1     
HEALTH CARE REFORM AMENDMENTS

2     
2024 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Ken Ivory

5     
Senate Sponsor: ____________

6     

7     LONG TITLE
8     General Description:
9          This bill amends provisions related to health care reform.
10     Highlighted Provisions:
11          This bill:
12          ▸     requires the Department of Health and Human Services (department) to issue a
13     request for information regarding lowering costs to the Medicaid program while
14     maintaining or improving the level of services offered to Medicaid enrollees;
15          ▸     authorizes the department to initiate request for proposals;
16          ▸     authorizes the department to apply for Medicaid waivers if necessary to implement
17     a proposal;
18          ▸     authorizes the use of the Medicaid Expansion Fund to pay for certain programs;
19          ▸     amends provisions related to the types of drugs a health care provider may dispense
20     in the health care provider's office; and
21          ▸     creates a sunset date.
22     Money Appropriated in this Bill:
23          None
24     Other Special Clauses:
25          This bill provides a special effective date.
26     Utah Code Sections Affected:
27     AMENDS:
28          26B-1-315, as last amended by Laws of Utah 2023, Chapter 471 and renumbered and
29     amended by Laws of Utah 2023, Chapter 305
30          58-88-202, as enacted by Laws of Utah 2022, Chapter 353
31          63I-1-226 (Superseded 07/01/24), as last amended by Laws of Utah 2023, Chapters
32     249, 269, 270, 275, 332, 335, 420, and 495 and repealed and reenacted by Laws of
33     Utah 2023, Chapter 329
34          63I-1-226 (Effective 07/01/24), as last amended by Laws of Utah 2023, Chapters 249,
35     269, 270, 275, 310, 332, 335, 420, and 495 and repealed and reenacted by Laws of
36     Utah 2023, Chapter 329 and last amended by Coordination Clause, Laws of Utah
37     2023, Chapters 329, 332
38     ENACTS:
39          26B-3-143, Utah Code Annotated 1953
40     

41     Be it enacted by the Legislature of the state of Utah:
42          Section 1. Section 26B-1-315 is amended to read:
43          26B-1-315. Medicaid Expansion Fund.
44          (1) There is created an expendable special revenue fund known as the "Medicaid
45     Expansion Fund."
46          (2) The fund consists of:
47          (a) assessments collected under Chapter 3, Part 5, Inpatient Hospital Assessment;
48          (b) intergovernmental transfers under Section 26B-3-508;
49          (c) savings attributable to the health coverage improvement program, as defined in
50     Section 26B-3-501, as determined by the department;
51          (d) savings attributable to the enhancement waiver program, as defined in Section
52     26B-3-501, as determined by the department;
53          (e) savings attributable to the Medicaid waiver expansion, as defined in Section
54     26B-3-501, as determined by the department;
55          (f) savings attributable to the inclusion of psychotropic drugs on the preferred drug list
56     under Subsection 26B-3-105(3) as determined by the department;
57          (g) revenues collected from the sales tax described in Subsection 59-12-103(11);
58          (h) gifts, grants, donations, or any other conveyance of money that may be made to the
59     fund from private sources;
60          (i) interest earned on money in the fund; and
61          (j) additional amounts as appropriated by the Legislature.
62          (3) (a) The fund shall earn interest.
63          (b) All interest earned on fund money shall be deposited into the fund.
64          (4) (a) A state agency administering the provisions of Chapter 3, Part 5, Inpatient
65     Hospital Assessment, may use money from the fund to pay the costs, not otherwise paid for
66     with federal funds or other revenue sources, of:
67          (i) the health coverage improvement program as defined in Section 26B-3-501;
68          (ii) the enhancement waiver program as defined in Section 26B-3-501;
69          (iii) a Medicaid waiver expansion as defined in Section 26B-3-501; [and]
70          (iv) the outpatient upper payment limit supplemental payments under Section
71     26B-3-511[.]; and
72          (v) administering and implementing a program or Medicaid waiver created under
73     Section 26B-3-143.
74          (b) A state agency administering the provisions of Chapter 3, Part 5, Inpatient Hospital
75     Assessment, may not use:
76          (i) funds described in Subsection (2)(b) to pay the cost of private outpatient upper
77     payment limit supplemental payments; or
78          (ii) money in the fund for any purpose not described in Subsection (4)(a).
79          Section 2. Section 26B-3-143 is enacted to read:
80          26B-3-143. Medicaid improvement projects.
81          (1) Before December 31, 2024, the department shall initiate a request for information
82     related to providing the same or improved services to enrollees at lower cost to the state.
83          (2) (a) After receiving responses under Subsection (1) and in accordance with Title
84     63G, Chapter 6a, Utah Procurement Code, the department may develop any number of request
85     for proposals that the department determines could result in the same or improved services to
86     enrollees at lower cost to the state.
87          (b) The department may determine the scope for a request for proposal described in
88     Subsection (2)(a).
89          (3) The department may apply for a Medicaid waiver to implement a program created
90     under this section.
91          Section 3. Section 58-88-202 is amended to read:
92          58-88-202. Dispensing practice -- Drugs that may be dispensed -- Limitations and
93     exceptions.
94          (1) Notwithstanding Section 58-17b-302, a dispensing practitioner may dispense a drug
95     at a licensed dispensing practice if the drug is:
96          (a) packaged in a fixed quantity per package by:
97          (i) the drug manufacturer;
98          (ii) a pharmaceutical wholesaler or distributor; or
99          (iii) a pharmacy licensed under Chapter 17b, Pharmacy Practice Act; and
100          (b) dispensed:
101          (i) at a licensed dispensing practice at which the dispensing practitioner regularly
102     practices; and
103          (ii) under a prescription issued by the dispensing practitioner to the dispensing
104     practitioner's patient[;].
105          [(c) for a condition that is not expected to last longer than 30 days; and]
106          [(d) for a condition for which the patient has been evaluated by the dispensing
107     practitioner on the same day on which the dispensing practitioner dispenses the drug.]
108          (2) A dispensing practitioner may not dispense:
109          (a) a controlled substance as defined in Section 58-37-2;
110          (b) a drug or class of drugs that is designated by the division under Subsection
111     58-88-205(2); or
112          (c) gabapentin[; or].
113          [(d) a supply of a drug under this part that exceeds a 30-day supply.]
114          (3) A dispensing practitioner may not make a claim against workers' compensation or
115     automobile insurance for a drug dispensed under this part for outpatient use unless the
116     dispensing practitioner is contracted with a pharmacy network established by the claim payor.
117          (4) When a dispensing practitioner dispenses a drug to the patient under this part, a
118     dispensing practitioner shall:
119          (a) disclose to the patient verbally and in writing that the patient is not required to fill
120     the prescription through the licensed dispensing practice and that the patient has a right to fill
121     the prescription through a pharmacy; and
122          (b) if the patient will be responsible to pay cash for the drug, disclose:
123          (i) that the patient will be responsible to pay cash for the drug; and
124          (ii) the amount that the patient will be charged by the licensed dispensing practice for
125     the drug.
126          (5) This part does not:
127          (a) require a dispensing practitioner to dispense a drug under this part;
128          (b) limit a health care prescriber from dispensing under Chapter 17b, Part 8,
129     Dispensing Medical Practitioner and Dispensing Medical Practitioner Clinic Pharmacy; or
130          (c) apply to a physician who dispenses:
131          (i) a drug sample, as defined in Section 58-17b-102, to a patient in accordance with
132     Section 58-1-501.3 or Section 58-17b-610;
133          (ii) a prescription drug or device to a patient for a patient's immediate need in an
134     emergency department in accordance with Section 58-17b-610.5; or
135          (iii) a drug in an emergency situation as defined by the division in rule under Chapter
136     17b, Pharmacy Practice Act.
137          Section 4. Section 63I-1-226 (Superseded 07/01/24) is amended to read:
138          63I-1-226 (Superseded 07/01/24). Repeal dates: Titles 26A through 26B.
139          (1) Subsection 26B-1-204(2)(i), related to the Primary Care Grant Committee, is
140     repealed July 1, 2025.
141          (2) Section 26B-1-315, which creates the Medicaid Expansion Fund, is repealed July 1,
142     2024.
143          (3) Subsection 26B-1-315(4)(a)(v), related to a program or Medicaid waiver created
144     under Section 26B-3-143, is repealed July 1, 2031.
145          [(3)] (4) Section 26B-1-319, which creates the Neuro-Rehabilitation Fund, is repealed
146     January 1, 2025.
147          [(4)] (5) Section 26B-1-320, which creates the Pediatric Neuro-Rehabilitation Fund, is
148     repealed January 1, 2025.
149          [(5)] (6) Subsection 26B-1-324(4), the language that states "the Behavioral Health
150     Crisis Response Commission, as defined in Section 63C-18-202," is repealed December 31,
151     2026.
152          [(6)] (7) Subsection 26B-1-329(6), related to the Behavioral Health Crisis Response
153     Commission, is repealed December 31, 2026.
154          [(7)] (8) Section 26B-1-402, related to the Rare Disease Advisory Council Grant
155     Program, is repealed July 1, 2026.
156          [(8)] (9) Section 26B-1-409, which creates the Utah Digital Health Service
157     Commission, is repealed July 1, 2025.
158          [(9)] (10) Section 26B-1-410, which creates the Primary Care Grant Committee, is
159     repealed July 1, 2025.
160          [(10)] (11) Section 26B-1-416, which creates the Utah Children's Health Insurance
161     Program Advisory Council, is repealed July 1, 2025.
162          [(11)] (12) Section 26B-1-417, which creates the Brain Injury Advisory Committee, is
163     repealed July 1, 2025.
164          [(12)] (13) Section 26B-1-418, which creates the Neuro-Rehabilitation Fund and
165     Pediatric Neuro-Rehabilitation Fund Advisory Committee, is repealed January 1, 2025.
166          [(13)] (14) Section 26B-1-422, which creates the Early Childhood Utah Advisory
167     Council, is repealed July 1, 2029.
168          [(14)] (15) Section 26B-1-428, which creates the Youth Electronic Cigarette,
169     Marijuana, and Other Drug Prevention Program, is repealed July 1, 2025.
170          [(15)] (16) Section 26B-1-430, which creates the Coordinating Council for Persons
171     with Disabilities, is repealed July 1, 2027.
172          [(16)] (17) Section 26B-1-431, which creates the Forensic Mental Health Coordinating
173     Council, is repealed July 1, 2023.
174          [(17)] (18) Section 26B-1-432, which creates the Newborn Hearing Screening
175     Committee, is repealed July 1, 2026.
176          [(18)] (19) Section 26B-1-434, regarding the Correctional Postnatal and Early
177     Childhood Advisory Board, is repealed July 1, 2026.
178          [(19)] (20) Section 26B-2-407, related to drinking water quality in child care centers, is
179     repealed July 1, 2027.
180          [(20)] (21) Subsection 26B-3-107(9), which addresses reimbursement for dental
181     hygienists, is repealed July 1, 2028.
182          [(21)] (22) Section 26B-3-136, which creates the Children's Health Care Coverage
183     Program, is repealed July 1, 2025.
184          [(22)] (23) Section 26B-3-137, related to reimbursement for the National Diabetes
185     Prevention Program, is repealed June 30, 2027.
186          (24) Section 26B-3-143 is repealed July 1, 2031.
187          [(23)] (25) Subsection 26B-3-213(2), the language that states "and the Behavioral
188     Health Crisis Response Commission created in Section 63C-18-202" is repealed December 31,
189     2026.
190          [(24)] (26) Sections 26B-3-302 through 26B-3-309, regarding the Drug Utilization
191     Review Board, are repealed July 1, 2027.
192          [(25)] (27) Title 26B, Chapter 3, Part 5, Inpatient Hospital Assessment, is repealed July
193     1, 2024.
194          [(26)] (28) Title 26B, Chapter 3, Part 6, Medicaid Expansion Hospital Assessment, is
195     repealed July 1, 2024.
196          [(27)] (29) Title 26B, Chapter 3, Part 7, Hospital Provider Assessment, is repealed July
197     1, 2028.
198          [(28)] (30) Section 26B-3-910, regarding alternative eligibility, is repealed July 1,
199     2028.
200          [(29)] (31) Section 26B-4-136, related to the Volunteer Emergency Medical Service
201     Personnel Health Insurance Program, is repealed July 1, 2027.
202          [(30)] (32) Section 26B-4-710, related to rural residency training programs, is repealed
203     July 1, 2025.
204          [(31)] (33) Subsections 26B-5-112(1) and (5), the language that states "In consultation
205     with the Behavioral Health Crisis Response Commission, established in Section 63C-18-202,"
206     is repealed December 31, 2026.
207          [(32)] (34) Section 26B-5-112.5 is repealed December 31, 2026.
208          [(33)] (35) Section 26B-5-114, related to the Behavioral Health Receiving Center
209     Grant Program, is repealed December 31, 2026.
210          [(34)] (36) Section 26B-5-118, related to collaborative care grant programs, is repealed
211     December 31, 2024.
212          [(35)] (37) Section 26B-5-120 is repealed December 31, 2026.
213          [(36)] (38) In relation to the Utah Assertive Community Treatment Act, on July 1,
214     2024:
215          (a) Subsection 26B-5-606(2)(a)(i), the language that states "and" is repealed; and
216          (b) Subsections 26B-5-606(2)(a)(ii), 26B-5-606(2)(b), and 26B-5-606(2)(c) are
217     repealed.
218          [(37)] (39) In relation to the Behavioral Health Crisis Response Commission, on
219     December 31, 2026:
220          (a) Subsection 26B-5-609(1)(a) is repealed;
221          (b) Subsection 26B-5-609(3)(a), the language that states "With recommendations from
222     the commission," is repealed;
223          (c) Subsection 26B-5-610(1)(b) is repealed;
224          (d) Subsection 26B-5-610(2)(b), the language that states "and in consultation with the
225     commission," is repealed; and
226          (e) Subsection 26B-5-610(4), the language that states "In consultation with the
227     commission," is repealed.
228          [(38)] (40) Subsections 26B-5-611(1)(a) and (10), in relation to the Utah Substance
229     Use and Mental Health Advisory Council, are repealed January 1, 2033.
230          [(39)] (41) Section 26B-5-612, related to integrated behavioral health care grant
231     programs, is repealed December 31, 2025.
232          [(40)] (42) Subsection 26B-7-119(5), related to reports to the Legislature on the
233     outcomes of the Hepatitis C Outreach Pilot Program, is repealed July 1, 2028.
234          [(41)] (43) Section 26B-7-224, related to reports to the Legislature on violent incidents
235     and fatalities involving substance abuse, is repealed December 31, 2027.
236          [(42)] (44) Title 26B, Chapter 8, Part 5, Utah Health Data Authority, is repealed July 1,
237     2024.
238          [(43)] (45) Section 26B-8-513, related to identifying overuse of non-evidence-based
239     health care, is repealed December 31, 2023.
240          Section 5. Section 63I-1-226 (Effective 07/01/24) is amended to read:
241          63I-1-226 (Effective 07/01/24). Repeal dates: Titles 26A through 26B.
242          (1) Subsection 26B-1-204(2)(i), related to the Primary Care Grant Committee, is
243     repealed July 1, 2025.
244          (2) Section 26B-1-315, which creates the Medicaid Expansion Fund, is repealed July 1,
245     2024.
246          (3) Subsection 26B-1-315(4)(a)(v), related to a program or Medicaid waiver created
247     under Section 26B-3-143, is repealed July 1, 2031.
248          [(3)] (4) Section 26B-1-319, which creates the Neuro-Rehabilitation Fund, is repealed
249     January 1, 2025.
250          [(4)] (5) Section 26B-1-320, which creates the Pediatric Neuro-Rehabilitation Fund, is
251     repealed January 1, 2025.
252          [(5)] (6) Subsection 26B-1-324(4), the language that states "the Behavioral Health
253     Crisis Response Commission, as defined in Section 63C-18-202," is repealed December 31,
254     2026.
255          [(6)] (7) Subsection 26B-1-329(6), related to the Behavioral Health Crisis Response
256     Commission, is repealed December 31, 2026.
257          [(7)] (8) Section 26B-1-402, related to the Rare Disease Advisory Council Grant
258     Program, is repealed July 1, 2026.
259          [(8)] (9) Section 26B-1-409, which creates the Utah Digital Health Service
260     Commission, is repealed July 1, 2025.
261          [(9)] (10) Section 26B-1-410, which creates the Primary Care Grant Committee, is
262     repealed July 1, 2025.
263          [(10)] (11) Section 26B-1-416, which creates the Utah Children's Health Insurance
264     Program Advisory Council, is repealed July 1, 2025.
265          [(11)] (12) Section 26B-1-417, which creates the Brain Injury Advisory Committee, is
266     repealed July 1, 2025.
267          [(12)] (13) Section 26B-1-418, which creates the Neuro-Rehabilitation Fund and
268     Pediatric Neuro-Rehabilitation Fund Advisory Committee, is repealed January 1, 2025.
269          [(13)] (14) Section 26B-1-422, which creates the Early Childhood Utah Advisory
270     Council, is repealed July 1, 2029.
271          [(14)] (15) Section 26B-1-428, which creates the Youth Electronic Cigarette,
272     Marijuana, and Other Drug Prevention Program, is repealed July 1, 2025.
273          [(15)] (16) Section 26B-1-430, which creates the Coordinating Council for Persons
274     with Disabilities, is repealed July 1, 2027.
275          [(16)] (17) Section 26B-1-431, which creates the Forensic Mental Health Coordinating
276     Council, is repealed July 1, 2023.
277          [(17)] (18) Section 26B-1-432, which creates the Newborn Hearing Screening
278     Committee, is repealed July 1, 2026.
279          [(18)] (19) Section 26B-1-434, regarding the Correctional Postnatal and Early
280     Childhood Advisory Board, is repealed July 1, 2026.
281          [(19)] (20) Section 26B-2-407, related to drinking water quality in child care centers, is
282     repealed July 1, 2027.
283          [(20)] (21) Subsection 26B-3-107(9), which addresses reimbursement for dental
284     hygienists, is repealed July 1, 2028.
285          [(21)] (22) Section 26B-3-136, which creates the Children's Health Care Coverage
286     Program, is repealed July 1, 2025.
287          [(22)] (23) Section 26B-3-137, related to reimbursement for the National Diabetes
288     Prevention Program, is repealed June 30, 2027.
289          (24) Section 26B-3-143 is repealed July 1, 2031.
290          [(23)] (25) Subsection 26B-3-213(2), the language that states "and the Behavioral
291     Health Crisis Response Commission created in Section 63C-18-202" is repealed December 31,
292     2026.
293          [(24)] (26) Sections 26B-3-302 through 26B-3-309, regarding the Drug Utilization
294     Review Board, are repealed July 1, 2027.
295          [(25)] (27) Title 26B, Chapter 3, Part 5, Inpatient Hospital Assessment, is repealed July
296     1, 2024.
297          [(26)] (28) Title 26B, Chapter 3, Part 6, Medicaid Expansion Hospital Assessment, is
298     repealed July 1, 2024.
299          [(27)] (29) Title 26B, Chapter 3, Part 7, Hospital Provider Assessment, is repealed July
300     1, 2028.
301          [(28)] (30) Section 26B-3-910, regarding alternative eligibility, is repealed July 1,
302     2028.
303          [(29)] (31) Section 26B-4-710, related to rural residency training programs, is repealed
304     July 1, 2025.
305          [(30)] (32) Subsections 26B-5-112(1) and (5), the language that states "In consultation
306     with the Behavioral Health Crisis Response Commission, established in Section 63C-18-202,"
307     is repealed December 31, 2026.
308          [(31)] (33) Section 26B-5-112.5 is repealed December 31, 2026.
309          [(32)] (34) Section 26B-5-114, related to the Behavioral Health Receiving Center
310     Grant Program, is repealed December 31, 2026.
311          [(33)] (35) Section 26B-5-118, related to collaborative care grant programs, is repealed
312     December 31, 2024.
313          [(34)] (36) Section 26B-5-120 is repealed December 31, 2026.
314          [(35)] (37) In relation to the Utah Assertive Community Treatment Act, on July 1,
315     2024:
316          (a) Subsection 26B-5-606(2)(a)(i), the language that states "and" is repealed; and
317          (b) Subsections 26B-5-606(2)(a)(ii), 26B-5-606(2)(b), and 26B-5-606(2)(c) are
318     repealed.
319          [(36)] (38) In relation to the Behavioral Health Crisis Response Commission, on
320     December 31, 2026:
321          (a) Subsection 26B-5-609(1)(a) is repealed;
322          (b) Subsection 26B-5-609(3)(a), the language that states "With recommendations from
323     the commission," is repealed;
324          (c) Subsection 26B-5-610(1)(b) is repealed;
325          (d) Subsection 26B-5-610(2)(b), the language that states "and in consultation with the
326     commission," is repealed; and
327          (e) Subsection 26B-5-610(4), the language that states "In consultation with the
328     commission," is repealed.
329          [(37)] (39) Subsections 26B-5-611(1)(a) and (10), in relation to the Utah Substance
330     Use and Mental Health Advisory Council, are repealed January 1, 2033.
331          [(38)] (40) Section 26B-5-612, related to integrated behavioral health care grant
332     programs, is repealed December 31, 2025.
333          [(39)] (41) Subsection 26B-7-119(5), related to reports to the Legislature on the
334     outcomes of the Hepatitis C Outreach Pilot Program, is repealed July 1, 2028.
335          [(40)] (42) Section 26B-7-224, related to reports to the Legislature on violent incidents
336     and fatalities involving substance abuse, is repealed December 31, 2027.
337          [(41)] (43) Title 26B, Chapter 8, Part 5, Utah Health Data Authority, is repealed July 1,
338     2024.
339          [(42)] (44) Section 26B-8-513, related to identifying overuse of non-evidence-based
340     health care, is repealed December 31, 2023.
341          Section 6. Effective date.
342          (1) Except as provided in Subsection (2), this bill takes effect on May 1, 2024.
343          (2) The actions affecting Section 63I-1-226 (Effective 07/01/24) take effect on July 1,
344     2024.