:
2152 (i) physical health services; or
2153 (ii) integrated physical and behavioral health services.
2154 (b) "Base budget" means the same as that term is defined in legislative rule.
2155 (c) "Behavioral health plan" means a managed care or fee for service delivery system
2156 that contracts with or is operated by the department to provide behavioral health services to
2157 Medicaid eligible individuals.
2158 (d) "Behavioral health services" means mental health or substance use treatment or
2159 services.
2160 (e) "General Fund growth factor" means the amount determined by dividing the next
2161 fiscal year ongoing General Fund revenue estimate by current fiscal year ongoing
2162 appropriations from the General Fund.
2163 (f) "Next fiscal year ongoing General Fund revenue estimate" means the next fiscal
2164 year ongoing General Fund revenue estimate identified by the Executive Appropriations
2165 Committee, in accordance with legislative rule, for use by the Office of the Legislative Fiscal
2166 Analyst in preparing budget recommendations.
2167 (g) "PMPM" means per-member-per-month funding.
2168 (2) If the General Fund growth factor is less than 100%, the next fiscal year base
2169 budget shall, subject to Subsection (5), include an appropriation to the department in an
2170 amount necessary to ensure that the next fiscal year PMPM for ACOs and behavioral health
2171 plans equals the current fiscal year PMPM for the ACOs and behavioral health plans multiplied
2172 by 100%.
2173 (3) If the General Fund growth factor is greater than or equal to 100%, but less than
2174 102%, the next fiscal year base budget shall, subject to Subsection (5), include an appropriation
2175 to the department in an amount necessary to ensure that the next fiscal year PMPM for ACOs
2176 and behavioral health plans equals the current fiscal year PMPM for the ACOs and behavioral
2177 health plans multiplied by the General Fund growth factor.
2178 (4) If the General Fund growth factor is greater than or equal to 102%, the next fiscal
2179 year base budget shall, subject to Subsection (5), include an appropriation to the department in
2180 an amount necessary to ensure that the next fiscal year PMPM for ACOs and behavioral health
2181 plans is greater than or equal to the current fiscal year PMPM for the ACOs and behavioral
2182 health plans multiplied by 102% and less than or equal to the current fiscal year PMPM for the
2183 ACOs and behavioral health plans multiplied by the General Fund growth factor.
2184 (5) The appropriations provided to the department for behavioral health plans under
2185 this section shall be reduced by the amount contributed by counties in the current fiscal year for
2186 behavioral health plans in accordance with Subsections 17-43-201(5)(k) and
2187 17-43-301(6)(a)(x).
2188 (6) In order for the department to estimate the impact of Subsections (2) through (4)
2189 before identification of the next fiscal year ongoing General Fund revenue estimate, the
2190 Governor's Office of Planning and Budget shall, in cooperation with the Office of the
2191 Legislative Fiscal Analyst, develop an estimate of ongoing General Fund revenue for the next
2192 fiscal year and provide the estimate to the department no later than November 1 of each year.
2193 (7) The Office of the Legislative Fiscal Analyst shall include an estimate of the cost of
2194 behavioral health services in any state Medicaid funding or savings forecast that is completed
2195 in coordination with the department and the Governor's Office of Planning and Budget.
2196 Section 45. Section 26B-3-204, which is renumbered from Section 26-18-408 is
2197 renumbered and amended to read:
2198 [
2199 department services.
2200 (1) (a) This section applies to the Medicaid program and to the Utah Children's Health
2201 Insurance Program created in [
2202 26B-3-902.
2203 (b) As used in this section:
2204 (i) "Managed care organization" means a comprehensive full risk managed care
2205 delivery system that contracts with the Medicaid program or the Children's Health Insurance
2206 Program to deliver health care through a managed care plan.
2207 (ii) "Managed care plan" means a risk-based delivery service model authorized by
2208 Section [
2209 (iii) "Non-emergent care":
2210 (A) means use of the emergency department to receive health care that is non-emergent
2211 as defined by the department by administrative rule adopted in accordance with Title 63G,
2212 Chapter 3, Utah Administrative Rulemaking Act, and the Emergency Medical Treatment and
2213 Active Labor Act; and
2214 (B) does not mean the medical services provided to an individual required by the
2215 Emergency Medical Treatment and Active Labor Act, including services to conduct a medical
2216 screening examination to determine if the recipient has an emergent or non-emergent condition.
2217 (iv) "Professional compensation" means payment made for services rendered to a
2218 Medicaid recipient by an individual licensed to provide health care services.
2219 (v) "Super-utilizer" means a Medicaid recipient who has been identified by the
2220 recipient's managed care organization as a person who uses the emergency department
2221 excessively, as defined by the managed care organization.
2222 (2) (a) A managed care organization may, in accordance with Subsections (2)(b) and
2223 (c):
2224 (i) audit emergency department services provided to a recipient enrolled in the
2225 managed care plan to determine if non-emergent care was provided to the recipient; and
2226 (ii) establish differential payment for emergent and non-emergent care provided in an
2227 emergency department.
2228 (b) (i) The differential payments under Subsection (2)(a)(ii) do not apply to
2229 professional compensation for services rendered in an emergency department.
2230 (ii) Except in cases of suspected fraud, waste, and abuse, a managed care organization's
2231 audit of payment under Subsection (2)(a)(i) is limited to the 18-month period of time after the
2232 date on which the medical services were provided to the recipient. If fraud, waste, or abuse is
2233 alleged, the managed care organization's audit of payment under Subsection (2)(a)(i) is limited
2234 to three years after the date on which the medical services were provided to the recipient.
2235 (c) The audits and differential payments under Subsections (2)(a) and (b) apply to
2236 services provided to a recipient on or after July 1, 2015.
2237 (3) A managed care organization shall:
2238 (a) use the savings under Subsection (2) to maintain and improve access to primary
2239 care and urgent care services for all Medicaid or CHIP recipients enrolled in the managed care
2240 plan;
2241 (b) provide viable alternatives for increasing primary care provider reimbursement
2242 rates to incentivize after hours primary care access for recipients; and
2243 (c) report to the department on how the managed care organization complied with this
2244 Subsection (3).
2245 (4) The department may:
2246 (a) through administrative rule adopted by the department, develop quality
2247 measurements that evaluate a managed care organization's delivery of:
2248 (i) appropriate emergency department services to recipients enrolled in the managed
2249 care plan;
2250 (ii) expanded primary care and urgent care for recipients enrolled in the managed care
2251 plan, with consideration of the managed care organization's:
2252 (A) delivery of primary care, urgent care, and after hours care through means other than
2253 the emergency department;
2254 (B) recipient access to primary care providers and community health centers including
2255 evening and weekend access; and
2256 (C) other innovations for expanding access to primary care; and
2257 (iii) quality of care for the managed care plan members;
2258 (b) compare the quality measures developed under Subsection (4)(a) for each managed
2259 care organization; and
2260 (c) develop, by administrative rule, an algorithm to determine assignment of new,
2261 unassigned recipients to specific managed care plans based on the plan's performance in
2262 relation to the quality measures developed pursuant to Subsection (4)(a).
2263 Section 46. Section 26B-3-205, which is renumbered from Section 26-18-409 is
2264 renumbered and amended to read:
2265 [
2266 (1) As used in this section:
2267 (a) "Qualified long-term care insurance contract" is as defined in 26 U.S.C. Sec.
2268 7702B(b).
2269 (b) "Qualified long-term care insurance partnership" is as defined in 42 U.S.C. Sec.
2270 1396p(b)(1)(C)(iii).
2271 (c) "State plan amendment" means an amendment to the state Medicaid plan drafted by
2272 the department in compliance with this section.
2273 (2) No later than July 1, 2014, the department shall seek federal approval of a state plan
2274 amendment that creates a qualified long-term care insurance partnership.
2275 (3) The department may make rules to comply with federal laws and regulations
2276 relating to qualified long-term care insurance partnerships and qualified long-term care
2277 insurance contracts.
2278 Section 47. Section 26B-3-206, which is renumbered from Section 26-18-410 is
2279 renumbered and amended to read:
2280 [
2281 and complex medical needs.
2282 (1) As used in this section:
2283 (a) "Additional eligibility criteria" means the additional eligibility criteria set by the
2284 department under Subsection (4)(e).
2285 (b) "Complex medical condition" means a physical condition of an individual that:
2286 (i) results in severe functional limitations for the individual; and
2287 (ii) is likely to:
2288 (A) last at least 12 months; or
2289 (B) result in death.
2290 (c) "Program" means the program for children with complex medical conditions
2291 created in Subsection (3).
2292 (d) "Qualified child" means a child who:
2293 (i) is less than 19 years old;
2294 (ii) is diagnosed with a complex medical condition;
2295 (iii) has a condition that meets the definition of disability in 42 U.S.C. Sec. 12102; and
2296 (iv) meets the additional eligibility criteria.
2297 (2) The department shall apply for a Medicaid home and community-based waiver with
2298 CMS to implement, within the state Medicaid program, the program described in Subsection
2299 (3).
2300 (3) If the waiver described in Subsection (2) is approved, the department shall offer a
2301 program that:
2302 (a) as funding permits, provides treatment for qualified children;
2303 (b) if approved by CMS and as funding permits, beginning in fiscal year 2023 provides
2304 on an ongoing basis treatment for 130 more qualified children than the program provided
2305 treatment for during fiscal year 2022; and
2306 (c) accepts applications for the program on an ongoing basis.
2307 (i) requires periodic reevaluations of an enrolled child's eligibility and other applicants
2308 or eligible children waiting for services in the program based on the additional eligibility
2309 criteria; and
2310 (ii) at the time of reevaluation, allows the department to disenroll a child based on the
2311 prioritization described in Subsection (4)(a) and additional eligibility criteria.
2312 (4) The department shall:
2313 (a) establish by rule made in accordance with Title 63G, Chapter 3, Utah
2314 Administrative Rulemaking Act, criteria to prioritize qualified children's participation in the
2315 program based on the following factors, in the following priority order:
2316 (i) the complexity of a qualified child's medical condition; and
2317 (ii) the financial needs of the qualified child and the qualified child's family;
2318 (b) convene a public process to determine the benefits and services to offer a qualified
2319 child under the program;
2320 (c) evaluate, on an ongoing basis, the cost and effectiveness of the program;
2321 (d) if funding for the program is reduced, develop an evaluation process to reduce the
2322 number of children served based on the participation criteria established under Subsection
2323 (4)(a); and
2324 (e) establish, by rule made in accordance with Title 63G, Chapter 3, Utah
2325 Administrative Rulemaking Act, additional eligibility criteria based on the factors described in
2326 Subsections (4)(a)(i) and (ii).
2327 Section 48. Section 26B-3-207, which is renumbered from Section 26-18-411 is
2328 renumbered and amended to read:
2329 [
2330 Eligibility -- Annual report -- Expansion of eligibility for adults with dependent children.
2331 (1) As used in this section:
2332 (a) "Adult in the expansion population" means an individual who:
2333 (i) is described in 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII); and
2334 (ii) is not otherwise eligible for Medicaid as a mandatory categorically needy
2335 individual.
2336 (b) "Enhancement waiver program" means the Primary Care Network enhancement
2337 waiver program described in Section [
2338 (c) "Federal poverty level" means the poverty guidelines established by the Secretary of
2339 the United States Department of Health and Human Services under 42 U.S.C. Sec. 9909(2).
2340 (d) "Health coverage improvement program" means the health coverage improvement
2341 program described in Subsections (3) through [
2342 (e) "Homeless":
2343 (i) means an individual who is chronically homeless, as determined by the department;
2344 and
2345 (ii) includes someone who was chronically homeless and is currently living in
2346 supported housing for the chronically homeless.
2347 (f) "Income eligibility ceiling" means the percent of federal poverty level:
2348 (i) established by the state in an appropriations act adopted pursuant to Title 63J,
2349 Chapter 1, Budgetary Procedures Act; and
2350 (ii) under which an individual may qualify for Medicaid coverage in accordance with
2351 this section.
2352 (g) "Targeted adult Medicaid program" means the program implemented by the
2353 department under Subsections (5) through (7).
2354 (2) Beginning July 1, 2016, the department shall amend the state Medicaid plan to
2355 allow temporary residential treatment for substance abuse, for the traditional Medicaid
2356 population, in a short term, non-institutional, 24-hour facility, without a bed capacity limit that
2357 provides rehabilitation services that are medically necessary and in accordance with an
2358 individualized treatment plan, as approved by CMS and as long as the county makes the
2359 required match under Section 17-43-201.
2360 (3) Beginning July 1, 2016, the department shall amend the state Medicaid plan to
2361 increase the income eligibility ceiling to a percentage of the federal poverty level designated by
2362 the department, based on appropriations for the program, for an individual with a dependent
2363 child.
2364 (4) Before July 1, 2016, the division shall submit to CMS a request for waivers, or an
2365 amendment of existing waivers, from federal statutory and regulatory law necessary for the
2366 state to implement the health coverage improvement program in the Medicaid program in
2367 accordance with this section.
2368 (5) (a) An adult in the expansion population is eligible for Medicaid if the adult meets
2369 the income eligibility and other criteria established under Subsection (6).
2370 (b) An adult who qualifies under Subsection (6) shall receive Medicaid coverage:
2371 (i) through the traditional fee for service Medicaid model in counties without Medicaid
2372 accountable care organizations or the state's Medicaid accountable care organization delivery
2373 system, where implemented and subject to Section [
2374 (ii) except as provided in Subsection (5)(b)(iii), for behavioral health, through the
2375 counties in accordance with Sections 17-43-201 and 17-43-301;
2376 (iii) that, subject to Section [
2377 services and physical health services with Medicaid accountable care organizations in select
2378 geographic areas of the state that choose an integrated model; and
2379 (iv) that permits temporary residential treatment for substance abuse in a short term,
2380 non-institutional, 24-hour facility, without a bed capacity limit, as approved by CMS, that
2381 provides rehabilitation services that are medically necessary and in accordance with an
2382 individualized treatment plan.
2383 (6) (a) An individual is eligible for the health coverage improvement program under
2384 Subsection (5) if:
2385 (i) at the time of enrollment, the individual's annual income is below the income
2386 eligibility ceiling established by the state under Subsection (1)(f); and
2387 (ii) the individual meets the eligibility criteria established by the department under
2388 Subsection (6)(b).
2389 (b) Based on available funding and approval from CMS, the department shall select the
2390 criteria for an individual to qualify for the Medicaid program under Subsection (6)(a)(ii), based
2391 on the following priority:
2392 (i) a chronically homeless individual;
2393 (ii) if funding is available, an individual:
2394 (A) involved in the justice system through probation, parole, or court ordered
2395 treatment; and
2396 (B) in need of substance abuse treatment or mental health treatment, as determined by
2397 the department; or
2398 (iii) if funding is available, an individual in need of substance abuse treatment or
2399 mental health treatment, as determined by the department.
2400 (c) An individual who qualifies for Medicaid coverage under Subsections (6)(a) and (b)
2401 may remain on the Medicaid program for a 12-month certification period as defined by the
2402 department. Eligibility changes made by the department under Subsection (1)(f) or (6)(b) shall
2403 not apply to an individual during the 12-month certification period.
2404 (7) The state may request a modification of the income eligibility ceiling and other
2405 eligibility criteria under Subsection (6) each fiscal year based on projected enrollment, costs to
2406 the state, and the state budget.
2407 (8) The current Medicaid program and the health coverage improvement program,
2408 when implemented, shall coordinate with a state prison or county jail to expedite Medicaid
2409 enrollment for an individual who is released from custody and was eligible for or enrolled in
2410 Medicaid before incarceration.
2411 (9) Notwithstanding Sections 17-43-201 and 17-43-301, a county does not have to
2412 provide matching funds to the state for the cost of providing Medicaid services to newly
2413 enrolled individuals who qualify for Medicaid coverage under the health coverage
2414 improvement program under Subsection (6).
2415 (10) If the enhancement waiver program is implemented, the department:
2416 (a) may not accept any new enrollees into the health coverage improvement program
2417 after the day on which the enhancement waiver program is implemented;
2418 (b) shall transition all individuals who are enrolled in the health coverage improvement
2419 program into the enhancement waiver program;
2420 (c) shall suspend the health coverage improvement program within one year after the
2421 day on which the enhancement waiver program is implemented;
2422 (d) shall, within one year after the day on which the enhancement waiver program is
2423 implemented, use all appropriations for the health coverage improvement program to
2424 implement the enhancement waiver program; and
2425 (e) shall work with CMS to maintain any waiver for the health coverage improvement
2426 program while the health coverage improvement program is suspended under Subsection [
2427 (10)(c).
2428 (11) If, after the enhancement waiver program takes effect, the enhancement waiver
2429 program is repealed or suspended by either the state or federal government, the department
2430 shall reinstate the health coverage improvement program and continue to accept new enrollees
2431 into the health coverage improvement program in accordance with the provisions of this
2432 section.
2433 Section 49. Section 26B-3-208, which is renumbered from Section 26-18-413 is
2434 renumbered and amended to read:
2435 [
2436 services.
2437 (1) (a) Before June 30, 2016, the department shall ask CMS to grant waivers from
2438 federal statutory and regulatory law necessary for the Medicaid program to provide dental
2439 services in the manner described in Subsection (2)(a).
2440 (b) Before June 30, 2018, the department shall submit to CMS a request for waivers, or
2441 an amendment of existing waivers, from federal law necessary for the state to provide dental
2442 services, in accordance with Subsections (2)(b)(i) and (d) through (g), to an individual
2443 described in Subsection (2)(b)(i).
2444 (c) Before June 30, 2019, the department shall submit to the Centers for Medicare and
2445 Medicaid Services a request for waivers, or an amendment to existing waivers, from federal
2446 law necessary for the state to:
2447 (i) provide dental services, in accordance with Subsections (2)(b)(ii) and (d) through
2448 (g) to an individual described in Subsection (2)(b)(ii); and
2449 (ii) provide the services described in Subsection (2)(h).
2450 (2) (a) To the extent funded, the department shall provide services to only blind or
2451 disabled individuals, as defined in 42 U.S.C. Sec. 1382c(a)(1), who are 18 years old or older
2452 and eligible for the program.
2453 (b) Notwithstanding Subsection (2)(a):
2454 (i) if a waiver is approved under Subsection (1)(b), the department shall provide dental
2455 services to an individual who:
2456 (A) qualifies for the health coverage improvement program described in Section
2457 26-18-411; and
2458 (B) is receiving treatment in a substance abuse treatment program, as defined in
2459 Section [
2460
2461 (ii) if a waiver is approved under Subsection (1)(c)(i), the department shall provide
2462 dental services to an individual who is an aged individual as defined in 42 U.S.C. Sec.
2463 1382c(a)(1).
2464 (c) To the extent possible, services to individuals described in Subsection (2)(a) shall
2465 be provided through the University of Utah School of Dentistry and the University of Utah
2466 School of Dentistry's associated statewide network.
2467 (d) The department shall provide the services to individuals described in Subsection
2468 (2)(b):
2469 (i) by contracting with an entity that:
2470 (A) has demonstrated experience working with individuals who are being treated for
2471 both a substance use disorder and a major oral health disease;
2472 (B) operates a program, targeted at the individuals described in Subsection (2)(b), that
2473 has demonstrated, through a peer-reviewed evaluation, the effectiveness of providing dental
2474 treatment to those individuals described in Subsection (2)(b);
2475 (C) is willing to pay for an amount equal to the program's non-federal share of the cost
2476 of providing dental services to the population described in Subsection (2)(b); and
2477 (D) is willing to pay all state costs associated with applying for the waiver described in
2478 Subsection (1)(b) and administering the program described in Subsection (2)(b); and
2479 (ii) through a fee-for-service payment model.
2480 (e) The entity that receives the contract under Subsection (2)(d)(i) shall cover all state
2481 costs of the program described in Subsection (2)(b).
2482 (f) Each fiscal year, the University of Utah School of Dentistry shall, in compliance
2483 with state and federal regulations regarding intergovernmental transfers, transfer funds to the
2484 program in an amount equal to the program's non-federal share of the cost of providing services
2485 under this section through the school during the fiscal year.
2486 (g) If a waiver is approved under Subsection (1)(c)(ii), the department shall provide
2487 coverage for porcelain and porcelain-to-metal crowns if the services are provided:
2488 (i) to an individual who qualifies for dental services under Subsection (2)(b); and
2489 (ii) by an entity that covers all state costs of:
2490 (A) providing the coverage described in this Subsection (2)(h); and
2491 (B) applying for the waiver described in Subsection (1)(c).
2492 (h) Where possible, the department shall ensure that services described in Subsection
2493 (2)(a) that are not provided by the University of Utah School of Dentistry or the University of
2494 Utah School of Dentistry's associated network are provided:
2495 (i) through fee for service reimbursement until July 1, 2018; and
2496 (ii) after July 1, 2018, through the method of reimbursement used by the division for
2497 Medicaid dental benefits.
2498 (i) Subject to appropriations by the Legislature, and as determined by the department,
2499 the scope, amount, duration, and frequency of services may be limited.
2500 (3) (a) If the waivers requested under Subsection (1)(a) are granted, the Medicaid
2501 program shall begin providing dental services in the manner described in Subsection (2) no
2502 later than July 1, 2017.
2503 (b) If the waivers requested under Subsection (1)(b) are granted, the Medicaid program
2504 shall begin providing dental services to the population described in Subsection (2)(b) within 90
2505 days from the day on which the waivers are granted.
2506 (c) If the waivers requested under Subsection (1)(c)(i) are granted, the Medicaid
2507 program shall begin providing dental services to the population described in Subsection
2508 (2)(b)(ii) within 90 days after the day on which the waivers are granted.
2509 (4) If the federal share of the cost of providing dental services under this section will be
2510 less than 65% during any portion of the next fiscal year, the Medicaid program shall cease
2511 providing dental services under this section no later than the end of the current fiscal year.
2512 Section 50. Section 26B-3-209, which is renumbered from Section 26-18-414 is
2513 renumbered and amended to read:
2514 [
2515 coordinator.
2516 (1) There is created within the Medicaid program a full-time-equivalent position of
2517 Medicaid long-term support services housing coordinator.
2518 (2) The coordinator shall help Medicaid recipients receive long-term support services
2519 in a home or other community-based setting rather than in a nursing home or other institutional
2520 setting by:
2521 (a) working with municipalities, counties, the Housing and Community Development
2522 Division within the Department of Workforce Services, and others to identify
2523 community-based settings available to recipients;
2524 (b) working with the same entities to promote the development, construction, and
2525 availability of additional community-based settings;
2526 (c) training Medicaid case managers and support coordinators on how to help Medicaid
2527 recipients move from an institutional setting to a community-based setting; and
2528 (d) performing other related duties.
2529 Section 51. Section 26B-3-210, which is renumbered from Section 26-18-415 is
2530 renumbered and amended to read:
2531 [
2532 (1) As used in this section:
2533 (a) "Federal poverty level" means the same as that term is defined in Section
2534 [
2535 (b) "Medicaid waiver expansion" means an expansion of the Medicaid program in
2536 accordance with this section.
2537 (2) (a) Before January 1, 2019, the department shall apply to CMS for approval of a
2538 waiver or state plan amendment to implement the Medicaid waiver expansion.
2539 (b) The Medicaid waiver expansion shall:
2540 (i) expand Medicaid coverage to eligible individuals whose income is below 95% of
2541 the federal poverty level;
2542 (ii) obtain maximum federal financial participation under 42 U.S.C. Sec. 1396d(y) for
2543 enrolling an individual in the Medicaid program;
2544 (iii) provide Medicaid benefits through the state's Medicaid accountable care
2545 organizations in areas where a Medicaid accountable care organization is implemented;
2546 (iv) integrate the delivery of behavioral health services and physical health services
2547 with Medicaid accountable care organizations in select geographic areas of the state that
2548 choose an integrated model;
2549 (v) include a path to self-sufficiency, including work activities as defined in 42 U.S.C.
2550 Sec. 607(d), for qualified adults;
2551 (vi) require an individual who is offered a private health benefit plan by an employer to
2552 enroll in the employer's health plan;
2553 (vii) sunset in accordance with Subsection (5)(a); and
2554 (viii) permit the state to close enrollment in the Medicaid waiver expansion if the
2555 department has insufficient funding to provide services to additional eligible individuals.
2556 (3) If the Medicaid waiver described in Subsection (2)(a) is approved, the department
2557 may only pay the state portion of costs for the Medicaid waiver expansion with appropriations
2558 from:
2559 (a) the Medicaid Expansion Fund, created in Section [
2560 (b) county contributions to the non-federal share of Medicaid expenditures; and
2561 (c) any other contributions, funds, or transfers from a non-state agency for Medicaid
2562 expenditures.
2563 (4) (a) In consultation with the department, Medicaid accountable care organizations
2564 and counties that elect to integrate care under Subsection (2)(b)(iv) shall collaborate on
2565 enrollment, engagement of patients, and coordination of services.
2566 (b) As part of the provision described in Subsection (2)(b)(iv), the department shall
2567 apply for a waiver to permit the creation of an integrated delivery system:
2568 (i) for any geographic area that expresses interest in integrating the delivery of services
2569 under Subsection (2)(b)(iv); and
2570 (ii) in which the department:
2571 (A) may permit a local mental health authority to integrate the delivery of behavioral
2572 health services and physical health services;
2573 (B) may permit a county, local mental health authority, or Medicaid accountable care
2574 organization to integrate the delivery of behavioral health services and physical health services
2575 to select groups within the population that are newly eligible under the Medicaid waiver
2576 expansion; and
2577 (C) may make rules in accordance with Title 63G, Chapter 3, Utah Administrative
2578 Rulemaking Act, to integrate payments for behavioral health services and physical health
2579 services to plans or providers.
2580 (5) (a) If federal financial participation for the Medicaid waiver expansion is reduced
2581 below 90%, the authority of the department to implement the Medicaid waiver expansion shall
2582 sunset no later than the next July 1 after the date on which the federal financial participation is
2583 reduced.
2584 (b) The department shall close the program to new enrollment if the cost of the
2585 Medicaid waiver expansion is projected to exceed the appropriations for the fiscal year that are
2586 authorized by the Legislature through an appropriations act adopted in accordance with Title
2587 63J, Chapter 1, Budgetary Procedures Act.
2588 (6) If the Medicaid waiver expansion is approved by CMS, the department shall report
2589 to the Social Services Appropriations Subcommittee on or before November 1 of each year that
2590 the Medicaid waiver expansion is operational:
2591 (a) the number of individuals who enrolled in the Medicaid waiver program;
2592 (b) costs to the state for the Medicaid waiver program;
2593 (c) estimated costs for the current and following state fiscal year; and
2594 (d) recommendations to control costs of the Medicaid waiver expansion.
2595 Section 52. Section 26B-3-211, which is renumbered from Section 26-18-416 is
2596 renumbered and amended to read:
2597 [
2598 program.
2599 (1) As used in this section:
2600 (a) "Enhancement waiver program" means the Primary Care Network enhancement
2601 waiver program described in this section.
2602 (b) "Federal poverty level" means the poverty guidelines established by the secretary of
2603 the United States Department of Health and Human Services under 42 U.S.C. Sec. 9902(2).
2604 (c) "Health coverage improvement program" means the same as that term is defined in
2605 Section [
2606 (d) "Income eligibility ceiling" means the percentage of federal poverty level:
2607 (i) established by the Legislature in an appropriations act adopted pursuant to Title 63J,
2608 Chapter 1, Budgetary Procedures Act; and
2609 (ii) under which an individual may qualify for coverage in the enhancement waiver
2610 program in accordance with this section.
2611 (e) "Optional population" means the optional expansion population under PPACA if
2612 the expansion provides coverage for individuals at or above 95% of the federal poverty level.
2613 (f) "Primary Care Network" means the state Primary Care Network program created by
2614 the Medicaid primary care network demonstration waiver obtained under Section [
2615 26B-3-108.
2616 (2) The department shall continue to implement the Primary Care Network program for
2617 qualified individuals under the Primary Care Network program.
2618 (3) (a) The division shall apply for a Medicaid waiver or a state plan amendment with
2619 CMS to implement, within the state Medicaid program, the enhancement waiver program
2620 described in this section within six months after the day on which:
2621 (i) the division receives a notice from CMS that the waiver for the Medicaid waiver
2622 expansion submitted under Section [
2623 not be approved; or
2624 (ii) the division withdraws the waiver for the Medicaid waiver expansion submitted
2625 under Section [
2626 (b) The division may not apply for a waiver under Subsection (3)(a) while a waiver
2627 request under Section [
2628 CMS.
2629 (4) An individual who is eligible for the enhancement waiver program may receive the
2630 following benefits under the enhancement waiver program:
2631 (a) the benefits offered under the Primary Care Network program;
2632 (b) diagnostic testing and procedures;
2633 (c) medical specialty care;
2634 (d) inpatient hospital services;
2635 (e) outpatient hospital services;
2636 (f) outpatient behavioral health care, including outpatient substance abuse care; and
2637 (g) for an individual who qualifies for the health coverage improvement program, as
2638 approved by CMS, temporary residential treatment for substance abuse in a short term,
2639 non-institutional, 24-hour facility, without a bed capacity limit, that provides rehabilitation
2640 services that are medically necessary and in accordance with an individualized treatment plan.
2641 (5) An individual is eligible for the enhancement waiver program if, at the time of
2642 enrollment:
2643 (a) the individual is qualified to enroll in the Primary Care Network or the health
2644 coverage improvement program;
2645 (b) the individual's annual income is below the income eligibility ceiling established by
2646 the Legislature under Subsection (1)(d); and
2647 (c) the individual meets the eligibility criteria established by the department under
2648 Subsection (6).
2649 (6) (a) Based on available funding and approval from CMS, the department shall
2650 determine the criteria for an individual to qualify for the enhancement waiver program, based
2651 on the following priority:
2652 (i) adults in the expansion population, as defined in Section [
2653 who qualify for the health coverage improvement program;
2654 (ii) adults with dependent children who qualify for the health coverage improvement
2655 program under Subsection [
2656 (iii) adults with dependent children who do not qualify for the health coverage
2657 improvement program; and
2658 (iv) if funding is available, adults without dependent children.
2659 (b) The number of individuals enrolled in the enhancement waiver program may not
2660 exceed 105% of the number of individuals who were enrolled in the Primary Care Network on
2661 December 31, 2017.
2662 (c) The department may only use appropriations from the Medicaid Expansion Fund
2663 created in Section [
2664 program.
2665 (7) The department may request a modification of the income eligibility ceiling and the
2666 eligibility criteria under Subsection (6) from CMS each fiscal year based on enrollment in the
2667 enhancement waiver program, projected enrollment in the enhancement waiver program, costs
2668 to the state, and the state budget.
2669 (8) The department may implement the enhancement waiver program by contracting
2670 with Medicaid accountable care organizations to administer the enhancement waiver program.
2671 (9) In accordance with Subsections [
2672 the department may use funds that have been appropriated for the health coverage
2673 improvement program to implement the enhancement waiver program.
2674 (10) If the department expands the state Medicaid program to the optional population,
2675 the department:
2676 (a) except as provided in Subsection (11), may not accept any new enrollees into the
2677 enhancement waiver program after the day on which the expansion to the optional population
2678 is effective;
2679 (b) shall suspend the enhancement waiver program within one year after the day on
2680 which the expansion to the optional population is effective; and
2681 (c) shall work with CMS to maintain the waiver for the enhancement waiver program
2682 submitted under Subsection (3) while the enhancement waiver program is suspended under
2683 Subsection (10)(b).
2684 (11) If, after the expansion to the optional population described in Subsection (10)
2685 takes effect, the expansion to the optional population is repealed by either the state or the
2686 federal government, the department shall reinstate the enhancement waiver program and
2687 continue to accept new enrollees into the enhancement waiver program in accordance with the
2688 provisions of this section.
2689 Section 53. Section 26B-3-212, which is renumbered from Section 26-18-417 is
2690 renumbered and amended to read:
2691 [
2692 individuals.
2693 (1) As used in this section:
2694 (a) (i) "Family planning services" means family planning services that are provided
2695 under the state Medicaid program, including:
2696 (A) sexual health education and family planning counseling; and
2697 (B) other medical diagnosis, treatment, or preventative care routinely provided as part
2698 of a family planning service visit.
2699 (ii) "Family planning services" do not include an abortion, as that term is defined in
2700 Section 76-7-301.
2701 (b) "Low-income individual" means an individual who:
2702 (i) has an income level that is equal to or below 95% of the federal poverty level; and
2703 (ii) does not qualify for full coverage under the Medicaid program.
2704 (2) Before July 1, 2018, the division shall apply for a Medicaid waiver or a state plan
2705 amendment with CMS to:
2706 (a) offer a program that provides family planning services to low-income individuals;
2707 and
2708 (b) receive a federal match rate of 90% of state expenditures for family planning
2709 services provided under the waiver or state plan amendment.
2710 Section 54. Section 26B-3-213, which is renumbered from Section 26-18-418 is
2711 renumbered and amended to read:
2712 [
2713 and mobile crisis outreach teams.
2714 (1) As used in this section:
2715 (a) "Local mental health crisis line" means the same as that term is defined in Section
2716 [
2717 (b) "Mental health crisis" means:
2718 (i) a mental health condition that manifests itself in an individual by symptoms of
2719 sufficient severity that a prudent layperson who possesses an average knowledge of mental
2720 health issues could reasonably expect the absence of immediate attention or intervention to
2721 result in:
2722 (A) serious danger to the individual's health or well-being; or
2723 (B) a danger to the health or well-being of others; or
2724 (ii) a mental health condition that, in the opinion of a mental health therapist or the
2725 therapist's designee, requires direct professional observation or the intervention of a mental
2726 health therapist.
2727 (c) (i) "Mental health crisis services" means direct mental health services and on-site
2728 intervention that a mobile crisis outreach team provides to an individual suffering from a
2729 mental health crisis, including the provision of safety and care plans, prolonged mental health
2730 services for up to 90 days, and referrals to other community resources.
2731 (ii) "Mental health crisis services" includes:
2732 (A) local mental health crisis lines; and
2733 (B) the statewide mental health crisis line.
2734 (d) "Mental health therapist" means the same as that term is defined in Section
2735 58-60-102.
2736 (e) "Mobile crisis outreach team" or "MCOT" means a mobile team of medical and
2737 mental health professionals that, in coordination with local law enforcement and emergency
2738 medical service personnel, provides mental health crisis services.
2739 (f) "Statewide mental health crisis line" means the same as that term is defined in
2740 Section [
2741 (2) In consultation with the Department of Human Services and the Behavioral Health
2742 Crisis Response Commission created in Section 63C-18-202, the department shall develop a
2743 proposal to amend the state Medicaid plan to include mental health crisis services, including
2744 the statewide mental health crisis line, local mental health crisis lines, and mobile crisis
2745 outreach teams.
2746 (3) By January 1, 2019, the department shall apply for a Medicaid waiver with CMS, if
2747 necessary to implement, within the state Medicaid program, the mental health crisis services
2748 described in Subsection (2).
2749 Section 55. Section 26B-3-214, which is renumbered from Section 26-18-419 is
2750 renumbered and amended to read:
2751 [
2752 services in schools.
2753 (1) As used in this section, "local education agency" means:
2754 (a) a school district;
2755 (b) a charter school; or
2756 (c) the Utah Schools for the Deaf and the Blind.
2757 (2) In consultation with [
2758 Education, the department shall develop a proposal to allow the state Medicaid program to
2759 reimburse a local education agency, a local mental health authority, or a private provider for
2760 covered mental health services provided:
2761 (a) in accordance with Section 53E-9-203; and
2762 (b) (i) at a local education agency building or facility; or
2763 (ii) by an employee or contractor of a local education agency.
2764 (3) Before January 1, 2020, the department shall apply to CMS for a state plan
2765 amendment to implement the coverage described in Subsection (2).
2766 Section 56. Section 26B-3-215, which is renumbered from Section 26-18-420 is
2767 renumbered and amended to read:
2768 [
2769 testing.
2770 (1) As used in this section:
2771 (a) "Qualified condition" means:
2772 (i) cystic fibrosis;
2773 (ii) spinal muscular atrophy;
2774 (iii) Morquio Syndrome;
2775 (iv) myotonic dystrophy; or
2776 (v) sickle cell anemia.
2777 (b) "Qualified enrollee" means an individual who:
2778 (i) is enrolled in the Medicaid program;
2779 (ii) has been diagnosed by a physician as having a genetic trait associated with a
2780 qualified condition; and
2781 (iii) intends to get pregnant with a partner who is diagnosed by a physician as having a
2782 genetic trait associated with the same qualified condition as the individual.
2783 (2) Before January 1, 2021, the department shall apply for a Medicaid waiver or a state
2784 plan amendment with the Centers for Medicare and Medicaid Services within the United States
2785 Department of Health and Human Services to implement the coverage described in Subsection
2786 (3).
2787 (3) If the waiver described in Subsection (2) is approved, the Medicaid program shall
2788 provide coverage to a qualified enrollee for:
2789 (a) in vitro fertilization services; and
2790 (b) genetic testing of a qualified enrollee who receives in vitro fertilization services
2791 under Subsection (3)(a).
2792 (4) The Medicaid program may not provide the coverage described in Subsection (3)
2793 before the later of:
2794 (a) the day on which the waiver described in Subsection (2) is approved; and
2795 (b) January 1, 2021.
2796 (5) Before November 1, 2022, and before November 1 of every third year thereafter,
2797 the department shall:
2798 (a) calculate the change in state spending attributable to the coverage under this
2799 section; and
2800 (b) report the amount described in Subsection (4)(a) to the Health and Human Services
2801 Interim Committee and the Social Services Appropriations Subcommittee.
2802 Section 57. Section 26B-3-216, which is renumbered from Section 26-18-420.1 is
2803 renumbered and amended to read:
2804 [
2805 services.
2806 (1) As used in this section:
2807 (a) "Iatrogenic infertility" means an impairment of fertility or reproductive functioning
2808 caused by surgery, chemotherapy, radiation, or other medical treatment.
2809 (b) "Physician" means an individual licensed to practice under Title 58, Chapter 67,
2810 Utah Medical Practice Act, or Title 58, Chapter 68, Utah Osteopathic Medical Practice Act.
2811 (c) "Qualified enrollee" means an individual who:
2812 (i) is enrolled in the Medicaid program;
2813 (ii) has been diagnosed with a form of cancer by a physician; and
2814 (iii) needs treatment for that cancer that may cause a substantial risk of sterility or
2815 iatrogenic infertility, including surgery, radiation, or chemotherapy.
2816 (d) "Standard fertility preservation service" means a fertility preservation procedure
2817 and service that:
2818 (i) is not considered experimental or investigational by the American Society for
2819 Reproductive Medicine or the American Society of Clinical Oncology; and
2820 (ii) is consistent with established medical practices or professional guidelines
2821 published by the American Society for Reproductive Medicine or the American Society of
2822 Clinical Oncology, including:
2823 (A) sperm banking;
2824 (B) oocyte banking;
2825 (C) embryo banking;
2826 (D) banking of reproductive tissues; and
2827 (E) storage of reproductive cells and tissues.
2828 (2) Before January 1, 2022, the department shall apply for a Medicaid waiver or a state
2829 plan amendment with CMS to implement the coverage described in Subsection (3).
2830 (3) If the waiver or state plan amendment described in Subsection (2) is approved, the
2831 Medicaid program shall provide coverage to a qualified enrollee for standard fertility
2832 preservation services.
2833 (4) The Medicaid program may not provide the coverage described in Subsection (3)
2834 before the later of:
2835 (a) the day on which the waiver described in Subsection (2) is approved; and
2836 (b) January 1, 2023.
2837 (5) Before November 1, 2023, and before November 1 of each third year after 2023,
2838 the department shall:
2839 (a) calculate the change in state spending attributable to the coverage described in this
2840 section; and
2841 (b) report the amount described in Subsection (5)(a) to the Health and Human Services
2842 Interim Committee and the Social Services Appropriations Subcommittee.
2843 Section 58. Section 26B-3-217, which is renumbered from Section 26-18-421 is
2844 renumbered and amended to read:
2845 [
2846 inmates leaving prison or jail.
2847 (1) As used in this section:
2848 (a) "Correctional facility" means:
2849 (i) a county jail;
2850 (ii) the Department of Corrections, created in Section 64-13-2; or
2851 (iii) a prison, penitentiary, or other institution operated by or under contract with the
2852 Department of Corrections for the confinement of an offender, as defined in Section 64-13-1.
2853 (b) "Qualified inmate" means an individual who:
2854 (i) is incarcerated in a correctional facility; and
2855 (ii) has:
2856 (A) a chronic physical or behavioral health condition;
2857 (B) a mental illness, as defined in Section [
2858 (C) an opioid use disorder.
2859 (2) Before July 1, 2020, the division shall apply for a Medicaid waiver or a state plan
2860 amendment with CMS to offer a program to provide Medicaid coverage to a qualified inmate
2861 for up to 30 days immediately before the day on which the qualified inmate is released from a
2862 correctional facility.
2863 (3) If the waiver or state plan amendment described in Subsection (2) is approved, the
2864 department shall report to the Health and Human Services Interim Committee each year before
2865 November 30 while the waiver or state plan amendment is in effect regarding:
2866 (a) the number of qualified inmates served under the program;
2867 (b) the cost of the program; and
2868 (c) the effectiveness of the program, including:
2869 (i) any reduction in the number of emergency room visits or hospitalizations by
2870 inmates after release from a correctional facility;
2871 (ii) any reduction in the number of inmates undergoing inpatient treatment after release
2872 from a correctional facility;
2873 (iii) any reduction in overdose rates and deaths of inmates after release from a
2874 correctional facility; and
2875 (iv) any other costs or benefits as a result of the program.
2876 (4) If the waiver or state plan amendment described in Subsection (2) is approved, a
2877 county that is responsible for the cost of a qualified inmate's medical care shall provide the
2878 required matching funds to the state for:
2879 (a) any costs to enroll the qualified inmate for the Medicaid coverage described in
2880 Subsection (2);
2881 (b) any administrative fees for the Medicaid coverage described in Subsection (2); and
2882 (c) the Medicaid coverage that is provided to the qualified inmate under Subsection
2883 (2).
2884 Section 59. Section 26B-3-218, which is renumbered from Section 26-18-422 is
2885 renumbered and amended to read:
2886 [
2887 institution for mental diseases.
2888 (1) As used in this section, "institution for mental diseases" means the same as that
2889 term is defined in 42 C.F.R. Sec. 435.1010.
2890 (2) Before August 1, 2020, the division shall apply for a Medicaid waiver or a state
2891 plan amendment with CMS to offer a program that provides reimbursement for mental health
2892 services that are provided:
2893 (a) in an institution for mental diseases that includes more than 16 beds; and
2894 (b) to an individual who receives mental health services in an institution for mental
2895 diseases for a period of more than 15 days in a calendar month.
2896 (3) If the waiver or state plan amendment described in Subsection (2) is approved, the
2897 department shall:
2898 (a) [
2899 program described in Subsection (2); and
2900 (b) submit to the Health and Human Services Interim Committee and the Social
2901 Services Appropriations Subcommittee any report that the department submits to CMS that
2902 relates to the budget neutrality, independent waiver evaluation, or performance metrics of the
2903 program described in Subsection (2), within 15 days after the day on which the report is
2904 submitted to CMS.
2905 (4) Notwithstanding Sections 17-43-201 and 17-43-301, if the waiver or state plan
2906 amendment described in Subsection (2) is approved, a county does not have to provide
2907 matching funds to the state for the mental health services described in Subsection (2) that are
2908 provided to an individual who qualifies for Medicaid coverage under Section [
2909
2910 Section 60. Section 26B-3-219, which is renumbered from Section 26-18-423 is
2911 renumbered and amended to read:
2912 [
2913 provided in a behavioral health receiving center -- Integration of payment for physical
2914 health services.
2915 (1) As used in this section:
2916 (a) "Accountable care organization" means the same as that term is defined in Section
2917 [
2918 (b) "Behavioral health receiving center" means the same as that term is defined in
2919 Section [
2920 (c) "Crisis management services" means behavioral health services provided to an
2921 individual who is experiencing a mental health crisis.
2922 (d) "Managed care organization" means the same as that term is defined in 42 C.F.R.
2923 Sec. 438.2.
2924 (2) Before July 1, 2020, the division shall apply for a Medicaid waiver or state plan
2925 amendment with CMS to offer a program that provides reimbursement through a bundled daily
2926 rate for crisis management services that are delivered to an individual during the individual's
2927 stay at a behavioral health receiving center.
2928 (3) If the waiver or state plan amendment described in Subsection (2) is approved, the
2929 department shall:
2930 (a) implement the program described in Subsection (2); and
2931 (b) require a managed care organization that contracts with the state's Medicaid
2932 program for behavioral health services or integrated health services to provide coverage for
2933 crisis management services that are delivered to an individual during the individual's stay at a
2934 behavioral health receiving center.
2935 (4) (a) The department may elect to integrate payment for physical health services
2936 provided in a behavioral health receiving center.
2937 (b) In determining whether to integrate payment under Subsection (4)(a), the
2938 department shall consult with accountable care organizations and counties in the state.
2939 Section 61. Section 26B-3-220, which is renumbered from Section 26-18-424 is
2940 renumbered and amended to read:
2941 [
2942 The Department shall submit a waiver or state plan amendment to allow for
2943 reimbursement for 988 services provided to an individual who is eligible and enrolled in
2944 Medicaid at the time this service is provided.
2945 Section 62. Section 26B-3-221, which is renumbered from Section 26-18-425 is
2946 renumbered and amended to read:
2947 [
2948 provides services to homeless individuals.
2949 (1) As used in this section:
2950 (a) "Adult in the expansion population" means an adult:
2951 (i) described in 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII); and
2952 (ii) not otherwise eligible for Medicaid as a mandatory categorically needy individual.
2953 (b) "Homeless" means the same as that term is defined in Section [
2954 26B-3-207.
2955 (c) "Medical respite care" means short-term housing with supportive medical services.
2956 (d) "Medical respite facility" means a residential facility that provides medical respite
2957 care to homeless individuals.
2958 (2) Before January 1, 2022, the department shall apply for a Medicaid waiver or state
2959 plan amendment with CMS to choose a single medical respite facility to reimburse for services
2960 provided to an individual who is:
2961 (a) homeless; and
2962 (b) an adult in the expansion population.
2963 (3) The department shall choose a medical respite facility best able to serve homeless
2964 individuals who are adults in the expansion population.
2965 (4) If the waiver or state plan amendment described in Subsection (2) is approved,
2966 while the waiver or state plan amendment is in effect, the department shall submit a report to
2967 the Health and Human Services Interim Committee each year before November 30 detailing:
2968 (a) the number of homeless individuals served at the facility;
2969 (b) the cost of the program; and
2970 (c) the reduction of health care costs due to the program's implementation.
2971 (5) Through administrative rule made in accordance with Title 63G, Chapter 3, Utah
2972 Administrative Rulemaking Act, the department shall further define and limit the services,
2973 described in this section, provided to a homeless individual.
2974 Section 63. Section 26B-3-222, which is renumbered from Section 26-18-426 is
2975 renumbered and amended to read:
2976 [
2977 care reimbursement.
2978 (1) As used in this section:
2979 (a) "Existing home and community-based services waiver" means an existing home
2980 and community-based services waiver in the state that serves an individual:
2981 (i) with an acquired brain injury;
2982 (ii) with an intellectual or physical disability; or
2983 (iii) who is 65 years old or older.
2984 (b) "Personal care services" means a service that:
2985 (i) is furnished to an individual who is not an inpatient nor a resident of a hospital,
2986 nursing facility, intermediate care facility, or institution for mental diseases;
2987 (ii) is authorized for an individual described in Subsection (1)(b)(i) in accordance with
2988 a plan of treatment;
2989 (iii) is provided by an individual who is qualified to provide the services; and
2990 (iv) is furnished in a home or another community-based setting.
2991 (c) "Waiver enrollee" means an individual who is enrolled in an existing home and
2992 community-based services waiver.
2993 (2) Before July 1, 2021, the department shall apply with CMS for an amendment to an
2994 existing home and community-based services waiver to implement a program to offer
2995 reimbursement to an individual who provides personal care services that constitute
2996 extraordinary care to a waiver enrollee who is the individual's spouse.
2997 (3) If CMS approves the amendment described in Subsection (2), the department shall
2998 implement the program described in Subsection (2).
2999 (4) The department shall by rule, made in accordance with Title 63G, Chapter 3, Utah
3000 Administrative Rulemaking Act, define "extraordinary care" for purposes of Subsection (2).
3001 Section 64. Section 26B-3-223, which is renumbered from Section 26-18-428 is
3002 renumbered and amended to read:
3003 [
3004 adult Medicaid program.
3005 (1) As used in this section, "targeted adult Medicaid program" means the same as that
3006 term is defined in Section [
3007 (2) The department may implement the delivery system adjustments authorized under
3008 Subsection (3) only on the later of:
3009 (a) July 1, 2023; and
3010 (b) the department determining that the Medicaid program, including providers and
3011 managed care organizations, are satisfying the metrics established in collaboration with the
3012 working group convened under Subsection [
3013 (3) The department may, for individuals who are enrolled in the targeted adult
3014 Medicaid program:
3015 (a) integrate the delivery of behavioral and physical health in certain counties; and
3016 (b) deliver behavioral health services through an accountable care organization where
3017 implemented.
3018 (4) Before implementing the delivery system adjustments described in Subsection (3)
3019 in a county, the department shall, at a minimum, seek input from:
3020 (a) individuals who qualify for the targeted adult Medicaid program who reside in the
3021 county;
3022 (b) the county's executive officer, legislative body, and other county officials who are
3023 involved in the delivery of behavioral health services;
3024 (c) the local mental health authority and substance use authority that serves the county;
3025 (d) Medicaid managed care organizations operating in the state, including Medicaid
3026 accountable care organizations;
3027 (e) providers of physical or behavioral health services in the county who provide
3028 services to enrollees in the targeted adult Medicaid program in the county; and
3029 (f) other individuals that the department deems necessary.
3030 (5) If the department provides Medicaid coverage through a managed care delivery
3031 system under this section, the department shall include language in the department's managed
3032 care contracts that require the managed care plan to:
3033 (a) be in compliance with federal Medicaid managed care requirements;
3034 (b) timely and accurately process authorizations and claims in accordance with
3035 Medicaid policy and contract requirements;
3036 (c) adequately reimburse providers to maintain adequacy of access to care;
3037 (d) provide care management services sufficient to meet the needs of Medicaid eligible
3038 individuals enrolled in the managed care plan's plan; and
3039 (e) timely resolve any disputes between a provider or enrollee with the managed care
3040 plan.
3041 (6) The department may take corrective action if the managed care organization fails to
3042 comply with the terms of the managed care organization's contract.
3043 Section 65. Section 26B-3-224, which is renumbered from Section 26-18-429 is
3044 renumbered and amended to read:
3045 [
3046 care reimbursement.
3047 (1) As used in this section:
3048 (a) "Integrated health care setting" means a health care or behavioral health care setting
3049 that provides integrated physical and behavioral health care services.
3050 (b) "Local mental health authority" means a local mental health authority described in
3051 Section 17-43-301.
3052 (2) The department shall develop a proposal to allow the state Medicaid program to
3053 reimburse a local mental health authority for covered physical health care services provided in
3054 an integrated health care setting to Medicaid eligible individuals.
3055 (3) Before December 31, 2022, the department shall apply for a Medicaid waiver or a
3056 state plan amendment with CMS to implement the proposal described in Subsection (2).
3057 (4) If the waiver or state plan amendment described in Subsection (3) is approved, the
3058 department shall:
3059 (a) implement the proposal described in Subsection (2); and
3060 (b) while the waiver or state plan amendment is in effect, submit a report to the Health
3061 and Human Services Interim Committee each year before November 30 detailing:
3062 (i) the number of patients served under the waiver or state plan amendment;
3063 (ii) the cost of the waiver or state plan amendment; and
3064 (iii) any benefits of the waiver or state plan amendment.
3065 Section 66. Section 26B-3-301, which is renumbered from Section 26-18-101 is
3066 renumbered and amended to read:
3067
3068
3069 [
3070 As used in this part:
3071 (1) "Appropriate and medically necessary" means, regarding drug prescribing,
3072 dispensing, and patient usage, that it is in conformity with the criteria and standards developed
3073 in accordance with this part.
3074 (2) "Board" means the Drug Utilization Review Board created in Section [
3075 26B-3-302.
3076 (3) "Certified program" means a nursing care facility program with Medicaid
3077 certification.
3078 [
3079 the efficacious use of drugs, including "American Hospital Formulary Services Drug
3080 Information," "U.S. Pharmacopeia - Drug Information," "A.M.A. Drug Evaluations,"
3081 peer-reviewed medical literature, and information provided by manufacturers of drug products.
3082 [
3083 Medicaid recipients about the proper use of drugs, as required by the board under this part.
3084 [
3085 measure drug use on an ongoing basis in order to determine if the use is appropriate, medically
3086 necessary, and not likely to result in adverse medical outcomes.
3087 [
3088 adversely altered by the presence of another disease condition.
3089 [
3090 clinically significant toxicity that is characteristic of one or any of the drugs present, or that
3091 leads to interference with the effectiveness of one or any of the drugs.
3092 [
3093 and assess, on a retrospective and prospective basis, the proper use of outpatient drugs in the
3094 Medicaid program.
3095 [
3096 prescriber or pharmacist to inform about or influence prescribing or dispensing practices.
3097 (11) "Medicaid certification" means the right of a nursing care facility, as a provider of
3098 a nursing care facility program, to receive Medicaid reimbursement for a specified number of
3099 beds within the facility.
3100 (12) (a) "Nursing care facility" means the following facilities licensed by the
3101 department under Chapter 2, Part 2, Health Care Facility Licensing and Inspection:
3102 (i) skilled nursing facilities;
3103 (ii) intermediate care facilities; and
3104 (iii) an intermediate care facility for people with an intellectual disability.
3105 (b) "Nursing care facility" does not mean a critical access hospital that meets the
3106 criteria of 42 U.S.C. 1395i-4(c)(2) (1998).
3107 (13) "Nursing care facility program" means the personnel, licenses, services, contracts
3108 and all other requirements that shall be met for a nursing care facility to be eligible for
3109 Medicaid certification under this part and division rule.
3110 [
3111 quantities that the desired therapeutic goal is not achieved.
3112 [
3113 of pharmacy under Title 58, Chapter 17b, Pharmacy Practice Act.
3114 (16) "Physical facility" means the buildings or other physical structures where a
3115 nursing care facility program is operated.
3116 [
3117 surgery under Section 58-67-301 or osteopathic medicine under Section 58-68-301.
3118 [
3119 that occurs before a drug is dispensed, and that is designed to screen for potential drug therapy
3120 problems based on explicit and predetermined criteria and standards.
3121 [
3122 program that assesses or measures drug use based on an historical review of drug use data
3123 against predetermined and explicit criteria and standards, on an ongoing basis with professional
3124 input.
3125 (20) "Rural county" means a county with a population of less than 50,000, as
3126 determined by:
3127 (a) the most recent official census or census estimate of the United States Bureau of the
3128 Census; or
3129 (b) the most recent population estimate for the county from the Utah Population
3130 Committee, if a population figure for the county is not available under Subsection (7)(a).
3131 (21) "Service area" means the boundaries of the distinct geographic area served by a
3132 certified program as determined by the division in accordance with this part and division rule.
3133 [
3134 reflects local medical practice and that is tested on the Medicaid recipient database.
3135 [
3136 program.
3137 [
3138 on rational drug therapy that is consistent with criteria and standards.
3139 [
3140 or two or more drugs from the same therapeutic class where periods of drug administration
3141 overlap and where that practice is not medically indicated.
3142 (26) "Urban county" means a county that is not a rural county.
3143 Section 67. Section 26B-3-302, which is renumbered from Section 26-18-102 is
3144 renumbered and amended to read:
3145 [
3146 Expenses.
3147 (1) There is created a 12-member Drug Utilization Review Board responsible for
3148 implementation of a retrospective and prospective DUR program.
3149 (2) (a) Except as required by Subsection (2)(b), as terms of current board members
3150 expire, the executive director shall appoint each new member or reappointed member to a
3151 four-year term.
3152 (b) Notwithstanding the requirements of Subsection (2)(a), the executive director shall,
3153 at the time of appointment or reappointment, adjust the length of terms to ensure that the terms
3154 of board members are staggered so that approximately half of the board is appointed every two
3155 years.
3156 (c) Persons appointed to the board may be reappointed upon completion of their terms,
3157 but may not serve more than two consecutive terms.
3158 (d) The executive director shall provide for geographic balance in representation on the
3159 board.
3160 (3) When a vacancy occurs in the membership for any reason, the replacement shall be
3161 appointed for the unexpired term.
3162 (4) The membership shall be comprised of the following:
3163 (a) four physicians who are actively engaged in the practice of medicine or osteopathic
3164 medicine in this state, to be selected from a list of nominees provided by the Utah Medical
3165 Association;
3166 (b) one physician in this state who is actively engaged in academic medicine;
3167 (c) three pharmacists who are actively practicing in retail pharmacy in this state, to be
3168 selected from a list of nominees provided by the Utah Pharmaceutical Association;
3169 (d) one pharmacist who is actively engaged in academic pharmacy;
3170 (e) one person who shall represent consumers;
3171 (f) one person who shall represent pharmaceutical manufacturers, to be recommended
3172 by the Pharmaceutical Manufacturers Association; and
3173 (g) one dentist licensed to practice in this state under Title 58, Chapter 69, Dentist and
3174 Dental Hygienist Practice Act, who is actively engaged in the practice of dentistry, nominated
3175 by the Utah Dental Association.
3176 (5) Physician and pharmacist members of the board shall have expertise in clinically
3177 appropriate prescribing and dispensing of outpatient drugs.
3178 (6) The board shall elect a chair from among its members who shall serve a one-year
3179 term, and may serve consecutive terms.
3180 (7) A member may not receive compensation or benefits for the member's service, but
3181 may receive per diem and travel expenses in accordance with:
3182 (a) Section 63A-3-106;
3183 (b) Section 63A-3-107; and
3184 (c) rules made by the Division of Finance pursuant to Sections 63A-3-106 and
3185 63A-3-107.
3186 Section 68. Section 26B-3-303, which is renumbered from Section 26-18-103 is
3187 renumbered and amended to read:
3188 [
3189 The board shall:
3190 (1) develop rules necessary to carry out its responsibilities as defined in this part;
3191 (2) oversee the implementation of a Medicaid retrospective and prospective DUR
3192 program in accordance with this part, including responsibility for approving provisions of
3193 contractual agreements between the Medicaid program and any other entity that will process
3194 and review Medicaid drug claims and profiles for the DUR program in accordance with this
3195 part;
3196 (3) develop and apply predetermined criteria and standards to be used in retrospective
3197 and prospective DUR, ensuring that the criteria and standards are based on the compendia, and
3198 that they are developed with professional input, in a consensus fashion, with provisions for
3199 timely revision and assessment as necessary. The DUR standards developed by the board shall
3200 reflect the local practices of physicians in order to monitor:
3201 (a) therapeutic appropriateness;
3202 (b) overutilization or underutilization;
3203 (c) therapeutic duplication;
3204 (d) drug-disease contraindications;
3205 (e) drug-drug interactions;
3206 (f) incorrect drug dosage or duration of drug treatment; and
3207 (g) clinical abuse and misuse;
3208 (4) develop, select, apply, and assess interventions and remedial strategies for
3209 physicians, pharmacists, and recipients that are educational and not punitive in nature, in order
3210 to improve the quality of care;
3211 (5) disseminate information to physicians and pharmacists to ensure that they are aware
3212 of the board's duties and powers;
3213 (6) provide written, oral, or electronic reminders of patient-specific or drug-specific
3214 information, designed to ensure recipient, physician, and pharmacist confidentiality, and
3215 suggest changes in prescribing or dispensing practices designed to improve the quality of care;
3216 (7) utilize face-to-face discussions between experts in drug therapy and the prescriber
3217 or pharmacist who has been targeted for educational intervention;
3218 (8) conduct intensified reviews or monitoring of selected prescribers or pharmacists;
3219 (9) create an educational program using data provided through DUR to provide active
3220 and ongoing educational outreach programs to improve prescribing and dispensing practices,
3221 either directly or by contract with other governmental or private entities;
3222 (10) provide a timely evaluation of intervention to determine if those interventions
3223 have improved the quality of care;
3224 (11) publish the annual Drug Utilization Review report required under 42 C.F.R. Sec.
3225 712;
3226 (12) develop a working agreement with related boards or agencies, including the State
3227 Board of Pharmacy, Physicians' Licensing Board, and SURS staff within the division, in order
3228 to clarify areas of responsibility for each, where those areas may overlap;
3229 (13) establish a grievance process for physicians and pharmacists under this part, in
3230 accordance with Title 63G, Chapter 4, Administrative Procedures Act;
3231 (14) publish and disseminate educational information to physicians and pharmacists
3232 concerning the board and the DUR program, including information regarding:
3233 (a) identification and reduction of the frequency of patterns of fraud, abuse, gross
3234 overuse, inappropriate, or medically unnecessary care among physicians, pharmacists, and
3235 recipients;
3236 (b) potential or actual severe or adverse reactions to drugs;
3237 (c) therapeutic appropriateness;
3238 (d) overutilization or underutilization;
3239 (e) appropriate use of generics;
3240 (f) therapeutic duplication;
3241 (g) drug-disease contraindications;
3242 (h) drug-drug interactions;
3243 (i) incorrect drug dosage and duration of drug treatment;
3244 (j) drug allergy interactions; and
3245 (k) clinical abuse and misuse;
3246 (15) develop and publish, with the input of the State Board of Pharmacy, guidelines
3247 and standards to be used by pharmacists in counseling Medicaid recipients in accordance with
3248 this part. The guidelines shall ensure that the recipient may refuse counseling and that the
3249 refusal is to be documented by the pharmacist. Items to be discussed as part of that counseling
3250 include:
3251 (a) the name and description of the medication;
3252 (b) administration, form, and duration of therapy;
3253 (c) special directions and precautions for use;
3254 (d) common severe side effects or interactions, and therapeutic interactions, and how to
3255 avoid those occurrences;
3256 (e) techniques for self-monitoring drug therapy;
3257 (f) proper storage;
3258 (g) prescription refill information; and
3259 (h) action to be taken in the event of a missed dose; and
3260 (16) establish procedures in cooperation with the State Board of Pharmacy for
3261 pharmacists to record information to be collected under this part. The recorded information
3262 shall include:
3263 (a) the name, address, age, and gender of the recipient;
3264 (b) individual history of the recipient where significant, including disease state, known
3265 allergies and drug reactions, and a comprehensive list of medications and relevant devices;
3266 (c) the pharmacist's comments on the individual's drug therapy;
3267 (d) name of prescriber; and
3268 (e) name of drug, dose, duration of therapy, and directions for use.
3269 Section 69. Section 26B-3-304, which is renumbered from Section 26-18-104 is
3270 renumbered and amended to read:
3271 [
3272 (1) Information obtained under this part shall be treated as confidential or controlled
3273 information under Title 63G, Chapter 2, Government Records Access and Management Act.
3274 (2) The board shall establish procedures insuring that the information described in
3275 Subsection [
3276 to the physician only upon request.
3277 (3) The board shall adopt and implement procedures designed to ensure the
3278 confidentiality of all information collected, stored, retrieved, assessed, or analyzed by the
3279 board, staff to the board, or contractors to the DUR program, that identifies individual
3280 physicians, pharmacists, or recipients. The board may have access to identifying information
3281 for purposes of carrying out intervention activities, but that identifying information may not be
3282 released to anyone other than a member of the board. The board may release cumulative
3283 nonidentifying information for research purposes.
3284 Section 70. Section 26B-3-305, which is renumbered from Section 26-18-105 is
3285 renumbered and amended to read:
3286 [
3287 (1) A drug prior approval program approved or implemented by the board shall meet
3288 the following conditions:
3289 (a) except as provided in Subsection (2), a drug may not be placed on prior approval
3290 for other than medical reasons;
3291 (b) the board shall hold a public hearing at least 30 days prior to placing a drug on prior
3292 approval;
3293 (c) notwithstanding the provisions of Section 52-4-202, the board shall provide not less
3294 than 14 days' notice to the public before holding a public hearing under Subsection (1)(b);
3295 (d) the board shall consider written and oral comments submitted by interested parties
3296 prior to or during the hearing held in accordance with Subsection (1)(b);
3297 (e) the board shall provide evidence that placing a drug class on prior approval:
3298 (i) will not impede quality of recipient care; and
3299 (ii) that the drug class is subject to clinical abuse or misuse;
3300 (f) the board shall reconsider its decision to place a drug on prior approval:
3301 (i) no later than nine months after any drug class is placed on prior approval; and
3302 (ii) at a public hearing with notice as provided in Subsection (1)(b);
3303 (g) the program shall provide an approval or denial of a request for prior approval:
3304 (i) by either:
3305 (A) fax;
3306 (B) telephone; or
3307 (C) electronic transmission;
3308 (ii) at least Monday through Friday, except for state holidays; and
3309 (iii) within 24 hours after receipt of the prior approval request;
3310 (h) the program shall provide for the dispensing of at least a 72-hour supply of the drug
3311 on the prior approval program:
3312 (i) in an emergency situation; or
3313 (ii) on weekends or state holidays;
3314 (i) the program may be applied to allow acceptable medical use of a drug on prior
3315 approval for appropriate off-label indications; and
3316 (j) before placing a drug class on the prior approval program, the board shall:
3317 (i) determine that the requirements of Subsections (1)(a) through (i) have been met;
3318 and
3319 (ii) by majority vote, place the drug class on prior approval.
3320 (2) The board may, only after complying with Subsections (1)(b) through (j), consider
3321 the cost:
3322 (a) of a drug when placing a drug on the prior approval program; and
3323 (b) associated with including, or excluding a drug from the prior approval process,
3324 including:
3325 (i) potential side effects associated with a drug; or
3326 (ii) potential hospitalizations or other complications that may occur as a result of a
3327 drug's inclusion on the prior approval process.
3328 Section 71. Section 26B-3-306, which is renumbered from Section 26-18-106 is
3329 renumbered and amended to read:
3330 [
3331 The board may establish advisory committees to assist it in carrying out its duties under
3332 [
3333 Section 72. Section 26B-3-307, which is renumbered from Section 26-18-107 is
3334 renumbered and amended to read:
3335 [
3336 (1) The board, in cooperation with the division, shall include in its state plan the
3337 creation and implementation of a retrospective and prospective DUR program for Medicaid
3338 outpatient drugs to ensure that prescriptions are appropriate, medically necessary, and not likely
3339 to result in adverse medical outcomes.
3340 (2) The retrospective and prospective DUR program shall be operated under guidelines
3341 established by the board under Subsections (3) and (4).
3342 (3) The retrospective DUR program shall be based on guidelines established by the
3343 board, using the mechanized drug claims processing and information retrieval system to
3344 analyze claims data in order to:
3345 (a) identify patterns of fraud, abuse, gross overuse, and inappropriate or medically
3346 unnecessary care; and
3347 (b) assess data on drug use against explicit predetermined standards that are based on
3348 the compendia and other sources for the purpose of monitoring:
3349 (i) therapeutic appropriateness;
3350 (ii) overutilization or underutilization;
3351 (iii) therapeutic duplication;
3352 (iv) drug-disease contraindications;
3353 (v) drug-drug interactions;
3354 (vi) incorrect drug dosage or duration of drug treatment; and
3355 (vii) clinical abuse and misuse.
3356 (4) The prospective DUR program shall be based on guidelines established by the
3357 board and shall provide that, before a prescription is filled or delivered, a review will be
3358 conducted by the pharmacist at the point of sale to screen for potential drug therapy problems
3359 resulting from:
3360 (a) therapeutic duplication;
3361 (b) drug-drug interactions;
3362 (c) incorrect dosage or duration of treatment;
3363 (d) drug-allergy interactions; and
3364 (e) clinical abuse or misuse.
3365 (5) In conducting the prospective DUR, a pharmacist may not alter the prescribed
3366 outpatient drug therapy without the consent of the prescribing physician or physician assistant.
3367 This section does not effect the ability of a pharmacist to substitute a generic equivalent.
3368 Section 73. Section 26B-3-308, which is renumbered from Section 26-18-108 is
3369 renumbered and amended to read:
3370 [
3371 Any person who violates the confidentiality provisions of [
3372 26B-3-302 through 26B-3-307 is guilty of a class B misdemeanor.
3373 Section 74. Section 26B-3-309, which is renumbered from Section 26-18-109 is
3374 renumbered and amended to read:
3375 [
3376 There is no liability on the part of, and no cause of action of any nature arises against
3377 any member of the board, its agents, or employees for any action or omission by them in
3378 effecting the provisions of [
3379 Section 75. Section 26B-3-310, which is renumbered from Section 26-18-502 is
3380 renumbered and amended to read:
3381 [
3382 facilities.
3383 (1) The Legislature finds:
3384 (a) that an oversupply of nursing care facilities in the state adversely affects the state
3385 Medicaid program and the health of the people in the state;
3386 (b) it is in the best interest of the state to prohibit nursing care facilities from receiving
3387 Medicaid certification, except as provided by [
3388 26B-3-313; and
3389 (c) it is in the best interest of the state to encourage aging nursing care facilities with
3390 Medicaid certification to renovate the nursing care facilities' physical facilities so that the
3391 quality of life and clinical services for Medicaid residents are preserved.
3392 (2) Medicaid reimbursement of nursing care facility programs is limited to:
3393 (a) the number of nursing care facility programs with Medicaid certification as of May
3394 9, 2016; and
3395 (b) additional nursing care facility programs approved for Medicaid certification under
3396 the provisions of Subsections [
3397 (3) The division may not:
3398 (a) except as authorized by Section [
3399 (i) process initial applications for Medicaid certification or execute provider
3400 agreements with nursing care facility programs; or
3401 (ii) reinstate Medicaid certification for a nursing care facility whose certification
3402 expired or was terminated by action of the federal or state government; or
3403 (b) execute a Medicaid provider agreement with a certified program that moves to a
3404 different physical facility, except as authorized by Subsection [
3405 (4) Notwithstanding Section [
3406 division may not approve a new or additional bed in an intermediate care facility for
3407 individuals with an intellectual disability for Medicaid certification, unless certification of the
3408 bed by the division does not increase the total number in the state of Medicaid-certified beds in
3409 intermediate care facilities for individuals with an intellectual disability.
3410 Section 76. Section 26B-3-311, which is renumbered from Section 26-18-503 is
3411 renumbered and amended to read:
3412 [
3413 Medicaid certified programs -- Reimbursement methodology.
3414 (1) (a) The division may renew Medicaid certification of a certified program if the
3415 program, without lapse in service to Medicaid recipients, has its nursing care facility program
3416 certified by the division at the same physical facility as long as the licensed and certified bed
3417 capacity at the facility has not been expanded, unless the director has approved additional beds
3418 in accordance with Subsection (5).
3419 (b) The division may renew Medicaid certification of a nursing care facility program
3420 that is not currently certified if:
3421 (i) since the day on which the program last operated with Medicaid certification:
3422 (A) the physical facility where the program operated has functioned solely and
3423 continuously as a nursing care facility; and
3424 (B) the owner of the program has not, under this section or Section [
3425 26B-3-313, transferred to another nursing care facility program the license for any of the
3426 Medicaid beds in the program; and
3427 (ii) except as provided in Subsection [
3428 granted renewed Medicaid certification does not exceed the number of beds certified at the
3429 time the program last operated with Medicaid certification, excluding a period of time where
3430 the program operated with temporary certification under Subsection [
3431 (2) (a) The division may issue a Medicaid certification for a new nursing care facility
3432 program if a current owner of the Medicaid certified program transfers its ownership of the
3433 Medicaid certification to the new nursing care facility program and the new nursing care
3434 facility program meets all of the following conditions:
3435 (i) the new nursing care facility program operates at the same physical facility as the
3436 previous Medicaid certified program;
3437 (ii) the new nursing care facility program gives a written assurance to the director in
3438 accordance with Subsection (4);
3439 (iii) the new nursing care facility program receives the Medicaid certification within
3440 one year of the date the previously certified program ceased to provide medical assistance to a
3441 Medicaid recipient; and
3442 (iv) the licensed and certified bed capacity at the facility has not been expanded, unless
3443 the director has approved additional beds in accordance with Subsection (5).
3444 (b) A nursing care facility program that receives Medicaid certification under the
3445 provisions of Subsection (2)(a) does not assume the Medicaid liabilities of the previous nursing
3446 care facility program if the new nursing care facility program:
3447 (i) is not owned in whole or in part by the previous nursing care facility program; or
3448 (ii) is not a successor in interest of the previous nursing care facility program.
3449 (3) The division may issue a Medicaid certification to a nursing care facility program
3450 that was previously a certified program but now resides in a new or renovated physical facility
3451 if the nursing care facility program meets all of the following:
3452 (a) the nursing care facility program met all applicable requirements for Medicaid
3453 certification at the time of closure;
3454 (b) the new or renovated physical facility is in the same county or within a five-mile
3455 radius of the original physical facility;
3456 (c) the time between which the certified program ceased to operate in the original
3457 facility and will begin to operate in the new physical facility is not more than three years,
3458 unless:
3459 (i) an emergency is declared by the president of the United States or the governor,
3460 affecting the building or renovation of the physical facility;
3461 (ii) the director approves an exception to the three-year requirement for any nursing
3462 care facility program within the three-year requirement;
3463 (iii) the provider submits documentation supporting a request for an extension to the
3464 director that demonstrates a need for an extension; and
3465 (iv) the exception does not extend for more than two years beyond the three-year
3466 requirement;
3467 (d) if Subsection (3)(c) applies, the certified program notifies the department within 90
3468 days after ceasing operations in its original facility, of its intent to retain its Medicaid
3469 certification;
3470 (e) the provider gives written assurance to the director in accordance with Subsection
3471 (4) that no third party has a legitimate claim to operate a certified program at the previous
3472 physical facility; and
3473 (f) the bed capacity in the physical facility has not been expanded unless the director
3474 has approved additional beds in accordance with Subsection (5).
3475 (4) (a) The entity requesting Medicaid certification under Subsections (2) and (3) shall
3476 give written assurances satisfactory to the director or the director's designee that:
3477 (i) no third party has a legitimate claim to operate the certified program;
3478 (ii) the requesting entity agrees to defend and indemnify the department against any
3479 claims by a third party who may assert a right to operate the certified program; and
3480 (iii) if a third party is found, by final agency action of the department after exhaustion
3481 of all administrative and judicial appeal rights, to be entitled to operate a certified program at
3482 the physical facility the certified program shall voluntarily comply with Subsection (4)(b).
3483 (b) If a finding is made under the provisions of Subsection (4)(a)(iii):
3484 (i) the certified program shall immediately surrender its Medicaid certification and
3485 comply with division rules regarding billing for Medicaid and the provision of services to
3486 Medicaid patients; and
3487 (ii) the department shall transfer the surrendered Medicaid certification to the third
3488 party who prevailed under Subsection (4)(a)(iii).
3489 (5) (a) The director may approve additional nursing care facility programs for Medicaid
3490 certification, or additional beds for Medicaid certification within an existing nursing care
3491 facility program, if a nursing care facility or other interested party requests Medicaid
3492 certification for a nursing care facility program or additional beds within an existing nursing
3493 care facility program, and the nursing care facility program or other interested party complies
3494 with this section.
3495 (b) The nursing care facility or other interested party requesting Medicaid certification
3496 for a nursing care facility program or additional beds within an existing nursing care facility
3497 program under Subsection (5)(a) shall submit to the director:
3498 (i) proof of the following as reasonable evidence that bed capacity provided by
3499 Medicaid certified programs within the county or group of counties impacted by the requested
3500 additional Medicaid certification is insufficient:
3501 (A) nursing care facility occupancy levels for all existing and proposed facilities will
3502 be at least 90% for the next three years;
3503 (B) current nursing care facility occupancy is 90% or more; or
3504 (C) there is no other nursing care facility within a 35-mile radius of the nursing care
3505 facility requesting the additional certification; and
3506 (ii) an independent analysis demonstrating that at projected occupancy rates the nursing
3507 care facility's after-tax net income is sufficient for the facility to be financially viable.
3508 (c) Any request for additional beds as part of a renovation project are limited to the
3509 maximum number of beds allowed in Subsection (7).
3510 (d) The director shall determine whether to issue additional Medicaid certification by
3511 considering:
3512 (i) whether bed capacity provided by certified programs within the county or group of
3513 counties impacted by the requested additional Medicaid certification is insufficient, based on
3514 the information submitted to the director under Subsection (5)(b);
3515 (ii) whether the county or group of counties impacted by the requested additional
3516 Medicaid certification is underserved by specialized or unique services that would be provided
3517 by the nursing care facility;
3518 (iii) whether any Medicaid certified beds are subject to a claim by a previous certified
3519 program that may reopen under the provisions of Subsections (2) and (3);
3520 (iv) how additional bed capacity should be added to the long-term care delivery system
3521 to best meet the needs of Medicaid recipients; and
3522 (v) (A) whether the existing certified programs within the county or group of counties
3523 have provided services of sufficient quality to merit at least a two-star rating in the Medicare
3524 Five-Star Quality Rating System over the previous three-year period; and
3525 (B) information obtained under Subsection (9).
3526 (6) The department shall adopt administrative rules in accordance with Title 63G,
3527 Chapter 3, Utah Administrative Rulemaking Act, to adjust the Medicaid nursing care facility
3528 property reimbursement methodology to:
3529 (a) only pay that portion of the property component of rates, representing actual bed
3530 usage by Medicaid clients as a percentage of the greater of:
3531 (i) actual occupancy; or
3532 (ii) (A) for a nursing care facility other than a facility described in Subsection
3533 (6)(a)(ii)(B), 85% of total bed capacity; or
3534 (B) for a rural nursing care facility, 65% of total bed capacity; and
3535 (b) not allow for increases in reimbursement for property values without major
3536 renovation or replacement projects as defined by the department by rule.
3537 (7) (a) Except as provided in Subsection 26-18-502(3), if a nursing care facility does
3538 not seek Medicaid certification for a bed under Subsections (1) through (6), the department
3539 shall, notwithstanding Subsections [
3540 certification for additional beds in an existing Medicaid certified nursing care facility that has
3541 90 or fewer licensed beds, including Medicaid certified beds, in the facility if:
3542 (i) the nursing care facility program was previously a certified program for all beds but
3543 now resides in a new facility or in a facility that underwent major renovations involving major
3544 structural changes, with 50% or greater facility square footage design changes, requiring review
3545 and approval by the department;
3546 (ii) the nursing care facility meets the quality of care regulations issued by CMS; and
3547 (iii) the total number of additional beds in the facility granted Medicaid certification
3548 under this section does not exceed 10% of the number of licensed beds in the facility.
3549 (b) The department may not revoke the Medicaid certification of a bed under this
3550 Subsection (7) as long as the provisions of Subsection (7)(a)(ii) are met.
3551 (8) (a) If a nursing care facility or other interested party indicates in its request for
3552 additional Medicaid certification under Subsection (5)(a) that the facility will offer specialized
3553 or unique services, but the facility does not offer those services after receiving additional
3554 Medicaid certification, the director shall revoke the additional Medicaid certification.
3555 (b) The nursing care facility program shall obtain Medicaid certification for any
3556 additional Medicaid beds approved under Subsection (5) or (7) within three years of the date of
3557 the director's approval, or the approval is void.
3558 (9) (a) If the director makes an initial determination that quality standards under
3559 Subsection (5)(d)(v) have not been met in a rural county or group of rural counties over the
3560 previous three-year period, the director shall, before approving certification of additional
3561 Medicaid beds in the rural county or group of counties:
3562 (i) notify the certified program that has not met the quality standards in Subsection
3563 (5)(d)(v) that the director intends to certify additional Medicaid beds under the provisions of
3564 Subsection (5)(d)(v); and
3565 (ii) consider additional information submitted to the director by the certified program
3566 in a rural county that has not met the quality standards under Subsection (5)(d)(v).
3567 (b) The notice under Subsection (9)(a) does not give the certified program that has not
3568 met the quality standards under Subsection (5)(d)(v), the right to legally challenge or appeal the
3569 director's decision to certify additional Medicaid beds under Subsection (5)(d)(v).
3570 Section 77. Section 26B-3-312, which is renumbered from Section 26-18-504 is
3571 renumbered and amended to read:
3572 [
3573 authority -- Application of act.
3574 (1) A decision by the director under this part to deny Medicaid certification for a
3575 nursing care facility program or to deny additional bed capacity for an existing certified
3576 program is subject to review under the procedures and requirements of Title 63G, Chapter 4,
3577 Administrative Procedures Act.
3578 (2) The department shall make rules to administer and enforce [
3579 26B-3-310 through 26B-3-313 in accordance with Title 63G, Chapter 3, Utah Administrative
3580 Rulemaking Act.
3581 (3) (a) In the event the department is at risk for a federal disallowance with regard to a
3582 Medicaid recipient being served in a nursing care facility program that is not Medicaid
3583 certified, the department may grant temporary Medicaid certification to that facility for up to 24
3584 months.
3585 (b) (i) The department may extend a temporary Medicaid certification granted to a
3586 facility under Subsection (3)(a):
3587 (A) for the number of beds in the nursing care facility occupied by a Medicaid
3588 recipient; and
3589 (B) for the period of time during which the Medicaid recipient resides at the facility.
3590 (ii) A temporary Medicaid certification granted under this Subsection (3) is revoked
3591 upon:
3592 (A) the discharge of the patient from the facility; or
3593 (B) the patient no longer residing at the facility for any reason.
3594 (c) The department may place conditions on the temporary certification granted under
3595 Subsections (3)(a) and (b), such as:
3596 (i) not allowing additional admissions of Medicaid recipients to the program; and
3597 (ii) not paying for the care of the patient after October 1, 2008, with state only dollars.
3598 Section 78. Section 26B-3-313, which is renumbered from Section 26-18-505 is
3599 renumbered and amended to read:
3600 [
3601 Medicaid beds -- Duties of transferor -- Duties of transferee -- Duties of division.
3602 (1) This section provides a method to transfer or sell the license for a Medicaid bed
3603 from a nursing care facility program to another entity that is in addition to the authorization to
3604 transfer under Section [
3605 (2) (a) A nursing care facility program may transfer or sell one or more of its licenses
3606 for Medicaid beds in accordance with Subsection (2)(b) if:
3607 (i) at the time of the transfer, and with respect to the license for the Medicaid bed that
3608 will be transferred, the nursing care facility program that will transfer the Medicaid license
3609 meets all applicable regulations for Medicaid certification;
3610 (ii) the nursing care facility program gives a written assurance, which is postmarked or
3611 has proof of delivery 30 days before the transfer, to the director and to the transferee in
3612 accordance with Subsection [
3613 (iii) the nursing care facility program that will transfer the license for a Medicaid bed
3614 notifies the division in writing, which is postmarked or has proof of delivery 30 days before the
3615 transfer, of:
3616 (A) the number of bed licenses that will be transferred;
3617 (B) the date of the transfer; and
3618 (C) the identity and location of the entity receiving the transferred licenses; and
3619 (iv) if the nursing care facility program for which the license will be transferred or
3620 purchased is located in an urban county with a nursing care facility average annual occupancy
3621 rate over the previous two years less than or equal to 75%, the nursing care facility program
3622 transferring or selling the license demonstrates to the satisfaction of the director that the sale or
3623 transfer:
3624 (A) will not result in an excessive number of Medicaid certified beds within the county
3625 or group of counties that would be impacted by the transfer or sale; and
3626 (B) best meets the needs of Medicaid recipients.
3627 (b) Except as provided in Subsection (2)(c), a nursing care facility program may
3628 transfer or sell one or more of its licenses for Medicaid beds to:
3629 (i) a nursing care facility program that has the same owner or successor in interest of
3630 the same owner;
3631 (ii) a nursing care facility program that has a different owner; or
3632 (iii) a related-party nonnursing-care-facility entity that wants to hold one or more of the
3633 licenses for a nursing care facility program not yet identified, as long as:
3634 (A) the licenses are subsequently transferred or sold to a nursing care facility program
3635 within three years; and
3636 (B) the nursing care facility program notifies the director of the transfer or sale in
3637 accordance with Subsection (2)(a)(iii).
3638 (c) A nursing care facility program may not transfer or sell one or more of its licenses
3639 for Medicaid beds to an entity under Subsection (2)(b)(i), (ii), or (iii) that is located in a rural
3640 county unless the entity requests, and the director issues, Medicaid certification for the beds
3641 under Subsection [
3642 (3) A nursing care facility program or entity under Subsection (2)(b)(i), (ii), or (iii) that
3643 receives or purchases a license for a Medicaid bed under Subsection (2)(b):
3644 (a) may receive a license for a Medicaid bed from more than one nursing care facility
3645 program;
3646 (b) shall give the division notice, which is postmarked or has proof of delivery within
3647 14 days of the nursing care facility program or entity seeking Medicaid certification of beds in
3648 the nursing care facility program or entity, of the total number of licenses for Medicaid beds
3649 that the entity received and who it received the licenses from;
3650 (c) may only seek Medicaid certification for the number of licensed beds in the nursing
3651 care facility program equal to the total number of licenses for Medicaid beds received by the
3652 entity;
3653 (d) does not have to demonstrate need or seek approval for the Medicaid licensed bed
3654 under Subsection [
3655 (2)(c) ;
3656 (e) shall meet the standards for Medicaid certification other than those in Subsection
3657 [
3658 under [
3659 Health Care Facility Licensing and Inspection; and
3660 (f) shall obtain Medicaid certification for the licensed Medicaid beds within three years
3661 of the date of transfer as documented under Subsection (2)(a)(iii)(B).
3662 (4) (a) When the division receives notice of a transfer of a license for a Medicaid bed
3663 under Subsection (2)(a)(iii)(A), the department shall reduce the number of licenses for
3664 Medicaid beds at the transferring nursing care facility:
3665 (i) equal to the number of licenses transferred; and
3666 (ii) effective on the date of the transfer as reported under Subsection (2)(a)(iii)(B).
3667 (b) For purposes of Section [
3668 Medicaid certification for the receiving nursing care facility program or entity:
3669 (i) in accordance with the formula established in Subsection (3)(c); and
3670 (ii) if:
3671 (A) the nursing care facility seeks Medicaid certification for the transferred licenses
3672 within the time limit required by Subsection (3)(f); and
3673 (B) the nursing care facility program meets other requirements for Medicaid
3674 certification under Subsection (3)(e).
3675 (c) A license for a Medicaid bed may not be approved for Medicaid certification
3676 without meeting the requirements of Sections [
3677 26B-3-311 if:
3678 (i) the license for a Medicaid bed is transferred under this section but the receiving
3679 entity does not obtain Medicaid certification for the licensed bed within the time required by
3680 Subsection (3)(f); or
3681 (ii) the license for a Medicaid bed is transferred under this section but the license is no
3682 longer eligible for Medicaid certification.
3683 Section 79. Section 26B-3-401, which is renumbered from Section 26-35a-103 is
3684 renumbered and amended to read:
3685
3686 [
3687 As used in this [
3688 (1) (a) "Nursing care facility" means:
3689 (i) a nursing care facility [
3690 26B-2-201;
3691 (ii) beginning January 1, 2006, a designated swing bed in:
3692 (A) a general acute hospital as defined in [
3693 and
3694 (B) a critical access hospital which meets the criteria of 42 U.S.C. Sec. 1395i-4(c)(2)
3695 (1998); and
3696 (iii) an intermediate care facility for people with an intellectual disability that is
3697 licensed under Section [
3698 (b) "Nursing care facility" does not include:
3699 (i) the Utah State Developmental Center;
3700 (ii) the Utah State Hospital;
3701 (iii) a general acute hospital, specialty hospital, or small health care facility as those
3702 terms are defined in Section [
3703 (iv) a Utah State Veterans Home.
3704 (2) "Patient day" means each calendar day in which an individual patient is admitted to
3705 the nursing care facility during a calendar month, even if on a temporary leave of absence from
3706 the facility.
3707 Section 80. Section 26B-3-402, which is renumbered from Section 26-35a-102 is
3708 renumbered and amended to read:
3709 [
3710 (1) The Legislature finds that there is an important state purpose to improve the quality
3711 of care given to persons who are elderly and to people who have a disability, in long-term care
3712 nursing facilities.
3713 (2) The Legislature finds that in order to improve the quality of care to those persons
3714 described in Subsection (1), the rates paid to the nursing care facilities by the Medicaid
3715 program must be adequate to encourage and support quality care.
3716 (3) The Legislature finds that in order to meet the objectives in Subsections (1) and (2),
3717 adequate funding must be provided to increase the rates paid to nursing care facilities providing
3718 services pursuant to the Medicaid program.
3719 Section 81. Section 26B-3-403, which is renumbered from Section 26-35a-104 is
3720 renumbered and amended to read:
3721 [
3722 care facilities assessment.
3723 (1) (a) Beginning July 1, 2004, an assessment is imposed upon each nursing care
3724 facility in the amount designated in Subsection (1)(c).
3725 (b) (i) The department shall establish by rule, a uniform rate per non-Medicare patient
3726 day that may not exceed 6% of the total gross revenue for services provided to patients of all
3727 nursing care facilities licensed in this state.
3728 (ii) For purposes of Subsection (1)(b)(i), total revenue does not include charitable
3729 contribution received by a nursing care facility.
3730 (c) The department shall calculate the assessment imposed under Subsection (1)(a) by
3731 multiplying the total number of patient days of care provided to non-Medicare patients by the
3732 nursing care facility, as provided to the department pursuant to Subsection (3)(a), by the
3733 uniform rate established by the department pursuant to Subsection (1)(b).
3734 (2) (a) The assessment imposed by this [
3735 basis on or before the last day of the month next succeeding each monthly period.
3736 (b) The collecting agent for this assessment shall be the department which is vested
3737 with the administration and enforcement of this [
3738 records of a nursing care facility related to patient days of care for the facility.
3739 (c) The department shall forward proceeds from the assessment imposed by this
3740 [
3741 specified in Section [
3742 (3) Each nursing care facility shall, on or before the end of the month next succeeding
3743 each calendar monthly period, file with the department:
3744 (a) a report which includes:
3745 (i) the total number of patient days of care the facility provided to non-Medicare
3746 patients during the preceding month;
3747 (ii) the total gross revenue the facility earned as compensation for services provided to
3748 patients during the preceding month; and
3749 (iii) any other information required by the department; and
3750 (b) a return for the monthly period, and shall remit with the return the assessment
3751 required by this [
3752 (4) Each return shall contain information and be in the form the department prescribes
3753 by rule.
3754 (5) The assessment as computed in the return is an allowable cost for Medicaid
3755 reimbursement purposes.
3756 (6) The department may by rule, extend the time for making returns and paying the
3757 assessment.
3758 (7) Each nursing care facility that fails to pay any assessment required to be paid to the
3759 state, within the time required by this [
3760 this [
3761 Section [
3762 Section 82. Section 26B-3-404, which is renumbered from Section 26-35a-105 is
3763 renumbered and amended to read:
3764 [
3765 (1) The penalty for failure to file a return or pay the assessment due within the time
3766 prescribed by this [
3767 return.
3768 (2) For failure to pay within 30 days of a notice of deficiency of assessment required to
3769 be paid, the penalty is the greater of $50 or 5% of the assessment due.
3770 (3) The penalty for underpayment of the assessment is as follows:
3771 (a) If any underpayment of assessment is due to negligence, the penalty is 25% of the
3772 underpayment.
3773 (b) If the underpayment of the assessment is due to intentional disregard of law or rule,
3774 the penalty is 50% of the underpayment.
3775 (4) For intent to evade the assessment, the penalty is 100% of the underpayment.
3776 (5) The rate of interest applicable to an underpayment of an assessment under this
3777 [
3778 (6) The department may waive the imposition of a penalty for good cause.
3779 Section 83. Section 26B-3-405, which is renumbered from Section 26-35a-107 is
3780 renumbered and amended to read:
3781 [
3782 reimbursement rates.
3783 If federal law or regulation prohibits the money in the Nursing Care Facilities Provider
3784 Assessment Fund from being used in the manner set forth in Subsection [
3785 26B-1-332(1)(b), the rates paid to nursing care facilities for providing services pursuant to the
3786 Medicaid program shall be changed:
3787 (1) except as otherwise provided in Subsection (2), to the rates paid to nursing care
3788 facilities on June 30, 2004; or
3789 (2) if the Legislature or the department has on or after July 1, 2004, changed the rates
3790 paid to facilities through a manner other than the use of expenditures from the Nursing Care
3791 Facilities Provider Assessment Fund, to the rates provided for by the Legislature or the
3792 department.
3793 Section 84. Section 26B-3-406, which is renumbered from Section 26-35a-108 is
3794 renumbered and amended to read:
3795 [
3796 intellectual disability -- Uniform rate.
3797 An intermediate care facility for people with an intellectual disability is subject to all
3798 the provisions of this [
3799 for an intermediate care facility for people with an intellectual disability that:
3800 (1) is based on the same formula specified for nursing care facilities under the
3801 provisions of Subsection [
3802 (2) may be different than the uniform rate established for other nursing care facilities.
3803 Section 85. Section 26B-3-501, which is renumbered from Section 26-36b-103 is
3804 renumbered and amended to read:
3805
3806 [
3807 As used in this [
3808 (1) "Assessment" means the inpatient hospital assessment established by this [
3809 part.
3810 (2) "CMS" means the Centers for Medicare and Medicaid Services within the United
3811 States Department of Health and Human Services.
3812 (3) "Discharges" means the number of total hospital discharges reported on:
3813 (a) Worksheet S-3 Part I, column 15, lines 14, 16, and 17 of the 2552-10 Medicare cost
3814 report for the applicable assessment year; or
3815 (b) a similar report adopted by the department by administrative rule, if the report
3816 under Subsection (3)(a) is no longer available.
3817 (4) "Division" means the Division of Health Care Financing within the department.
3818 (5) "Enhancement waiver program" means the program established by the Primary
3819 Care Network enhancement waiver program described in Section [
3820 (6) "Health coverage improvement program" means the health coverage improvement
3821 program described in Section [
3822 (7) "Hospital share" means the hospital share described in Section [
3823 26B-3-505.
3824 (8) "Medicaid accountable care organization" means a managed care organization, as
3825 defined in 42 C.F.R. Sec. 438, that contracts with the department under the provisions of
3826 Section [
3827 (9) "Medicaid waiver expansion" means a Medicaid expansion in accordance with
3828 Section [
3829 (10) "Medicare cost report" means CMS-2552-10, the cost report for electronic filing
3830 of hospitals.
3831 (11) (a) "Non-state government hospital" means a hospital owned by a non-state
3832 government entity.
3833 (b) "Non-state government hospital" does not include:
3834 (i) the Utah State Hospital; or
3835 (ii) a hospital owned by the federal government, including the Veterans Administration
3836 Hospital.
3837 (12) (a) "Private hospital" means:
3838 (i) a general acute hospital, as defined in Section [
3839 owned and operating in the state; and
3840 (ii) a privately owned specialty hospital operating in the state, including a privately
3841 owned hospital whose inpatient admissions are predominantly for:
3842 (A) rehabilitation;
3843 (B) psychiatric care;
3844 (C) chemical dependency services; or
3845 (D) long-term acute care services.
3846 (b) "Private hospital" does not include a facility for residential treatment as defined in
3847 Section [
3848 (13) "State teaching hospital" means a state owned teaching hospital that is part of an
3849 institution of higher education.
3850 (14) "Upper payment limit gap" means the difference between the private hospital
3851 outpatient upper payment limit and the private hospital Medicaid outpatient payments, as
3852 determined in accordance with 42 C.F.R. Sec. 447.321.
3853 Section 86. Section 26B-3-502, which is renumbered from Section 26-36b-102 is
3854 renumbered and amended to read:
3855 [
3856 (1) Other than for the imposition of the assessment described in this [
3857 nothing in this [
3858 charitable, religious, or educational health care provider under any:
3859 (a) state law;
3860 (b) ad valorem property taxes;
3861 (c) sales or use taxes; or
3862 (d) other taxes, fees, or assessments, whether imposed or sought to be imposed, by the
3863 state or any political subdivision of the state.
3864 (2) All assessments paid under this [
3865 of a hospital for purposes of any applicable Medicaid reimbursement formula.
3866 (3) This [
3867 (a) license a hospital for revenue;
3868 (b) impose a tax or assessment upon a hospital; or
3869 (c) impose a tax or assessment measured by the income or earnings of a hospital.
3870 Section 87. Section 26B-3-503, which is renumbered from Section 26-36b-201 is
3871 renumbered and amended to read:
3872 [
3873 (1) An assessment is imposed on each private hospital:
3874 (a) beginning upon the later of CMS approval of:
3875 (i) the health coverage improvement program waiver under Section [
3876 26B-3-207; and
3877 (ii) the assessment under this [
3878 (b) in the amount designated in Sections [
3879 26B-3-507; and
3880 (c) in accordance with Section [
3881 (2) Subject to Section [
3882 [
3883 payment limit supplemental payments under Section [
3884 (3) The first quarterly payment is not due until at least three months after the earlier of
3885 the effective dates of the coverage provided through:
3886 (a) the health coverage improvement program;
3887 (b) the enhancement waiver program; or
3888 (c) the Medicaid waiver expansion.
3889 Section 88. Section 26B-3-504, which is renumbered from Section 26-36b-202 is
3890 renumbered and amended to read:
3891 [
3892 Rulemaking.
3893 (1) The collecting agent for the assessment imposed under Section [
3894 26B-3-503 is the department.
3895 (2) The department is vested with the administration and enforcement of this [
3896 part, and may make rules in accordance with Title 63G, Chapter 3, Utah Administrative
3897 Rulemaking Act, necessary to:
3898 (a) collect the assessment, intergovernmental transfers, and penalties imposed under
3899 this [
3900 (b) audit records of a facility that:
3901 (i) is subject to the assessment imposed by this [
3902 (ii) does not file a Medicare cost report; and
3903 (c) select a report similar to the Medicare cost report if Medicare no longer uses a
3904 Medicare cost report.
3905 (3) The department shall:
3906 (a) administer the assessment in this [
3907 [
3908 (b) deposit assessments collected under this [
3909 Fund created by Section [
3910 Section 89. Section 26B-3-505, which is renumbered from Section 26-36b-203 is
3911 renumbered and amended to read:
3912 [
3913 (1) Quarterly assessments imposed by this [
3914 within 15 business days after the original invoice date that appears on the invoice issued by the
3915 division.
3916 (2) The department may, by rule, extend the time for paying the assessment.
3917 Section 90. Section 26B-3-506, which is renumbered from Section 26-36b-204 is
3918 renumbered and amended to read:
3919 [
3920 improvement program Medicaid waiver expansion -- Hospital share.
3921 (1) The hospital share is:
3922 (a) 45% of the state's net cost of the health coverage improvement program, including
3923 Medicaid coverage for individuals with dependent children up to the federal poverty level
3924 designated under Section [
3925 (b) 45% of the state's net cost of the enhancement waiver program;
3926 (c) if the waiver for the Medicaid waiver expansion is approved, $11,900,000; and
3927 (d) 45% of the state's net cost of the upper payment limit gap.
3928 (2) (a) The hospital share is capped at no more than $13,600,000 annually, consisting
3929 of:
3930 (i) an $11,900,000 cap for the programs specified in Subsections (1)(a) through (c);
3931 and
3932 (ii) a $1,700,000 cap for the program specified in Subsection (1)(d).
3933 (b) The department shall prorate the cap described in Subsection (2)(a) in any year in
3934 which the programs specified in Subsections (1)(a) and (d) are not in effect for the full fiscal
3935 year.
3936 (3) Private hospitals shall be assessed under this [
3937 (a) 69% of the portion of the hospital share for the programs specified in Subsections
3938 (1)(a) through (c); and
3939 (b) 100% of the portion of the hospital share specified in Subsection (1)(d).
3940 (4) (a) In the report described in Subsection [
3941 shall calculate the state's net cost of each of the programs described in Subsections (1)(a)
3942 through (c) that are in effect for that year.
3943 (b) If the assessment collected in the previous fiscal year is above or below the hospital
3944 share for private hospitals for the previous fiscal year, the underpayment or overpayment of the
3945 assessment by the private hospitals shall be applied to the fiscal year in which the report is
3946 issued.
3947 (5) A Medicaid accountable care organization shall, on or before October 15 of each
3948 year, report to the department the following data from the prior state fiscal year for each private
3949 hospital, state teaching hospital, and non-state government hospital provider that the Medicaid
3950 accountable care organization contracts with:
3951 (a) for the traditional Medicaid population:
3952 (i) hospital inpatient payments;
3953 (ii) hospital inpatient discharges;
3954 (iii) hospital inpatient days; and
3955 (iv) hospital outpatient payments; and
3956 (b) if the Medicaid accountable care organization enrolls any individuals in the health
3957 coverage improvement program, the enhancement waiver program, or the Medicaid waiver
3958 expansion, for the population newly eligible for any of those programs:
3959 (i) hospital inpatient payments;
3960 (ii) hospital inpatient discharges;
3961 (iii) hospital inpatient days; and
3962 (iv) hospital outpatient payments.
3963 (6) The department shall, by rule made in accordance with Title 63G, Chapter 3, Utah
3964 Administrative Rulemaking Act, provide details surrounding specific content and format for
3965 the reporting by the Medicaid accountable care organization.
3966 Section 91. Section 26B-3-507, which is renumbered from Section 26-36b-205 is
3967 renumbered and amended to read:
3968 [
3969 (1) (a) Except as provided in Subsection (1)(b), an annual assessment is payable on a
3970 quarterly basis for each private hospital in an amount calculated by the division at a uniform
3971 assessment rate for each hospital discharge, in accordance with this section.
3972 (b) A private teaching hospital with more than 425 beds and 60 residents shall pay an
3973 assessment rate 2.5 times the uniform rate established under Subsection (1)(c).
3974 (c) The division shall calculate the uniform assessment rate described in Subsection
3975 (1)(a) by dividing the hospital share for assessed private hospitals, described in Subsections
3976 [
3977 (i) the total number of discharges for assessed private hospitals that are not a private
3978 teaching hospital; and
3979 (ii) 2.5 times the number of discharges for a private teaching hospital, described in
3980 Subsection (1)(b).
3981 (d) The division may, by rule made in accordance with Title 63G, Chapter 3, Utah
3982 Administrative Rulemaking Act, adjust the formula described in Subsection (1)(c) to address
3983 unforeseen circumstances in the administration of the assessment under this [
3984 (e) Any quarterly changes to the uniform assessment rate shall be applied uniformly to
3985 all assessed private hospitals.
3986 (2) Except as provided in Subsection (3), for each state fiscal year, the division shall
3987 determine a hospital's discharges as follows:
3988 (a) for state fiscal year 2017, the hospital's cost report data for the hospital's fiscal year
3989 ending between July 1, 2013, and June 30, 2014; and
3990 (b) for each subsequent state fiscal year, the hospital's cost report data for the hospital's
3991 fiscal year that ended in the state fiscal year two years before the assessment fiscal year.
3992 (3) (a) If a hospital's fiscal year Medicare cost report is not contained in the CMS
3993 Healthcare Cost Report Information System file:
3994 (i) the hospital shall submit to the division a copy of the hospital's Medicare cost report
3995 applicable to the assessment year; and
3996 (ii) the division shall determine the hospital's discharges.
3997 (b) If a hospital is not certified by the Medicare program and is not required to file a
3998 Medicare cost report:
3999 (i) the hospital shall submit to the division the hospital's applicable fiscal year
4000 discharges with supporting documentation;
4001 (ii) the division shall determine the hospital's discharges from the information
4002 submitted under Subsection (3)(b)(i); and
4003 (iii) failure to submit discharge information shall result in an audit of the hospital's
4004 records and a penalty equal to 5% of the calculated assessment.
4005 (4) Except as provided in Subsection (5), if a hospital is owned by an organization that
4006 owns more than one hospital in the state:
4007 (a) the assessment for each hospital shall be separately calculated by the department;
4008 and
4009 (b) each separate hospital shall pay the assessment imposed by this [
4010 (5) If multiple hospitals use the same Medicaid provider number:
4011 (a) the department shall calculate the assessment in the aggregate for the hospitals
4012 using the same Medicaid provider number; and
4013 (b) the hospitals may pay the assessment in the aggregate.
4014 Section 92. Section 26B-3-508, which is renumbered from Section 26-36b-206 is
4015 renumbered and amended to read:
4016 [
4017 hospital mandatory intergovernmental transfer.
4018 (1) The state teaching hospital and a non-state government hospital shall make an
4019 intergovernmental transfer to the Medicaid Expansion Fund created in Section [
4020 26B-1-315, in accordance with this section.
4021 (2) The hospitals described in Subsection (1) shall pay the intergovernmental transfer
4022 beginning on the later of CMS approval of:
4023 (a) the health improvement program waiver under Section [
4024 (b) the assessment for private hospitals in this [
4025 (3) The intergovernmental transfer is apportioned as follows:
4026 (a) the state teaching hospital is responsible for:
4027 (i) 30% of the portion of the hospital share specified in Subsections [
4028 26B-3-506(1)(a) through (c); and
4029 (ii) 0% of the hospital share specified in Subsection [
4030 and
4031 (b) non-state government hospitals are responsible for:
4032 (i) 1% of the portion of the hospital share specified in Subsections [
4033 26B-3-506(1)(a) through (c); and
4034 (ii) 0% of the hospital share specified in Subsection [
4035 (4) The department shall, by rule made in accordance with Title 63G, Chapter 3, Utah
4036 Administrative Rulemaking Act, designate:
4037 (a) the method of calculating the amounts designated in Subsection (3); and
4038 (b) the schedule for the intergovernmental transfers.
4039 Section 93. Section 26B-3-509, which is renumbered from Section 26-36b-207 is
4040 renumbered and amended to read:
4041 [
4042 (1) A hospital that fails to pay a quarterly assessment, make the mandated
4043 intergovernmental transfer, or file a return as required under this [
4044 required by this [
4045 assessment or intergovernmental transfer.
4046 (2) If a hospital fails to timely pay the full amount of a quarterly assessment or the
4047 mandated intergovernmental transfer, the department shall add to the assessment or
4048 intergovernmental transfer:
4049 (a) a penalty equal to 5% of the quarterly amount not paid on or before the due date;
4050 and
4051 (b) on the last day of each quarter after the due date until the assessed amount and the
4052 penalty imposed under Subsection (2)(a) are paid in full, an additional 5% penalty on:
4053 (i) any unpaid quarterly assessment or intergovernmental transfer; and
4054 (ii) any unpaid penalty assessment.
4055 (3) Upon making a record of the division's actions, and upon reasonable cause shown,
4056 the division may waive, reduce, or compromise any of the penalties imposed under this
4057 [
4058 Section 94. Section 26B-3-510, which is renumbered from Section 26-36b-209 is
4059 renumbered and amended to read:
4060 [
4061 (1) If the health coverage improvement program, the enhancement waiver program, or
4062 the Medicaid waiver expansion is implemented by contracting with a Medicaid accountable
4063 care organization, the department shall, to the extent allowed by law, include, in a contract to
4064 provide benefits under the health coverage improvement program, the enhancement waiver
4065 program, or the Medicaid waiver expansion, a requirement that the Medicaid accountable care
4066 organization reimburse hospitals in the accountable care organization's provider network at no
4067 less than the Medicaid fee-for-service rate.
4068 (2) If the health coverage improvement program, the enhancement waiver program, or
4069 the Medicaid waiver expansion is implemented by the department as a fee-for-service program,
4070 the department shall reimburse hospitals at no less than the Medicaid fee-for-service rate.
4071 (3) Nothing in this section prohibits a Medicaid accountable care organization from
4072 paying a rate that exceeds the Medicaid fee-for-service rate.
4073 Section 95. Section 26B-3-511, which is renumbered from Section 26-36b-210 is
4074 renumbered and amended to read:
4075 [
4076 payments.
4077 (1) Beginning on the effective date of the assessment imposed under this [
4078 and for each subsequent fiscal year, the department shall implement an outpatient upper
4079 payment limit program for private hospitals that shall supplement the reimbursement to private
4080 hospitals in accordance with Subsection (2).
4081 (2) The division shall ensure that supplemental payment to Utah private hospitals
4082 under Subsection (1):
4083 (a) does not exceed the positive upper payment limit gap; and
4084 (b) is allocated based on the Medicaid state plan.
4085 (3) The department shall use the same outpatient data to allocate the payments under
4086 Subsection (2) and to calculate the upper payment limit gap.
4087 (4) The supplemental payments to private hospitals under Subsection (1) are payable
4088 for outpatient hospital services provided on or after the later of:
4089 (a) July 1, 2016;
4090 (b) the effective date of the Medicaid state plan amendment necessary to implement the
4091 payments under this section; or
4092 (c) the effective date of the coverage provided through the health coverage
4093 improvement program waiver.
4094 Section 96. Section 26B-3-512, which is renumbered from Section 26-36b-211 is
4095 renumbered and amended to read:
4096 [
4097 (1) The assessment imposed by this [
4098 (a) the executive director certifies that:
4099 (i) action by Congress is in effect that disqualifies the assessment imposed by this
4100 [
4101 amount of federal financial participation;
4102 (ii) a decision, enactment, or other determination by the Legislature or by any court,
4103 officer, department, or agency of the state, or of the federal government, is in effect that:
4104 (A) disqualifies the assessment from counting toward state Medicaid funds available to
4105 be used to determine federal financial participation for Medicaid matching funds; or
4106 (B) creates for any reason a failure of the state to use the assessments for at least one of
4107 the Medicaid programs described in this [
4108 (iii) a change is in effect that reduces the aggregate hospital inpatient and outpatient
4109 payment rate below the aggregate hospital inpatient and outpatient payment rate for July 1,
4110 2015; or
4111 (b) this [
4112 (2) If the assessment is repealed under Subsection (1):
4113 (a) the division may not collect any assessment or intergovernmental transfer under this
4114 [
4115 (b) the department shall disburse money in the special Medicaid Expansion Fund in
4116 accordance with the requirements in Subsection [
4117 federal matching is not reduced by CMS due to the repeal of the assessment;
4118 (c) any money remaining in the Medicaid Expansion Fund after the disbursement
4119 described in Subsection (2)(b) that was derived from assessments imposed by this [
4120 part shall be refunded to the hospitals in proportion to the amount paid by each hospital for the
4121 last three fiscal years; and
4122 (d) any money remaining in the Medicaid Expansion Fund after the disbursements
4123 described in Subsections (2)(b) and (c) shall be deposited into the General Fund by the end of
4124 the fiscal year that the assessment is suspended.
4125 Section 97. Section 26B-3-601, which is renumbered from Section 26-36c-102 is
4126 renumbered and amended to read:
4127
4128 [
4129 As used in this [
4130 (1) "Assessment" means the Medicaid expansion hospital assessment established by
4131 this [
4132 (2) "CMS" means the Centers for Medicare and Medicaid Services within the United
4133 States Department of Health and Human Services.
4134 (3) "Discharges" means the number of total hospital discharges reported on:
4135 (a) Worksheet S-3 Part I, column 15, lines 14, 16, and 17 of the 2552-10 Medicare cost
4136 report for the applicable assessment year; or
4137 (b) a similar report adopted by the department by administrative rule, if the report
4138 under Subsection (3)(a) is no longer available.
4139 (4) "Division" means the Division of Health Care Financing within the department.
4140 (5) "Hospital share" means the hospital share described in Section [
4141 26B-3-605.
4142 (6) "Medicaid accountable care organization" means a managed care organization, as
4143 defined in 42 C.F.R. Sec. 438, that contracts with the department under the provisions of
4144 Section [
4145 (7) "Medicaid Expansion Fund" means the Medicaid Expansion Fund created in
4146 Section [
4147 (8) "Medicaid waiver expansion" means the same as that term is defined in Section
4148 [
4149 (9) "Medicare cost report" means CMS-2552-10, the cost report for electronic filing of
4150 hospitals.
4151 (10) (a) "Non-state government hospital" means a hospital owned by a non-state
4152 government entity.
4153 (b) "Non-state government hospital" does not include:
4154 (i) the Utah State Hospital; or
4155 (ii) a hospital owned by the federal government, including the Veterans Administration
4156 Hospital.
4157 (11) (a) "Private hospital" means:
4158 (i) a privately owned general acute hospital operating in the state as defined in Section
4159 [
4160 (ii) a privately owned specialty hospital operating in the state, including a privately
4161 owned hospital for which inpatient admissions are predominantly:
4162 (A) rehabilitation;
4163 (B) psychiatric;
4164 (C) chemical dependency; or
4165 (D) long-term acute care services.
4166 (b) "Private hospital" does not include a facility for residential treatment as defined in
4167 Section [
4168 (12) "Qualified Medicaid expansion" means an expansion of the Medicaid program in
4169 accordance with Subsection [
4170 (13) "State teaching hospital" means a state owned teaching hospital that is part of an
4171 institution of higher education.
4172 Section 98. Section 26B-3-602, which is renumbered from Section 26-36c-103 is
4173 renumbered and amended to read:
4174 [
4175 (1) Other than for the imposition of the assessment described in this [
4176 nothing in this [
4177 charitable, religious, or educational health care provider under any:
4178 (a) state law;
4179 (b) ad valorem property tax requirement;
4180 (c) sales or use tax requirement; or
4181 (d) other requirements imposed by taxes, fees, or assessments, whether imposed or
4182 sought to be imposed, by the state or any political subdivision of the state.
4183 (2) A hospital paying an assessment under this [
4184 assessment as an allowable cost of a hospital for purposes of any applicable Medicaid
4185 reimbursement formula.
4186 (3) This [
4187 (a) license a hospital for revenue;
4188 (b) impose a tax or assessment upon a hospital; or
4189 (c) impose a tax or assessment measured by the income or earnings of a hospital.
4190 Section 99. Section 26B-3-603, which is renumbered from Section 26-36c-201 is
4191 renumbered and amended to read:
4192 [
4193 (1) An assessment is imposed on each private hospital:
4194 (a) beginning upon the later of:
4195 (i) April 1, 2019; and
4196 (ii) CMS approval of the assessment under this [
4197 (b) in the amount designated in Sections [
4198 26B-3-607; and
4199 (c) in accordance with Section [
4200 (2) The assessment imposed by this [
4201 with Subsection [
4202 Section 100. Section 26B-3-604, which is renumbered from Section 26-36c-202 is
4203 renumbered and amended to read:
4204 [
4205 Rulemaking.
4206 (1) The department shall act as the collecting agent for the assessment imposed under
4207 Section [
4208 (2) The department shall administer and enforce the provisions of this [
4209 and may make rules, in accordance with Title 63G, Chapter 3, Utah Administrative
4210 Rulemaking Act, necessary to:
4211 (a) collect the assessment, intergovernmental transfers, and penalties imposed under
4212 this [
4213 (b) audit records of a facility that:
4214 (i) is subject to the assessment imposed under this [
4215 (ii) does not file a Medicare cost report; and
4216 (c) select a report similar to the Medicare cost report if Medicare no longer uses a
4217 Medicare cost report.
4218 (3) The department shall:
4219 (a) administer the assessment in this part separately from the assessments in [
4220
4221 Assessment [
4222 (b) deposit assessments collected under this [
4223 Fund.
4224 (4) (a) Hospitals shall pay the quarterly assessments imposed by this [
4225 the division within 15 business days after the original invoice date that appears on the invoice
4226 issued by the division.
4227 (b) The department may make rules creating requirements to allow the time for paying
4228 the assessment to be extended.
4229 Section 101. Section 26B-3-605, which is renumbered from Section 26-36c-203 is
4230 renumbered and amended to read:
4231 [
4232 (1) The hospital share is:
4233 (a) for the period from April 1, 2019, through June 30, 2020, $15,000,000; and
4234 (b) beginning July 1, 2020, 100% of the state's net cost of the qualified Medicaid
4235 expansion, after deducting appropriate offsets and savings expected as a result of implementing
4236 the qualified Medicaid expansion, including:
4237 (i) savings from:
4238 (A) the Primary Care Network program;
4239 (B) the health coverage improvement program, as defined in Section [
4240 26B-3-207;
4241 (C) the state portion of inpatient prison medical coverage;
4242 (D) behavioral health coverage; and
4243 (E) county contributions to the non-federal share of Medicaid expenditures; and
4244 (ii) any funds appropriated to the Medicaid Expansion Fund.
4245 (2) (a) Beginning July 1, 2020, the hospital share is capped at no more than
4246 $15,000,000 annually.
4247 (b) Beginning July 1, 2020, the division shall prorate the cap specified in Subsection
4248 (2)(a) in any year in which the qualified Medicaid expansion is not in effect for the full fiscal
4249 year.
4250 Section 102. Section 26B-3-606, which is renumbered from Section 26-36c-204 is
4251 renumbered and amended to read:
4252 [
4253 (1) Private hospitals shall be assessed under this [
4254 hospital share described in Section [
4255 (2) In the report described in Subsection [
4256 shall calculate the state's net cost of the qualified Medicaid expansion.
4257 (3) If the assessment collected in the previous fiscal year is above or below the hospital
4258 share for private hospitals for the previous fiscal year, the division shall apply the
4259 underpayment or overpayment of the assessment by the private hospitals to the fiscal year in
4260 which the report is issued.
4261 Section 103. Section 26B-3-607, which is renumbered from Section 26-36c-205 is
4262 renumbered and amended to read:
4263 [
4264 (1) (a) Except as provided in Subsection (1)(b), each private hospital shall pay an
4265 annual assessment due on the last day of each quarter in an amount calculated by the division at
4266 a uniform assessment rate for each hospital discharge, in accordance with this section.
4267 (b) A private teaching hospital with more than 425 beds and more than 60 residents
4268 shall pay an assessment rate 2.5 times the uniform rate established under Subsection (1)(c).
4269 (c) The division shall calculate the uniform assessment rate described in Subsection
4270 (1)(a) by dividing the hospital share for assessed private hospitals, as described in Subsection
4271 [
4272 (i) the total number of discharges for assessed private hospitals that are not a private
4273 teaching hospital; and
4274 (ii) 2.5 times the number of discharges for a private teaching hospital, described in
4275 Subsection (1)(b).
4276 (d) The division may make rules in accordance with Title 63G, Chapter 3, Utah
4277 Administrative Rulemaking Act, to adjust the formula described in Subsection (1)(c) to address
4278 unforeseen circumstances in the administration of the assessment under this [
4279 (e) The division shall apply any quarterly changes to the uniform assessment rate
4280 uniformly to all assessed private hospitals.
4281 (2) Except as provided in Subsection (3), for each state fiscal year, the division shall
4282 determine a hospital's discharges as follows:
4283 (a) for state fiscal year 2019, the hospital's cost report data for the hospital's fiscal year
4284 ending between July 1, 2015, and June 30, 2016; and
4285 (b) for each subsequent state fiscal year, the hospital's cost report data for the hospital's
4286 fiscal year that ended in the state fiscal year two years before the assessment fiscal year.
4287 (3) (a) If a hospital's fiscal year Medicare cost report is not contained in the Centers for
4288 Medicare and Medicaid Services' Healthcare Cost Report Information System file:
4289 (i) the hospital shall submit to the division a copy of the hospital's Medicare cost report
4290 applicable to the assessment year; and
4291 (ii) the division shall determine the hospital's discharges.
4292 (b) If a hospital is not certified by the Medicare program and is not required to file a
4293 Medicare cost report:
4294 (i) the hospital shall submit to the division the hospital's applicable fiscal year
4295 discharges with supporting documentation;
4296 (ii) the division shall determine the hospital's discharges from the information
4297 submitted under Subsection (3)(b)(i); and
4298 (iii) if the hospital fails to submit discharge information, the division shall audit the
4299 hospital's records and may impose a penalty equal to 5% of the calculated assessment.
4300 (4) Except as provided in Subsection (5), if a hospital is owned by an organization that
4301 owns more than one hospital in the state:
4302 (a) the division shall calculate the assessment for each hospital separately; and
4303 (b) each separate hospital shall pay the assessment imposed by this [
4304 (5) If multiple hospitals use the same Medicaid provider number:
4305 (a) the department shall calculate the assessment in the aggregate for the hospitals
4306 using the same Medicaid provider number; and
4307 (b) the hospitals may pay the assessment in the aggregate.
4308 Section 104. Section 26B-3-608, which is renumbered from Section 26-36c-206 is
4309 renumbered and amended to read:
4310 [
4311 hospital mandatory intergovernmental transfer.
4312 (1) A state teaching hospital and a non-state government hospital shall make an
4313 intergovernmental transfer to the Medicaid Expansion Fund, in accordance with this section.
4314 (2) The hospitals described in Subsection (1) shall pay the intergovernmental transfer
4315 beginning on the later of:
4316 (a) April 1, 2019; or
4317 (b) CMS approval of the assessment for private hospitals in this [
4318 (3) The intergovernmental transfer is apportioned between the non-state government
4319 hospitals as follows:
4320 (a) the state teaching hospital shall pay for the portion of the hospital share described in
4321 Section [
4322 (b) non-state government hospitals shall pay for the portion of the hospital share
4323 described in Section [
4324 (4) The department shall, by rule made in accordance with Title 63G, Chapter 3, Utah
4325 Administrative Rulemaking Act, designate:
4326 (a) the method of calculating the amounts designated in Subsection (3); and
4327 (b) the schedule for the intergovernmental transfers.
4328 Section 105. Section 26B-3-609, which is renumbered from Section 26-36c-207 is
4329 renumbered and amended to read:
4330 [
4331 (1) A hospital that fails to pay a quarterly assessment, make the mandated
4332 intergovernmental transfer, or file a return as required under this [
4333 required by this [
4334 assessment or intergovernmental transfer.
4335 (2) If a hospital fails to timely pay the full amount of a quarterly assessment or the
4336 mandated intergovernmental transfer, the department shall add to the assessment or
4337 intergovernmental transfer:
4338 (a) a penalty equal to 5% of the quarterly amount not paid on or before the due date;
4339 and
4340 (b) on the last day of each quarter after the due date until the assessed amount and the
4341 penalty imposed under Subsection (2)(a) are paid in full, an additional 5% penalty on:
4342 (i) any unpaid quarterly assessment or intergovernmental transfer; and
4343 (ii) any unpaid penalty assessment.
4344 (3) Upon making a record of the division's actions, and upon reasonable cause shown,
4345 the division may waive or reduce any of the penalties imposed under this [
4346 Section 106. Section 26B-3-610, which is renumbered from Section 26-36c-208 is
4347 renumbered and amended to read:
4348 [
4349 (1) If the qualified Medicaid expansion is implemented by contracting with a Medicaid
4350 accountable care organization, the department shall, to the extent allowed by law, include in a
4351 contract to provide benefits under the qualified Medicaid expansion a requirement that the
4352 accountable care organization reimburse hospitals in the accountable care organization's
4353 provider network at no less than the Medicaid fee-for-service rate.
4354 (2) If the qualified Medicaid expansion is implemented by the department as a
4355 fee-for-service program, the department shall reimburse hospitals at no less than the Medicaid
4356 fee-for-service rate.
4357 (3) Nothing in this section prohibits the department or a Medicaid accountable care
4358 organization from paying a rate that exceeds the Medicaid fee-for-service rate.
4359 Section 107. Section 26B-3-611, which is renumbered from Section 26-36c-209 is
4360 renumbered and amended to read:
4361 [
4362 (1) For the first two full fiscal years that the assessment is in effect, the department
4363 shall:
4364 (a) assess private hospitals under this [
4365 (b) require the state teaching hospital to make an intergovernmental transfer under this
4366 [
4367 (c) require non-state government hospitals to make an intergovernmental transfer under
4368 this [
4369 (2) (a) At the beginning of the third full fiscal year that the assessment is in effect, and
4370 at the beginning of each subsequent fiscal year, the department may set a different percentage
4371 share for private hospitals, the state teaching hospital, and non-state government hospitals by
4372 rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, with
4373 input from private hospitals and private teaching hospitals.
4374 (b) If the department does not set a different percentage share under Subsection (2)(a),
4375 the percentage shares in Subsection (1) shall apply.
4376 Section 108. Section 26B-3-612, which is renumbered from Section 26-36c-210 is
4377 renumbered and amended to read:
4378 [
4379 (1) The department shall suspend the assessment imposed by this [
4380 the executive director certifies that:
4381 (a) action by Congress is in effect that disqualifies the assessment imposed by this
4382 [
4383 amount of federal financial participation;
4384 (b) a decision, enactment, or other determination by the Legislature or by any court,
4385 officer, department, or agency of the state, or of the federal government, is in effect that:
4386 (i) disqualifies the assessment from counting toward state Medicaid funds available to
4387 be used to determine federal financial participation for Medicaid matching funds; or
4388 (ii) creates for any reason a failure of the state to use the assessments for at least one of
4389 the Medicaid programs described in this [
4390 (c) a change is in effect that reduces the aggregate hospital inpatient and outpatient
4391 payment rate below the aggregate hospital inpatient and outpatient payment rate for July 1,
4392 2015.
4393 (2) If the assessment is suspended under Subsection (1):
4394 (a) the division may not collect any assessment or intergovernmental transfer under this
4395 [
4396 (b) the division shall disburse money in the Medicaid Expansion Fund that was derived
4397 from assessments imposed by this [
4398 Subsection [
4399 due to the repeal of the assessment; and
4400 (c) the division shall refund any money remaining in the Medicaid Expansion Fund
4401 after the disbursement described in Subsection (2)(b) that was derived from assessments
4402 imposed by this [
4403 for the last three fiscal years.
4404 Section 109. Section 26B-3-701, which is renumbered from Section 26-36d-103 is
4405 renumbered and amended to read:
4406
4407 [
4408 As used in this [
4409 (1) "Accountable care organization" means a managed care organization, as defined in
4410 42 C.F.R. Sec. 438, that contracts with the department under the provisions of Section
4411 [
4412 (2) "Assessment" means the Medicaid hospital provider assessment established by this
4413 [
4414 (3) "Discharges" means the number of total hospital discharges reported on Worksheet
4415 S-3 Part I, column 15, lines 12, 14, and 14.01 of the 2552-96 Medicare Cost Report or on
4416 Worksheet S-3 Part I, column 15, lines 14, 16, and 17 of the 2552-10 Medicare Cost Report for
4417 the applicable assessment year.
4418 (4) "Division" means the Division of Health Care Financing of the department.
4419 (5) "Hospital":
4420 (a) means a privately owned:
4421 (i) general acute hospital operating in the state as defined in Section [
4422 26B-2-201; and
4423 (ii) specialty hospital operating in the state, which shall include a privately owned
4424 hospital whose inpatient admissions are predominantly:
4425 (A) rehabilitation;
4426 (B) psychiatric;
4427 (C) chemical dependency; or
4428 (D) long-term acute care services; and
4429 (b) does not include:
4430 (i) a human services program, as defined in Section [
4431 (ii) a hospital owned by the federal government, including the Veterans Administration
4432 Hospital; or
4433 (iii) a hospital that is owned by the state government, a state agency, or a political
4434 subdivision of the state, including:
4435 (A) a state-owned teaching hospital; and
4436 (B) the Utah State Hospital.
4437 (6) "Medicare Cost Report" means CMS-2552-96 or CMS-2552-10, the cost report for
4438 electronic filing of hospitals.
4439 (7) "State plan amendment" means a change or update to the state Medicaid plan.
4440 Section 110. Section 26B-3-702, which is renumbered from Section 26-36d-102 is
4441 renumbered and amended to read:
4442 [
4443 (1) The Legislature finds that there is an important state purpose to improve the access
4444 of Medicaid patients to quality care in Utah hospitals because of continuous decreases in state
4445 revenues and increases in enrollment under the Utah Medicaid program.
4446 (2) The Legislature finds that in order to improve this access to those persons described
4447 in Subsection (1):
4448 (a) the rates paid to Utah hospitals shall be adequate to encourage and support
4449 improved access; and
4450 (b) adequate funding shall be provided to increase the rates paid to Utah hospitals
4451 providing services pursuant to the Utah Medicaid program.
4452 Section 111. Section 26B-3-703, which is renumbered from Section 26-36d-201 is
4453 renumbered and amended to read:
4454 [
4455 (1) Other than for the imposition of the assessment described in this [
4456 nothing in this [
4457 charitable, religious, or educational health care provider under:
4458 (a) Section 501(c), as amended, of the Internal Revenue Code;
4459 (b) other applicable federal law;
4460 (c) any state law;
4461 (d) any ad valorem property taxes;
4462 (e) any sales or use taxes; or
4463 (f) any other taxes, fees, or assessments, whether imposed or sought to be imposed by
4464 the state or any political subdivision, county, municipality, district, authority, or any agency or
4465 department thereof.
4466 (2) All assessments paid under this [
4467 of a hospital for purposes of any applicable Medicaid reimbursement formula.
4468 (3) This [
4469 (a) license a hospital for revenue;
4470 (b) impose a tax or assessment upon hospitals; or
4471 (c) impose a tax or assessment measured by the income or earnings of a hospital.
4472 Section 112. Section 26B-3-704, which is renumbered from Section 26-36d-202 is
4473 renumbered and amended to read:
4474 [
4475 provider assessment.
4476 (1) A uniform, broad based, assessment is imposed on each hospital as defined in
4477 Subsection [
4478 (a) in the amount designated in Section [
4479 (b) in accordance with Section [
4480 (2) (a) The assessment imposed by this [
4481 basis in accordance with Section [
4482 (b) The collecting agent for this assessment is the department which is vested with the
4483 administration and enforcement of this [
4484 administrative rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking
4485 Act, necessary to:
4486 (i) implement and enforce the provisions of this act; and
4487 (ii) audit records of a facility:
4488 (A) that is subject to the assessment imposed by this [
4489 (B) does not file a Medicare Cost Report.
4490 (c) The department shall forward proceeds from the assessment imposed by this
4491 [
4492 specified in Section [
4493 (3) The department may, by rule, extend the time for paying the assessment.
4494 Section 113. Section 26B-3-705, which is renumbered from Section 26-36d-203 is
4495 renumbered and amended to read:
4496 [
4497 (1) (a) An annual assessment is payable on a quarterly basis for each hospital in an
4498 amount calculated at a uniform assessment rate for each hospital discharge, in accordance with
4499 this section.
4500 (b) The uniform assessment rate shall be determined using the total number of hospital
4501 discharges for assessed hospitals divided into the total non-federal portion in an amount
4502 consistent with Section [
4503 accountable care organizations for purposes of hospital services provided to Medicaid
4504 enrollees.
4505 (c) Any quarterly changes to the uniform assessment rate shall be applied uniformly to
4506 all assessed hospitals.
4507 (d) The annual uniform assessment rate may not generate more than:
4508 (i) $1,000,000 to offset Medicaid mandatory expenditures; and
4509 (ii) the non-federal share to seed amounts needed to support capitated rates for
4510 accountable care organizations as provided for in Subsection (1)(b).
4511 (2) (a) For each state fiscal year, discharges shall be determined using the data from
4512 each hospital's Medicare Cost Report contained in the Centers for Medicare and Medicaid
4513 Services' Healthcare Cost Report Information System file. The hospital's discharge data will be
4514 derived as follows:
4515 (i) for state fiscal year 2013, the hospital's cost report data for the hospital's fiscal year
4516 ending between July 1, 2009, and June 30, 2010;
4517 (ii) for state fiscal year 2014, the hospital's cost report data for the hospital's fiscal year
4518 ending between July 1, 2010, and June 30, 2011;
4519 (iii) for state fiscal year 2015, the hospital's cost report data for the hospital's fiscal year
4520 ending between July 1, 2011, and June 30, 2012;
4521 (iv) for state fiscal year 2016, the hospital's cost report data for the hospital's fiscal year
4522 ending between July 1, 2012, and June 30, 2013; and
4523 (v) for each subsequent state fiscal year, the hospital's cost report data for the hospital's
4524 fiscal year that ended in the state fiscal year two years prior to the assessment fiscal year.
4525 (b) If a hospital's fiscal year Medicare Cost Report is not contained in the Centers for
4526 Medicare and Medicaid Services' Healthcare Cost Report Information System file:
4527 (i) the hospital shall submit to the division a copy of the hospital's Medicare Cost
4528 Report applicable to the assessment year; and
4529 (ii) the division shall determine the hospital's discharges.
4530 (c) If a hospital is not certified by the Medicare program and is not required to file a
4531 Medicare Cost Report:
4532 (i) the hospital shall submit to the division its applicable fiscal year discharges with
4533 supporting documentation;
4534 (ii) the division shall determine the hospital's discharges from the information
4535 submitted under Subsection (2)(c)(i); and
4536 (iii) the failure to submit discharge information shall result in an audit of the hospital's
4537 records and a penalty equal to 5% of the calculated assessment.
4538 (3) Except as provided in Subsection (4), if a hospital is owned by an organization that
4539 owns more than one hospital in the state:
4540 (a) the assessment for each hospital shall be separately calculated by the department;
4541 and
4542 (b) each separate hospital shall pay the assessment imposed by this [
4543 (4) Notwithstanding the requirement of Subsection (3), if multiple hospitals use the
4544 same Medicaid provider number:
4545 (a) the department shall calculate the assessment in the aggregate for the hospitals
4546 using the same Medicaid provider number; and
4547 (b) the hospitals may pay the assessment in the aggregate.
4548 Section 114. Section 26B-3-706, which is renumbered from Section 26-36d-204 is
4549 renumbered and amended to read:
4550 [
4551 Quarterly assessments imposed by this [
4552 15 business days after the original invoice date that appears on the invoice issued by the
4553 division.
4554 Section 115. Section 26B-3-707, which is renumbered from Section 26-36d-205 is
4555 renumbered and amended to read:
4556 [
4557 care organization rates.
4558 To preserve and improve access to hospital services, the division shall, for accountable
4559 care organization rates effective on or after April 1, 2013, incorporate into the accountable care
4560 organization rate structure calculation consistent with the certified actuarial rate range:
4561 (1) $154,000,000 to be allocated toward the hospital inpatient directed payments for
4562 the Medicaid eligibility categories covered in Utah before January 1, 2019; and
4563 (2) an amount equal to the difference between payments made to hospitals by
4564 accountable care organizations for the Medicaid eligibility categories covered in Utah before
4565 January 1, 2019, based on submitted encounter data and the maximum amount that could be
4566 paid for those services using Medicare payment principles to be used for directed payments to
4567 hospitals for outpatient services.
4568 Section 116. Section 26B-3-708, which is renumbered from Section 26-36d-206 is
4569 renumbered and amended to read:
4570 [
4571 (1) A facility that fails to pay any assessment or file a return as required under this
4572 [
4573 assessment, penalties and interest established by the department.
4574 (2) (a) Consistent with Subsection (2)(b), the department shall adopt rules in
4575 accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, which establish
4576 reasonable penalties and interest for the violations described in Subsection (1).
4577 (b) If a hospital fails to timely pay the full amount of a quarterly assessment, the
4578 department shall add to the assessment:
4579 (i) a penalty equal to 5% of the quarterly amount not paid on or before the due date;
4580 and
4581 (ii) on the last day of each quarter after the due date until the assessed amount and the
4582 penalty imposed under Subsection (2)(b)(i) are paid in full, an additional 5% penalty on:
4583 (A) any unpaid quarterly assessment; and
4584 (B) any unpaid penalty assessment.
4585 (c) Upon making a record of its actions, and upon reasonable cause shown, the division
4586 may waive, reduce, or compromise any of the penalties imposed under this part.
4587 Section 117. Section 26B-3-709, which is renumbered from Section 26-36d-208 is
4588 renumbered and amended to read:
4589 [
4590 (1) The repeal of the assessment imposed by this [
4591 certification by the executive director of the department that the sooner of the following has
4592 occurred:
4593 (a) the effective date of any action by Congress that would disqualify the assessment
4594 imposed by this [
4595 to determine the federal financial participation;
4596 (b) the effective date of any decision, enactment, or other determination by the
4597 Legislature or by any court, officer, department, or agency of the state, or of the federal
4598 government that has the effect of:
4599 (i) disqualifying the assessment from counting towards state Medicaid funds available
4600 to be used to determine federal financial participation for Medicaid matching funds; or
4601 (ii) creating for any reason a failure of the state to use the assessments for the Medicaid
4602 program as described in this [
4603 (c) the effective date of:
4604 (i) an appropriation for any state fiscal year from the General Fund for hospital
4605 payments under the state Medicaid program that is less than the amount appropriated for state
4606 fiscal year 2012;
4607 (ii) the annual revenues of the state General Fund budget return to the level that was
4608 appropriated for fiscal year 2008;
4609 (iii) a division change in rules that reduces any of the following below July 1, 2011,
4610 payments:
4611 (A) aggregate hospital inpatient payments;
4612 (B) adjustment payment rates; or
4613 (C) any cost settlement protocol; or
4614 (iv) a division change in rules that reduces the aggregate outpatient payments below
4615 July 1, 2011, payments; and
4616 (d) the sunset of this [
4617 (2) If the assessment is repealed under Subsection (1), money in the fund that was
4618 derived from assessments imposed by this [
4619 Subsection (1), shall be disbursed under Section [
4620 matching is not reduced due to the impermissibility of the assessments. Any funds remaining in
4621 the special revenue fund shall be refunded to the hospitals in proportion to the amount paid by
4622 each hospital.
4623 Section 118. Section 26B-3-801, which is renumbered from Section 26-37a-102 is
4624 renumbered and amended to read:
4625
4626 [
4627 As used in this [
4628 (1) "Ambulance service provider" means:
4629 (a) an ambulance provider as defined in Section [
4630 (b) a non-911 service provider as defined in Section [
4631 (2) "Assessment" means the Medicaid ambulance service provider assessment
4632 established by this [
4633 (3) "Division" means the Division of Health Care Financing within the department.
4634 (4) "Non-federal portion" means the non-federal share the division needs to seed
4635 amounts that will support fee-for-service ambulance service provider rates, as described in
4636 Section [
4637 (5) "Total transports" means the number of total ambulance transports applicable to a
4638 given fiscal year, as determined under Subsection [
4639 Section 119. Section 26B-3-802, which is renumbered from Section 26-37a-103 is
4640 renumbered and amended to read:
4641 [
4642 ambulance service provider assessment.
4643 (1) An ambulance service provider shall pay an assessment to the division:
4644 (a) in the amount designated in Section [
4645 (b) in accordance with this [
4646 (c) quarterly, on a day determined by the division by rule made under Subsection
4647 (2)(b); and
4648 (d) no more than 15 business days after the day on which the division issues the
4649 ambulance service provider notice of the assessment.
4650 (2) The division shall:
4651 (a) collect the assessment described in Subsection (1);
4652 (b) determine, by rule made in accordance with Title 63G, Chapter 3, Utah
4653 Administrative Rulemaking Act, standards and procedures for implementing and enforcing the
4654 provisions of this [
4655 (c) transfer assessment proceeds to the state treasurer for deposit into the Ambulance
4656 Service Provider Assessment Expendable Revenue Fund created in Section [
4657 26B-1-317.
4658 Section 120. Section 26B-3-803, which is renumbered from Section 26-37a-104 is
4659 renumbered and amended to read:
4660 [
4661 (1) The division shall calculate a uniform assessment per transport as described in this
4662 section.
4663 (2) The assessment due from a given ambulance service provider equals the
4664 non-federal portion divided by total transports, multiplied by the number of transports for the
4665 ambulance service provider.
4666 (3) The division shall apply any quarterly changes to the assessment rate, calculated as
4667 described in Subsection (2), uniformly to all assessed ambulance service providers.
4668 (4) The assessment may not generate more than the total of:
4669 (a) an annual amount of $20,000 to offset Medicaid administration expenses; and
4670 (b) the non-federal portion.
4671 (5) (a) For each state fiscal year, the division shall calculate total transports using data
4672 from the Emergency Medical System as follows:
4673 (i) for state fiscal year 2016, the division shall use ambulance service provider
4674 transports during the 2014 calendar year; and
4675 (ii) for a fiscal year after 2016, the division shall use ambulance service provider
4676 transports during the calendar year ending 18 months before the end of the fiscal year.
4677 (b) If an ambulance service provider fails to submit transport information to the
4678 Emergency Medical System, the division may audit the ambulance service provider to
4679 determine the ambulance service provider's transports for a given fiscal year.
4680 Section 121. Section 26B-3-804, which is renumbered from Section 26-37a-105 is
4681 renumbered and amended to read:
4682 [
4683 under fee-for-service rates.
4684 The division shall, if the assessment imposed by this [
4685 Centers for Medicare and Medicaid Services, for fee-for-service rates effective on or after July
4686 1, 2015, reimburse an ambulance service provider in an amount up to the Emergency Medical
4687 Services Ambulance Rates adopted annually by the department.
4688 Section 122. Section 26B-3-805, which is renumbered from Section 26-37a-106 is
4689 renumbered and amended to read:
4690 [
4691 The division shall require an ambulance service provider that fails to pay an assessment
4692 due under this [
4693 determined by the division by rule made in accordance with Title 63G, Chapter 3, Utah
4694 Administrative Rulemaking Act.
4695 Section 123. Section 26B-3-806, which is renumbered from Section 26-37a-108 is
4696 renumbered and amended to read:
4697 [
4698 (1) This [
4699 department, any of the following occurs:
4700 (a) an action by Congress that disqualifies the assessment imposed by this [
4701 part from state Medicaid funds available to be used to determine the federal financial
4702 participation takes legal effect; or
4703 (b) an action, decision, enactment, or other determination by the Legislature or by any
4704 court, officer, department, or agency of the state or federal government takes effect that:
4705 (i) disqualifies the assessment from counting toward state Medicaid funds available to
4706 be used to determine federal financial participation for Medicaid matching funds; or
4707 (ii) creates for any reason a failure of the state to use the assessments for the Medicaid
4708 program as described in this [
4709 (2) If this [
4710 (a) money in the Ambulance Service Provider Assessment Expendable Revenue Fund
4711 that was derived from assessments imposed by this [
4712 determination made under Subsection (1), shall be disbursed under Section [
4713 26B-1-317 to the extent federal matching is not reduced due to the impermissibility of the
4714 assessments; and
4715 (b) any funds remaining in the special revenue fund shall be refunded to each
4716 ambulance service provider in proportion to the amount paid by the ambulance service
4717 provider.
4718 Section 124. Section 26B-3-901, which is renumbered from Section 26-40-102 is
4719 renumbered and amended to read:
4720
4721 [
4722 As used in this [
4723 (1) "Child" means [
4724 younger than 19 years old.
4725 (2) "Eligible child" means a child who qualifies for enrollment in the program as
4726 provided in Section [
4727 (3) "Member" means a child enrolled in the program.
4728 (4) "Plan" means the department's plan submitted to the United States Department of
4729 Health and Human Services pursuant to 42 U.S.C. Sec. 1397ff.
4730 (5) "Program" means the Utah Children's Health Insurance Program created by this
4731 [
4732 Section 125. Section 26B-3-902, which is renumbered from Section 26-40-103 is
4733 renumbered and amended to read:
4734 [
4735 Children's Health Insurance Program.
4736 (1) There is created the Utah Children's Health Insurance Program to be administered
4737 by the department in accordance with the provisions of:
4738 (a) this [
4739 (b) the State Children's Health Insurance Program, 42 U.S.C. Sec. 1397aa et seq.
4740 (2) The department shall:
4741 (a) prepare and submit the state's children's health insurance plan before May 1, 1998,
4742 and any amendments to the federal Department of Health and Human Services in accordance
4743 with 42 U.S.C. Sec. 1397ff; and
4744 (b) make rules in accordance with Title 63G, Chapter 3, Utah Administrative
4745 Rulemaking Act, regarding:
4746 (i) eligibility requirements consistent with Section [
4747 (ii) program benefits;
4748 (iii) the level of coverage for each program benefit;
4749 (iv) cost-sharing requirements for members, which may not:
4750 (A) exceed the guidelines set forth in 42 U.S.C. Sec. 1397ee; or
4751 (B) impose deductible, copayment, or coinsurance requirements on a member for
4752 well-child, well-baby, and immunizations;
4753 (v) the administration of the program; and
4754 (vi) a requirement that:
4755 (A) members in the program shall participate in the electronic exchange of clinical
4756 health records established in accordance with Section [
4757 opts out of participation;
4758 (B) prior to enrollment in the electronic exchange of clinical health records the member
4759 shall receive notice of the enrollment in the electronic exchange of clinical health records and
4760 the right to opt out of participation at any time; and
4761 (C) beginning July 1, 2012, when the program sends enrollment or renewal information
4762 to the member and when the member logs onto the program's website, the member shall
4763 receive notice of the right to opt out of the electronic exchange of clinical health records.
4764 Section 126. Section 26B-3-903, which is renumbered from Section 26-40-105 is
4765 renumbered and amended to read:
4766 [
4767 (1) A child is eligible to enroll in the program if the child:
4768 (a) is a bona fide Utah resident;
4769 (b) is a citizen or legal resident of the United States;
4770 (c) is under 19 years of age;
4771 (d) does not have access to or coverage under other health insurance, including any
4772 coverage available through a parent or legal guardian's employer;
4773 (e) is ineligible for Medicaid benefits;
4774 (f) resides in a household whose gross family income, as defined by rule, is at or below
4775 200% of the federal poverty level; and
4776 (g) is not an inmate of a public institution or a patient in an institution for mental
4777 diseases.
4778 (2) A child who qualifies for enrollment in the program under Subsection (1) may not
4779 be denied enrollment due to a diagnosis or pre-existing condition.
4780 (3) (a) The department shall determine eligibility and send notification of the eligibility
4781 decision within 30 days after receiving the application for coverage.
4782 (b) If the department cannot reach a decision because the applicant fails to take a
4783 required action, or because there is an administrative or other emergency beyond the
4784 department's control, the department shall:
4785 (i) document the reason for the delay in the applicant's case record; and
4786 (ii) inform the applicant of the status of the application and time frame for completion.
4787 (4) The department may not close enrollment in the program for a child who is eligible
4788 to enroll in the program under the provisions of Subsection (1).
4789 (5) The program shall:
4790 (a) apply for grants to make technology system improvements necessary to implement
4791 a simplified enrollment and renewal process in accordance with Subsection (5)(b); and
4792 (b) if funding is available, implement a simplified enrollment and renewal process.
4793 Section 127. Section 26B-3-904, which is renumbered from Section 26-40-106 is
4794 renumbered and amended to read:
4795 [
4796 (1) Except as provided in Subsection (3), medical and dental program benefits shall be
4797 benchmarked, in accordance with 42 U.S.C. Sec. 1397cc, as follows:
4798 (a) medical program benefits, including behavioral health care benefits, shall be
4799 benchmarked effective July 1, 2019, and on July 1 every third year thereafter, to:
4800 (i) be substantially equal to a health benefit plan with the largest insured commercial
4801 enrollment offered by a health maintenance organization in the state; and
4802 (ii) comply with the Mental Health Parity and Addiction Equity Act, Pub. L. No.
4803 110-343; and
4804 (b) dental program benefits shall be benchmarked effective July 1, 2019, and on July 1
4805 every third year thereafter in accordance with the Children's Health Insurance Program
4806 Reauthorization Act of 2009, to be substantially equal to a dental benefit plan that has the
4807 largest insured, commercial, non-Medicaid enrollment of covered lives that is offered in the
4808 state, except that the utilization review mechanism for orthodontia shall be based on medical
4809 necessity.
4810 (2) On or before July 1 of each year, the department shall publish the benchmark for
4811 dental program benefits established under Subsection (1)(b).
4812 (3) The program benefits:
4813 (a) for enrollees who are at or below 100% of the federal poverty level are exempt
4814 from the benchmark requirements of Subsections (1) and (2); and
4815 (b) shall include treatment for autism spectrum disorder as defined in Section
4816 31A-22-642, which:
4817 (i) shall include coverage for applied behavioral analysis; and
4818 (ii) if the benchmark described in Subsection (1)(a) does not include the coverage
4819 described in this Subsection (3)(b), the department shall exclude from the benchmark described
4820 in Subsection (1)(a) for any purpose other than providing benefits under the program.
4821 Section 128. Section 26B-3-905, which is renumbered from Section 26-40-107 is
4822 renumbered and amended to read:
4823 [
4824 Abortion is not a covered benefit, except as provided in 42 U.S.C. Sec. 1397ee.
4825 Section 129. Section 26B-3-906, which is renumbered from Section 26-40-108 is
4826 renumbered and amended to read:
4827 [
4828 (1) The program shall be funded by federal matching funds received under, together
4829 with state matching funds required by, 42 U.S.C. Sec. 1397ee.
4830 (2) Program expenditures in the following categories may not exceed 10% in the
4831 aggregate of all federal payments pursuant to 42 U.S.C. Sec. 1397ee:
4832 (a) other forms of child health assistance for children with gross family incomes below
4833 200% of the federal poverty level;
4834 (b) other health services initiatives to improve low-income children's health;
4835 (c) outreach program expenditures; and
4836 (d) administrative costs.
4837 Section 130. Section 26B-3-907, which is renumbered from Section 26-40-109 is
4838 renumbered and amended to read:
4839 [
4840 The department shall develop performance measures and annually evaluate the
4841 program's performance.
4842 Section 131. Section 26B-3-908, which is renumbered from Section 26-40-110 is
4843 renumbered and amended to read:
4844 [
4845 (1) Program benefits provided to a member under the program, as described in Section
4846 [
4847 determines that adequate services are available where the member lives or resides.
4848 (2) The department may contract with a managed care organization to provide program
4849 benefits. The department shall evaluate a potential contract with a managed care organization
4850 based on:
4851 (a) the managed care organization's:
4852 (i) ability to manage medical expenses, including mental health costs;
4853 (ii) proven ability to handle accident and health insurance;
4854 (iii) efficiency of claim paying procedures;
4855 (iv) proven ability for managed care and quality assurance;
4856 (v) provider contracting and discounts;
4857 (vi) pharmacy benefit management;
4858 (vii) estimated total charges for administering the pool;
4859 (viii) ability to administer the pool in a cost-efficient manner;
4860 (ix) ability to provide adequate providers and services in the state; and
4861 (x) ability to meet quality measures for emergency room use and access to primary care
4862 established by the department under Subsection [
4863 (b) other factors established by the department.
4864 (3) The department may enter into separate managed care organization contracts to
4865 provide dental benefits required by Section [
4866 (4) The department's contract with a managed care organization for the program's
4867 benefits shall include risk sharing provisions in which the plan shall accept at least 75% of the
4868 risk for any difference between the department's premium payments per member and actual
4869 medical expenditures.
4870 (5) (a) The department may contract with the Group Insurance Division within the
4871 Utah State Retirement Office to provide services under Subsection (1) if no managed care
4872 organization is willing to contract with the department or the department determines no
4873 managed care organization meets the criteria established under Subsection (2).
4874 (b) In accordance with Section 49-20-201, a contract awarded under Subsection (5)(a)
4875 is not subject to the risk sharing required by Subsection (4).
4876 Section 132. Section 26B-3-909, which is renumbered from Section 26-40-115 is
4877 renumbered and amended to read:
4878 [
4879 health benefit plan coverage.
4880 (1) For purposes of Sections 17B-2a-818.5, 19-1-206, 63A-5b-607, 63C-9-403,
4881 72-6-107.5, and 79-2-404, "qualified health coverage" means, at the time the contract is entered
4882 into or renewed:
4883 (a) a health benefit plan and employer contribution level with a combined actuarial
4884 value at least actuarially equivalent to the combined actuarial value of:
4885 (i) the benchmark plan determined by the program under Subsection [
4886 26B-3-904(1)(a); and
4887 (ii) a contribution level at which the employer pays at least 50% of the premium or
4888 contribution amounts for the employee and the dependents of the employee who reside or work
4889 in the state; or
4890 (b) a federally qualified high deductible health plan that, at a minimum:
4891 (i) has a deductible that is:
4892 (A) the lowest deductible permitted for a federally qualified high deductible health
4893 plan; or
4894 (B) a deductible that is higher than the lowest deductible permitted for a federally
4895 qualified high deductible health plan, but includes an employer contribution to a health savings
4896 account in a dollar amount at least equal to the dollar amount difference between the lowest
4897 deductible permitted for a federally qualified high deductible plan and the deductible for the
4898 employer offered federally qualified high deductible plan;
4899 (ii) has an out-of-pocket maximum that does not exceed three times the amount of the
4900 annual deductible; and
4901 (iii) provides that the employer pays 60% of the premium or contribution amounts for
4902 the employee and the dependents of the employee who work or reside in the state.
4903 (2) The department shall:
4904 (a) on or before July 1, 2016:
4905 (i) determine the commercial equivalent of the benchmark plan described in Subsection
4906 (1)(a); and
4907 (ii) post the commercially equivalent benchmark plan described in Subsection (2)(a)(i)
4908 on the department's website, noting the date posted; and
4909 (b) update the posted commercially equivalent benchmark plan annually and at the
4910 time of any change in the benchmark.
4911 Section 133. Section 26B-3-1001, which is renumbered from Section 26-19-102 is
4912 renumbered and amended to read:
4913
4914 [
4915 As used in this [
4916 (1) "Annuity" shall have the same meaning as provided in Section 31A-1-301.
4917 (2) "Care facility" means:
4918 (a) a nursing facility;
4919 (b) an intermediate care facility for an individual with an intellectual disability; or
4920 (c) any other medical institution.
4921 (3) "Claim" means:
4922 (a) a request or demand for payment; or
4923 (b) a cause of action for money or damages arising under any law.
4924 (4) "Employee welfare benefit plan" means a medical insurance plan developed by an
4925 employer under 29 U.S.C. [
4926 Security Act of 1974 as amended.
4927 (5) "Health insurance entity" means:
4928 (a) an insurer;
4929 (b) a person who administers, manages, provides, offers, sells, carries, or underwrites
4930 health insurance, as defined in Section 31A-1-301;
4931 (c) a self-insured plan;
4932 (d) a group health plan, as defined in Subsection 607(1) of the federal Employee
4933 Retirement Income Security Act of 1974;
4934 (e) a service benefit plan;
4935 (f) a managed care organization;
4936 (g) a pharmacy benefit manager;
4937 (h) an employee welfare benefit plan; or
4938 (i) a person who is, by statute, contract, or agreement, legally responsible for payment
4939 of a claim for a health care item or service.
4940 (6) "Inpatient" means an individual who is a patient and a resident of a care facility.
4941 (7) "Insurer" includes:
4942 (a) a group health plan as defined in Subsection 607(1) of the federal Employee
4943 Retirement Income Security Act of 1974;
4944 (b) a health maintenance organization; and
4945 (c) any entity offering a health service benefit plan.
4946 (8) "Medical assistance" means:
4947 (a) all funds expended for the benefit of a recipient under Title 26, Chapter 18, Medical
4948 Assistance Act, or under Titles XVIII and XIX, federal Social Security Act; and
4949 (b) any other services provided for the benefit of a recipient by a prepaid health care
4950 delivery system under contract with the department.
4951 (9) "Office of Recovery Services" means the Office of Recovery Services within the
4952 [
4953 (10) "Provider" means a person or entity who provides services to a recipient.
4954 (11) "Recipient" means:
4955 (a) an individual who has applied for or received medical assistance from the state;
4956 (b) the guardian, conservator, or other personal representative of an individual under
4957 Subsection (11)(a) if the individual is a minor or an incapacitated person; or
4958 (c) the estate and survivors of an individual under Subsection (11)(a), if the individual
4959 is deceased.
4960 (12) "Recovery estate" means, regarding a deceased recipient:
4961 (a) all real and personal property or other assets included within a decedent's estate as
4962 defined in Section 75-1-201;
4963 (b) the decedent's augmented estate as defined in Section 75-2-203; and
4964 (c) that part of other real or personal property in which the decedent had a legal interest
4965 at the time of death including assets conveyed to a survivor, heir, or assign of the decedent
4966 through joint tenancy, tenancy in common, survivorship, life estate, living trust, or other
4967 arrangement.
4968 (13) "State plan" means the state Medicaid program as enacted in accordance with Title
4969 XIX, federal Social Security Act.
4970 (14) "TEFRA lien" means a lien, authorized under the Tax Equity and Fiscal
4971 Responsibility Act of 1982, against the real property of an individual prior to the individual's
4972 death, as described in 42 U.S.C. Sec. 1396p.
4973 (15) "Third party" includes:
4974 (a) an individual, institution, corporation, public or private agency, trust, estate,
4975 insurance carrier, employee welfare benefit plan, health maintenance organization, health
4976 service organization, preferred provider organization, governmental program such as Medicare,
4977 CHAMPUS, and workers' compensation, which may be obligated to pay all or part of the
4978 medical costs of injury, disease, or disability of a recipient, unless any of these are excluded by
4979 department rule; and
4980 (b) a spouse or a parent who:
4981 (i) may be obligated to pay all or part of the medical costs of a recipient under law or
4982 by court or administrative order; or
4983 (ii) has been ordered to maintain health, dental, or accident and health insurance to
4984 cover medical expenses of a spouse or dependent child by court or administrative order.
4985 (16) "Trust" shall have the same meaning as provided in Section 75-1-201.
4986 Section 134. Section 26B-3-1002, which is renumbered from Section 26-19-103 is
4987 renumbered and amended to read:
4988 [
4989 Promulgation of rules.
4990 (1) The department shall establish and maintain a program for the recoupment of
4991 medical assistance.
4992 (2) The department may promulgate rules to implement the purposes of this [
4993 part.
4994 Section 135. Section 26B-3-1003, which is renumbered from Section 26-19-201 is
4995 renumbered and amended to read:
4996 [
4997 (1) (a) Except as provided in Subsection [
4998 medical assistance is actually provided to a recipient, all benefits for medical services or
4999 payments from a third-party otherwise payable to or on behalf of a recipient are assigned by
5000 operation of law to the department if the department provides, or becomes obligated to provide,
5001 medical assistance, regardless of who made application for the benefits on behalf of the
5002 recipient.
5003 (b) The assignment:
5004 (i) authorizes the department to submit its claim to the third-party and authorizes
5005 payment of benefits directly to the department; and
5006 (ii) is effective for all medical assistance.
5007 (2) The department may recover the assigned benefits or payments in accordance with
5008 Section [
5009 (3) (a) The assignment of benefits includes medical support and third-party payments
5010 ordered, decreed, or adjudged by any court of this state or any other state or territory of the
5011 United States.
5012 (b) The assignment is not in lieu of, and does not supersede or alter any other court
5013 order, decree, or judgment.
5014 (4) When an assignment takes effect, the recipient is entitled to receive medical
5015 assistance, and the benefits paid to the department are a reimbursement to the department.
5016 Section 136. Section 26B-3-1004, which is renumbered from Section 26-19-301 is
5017 renumbered and amended to read:
5018 [
5019 claims for Medicaid payment or recovery.
5020 As a condition of doing business in the state, a health insurance entity shall:
5021 (1) with respect to an individual who is eligible for, or is provided, medical assistance
5022 under the state plan, upon the request of the [
5023 information to determine:
5024 (a) during what period the individual, or the spouse or dependent of the individual, may
5025 be or may have been, covered by the health insurance entity; and
5026 (b) the nature of the coverage that is or was provided by the health insurance entity
5027 described in Subsection (1)(a), including the name, address, and identifying number of the
5028 plan;
5029 (2) accept the state's right of recovery and the assignment to the state of any right of an
5030 individual to payment from a party for an item or service for which payment has been made
5031 under the state plan;
5032 (3) respond to any inquiry by the [
5033 for payment for any health care item or service that is submitted no later than three years after
5034 the day on which the health care item or service is provided; and
5035 (4) not deny a claim submitted by the [
5036 basis of the date of submission of the claim, the type or format of the claim form, or failure to
5037 present proper documentation at the point-of-sale that is the basis for the claim, if:
5038 (a) the claim is submitted no later than three years after the day on which the item or
5039 service is furnished; and
5040 (b) any action by the [
5041 state with respect to the claim is commenced no later than six years after the day on which the
5042 claim is submitted.
5043 Section 137. Section 26B-3-1005, which is renumbered from Section 26-19-302 is
5044 renumbered and amended to read:
5045 [
5046 of individuals eligible for state medical assistance -- Exemptions.
5047 (1) A policy of accident or sickness insurance may not contain any provision denying
5048 or reducing benefits because services are rendered to an insured or dependent who is eligible
5049 for or receiving medical assistance from the state.
5050 (2) An association, corporation, or organization may not deliver, issue for delivery, or
5051 renew any subscriber's contract which contains any provisions denying or reducing benefits
5052 because services are rendered to a subscriber or dependent who is eligible for or receiving
5053 medical assistance from the state.
5054 (3) An association, corporation, business, or organization authorized to do business in
5055 this state and which provides or pays for any health care benefits may not deny or reduce
5056 benefits because services are rendered to a beneficiary who is eligible for or receiving medical
5057 assistance from the state.
5058 (4) Notwithstanding Subsection (1), (2), or (3), the Utah State Public Employees'
5059 Health Program, administered by the Utah State Retirement Board, is not required to reimburse
5060 any agency of state government for custodial care which the agency provides, through its staff
5061 or facilities, to members of the Utah State Public Employees' Health Program.
5062 Section 138. Section 26B-3-1006, which is renumbered from Section 26-19-303 is
5063 renumbered and amended to read:
5064 [
5065 If the third party does not pay the department's claim or lien within 30 days from the
5066 date the claim or lien is received, the third party shall:
5067 (1) provide a written explanation if the claim is denied;
5068 (2) specifically describe and request any additional information from the department
5069 that is necessary to process the claim; and
5070 (3) provide the department or its agent a copy of any relevant or applicable insurance
5071 or benefit policy.
5072 Section 139. Section 26B-3-1007, which is renumbered from Section 26-19-304 is
5073 renumbered and amended to read:
5074 [
5075 As allowed pursuant to 29 U.S.C. [
5076 not include any provision that has the effect of limiting or excluding coverage or payment for
5077 any health care for an individual who would otherwise be covered or entitled to benefits or
5078 services under the terms of the employee benefit plan based on the fact that the individual is
5079 eligible for or is provided services under the state plan.
5080 Section 140. Section 26B-3-1008, which is renumbered from Section 26-19-305 is
5081 renumbered and amended to read:
5082 [
5083 action -- Insurance policy not to limit time allowed for recovery.
5084 (1) (a) Subject to Subsection (6), action commenced by the department under this
5085 [
5086 (i) subject to Subsection (7), six years after the day on which the department submits
5087 the claim for recovery or payment for the health care item or service upon which the action is
5088 based; or
5089 (ii) six months after the date of the last payment for medical assistance, whichever is
5090 later.
5091 (b) An action against any other third party, the recipient, or anyone to whom the
5092 proceeds are payable shall be commenced within:
5093 (i) four years after the date of the injury or onset of the illness; or
5094 (ii) six months after the date of the last payment for medical assistance, whichever is
5095 later.
5096 (2) The death of the recipient does not abate any right of action established by this
5097 [
5098 (3) (a) No insurance policy issued or renewed after June 1, 1981, may contain any
5099 provision that limits the time in which the department may submit its claim to recover medical
5100 assistance benefits to a period of less than 24 months from the date the provider furnishes
5101 services or goods to the recipient.
5102 (b) No insurance policy issued or renewed after April 30, 2007, may contain any
5103 provision that limits the time in which the department may submit its claim to recover medical
5104 assistance benefits to a period of less than that described in Subsection (1)(a).
5105 (4) The provisions of this section do not apply to Section [
5106
5107 (5) The provisions of this section supercede any other sections regarding the time limit
5108 in which an action shall be commenced, including Section 75-7-509.
5109 (6) (a) Subsection (1)(a) extends the statute of limitations on a cause of action
5110 described in Subsection (1)(a) that was not time-barred on or before April 30, 2007.
5111 (b) Subsection (1)(a) does not revive a cause of action that was time-barred on or
5112 before April 30, 2007.
5113 (7) An action described in Subsection (1)(a) may not be commenced if the claim for
5114 recovery or payment described in Subsection (1)(a)(i) is submitted later than three years after
5115 the day on which the health care item or service upon which the claim is based was provided.
5116 Section 141. Section 26B-3-1009, which is renumbered from Section 26-19-401 is
5117 renumbered and amended to read:
5118 [
5119 -- Lien -- Notice -- Action -- Compromise or waiver -- Recipient's right to action
5120 protected.
5121 (1) (a) Except as provided in Subsection (1)(c), if the department provides or becomes
5122 obligated to provide medical assistance to a recipient that a third-party is obligated to pay for,
5123 the department may recover the medical assistance directly from the third-party.
5124 (b) (i) A claim under Subsection (1)(a) or Section [
5125 medical assistance provided to a recipient is a lien against any proceeds payable to or on behalf
5126 of the recipient by the third-party.
5127 (ii) The lien described in Subsection (1)(b)(i) has priority over all other claims to the
5128 proceeds, except claims for attorney fees and costs authorized under Subsection [
5129 26B-3-1011(2)(c)(ii).
5130 (c) (i) The department may not recover medical assistance under Subsection (1)(a) if:
5131 (A) the third-party is obligated to pay the recipient for an injury to the recipient's child
5132 that occurred while the child was in the physical custody of the child's foster parent;
5133 (B) the child's injury is a physical or mental impairment that requires ongoing medical
5134 attention, or limits activities of daily living, for at least one year;
5135 (C) the third-party's payment to the recipient is placed in a trust, annuity, financial
5136 account, or other financial instrument for the benefit of the child; and
5137 (D) the recipient makes reasonable efforts to mitigate any other medical assistance
5138 costs for the recipient to the state.
5139 (ii) The department is responsible for any repayment to the federal government related
5140 to the medical assistance the department is prohibited from recovering under Subsection
5141 (1)(c)(i).
5142 (2) (a) The department shall mail or deliver written notice of the department's claim or
5143 lien to the third-party at the third-party's principal place of business or last-known address.
5144 (b) The notice shall include:
5145 (i) the recipient's name;
5146 (ii) the approximate date of illness or injury;
5147 (iii) a general description of the type of illness or injury; and
5148 (iv) if applicable, the general location where the injury is alleged to have occurred.
5149 (3) The department may commence an action on the department's claim or lien in the
5150 department's name, but the claim or lien is not enforceable as to a third-party unless:
5151 (a) the third-party receives written notice of the department's claim or lien before the
5152 third-party settles with the recipient; or
5153 (b) the department has evidence that the third party had knowledge that the department
5154 provided or was obligated to provide medical assistance.
5155 (4) The department may:
5156 (a) waive a claim or lien against a third party in whole or in part; or
5157 (b) compromise, settle, or release a claim or lien.
5158 (5) An action commenced under this section does not bar an action by a recipient or a
5159 dependent of a recipient for loss or damage not included in the department's action.
5160 (6) Except as provided in Subsection (1)(c), the department's claim or lien on proceeds
5161 under this section is not affected by the transfer of the proceeds to a trust, annuity, financial
5162 account, or other financial instrument.
5163 Section 142. Section 26B-3-1010, which is renumbered from Section 26-19-402 is
5164 renumbered and amended to read:
5165 [
5166 (1) (a) Within 30 days after commencing an action under Subsection [
5167 26B-3-1009(3), the department shall give the recipient, the recipient's guardian, personal
5168 representative, trustee, estate, or survivor, whichever is appropriate, written notice of the action
5169 by:
5170 (i) personal service or certified mail to the last known address of the person receiving
5171 the notice; or
5172 (ii) if no last-known address is available, by publishing a notice:
5173 (A) once a week for three successive weeks in a newspaper of general circulation in the
5174 county where the recipient resides; and
5175 (B) in accordance with Section 45-1-101 for three weeks.
5176 (b) Proof of service shall be filed in the action.
5177 (c) The recipient may intervene in the department's action at any time before trial.
5178 (2) The notice required by Subsection (1) shall name the court in which the action is
5179 commenced and advise the recipient of:
5180 (a) the right to intervene in the proceeding;
5181 (b) the right to obtain a private attorney; and
5182 (c) the department's right to recover medical assistance directly from the third party.
5183 Section 143. Section 26B-3-1011, which is renumbered from Section 26-19-403 is
5184 renumbered and amended to read:
5185 [
5186 response -- Conditions for proceeding -- Collection agreements.
5187 (1) (a) A recipient may not file a claim, commence an action, or settle, compromise,
5188 release, or waive a claim against a third party for recovery of medical costs for an injury,
5189 disease, or disability for which the department has provided or has become obligated to provide
5190 medical assistance, without the department's written consent as provided in Subsection (2)(b)
5191 or (4).
5192 (b) For purposes of Subsection (1)(a), consent may be obtained if:
5193 (i) a recipient who files a claim, or commences an action against a third party notifies
5194 the department in accordance with Subsection (1)(d) within 10 days of the recipient making the
5195 claim or commencing an action; or
5196 (ii) an attorney, who has been retained by the recipient to file a claim, or commence an
5197 action against a third party, notifies the department in accordance with Subsection (1)(d) of the
5198 recipient's claim:
5199 (A) within 30 days after being retained by the recipient for that purpose; or
5200 (B) within 30 days from the date the attorney either knew or should have known that
5201 the recipient received medical assistance from the department.
5202 (c) Service of the notice of claim to the department shall be made by certified mail,
5203 personal service, or by e-mail in accordance with Rule 5 of the Utah Rules of Civil Procedure,
5204 to the director of the Office of Recovery Services.
5205 (d) The notice of claim shall include the following information:
5206 (i) the name of the recipient;
5207 (ii) the recipient's Social Security number;
5208 (iii) the recipient's date of birth;
5209 (iv) the name of the recipient's attorney if applicable;
5210 (v) the name or names of individuals or entities against whom the recipient is making
5211 the claim, if known;
5212 (vi) the name of the third party's insurance carrier, if known;
5213 (vii) the date of the incident giving rise to the claim; and
5214 (viii) a short statement identifying the nature of the recipient's claim.
5215 (2) (a) Within 30 days of receipt of the notice of the claim required in Subsection (1),
5216 the department shall acknowledge receipt of the notice of the claim to the recipient or the
5217 recipient's attorney and shall notify the recipient or the recipient's attorney in writing of the
5218 following:
5219 (i) if the department has a claim or lien pursuant to Section [
5220 has become obligated to provide medical assistance; and
5221 (ii) whether the department is denying or granting written consent in accordance with
5222 Subsection (1)(a).
5223 (b) The department shall provide the recipient's attorney the opportunity to enter into a
5224 collection agreement with the department, with the recipient's consent, unless:
5225 (i) the department, prior to the receipt of the notice of the recipient's claim pursuant to
5226 Subsection (1), filed a written claim with the third party, the third party agreed to make
5227 payment to the department before the date the department received notice of the recipient's
5228 claim, and the agreement is documented in the department's record; or
5229 (ii) there has been a failure by the recipient's attorney to comply with any provision of
5230 this section by:
5231 (A) failing to comply with the notice provisions of this section;
5232 (B) failing or refusing to enter into a collection agreement;
5233 (C) failing to comply with the terms of a collection agreement with the department; or
5234 (D) failing to disburse funds owed to the state in accordance with this section.
5235 (c) (i) The collection agreement shall be:
5236 (A) consistent with this section and the attorney's obligation to represent the recipient
5237 and represent the state's claim; and
5238 (B) state the terms under which the interests of the department may be represented in
5239 an action commenced by the recipient.
5240 (ii) If the recipient's attorney enters into a written collection agreement with the
5241 department, or includes the department's claim in the recipient's claim or action pursuant to
5242 Subsection (4), the department shall pay attorney fees at the rate of 33.3% of the department's
5243 total recovery and shall pay a proportionate share of the litigation expenses directly related to
5244 the action.
5245 (d) The department is not required to enter into a collection agreement with the
5246 recipient's attorney for collection of personal injury protection under Subsection
5247 31A-22-302(2).
5248 (3) (a) If the department receives notice pursuant to Subsection (1), and notifies the
5249 recipient and the recipient's attorney that the department will not enter into a collection
5250 agreement with the recipient's attorney, the recipient may proceed with the recipient's claim or
5251 action against the third party if the recipient excludes from the claim:
5252 (i) any medical expenses paid by the department; or
5253 (ii) any medical costs for which the department is obligated to provide medical
5254 assistance.
5255 (b) When a recipient proceeds with a claim under Subsection (3)(a), the recipient shall
5256 provide written notice to the third party of the exclusion of the department's claim for expenses
5257 under Subsection (3)(a)(i) or (ii).
5258 (4) If the department receives notice pursuant to Subsection (1), and does not respond
5259 within 30 days to the recipient or the recipient's attorney, the recipient or the recipient's
5260 attorney:
5261 (a) may proceed with the recipient's claim or action against the third party;
5262 (b) may include the state's claim in the recipient's claim or action; and
5263 (c) may not negotiate, compromise, settle, or waive the department's claim without the
5264 department's consent.
5265 Section 144. Section 26B-3-1012, which is renumbered from Section 26-19-404 is
5266 renumbered and amended to read:
5267 [
5268 interests protected -- Remitting funds -- Disbursements -- Liability and penalty for
5269 noncompliance.
5270 (1) The department has an unconditional right to intervene in an action commenced by
5271 a recipient against a third party for the purpose of recovering medical costs for which the
5272 department has provided or has become obligated to provide medical assistance.
5273 (2) (a) If the recipient proceeds without complying with the provisions of Section
5274 [
5275 settlement, or compromise rendered or made on the claim or in the action.
5276 (b) The department:
5277 (i) may recover in full from the recipient, or any party to which the proceeds were
5278 made payable, all medical assistance that the department has provided; and
5279 (ii) retains its right to commence an independent action against the third party, subject
5280 to Subsection [
5281 (3) Any amounts assigned to and recoverable by the department pursuant to Sections
5282 [
5283 shall be remitted to the Bureau of Medical Collections within the Office of Recovery Services
5284 no later than five business days after receipt.
5285 (4) (a) Any amounts assigned to and recoverable by the department pursuant to
5286 Sections [
5287 recipient's attorney shall be remitted to the Bureau of Medical Collections within the Office of
5288 Recovery Services no later than 30 days after the funds are placed in the attorney's trust
5289 account.
5290 (b) The date by which the funds shall be remitted to the department may be modified
5291 based on agreement between the department and the recipient's attorney.
5292 (c) The department's consent to another date for remittance may not be unreasonably
5293 withheld.
5294 (d) If the funds are received by the recipient's attorney, no disbursements shall be made
5295 to the recipient or the recipient's attorney until the department's claim has been paid.
5296 (5) A recipient or recipient's attorney who knowingly and intentionally fails to comply
5297 with this section is liable to the department for:
5298 (a) the amount of the department's claim or lien pursuant to Subsection (1);
5299 (b) a penalty equal to 10% of the amount of the department's claim; and
5300 (c) attorney fees and litigation expenses related to recovering the department's claim.
5301 Section 145. Section 26B-3-1013, which is renumbered from Section 26-19-405 is
5302 renumbered and amended to read:
5303 [
5304 (1) (a) Except as provided in Subsection (1)(b), upon a recipient's death, the
5305 department may recover from the recipient's recovery estate and any trust, in which the
5306 recipient is the grantor and a beneficiary, medical assistance correctly provided for the benefit
5307 of the recipient when the recipient was 55 years of age or older.
5308 (b) The department may not make an adjustment or a recovery under Subsection (1)(a):
5309 (i) while the deceased recipient's spouse is still living; or
5310 (ii) if the deceased recipient has a surviving child who is:
5311 (A) under age 21; or
5312 (B) blind or disabled, as defined in the state plan.
5313 (2) (a) The amount of medical assistance correctly provided for the benefit of a
5314 recipient and recoverable under this section is a lien against the deceased recipient's recovery
5315 estate or any trust when the recipient is the grantor and a beneficiary.
5316 (b) The lien holds the same priority as reasonable and necessary medical expenses of
5317 the last illness as provided in Section 75-3-805.
5318 (3) (a) For a lien described in Subsection (2), the department shall provide notice in
5319 accordance with Section 38-12-102.
5320 (b) Before final distribution, the department shall perfect the lien as follows:
5321 (i) for an estate, by presenting the lien to the estate's personal representative in
5322 accordance with Section 75-3-804; and
5323 (ii) for a trust, by presenting the lien to the trustee in accordance with Section
5324 75-7-510.
5325 (c) The department may file an amended lien before the entry of the final order to close
5326 the estate or trust.
5327 (4) Claims against a deceased recipient's inter vivos trust shall be presented in
5328 accordance with Sections 75-7-509 and 75-7-510.
5329 (5) Any trust provision that denies recovery for medical assistance is void at the time of
5330 its making.
5331 (6) Nothing in this section affects the right of the department to recover Medicaid
5332 assistance before a recipient's death under Section [
5333 26B-3-1003 or 26B-3-1014.
5334 (7) A lien imposed under this section is of indefinite duration.
5335 Section 146. Section 26B-3-1014, which is renumbered from Section 26-19-406 is
5336 renumbered and amended to read:
5337 [
5338 medical assistance.
5339 The department may:
5340 (1) recover medical assistance incorrectly provided, whether due to administrative or
5341 factual error or fraud, from the recipient or the recipient's recovery estate; and
5342 (2) pursuant to a judgment, impose a lien against real property of the recipient.
5343 Section 147. Section 26B-3-1015, which is renumbered from Section 26-19-501 is
5344 renumbered and amended to read:
5345 [
5346 liens -- Exemptions.
5347 (1) Except as provided in Subsections (2) and (3), the department may impose a
5348 TEFRA lien on the real property of an individual for the amount of medical assistance provided
5349 for, or to, the individual while the individual is an inpatient in a care facility, if:
5350 (a) the individual is an inpatient in a care facility;
5351 (b) the individual is required, as a condition of receiving services under the state plan,
5352 to spend for costs of medical care all but a minimal amount of the individual's income required
5353 for personal needs; and
5354 (c) the department determines that the individual cannot reasonably be expected to:
5355 (i) be discharged from the care facility; and
5356 (ii) return to the individual's home.
5357 (2) The department may not impose a lien on the home of an individual described in
5358 Subsection (1), if any of the following individuals are lawfully residing in the home:
5359 (a) the spouse of the individual;
5360 (b) a child of the individual, if the child is:
5361 (i) under 21 years of age; or
5362 (ii) blind or permanently and totally disabled, as defined in Title 42 U.S.C. Sec.
5363 1382c(a)(3)(F); or
5364 (c) a sibling of the individual, if the sibling:
5365 (i) has an equity interest in the home; and
5366 (ii) resided in the home for at least one year immediately preceding the day on which
5367 the individual was admitted to the care facility.
5368 (3) The department may not impose a TEFRA lien on the real property of an
5369 individual, unless:
5370 (a) the individual has been an inpatient in a care facility for the 180-day period
5371 immediately preceding the day on which the lien is imposed;
5372 (b) the department serves:
5373 (i) a preliminary notice of intent to impose a TEFRA lien relating to the real property,
5374 in accordance with Section [
5375 (ii) a final notice of intent to impose a TEFRA lien relating to the real property, in
5376 accordance with Section [
5377 (c) (i) the individual does not file a timely request for review of the department's
5378 decision under Title 63G, Chapter 4, Administrative Procedures Act; or
5379 (ii) the department's decision is upheld upon final review or appeal under Title 63G,
5380 Chapter 4, Administrative Procedures Act.
5381 Section 148. Section 26B-3-1016, which is renumbered from Section 26-19-502 is
5382 renumbered and amended to read:
5383 [
5384 There is a rebuttable presumption that an individual who is an inpatient in a care facility
5385 cannot reasonably be expected to be discharged from a care facility and return to the
5386 individual's home, if the individual has been an inpatient in a care facility for a period of at
5387 least 180 consecutive days.
5388 Section 149. Section 26B-3-1017, which is renumbered from Section 26-19-503 is
5389 renumbered and amended to read:
5390 [
5391 lien.
5392 (1) Prior to imposing a TEFRA lien on real property, the department shall serve a
5393 preliminary notice of intent to impose a TEFRA lien, on the individual described in Subsection
5394 [
5395 (2) The preliminary notice of intent shall:
5396 (a) be served in person, or by certified mail, on the individual described in Subsection
5397 [
5398 authorized representative, on the representative;
5399 (b) include a statement indicating that, according to the department's records, the
5400 individual:
5401 (i) meets the criteria described in Subsections [
5402 (ii) has been an inpatient in a care facility for a period of at least 180 days immediately
5403 preceding the day on which the department provides the notice to the individual; and
5404 (iii) is legally presumed to be in a condition where it cannot reasonably be expected
5405 that the individual will be discharged from the care facility and return to the individual's home;
5406 (c) indicate that the department intends to impose a TEFRA lien on real property
5407 belonging to the individual;
5408 (d) describe the real property that the TEFRA lien will apply to;
5409 (e) describe the current amount of, and purpose of, the TEFRA lien;
5410 (f) indicate that the amount of the lien may continue to increase as the individual
5411 continues to receive medical assistance;
5412 (g) indicate that the individual may seek to prevent the TEFRA lien from being
5413 imposed on the real property by providing documentation to the department that:
5414 (i) establishes that the individual does not meet the criteria described in Subsection
5415 [
5416 (ii) establishes that the individual has not been an inpatient in a care facility for a
5417 period of at least 180 days;
5418 (iii) rebuts the presumption described in Section [
5419 (iv) establishes that the real property is exempt from imposition of a TEFRA lien under
5420 Subsection [
5421 (h) indicate that if the owner fails to provide the documentation described in
5422 Subsection (2)(g) within 30 days after the day on which the preliminary notice of intent is
5423 served, the department will issue a final notice of intent to impose a TEFRA lien on the real
5424 property and will proceed to impose the lien;
5425 (i) identify the type of documentation that the owner may provide to comply with
5426 Subsection (2)(g);
5427 (j) describe the circumstances under which a TEFRA lien is required to be released;
5428 and
5429 (k) describe the circumstances under which the department may seek to recover the
5430 lien.
5431 Section 150. Section 26B-3-1018, which is renumbered from Section 26-19-504 is
5432 renumbered and amended to read:
5433 [
5434 (1) The department may issue a final notice of intent to impose a TEFRA lien on real
5435 property if:
5436 (a) a preliminary notice of intent relating to the property is served in accordance with
5437 Section [
5438 (b) it is at least 30 days after the day on which the preliminary notice of intent was
5439 served; and
5440 (c) the department has not received documentation or other evidence that adequately
5441 establishes that a TEFRA lien may not be imposed on the real property.
5442 (2) The final notice of intent to impose a TEFRA lien on real property shall:
5443 (a) be served in person, or by certified mail, on the individual described in Subsection
5444 [
5445 individual has a legally authorized representative, on the representative;
5446 (b) indicate that the department has complied with the requirements for filing the final
5447 notice of intent under Subsection (1);
5448 (c) include a statement indicating that, according to the department's records, the
5449 individual:
5450 (i) meets the criteria described in Subsections [
5451 (ii) has been an inpatient in a care facility for a period of at least 180 days immediately
5452 preceding the day on which the department provides the notice to the individual; and
5453 (iii) is legally presumed to be in a condition where it cannot reasonably be expected
5454 that the individual will be discharged from the care facility and return to the individual's home;
5455 (d) indicate that the department intends to impose a TEFRA lien on real property
5456 belonging to the individual;
5457 (e) describe the real property that the TEFRA lien will apply to;
5458 (f) describe the current amount of, and purpose of, the TEFRA lien;
5459 (g) indicate that the amount of the lien may continue to increase as the individual
5460 continues to receive medical assistance;
5461 (h) describe the circumstances under which a TEFRA lien is required to be released;
5462 (i) describe the circumstances under which the department may seek to recover the
5463 lien;
5464 (j) describe the right of the individual to challenge the decision of the department in an
5465 adjudicative proceeding; and
5466 (k) indicate that failure by the individual to successfully challenge the decision of the
5467 department will result in the TEFRA lien being imposed.
5468 Section 151. Section 26B-3-1019, which is renumbered from Section 26-19-505 is
5469 renumbered and amended to read:
5470 [
5471 An individual who has been served with a final notice of intent to impose a TEFRA lien
5472 under Section [
5473 under Title 63G, Chapter 4, Administrative Procedures Act.
5474 Section 152. Section 26B-3-1020, which is renumbered from Section 26-19-506 is
5475 renumbered and amended to read:
5476 [
5477 (1) A TEFRA lien shall dissolve and be removed by the department if the individual
5478 described in Subsection [
5479 (a) (i) is discharged from the care facility; and
5480 (ii) returns to the individual's home; or
5481 (b) provides sufficient documentation to the department that:
5482 (i) rebuts the presumption described in Section [
5483 (ii) any of the following individuals are lawfully residing in the individual's home:
5484 (A) the spouse of the individual;
5485 (B) a child of the individual, if the child is under 21 years of age or blind or
5486 permanently and totally disabled, as defined in Title 42 U.S.C. Sec. 1382c(a)(3)(F); or
5487 (C) a sibling of the individual, if the sibling has an equity interest in the home and
5488 resided in the home for at least one year immediately preceding the day on which the individual
5489 was admitted to the care facility.
5490 (2) An individual described in Subsection [
5491 time after the department has imposed a lien under [
5492 26B-3-1023, file a request for the department to remove the lien.
5493 (3) A request filed under Subsection (2) shall be considered and reviewed pursuant to
5494 Title 63G, Chapter 4, Administrative Procedures Act.
5495 Section 153. Section 26B-3-1021, which is renumbered from Section 26-19-507 is
5496 renumbered and amended to read:
5497 [
5498 proceedings.
5499 (1) A TEFRA lien imposed on real property under [
5500 through 26B-3-1023 includes all expenses relating to medical assistance provided or paid for
5501 under the state plan from the first day that the individual is placed in a care facility, regardless
5502 of when the lien is imposed or filed on the property.
5503 (2) Nothing in this [
5504 the department from bringing or pursuing any other legally authorized action to recover
5505 medical assistance or to set aside a fraudulent or improper conveyance.
5506 Section 154. Section 26B-3-1022, which is renumbered from Section 26-19-508 is
5507 renumbered and amended to read:
5508 [
5509 If the department contracts with another government agency to recover funds paid for
5510 medical assistance under this [
5511 that determines whether to impose or remove a TEFRA lien under [
5512 26B-3-1015 through 26B-3-1023.
5513 Section 155. Section 26B-3-1023, which is renumbered from Section 26-19-509 is
5514 renumbered and amended to read:
5515 [
5516 Responsibility Act of 1982.
5517 If any provision of [
5518 the requirements of the Tax Equity and Fiscal Responsibility Act of 1982 for imposing a lien
5519 against the property of an individual prior to the individual's death, under 42 U.S.C. Sec.
5520 1396p, the provisions of the Tax Equity and Fiscal Responsibility Act of 1982 take precedence
5521 and shall be complied with by the department.
5522 Section 156. Section 26B-3-1024, which is renumbered from Section 26-19-601 is
5523 renumbered and amended to read:
5524 [
5525 Pursuant to Title 46, Chapter 4, Uniform Electronic Transactions Act:
5526 (1) a claim submitted to the department for payment may not be denied legal effect,
5527 enforceability, or admissibility as evidence in any court in any civil action because it is in
5528 electronic form; and
5529 (2) a third party shall accept an electronic record of payments by the department for
5530 medical services on behalf of a recipient as evidence in support of the department's claim.
5531 Section 157. Section 26B-3-1025, which is renumbered from Section 26-19-602 is
5532 renumbered and amended to read:
5533 [
5534 party.
5535 (1) Any third party required to make payment to the department pursuant to this
5536 [
5537 (2) The department may negotiate a payment or payment instrument it receives in
5538 connection with Subsection (1) without the cosignature or other participation of the recipient or
5539 any other party.
5540 Section 158. Section 26B-3-1026, which is renumbered from Section 26-19-603 is
5541 renumbered and amended to read:
5542 [
5543 represent department.
5544 The attorney general or a county attorney shall represent the department in any action
5545 commenced under this [
5546 Section 159. Section 26B-3-1027, which is renumbered from Section 26-19-604 is
5547 renumbered and amended to read:
5548 [
5549 In any action brought by the department under this [
5550 the department shall recover along with the principal sum and interest, a reasonable attorney
5551 fee and costs incurred.
5552 Section 160. Section 26B-3-1028, which is renumbered from Section 26-19-605 is
5553 renumbered and amended to read:
5554 [
5555 law prohibited.
5556 In no event shall any provision contained in this [
5557 existing federal law.
5558 Section 161. Section 26B-3-1101, which is renumbered from Section 26-20-2 is
5559 renumbered and amended to read:
5560
5561 [
5562 As used in this [
5563 (1) "Benefit" means the receipt of money, goods, or any other thing of pecuniary value.
5564 (2) "Claim" means any request or demand for money or property:
5565 (a) made to any:
5566 (i) employee, officer, or agent of the state;
5567 (ii) contractor with the state; or
5568 (iii) grantee or other recipient, whether or not under contract with the state; and
5569 (b) if:
5570 (i) any portion of the money or property requested or demanded was issued from or
5571 provided by the state; or
5572 (ii) the state will reimburse the contractor, grantee, or other recipient for any portion of
5573 the money or property.
5574 (3) "False statement" or "false representation" means a wholly or partially untrue
5575 statement or representation which is:
5576 (a) knowingly made; and
5577 (b) a material fact with respect to the claim.
5578 (4) "Knowing" and "knowingly":
5579 (a) for purposes of criminal prosecutions for violations of this [
5580 the culpable mental states described in Subsection [
5581 (b) for purposes of civil prosecutions for violations of this [
5582 required culpable mental state as defined in Subsection [
5583 (5) "Medical benefit" means a benefit paid or payable to a recipient or a provider under
5584 a program administered by the state under:
5585 (a) Titles V and XIX of the federal Social Security Act;
5586 (b) Title X of the federal Public Health Services Act;
5587 (c) the federal Child Nutrition Act of 1966 as amended by P.L. 94-105; and
5588 (d) any programs for medical assistance of the state.
5589 (6) "Person" means an individual, corporation, unincorporated association, professional
5590 corporation, partnership, or other form of business association.
5591 Section 162. Section 26B-3-1102, which is renumbered from Section 26-20-3 is
5592 renumbered and amended to read:
5593 [
5594 benefits.
5595 (1) A person may not make or cause to be made a false statement or false representation
5596 of a material fact in an application for medical benefits.
5597 (2) A person may not make or cause to be made a false statement or false
5598 representation of a material fact for use in determining rights to a medical benefit.
5599 (3) A person, who having knowledge of the occurrence of an event affecting the
5600 person's initial or continued right to receive a medical benefit or the initial or continued right of
5601 any other person on whose behalf the person has applied for or is receiving a medical benefit,
5602 may not conceal or fail to disclose that event with intent to obtain a medical benefit to which
5603 the person or any other person is not entitled or in an amount greater than that to which the
5604 person or any other person is entitled.
5605 Section 163. Section 26B-3-1103, which is renumbered from Section 26-20-4 is
5606 renumbered and amended to read:
5607 [
5608 (1) For purposes of this section, kickback or bribe:
5609 (a) includes rebates, compensation, or any other form of remuneration which is:
5610 (i) direct or indirect;
5611 (ii) overt or covert; or
5612 (iii) in cash or in kind; and
5613 (b) does not include a rebate paid to the state under 42 U.S.C. Sec. 1396r-8 or any state
5614 supplemental rebates.
5615 (2) A person may not solicit, offer, pay, or receive a kickback or bribe in return for or
5616 to induce:
5617 (a) the purchasing, leasing, or ordering of any goods or services for which payment is
5618 or may be made in whole or in part pursuant to a medical benefit program; or
5619 (b) the referral of an individual to another person for the furnishing of any goods or
5620 services for which payment is or may be made in whole or in part pursuant to a medical benefit
5621 program.
5622 Section 164. Section 26B-3-1104, which is renumbered from Section 26-20-5 is
5623 renumbered and amended to read:
5624 [
5625 qualification of health institution or facility prohibited -- Felony.
5626 (1) A person may not knowingly, intentionally, or recklessly make, induce, or seek to
5627 induce, the making of a false statement or false representation of a material fact with respect to
5628 the conditions or operation of an institution or facility in order that the institution or facility
5629 may qualify, upon initial certification or upon recertification, as a hospital, skilled nursing
5630 facility, intermediate care facility, or home health agency.
5631 (2) A person who violates this section is guilty of a second degree felony.
5632 Section 165. Section 26B-3-1105, which is renumbered from Section 26-20-6 is
5633 renumbered and amended to read:
5634 [
5635 A person may not enter into an agreement, combination, or conspiracy to defraud the
5636 state by obtaining or aiding another to obtain the payment or allowance of a false, fictitious, or
5637 fraudulent claim for a medical benefit.
5638 Section 166. Section 26B-3-1106, which is renumbered from Section 26-20-7 is
5639 renumbered and amended to read:
5640 [
5641 (1) A person may not make or present or cause to be made or presented to an employee
5642 or officer of the state a claim for a medical benefit:
5643 (a) which is wholly or partially false, fictitious, or fraudulent;
5644 (b) for services which were not rendered or for items or materials which were not
5645 delivered;
5646 (c) which misrepresents the type, quality, or quantity of items or services rendered;
5647 (d) representing charges at a higher rate than those charged by the provider to the
5648 general public;
5649 (e) for items or services which the person or the provider knew were not medically
5650 necessary in accordance with professionally recognized standards;
5651 (f) which has previously been paid;
5652 (g) for services also covered by one or more private sources when the person or
5653 provider knew of the private sources without disclosing those sources on the claim; or
5654 (h) where a provider:
5655 (i) unbundles a product, procedure, or group of procedures usually and customarily
5656 provided or performed as a single billable product or procedure into artificial components or
5657 separate procedures; and
5658 (ii) bills for each component of the product, procedure, or group of procedures:
5659 (A) as if they had been provided or performed independently and at separate times; and
5660 (B) the aggregate billing for the components exceeds the amount otherwise billable for
5661 the usual and customary single product or procedure.
5662 (2) In addition to the prohibitions in Subsection (1), a person may not:
5663 (a) fail to credit the state for payments received from other sources;
5664 (b) recover or attempt to recover payment in violation of the provider agreement from:
5665 (i) a recipient under a medical benefit program; or
5666 (ii) the recipient's family;
5667 (c) falsify or alter with intent to deceive, any report or document required by state or
5668 federal law, rule, or Medicaid provider agreement;
5669 (d) retain any unauthorized payment as a result of acts described by this section; or
5670 (e) aid or abet the commission of any act prohibited by this section.
5671 Section 167. Section 26B-3-1107, which is renumbered from Section 26-20-8 is
5672 renumbered and amended to read:
5673 [
5674 that false statement or representation knowingly made.
5675 In prosecution under this [
5676 knowledge of similar acts having been performed in the past on the part of persons acting on
5677 his behalf nor to show that the person had actual notice that the acts by the persons acting on
5678 his behalf occurred to establish the fact that a false statement or representation was knowingly
5679 made.
5680 Section 168. Section 26B-3-1108, which is renumbered from Section 26-20-9 is
5681 renumbered and amended to read:
5682 [
5683 (1) (a) Except as provided in Subsection (1)(b) the culpable mental state required for a
5684 criminal violation of this [
5685 Section 76-2-103.
5686 (b) The culpable mental state required for a criminal violation of this [
5687 kickbacks and bribes under Section [
5688 defined in Section 76-2-103.
5689 (2) The punishment for a criminal violation of any provision of this [
5690 except as provided under Section [
5691 of the funds or other benefits received or claimed in the commission of all violations of a
5692 similar nature, and not by each separate violation.
5693 (3) Punishment for criminal violation of this [
5694 Section [
5695 class A misdemeanor, or class B misdemeanor based on the dollar amounts as prescribed by
5696 Subsection 76-6-412(1) for theft of property and services.
5697 Section 169. Section 26B-3-1109, which is renumbered from Section 26-20-9.5 is
5698 renumbered and amended to read:
5699 [
5700 (1) The culpable mental state required for a civil violation of this [
5701 "knowing" or "knowingly" which:
5702 (a) means that person, with respect to information:
5703 (i) has actual knowledge of the information;
5704 (ii) acts in deliberate ignorance of the truth or falsity of the information; or
5705 (iii) acts in reckless disregard of the truth or falsity of the information; and
5706 (b) does not require a specific intent to defraud.
5707 (2) Any person who violates this [
5708 penalties provided by law, be required to:
5709 (a) make full and complete restitution to the state of all damages that the state sustains
5710 because of the person's violation of this [
5711 (b) pay to the state its costs of enforcement of this [
5712 the cost of investigators, attorneys, and other public employees, as determined by the state; and
5713 (c) pay to the state a civil penalty equal to:
5714 (i) three times the amount of damages that the state sustains because of the person's
5715 violation of this [
5716 (ii) not less than $5,000 or more than $10,000 for each claim filed or act done in
5717 violation of this [
5718 (3) Any civil penalties assessed under Subsection (2) shall be awarded by the court as
5719 part of its judgment in both criminal and civil actions.
5720 (4) A criminal action need not be brought against a person in order for that person to be
5721 civilly liable under this section.
5722 Section 170. Section 26B-3-1110, which is renumbered from Section 26-20-10 is
5723 renumbered and amended to read:
5724 [
5725 Appointment of receiver.
5726 (1) If the license of an assisted living facility is revoked for violation of this [
5727 part, the county attorney may file a petition with the district court for the county in which the
5728 facility is located for the appointment of a receiver.
5729 (2) The district court shall issue an order to show cause why a receiver should not be
5730 appointed returnable within five days after the filing of the petition.
5731 (3) (a) If the court finds that the facts warrant the granting of the petition, the court
5732 shall appoint a receiver to take charge of the facility.
5733 (b) The court may determine fair compensation for the receiver.
5734 (4) A receiver appointed pursuant to this section shall have the powers and duties
5735 prescribed by the court.
5736 Section 171. Section 26B-3-1111, which is renumbered from Section 26-20-11 is
5737 renumbered and amended to read:
5738 [
5739 medical benefits -- Repayment of benefits.
5740 (1) In any civil or criminal action brought under this [
5741 warrant, made payable to the order of a party, creates a presumption that the party received
5742 funds from the state.
5743 (2) In any civil or criminal action brought under this [
5744 benefits received shall be the ordinary or usual charge for similar benefits in the private sector.
5745 (3) In any criminal action under this [
5746 benefits obtained in violation of the provisions of this [
5747 defense to, or grounds for dismissal of that action.
5748 Section 172. Section 26B-3-1112, which is renumbered from Section 26-20-12 is
5749 renumbered and amended to read:
5750 [
5751 (1) The provisions of this [
5752 (a) not exclusive, and the remedies provided for in this [
5753 any other remedies provided for under:
5754 (i) any other applicable law; or
5755 (ii) common law; and
5756 (b) to be liberally construed and applied to:
5757 (i) effectuate the chapter's remedial and deterrent purposes; and
5758 (ii) serve the public interest.
5759 (2) If any provision of this [
5760 person or circumstance is held unconstitutional:
5761 (a) the remaining provisions of this [
5762 (b) the application of this [
5763 affected.
5764 Section 173. Section 26B-3-1113, which is renumbered from Section 26-20-13 is
5765 renumbered and amended to read:
5766 [
5767 (1) This [
5768 (2) The department is responsible for:
5769 (a) (i) investigating and prosecuting suspected civil violations of this [
5770 (ii) referring suspected civil violations of this [
5771 investigation and prosecution; and
5772 (b) promptly referring suspected criminal violations of this [
5773 attorney general for criminal investigation and prosecution.
5774 (3) The attorney general has:
5775 (a) concurrent jurisdiction with the department for investigating and prosecuting
5776 suspected civil violations of this [
5777 (b) exclusive jurisdiction to investigate and prosecute all suspected criminal violations
5778 of this [
5779 (4) The department and the attorney general share concurrent civil enforcement
5780 authority under this [
5781 investigation and prosecution of violations of this [
5782 section, the requirements of Title XIX of the federal Social Security Act, and applicable federal
5783 regulations.
5784 (5) (a) Any violation of this [
5785 government officer or agency shall be reported to the attorney general or the department.
5786 (b) All state government officers and agencies shall cooperate with and assist in any
5787 prosecution for violation of this [
5788 Section 174. Section 26B-3-1114, which is renumbered from Section 26-20-14 is
5789 renumbered and amended to read:
5790 [
5791 (1) The attorney general may take investigative action under Subsection (2) if the
5792 attorney general has reason to believe that:
5793 (a) a person has information or custody or control of documentary material relevant to
5794 the subject matter of an investigation of an alleged violation of this [
5795 (b) a person is committing, has committed, or is about to commit a violation of this
5796 [
5797 (c) it is in the public interest to conduct an investigation to ascertain whether or not a
5798 person is committing, has committed, or is about to commit a violation of this [
5799 (2) In taking investigative action, the attorney general may:
5800 (a) require the person to file on a prescribed form a statement in writing, under oath or
5801 affirmation describing:
5802 (i) the facts and circumstances concerning the alleged violation of this [
5803 and
5804 (ii) other information considered necessary by the attorney general;
5805 (b) examine under oath a person in connection with the alleged violation of this
5806 [
5807 (c) in accordance with Subsections (7) through (18), execute in writing, and serve on
5808 the person, a civil investigative demand requiring the person to produce the documentary
5809 material and permit inspection and copying of the material.
5810 (3) The attorney general may not release or disclose information that is obtained under
5811 Subsection (2)(a) or (b), or any documentary material or other record derived from the
5812 information obtained under Subsection (2)(a) or (b), except:
5813 (a) by court order for good cause shown;
5814 (b) with the consent of the person who provided the information;
5815 (c) to an employee of the attorney general or the department;
5816 (d) to an agency of this state, the United States, or another state;
5817 (e) to a special assistant attorney general representing the state in a civil action;
5818 (f) to a political subdivision of this state; or
5819 (g) to a person authorized by the attorney general to receive the information.
5820 (4) The attorney general may use documentary material derived from information
5821 obtained under Subsection (2)(a) or (b), or copies of that material, as the attorney general
5822 determines necessary in the enforcement of this [
5823 court.
5824 (5) (a) If a person fails to file a statement as required by Subsection (2)(a) or fails to
5825 submit to an examination as required by Subsection (2)(b), the attorney general may file in
5826 district court a complaint for an order to compel the person to within a period stated by court
5827 order:
5828 (i) file the statement required by Subsection (2)(a); or
5829 (ii) submit to the examination required by Subsection (2)(b).
5830 (b) Failure to comply with an order entered under Subsection (5)(a) is punishable as
5831 contempt.
5832 (6) A civil investigative demand shall:
5833 (a) state the rule or statute under which the alleged violation of this [
5834 being investigated;
5835 (b) describe the:
5836 (i) general subject matter of the investigation; and
5837 (ii) class or classes of documentary material to be produced with reasonable specificity
5838 to fairly indicate the documentary material demanded;
5839 (c) designate a date within which the documentary material is to be produced; and
5840 (d) identify an authorized employee of the attorney general to whom the documentary
5841 material is to be made available for inspection and copying.
5842 (7) A civil investigative demand may require disclosure of any documentary material
5843 that is discoverable under the Utah Rules of Civil Procedure.
5844 (8) Service of a civil investigative demand may be made by:
5845 (a) delivering an executed copy of the demand to the person to be served or to a
5846 partner, an officer, or an agent authorized by appointment or by law to receive service of
5847 process on behalf of that person;
5848 (b) delivering an executed copy of the demand to the principal place of business in this
5849 state of the person to be served; or
5850 (c) mailing by registered or certified mail an executed copy of the demand addressed to
5851 the person to be served:
5852 (i) at the person's principal place of business in this state; or
5853 (ii) if the person has no place of business in this state, to the person's principal office or
5854 place of business.
5855 (9) Documentary material demanded in a civil investigative demand shall be produced
5856 for inspection and copying during normal business hours at the office of the attorney general or
5857 as agreed by the person served and the attorney general.
5858 (10) The attorney general may not produce for inspection or copying or otherwise
5859 disclose the contents of documentary material obtained pursuant to a civil investigative demand
5860 except:
5861 (a) by court order for good cause shown;
5862 (b) with the consent of the person who produced the information;
5863 (c) to an employee of the attorney general or the department;
5864 (d) to an agency of this state, the United States, or another state;
5865 (e) to a special assistant attorney general representing the state in a civil action;
5866 (f) to a political subdivision of this state; or
5867 (g) to a person authorized by the attorney general to receive the information.
5868 (11) (a) With respect to documentary material obtained pursuant to a civil investigative
5869 demand, the attorney general shall prescribe reasonable terms and conditions allowing such
5870 documentary material to be available for inspection and copying by the person who produced
5871 the material or by an authorized representative of that person.
5872 (b) The attorney general may use such documentary material or copies of it as the
5873 attorney general determines necessary in the enforcement of this [
5874 presentation before a court.
5875 (12) (a) A person may file a complaint, stating good cause, to extend the return date for
5876 the demand or to modify or set aside the demand.
5877 (b) A complaint under this Subsection (12) shall be filed in district court before the
5878 earlier of:
5879 [
5880 [
5881 (13) Except as provided by court order, a person who has been served with a civil
5882 investigative demand shall comply with the terms of the demand.
5883 (14) (a) A person who has committed a violation of this [
5884 Medicaid program in this state or to any other medical benefit program administered by the
5885 state has submitted to the jurisdiction of this state.
5886 (b) Personal service of a civil investigative demand under this section may be made on
5887 the person described in Subsection (14)(a) outside of this state.
5888 (15) This section does not limit the authority of the attorney general to conduct
5889 investigations or to access a person's documentary materials or other information under another
5890 state or federal law, the Utah Rules of Civil Procedure, or the Federal Rules of Civil Procedure.
5891 (16) The attorney general may file a complaint in district court for an order to enforce
5892 the civil investigative demand if:
5893 (a) a person fails to comply with a civil investigative demand; or
5894 (b) copying and reproduction of the documentary material demanded:
5895 (i) cannot be satisfactorily accomplished; and
5896 (ii) the person refuses to surrender the documentary material.
5897 (17) If a complaint is filed under Subsection (16), the court may determine the matter
5898 presented and may enter an order to enforce the civil investigative demand.
5899 (18) Failure to comply with a final order entered under Subsection (17) is punishable
5900 by contempt.
5901 Section 175. Section 26B-3-1115, which is renumbered from Section 26-20-15 is
5902 renumbered and amended to read:
5903 [
5904 section -- Civil burden of proof -- Estoppel -- Joint civil liability -- Venue.
5905 (1) An action under this [
5906 (a) six years after the date on which the violation was committed; or
5907 (b) three years after the date an official of the state charged with responsibility to act in
5908 the circumstances discovers the violation, but in no event more than 10 years after the date on
5909 which the violation was committed.
5910 (2) A civil action brought under this [
5911 prior to the effective date of this section if the limitations period set forth in Subsection (1) has
5912 not lapsed.
5913 (3) In any civil action brought under this [
5914 prove by a preponderance of evidence, all essential elements of the cause of action including
5915 damages.
5916 (4) Notwithstanding any other provision of law, a final judgment rendered in favor of
5917 the state in any criminal proceeding under this [
5918 or upon a plea of guilty or nolo contendere, shall estop the defendant from denying the essential
5919 elements of the offense in any civil action under this [
5920 transaction.
5921 (5) Civil liability under this [
5922 committed by two or more persons.
5923 (6) Any action brought by the state under this [
5924 court in Salt Lake County or in any county where the defendant resides or does business.
5925 Section 176. Section 26B-8-101 is amended to read:
5926
5927
5928
5929 26B-8-101. Definitions.
5930 [
5931 As used in this part:
5932 (1) "Adoption document" means an adoption-related document filed with the office, a
5933 petition for adoption, a decree of adoption, an original birth certificate, or evidence submitted
5934 in support of a supplementary birth certificate.
5935 (2) "Certified nurse midwife" means an individual who:
5936 (a) is licensed to practice as a certified nurse midwife under Title 58, Chapter 44a,
5937 Nurse Midwife Practice Act; and
5938 (b) has completed an education program regarding the completion of a certificate of
5939 death developed by the department by rule made in accordance with Title 63G, Chapter 3, Utah
5940 Administrative Rulemaking Act.
5941 (3) "Custodial funeral service director" means a funeral service director who:
5942 (a) is employed by a licensed funeral establishment; and
5943 (b) has custody of a dead body.
5944 (4) "Dead body" means a human body or parts of the human body from the condition
5945 of which it reasonably may be concluded that death occurred.
5946 (5) "Decedent" means the same as dead body.
5947 (6) "Dead fetus" means a product of human conception, other than those circumstances
5948 described in Subsection 76-7-301(1):
5949 (a) of 20 weeks' gestation or more, calculated from the date the last normal menstrual
5950 period began to the date of delivery; and
5951 (b) that was not born alive.
5952 (7) "Declarant father" means a male who claims to be the genetic father of a child, and,
5953 along with the biological mother, signs a voluntary declaration of paternity to establish the
5954 child's paternity.
5955 (8) "Dispositioner" means:
5956 (a) a person designated in a written instrument, under Subsection 58-9-602(1), as
5957 having the right and duty to control the disposition of the decedent, if the person voluntarily
5958 acts as the dispositioner; or
5959 (b) the next of kin of the decedent, if:
5960 (i) (A) a person has not been designated as described in Subsection (8)(a); or
5961 (B) the person described in Subsection (8)(a) is unable or unwilling to exercise the
5962 right and duty described in Subsection (8)(a); and
5963 (ii) the next of kin voluntarily acts as the dispositioner.
5964 (9) "Fetal remains" means:
5965 (a) an aborted fetus as that term is defined in Section 26B-2-232; or
5966 (b) a miscarried fetus as that term is defined in Section 26B-2-233.
5967 (10) "File" means the submission of a completed certificate or other similar document,
5968 record, or report as provided under this part for registration by the state registrar or a local
5969 registrar.
5970 (11) "Funeral service director" means the same as that term is defined in Section
5971 58-9-102.
5972 (12) "Health care facility" means the same as that term is defined in Section
5973 26B-2-201.
5974 (13) "Health care professional" means a physician, physician assistant, nurse
5975 practitioner, or certified nurse midwife.
5976 (14) "Licensed funeral establishment" means:
5977 (a) if located in Utah, a funeral service establishment, as that term is defined in Section
5978 58-9-102, that is licensed under Title 58, Chapter 9, Funeral Services Licensing Act; or
5979 (b) if located in a state, district, or territory of the United States other than Utah, a
5980 funeral service establishment that complies with the licensing laws of the jurisdiction where the
5981 establishment is located.
5982 (15) "Live birth" means the birth of a child who shows evidence of life after the child is
5983 entirely outside of the mother.
5984 (16) "Local registrar" means a person appointed under Subsection 26B-8-102(3)(b).
5985 (17) "Nurse practitioner" means an individual who:
5986 (a) is licensed to practice as an advanced practice registered nurse under Title 58,
5987 Chapter 31b, Nurse Practice Act; and
5988 (b) has completed an education program regarding the completion of a certificate of
5989 death developed by the department by administrative rule made in accordance with Title 63G,
5990 Chapter 3, Utah Administrative Rulemaking Act.
5991 (18) "Office" means the Office of Vital Records and Statistics within the department.
5992 (19) "Physician" means a person licensed to practice as a physician or osteopath in this
5993 state under Title 58, Chapter 67, Utah Medical Practice Act, or Title 58, Chapter 68, Utah
5994 Osteopathic Medical Practice Act.
5995 (20) "Physician assistant" means an individual who:
5996 (a) is licensed to practice as a physician assistant under Title 58, Chapter 70a, Utah
5997 Physician Assistant Act; and
5998 (b) has completed an education program regarding the completion of a certificate of
5999 death developed by the department by administrative rule made in accordance with Title 63G,
6000 Chapter 3, Utah Administrative Rulemaking Act.
6001 (21) "Presumed father" means the father of a child conceived or born during a marriage
6002 as defined in Section 30-1-17.2.
6003 (22) "Registration" or "register" means acceptance by the local or state registrar of a
6004 certificate and incorporation of the certificate into the permanent records of the state.
6005 (23) "State registrar" means the state registrar of vital records appointed under Section
6006 26B-8-102.
6007 (24) "Vital records" means:
6008 (a) registered certificates or reports of birth, death, fetal death, marriage, divorce,
6009 dissolution of marriage, or annulment;
6010 (b) amendments to any of the registered certificates or reports described in Subsection
6011 (24)(a);
6012 (c) an adoption document; and
6013 (d) other similar documents.
6014 (25) "Vital statistics" means the data derived from registered certificates and reports of
6015 birth, death, fetal death, induced termination of pregnancy, marriage, divorce, dissolution of
6016 marriage, or annulment.
6017 Section 177. Section 26B-8-102, which is renumbered from Section 26-2-3 is
6018 renumbered and amended to read:
6019 [
6020 (1) As used in this section:
6021 (a) "Compact" means the Compact for Interstate Sharing of Putative Father Registry
6022 Information created in Section 78B-6-121.5, effective on May 10, 2016.
6023 (b) "Putative father":
6024 (i) means the same as that term is as defined in Section 78B-6-121.5; and
6025 (ii) includes an unmarried biological father.
6026 (c) "State registrar" means the state registrar of vital records appointed under
6027 Subsection (2)(e).
6028 (d) "Unmarried biological father" means the same as that term is defined in Section
6029 78B-6-103.
6030 (2) The department shall:
6031 (a) provide offices properly equipped for the preservation of vital records made or
6032 received under this [
6033 (b) establish a statewide vital records system for the registration, collection,
6034 preservation, amendment, and certification of vital records and other similar documents
6035 required by this [
6036 and publication of vital statistics;
6037 (c) prescribe forms for certificates, certification, reports, and other documents and
6038 records necessary to establish and maintain a statewide system of vital records;
6039 (d) prepare an annual compilation, analysis, and publication of statistics derived from
6040 vital records; and
6041 (e) appoint a state registrar to direct the statewide system of vital records.
6042 (3) The department may:
6043 (a) divide the state from time to time into registration districts; and
6044 (b) appoint local registrars for registration districts who under the direction and
6045 supervision of the state registrar shall perform all duties required of them by this [
6046 and department rules.
6047 (4) The state registrar appointed under Subsection (2)(e) shall, with the input of Utah
6048 stakeholders and the Uniform Law Commission, study the following items for the state's
6049 implementation of the compact:
6050 (a) the feasibility of using systems developed by the National Association for Public
6051 Health Statistics and Information Systems, including the State and Territorial Exchange of
6052 Vital Events (STEVE) system and the Electronic Verification of Vital Events (EVVE) system,
6053 or similar systems, to exchange putative father registry information with states that are parties
6054 to the compact;
6055 (b) procedures necessary to share putative father information, located in the
6056 confidential registry maintained by the state registrar, upon request from the state registrar of
6057 another state that is a party to the compact;
6058 (c) procedures necessary for the state registrar to access putative father information
6059 located in a state that is a party to the compact, and share that information with persons who
6060 request a certificate from the state registrar;
6061 (d) procedures necessary to ensure that the name of the mother of the child who is the
6062 subject of a putative father's notice of commencement, filed pursuant to Section 78B-6-121, is
6063 kept confidential when a state that is a party to the compact accesses this state's confidential
6064 registry through the state registrar; and
6065 (e) procedures necessary to ensure that a putative father's registration with a state that
6066 is a party to the compact is given the same effect as a putative father's notice of commencement
6067 filed pursuant to Section 78B-6-121.
6068 Section 178. Section 26B-8-103, which is renumbered from Section 26-2-4 is
6069 renumbered and amended to read:
6070 [
6071 (1) As used in this section:
6072 (a) "Additional information" means information that is beyond the information
6073 necessary to comply with federal standards or state law for registering a birth.
6074 (b) "Diacritical mark" means a mark on a letter from the ISO basic Latin alphabet used
6075 to indicate a special pronunciation.
6076 (c) "Diacritical mark" includes accents, tildes, graves, umlauts, and cedillas.
6077 (2) Except as provided in Subsection (8), to promote and maintain nationwide
6078 uniformity in the vital records system, the forms of certificates, certification, reports, and other
6079 documents and records required by this [
6080 part shall include as a minimum the items recommended by the federal agency responsible for
6081 national vital statistics, subject to approval, additions, and modifications by the department.
6082 (3) Certificates, certifications, forms, reports, other documents and records, and the
6083 form of communications between persons required by this [
6084 the format prescribed by department rule.
6085 (4) All vital records shall include the date of filing.
6086 (5) Certificates, certifications, forms, reports, other documents and records, and
6087 communications between persons required by this [
6088 registered, and stored by photographic, electronic, or other means as prescribed by department
6089 rule.
6090 (6) (a) An individual may use a diacritical mark in an application for a vital record.
6091 (b) The office shall record a diacritical mark on a vital record as indicated on the
6092 application for the vital record.
6093 (7) The absence of a diacritical mark on a vital record does not render the document
6094 invalid or affect any constructive notice imparted by proper recordation of the document.
6095 (8) (a) The state:
6096 (i) may collect the Social Security number of a deceased individual; and
6097 (ii) may not include the Social Security number of an individual on a certificate of
6098 death.
6099 (b) For registering a birth, the department may not require an individual to provide
6100 additional information.
6101 (c) The department may request additional information if the department provides a
6102 written statement that:
6103 (i) discloses that providing the additional information is voluntary;
6104 (ii) discloses how the additional information will be used and the duration of use;
6105 (iii) describes how the department prevents the additional information from being used
6106 in a manner different from the disclosure given under Subsection (6)(c)(ii); and
6107 (iv) includes a notice that the individual is consenting to the department's use of the
6108 additional information by providing the additional information.
6109 (d) (i) Beginning July 1, 2022, an individual may submit a written request to the
6110 department to de-identify the individual's additional information contained in the department's
6111 databases.
6112 (ii) Upon receiving the written request, the department shall de-identify the additional
6113 information.
6114 (e) The department shall de-identify additional information contained in the
6115 department's databases before the additional information is held by the department for longer
6116 than six years.
6117 Section 179. Section 26B-8-104, which is renumbered from Section 26-2-5 is
6118 renumbered and amended to read:
6119 [
6120 requirements.
6121 (1) As used in this section, "birthing facility" means a general acute hospital or birthing
6122 center as defined in Section [
6123 (2) For each live birth occurring in the state, a certificate shall be filed with the local
6124 registrar for the district in which the birth occurred within 10 days following the birth. The
6125 certificate shall be registered if it is completed and filed in accordance with this [
6126 (3) (a) For each live birth that occurs in a birthing facility, the administrator of the
6127 birthing facility, or his designee, shall obtain and enter the information required under this
6128 [
6129 (b) (i) The date, time, place of birth, and required medical information shall be certified
6130 by the birthing facility administrator or his designee.
6131 (ii) The attending physician or nurse midwife may sign the certificate, but if the
6132 attending physician or nurse midwife has not signed the certificate within seven days of the
6133 date of birth, the birthing facility administrator or his designee shall enter the attending
6134 physician's or nurse midwife's name and transmit the certificate to the local registrar.
6135 (iii) The information on the certificate about the parents shall be provided and certified
6136 by the mother or father or, in their incapacity or absence, by a person with knowledge of the
6137 facts.
6138 (4) (a) For live births that occur outside a birthing facility, the birth certificate shall be
6139 completed and filed by the physician, physician assistant, nurse, midwife, or other person
6140 primarily responsible for providing assistance to the mother at the birth. If there is no such
6141 person, either the presumed or declarant father shall complete and file the certificate. In his
6142 absence, the mother shall complete and file the certificate, and in the event of her death or
6143 disability, the owner or operator of the premises where the birth occurred shall do so.
6144 (b) The certificate shall be completed as fully as possible and shall include the date,
6145 time, and place of birth, the mother's name, and the signature of the person completing the
6146 certificate.
6147 (5) (a) For each live birth to an unmarried mother that occurs in a birthing facility, the
6148 administrator or director of that facility, or his designee, shall:
6149 (i) provide the birth mother and declarant father, if present, with:
6150 (A) a voluntary declaration of paternity form published by the state registrar;
6151 (B) oral and written notice to the birth mother and declarant father of the alternatives
6152 to, the legal consequences of, and the rights and responsibilities that arise from signing the
6153 declaration; and
6154 (C) the opportunity to sign the declaration;
6155 (ii) witness the signature of a birth mother or declarant father in accordance with
6156 Section 78B-15-302 if the signature occurs at the facility;
6157 (iii) enter the declarant father's information on the original birth certificate, but only if
6158 the mother and declarant father have signed a voluntary declaration of paternity or a court or
6159 administrative agency has issued an adjudication of paternity; and
6160 (iv) file the completed declaration with the original birth certificate.
6161 (b) If there is a presumed father, the voluntary declaration will only be valid if the
6162 presumed father also signs the voluntary declaration.
6163 (c) The state registrar shall file the information provided on the voluntary declaration
6164 of paternity form with the original birth certificate and may provide certified copies of the
6165 declaration of paternity as otherwise provided under Title 78B, Chapter 15, Utah Uniform
6166 Parentage Act.
6167 (6) (a) The state registrar shall publish a form for the voluntary declaration of paternity,
6168 a description of the process for filing a voluntary declaration of paternity, and of the rights and
6169 responsibilities established or effected by that filing, in accordance with Title 78B, Chapter 15,
6170 Utah Uniform Parentage Act.
6171 (b) Information regarding the form and services related to voluntary paternity
6172 establishment shall be made available to birthing facilities and to any other entity or individual
6173 upon request.
6174 (7) The name of a declarant father may only be included on the birth certificate of a
6175 child of unmarried parents if:
6176 (a) the mother and declarant father have signed a voluntary declaration of paternity; or
6177 (b) a court or administrative agency has issued an adjudication of paternity.
6178 (8) Voluntary declarations of paternity, adjudications of paternity by judicial or
6179 administrative agencies, and voluntary rescissions of paternity shall be filed with and
6180 maintained by the state registrar for the purpose of comparing information with the state case
6181 registry maintained by the Office of Recovery Services pursuant to Section [
6182 26B-9-104.
6183 Section 180. Section 26B-8-105, which is renumbered from Section 26-2-5.5 is
6184 renumbered and amended to read:
6185 [
6186 (1) For each live birth that occurs in this state, the administrator of the birthing facility,
6187 as defined in Section [
6188 the birth certificate under Section [
6189 of each parent and provide those numbers to the state registrar.
6190 (2) Each parent shall furnish his or her social security number to the person authorized
6191 to obtain the numbers under Subsection (1) unless a court or administrative agency has
6192 determined there is good cause for not furnishing a number under Subsection (1).
6193 (3) The state registrar shall, as soon as practicable, supply those social security
6194 numbers to the Office of Recovery Services within the [
6195 department.
6196 (4) The social security numbers obtained under this section may not be recorded on the
6197 child's birth certificate.
6198 (5) The state may not use any social security number obtained under this section for
6199 any reason other than enforcement of child support orders in accordance with the federal
6200 Family Support Act of 1988, [
6201 Section 181. Section 26B-8-106, which is renumbered from Section 26-2-6 is
6202 renumbered and amended to read:
6203 [
6204 (1) A foundling certificate shall be filed for each infant of unknown parentage found in
6205 the state. The certificate shall be prepared and filed with the local registrar of the district in
6206 which the infant was found by the person assuming custody.
6207 (2) The certificate shall be filed within 10 days after the infant is found and is
6208 acceptable for all purposes in lieu of a certificate of birth.
6209 Section 182. Section 26B-8-107, which is renumbered from Section 26-2-7 is
6210 renumbered and amended to read:
6211 [
6212 Conflicting birth and foundling certificates -- Rulemaking.
6213 In accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, the
6214 department may make rules:
6215 (1) governing applications to correct alleged errors or omissions on any vital record;
6216 (2) establishing procedures to resolve conflicting birth and foundling certificates; and
6217 (3) allowing for the correction and reissuance of a vital record that was originally
6218 created omitting a diacritical mark.
6219 Section 183. Section 26B-8-108, which is renumbered from Section 26-2-8 is
6220 renumbered and amended to read:
6221 [
6222 (1) When a certificate of birth of a person born in this state has not been filed within
6223 the time provided in Subsection [
6224 accordance with department rules and subject to this section.
6225 (2) (a) The registrar shall mark a certificate of birth as "delayed" and show the date of
6226 registration if the certificate is registered one year or more after the date of birth.
6227 (b) The registrar shall abstract a summary statement of the evidence submitted in
6228 support of delayed registration onto the certificate.
6229 (3) When the minimum evidence required for delayed registration is not submitted or
6230 when the state registrar has reasonable cause to question the validity or adequacy of the
6231 evidence supporting the application, and the deficiencies are not corrected, the state registrar:
6232 (a) may not register the certificate; and
6233 (b) shall provide the applicant with a written statement indicating the reasons for denial
6234 of registration.
6235 (4) The state registrar has no duty to take further action regarding an application which
6236 is not actively pursued.
6237 Section 184. Section 26B-8-109, which is renumbered from Section 26-2-9 is
6238 renumbered and amended to read:
6239 [
6240 certificate -- Court procedure.
6241 (1) (a) If registration of a certificate of birth under Section [
6242 denied, the person seeking registration may bring an action by a verified petition in the Utah
6243 [
6244 Lake City.
6245 (b) The petition shall request an order establishing a record of the date and place of the
6246 birth and the parentage of the person whose birth is to be registered.
6247 (2) The petition shall be on a form furnished by the state registrar and shall allege:
6248 (a) the person for whom registration of a delayed certificate is sought was born in this
6249 state and is still living;
6250 (b) no registered certificate of birth of the person can be found in the state office of
6251 vital statistics or the office of any local registrar;
6252 (c) diligent efforts by the petitioner have failed to obtain the evidence required by
6253 department rule; and
6254 (d) the state registrar has denied the petitioner's request to register a delayed certificate
6255 of birth.
6256 (3) The petition shall be accompanied by a written statement of the state registrar
6257 indicating the reasons for denial of registration and all documentary evidence which was
6258 submitted in support of registration.
6259 (4) The court shall fix a time and place for hearing the petition and shall give the state
6260 registrar 15 days notice of the hearing. The state registrar or his authorized representative may
6261 appear and testify at the hearing.
6262 (5) (a) If the court finds the person for whom registration of a certificate of birth is
6263 sought under Section [
6264 place and date of birth, parentage, and other findings as may be required and shall issue an
6265 order, on a form prescribed and furnished by the state registrar, to establish a court-ordered
6266 delayed certificate of birth.
6267 (b) The order shall include the birth data to be registered, a description of the evidence
6268 presented, and the date of the court's action.
6269 [
6270 than the tenth day of the calendar month following the month in which the order was entered.
6271 (d) The order described in Subsection (5)(a) shall be registered by the state registrar
6272 and constitutes the certificate of birth.
6273 Section 185. Section 26B-8-110, which is renumbered from Section 26-2-10 is
6274 renumbered and amended to read:
6275 [
6276 (1) An individual born in this state may request the state registrar to register a
6277 supplementary birth certificate for the individual if:
6278 (a) the individual is legally recognized as a child of the individual's natural parents
6279 when the individual's natural parents are subsequently married;
6280 (b) the individual's parentage has been determined by a state court of the United States
6281 or a Canadian provincial court with jurisdiction; or
6282 (c) the individual has been legally adopted, as a child or as an adult, under the law of
6283 this state, any other state, or any province of Canada.
6284 (2) The application for registration of a supplementary birth certificate may be made
6285 by:
6286 (a) the individual requesting registration under Subsection (1) if the individual is of
6287 legal age;
6288 (b) a legal representative; or
6289 (c) any agency authorized to receive children for placement or adoption under the laws
6290 of this or any other state.
6291 (3) (a) The state registrar shall require that an applicant submit identification and proof
6292 according to department rules.
6293 (b) In the case of an adopted individual, that proof may be established by order of the
6294 court in which the adoption proceedings were held.
6295 (4) (a) After the supplementary birth certificate is registered, any information disclosed
6296 from the record shall be from the supplementary birth certificate.
6297 (b) Access to the original birth certificate and to the evidence submitted in support of
6298 the supplementary birth certificate are not open to inspection except upon the order of a Utah
6299 district court or as described in Section 78B-6-141 or Section 78B-6-144.
6300 Section 186. Section 26B-8-111, which is renumbered from Section 26-2-11 is
6301 renumbered and amended to read:
6302 [
6303 amendment of birth certificate.
6304 (1) When a person born in this state has a name change or sex change approved by an
6305 order of a Utah [
6306 province of Canada, a certified copy of the order may be filed with the state registrar with an
6307 application form provided by the registrar.
6308 (2) (a) Upon receipt of the application, a certified copy of the order, and payment of the
6309 required fee, the state registrar shall review the application, and if complete, register it and note
6310 the fact of the amendment on the otherwise unaltered original certificate.
6311 (b) The amendment shall be registered with and become a part of the original
6312 certificate and a certified copy shall be issued to the applicant without additional cost.
6313 Section 187. Section 26B-8-112, which is renumbered from Section 26-2-12.5 is
6314 renumbered and amended to read:
6315 [
6316 Children's Account.
6317 (1) In addition to the fees provided for in Section 26B-1-209, the department and local
6318 registrars authorized to issue certified copies shall charge an additional $3 fee for each certified
6319 copy of a birth certificate, including certified copies of supplementary and amended birth
6320 certificates, under Sections [
6321 (2) The additional fee described in Subsection (1) may be charged only for the first
6322 copy requested at any one time.
6323 [
6324 Children's Account [
6325 Section 188. Section 26B-8-113, which is renumbered from Section 26-2-12.6 is
6326 renumbered and amended to read:
6327 [
6328 (1) Notwithstanding [
6329 the department shall waive a fee that would otherwise be charged for a certified copy of a birth
6330 certificate, if the individual whose birth is confirmed by the birth certificate is:
6331 (a) the individual requesting the certified copy of the birth certificate; and
6332 (b) (i) homeless, as defined in Section [
6333 (ii) a person who is homeless, as defined in Section 35A-5-302;
6334 (iii) an individual whose primary nighttime residence is a location that is not designed
6335 for or ordinarily used as a sleeping accommodation for an individual;
6336 (iv) a homeless service provider as verified by the Department of Workforce Services;
6337 or
6338 (v) a homeless child or youth, as defined in 42 U.S.C. Sec. 11434a.
6339 (2) To satisfy the requirement in Subsection (1)(b), the department shall accept written
6340 verification that the individual is homeless or a person, child, or youth who is homeless from:
6341 (a) a homeless shelter;
6342 (b) a permanent housing, permanent, supportive, or transitional facility, as defined in
6343 Section 35A-5-302;
6344 (c) the Department of Workforce Services;
6345 (d) a homeless service provider as verified by the Department of Workforce Services;
6346 or
6347 (e) a local educational agency liaison for homeless children and youth designated under
6348 42 U.S.C. Sec. 11432(g)(1)(J)(ii).
6349 Section 189. Section 26B-8-114, which is renumbered from Section 26-2-13 is
6350 renumbered and amended to read:
6351 [
6352 requirements -- Information provided to lieutenant governor.
6353 (1) (a) A certificate of death for each death that occurs in this state shall be filed with
6354 the local registrar of the district in which the death occurs, or as otherwise directed by the state
6355 registrar, within five days after death and prior to the decedent's interment, any other disposal,
6356 or removal from the registration district where the death occurred.
6357 (b) A certificate of death shall be registered if the certificate of death is completed and
6358 filed in accordance with this [
6359 (2) (a) If the place of death is unknown but the dead body is found in this state:
6360 (i) the certificate of death shall be completed and filed in accordance with this section;
6361 and
6362 (ii) the place where the dead body is found shall be shown as the place of death.
6363 (b) If the date of death is unknown, the date shall be determined by approximation.
6364 (3) (a) When death occurs in a moving conveyance in the United States and the
6365 decedent is first removed from the conveyance in this state:
6366 (i) the certificate of death shall be filed with:
6367 (A) the local registrar of the district where the decedent is removed; or
6368 (B) a person designated by the state registrar; and
6369 (ii) the place where the decedent is removed shall be considered the place of death.
6370 (b) When a death occurs on a moving conveyance outside the United States and the
6371 decedent is first removed from the conveyance in this state:
6372 (i) the certificate of death shall be filed with:
6373 (A) the local registrar of the district where the decedent is removed; or
6374 (B) a person designated by the state registrar; and
6375 (ii) the certificate of death shall show the actual place of death to the extent it can be
6376 determined.
6377 (4) (a) Subject to Subsections (4)(d) and (10), a custodial funeral service director or, if a
6378 funeral service director is not retained, a dispositioner shall sign the certificate of death.
6379 (b) The custodial funeral service director, an agent of the custodial funeral service
6380 director, or, if a funeral service director is not retained, a dispositioner shall:
6381 (i) file the certificate of death prior to any disposition of a dead body or fetus; and
6382 (ii) obtain the decedent's personal data from the next of kin or the best qualified person
6383 or source available, including the decedent's social security number, if known.
6384 (c) The certificate of death may not include the decedent's social security number.
6385 (d) A dispositioner may not sign a certificate of death, unless the signature is witnessed
6386 by the state registrar or a local registrar.
6387 (5) (a) Except as provided in Section [
6388 medical section of the certificate of death shall be completed, signed, and returned to the
6389 funeral service director, or, if a funeral service director is not retained, a dispositioner, within
6390 72 hours after death by the health care professional who was in charge of the decedent's care
6391 for the illness or condition which resulted in death, except when inquiry is required by [
6392
6393 (b) In the absence of the health care professional or with the health care professional's
6394 approval, the certificate of death may be completed and signed by an associate physician, the
6395 chief medical officer of the institution in which death occurred, or a physician who performed
6396 an autopsy upon the decedent, if:
6397 (i) the person has access to the medical history of the case;
6398 (ii) the person views the decedent at or after death; and
6399 (iii) the death is not due to causes required to be investigated by the medical examiner.
6400 (6) When death occurs more than 365 days after the day on which the decedent was last
6401 treated by a health care professional, the case shall be referred to the medical examiner for
6402 investigation to determine and certify the cause, date, and place of death.
6403 (7) When inquiry is required by [
6404 2, Utah Medical Examiner, the medical examiner shall make an investigation and complete and
6405 sign the medical section of the certificate of death within 72 hours after taking charge of the
6406 case.
6407 (8) If the cause of death cannot be determined within 72 hours after death:
6408 (a) the medical section of the certificate of death shall be completed as provided by
6409 department rule;
6410 (b) the attending health care professional or medical examiner shall give the funeral
6411 service director, or, if a funeral service director is not retained, a dispositioner, notice of the
6412 reason for the delay; and
6413 (c) final disposition of the decedent may not be made until authorized by the attending
6414 health care professional or medical examiner.
6415 (9) (a) When a death is presumed to have occurred within this state but the dead body
6416 cannot be located, a certificate of death may be prepared by the state registrar upon receipt of
6417 an order of a Utah [
6418 (b) The order described in Subsection (9)(a) shall include a finding of fact stating the
6419 name of the decedent, the date of death, and the place of death.
6420 (c) A certificate of death prepared under Subsection (9)(a) shall:
6421 (i) show the date of registration; and
6422 (ii) identify the court and the date of the order.
6423 (10) It is unlawful for a dispositioner to charge for or accept any remuneration for:
6424 (a) signing a certificate of death; or
6425 (b) performing any other duty of a dispositioner, as described in this section.
6426 (11) The state registrar shall, within five business days after the day on which the state
6427 registrar or local registrar registers a certificate of death for a Utah resident, inform the
6428 lieutenant governor of:
6429 (a) the decedent's name, last known residential address, date of birth, and date of death;
6430 and
6431 (b) any other information requested by the lieutenant governor to assist the county
6432 clerk in identifying the decedent for the purpose of removing the decedent from the official
6433 register of voters.
6434 (12) The lieutenant governor shall, within one business day after the day on which the
6435 lieutenant governor receives the information described in Subsection (11), provide the
6436 information to the county clerks.
6437 Section 190. Section 26B-8-115, which is renumbered from Section 26-2-14 is
6438 renumbered and amended to read:
6439 [
6440 requirements.
6441 (1) A fetal death certificate shall be filed for each fetal death which occurs in this state.
6442 The certificate shall be filed within five days after delivery with the local registrar or as
6443 otherwise directed by the state registrar. The certificate shall be registered if it is completed and
6444 filed in accordance with this [
6445 (2) When a dead fetus is delivered in an institution, the institution administrator or his
6446 designated representative shall prepare and file the fetal death certificate. The attending
6447 physician shall state in the certificate the cause of death and sign the certificate.
6448 (3) When a dead fetus is delivered outside an institution, the physician in attendance at
6449 or immediately after delivery shall complete, sign, and file the fetal death certificate.
6450 (4) When a fetal death occurs without medical attendance at or immediately after the
6451 delivery or when inquiry is required by [
6452 2, Utah Medical Examiner, the medical examiner shall investigate the cause of death and
6453 prepare and file the certificate of fetal death within five days after taking charge of the case.
6454 (5) When a fetal death occurs in a moving conveyance and the dead fetus is first
6455 removed from the conveyance in this state or when a dead fetus is found in this state and the
6456 place of death is unknown, the death shall be registered in this state. The place where the dead
6457 fetus was first removed from the conveyance or found shall be considered the place of death.
6458 (6) Final disposition of the dead fetus may not be made until the fetal death certificate
6459 has been registered.
6460 Section 191. Section 26B-8-116, which is renumbered from Section 26-2-14.1 is
6461 renumbered and amended to read:
6462 [
6463 (1) [
6464 "stillbirth" and "stillborn child" [
6465 as defined in Section [
6466 (2) (a) In addition to the requirements of Section [
6467 registrar shall establish a certificate of birth resulting in stillbirth on a form approved by the
6468 state registrar for each stillbirth occurring in this state.
6469 (b) This certificate shall be offered to the parent or parents of a stillborn child.
6470 (3) The certificate of birth resulting in stillbirth shall meet all of the format and filing
6471 requirements of Sections [
6472 birth.
6473 (4) The person who prepares a certificate pursuant to this section shall leave blank any
6474 references to the stillborn child's name if the stillborn child's parent or parents do not wish to
6475 provide a name for the stillborn child.
6476 (5) Notwithstanding Subsections (2) and (3), the certificate of birth resulting in
6477 stillbirth shall be filed with the designated registrar within 10 days following the delivery and
6478 prior to cremation or removal of the fetus from the registration district.
6479 Section 192. Section 26B-8-117, which is renumbered from Section 26-2-14.2 is
6480 renumbered and amended to read:
6481 [
6482 When a birth resulting in stillbirth occurring in this state has not been registered within
6483 one year after the date of delivery, a certificate marked "delayed" may be filed and registered in
6484 accordance with department rule relating to evidentiary and other requirements sufficient to
6485 substantiate the alleged facts of birth resulting in stillbirth.
6486 Section 193. Section 26B-8-118, which is renumbered from Section 26-2-14.3 is
6487 renumbered and amended to read:
6488 [
6489 (1) As used in this section, "early term stillborn child" means a product of human
6490 conception, other than in the circumstances described in Subsection 76-7-301(1), that:
6491 (a) is of at least 16 weeks' gestation but less than 20 weeks' gestation, calculated from
6492 the day on which the mother's last normal menstrual period began to the day of delivery; and
6493 (b) is not born alive.
6494 (2) The state registrar shall issue a certificate of early term stillbirth to a parent of an
6495 early term stillborn child if:
6496 (a) the parent requests, on a form created by the state registrar, that the state registrar
6497 register and issue a certificate of early term stillbirth for the early term stillborn child; and
6498 (b) the parent files with the state registrar:
6499 (i) (A) a signed statement from a physician confirming the delivery of the early term
6500 stillborn child; or
6501 (B) an accurate copy of the parent's medical records related to the early term stillborn
6502 child; and
6503 (ii) any other record the state registrar determines, by rule made in accordance with
6504 Title 63G, Chapter 3, Utah Administrative Rulemaking Act, is necessary for accurate
6505 recordkeeping.
6506 (3) The certificate of early term stillbirth described in Subsection (2) shall meet all of
6507 the format and filing requirements of Section [
6508 (4) A person who prepares a certificate of early term stillbirth under this section shall
6509 leave blank any references to an early term stillborn child's name if the early term stillborn
6510 child's parent does not wish to provide a name for the early term stillborn child.
6511 Section 194. Section 26B-8-119, which is renumbered from Section 26-2-15 is
6512 renumbered and amended to read:
6513 [
6514 -- Court procedure.
6515 (1) A person holding a direct, tangible, and legitimate interest as described in
6516 Subsection [
6517 fact, time, and place of a birth or death that is not registered or for which a certified copy of the
6518 registered birth or death certificate is not obtainable. The person shall verify the petition and
6519 file the petition in the Utah [
6520 (a) the birth or death is alleged to have occurred;
6521 (b) the person resides whose birth is to be established; or
6522 (c) the decedent named in the petition resided at the date of death.
6523 (2) In order for the court to have jurisdiction, the petition shall:
6524 (a) allege the date, time, and place of the birth or death; and
6525 (b) state either that no certificate of birth or death has been registered or that a copy of
6526 the registered certificate cannot be obtained.
6527 (3) The court shall set a hearing for five to 10 days after the day on which the petition
6528 is filed.
6529 (4) (a) If the time and place of birth or death are in question, the court shall hear
6530 available evidence and determine the time and place of the birth or death.
6531 (b) If the time and place of birth or death are not in question, the court shall determine
6532 the time and place of birth or death to be those alleged in the petition.
6533 (5) A court order under this section shall be made on a form prescribed and furnished
6534 by the department and is effective upon the filing of a certified copy of the order with the state
6535 registrar.
6536 (6) (a) For purposes of this section, the birth certificate of an adopted alien child, as
6537 defined in Section 78B-6-108, is considered to be unobtainable if the child was born in a
6538 country that is not recognized by department rule as having an established vital records
6539 registration system.
6540 (b) If the adopted child was born in a country recognized by department rule, but a
6541 person described in Subsection (1) is unable to obtain a certified copy of the birth certificate,
6542 the state registrar shall authorize the preparation of a birth certificate if the state registrar
6543 receives a written statement signed by the registrar of the child's birth country stating a certified
6544 copy of the birth certificate is not available.
6545 Section 195. Section 26B-8-120, which is renumbered from Section 26-2-16 is
6546 renumbered and amended to read:
6547 [
6548 service director, an agent of a funeral service director, or a dispositioner -- Medical
6549 certification -- Records of funeral service director or dispositioner -- Information filed
6550 with local registrar -- Unlawful signing of certificate of death.
6551 (1) The custodial funeral service director or, if a funeral service director is not retained,
6552 a dispositioner shall sign the certificate of death prior to any disposition of a dead body or dead
6553 fetus.
6554 (2) The custodial funeral service director, an agent of the custodial funeral service
6555 director, or, if a funeral service director is not retained, a dispositioner shall:
6556 (a) obtain personal and statistical information regarding the decedent from the
6557 available persons best qualified to provide the information;
6558 (b) present the certificate of death to the attending health care professional, if any, or to
6559 the medical examiner who shall certify the cause of death and other information required on the
6560 certificate of death;
6561 (c) provide the address of the custodial funeral service director or, if a funeral service
6562 director is not retained, a dispositioner;
6563 (d) certify the date and place of burial; and
6564 (e) file the certificate of death with the state or local registrar.
6565 (3) A funeral service director, dispositioner, embalmer, or other person who removes a
6566 dead body or dead fetus from the place of death or transports or is in charge of final disposal of
6567 a dead body or dead fetus, shall keep a record identifying the dead body or dead fetus, and
6568 containing information pertaining to receipt, removal, and delivery of the dead body or dead
6569 fetus as prescribed by department rule.
6570 (4) (a) Not later than the tenth day of each month, every licensed funeral service
6571 establishment shall send to the local registrar and the department a list of the information
6572 required in Subsection (3) for each casket furnished and for funerals performed when no casket
6573 was furnished, during the preceding month.
6574 (b) The list described in Subsection (4)(a) shall be in the form prescribed by the state
6575 registrar.
6576 (5) Any person who intentionally signs the portion of a certificate of death that is
6577 required to be signed by a funeral service director or a dispositioner under Subsection (1) is
6578 guilty of a class B misdemeanor, unless the person:
6579 (a) (i) is a funeral service director; and
6580 (ii) is employed by a licensed funeral establishment; or
6581 (b) is a dispositioner, if a funeral service director is not retained.
6582 (6) The state registrar shall post information on the state registrar's website, providing
6583 instructions to a dispositioner for complying with the requirements of law relating to the
6584 dispositioner's responsibilities for:
6585 (a) completing and filing a certificate of death; and
6586 (b) possessing, transporting, and disposing of a dead body or dead fetus.
6587 (7) The provisions of this [
6588 fullest extent possible, with the ceremonies, customs, rites, or beliefs of the decedent and the
6589 decedent's next of kin for disposing of a dead body or dead fetus.
6590 Section 196. Section 26B-8-121, which is renumbered from Section 26-2-17 is
6591 renumbered and amended to read:
6592 [
6593 interment -- Burial-transit permits -- Procedure where body donated under anatomical
6594 gift law -- Permit for disinterment.
6595 (1) (a) A dead body or dead fetus may not be interred or otherwise disposed of or
6596 removed from the registration district in which death or fetal death occurred or the remains are
6597 found until a certificate of death is registered.
6598 (b) Subsection (1)(a) does not apply to fetal remains for a fetus that is less than 20
6599 weeks in gestational age.
6600 (2) (a) For deaths or fetal deaths which occur in this state, no burial-transit permit is
6601 required for final disposition of the remains if:
6602 (i) disposition occurs in the state and is performed by a funeral service director; or
6603 (ii) the disposition takes place with authorization of the next of kin and in:
6604 (A) a general acute hospital as [
6605 that is licensed by the department; or
6606 (B) in a pathology laboratory operated under contract with a general acute hospital
6607 licensed by the department.
6608 (b) For an abortion or miscarriage that occurs at a health care facility, no burial-transit
6609 permit is required for final disposition of the fetal remains if:
6610 (i) disposition occurs in the state and is performed by a funeral service director; or
6611 (ii) the disposition takes place:
6612 (A) with authorization of the parent of a miscarried fetus or the pregnant woman for an
6613 aborted fetus; and
6614 (B) in a general acute hospital as [
6615 or a pathology laboratory operated under contract with a general acute hospital.
6616 (3) (a) A burial-transit permit shall be issued by the local registrar of the district where
6617 the certificate of death or fetal death is registered:
6618 (i) for a dead body or a dead fetus to be transported out of the state for final
6619 disposition; or
6620 (ii) when disposition of the dead body or dead fetus is made by a person other than a
6621 funeral service director.
6622 (b) For fetal remains that are less than 20 weeks in gestational age, a burial-transit
6623 permit shall be issued by the local registrar of the district where the health care facility that is in
6624 possession of the fetal remains is located:
6625 (i) for the fetal remains to be transported out of the state for final disposition; or
6626 (ii) when disposition of the fetal remains is made by a person other than a funeral
6627 service director.
6628 (c) A local registrar issuing a burial-transit permit issued under Subsection (3)(b):
6629 (i) may not require an individual to designate a name for the fetal remains; and
6630 (ii) may leave the space for a name on the burial-transit permit blank; and
6631 (d) shall redact from any public records maintained under this [
6632 information:
6633 (i) that is submitted under Subsection (3)(c); and
6634 (ii) that may be used to identify the parent or pregnant woman.
6635 (4) A burial-transit permit issued under the law of another state which accompanies a
6636 dead body, dead fetus, or fetal remains brought into this state is authority for final disposition
6637 of the dead body, dead fetus, or fetal remains in this state.
6638 (5) When a dead body or dead fetus or any part of the dead body or dead fetus has been
6639 donated under [
6640 state and the preservation of the gift requires the immediate transportation of the dead body,
6641 dead fetus, or any part of the body or fetus outside of the registration district in which death
6642 occurs or the remains are found, or into this state from another state, the dead body or dead
6643 fetus or any part of the body or fetus may be transported and the burial-transit permit required
6644 by this section obtained within a reasonable time after transportation.
6645 (6) A permit for disinterment and reinterment is required prior to disinterment of a
6646 dead body, dead fetus, or fetal remains, except as otherwise provided by statute or department
6647 rule.
6648 Section 197. Section 26B-8-122, which is renumbered from Section 26-2-18 is
6649 renumbered and amended to read:
6650 [
6651 Record of interments -- Information filed with local registrar.
6652 (1) (a) A sexton or person in charge of any premises in which interments are made may
6653 not inter or permit the interment of any dead body, dead fetus, or fetal remains unless the
6654 interment is made by a funeral service director or by a person holding a burial-transit permit.
6655 (b) The right and duty to control the disposition of a deceased person shall be governed
6656 by Sections 58-9-601 through 58-9-604.
6657 (2) (a) The sexton or the person in charge of any premises where interments are made
6658 shall keep a record of all interments made in the premises under their charge, stating the name
6659 of the decedent, place of death, date of burial, and name and address of the funeral service
6660 director or other person making the interment.
6661 (b) The record described in this Subsection (2) shall be open to public inspection.
6662 (c) A city or county clerk may, at the clerk's option, maintain the interment records
6663 described in this Subsection (2) on behalf of the sexton or person in charge of any premises in
6664 which interments are made.
6665 (3) (a) Not later than the tenth day of each month, the sexton, person in charge of the
6666 premises, or city or county clerk who maintains the interment records shall send to the local
6667 registrar and the department a list of all interments made in the premises during the preceding
6668 month.
6669 (b) The list described in Subsection (3)(a) shall be in the form prescribed by the state
6670 registrar.
6671 Section 198. Section 26B-8-123, which is renumbered from Section 26-2-19 is
6672 renumbered and amended to read:
6673 [
6674 keeping of records by local registrar.
6675 Each local registrar shall transmit all records registered by him to the department in
6676 accordance with department rules. The manner of keeping local copies of vital records and the
6677 uses of them shall be prescribed by department rules.
6678 Section 199. Section 26B-8-124, which is renumbered from Section 26-2-21 is
6679 renumbered and amended to read:
6680 [
6681 records.
6682 The state registrar may authorize local registrars to issue certified copies of vital
6683 records.
6684 Section 200. Section 26B-8-125, which is renumbered from Section 26-2-22 is
6685 renumbered and amended to read:
6686 [
6687 (1) As used in this section:
6688 (a) "Designated legal representative" means an attorney, physician, funeral service
6689 director, genealogist, or other agent of the subject, or an immediate family member of the
6690 subject, who has been delegated the authority to access vital records.
6691 (b) "Drug use intervention or suicide prevention effort" means a program that studies
6692 or promotes the prevention of drug overdose deaths or suicides in the state.
6693 (c) "Immediate family member" means a spouse, child, parent, sibling, grandparent, or
6694 grandchild.
6695 (2) (a) The vital records shall be open to inspection, but only in compliance with the
6696 provisions of this [
6697 (b) It is unlawful for any state or local officer or employee to disclose data contained in
6698 vital records contrary to this [
6699 78B-6-144.
6700 (c) (i) An adoption document is open to inspection as provided in Section 78B-6-141
6701 or Section 78B-6-144.
6702 (ii) A birth parent may not access an adoption document under Subsection
6703 78B-6-141(3).
6704 (d) A custodian of vital records may permit inspection of a vital record or issue a
6705 certified copy of a record or a part of a record when the custodian is satisfied that the applicant
6706 has demonstrated a direct, tangible, and legitimate interest.
6707 (3) Except as provided in Subsection (4), a direct, tangible, and legitimate interest in a
6708 vital record is present only if:
6709 (a) the request is from:
6710 (i) the subject;
6711 (ii) an immediate family member of the subject;
6712 (iii) the guardian of the subject;
6713 (iv) a designated legal representative of the subject; or
6714 (v) a person, including a child-placing agency as defined in Section 78B-6-103, with
6715 whom a child has been placed pending finalization of an adoption of the child;
6716 (b) the request involves a personal or property right of the subject of the record;
6717 (c) the request is for official purposes of a public health authority or a state, local, or
6718 federal governmental agency;
6719 (d) the request is for a drug use intervention or suicide prevention effort or a statistical
6720 or medical research program and prior consent has been obtained from the state registrar; or
6721 (e) the request is a certified copy of an order of a court of record specifying the record
6722 to be examined or copied.
6723 (4) (a) Except as provided in Title 78B, Chapter 6, Part 1, Utah Adoption Act, a parent,
6724 or an immediate family member of a parent, who does not have legal or physical custody of or
6725 visitation or parent-time rights for a child because of the termination of parental rights under
6726 Title 80, Chapter 4, Termination and Restoration of Parental Rights, or by virtue of consenting
6727 to or relinquishing a child for adoption pursuant to Title 78B, Chapter 6, Part 1, Utah Adoption
6728 Act, may not be considered as having a direct, tangible, and legitimate interest under this
6729 section.
6730 (b) Except as provided in Subsection (2)(d), a commercial firm or agency requesting
6731 names, addresses, or similar information may not be considered as having a direct, tangible,
6732 and legitimate interest under this section.
6733 (5) Upon payment of a fee established in accordance with Section 63J-1-504, the office
6734 shall make the following records available to the public:
6735 (a) except as provided in Subsection [
6736 excluding confidential information collected for medical and health use, if 100 years or more
6737 have passed since the date of birth;
6738 (b) a death record if 50 years or more have passed since the date of death; and
6739 (c) a vital record not subject to Subsection (5)(a) or (b) if 75 years or more have passed
6740 since the date of the event upon which the record is based.
6741 (6) Upon payment of a fee established in accordance with Section 63J-1-504, the office
6742 shall make an adoption document available as provided in Sections 78B-6-141 and 78B-6-144.
6743 (7) The office shall make rules in accordance with Title 63G, Chapter 3, Utah
6744 Administrative Rulemaking Act, establishing procedures and the content of forms as follows:
6745 (a) for the inspection of adoption documents under Subsection 78B-6-141(4);
6746 (b) for a birth parent's election to permit identifying information about the birth parent
6747 to be made available, under Section 78B-6-141;
6748 (c) for the release of information by the mutual-consent, voluntary adoption registry,
6749 under Section 78B-6-144;
6750 (d) for collecting fees and donations under Section 78B-6-144.5; and
6751 (e) for the review and approval of a request described in Subsection (3)(d).
6752 Section 201. Section 26B-8-126, which is renumbered from Section 26-2-23 is
6753 renumbered and amended to read:
6754 [
6755 -- Information filed with local registrar and department.
6756 (1) (a) All administrators or other persons in charge of hospitals, nursing homes, or
6757 other institutions, public or private, to which persons resort for treatment of diseases,
6758 confinements, or are committed by law, shall record all the personal and statistical information
6759 about patients of their institutions as required in certificates prescribed by this [
6760 (b) The information described in Subsection (1)(a) shall:
6761 (i) be recorded for collection at the time of admission of a patient;
6762 (ii) be obtained from the patient, if possible; and
6763 (iii) if the information cannot be obtained from the patient, the information shall be
6764 secured in as complete a manner as possible from other persons acquainted with the facts.
6765 (2) (a) When a dead body or dead fetus is released or disposed of by an institution, the
6766 person in charge of the institution shall keep a record showing:
6767 (i) the name of the deceased;
6768 (ii) the date of death of the deceased;
6769 (iii) the name and address of the person to whom the dead body or dead fetus is
6770 released; and
6771 (iv) the date that the dead body or dead fetus is removed from the institution.
6772 (b) If final disposal is by the institution, the date, place, manner of disposition, and the
6773 name of the person authorizing disposition shall be recorded by the person in charge of the
6774 institution.
6775 (3) Not later than the tenth day of each month, the administrator of each institution
6776 shall cause to be sent to the local registrar and the department a list of all births, deaths, fetal
6777 deaths, and induced abortions occurring in the institution during the preceding month. The list
6778 shall be in the form prescribed by the state registrar.
6779 (4) A person or institution who, in good faith, releases a dead body or dead fetus, under
6780 this section, to a funeral service director or a dispositioner is immune from civil liability
6781 connected, directly or indirectly, with release of the dead body or dead fetus.
6782 Section 202. Section 26B-8-127, which is renumbered from Section 26-2-24 is
6783 renumbered and amended to read:
6784 [
6785 (1) The state registrar shall supply county clerks with application forms for marriage
6786 licenses.
6787 (2) Completed applications shall be transmitted by the clerks to the state registrar
6788 monthly.
6789 (3) The personal identification information contained on each application for a
6790 marriage license filed with the county clerk shall be entered on a form supplied by the state
6791 registrar.
6792 (4) The person performing the marriage shall furnish the date and place of marriage
6793 and his name and address.
6794 (5) The form described in Subsection (1) shall be completed and certified by the county
6795 clerk before it is filed with the state registrar.
6796 Section 203. Section 26B-8-128, which is renumbered from Section 26-2-25 is
6797 renumbered and amended to read:
6798 [
6799 certificates or reports.
6800 (1) For each adoption, annulment of adoption, divorce, and annulment of marriage
6801 ordered or decreed in this state, the clerk of the court shall prepare a divorce certificate or
6802 report of adoption on a form furnished by the state registrar.
6803 (2) The petitioner shall provide the information necessary to prepare the certificate or
6804 report under Subsection (1).
6805 (3) The clerk shall:
6806 (a) prepare the certificate or report under Subsection (1); and
6807 (b) complete the remaining entries for the certificate or report immediately after the
6808 decree or order becomes final.
6809 (4) On or before the 15th day of each month, the clerk shall forward the divorce
6810 certificates and reports of adoption under Subsection (1) completed by the clerk during the
6811 preceding month to the state registrar.
6812 (5) (a) A report of adoption under Subsection (1) may be provided to the attorney who
6813 is providing representation of a party to the adoption or the child-placing agency, as defined in
6814 Section 78B-6-103, that is placing the child.
6815 (b) If a report of adoption is provided to the attorney or the child-placing agency, as
6816 defined in Section 78B-6-103, the attorney or the child-placing agency shall immediately
6817 provide the report of adoption to the state registrar.
6818 Section 204. Section 26B-8-129, which is renumbered from Section 26-2-26 is
6819 renumbered and amended to read:
6820 [
6821 and local registrars -- Evidentiary value.
6822 (1) The state registrar and local registrars authorized by the department under Section
6823 [
6824 of vital records and certify their correctness.
6825 (2) Certified copies of the vital record, or authorized reproductions of the original,
6826 issued by either the state registrar or a designated local registrar are prima facie evidence in all
6827 courts of the state with like effect as the vital record.
6828 Section 205. Section 26B-8-130, which is renumbered from Section 26-2-27 is
6829 renumbered and amended to read:
6830 [
6831 Procedures.
6832 (1) As used in this section:
6833 (a) "Division" means the Criminal Investigations and Technical Services Division,
6834 Department of Public Safety, in Title 53, Chapter 10, Criminal Investigations and Technical
6835 Services Act.
6836 (b) "Missing child" means a person younger than 18 years of age who is missing from
6837 the person's home environment or a temporary placement facility for any reason, and whose
6838 whereabouts cannot be determined by the person responsible for the child's care.
6839 (c) "Missing person" means a person who:
6840 (i) is missing from the person's home environment; and
6841 (ii) (A) has a physical or mental disability;
6842 (B) is missing under circumstances that indicate that the person is endangered, missing
6843 involuntarily, or a victim of a catastrophe; or
6844 (C) is a missing child.
6845 (2) (a) In accordance with Section 53-10-203, upon the state registrar's notification by
6846 the division that a person who was born in this state is missing, the state and local registrars
6847 shall flag the registered birth certificate of that person so that when a copy of the registered
6848 birth certificate or information regarding the birth record is requested, the state and local
6849 registrars are alerted to the fact the registered birth certificate is that of a missing person.
6850 (b) Upon notification by the division the missing person has been recovered, the state
6851 and local registrars shall remove the flag from that person's registered birth certificate.
6852 (3) The state and local registrars may not provide a copy of a registered birth certificate
6853 of any person whose record is flagged under Subsection (2), except as approved by the
6854 division.
6855 (4) (a) When a copy of the registered birth certificate of a person whose record has
6856 been flagged is requested in person, the state or local registrar shall require that person to
6857 complete a form supplying that person's name, address, telephone number, and relationship to
6858 the missing person, and the name and birth date of the missing person.
6859 (b) The state or local registrar shall inform the requester that a copy of the registered
6860 birth certificate will be mailed to the requester.
6861 (c) The state or local registrar shall note the physical description of the person making
6862 the request, and shall immediately notify the division of the request and the information
6863 obtained pursuant to this Subsection (4).
6864 (5) When a copy of the registered birth certificate of a person whose record has been
6865 flagged is requested in writing, the state or local registrar or personnel of the state or local
6866 registrar shall immediately notify the division, and provide it with a copy of the written request.
6867 Section 206. Section 26B-8-131, which is renumbered from Section 26-2-28 is
6868 renumbered and amended to read:
6869 [
6870 Upon presentation of a court order of adoption and an order establishing the fact, time,
6871 and place of birth under Section [
6872 certificate for an individual who:
6873 (1) was adopted under the laws of this state; and
6874 (2) was at the time of adoption, as a child or as an adult, considered an alien child or
6875 adult for whom the court received documentary evidence of lawful admission under Section
6876 78B-6-108.
6877 Section 207. Section 26B-8-132, which is renumbered from Section 26-34-4 is
6878 renumbered and amended to read:
6879 [
6880 (1) As used in this section[
6881
6882
6883
6884 58, Chapter 31b, Nurse Practice Act.
6885 (2) (a) An individual is dead if the individual has sustained either:
6886 (i) irreversible cessation of circulatory and respiratory functions; or
6887 (ii) irreversible cessation of all functions of the entire brain, including the brain stem.
6888 (b) A determination of death shall be made in accordance with this part and accepted
6889 medical standards.
6890 [
6891 (a) an attending physician has:
6892 (i) documented in the individual's medical or clinical record that the individual's death
6893 is anticipated due to illness, infirmity, or disease no later than 180 days after the day on which
6894 the physician makes the documentation; and
6895 (ii) established clear assessment procedures for determining death;
6896 (b) the death actually occurs within the 180-day period described in Subsection [
6897 (3)(a); and
6898 (c) at the time of the documentation described in Subsection [
6899 authorized the following, in writing, to make the determination of death:
6900 (i) one or more specific registered nurses; or
6901 (ii) if the individual is in a health care facility that has complied with Subsection [
6902 (6), all registered nurses that the facility employs.
6903 [
6904 (a) document the clinical criteria for the determination in the individual's medical or
6905 clinical record;
6906 (b) notify the physician described in Subsection [
6907 (c) ensure that the death certificate includes:
6908 (i) the name of the deceased;
6909 (ii) the presence of a contagious disease, if known; and
6910 (iii) the date and time of death.
6911 [
6912
6913
6914 hours after the registered nurse makes the determination of death.
6915 [
6916 in Subsection [
6917 for the determination of death by a registered nurse under this section.
6918 (b) A registered nurse that a health care facility employs may not make a determination
6919 of death under this section unless the facility has adopted the written policies and procedures
6920 described in Subsection [
6921 [
6922 Utah Administrative Rulemaking Act, to ensure the appropriate determination of death under
6923 this section.
6924 Section 208. Section 26B-8-133, which is renumbered from Section 26-23-5 is
6925 renumbered and amended to read:
6926 [
6927 reports -- Unlawful transportation or acceptance of dead human body.
6928 It is unlawful for any person, association, or corporation and the officers of any of them:
6929 (1) to willfully and knowingly make any false statement in a certificate, record, or
6930 report required to be filed with the department, or in an application for a certified copy of a
6931 vital record, or to willfully and knowingly supply false information intending that the
6932 information be used in the preparation of any report, record, or certificate, or an amendment to
6933 any of these;
6934 (2) to make, counterfeit, alter, amend, or mutilate any certificate, record, or report
6935 required to be filed under this code or a certified copy of the certificate, record, or report
6936 without lawful authority and with the intent to deceive;
6937 (3) to willfully and knowingly obtain, possess, use, sell, furnish, or attempt to obtain,
6938 possess, use, sell, or furnish to another, for any purpose of deception, any certificate, record,
6939 report, or certified copy of any of them, including any that are counterfeited, altered, amended,
6940 or mutilated;
6941 (4) without lawful authority, to possess any certificate, record, or report, required by
6942 the department or a copy or certified copy of the certificate, record, or report, knowing it to
6943 have been stolen or otherwise unlawfully obtained; or
6944 (5) to willfully and knowingly transport or accept for transportation, interment, or other
6945 disposition a dead human body without a permit required by law.
6946 Section 209. Section 26B-8-134, which is renumbered from Section 26-23-5.5 is
6947 renumbered and amended to read:
6948 [
6949 (1) It is a third degree felony for any person to willfully and knowingly:
6950 (a) and with the intent to deceive, obtain, possess, use, sell, furnish, or attempt to
6951 obtain, possess, use, sell, or furnish to another any certificate of birth or certified copy of a
6952 certificate of birth knowing that the certificate or certified copy was issued upon information
6953 which is false in whole or in part or which relates to the birth of another person, whether living
6954 or deceased; or
6955 (b) furnish or process a certificate of birth or certified copy of a certificate of birth with
6956 the knowledge or intention that it be used for the purpose of deception by a person other than
6957 the person to whom the certificate of birth relates.
6958 (2) The specific criminal violations and the criminal penalty under this section take
6959 precedence over any more general criminal offense as described in Section [
6960 26B-8-133.
6961 Section 210. Section 26B-8-201, which is renumbered from Section 26-4-2 is
6962 renumbered and amended to read:
6963
6964 [
6965 As used in this [
6966 (1) "Dead body" means the same as that term is defined in Section [
6967 (2) (a) "Death by violence" means death that resulted by the decedent's exposure to
6968 physical, mechanical, or chemical forces.
6969 (b) "Death by violence" includes death that appears to have been due to homicide,
6970 death that occurred during or in an attempt to commit rape, mayhem, kidnapping, robbery,
6971 burglary, housebreaking, extortion, or blackmail accompanied by threats of violence, assault
6972 with a dangerous weapon, assault with intent to commit any offense punishable by
6973 imprisonment for more than one year, arson punishable by imprisonment for more than one
6974 year, or any attempt to commit any of the foregoing offenses.
6975 (3) "Immediate relative" means an individual's spouse, child, parent, sibling,
6976 grandparent, or grandchild.
6977 (4) "Health care professional" means any of the following while acting in a
6978 professional capacity:
6979 (a) a physician licensed under Title 58, Chapter 67, Utah Medical Practice Act, or Title
6980 58, Chapter 68, Utah Osteopathic Medical Practice Act;
6981 (b) a physician assistant licensed under Title 58, Chapter 70a, Utah Physician Assistant
6982 Act; or
6983 (c) an advance practice registered nurse licensed under Subsection 58-31b-301(2)(e).
6984 (5) "Medical examiner" means the state medical examiner appointed pursuant to
6985 Section [
6986 (6) "Medical examiner record" means:
6987 (a) all information that the medical examiner obtains regarding a decedent; and
6988 (b) reports that the medical examiner makes regarding a decedent.
6989 (7) "Regional pathologist" means a trained pathologist licensed to practice medicine
6990 and surgery in the state, appointed by the medical examiner pursuant to Subsection [
6991 26B-8-202(3).
6992 (8) "Sudden death while in apparent good health" means apparently instantaneous
6993 death without obvious natural cause, death during or following an unexplained syncope or
6994 coma, or death during an acute or unexplained rapidly fatal illness.
6995 (9) "Sudden infant death syndrome" means the death of a child who was thought to be
6996 in good health or whose terminal illness appeared to be so mild that the possibility of a fatal
6997 outcome was not anticipated.
6998 (10) "Suicide" means death caused by an intentional and voluntary act of an individual
6999 who understands the physical nature of the act and intends by such act to accomplish
7000 self-destruction.
7001 (11) "Unattended death" means a death that occurs more than 365 days after the day on
7002 which a health care professional examined or treated the deceased individual for any purpose,
7003 including writing a prescription.
7004 (12) (a) "Unavailable for postmortem investigation" means that a dead body is:
7005 (i) transported out of state;
7006 (ii) buried at sea;
7007 (iii) cremated;
7008 (iv) processed by alkaline hydrolysis; or
7009 (v) otherwise made unavailable to the medical examiner for postmortem investigation
7010 or autopsy.
7011 (b) "Unavailable for postmortem investigation" does not include embalming or burial
7012 of a dead body pursuant to the requirements of law.
7013 (13) "Within the scope of the decedent's employment" means all acts reasonably
7014 necessary or incident to the performance of work, including matters of personal convenience
7015 and comfort not in conflict with specific instructions.
7016 Section 211. Section 26B-8-202, which is renumbered from Section 26-4-4 is
7017 renumbered and amended to read:
7018 [
7019 -- Authority.
7020 (1) The executive director, with the advice of an advisory board consisting of the
7021 chairman of the Department of Pathology at the University of Utah medical school and the
7022 dean of the law school at the University of Utah, shall appoint a chief medical examiner who
7023 shall be licensed to practice medicine in the state and shall meet the qualifications of a forensic
7024 pathologist, certified by the American Board of Pathologists.
7025 (2) (a) The medical examiner shall serve at the will of the executive director.
7026 (b) The medical examiner has authority to:
7027 (i) employ medical, technical and clerical personnel as may be required to effectively
7028 administer this chapter, subject to the rules of the department and the state merit system;
7029 (ii) conduct investigations and pathological examinations;
7030 (iii) perform autopsies authorized in this title;
7031 (iv) conduct or authorize necessary examinations on dead bodies; and
7032 (v) notwithstanding the provisions of Subsection [
7033 tissues and biological samples:
7034 (A) for scientific purposes;
7035 (B) where necessary to accurately certify the cause and manner of death; or
7036 (C) for tissue from an unclaimed body, subject to Section [
7037 order to donate the tissue or biological sample to an individual who is affiliated with an
7038 established search and rescue dog organization, for the purpose of training a dog to search for
7039 human remains.
7040 (c) In the case of an unidentified body, the medical examiner shall authorize or conduct
7041 investigations, tests and processes in order to determine its identity as well as the cause of
7042 death.
7043 (3) The medical examiner may appoint regional pathologists, each of whom shall be
7044 approved by the executive director.
7045 Section 212. Section 26B-8-203, which is renumbered from Section 26-4-5 is
7046 renumbered and amended to read:
7047 [
7048 The county executive, with the advice and consent of the county legislative body, may
7049 appoint medical examiners for their respective counties.
7050 Section 213. Section 26B-8-204, which is renumbered from Section 26-4-6 is
7051 renumbered and amended to read:
7052 [
7053 (1) The following have authority to investigate a death described in Section [
7054 26B-8-205 and any other case which may be within their jurisdiction:
7055 (a) the attorney general or an assistant attorney general;
7056 (b) the district attorney or county attorney who has criminal jurisdiction over the death
7057 or case;
7058 (c) a deputy of the district attorney or county attorney described in Subsection (1)(b);
7059 or
7060 (d) a peace officer within the jurisdiction described in Subsection (1)(b).
7061 (2) If, in the opinion of the medical examiner, an autopsy should be performed or if an
7062 autopsy is requested by the district attorney or county attorney having criminal jurisdiction, or
7063 by the attorney general, the autopsy shall be performed by the medical examiner or a regional
7064 pathologist.
7065 Section 214. Section 26B-8-205, which is renumbered from Section 26-4-7 is
7066 renumbered and amended to read:
7067 [
7068 Upon notification under Section [
7069 examiner's office, the medical examiner shall assume custody of a deceased body if it appears
7070 that death:
7071 (1) was by violence, gunshot, suicide, or accident;
7072 (2) was sudden death while in apparent good health;
7073 (3) occurred unattended, except that an autopsy may only be performed in accordance
7074 with the provisions of Subsection [
7075 (4) occurred under suspicious or unusual circumstances;
7076 (5) resulted from poisoning or overdose of drugs;
7077 (6) resulted from a disease that may constitute a threat to the public health;
7078 (7) resulted from disease, injury, toxic effect, or unusual exertion incurred within the
7079 scope of the decedent's employment;
7080 (8) was due to sudden infant death syndrome;
7081 (9) occurred while the decedent was in prison, jail, police custody, the state hospital, or
7082 in a detention or medical facility operated for the treatment of persons with a mental illness,
7083 persons who are emotionally disturbed, or delinquent persons;
7084 (10) resulted directly from the actions of a law enforcement officer, as defined in
7085 Section 53-13-103;
7086 (11) was associated with diagnostic or therapeutic procedures; or
7087 (12) was described in this section when request is made to assume custody by a county
7088 or district attorney or law enforcement agency in connection with a potential homicide
7089 investigation or prosecution.
7090 Section 215. Section 26B-8-206, which is renumbered from Section 26-4-8 is
7091 renumbered and amended to read:
7092 [
7093 Procedure.
7094 (1) When death occurs under circumstances listed in Section [
7095 person or persons finding or having custody of the body shall immediately notify the nearest
7096 law enforcement agency. The law enforcement agency having jurisdiction over the case shall
7097 then proceed to the place where the body is and conduct an investigation concerning the cause
7098 and circumstances of death for the purpose of determining whether there exists any criminal
7099 responsibility for the death.
7100 (2) On a determination by the law enforcement agency that death may have occurred in
7101 any of the ways described in Section [
7102 district attorney or county attorney having criminal jurisdiction and to the medical examiner by
7103 the law enforcement agency having jurisdiction over the investigation.
7104 (3) The report shall be made by the most expeditious means available. Failure to give
7105 notification or report to the district attorney or county attorney having criminal jurisdiction and
7106 medical examiner is a class B misdemeanor.
7107 Section 216. Section 26B-8-207, which is renumbered from Section 26-4-9 is
7108 renumbered and amended to read:
7109 [
7110 Examination of scene of death -- Preservation of body -- Autopsies.
7111 (1) (a) Upon notification of a death under Section [
7112 examiner shall assume custody of the deceased body, clothing on the body, biological samples
7113 taken, and any article on or near the body which may aid the medical examiner in determining
7114 the cause of death except those articles which will assist the investigative agency to proceed
7115 without delay with the investigation.
7116 (b) In all cases the scene of the event may not be disturbed until authorization is given
7117 by the senior ranking peace officer from the law enforcement agency having jurisdiction of the
7118 case and conducting the investigation.
7119 (c) Where death appears to have occurred under circumstances listed in Section
7120 [
7121 jurisdiction over the investigation of the death, shall take reasonable precautions to preserve the
7122 body and body fluids so that minimum deterioration takes place.
7123 (d) A person may not move a body in the custody of the medical examiner unless:
7124 (i) the medical examiner, or district attorney or county attorney that has criminal
7125 jurisdiction, authorizes the person to move the body;
7126 (ii) a designee of an individual listed in Subsection (1)(d) authorizes the person to
7127 move the body;
7128 (iii) not moving the body would be an affront to public decency or impractical; or
7129 (iv) the medical examiner determines the cause of death is likely due to natural causes.
7130 (e) The body can under direction of the medical examiner or the medical examiner's
7131 designee be moved to a place specified by the medical examiner or the medical examiner's
7132 designee.
7133 (2) (a) If the medical examiner has custody of a body, a person may not clean or
7134 embalm the body without first obtaining the medical examiner's permission.
7135 (b) An intentional or knowing violation of Subsection (2)(a) is a class B misdemeanor.
7136 (3) (a) When the medical examiner assumes lawful custody of a body under Subsection
7137 [
7138 performed unless requested by the district attorney, county attorney having criminal
7139 jurisdiction, or law enforcement agency having jurisdiction of the place where the body is
7140 found.
7141 (b) The county attorney or district attorney and law enforcement agency having
7142 jurisdiction shall consult with the medical examiner to determine the need for an autopsy.
7143 (c) If the deceased chose not to be seen or treated by a health care professional for a
7144 spiritual or religious reason, a district attorney, county attorney, or law enforcement agency,
7145 may not request an autopsy or inquest under Subsection (3)(a) solely because of the deceased's
7146 choice.
7147 (d) The medical examiner or medical examiner's designee may not conduct a requested
7148 autopsy described in Subsection (3)(a) if the medical examiner or medical examiner's designee
7149 determines:
7150 (i) the request violates Subsection (3)(c); or
7151 (ii) the cause of death can be determined without performing an autopsy.
7152 Section 217. Section 26B-8-208, which is renumbered from Section 26-2-18.5 is
7153 renumbered and amended to read:
7154 [
7155 investigation.
7156 (1) As used in this section:
7157 (a) "Medical examiner" means the same as that term is defined in Section [
7158 26B-8-201.
7159 (b) "Unavailable for postmortem investigation" means the same as that term is defined
7160 in Section [
7161 (2) It is unlawful for a person to engage in any conduct that makes a dead body
7162 unavailable for postmortem investigation, unless, before engaging in that conduct, the person
7163 obtains a permit from the medical examiner to render the dead body unavailable for
7164 postmortem investigation, under Section [
7165 the body unavailable for postmortem investigation.
7166 (3) A person who violates Subsection (2) is guilty of a third degree felony.
7167 (4) If a person engages in conduct that constitutes both a violation of this section and a
7168 violation of Section 76-9-704, the provisions and penalties of Section 76-9-704 supersede the
7169 provisions and penalties of this section.
7170 Section 218. Section 26B-8-209, which is renumbered from Section 26-4-10 is
7171 renumbered and amended to read:
7172 [
7173 (1) (a) For a death under any of the circumstances described in Section [
7174 26B-8-205, only the medical examiner or the medical examiner's designee may certify the
7175 cause of death.
7176 (b) An individual who knowingly certifies the cause of death in violation of Subsection
7177 (1)(a) is guilty of a class B misdemeanor.
7178 (2) (a) For a death described in Section [
7179 knowingly give false information, with the intent to mislead, to the medical examiner or the
7180 medical examiner's designee.
7181 (b) A violation of Subsection (2)(a) is a class B misdemeanor.
7182 Section 219. Section 26B-8-210, which is renumbered from Section 26-4-10.5 is
7183 renumbered and amended to read:
7184 [
7185 controlled substance poisoning or overdose.
7186 (1) If a medical examiner determines that the death of a person who is 12 years old or
7187 older at the time of death resulted from poisoning or overdose involving a prescribed controlled
7188 substance, the medical examiner shall, within three business days after the day on which the
7189 medical examiner determines the cause of death, send a written report to the Division of
7190 Professional Licensing, created in Section 58-1-103, that includes:
7191 (a) the decedent's name;
7192 (b) each drug or other substance found in the decedent's system that may have
7193 contributed to the poisoning or overdose, if known; and
7194 (c) the name of each person the medical examiner has reason to believe may have
7195 prescribed a controlled substance described in Subsection (1)(b) to the decedent.
7196 (2) This section does not create a new cause of action.
7197 Section 220. Section 26B-8-211, which is renumbered from Section 26-4-11 is
7198 renumbered and amended to read:
7199 [
7200 (1) A complete copy of all written records and reports of investigations and facts
7201 resulting from medical care treatment, autopsies conducted by any person on the body of the
7202 deceased who died in any manner listed in Section [
7203 of any investigative agency making inquiry into the incident shall be promptly made and filed
7204 with the medical examiner.
7205 (2) The judiciary or a state or local government entity that retains a record, other than a
7206 document described in Subsection (1), of the decedent shall provide a copy of the record to the
7207 medical examiner:
7208 (a) in accordance with federal law; and
7209 (b) upon receipt of the medical examiner's written request for the record.
7210 (3) Failure to submit reports or records described in Subsection (1) or (2), other than
7211 reports of a county attorney, district attorney, or law enforcement agency, within 10 days after
7212 the day on which the person in possession of the report or record receives the medical
7213 examiner's written request for the report or record is a class B misdemeanor.
7214 Section 221. Section 26B-8-212, which is renumbered from Section 26-4-12 is
7215 renumbered and amended to read:
7216 [
7217 (1) In case of any death described in Section [
7218 buried without an investigation by the medical examiner as to the cause and manner of death, it
7219 shall be the duty of the medical examiner, upon being advised of the fact, to notify the district
7220 attorney or county attorney having criminal jurisdiction where the body is buried or death
7221 occurred. Upon notification, the district attorney or county attorney having criminal
7222 jurisdiction may file an action in the district court to obtain an order to exhume the body. A
7223 district judge may order the body exhumed upon an ex parte hearing.
7224 (2) (a) A body may not be exhumed until notice of the order has been served upon the
7225 executor or administrator of the deceased's estate, or if no executor or administrator has been
7226 appointed, upon the nearest heir of the deceased, determined as if the deceased had died
7227 intestate. If the nearest heir of the deceased cannot be located within the jurisdiction, then the
7228 next heir in succession within the jurisdiction may be served.
7229 (b) The executor, administrator, or heir shall have 24 hours to notify the issuing court
7230 of any objection to the order prior to the time the body is exhumed. If no heirs can be located
7231 within the jurisdiction within 24 hours, the facts shall be reported to the issuing court which
7232 may order that the body be exhumed forthwith.
7233 (c) Notification to the executor, administrator, or heir shall specifically state the nature
7234 of the action and the fact that any objection shall be filed with the issuing court within 24 hours
7235 of the time of service.
7236 (d) In the event an heir files an objection, the court shall set hearing on the matter at the
7237 earliest possible time and issue an order on the matter immediately at the conclusion of the
7238 hearing. Upon the receipt of notice of objection, the court shall immediately notify the county
7239 attorney who requested the order, so that the interest of the state may be represented at the
7240 hearing.
7241 (e) When there is reason to believe that death occurred in a manner described in
7242 Section [
7243 jurisdiction may make a motion that the court, upon ex parte hearing, order the body exhumed
7244 forthwith and without notice. Upon a showing of exigent circumstances the court may order
7245 the body exhumed forthwith and without notice. In any event, upon motion of the district
7246 attorney or county attorney having criminal jurisdiction and upon the personal appearance of
7247 the medical examiner, the court for good cause may order the body exhumed forthwith and
7248 without notice.
7249 (3) An order to exhume a body shall be directed to the medical examiner, commanding
7250 the medical examiner to cause the body to be exhumed, perform the required autopsy, and
7251 properly cause the body to be reburied upon completion of the examination.
7252 (4) The examination shall be completed and the complete autopsy report shall be made
7253 to the district attorney or county attorney having criminal jurisdiction for any action the
7254 attorney considers appropriate. The district attorney or county attorney shall submit the return
7255 of the order to exhume within 10 days in the manner prescribed by the issuing court.
7256 Section 222. Section 26B-8-213, which is renumbered from Section 26-4-13 is
7257 renumbered and amended to read:
7258 [
7259 (1) The medical examiner shall perform an autopsy to:
7260 (a) aid in the discovery and prosecution of a crime;
7261 (b) protect an innocent person accused of a crime; and
7262 (c) disclose hazards to public health.
7263 (2) The medical examiner may perform an autopsy:
7264 (a) to aid in the administration of civil justice in life and accident insurance problems
7265 in accordance with Title 34A, Chapter 2, Workers' Compensation Act;
7266 (b) in other cases involving questions of civil liability.
7267 Section 223. Section 26B-8-214, which is renumbered from Section 26-4-14 is
7268 renumbered and amended to read:
7269 [
7270 professional -- Deaths without medical attendance -- Cause of death uncertain -- Notice
7271 requirements.
7272 (1) (a) A health care professional who treats or examines an individual within 365 days
7273 from the day on which the individual dies, shall certify the individual's cause of death to the
7274 best of the health care professional's knowledge and belief unless the health care professional
7275 determines the individual may have died in a manner described in Section [
7276 (b) If a health care professional is unable to determine an individual's cause of death in
7277 accordance with Subsection (1)(a), the health care professional shall notify the medical
7278 examiner.
7279 (2) For an unattended death, the person with custody of the body shall notify the
7280 medical examiner of the death.
7281 (3) If the medical examiner determines there may be criminal responsibility for a death,
7282 the medical examiner shall notify:
7283 (a) the district attorney or county attorney that has criminal jurisdiction; or
7284 (b) the head of the law enforcement agency that has jurisdiction to investigate the
7285 death.
7286 Section 224. Section 26B-8-215, which is renumbered from Section 26-4-15 is
7287 renumbered and amended to read:
7288 [
7289 All death certificates of any decedent who died in a teaching medical center or a federal
7290 medical facility unattended or in the care of an unlicensed physician or other medical personnel
7291 shall be signed by the licensed supervisory physician, attending physician or licensed resident
7292 physician of the medical center or facility.
7293 Section 225. Section 26B-8-216, which is renumbered from Section 26-4-16 is
7294 renumbered and amended to read:
7295 [
7296 (1) (a) Where a body is held for investigation or autopsy under this chapter or for a
7297 medical investigation permitted by law, the body shall, if requested by the person given priority
7298 under Section 58-9-602, be released for funeral preparations no later than 24 hours after the
7299 arrival at the office of the medical examiner or regional medical facility.
7300 (b) An extension may be ordered only by a district court.
7301 (2) The right and duty to control the disposition of a deceased person is governed by
7302 Sections 58-9-601 through 58-9-606.
7303 Section 226. Section 26B-8-217, which is renumbered from Section 26-4-17 is
7304 renumbered and amended to read:
7305 [
7306 (1) The medical examiner shall maintain complete, original records for the medical
7307 examiner record, which shall:
7308 (a) be properly indexed, giving the name, if known, or otherwise identifying every
7309 individual whose death is investigated;
7310 (b) indicate the place where the body was found;
7311 (c) indicate the date of death;
7312 (d) indicate the cause and manner of death;
7313 (e) indicate the occupation of the decedent, if available;
7314 (f) include all other relevant information concerning the death; and
7315 (g) include a full report and detailed findings of the autopsy or report of the
7316 investigation.
7317 (2) (a) Upon written request from an individual described in Subsections (2)(a)(i)
7318 through (iv), the medical examiner shall provide a copy of the medical examiner's final report
7319 of examination for the decedent, including the autopsy report, toxicology report, lab reports,
7320 and investigative reports to any of the following:
7321 (i) a decedent's immediate relative;
7322 (ii) a decedent's legal representative;
7323 (iii) a physician or physician assistant who attended the decedent during the year before
7324 the decedent's death; or
7325 (iv) a county attorney, a district attorney, a criminal defense attorney, or other law
7326 enforcement official with jurisdiction, as necessary for the performance of the attorney or
7327 official's professional duties.
7328 (b) Upon written request from the director or a designee of the director of an entity
7329 described in Subsections (2)(b)(i) through (iv), the medical examiner may provide a copy of the
7330 of the medical examiner's final report of examination for the decedent, including any other
7331 reports described in Subsection (2)(a), to any of the following entities as necessary for
7332 performance of the entity's official purposes:
7333 (i) a local health department;
7334 (ii) a local mental health authority;
7335 (iii) a public health authority; or
7336 (iv) another state or federal governmental agency.
7337 (c) The medical examiner may provide a copy of the medical examiner's final report of
7338 examination, including any other reports described in Subsection (2)(a), if the final report
7339 relates to an issue of public health or safety, as further defined by rule made by the department
7340 in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.
7341 (3) Reports provided under Subsection (2) may not include records that the medical
7342 examiner obtains from a third party in the course of investigating the decedent's death.
7343 (4) The medical examiner may provide a medical examiner record to a researcher who:
7344 (a) has an advanced degree;
7345 (b) (i) is affiliated with an accredited college or university, a hospital, or another
7346 system of care, including an emergency medical response or a local health agency; or
7347 (ii) is part of a research firm contracted with an accredited college or university, a
7348 hospital, or another system of care;
7349 (c) requests a medical examiner record for a research project or a quality improvement
7350 initiative that will have a public health benefit, as determined by the department; and
7351 (d) provides to the medical examiner an approval from:
7352 (i) the researcher's sponsoring organization; and
7353 (ii) the Utah Department of Health and Human Services Institutional Review Board.
7354 (5) Records provided under Subsection (4) may not include a third party record, unless:
7355 (a) a court has ordered disclosure of the third party record; and
7356 (b) disclosure is conducted in compliance with state and federal law.
7357 (6) A person who obtains a medical examiner record under Subsection (4) shall:
7358 (a) maintain the confidentiality of the medical examiner record by removing personally
7359 identifying information about a decedent or the decedent's family and any other information
7360 that may be used to identify a decedent before using the medical examiner record in research;
7361 (b) conduct any research within and under the supervision of the Office of the Medical
7362 Examiner, if the medical examiner record contains a third party record with personally
7363 identifiable information;
7364 (c) limit the use of a medical examiner record to the purpose for which the person
7365 requested the medical examiner record;
7366 (d) destroy a medical examiner record and the data abstracted from the medical
7367 examiner record at the conclusion of the research for which the person requested the medical
7368 examiner record;
7369 (e) reimburse the medical examiner, as provided in Section 26B-1-209, for any costs
7370 incurred by the medical examiner in providing a medical examiner record;
7371 (f) allow the medical examiner to review, before public release, a publication in which
7372 data from a medical examiner record is referenced or analyzed; and
7373 (g) provide the medical examiner access to the researcher's database containing data
7374 from a medical examiner record, until the day on which the researcher permanently destroys
7375 the medical examiner record and all data obtained from the medical examiner record.
7376 (7) The department may make rules, in accordance with Title 63G, Chapter 3, Utah
7377 Administrative Rulemaking Act, and in consideration of applicable state and federal law, to
7378 establish permissible uses and disclosures of a medical examiner record or other record
7379 obtained under this section.
7380 (8) Except as provided in this chapter or ordered by a court, the medical examiner may
7381 not disclose any part of a medical examiner record.
7382 (9) A person who obtains a medical examiner record under Subsection (4) is guilty of a
7383 class B misdemeanor, if the person fails to comply with the requirements of Subsections (6)(a)
7384 through (d).
7385 Section 227. Section 26B-8-218, which is renumbered from Section 26-4-18 is
7386 renumbered and amended to read:
7387 [
7388 evidence -- Subpoena of person who prepared record.
7389 The records of the medical examiner or transcripts thereof certified by the medical
7390 examiner are admissible as evidence in any civil action in any court in this state except that
7391 statements by witnesses or other persons, unless taken pursuant to Section [
7392 26B-8-221, as conclusions upon extraneous matters are not hereby made admissible. The
7393 person who prepared a report or record offered in evidence hereunder may be subpoenaed as a
7394 witness in the case by any party.
7395 Section 228. Section 26B-8-219, which is renumbered from Section 26-4-19 is
7396 renumbered and amended to read:
7397 [
7398 (1) Personal property of the deceased not held as evidence shall be turned over to the
7399 legal representative of the deceased within 30 days after completion of the investigation of the
7400 death of the deceased. If no legal representative is known, the county attorney, district attorney,
7401 or the medical examiner shall, within 30 days after the investigation, turn the personal property
7402 over to the county treasurer to be handled pursuant to the escheat laws.
7403 (2) An affidavit shall be filed with the county treasurer by the county attorney, district
7404 attorney, or the medical examiner within 30 days after investigation of the death of the
7405 deceased showing the money or other property belonging to the estate of the deceased person
7406 which has come into his possession and the disposition made of the property.
7407 (3) Property required to be turned over to the legal representative of the deceased may
7408 be held longer than 30 days if, in the opinion of the county attorney, district attorney, or
7409 attorney general, the property is necessary evidence in a court proceeding. Upon conclusion of
7410 the court proceedings, the personal property shall be turned over as described in this section
7411 and in accordance with the rules of the court.
7412 Section 229. Section 26B-8-220, which is renumbered from Section 26-4-20 is
7413 renumbered and amended to read:
7414 [
7415 Except as provided in this [
7416 the county attorney, district attorney, or his deputies, the medical examiner or his deputies, or
7417 regional pathologists for authorizing or performing autopsies authorized by this [
7418 or for any other act authorized by this [
7419 Section 230. Section 26B-8-221, which is renumbered from Section 26-4-21 is
7420 renumbered and amended to read:
7421 [
7422 subpoena witnesses and compel testimony -- Determination if decedent died by unlawful
7423 means.
7424 (1) The district attorney or county attorney having criminal jurisdiction may subpoena
7425 witnesses and compel testimony concerning the death of any person and have such testimony
7426 reduced to writing under his direction and may employ a shorthand reporter for that purpose at
7427 the same compensation as is allowed to reporters in the district courts. When the testimony has
7428 been taken down by the shorthand reporter, a transcript thereof, duly certified, shall constitute
7429 the deposition of the witness.
7430 (2) Upon review of all facts and testimony taken concerning the death of a person, the
7431 district attorney or county attorney having criminal jurisdiction shall determine if the decedent
7432 died by unlawful means and shall also determine if criminal prosecution shall be instituted.
7433 Section 231. Section 26B-8-222, which is renumbered from Section 26-4-22 is
7434 renumbered and amended to read:
7435 [
7436 The department may:
7437 (1) establish rules to carry out the provisions of this [
7438 (2) arrange for the state health laboratory to perform toxicologic analysis for public or
7439 private institutions and fix fees for the services;
7440 (3) cooperate and train law enforcement personnel in the techniques of criminal
7441 investigation as related to medical and pathological matters; and
7442 (4) pay to private parties, institutions or funeral directors the reasonable value of
7443 services performed for the medical examiner's office.
7444 Section 232. Section 26B-8-223, which is renumbered from Section 26-4-23 is
7445 renumbered and amended to read:
7446 [
7447 for transplant purposes.
7448 (1) When requested by the licensed physician of a patient who is in need of an organ or
7449 other tissue for transplant purpose, by a legally created Utah eye bank, organ bank or medical
7450 facility, the medical examiner may provide an organ or other tissue if:
7451 (a) a decedent who may provide a suitable organ or other tissue for the transplant is in
7452 the custody of the medical examiner;
7453 (b) the medical examiner is assured that the requesting party has made reasonable
7454 search for and inquiry of next of kin of the decedent and that no objection by the next of kin is
7455 known by the requesting party; and
7456 (c) the removal of the organ or other tissue will not interfere with the investigation or
7457 autopsy or alter the post-mortem facial appearance.
7458 (2) When the medical examiner is in custody of a decedent who may provide a suitable
7459 organ or other tissue for transplant purposes, he may contact the appropriate eye bank, organ
7460 bank or medical facility and notify them concerning the suitability of the organ or other tissue.
7461 In such contact the medical examiner may disclose the name of the decedent so that necessary
7462 clearances can be obtained.
7463 (3) No person shall be held civilly or criminally liable for any acts performed pursuant
7464 to this section.
7465 Section 233. Section 26B-8-224, which is renumbered from Section 26-4-24 is
7466 renumbered and amended to read:
7467 [
7468 (1) Autopsies may be authorized:
7469 (a) by the commissioner of the Labor Commission or the commissioner's designee as
7470 provided in Section 34A-2-603;
7471 (b) by individuals by will or other written document;
7472 (c) upon a decedent by the next of kin in the following order and as known: surviving
7473 spouse, child, if 18 years or older, otherwise the legal guardian of the child, parent, sibling,
7474 uncle or aunt, nephew or niece, cousin, others charged by law with the duty of burial, or friend
7475 assuming the obligation of burial;
7476 (d) by the county attorney, district attorney, or the district attorney's deputy, or a district
7477 judge; and
7478 (e) by the medical examiner as provided in this [
7479 (2) Autopsies authorized under Subsections (1)(a) and (1)(d) shall be performed by a
7480 certified pathologist.
7481 (3) No criminal or civil action arises against a pathologist or a physician who proceeds
7482 in good faith and performs an autopsy authorized by this section.
7483 Section 234. Section 26B-8-225, which is renumbered from Section 26-4-25 is
7484 renumbered and amended to read:
7485 [
7486 medicine at the University of Utah -- Medical examiner may retain tissue for dog
7487 training.
7488 (1) Except as described in Subsection (2) or (3), a county shall provide, at the county's
7489 expense, decent burial for an unclaimed body found in the county.
7490 (2) A county is not responsible for decent burial of an unclaimed body found in the
7491 county if the body is requested by the dean of the school of medicine at the University of Utah
7492 under Section 53B-17-301.
7493 (3) For an unclaimed body that is temporarily in the medical examiner's custody before
7494 burial under Subsection (1), the medical examiner may retain tissue from the unclaimed body
7495 in order to donate the tissue to an individual who is affiliated with an established search and
7496 rescue dog organization, for the purpose of training a dog to search for human remains.
7497 Section 235. Section 26B-8-226, which is renumbered from Section 26-4-26 is
7498 renumbered and amended to read:
7499 [
7500 A certification of death shall include, if known, the social security number of the
7501 deceased person, and a copy of the certification shall be sent to the Office of Recovery Services
7502 within the [
7503 Section 236. Section 26B-8-227, which is renumbered from Section 26-4-27 is
7504 renumbered and amended to read:
7505 [
7506 (1) If the identity of a deceased person over which the medical examiner has
7507 jurisdiction under Section [
7508 following before releasing the body to the county in which the body was found as provided in
7509 Section [
7510 (a) assign a unique identifying number to the body;
7511 (b) create and maintain a file under the assigned number;
7512 (c) examine the body, take samples, and perform other related tasks for the purpose of
7513 deriving information that may be useful in ascertaining the identity of the deceased person;
7514 (d) use the identifying number in all records created by the medical examiner that
7515 pertains to the body;
7516 (e) record all information pertaining to the body in the file created and maintained
7517 under Subsection (1)(b);
7518 (f) communicate the unique identifying number to the county in which the body was
7519 found; and
7520 (g) access information from available government sources and databases in an attempt
7521 to ascertain the identity of the deceased person.
7522 (2) A county which has received a body to which Subsection (1) applies:
7523 (a) shall adopt and use the same identifying number assigned by Subsection (1) in all
7524 records created by the county that pertain to the body;
7525 (b) require any funeral director or sexton who is involved in the disposition of the body
7526 to adopt and use the same identifying number assigned by Subsection (1) in all records created
7527 by the funeral director or sexton pertaining to the body; and
7528 (c) shall provide a decent burial for the body.
7529 (3) Within 30 days of receiving a body to which Subsection (1) applies, the county
7530 shall inform the medical examiner of the disposition of the body including the burial plot. The
7531 medical examiner shall record this information in the file created and maintained under
7532 Subsection (1)(b).
7533 (4) The requirements of Subsections (1) and (6) apply to a county examiner appointed
7534 under Section [
7535 (a) obtain a unique identifying number from the medical examiner for the body; and
7536 (b) send to the medical examiner a copy of the file created and maintained in
7537 accordance with Subsection (1)(b), including the disposition of the body and burial plot, within
7538 30 days of releasing the body.
7539 (5) The medical examiner shall maintain a file received under Subsection (4) in the
7540 same way that it maintains a file created and maintained by the medical examiner in accordance
7541 with Subsection (1)(b).
7542 (6) The medical examiner shall cooperate and share information generated and
7543 maintained under this section with a person who demonstrates:
7544 (a) a legitimate personal or governmental interest in determining the identity of a
7545 deceased person; and
7546 (b) a reasonable belief that the body of that deceased person may have come into the
7547 custody of the medical examiner.
7548 Section 237. Section 26B-8-228, which is renumbered from Section 26-4-28 is
7549 renumbered and amended to read:
7550 [
7551 information -- Compensation to deputy medical examiners.
7552 (1) In all cases where it is suspected that a death resulted from suicide, including
7553 assisted suicide, the medical examiner shall endeavor to have the following tests conducted
7554 upon samples taken from the body of the deceased:
7555 (a) a test that detects all of the substances included in the volatiles panel of the Bureau
7556 of Forensic Toxicology within the [
7557 (b) a test that detects all of the substances included in the drugs of abuse panel of the
7558 Bureau of Forensic Toxicology within the [
7559 (c) a test that detects all of the substances included in the prescription drug panel of the
7560 Bureau of Forensic Toxicology within the [
7561 (2) The medical examiner shall maintain information regarding the types of substances
7562 found present in the samples taken from the body of a person who is suspected to have died as
7563 a result of suicide or assisted suicide.
7564 (3) Within funds appropriated by the Legislature for this purpose, the medical
7565 examiner shall provide compensation, at a standard rate determined by the medical examiner,
7566 to a deputy medical examiner who collects samples for the purposes described in Subsection
7567 (1).
7568 Section 238. Section 26B-8-229, which is renumbered from Section 26-4-28.5 is
7569 renumbered and amended to read:
7570 [
7571 (1) With funds appropriated by the Legislature for this purpose, the department shall
7572 provide compensation, at a standard rate determined by the department, to a psychological
7573 autopsy examiner.
7574 (2) The psychological autopsy examiner shall:
7575 (a) work with the medical examiner to compile data regarding suicide related deaths;
7576 (b) as relatives of the deceased are willing, gather information from relatives of the
7577 deceased regarding the psychological reasons for the decedent's death;
7578 (c) maintain a database of information described in Subsections (2)(a) and (b);
7579 (d) in accordance with all applicable privacy laws subject to approval by the
7580 department, share the database described in Subsection (2)(c) with the University of Utah
7581 Department of Psychiatry or other university-based departments conducting research on
7582 suicide;
7583 (e) coordinate no less than monthly with the suicide prevention coordinator described
7584 in Subsection [
7585 (f) coordinate no less than quarterly with the state suicide prevention coalition.
7586 Section 239. Section 26B-8-230, which is renumbered from Section 26-4-29 is
7587 renumbered and amended to read:
7588 [
7589 unavailable for postmortem examination -- Fees.
7590 (1) Upon receiving an application by a person for a permit to render a dead body
7591 unavailable for postmortem investigation, the medical examiner shall review the application to
7592 determine whether:
7593 (a) the person is authorized by law to render the dead body unavailable for postmortem
7594 investigation in the manner specified in the application; and
7595 (b) there is a need to delay any action that will render the dead body unavailable for
7596 postmortem investigation until a postmortem investigation or an autopsy of the dead body is
7597 performed by the medical examiner.
7598 (2) Except as provided in Subsection (4), within three days after receiving an
7599 application described in Subsection (1), the medical examiner shall:
7600 (a) make the determinations described in Subsection (1); and
7601 (b) (i) issue a permit to render the dead body unavailable for postmortem investigation
7602 in the manner specified in the application; or
7603 (ii) deny the permit.
7604 (3) The medical examiner may deny a permit to render a dead body unavailable for
7605 postmortem investigation only if:
7606 (a) the applicant is not authorized by law to render the dead body unavailable for
7607 postmortem investigation in the manner specified in the application;
7608 (b) the medical examiner determines that there is a need to delay any action that will
7609 render the dead body unavailable for postmortem investigation; or
7610 (c) the applicant fails to pay the fee described in Subsection (5).
7611 (4) If the medical examiner cannot in good faith make the determinations described in
7612 Subsection (1) within three days after receiving an application described in Subsection (1), the
7613 medical examiner shall notify the applicant:
7614 (a) that more time is needed to make the determinations described in Subsection (1);
7615 and
7616 (b) of the estimated amount of time needed before the determinations described in
7617 Subsection (1) can be made.
7618 (5) The medical examiner may charge a fee, pursuant to Section 63J-1-504, to recover
7619 the costs of fulfilling the duties of the medical examiner described in this section.
7620 Section 240. Section 26B-8-231, which is renumbered from Section 26-4-30 is
7621 renumbered and amended to read:
7622 [
7623 (1) Within funds appropriated by the Legislature, the department shall provide
7624 compensation, at a standard rate determined by the department, to an overdose fatality
7625 examiner.
7626 (2) The overdose fatality examiner shall:
7627 (a) work with the medical examiner to compile data regarding overdose and opioid
7628 related deaths, including:
7629 (i) toxicology information;
7630 (ii) demographics; and
7631 (iii) the source of opioids or drugs;
7632 (b) as relatives of the deceased are willing, gather information from relatives of the
7633 deceased regarding the circumstances of the decedent's death;
7634 (c) maintain a database of information described in Subsections (2)(a) and (b);
7635 (d) coordinate no less than monthly with the suicide prevention coordinator described
7636 in Section [
7637 (e) coordinate no less than quarterly with the Opioid and Overdose Fatality Review
7638 Committee created in Section 26-7-13.
7639 Section 241. Section 26B-8-301, which is renumbered from Section 26-28-102 is
7640 renumbered and amended to read:
7641
7642 [
7643 As used in this [
7644 (1) "Adult" means an individual who is at least 18 years of age.
7645 (2) "Agent" means an individual:
7646 (a) authorized to make health care decisions on the principal's behalf by a power of
7647 attorney for health care; or
7648 (b) expressly authorized to make an anatomical gift on the principal's behalf by any
7649 other record signed by the principal.
7650 (3) "Anatomical gift" means a donation of all or part of a human body to take effect
7651 after the donor's death for the purpose of transplantation, therapy, research, or education.
7652 (4) "Decedent" means:
7653 (a) a deceased individual whose body or part is or may be the source of an anatomical
7654 gift; and
7655 (b) includes:
7656 (i) a stillborn infant; and
7657 (ii) subject to restrictions imposed by law other than this [
7658 (5) (a) "Disinterested witness" means:
7659 (i) a witness other than the spouse, child, parent, sibling, grandchild, grandparent, or
7660 guardian of the individual who makes, amends, revokes, or refuses to make an anatomical gift;
7661 or
7662 (ii) another adult who exhibited special care and concern for the individual.
7663 (b) "Disinterested witness" does not include a person to which an anatomical gift could
7664 pass under Section [
7665 (6) "Document of gift" means a donor card or other record used to make an anatomical
7666 gift. The term includes a statement or symbol on a driver license, identification card, or donor
7667 registry.
7668 (7) "Donor" means an individual whose body or part is the subject of an anatomical
7669 gift.
7670 (8) "Donor registry" means a database that contains records of anatomical gifts and
7671 amendments to or revocations of anatomical gifts.
7672 (9) "Driver license" means a license or permit issued by the Driver License Division of
7673 the Department of Public Safety, to operate a vehicle, whether or not conditions are attached to
7674 the license or permit.
7675 (10) "Eye bank" means a person that is licensed, accredited, or regulated under federal
7676 or state law to engage in the recovery, screening, testing, processing, storage, or distribution of
7677 human eyes or portions of human eyes.
7678 (11) "Guardian":
7679 (a) means a person appointed by a court to make decisions regarding the support, care,
7680 education, health, or welfare of an individual; and
7681 (b) does not include a guardian ad litem.
7682 (12) "Hospital" means a facility licensed as a hospital under the law of any state or a
7683 facility operated as a hospital by the United States, a state, or a subdivision of a state.
7684 (13) "Identification card" means an identification card issued by the Driver License
7685 Division of the Department of Public Safety.
7686 (14) "Know" means to have actual knowledge.
7687 (15) "Minor" means an individual who is under 18 years of age.
7688 (16) "Organ procurement organization" means a person designated by the Secretary of
7689 the United States Department of Health and Human Services as an organ procurement
7690 organization.
7691 (17) "Parent" means a parent whose parental rights have not been terminated.
7692 (18) "Part" means an organ, an eye, or tissue of a human being. The term does not
7693 include the whole body.
7694 (19) "Person" means an individual, corporation, business trust, estate, trust,
7695 partnership, limited liability company, association, joint venture, public corporation,
7696 government or governmental subdivision, agency, or instrumentality, or any other legal or
7697 commercial entity.
7698 (20) "Physician" means an individual authorized to practice medicine or osteopathy
7699 under the law of any state.
7700 (21) "Procurement organization" means an eye bank, organ procurement organization,
7701 or tissue bank.
7702 (22) "Prospective donor":
7703 (a) means an individual who is dead or near death and has been determined by a
7704 procurement organization to have a part that could be medically suitable for transplantation,
7705 therapy, research, or education; and
7706 (b) does not include an individual who has made a refusal.
7707 (23) "Reasonably available" means able to be contacted by a procurement organization
7708 without undue effort and willing and able to act in a timely manner consistent with existing
7709 medical criteria necessary for the making of an anatomical gift.
7710 (24) "Recipient" means an individual into whose body a decedent's part has been or is
7711 intended to be transplanted.
7712 (25) "Record" means information that is inscribed on a tangible medium or that is
7713 stored in an electronic or other medium and is retrievable in perceivable form.
7714 (26) "Refusal" means a record created under Section [
7715 expressly states an intent to bar other persons from making an anatomical gift of an individual's
7716 body or part.
7717 (27) "Sign" means, with the present intent to authenticate or adopt a record:
7718 (a) to execute or adopt a tangible symbol; or
7719 (b) to attach to or logically associate with the record an electronic symbol, sound, or
7720 process.
7721 (28) "State" means a state of the United States, the District of Columbia, Puerto Rico,
7722 the United States Virgin Islands, or any territory or insular possession subject to the jurisdiction
7723 of the United States.
7724 (29) "Technician":
7725 (a) means an individual determined to be qualified to remove or process parts by an
7726 appropriate organization that is licensed, accredited, or regulated under federal or state law; and
7727 (b) includes an enucleator.
7728 (30) "Tissue" means a portion of the human body other than an organ or an eye. The
7729 term does not include blood unless the blood is donated for the purpose of research or
7730 education.
7731 (31) "Tissue bank" means a person that is licensed, accredited, or regulated under
7732 federal or state law to engage in the recovery, screening, testing, processing, storage, or
7733 distribution of tissue.
7734 (32) "Transplant hospital" means a hospital that furnishes organ transplants and other
7735 medical and surgical specialty services required for the care of transplant patients.
7736 Section 242. Section 26B-8-302, which is renumbered from Section 26-28-103 is
7737 renumbered and amended to read:
7738 [
7739 This [
7740 refusal to make an anatomical gift, whenever made.
7741 Section 243. Section 26B-8-303, which is renumbered from Section 26-28-104 is
7742 renumbered and amended to read:
7743 [
7744 death.
7745 Subject to Section [
7746 may be made during the life of the donor for the purpose of transplantation, therapy, research,
7747 or education in the manner provided in Section [
7748 (1) the donor, if the donor is an adult or if the donor is a minor and is:
7749 (a) emancipated; or
7750 (b) authorized under state law to apply for a driver license because the donor is at least
7751 15 years of age;
7752 (2) an agent of the donor, unless the power of attorney for health care or other record
7753 prohibits the agent from making an anatomical gift;
7754 (3) a parent of the donor, if the donor is an unemancipated minor; or
7755 (4) the donor's guardian.
7756 Section 244. Section 26B-8-304, which is renumbered from Section 26-28-105 is
7757 renumbered and amended to read:
7758 [
7759 death.
7760 (1) A donor may make an anatomical gift:
7761 (a) by authorizing a statement or symbol indicating that the donor has made an
7762 anatomical gift to be imprinted on the donor's driver license or identification card;
7763 (b) in a will;
7764 (c) during a terminal illness or injury of the donor, by any form of communication
7765 addressed to at least two adults, at least one of whom is a disinterested witness; or
7766 (d) as provided in Subsection (2).
7767 (2) A donor or other person authorized to make an anatomical gift under Section
7768 [
7769 other person making the gift or by authorizing that a statement or symbol indicating that the
7770 donor has made an anatomical gift be included on a donor registry. If the donor or other person
7771 is physically unable to sign a record, the record may be signed by another individual at the
7772 direction of the donor or other person and shall:
7773 (a) be witnessed by at least two adults, at least one of whom is a disinterested witness,
7774 who have signed at the request of the donor or the other person; and
7775 (b) state that it has been signed and witnessed as provided in Subsection (2)(a).
7776 (3) Revocation, suspension, expiration, or cancellation of a driver license or
7777 identification card upon which an anatomical gift is indicated does not invalidate the gift.
7778 (4) An anatomical gift made by will takes effect upon the donor's death whether or not
7779 the will is probated. Invalidation of the will after the donor's death does not invalidate the gift.
7780 Section 245. Section 26B-8-305, which is renumbered from Section 26-28-106 is
7781 renumbered and amended to read:
7782 [
7783 donor's death.
7784 (1) Subject to Section [
7785 make an anatomical gift under Section [
7786 anatomical gift by:
7787 (a) a record signed by:
7788 (i) the donor;
7789 (ii) the other person; or
7790 (iii) subject to Subsection (2), another individual acting at the direction of the donor or
7791 the other person if the donor or other person is physically unable to sign; or
7792 (b) a later-executed document of gift that amends or revokes a previous anatomical gift
7793 or portion of an anatomical gift, either expressly or by inconsistency.
7794 (2) A record signed pursuant to Subsection (1)(a)(iii) shall:
7795 (a) be witnessed by at least two adults, at least one of whom is a disinterested witness,
7796 who have signed at the request of the donor or the other person; and
7797 (b) state that it has been signed and witnessed as provided in Subsection (1)(a).
7798 (3) Subject to Section [
7799 make an anatomical gift under Section [
7800 by the destruction or cancellation of the document of gift, or the portion of the document of gift
7801 used to make the gift, with the intent to revoke the gift.
7802 (4) A donor may amend or revoke an anatomical gift that was not made in a will by any
7803 form of communication during a terminal illness or injury addressed to at least two adults, at
7804 least one of whom is a disinterested witness.
7805 (5) A donor who makes an anatomical gift in a will may amend or revoke the gift in the
7806 manner provided for amendment or revocation of wills or as provided in Subsection (1).
7807 Section 246. Section 26B-8-306, which is renumbered from Section 26-28-107 is
7808 renumbered and amended to read:
7809 [
7810 refusal.
7811 (1) An individual may refuse to make an anatomical gift of the individual's body or part
7812 by:
7813 (a) a record signed by:
7814 (i) the individual; or
7815 (ii) subject to Subsection (2), another individual acting at the direction of the individual
7816 if the individual is physically unable to sign;
7817 (b) the individual's will, whether or not the will is admitted to probate or invalidated
7818 after the individual's death; or
7819 (c) any form of communication made by the individual during the individual's terminal
7820 illness or injury addressed to at least two adults, at least one of whom is a disinterested witness.
7821 (2) A record signed pursuant to Subsection (1)(a)(ii) shall:
7822 (a) be witnessed by at least two adults, at least one of whom is a disinterested witness,
7823 who have signed at the request of the individual; and
7824 (b) state that it has been signed and witnessed as provided in Subsection (1)(a).
7825 (3) An individual who has made a refusal may amend or revoke the refusal:
7826 (a) in the manner provided in Subsection (1) for making a refusal;
7827 (b) by subsequently making an anatomical gift pursuant to Section [
7828 26B-8-304 that is inconsistent with the refusal; or
7829 (c) by destroying or canceling the record evidencing the refusal, or the portion of the
7830 record used to make the refusal, with the intent to revoke the refusal.
7831 (4) Except as otherwise provided in Subsection [
7832 absence of an express, contrary indication by the individual set forth in the refusal, an
7833 individual's unrevoked refusal to make an anatomical gift of the individual's body or part bars
7834 all other persons from making an anatomical gift of the individual's body or part.
7835 Section 247. Section 26B-8-307, which is renumbered from Section 26-28-108 is
7836 renumbered and amended to read:
7837 [
7838 or revocation.
7839 (1) Except as otherwise provided in Subsection (7) and subject to Subsection (6), in the
7840 absence of an express, contrary indication by the donor, a person other than the donor is barred
7841 from making, amending, or revoking an anatomical gift of a donor's body or part if the donor
7842 made an anatomical gift of the donor's body or part under Section [
7843 amendment to an anatomical gift of the donor's body or part under Section [
7844 26B-8-305.
7845 (2) A donor's revocation of an anatomical gift of the donor's body or part under Section
7846 [
7847 [
7848 donor's body or part under Section [
7849 (3) If a person other than the donor makes an unrevoked anatomical gift of the donor's
7850 body or part under Section [
7851 the donor's body or part under Section [
7852 amend, or revoke the gift of the donor's body or part under Section [
7853 (4) A revocation of an anatomical gift of a donor's body or part under Section
7854 26-28-106 by a person other than the donor does not bar another person from making an
7855 anatomical gift of the body or part under Section [
7856 26B-8-309.
7857 (5) In the absence of an express, contrary indication by the donor or other person
7858 authorized to make an anatomical gift under Section [
7859 gift of a part is neither a refusal to give another part nor a limitation on the making of an
7860 anatomical gift of another part at a later time by the donor or another person.
7861 (6) In the absence of an express, contrary indication by the donor or other person
7862 authorized to make an anatomical gift under Section [
7863 gift of a part for one or more of the purposes set forth in Section [
7864 a limitation on the making of an anatomical gift of the part for any of the other purposes by the
7865 donor or any other person under Section [
7866 (7) If a donor who is an unemancipated minor dies, a parent of the donor who is
7867 reasonably available may revoke or amend an anatomical gift of the donor's body or part.
7868 (8) If an unemancipated minor who signed a refusal dies, a parent of the minor who is
7869 reasonably available may revoke the minor's refusal.
7870 Section 248. Section 26B-8-308, which is renumbered from Section 26-28-109 is
7871 renumbered and amended to read:
7872 [
7873 body or part.
7874 (1) Subject to Subsections (2) and (3) and unless barred by Section [
7875
7876 purpose of transplantation, therapy, research, or education may be made by any member of the
7877 following classes of persons who is reasonably available, in the order of priority listed:
7878 (a) an agent of the decedent at the time of death who could have made an anatomical
7879 gift under Subsection [
7880 (b) the spouse of the decedent;
7881 (c) adult children of the decedent;
7882 (d) parents of the decedent;
7883 (e) adult siblings of the decedent;
7884 (f) adult grandchildren of the decedent;
7885 (g) grandparents of the decedent;
7886 (h) the persons who were acting as the guardians of the person of the decedent at the
7887 time of death;
7888 (i) an adult who exhibited special care and concern for the decedent; and
7889 (j) any other person having the authority to dispose of the decedent's body.
7890 (2) If there is more than one member of a class listed in Subsection (1)(a), (c), (d), (e),
7891 (f), (g), or (j) entitled to make an anatomical gift, an anatomical gift may be made by a member
7892 of the class unless that member or a person to which the gift may pass under Section
7893 [
7894 is known, the gift may be made only by a majority of the members of the class who are
7895 reasonably available.
7896 (3) A person may not make an anatomical gift if, at the time of the decedent's death, a
7897 person in a prior class under Subsection (1) is reasonably available to make or to object to the
7898 making of an anatomical gift.
7899 Section 249. Section 26B-8-309, which is renumbered from Section 26-28-110 is
7900 renumbered and amended to read:
7901 [
7902 anatomical gift of decedent's body or part.
7903 (1) A person authorized to make an anatomical gift under Section [
7904 26B-8-308 may make an anatomical gift by a document of gift signed by the person making the
7905 gift or by that person's oral communication that is electronically recorded or is
7906 contemporaneously reduced to a record and signed by the individual receiving the oral
7907 communication.
7908 (2) Subject to Subsection (3), an anatomical gift by a person authorized under Section
7909 [
7910 prior class who is reasonably available. If more than one member of the prior class is
7911 reasonably available, the gift made by a person authorized under Section [
7912 26B-8-308 may be:
7913 (a) amended only if a majority of the reasonably available members agree to the
7914 amending of the gift; or
7915 (b) revoked only if a majority of the reasonably available members agree to the
7916 revoking of the gift or if they are equally divided as to whether to revoke the gift.
7917 (3) A revocation under Subsection (2) is effective only if, before an incision has been
7918 made to remove a part from the donor's body or before invasive procedures have begun to
7919 prepare the recipient, the procurement organization, transplant hospital, or physician or
7920 technician knows of the revocation.
7921 Section 250. Section 26B-8-310, which is renumbered from Section 26-28-111 is
7922 renumbered and amended to read:
7923 [
7924 Purpose of anatomical gift.
7925 (1) An anatomical gift may be made to the following persons named in the document
7926 of gift:
7927 (a) a hospital, accredited medical school, dental school, college, university, organ
7928 procurement organization, or other appropriate person, for research or education;
7929 (b) subject to Subsection (2), an individual designated by the person making the
7930 anatomical gift if the individual is the recipient of the part; or
7931 (c) an eye bank or tissue bank.
7932 (2) If an anatomical gift to an individual under Subsection (1)(b) cannot be
7933 transplanted into the individual, the part passes in accordance with Subsection (7) in the
7934 absence of an express, contrary indication by the person making the anatomical gift.
7935 (3) If an anatomical gift of one or more specific parts or of all parts is made in a
7936 document of gift that does not name a person described in Subsection (1) but identifies the
7937 purpose for which an anatomical gift may be used, the following rules apply:
7938 (a) If the part is an eye and the gift is for the purpose of transplantation or therapy, the
7939 gift passes to the appropriate eye bank.
7940 (b) If the part is tissue and the gift is for the purpose of transplantation or therapy, the
7941 gift passes to the appropriate tissue bank.
7942 (c) If the part is an organ and the gift is for the purpose of transplantation or therapy,
7943 the gift passes to the appropriate organ procurement organization as custodian of the organ.
7944 (d) If the part is an organ, an eye, or tissue and the gift is for the purpose of research or
7945 education, the gift passes to the appropriate procurement organization.
7946 (4) For the purpose of Subsection (3), if there is more than one purpose of an
7947 anatomical gift set forth in the document of gift but the purposes are not set forth in any
7948 priority, the gift shall be used for transplantation or therapy, if suitable. If the gift cannot be
7949 used for transplantation or therapy, the gift may be used for research or education.
7950 (5) If an anatomical gift of one or more specific parts is made in a document of gift that
7951 does not name a person described in Subsection (1) and does not identify the purpose of the
7952 gift, the gift may be used only for transplantation or therapy, and the gift passes in accordance
7953 with Subsection (7).
7954 (6) If a document of gift specifies only a general intent to make an anatomical gift by
7955 words such as "donor," "organ donor," or "body donor," or by a symbol or statement of similar
7956 import, the gift may be used only for transplantation or therapy, and the gift passes in
7957 accordance with Subsection (7).
7958 (7) For purposes of Subsections (2), (5), and (7) the following rules apply:
7959 (a) If the part is an eye, the gift passes to the appropriate eye bank.
7960 (b) If the part is tissue, the gift passes to the appropriate tissue bank.
7961 (c) If the part is an organ, the gift passes to the appropriate organ procurement
7962 organization as custodian of the organ.
7963 (8) An anatomical gift of an organ for transplantation or therapy, other than an
7964 anatomical gift under Subsection (1)(b), passes to the organ procurement organization as
7965 custodian of the organ.
7966 (9) If an anatomical gift does not pass pursuant to Subsections (2) through (8) or the
7967 decedent's body or part is not used for transplantation, therapy, research, or education, custody
7968 of the body or part passes to the person under obligation to dispose of the body or part.
7969 (10) A person may not accept an anatomical gift if the person knows that the gift was
7970 not effectively made under Section [
7971 person knows that the decedent made a refusal under Section [
7972 not revoked. For purposes of this Subsection (10), if a person knows that an anatomical gift
7973 was made on a document of gift, the person is considered to know of any amendment or
7974 revocation of the gift or any refusal to make an anatomical gift on the same document of gift.
7975 (11) Except as otherwise provided in Subsection (1)(b), nothing in this [
7976 affects the allocation of organs for transplantation or therapy.
7977 Section 251. Section 26B-8-311, which is renumbered from Section 26-28-112 is
7978 renumbered and amended to read:
7979 [
7980 (1) The following persons shall make a reasonable search of an individual who the
7981 person reasonably believes is dead or near death for a document of gift or other information
7982 identifying the individual as a donor or as an individual who made a refusal:
7983 (a) a law enforcement officer, firefighter, paramedic, or other emergency rescuer
7984 finding the individual;
7985 (b) if no other source of the information is immediately available, a hospital, as soon as
7986 practical after the individual's arrival at the hospital; and
7987 (c) a law enforcement officer, firefighter, emergency medical services provider, or
7988 other emergency rescuer who finds an individual who is deceased at the scene of a motor
7989 vehicle accident, when the deceased individual is transported from the scene of the accident to
7990 a funeral establishment licensed under Title 58, Chapter 9, Funeral Services Licensing Act:
7991 (i) the law enforcement officer, firefighter, emergency medical services provider, or
7992 other emergency rescuer shall as soon as reasonably possible, notify the appropriate organ
7993 procurement organization, tissue bank, or eye bank of:
7994 (A) the identity of the deceased individual, if known;
7995 (B) information, if known, pertaining to the deceased individual's legal next-of-kin in
7996 accordance with Section [
7997 (C) the name and location of the funeral establishment which received custody of and
7998 transported the deceased individual; and
7999 (ii) the funeral establishment receiving custody of the deceased individual under this
8000 Subsection (1)(c) may not embalm the body of the deceased individual until:
8001 (A) the funeral establishment receives notice from the organ procurement organization,
8002 tissue bank, or eye bank that the readily available persons listed as having priority in Section
8003 [
8004 option to make or refuse to make an anatomical gift in accordance with Section [
8005 26B-8-303, with reasonable discretion and sensitivity appropriate to the circumstances of the
8006 family;
8007 (B) in accordance with federal law, prior approval for embalming has been obtained
8008 from a family member or other authorized person; and
8009 (C) the period of time in which embalming is prohibited under Subsection (1)(c)(ii)
8010 may not exceed 24 hours after death.
8011 (2) If a document of gift or a refusal to make an anatomical gift is located by the search
8012 required by Subsection (1)(a) and the individual or deceased individual to whom it relates is
8013 taken to a hospital, the person responsible for conducting the search shall send the document of
8014 gift or refusal to the hospital.
8015 (3) A person is not subject to criminal or civil liability for failing to discharge the
8016 duties imposed by this section but may be subject to administrative sanctions.
8017 Section 252. Section 26B-8-312, which is renumbered from Section 26-28-113 is
8018 renumbered and amended to read:
8019 [
8020 to examine.
8021 (1) A document of gift need not be delivered during the donor's lifetime to be effective.
8022 (2) Upon or after an individual's death, a person in possession of a document of gift or
8023 a refusal to make an anatomical gift with respect to the individual shall allow examination and
8024 copying of the document of gift or refusal by a person authorized to make or object to the
8025 making of an anatomical gift with respect to the individual or by a person to which the gift
8026 could pass under Section [
8027 Section 253. Section 26B-8-313, which is renumbered from Section 26-28-114 is
8028 renumbered and amended to read:
8029 [
8030 and others.
8031 (1) When a hospital refers an individual at or near death to a procurement organization,
8032 the organization shall make a reasonable search of the records of the Department of Public
8033 Safety and any donor registry that it knows exists for the geographical area in which the
8034 individual resides to ascertain whether the individual has made an anatomical gift.
8035 (2) A procurement organization shall be allowed reasonable access to information in
8036 the records of the Department of Public Safety to ascertain whether an individual at or near
8037 death is a donor.
8038 (3) When a hospital refers an individual at or near death to a procurement organization,
8039 the organization may conduct any reasonable examination necessary to ensure the medical
8040 suitability of a part that is or could be the subject of an anatomical gift for transplantation,
8041 therapy, research, or education from a donor or a prospective donor. During the examination
8042 period, measures necessary to ensure the medical suitability of the part may not be withdrawn
8043 unless the hospital or procurement organization knows that the individual expressed a contrary
8044 intent.
8045 (4) Unless prohibited by law other than this [
8046 death, the person to which a part passes under Section [
8047 any reasonable examination necessary to ensure the medical suitability of the body or part for
8048 its intended purpose.
8049 (5) Unless prohibited by law other than this [
8050 Subsection (3) or (4) may include an examination of all medical and dental records of the
8051 donor or prospective donor.
8052 (6) Upon the death of a minor who was a donor or had signed a refusal, unless a
8053 procurement organization knows the minor is emancipated, the procurement organization shall
8054 conduct a reasonable search for the parents of the minor and provide the parents with an
8055 opportunity to revoke or amend the anatomical gift or revoke the refusal.
8056 (7) Upon referral by a hospital under Subsection (1), a procurement organization shall
8057 make a reasonable search for any person listed in Section 26-28-109 having priority to make an
8058 anatomical gift on behalf of a prospective donor. If a procurement organization receives
8059 information that an anatomical gift to any other person was made, amended, or revoked, it shall
8060 promptly advise the other person of all relevant information.
8061 (8) Subject to Subsection 26-28-111(9) and Section 26-28-123, the rights of the person
8062 to which a part passes under Section 26-28-111 are superior to the rights of all others with
8063 respect to the part. The person may accept or reject an anatomical gift in whole or in part.
8064 Subject to the terms of the document of gift and this [
8065 anatomical gift of an entire body may allow embalming, burial or cremation, and use of
8066 remains in a funeral service. If the gift is of a part, the person to which the part passes under
8067 Section 26-28-111, upon the death of the donor and before embalming, burial, or cremation,
8068 shall cause the part to be removed without unnecessary mutilation.
8069 (9) Neither the physician or physician assistant who attends the decedent at death nor
8070 the physician or physician assistant who determines the time of the decedent's death may
8071 participate in the procedures for removing or transplanting a part from the decedent.
8072 (10) A physician, physician assistant, or technician may remove a donated part from
8073 the body of a donor that the physician, physician assistant, or technician is qualified to remove.
8074 Section 254. Section 26B-8-314, which is renumbered from Section 26-28-115 is
8075 renumbered and amended to read:
8076 [
8077 Each hospital in this state shall enter into agreements or affiliations with procurement
8078 organizations for coordination of procurement and use of anatomical gifts.
8079 Section 255. Section 26B-8-315, which is renumbered from Section 26-28-116 is
8080 renumbered and amended to read:
8081 [
8082 (1) Except as otherwise provided in Subsection (2), a person that for valuable
8083 consideration, knowingly purchases or sells a part for transplantation or therapy if removal of a
8084 part from an individual is intended to occur after the individual's death commits a third degree
8085 felony.
8086 (2) A person may charge a reasonable amount for the removal, processing,
8087 preservation, quality control, storage, transportation, implantation, or disposal of a part.
8088 Section 256. Section 26B-8-316, which is renumbered from Section 26-28-117 is
8089 renumbered and amended to read:
8090 [
8091 A person that, in order to obtain a financial gain, intentionally falsifies, forges,
8092 conceals, defaces, or obliterates a document of gift, an amendment, or revocation of a
8093 document of gift, or a refusal commits a third degree felony.
8094 Section 257. Section 26B-8-317, which is renumbered from Section 26-28-118 is
8095 renumbered and amended to read:
8096 [
8097 (1) A person that acts in accordance with this [
8098 anatomical gift law of another state, or attempts in good faith to do so, is not liable for the act
8099 in a civil action, criminal prosecution, or administrative proceeding.
8100 (2) Neither the person making an anatomical gift nor the donor's estate is liable for any
8101 injury or damage that results from the making or use of the gift.
8102 (3) In determining whether an anatomical gift has been made, amended, or revoked
8103 under this [
8104 Subsection 26-28-109(1)(b), (c), (d), (e), (f), (g), (h), (i), or (j) relating to the individual's
8105 relationship to the donor or prospective donor unless the person knows that the representation
8106 is untrue.
8107 Section 258. Section 26B-8-318, which is renumbered from Section 26-28-119 is
8108 renumbered and amended to read:
8109 [
8110 execution of document of gift -- Presumption of validity.
8111 (1) A document of gift is valid if executed in accordance with:
8112 (a) this [
8113 (b) the laws of the state or country where it was executed; or
8114 (c) the laws of the state or country where the person making the anatomical gift was
8115 domiciled, has a place of residence, or was a national at the time the document of gift was
8116 executed.
8117 (2) If a document of gift is valid under this section, the law of this state governs the
8118 interpretation of the document of gift.
8119 (3) A person may presume that a document of gift or amendment of an anatomical gift
8120 is valid unless that person knows that it was not validly executed or was revoked.
8121 Section 259. Section 26B-8-319, which is renumbered from Section 26-28-120 is
8122 renumbered and amended to read:
8123 [
8124 (1) The Department of Public Safety may establish or contract for the establishment of
8125 a donor registry.
8126 (2) The Driver License Division of the Department of Public Safety shall cooperate
8127 with a person that administers any donor registry that this state establishes, contracts for, or
8128 recognizes for the purpose of transferring to the donor registry all relevant information
8129 regarding a donor's making, amendment to, or revocation of an anatomical gift.
8130 (3) A donor registry shall:
8131 (a) allow a donor or other person authorized under Section [
8132 include on the donor registry a statement or symbol that the donor has made, amended, or
8133 revoked an anatomical gift;
8134 (b) be accessible to a procurement organization to allow it to obtain relevant
8135 information on the donor registry to determine, at or near death of the donor or a prospective
8136 donor, whether the donor or prospective donor has made, amended, or revoked an anatomical
8137 gift; and
8138 (c) be accessible for purposes of Subsections (3)(a) and (b) seven days a week on a
8139 24-hour basis.
8140 (4) Personally identifiable information on a donor registry about a donor or prospective
8141 donor may not be used or disclosed without the express consent of the donor, prospective
8142 donor, or person that made the anatomical gift for any purpose other than to determine, at or
8143 near death of the donor or prospective donor, whether the donor or prospective donor has
8144 made, amended, or revoked an anatomical gift.
8145 (5) This section does not prohibit any person from creating or maintaining a donor
8146 registry that is not established by or under contract with the state. Any such registry shall
8147 comply with Subsections (3) and (4).
8148 Section 260. Section 26B-8-320, which is renumbered from Section 26-28-121 is
8149 renumbered and amended to read:
8150 [
8151 directive.
8152 (1) As used in this section:
8153 (a) "Advance health care directive" means a power of attorney for health care or a
8154 record signed or authorized by a prospective donor containing the prospective donor's direction
8155 concerning a health care decision for the prospective donor.
8156 (b) "Declaration" means a record signed by a prospective donor specifying the
8157 circumstances under which a life support system may be withheld or withdrawn from the
8158 prospective donor.
8159 (c) "Health care decision" means any decision regarding the health care of the
8160 prospective donor.
8161 (2) If a prospective donor has a declaration or advance health care directive and the
8162 terms of the declaration or directive and the express or implied terms of a potential anatomical
8163 gift are in conflict with regard to the administration of measures necessary to ensure the
8164 medical suitability of a part for transplantation or therapy, the prospective donor's attending
8165 physician and prospective donor shall confer to resolve the conflict. If the prospective donor is
8166 incapable of resolving the conflict, an agent acting under the prospective donor's declaration or
8167 directive, or if no declaration or directive exists or the agent is not reasonably available,
8168 another person authorized by a law other than this [
8169 on behalf of the prospective donor, shall act for the donor to resolve the conflict. The conflict
8170 shall be resolved as expeditiously as possible. Information relevant to the resolution of the
8171 conflict may be obtained from the appropriate procurement organization and any other person
8172 authorized to make an anatomical gift for the prospective donor under Section [
8173 26B-8-308. Before resolution of the conflict, measures necessary to ensure the medical
8174 suitability of the part may not be withheld or withdrawn from the prospective donor if
8175 withholding or withdrawing the measures is not contraindicated by appropriate end of life care.
8176 Section 261. Section 26B-8-321, which is renumbered from Section 26-28-122 is
8177 renumbered and amended to read:
8178 [
8179 procurement organization.
8180 (1) A medical examiner shall cooperate with procurement organizations to maximize
8181 the opportunity to recover anatomical gifts for the purpose of transplantation, therapy, research,
8182 or education.
8183 (2) If a medical examiner receives notice from a procurement organization that an
8184 anatomical gift might be available or was made with respect to a decedent whose body is under
8185 the jurisdiction of the medical examiner and a postmortem examination is going to be
8186 performed, unless the medical examiner denies recovery in accordance with Section
8187 [
8188 examination of the body or the part in a manner and within a period compatible with its
8189 preservation for the purposes of the gift.
8190 (3) A part may not be removed from the body of a decedent under the jurisdiction of a
8191 medical examiner for transplantation, therapy, research, or education unless the part is the
8192 subject of an anatomical gift. The body of a decedent under the jurisdiction of the medical
8193 examiner may not be delivered to a person for research or education unless the body is the
8194 subject of an anatomical gift. This Subsection (3) does not preclude a medical examiner from
8195 performing the medicolegal investigation upon the body or parts of a decedent under the
8196 jurisdiction of the medical examiner.
8197 Section 262. Section 26B-8-322, which is renumbered from Section 26-28-123 is
8198 renumbered and amended to read:
8199 [
8200 whose body is under jurisdiction of medical examiner.
8201 (1) Upon request of a procurement organization, a medical examiner shall release to
8202 the procurement organization the name, contact information, and available medical and social
8203 history of a decedent whose body is under the jurisdiction of the medical examiner. If the
8204 decedent's body or part is medically suitable for transplantation, therapy, research, or education,
8205 the medical examiner shall release postmortem examination results to the procurement
8206 organization. The procurement organization may make a subsequent disclosure of the
8207 postmortem examination results or other information received from the medical examiner only
8208 if relevant to transplantation or therapy.
8209 (2) The medical examiner may conduct a medicolegal examination by reviewing all
8210 medical records, laboratory test results, x-rays, other diagnostic results, and other information
8211 that any person possesses about a donor or prospective donor whose body is under the
8212 jurisdiction of the medical examiner which the medical examiner determines may be relevant
8213 to the investigation.
8214 (3) A person that has any information requested by a medical examiner pursuant to
8215 Subsection (2) shall provide that information as expeditiously as possible to allow the medical
8216 examiner to conduct the medicolegal investigation within a period compatible with the
8217 preservation of parts for the purpose of transplantation, therapy, research, or education.
8218 (4) If an anatomical gift has been or might be made of a part of a decedent whose body
8219 is under the jurisdiction of the medical examiner and a postmortem examination is not
8220 required, or the medical examiner determines that a postmortem examination is required but
8221 that the recovery of the part that is the subject of an anatomical gift will not interfere with the
8222 examination, the medical examiner and procurement organization shall cooperate in the timely
8223 removal of the part from the decedent for the purpose of transplantation, therapy, research, or
8224 education.
8225 (5) If an anatomical gift of a part from the decedent under the jurisdiction of the
8226 medical examiner has been or might be made, but the medical examiner initially believes that
8227 the recovery of the part could interfere with the postmortem investigation into the decedent's
8228 cause or manner of death, the medical examiner shall consult with the procurement
8229 organization or physician or technician designated by the procurement organization about the
8230 proposed recovery. After consultation, the medical examiner may allow the recovery.
8231 (6) Following the consultation under Subsection (5), in the absence of mutually agreed
8232 upon protocols to resolve conflict between the medical examiner and the procurement
8233 organization, if the medical examiner intends to deny recovery, the medical examiner or
8234 designee, at the request of the procurement organization, may attend the removal procedure for
8235 the part before making a final determination not to allow the procurement organization to
8236 recover the part. During the removal procedure, the medical examiner or designee may allow
8237 recovery by the procurement organization to proceed, or, if the medical examiner or designee
8238 reasonably believes that the part may be involved in determining the decedent's cause or
8239 manner of death, deny recovery by the procurement organization.
8240 (7) If the medical examiner or designee denies recovery under Subsection (6), the
8241 medical examiner or designee shall:
8242 (a) explain in a record the specific reasons for not allowing recovery of the part;
8243 (b) include the specific reasons in the records of the medical examiner; and
8244 (c) provide a record with the specific reasons to the procurement organization.
8245 (8) If the medical examiner or designee allows recovery of a part under Subsection (4),
8246 (5), or (6), the procurement organization, upon request, shall cause the physician or technician
8247 who removes the part to provide the medical examiner with a record describing the condition
8248 of the part, a biopsy, a photograph, and any other information and observations that would
8249 assist in the postmortem examination.
8250 (9) If a medical examiner or designee is required to be present at a removal procedure
8251 under Subsection (6), upon request the procurement organization requesting the recovery of the
8252 part shall reimburse the medical examiner or designee for the additional costs incurred in
8253 complying with Subsection (6).
8254 Section 263. Section 26B-8-323, which is renumbered from Section 26-28-124 is
8255 renumbered and amended to read:
8256 [
8257 In applying and construing [
8258 given to the need to promote uniformity of the law with respect to its subject matter among
8259 states that enact it.
8260 Section 264. Section 26B-8-324, which is renumbered from Section 26-28-125 is
8261 renumbered and amended to read:
8262 [
8263 National Commerce Act.
8264 This act modifies, limits, and supersedes the Electronic Signatures in Global and
8265 National Commerce Act, 15 U.S.C. [
8266 supersede Section 101(a) of that act, 15 U.S.C. [
8267 delivery of any of the notices described in Section 103(b) of that act, 15 U.S.C. [
8268 7003(b).
8269 Section 265. Section 26B-8-401, which is renumbered from Section 26-3-1 is
8270 renumbered and amended to read:
8271
8272 [
8273 As used in this [
8274 (1) "Disclosure" or "disclose" means the communication of health data to any
8275 individual or organization outside the department.
8276 (2) "Health data" means any information, except vital records as defined in Section
8277 [
8278 resources and services, and the use and cost of these resources and services.
8279 (3) "Identifiable health data" means any item, collection, or grouping of health data
8280 which makes the individual supplying it or described in it identifiable.
8281 (4) "Individual" means a natural person.
8282 (5) "Organization" means any corporation, association, partnership, agency,
8283 department, unit, or other legally constituted institution or entity, or part of any of these.
8284 (6) "Research and statistical purposes" means the performance of activities relating to
8285 health data, including:
8286 (a) describing the group characteristics of individuals or organizations;
8287 (b) analyzing the interrelationships among the various characteristics of individuals or
8288 organizations;
8289 (c) the conduct of statistical procedures or studies to improve the quality of health data;
8290 (d) the design of sample surveys and the selection of samples of individuals or
8291 organizations;
8292 (e) the preparation and publication of reports describing these matters; and
8293 (f) other related functions.
8294 Section 266. Section 26B-8-402, which is renumbered from Section 26-3-2 is
8295 renumbered and amended to read:
8296 [
8297 data.
8298 The department may on a voluntary basis, except when there is specific legal authority
8299 to compel reporting of health data:
8300 (1) collect and maintain health data on:
8301 (a) the extent, nature, and impact of illness and disability on the population of the state;
8302 (b) the determinants of health and health hazards;
8303 (c) health resources, including the extent of available manpower and resources;
8304 (d) utilization of health care;
8305 (e) health care costs and financing; or
8306 (f) other health or health-related matters;
8307 (2) undertake and support research, demonstrations, and evaluations respecting new or
8308 improved methods for obtaining current data on the matters referred to in Subsection (1) of this
8309 section;
8310 (3) collect health data under other authorities and on behalf of other governmental or
8311 not-for-profit organizations.
8312 Section 267. Section 26B-8-403, which is renumbered from Section 26-3-4 is
8313 renumbered and amended to read:
8314 [
8315 The department shall:
8316 (1) take such actions as may be necessary to assure that statistics developed under this
8317 [
8318 and adequately analyzed and indexed; and
8319 (2) publish, make available, and disseminate such statistics on as wide a basis as
8320 practicable.
8321 Section 268. Section 26B-8-404, which is renumbered from Section 26-3-5 is
8322 renumbered and amended to read:
8323 [
8324 (1) The department shall coordinate health data activities within the state to eliminate
8325 unnecessary duplication of data collection and maximize the usefulness of data collected.
8326 (2) Except as specifically provided, this [
8327 authority for the department to compel the reporting of information.
8328 Section 269. Section 26B-8-405, which is renumbered from Section 26-3-6 is
8329 renumbered and amended to read:
8330 [
8331 The department may:
8332 (1) participate and cooperate with state, local, and federal agencies and other
8333 organizations in the design and implementation of uniform standards for the management of
8334 health information at the federal, state, and local levels; and
8335 (2) undertake and support research, development, demonstrations, and evaluations that
8336 support uniform health information standards.
8337 Section 270. Section 26B-8-406, which is renumbered from Section 26-3-7 is
8338 renumbered and amended to read:
8339 [
8340 The department may not [
8341 unless:
8342 (1) one of the following persons has consented to the disclosure:
8343 (a) the individual;
8344 (b) the next-of-kin if the individual is deceased;
8345 (c) the parent or legal guardian if the individual is a minor or mentally incompetent; or
8346 (d) a person holding a power of attorney covering such matters on behalf of the
8347 individual;
8348 (2) the disclosure is to a governmental entity in this or another state or the federal
8349 government, provided that:
8350 (a) the data will be used for a purpose for which they were collected by the department;
8351 and
8352 (b) the recipient enters into a written agreement satisfactory to the department agreeing
8353 to protect such data in accordance with the requirements of this [
8354 rule and not permit further disclosure without prior approval of the department;
8355 (3) the disclosure is to an individual or organization, for a specified period, solely for
8356 bona fide research and statistical purposes, determined in accordance with department rules,
8357 and the department determines that the data are required for the research and statistical
8358 purposes proposed and the requesting individual or organization enters into a written
8359 agreement satisfactory to the department to protect the data in accordance with this [
8360 part and department rule and not permit further disclosure without prior approval of the
8361 department;
8362 (4) the disclosure is to a governmental entity for the purpose of conducting an audit,
8363 evaluation, or investigation of the department and such governmental entity agrees not to use
8364 those data for making any determination affecting the rights, benefits, or entitlements of any
8365 individual to whom the health data relates;
8366 (5) the disclosure is of specific medical or epidemiological information to authorized
8367 personnel within the department, local health departments, public health authorities, official
8368 health agencies in other states, the United States Public Health Service, the Centers for Disease
8369 Control and Prevention (CDC), or agencies responsible to enforce quarantine, when necessary
8370 to continue patient services or to undertake public health efforts to control communicable,
8371 infectious, acute, chronic, or any other disease or health hazard that the department considers to
8372 be dangerous or important or that may affect the public health;
8373 (6) (a) the disclosure is of specific medical or epidemiological information to a "health
8374 care provider" as defined in Section 78B-3-403, health care personnel, or public health
8375 personnel who has a legitimate need to have access to the information in order to assist the
8376 patient or to protect the health of others closely associated with the patient; and
8377 (b) this Subsection (6) does not create a duty to warn third parties;
8378 (7) the disclosure is necessary to obtain payment from an insurer or other third-party
8379 payor in order for the department to obtain payment or to coordinate benefits for a patient; or
8380 (8) the disclosure is to the subject of the identifiable health data.
8381 Section 271. Section 26B-8-407, which is renumbered from Section 26-3-8 is
8382 renumbered and amended to read:
8383 [
8384 (1) Any disclosure provided for in Section 26-3-7 shall be made at the discretion of the
8385 department[
8386 (2) Notwithstanding Subsection (1), the disclosure provided for in Subsection [
8387 26B-8-406(4) shall be made when the requirements of that paragraph are met.
8388 Section 272. Section 26B-8-408, which is renumbered from Section 26-3-9 is
8389 renumbered and amended to read:
8390 [
8391 process -- Exception.
8392 Identifiable health data obtained in the course of activities undertaken or supported
8393 under this [
8394 process in any civil or criminal, judicial, administrative, or legislative proceeding, nor shall any
8395 individual or organization with lawful access to identifiable health data under the provisions of
8396 this [
8397 pertaining to a party in litigation may be subject to subpoena or similar compulsory process in
8398 an action brought by or on behalf of such individual to enforce any liability arising under this
8399 [
8400 Section 273. Section 26B-8-409, which is renumbered from Section 26-3-10 is
8401 renumbered and amended to read:
8402 [
8403 The department shall protect the security of identifiable health data by use of the
8404 following measures and any other measures adopted by rule:
8405 (1) limit access to identifiable health data to authorized individuals who have received
8406 training in the handling of such data;
8407 (2) designate a person to be responsible for physical security;
8408 (3) develop and implement a system for monitoring security; and
8409 (4) review periodically all identifiable health data to determine whether identifying
8410 characteristics should be removed from the data.
8411 Section 274. Section 26B-8-410, which is renumbered from Section 26-3-11 is
8412 renumbered and amended to read:
8413 [
8414 Because [
8415
8416
8417 disclosure of data, the provisions of this [
8418 [
8419 (1) Part 1, Vital Statistics;
8420 (2) Part 2, Utah Medical Examiner; and
8421 (3) Part 5, Utah Health Data Authority.
8422 Section 275. Section 26B-8-411, which is renumbered from Section 26-1-37 is
8423 renumbered and amended to read:
8424 [
8425 of clinical health information -- Immunity.
8426 (1) [
8427 (a) "Affiliate" means an organization that directly or indirectly through one or more
8428 intermediaries controls, is controlled by, or is under common control with another
8429 organization.
8430 (b) "Clinical health information" shall be defined by the department by administrative
8431 rule adopted in accordance with Subsection (2).
8432 (c) "Electronic exchange":
8433 (i) includes:
8434 (A) the electronic transmission of clinical health data via Internet or extranet; and
8435 (B) physically moving clinical health information from one location to another using
8436 magnetic tape, disk, or compact disc media; and
8437 (ii) does not include exchange of information by telephone or fax.
8438 (d) "Health care provider" means a licensing classification that is either:
8439 (i) licensed under Title 58, Occupations and Professions, to provide health care; or
8440 (ii) licensed under [
8441 Inspection [
8442 (e) "Health care system" shall include:
8443 (i) affiliated health care providers;
8444 (ii) affiliated third party payers; and
8445 (iii) other arrangement between organizations or providers as described by the
8446 department by administrative rule.
8447 (f) "Qualified network" means an entity that:
8448 (i) is a non-profit organization;
8449 (ii) is accredited by the Electronic Healthcare Network Accreditation Commission, or
8450 another national accrediting organization recognized by the department; and
8451 (iii) performs the electronic exchange of clinical health information among multiple
8452 health care providers not under common control, multiple third party payers not under common
8453 control, the department, and local health departments.
8454 (g) "Third party payer" means:
8455 (i) all insurers offering health insurance who are subject to Section 31A-22-614.5; and
8456 (ii) the state Medicaid program.
8457 (2) (a) [
8458 make rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to:
8459 (i) define:
8460 (A) "clinical health information" subject to this section; and
8461 (B) "health system arrangements between providers or organizations" as described in
8462 Subsection (1)(e)(iii); and
8463 (ii) adopt standards for the electronic exchange of clinical health information between
8464 health care providers and third party payers that are for treatment, payment, health care
8465 operations, or public health reporting, as provided for in 45 C.F.R. Parts 160, 162, and 164,
8466 Health Insurance Reform: Security Standards.
8467 (b) The department shall coordinate its rule making authority under the provisions of
8468 this section with the rule making authority of the Insurance Department under Section
8469 31A-22-614.5.
8470 (c) The department shall establish procedures for developing the rules adopted under
8471 this section, which ensure that the Insurance Department is given the opportunity to comment
8472 on proposed rules.
8473 (3) (a) Except as provided in Subsection (3)(e), a health care provider or third party
8474 payer in Utah is required to use the standards adopted by the department under the provisions
8475 of Subsection (2) if the health care provider or third party payer elects to engage in an
8476 electronic exchange of clinical health information with another health care provider or third
8477 party payer.
8478 (b) A health care provider or third party payer may [
8479 information to the department or a local health department, by electronic exchange of clinical
8480 health information, as permitted by Subsection 45 C.F.R. Sec. 164.512(b).
8481 (c) When functioning in its capacity as a health care provider or payer, the department
8482 or a local health department may [
8483 electronic exchange to another health care provider or third party payer.
8484 (d) An electronic exchange of clinical health information by a health care provider, a
8485 third party payer, the department, a local health department, or a qualified network is a
8486 disclosure for treatment, payment, or health care operations if it complies with Subsection
8487 (3)(a) or (c) and is for treatment, payment, or health care operations, as those terms are defined
8488 in 45 C.F.R. Parts 160, 162, and 164.
8489 (e) A health care provider or third party payer is not required to use the standards
8490 adopted by the department under the provisions of Subsection (2) if the health care provider or
8491 third party payer engage in the electronic exchange of clinical health information within a
8492 particular health care system.
8493 (4) Nothing in this section shall limit the number of networks eligible to engage in the
8494 electronic data interchange of clinical health information using the standards adopted by the
8495 department under Subsection (2)(a)(ii).
8496 (5) (a) The department, a local health department, a health care provider, a third party
8497 payer, or a qualified network is not subject to civil liability for a disclosure of clinical health
8498 information if the disclosure is in accordance with:
8499 (i) Subsection (3)(a); and
8500 (ii) Subsection (3)(b), (c), or (d).
8501 (b) The department, a local health department, a health care provider, a third party
8502 payer, or a qualified network that accesses or reviews clinical health information from or
8503 through the electronic exchange in accordance with the requirements in this section is not
8504 subject to civil liability for the access or review.
8505 (6) Within a qualified network, information generated or [
8506 disclosure is made in the electronic exchange of clinical health information is not subject to
8507 discovery, use, or receipt in evidence in any legal proceeding of any kind or character.
8508 Section 276. Section 26B-8-501, which is renumbered from Section 26-33a-102 is
8509 renumbered and amended to read:
8510
8511 [
8512 As used in this [
8513 (1) "Committee" means the Health Data Committee created [
8514 Section 26B-1-413.
8515 (2) "Control number" means a number assigned by the committee to an individual's
8516 health data as an identifier so that the health data can be disclosed or used in research and
8517 statistical analysis without readily identifying the individual.
8518 (3) "Data supplier" means a health care facility, health care provider, self-funded
8519 employer, third-party payor, health maintenance organization, or government department which
8520 could reasonably be expected to provide health data under this [
8521 (4) "Disclosure" or "disclose" means the communication of health care data to any
8522 individual or organization outside the committee, its staff, and contracting agencies.
8523 (5) (a) "Health care facility" means a facility that is licensed by the department under
8524 [
8525 (b) In accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, the
8526 committee, with the concurrence of the department, may by rule add, delete, or modify the list
8527 of facilities that come within this definition for purposes of this [
8528 (6) "Health care provider" means [
8529
8530
8531
8532
8533
8534
8535
8536
8537
8538
8539 (7) "Health data" means information relating to the health status of individuals, health
8540 services delivered, the availability of health manpower and facilities, and the use and costs of
8541 resources and services to the consumer, except vital records as defined in Section [
8542 26B-8-101 shall be excluded.
8543 (8) "Health maintenance organization" [
8544 that term is defined in Section 31A-8-101.
8545 (9) "Identifiable health data" means any item, collection, or grouping of health data that
8546 makes the individual supplying or described in the health data identifiable.
8547 (10) "Organization" means any corporation, association, partnership, agency,
8548 department, unit, or other legally constituted institution or entity, or part thereof.
8549 (11) "Research and statistical analysis" means activities using health data analysis
8550 including:
8551 (a) describing the group characteristics of individuals or organizations;
8552 (b) analyzing the noncompliance among the various characteristics of individuals or
8553 organizations;
8554 (c) conducting statistical procedures or studies to improve the quality of health data;
8555 (d) designing sample surveys and selecting samples of individuals or organizations;
8556 and
8557 (e) preparing and publishing reports describing these matters.
8558 (12) "Self-funded employer" means an employer who provides for the payment of
8559 health care services for employees directly from the employer's funds, thereby assuming the
8560 financial risks rather than passing them on to an outside insurer through premium payments.
8561 (13) "Plan" means the plan developed and adopted by the Health Data Committee
8562 under Section [
8563 (14) "Third party payor" means:
8564 (a) an insurer offering a health benefit plan, as defined by Section 31A-1-301, to at
8565 least 2,500 enrollees in the state;
8566 (b) a nonprofit health service insurance corporation licensed under Title 31A, Chapter
8567 7, Nonprofit Health Service Insurance Corporations;
8568 (c) a program funded or administered by Utah for the provision of health care services,
8569 including the Medicaid and medical assistance programs described in [
8570 Part 1, Medical Assistance Act; and
8571 (d) a corporation, organization, association, entity, or person:
8572 (i) which administers or offers a health benefit plan to at least 2,500 enrollees in the
8573 state; and
8574 (ii) which is required by administrative rule adopted by the department in accordance
8575 with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to supply health data to the
8576 committee.
8577 Section 277. Section 26B-8-502, which is renumbered from Section 26-33a-105 is
8578 renumbered and amended to read:
8579 [
8580 (1) An executive secretary shall be appointed by the executive director, with the
8581 approval of the committee, and shall serve under the administrative direction of the executive
8582 director.
8583 (2) The executive secretary shall:
8584 (a) employ full-time employees necessary to carry out this [
8585 (b) supervise the development of a draft health data plan for the committee's review,
8586 modification, and approval; and
8587 (c) supervise and conduct the staff functions of the committee in order to assist the
8588 committee in meeting its responsibilities under this [
8589 Section 278. Section 26B-8-503, which is renumbered from Section 26-33a-106 is
8590 renumbered and amended to read:
8591 [
8592 The committee may not use the health data provided to it by third-party payors, health
8593 care providers, or health care facilities to make recommendations with regard to a single health
8594 care provider or health care facility, or a group of health care providers or health care facilities.
8595 Section 279. Section 26B-8-504, which is renumbered from Section 26-33a-106.1 is
8596 renumbered and amended to read:
8597 [
8598 (1) The committee shall, as funding is available:
8599 (a) establish a plan for collecting data from data suppliers to determine measurements
8600 of cost and reimbursements for risk-adjusted episodes of health care;
8601 (b) share data regarding insurance claims and an individual's and small employer
8602 group's health risk factor and characteristics of insurance arrangements that affect claims and
8603 usage with the Insurance Department, only to the extent necessary for:
8604 (i) risk adjusting; and
8605 (ii) the review and analysis of health insurers' premiums and rate filings; and
8606 (c) assist the Legislature and the public with awareness of, and the promotion of,
8607 transparency in the health care market by reporting on:
8608 (i) geographic variances in medical care and costs as demonstrated by data available to
8609 the committee; and
8610 (ii) rate and price increases by health care providers:
8611 (A) that exceed the Consumer Price Index - Medical as provided by the United States
8612 Bureau of Labor Statistics;
8613 (B) as calculated yearly from June to June; and
8614 (C) as demonstrated by data available to the committee;
8615 (d) provide on at least a monthly basis, enrollment data collected by the committee to a
8616 not-for-profit, broad-based coalition of state health care insurers and health care providers that
8617 are involved in the standardized electronic exchange of health data as described in Section
8618 31A-22-614.5, to the extent necessary:
8619 (i) for the department or the Medicaid Office of the Inspector General to determine
8620 insurance enrollment of an individual for the purpose of determining Medicaid third party
8621 liability;
8622 (ii) for an insurer that is a data supplier, to determine insurance enrollment of an
8623 individual for the purpose of coordination of health care benefits; and
8624 (iii) for a health care provider, to determine insurance enrollment for a patient for the
8625 purpose of claims submission by the health care provider;
8626 (e) coordinate with the State Emergency Medical Services Committee to publish data
8627 regarding air ambulance charges under Section [
8628 (f) share data collected under this [
8629 health care price transparency tool described in Section 67-3-11; and
8630 (g) publish annually a report on primary care spending within Utah.
8631 (2) A data supplier is not liable for a breach of or unlawful disclosure of the data
8632 caused by an entity that obtains data in accordance with Subsection (1).
8633 (3) The plan adopted under Subsection (1) shall include:
8634 (a) the type of data that will be collected;
8635 (b) how the data will be evaluated;
8636 (c) how the data will be used;
8637 (d) the extent to which, and how the data will be protected; and
8638 (e) who will have access to the data.
8639 Section 280. Section 26B-8-505, which is renumbered from Section 26-33a-106.5 is
8640 renumbered and amended to read:
8641 [
8642 (1) The committee may publish compilations or reports that compare and identify
8643 health care providers or data suppliers from the data it collects under this [
8644 any other source.
8645 (2) (a) Except as provided in Subsection (7)(c), the committee shall publish
8646 compilations or reports from the data it collects under this [
8647 source which:
8648 (i) contain the information described in Subsection (2)(b); and
8649 (ii) compare and identify by name at least a majority of the health care facilities, health
8650 care plans, and institutions in the state.
8651 (b) Except as provided in Subsection (7)(c), the report required by this Subsection (2)
8652 shall:
8653 (i) be published at least annually;
8654 (ii) list, as determined by the committee, the median paid amount for at least the top 50
8655 medical procedures performed in the state by volume;
8656 (iii) describe the methodology approved by the committee to determine the amounts
8657 described in Subsection (2)(b)(ii); and
8658 (iv) contain comparisons based on at least the following factors:
8659 (A) nationally or other generally recognized quality standards;
8660 (B) charges; and
8661 (C) nationally recognized patient safety standards.
8662 (3) (a) The committee may contract with a private, independent analyst to evaluate the
8663 standard comparative reports of the committee that identify, compare, or rank the performance
8664 of data suppliers by name.
8665 (b) The evaluation described in this Subsection (3) shall include a validation of
8666 statistical methodologies, limitations, appropriateness of use, and comparisons using standard
8667 health services research practice.
8668 (c) The independent analyst described in Subsection (3)(a) shall be experienced in
8669 analyzing large databases from multiple data suppliers and in evaluating health care issues of
8670 cost, quality, and access.
8671 (d) The results of the analyst's evaluation shall be released to the public before the
8672 standard comparative analysis upon which it is based may be published by the committee.
8673 (4) [
8674 accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, [
8675
8676 collection and analysis of data from multiple types of data suppliers.
8677 (5) The comparative analysis required under Subsection (2) shall be available free of
8678 charge and easily accessible to the public.
8679 (6) (a) The department shall include in the report required by Subsection (2)(b), or
8680 include in a separate report, comparative information on commonly recognized or generally
8681 agreed upon measures of cost and quality identified in accordance with Subsection (7), for:
8682 (i) routine and preventive care; and
8683 (ii) the treatment of diabetes, heart disease, and other illnesses or conditions as
8684 determined by the committee.
8685 (b) The comparative information required by Subsection (6)(a) shall be based on data
8686 collected under Subsection (2) and clinical data that may be available to the committee, and
8687 shall compare:
8688 (i) results for health care facilities or institutions;
8689 (ii) results for health care providers by geographic regions of the state;
8690 (iii) a clinic's aggregate results for a physician who practices at a clinic with five or
8691 more physicians; and
8692 (iv) a geographic region's aggregate results for a physician who practices at a clinic
8693 with less than five physicians, unless the physician requests physician-level data to be
8694 published on a clinic level.
8695 (c) The department:
8696 (i) may publish information required by this Subsection (6) directly or through one or
8697 more nonprofit, community-based health data organizations; and
8698 (ii) may use a private, independent analyst under Subsection (3)(a) in preparing the
8699 report required by this section.
8700 (d) A report published by the department under this Subsection (6):
8701 (i) is subject to the requirements of Section [
8702 (ii) shall, prior to being published by the department, be submitted to a neutral,
8703 non-biased entity with a broad base of support from health care payers and health care
8704 providers in accordance with Subsection (7) for the purpose of validating the report.
8705 (7) (a) The Health Data Committee shall, through the department, for purposes of
8706 Subsection (6)(a), use the quality measures that are developed and agreed upon by a neutral,
8707 non-biased entity with a broad base of support from health care payers and health care
8708 providers.
8709 (b) If the entity described in Subsection (7)(a) does not submit the quality measures,
8710 the department may select the appropriate number of quality measures for purposes of the
8711 report required by Subsection (6).
8712 (c) (i) For purposes of the reports published on or after July 1, 2014, the department
8713 may not compare individual facilities or clinics as described in Subsections (6)(b)(i) through
8714 (iv) if the department determines that the data available to the department can not be
8715 appropriately validated, does not represent nationally recognized measures, does not reflect the
8716 mix of cases seen at a clinic or facility, or is not sufficient for the purposes of comparing
8717 providers.
8718 (ii) The department shall report to the Legislature's Health and Human Services Interim
8719 Committee prior to making a determination not to publish a report under Subsection (7)(c)(i).
8720 Section 281. Section 26B-8-506, which is renumbered from Section 26-33a-107 is
8721 renumbered and amended to read:
8722 [
8723 The committee may not release a compilation or report that compares and identifies
8724 health care providers or data suppliers unless it:
8725 (1) allows the data supplier and the health care provider to verify the accuracy of the
8726 information submitted to the committee and submit to the committee any corrections of errors
8727 with supporting evidence and comments within a reasonable period of time to be established by
8728 rule , with the concurrence of the department, made in accordance with Title 63G, Chapter 3,
8729 Utah Administrative Rulemaking Act ;
8730 (2) corrects data found to be in error; and
8731 (3) allows the data supplier a reasonable amount of time prior to publication to review
8732 the committee's interpretation of the data and prepare a response.
8733 Section 282. Section 26B-8-507, which is renumbered from Section 26-33a-108 is
8734 renumbered and amended to read:
8735 [
8736 (1) (a) All information, reports, statements, memoranda, or other data received by the
8737 committee are strictly confidential.
8738 (b) Any use, release, or publication of the information shall be done in such a way that
8739 no person is identifiable except as provided in Sections [
8740 [
8741 (2) No member of the committee may be held civilly liable by reason of having
8742 released or published reports or compilations of data supplied to the committee, so long as the
8743 publication or release is in accordance with the requirements of Subsection (1).
8744 (3) No person, corporation, or entity may be held civilly liable for having provided data
8745 to the committee in accordance with this [
8746 Section 283. Section 26B-8-508, which is renumbered from Section 26-33a-109 is
8747 renumbered and amended to read:
8748 [
8749 identifiable health data.
8750 (1) The committee may not disclose any identifiable health data unless:
8751 (a) the individual has authorized the disclosure;
8752 (b) the disclosure is to the department or a public health authority in accordance with
8753 Subsection (2); or
8754 (c) the disclosure complies with the provisions of:
8755 (i) Subsection (3);
8756 (ii) insurance enrollment and coordination of benefits under Subsection [
8757 26B-8-504(1)(d); or
8758 (iii) risk adjusting under Subsection [
8759 (2) The committee may disclose identifiable health data to the department or a public
8760 health authority under Subsection (1)(b) if:
8761 (a) the department or the public health authority has clear statutory authority to possess
8762 the identifiable health data; and
8763 (b) the disclosure is solely for use:
8764 (i) in the Utah Statewide Immunization Information System operated by the
8765 department;
8766 (ii) in the Utah Cancer Registry operated by the University of Utah, in collaboration
8767 with the department; or
8768 (iii) by the medical examiner, as defined in Section [
8769 examiner's designee.
8770 (3) The committee shall consider the following when responding to a request for
8771 disclosure of information that may include identifiable health data:
8772 (a) whether the request comes from a person after that person has received approval to
8773 do the specific research or statistical work from an institutional review board; and
8774 (b) whether the requesting entity complies with the provisions of Subsection (4).
8775 (4) A request for disclosure of information that may include identifiable health data
8776 shall:
8777 (a) be for a specified period; or
8778 (b) be solely for bona fide research or statistical purposes as determined in accordance
8779 with administrative rules adopted by the department in accordance with Title 63G, Chapter 3,
8780 Utah Administrative Rulemaking Act , which shall require:
8781 (i) the requesting entity to demonstrate to the department that the data is required for
8782 the research or statistical purposes proposed by the requesting entity; and
8783 (ii) the requesting entity to enter into a written agreement satisfactory to the department
8784 to protect the data in accordance with this [
8785 (5) A person accessing identifiable health data pursuant to Subsection (4) may not
8786 further disclose the identifiable health data:
8787 (a) without prior approval of the department; and
8788 (b) unless the identifiable health data is disclosed or identified by control number only.
8789 (6) Identifiable health data that has been designated by a data supplier as being subject
8790 to regulation under 42 C.F.R. Part 2, Confidentiality of Substance Use Disorder Patient
8791 Records, may only be used or disclosed in accordance with applicable federal regulations.
8792 Section 284. Section 26B-8-509, which is renumbered from Section 26-33a-110 is
8793 renumbered and amended to read:
8794 [
8795 (1) Any use, release, or publication of health care data contrary to the provisions of
8796 Sections [
8797 (2) Subsection (1) does not relieve the person or organization responsible for that use,
8798 release, or publication from civil liability.
8799 Section 285. Section 26B-8-510, which is renumbered from Section 26-33a-111 is
8800 renumbered and amended to read:
8801 [
8802 compulsory process -- Exception.
8803 Identifiable health data obtained in the course of activities undertaken or supported
8804 under this [
8805 or criminal, judicial, administrative, or legislative proceeding, nor shall any individual or
8806 organization with lawful access to identifiable health data under the provisions of this [
8807 part be compelled to testify with regard to such health data, except that data pertaining to a
8808 party in litigation may be subject to subpoena or similar compulsory process in an action
8809 brought by or on behalf of such individual to enforce any liability arising under this [
8810 part.
8811 Section 286. Section 26B-8-511, which is renumbered from Section 26-33a-115 is
8812 renumbered and amended to read:
8813 [
8814 payment reform demonstration project.
8815 (1) The Legislature finds that:
8816 (a) current health care delivery and payment systems do not provide system wide
8817 incentives for the competitive delivery and pricing of health care services to consumers;
8818 (b) there is a compelling state interest to encourage consumers to seek high quality, low
8819 cost care and educate themselves about health care options;
8820 (c) some health care providers and health care payers have developed
8821 consumer-focused ideas for health care delivery and payment system reform, but lack the
8822 critical number of patient lives and payer involvement to accomplish system-wide
8823 consumer-focused reform; and
8824 (d) there is a compelling state interest to encourage as many health care providers and
8825 health care payers to join together and coordinate efforts at consumer-focused health care
8826 delivery and payment reform that would provide to consumers enrolled in a high-deductible
8827 health plan:
8828 (i) greater choice in health care options;
8829 (ii) improved services through competition; and
8830 (iii) more affordable options for care.
8831 (2) (a) The department shall meet with health care providers and health care payers for
8832 the purpose of coordinating a demonstration project for consumer-based health care delivery
8833 and payment reform.
8834 (b) Participation in the coordination efforts is voluntary, but encouraged.
8835 (3) The department, in order to facilitate the coordination of a demonstration project
8836 for consumer-based health care delivery and payment reform, shall convene and consult with
8837 pertinent entities including:
8838 (a) the Utah Insurance Department;
8839 (b) the Office of Consumer Health Services;
8840 (c) the Utah Medical Association;
8841 (d) the Utah Hospital Association; and
8842 (e) neutral, non-biased third parties with an established record for broad based,
8843 multi-provider and multi-payer quality assurance efforts and data collection.
8844 (4) The department shall supervise the efforts by entities under Subsection (3)
8845 regarding:
8846 (a) applying for and obtaining grant funding and other financial assistance that may be
8847 available for demonstrating consumer-based improvements to health care delivery and
8848 payment;
8849 (b) obtaining and analyzing information and data related to current health system
8850 utilization and costs to consumers; and
8851 (c) consulting with those health care providers and health care payers who elect to
8852 participate in the consumer-based health delivery and payment demonstration project.
8853 [
8854
8855
8856 Section 287. Section 26B-8-512, which is renumbered from Section 26-33a-116 is
8857 renumbered and amended to read:
8858 [
8859 (1) Subject to Subsection (2), the department shall make aggregate data produced
8860 under this [
8861 interface format.
8862 (2) (a) The department shall ensure that data made available to the public under
8863 Subsection (1):
8864 (i) does not contain identifiable health data of a patient; and
8865 (ii) meets state and federal data privacy requirements, including the requirements of
8866 Section [
8867 (b) The department may not release any data under Subsection (1) that may be
8868 identifiable health data of a patient.
8869 Section 288. Section 26B-8-513, which is renumbered from Section 26-33a-117 is
8870 renumbered and amended to read:
8871 [
8872 non-evidence-based health care.
8873 (1) The department shall, in accordance with Title 63G, Chapter 6a, Utah Procurement
8874 Code, contract with an entity to provide a nationally-recognized health waste calculator that:
8875 (a) uses principles such as the principles of the Choosing Wisely initiative of the
8876 American Board of Internal Medicine Foundation; and
8877 (b) is approved by the committee.
8878 (2) The department shall use the calculator described in Subsection (1) to:
8879 (a) analyze the data in the state's All Payer Claims Database; and
8880 (b) flag data entries that the calculator identifies as potential overuse of non-
8881 evidence-based health care.
8882 (3) The department, or a third party organization that the department contracts with in
8883 accordance with Title 63G, Chapter 6a, Utah Procurement Code, shall:
8884 (a) analyze the data described in Subsection (2)(b);
8885 (b) review current scientific literature about medical services that are best practice;
8886 (c) review current scientific literature about eliminating duplication in health care;
8887 (d) solicit input from Utah health care providers, health systems, insurers, and other
8888 stakeholders regarding duplicative health care quality initiatives and instances of
8889 non-alignment in metrics used to measure health care quality that are required by different
8890 health systems;
8891 (e) solicit input from Utah health care providers, health systems, insurers, and other
8892 stakeholders on methods to avoid overuse of non-evidence-based health care; and
8893 (f) present the results of the analysis, research, and input described in Subsections
8894 (3)(a) through (e) to the committee.
8895 (4) The committee shall:
8896 (a) make recommendations for action and opportunities for improvement based on the
8897 results described in Subsection (3)(f);
8898 (b) make recommendations on methods to bring into alignment the various health care
8899 quality metrics different entities in the state use; and
8900 (c) identify priority issues and recommendations to include in an annual report.
8901 (5) The department, or the third party organization described in Subsection (3) shall:
8902 (a) compile the report described in Subsection (4)(c); and
8903 (b) submit the report to the committee for approval.
8904 (6) Beginning in 2021, on or before November 1 each year, the department shall
8905 submit the report approved in Subsection (5)(b) to the Health and Human Services Interim
8906 Committee.
8907 Section 289. Section 26B-8-514, which is renumbered from Section 26-70-102 is
8908 renumbered and amended to read:
8909 [
8910 (1) As used in this section:
8911 (a) "HIPAA" means the Health Insurance Portability and Accountability Act of 1996,
8912 Pub. L. No. 104-191, 110 Stat. 1936, as amended.
8913 (b) "Patient" means the individual whose information is being requested.
8914 (c) "Personal representative" means an individual described in 45 C.F.R. Sec.
8915 164.502(g).
8916 [
8917 (a) is compliant with HIPAA and 42 C.F.R. Part 2; and
8918 (b) a patient or a patient's personal representative may use to request that a copy of the
8919 patient's health records be sent to any of the following:
8920 (i) the patient;
8921 (ii) the patient's personal representative;
8922 (iii) the patient's attorney; or
8923 (iv) a third party authorized by the patient.
8924 [
8925 (a) the patient's name;
8926 (b) the patient's date of birth;
8927 (c) the patient's phone number;
8928 (d) the patient's address;
8929 (e) (i) the patient's signature and date of signature, which may not require notarization;
8930 or
8931 (ii) the signature of the patient's personal representative and date of signature, which
8932 may not require notarization;
8933 (f) the name, address, and phone number of the person to which the information will be
8934 disclosed;
8935 (g) the records requested, including whether the patient is requesting paper or
8936 electronic records;
8937 (h) the duration of time the authorization is valid; and
8938 (i) the dates of service requested.
8939 [
8940 the field described in Subsection [
8941 (a) history and physical examination records;
8942 (b) treatment plans;
8943 (c) emergency room records;
8944 (d) radiology and lab reports;
8945 (e) operative reports;
8946 (f) pathology reports;
8947 (g) consultations;
8948 (h) discharge summary;
8949 (i) outpatient clinic records and progress notes;
8950 (j) behavioral health evaluation;
8951 (k) behavioral health discharge summary;
8952 (l) mental health therapy records;
8953 (m) financial information including an itemized billing statement;
8954 (n) health insurance claim form;
8955 (o) billing form; and
8956 (p) other.
8957 Section 290. Revisor instructions.
8958 The Legislature intends that the Office of Legislative Research and General Counsel, in
8959 preparing the Utah Code database for publication:
8960 (1) not enroll this bill if any of the following bills do not pass:
8961 (a) S.B. 38, Health and Human Services Recodification - Administration, Licensing,
8962 and Recovery Services;
8963 (b) S.B. 40, Health and Human Services Recodification - Health Care Assistance and
8964 Data; or
8965 (c) S.B. 41, Health and Human Services Recodification - Health Care Delivery and
8966 Repeals; and
8967 (2) in any new language added to the Utah Code by legislation passed during the 2023
8968 General Session, replace any references to Titles 26 or 62A with the renumbered reference as it
8969 is renumbered in this bill.