diff --git a/assets/data-leg/ACLU_2023.csv b/assets/data-leg/ACLU_2023.csv
new file mode 100644
index 00000000..a48f9867
--- /dev/null
+++ b/assets/data-leg/ACLU_2023.csv
@@ -0,0 +1,513 @@
+State,Bill Name,Issues,Status,Status Detail,Status Date,In Court Link
+"Pennsylvania","HB 216","Restricting student & educator rights | School sports bans","Advancing","Referred to committee","03/08/2023",""
+"Pennsylvania","HB 138","Healthcare restrictions | Other healthcare barriers","Advancing","Referred to committee","03/08/2023",""
+"Pennsylvania","HB 319","Curriculum censorship | Restricting student & educator rights","Advancing","Referred to committee","03/13/2023",""
+"Ohio","HB 8","Forced outing in schools | Restricting student & educator rights","","","",""
+"Tennessee","SB 596","Religious exemptions | Weakening Civil Rights Laws","Advancing","Committee action deferred to","01/23/2024",""
+"New Hampshire","HB 619","Curriculum censorship | Healthcare age restrictions | Healthcare restrictions | Restricting student & educator rights | School facilities bans | School sports bans","Passed into Law","Signed by Governor","07/19/2024",""
+"Oklahoma","HB 1466","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Failed to meet House deadline","02/29/2024",""
+"Oklahoma","SB 887","Religious exemptions | Weakening Civil Rights Laws","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 788","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 937","Curriculum censorship | Drag bans | Free speech & expression bans | Other school restrictions | Restricting student & educator rights | School sports bans","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","HB 1377","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Failed to meet House deadline","02/29/2024",""
+"Oklahoma","SB 252","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 787","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 935","Other school restrictions | Restricting student & educator rights","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 345","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 786","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 614","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","HB 2736","Drag bans | Free speech & expression bans | ","Defeated","Failed to meet House deadline","02/29/2024",""
+"Oklahoma","HB 1780","Curriculum censorship | Restricting student & educator rights","Defeated","Failed to meet House deadline","02/29/2024",""
+"Oklahoma","HB 2186","Drag bans | Free speech & expression bans | ","Defeated","Failed to meet House deadline","02/29/2024",""
+"Oklahoma","SB 129","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Failed to meet House deadline","02/29/2024",""
+"Oklahoma","HB 2177","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Failed to meet House deadline","02/29/2024",""
+"Oklahoma","SB 408","Other anti-LGBTQ bills","Defeated","Failed to meet House deadline","02/29/2024",""
+"Oklahoma","SB 932","Other school restrictions | Restricting student & educator rights","Defeated","Failed to meet House deadline","02/29/2024",""
+"Oklahoma","SB 973","Curriculum censorship | Restricting student & educator rights","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","HB 1781","Curriculum censorship | Restricting student & educator rights","Defeated","Failed to meet House deadline","02/29/2024",""
+"Oklahoma","HB 1011","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Failed to meet House deadline","02/29/2024",""
+"Oklahoma","SB 789","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 943","Other school restrictions | Restricting student & educator rights","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 933","Drag bans | Free speech & expression bans | ","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 1004","Other anti-LGBTQ bills","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 1017","Other school restrictions | Restricting student & educator rights","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 30","Curriculum censorship | Forced outing in schools | Other school restrictions | Restricting student & educator rights","Advancing","Second read and referred to committee","02/07/2023",""
+"Oklahoma","SB 250","Healthcare funding restrictions | Healthcare restrictions | ","Advancing","Second read and referred to committee","02/07/2023",""
+"Oklahoma","SB 878","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 1007","Restricting student & educator rights | School sports bans","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 131","Curriculum censorship | Restricting student & educator rights","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Wisconsin","AB 377","Restricting student & educator rights | School sports bans","Defeated","Vetoed by Governor; Assembly failed to override veto","05/15/2024",""
+"Michigan","HB 4510","Restricting student & educator rights | School facilities bans","Advancing","First read and referred to committee","05/04/2023",""
+"South Carolina","SB 627","Healthcare age restrictions | Healthcare funding restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","05/09/2024",""
+"Kansas","HB 2427","Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","04/30/2024",""
+"New Hampshire","HB 396","Barriers to accurate IDs | ","","","",""
+"Oklahoma","HB 1449","Other anti-LGBTQ bills","Passed into Law","Governor signed","05/31/2024",""
+"Massachusetts","H 509","Curriculum censorship | Restricting student & educator rights","Advancing","Joint hearing scheduled","10/11/2023",""
+"South Carolina","HB 3728","Curriculum censorship | Other school restrictions | Restricting student & educator rights","","","",""
+"Ohio","HB 245","Drag bans | Free speech & expression bans | ","","","",""
+"Massachusetts","H 458","Curriculum censorship | Restricting student & educator rights","Advancing","Joint hearing","07/17/2023",""
+"Wisconsin","AB 465","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Vetoed by Governor; Assembly failed to override veto","05/15/2024",""
+"Wisconsin","AB 510","Curriculum censorship | Other school restrictions | Restricting student & educator rights","Defeated","Vetoed by Governor; Assembly failed to override veto","05/15/2024",""
+"Alaska","H.B. 183","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","05/15/2024",""
+"Alaska","HB 174","Other anti-LGBTQ bills","Defeated","Legislative session ended","05/15/2024",""
+"Alaska","H.B. 105","Curriculum censorship | Other school restrictions | Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","05/15/2024",""
+"Kansas","HB 2436","Other anti-LGBTQ bills","","","",""
+"Kansas","SB 233","Healthcare age restrictions | Healthcare restrictions | ","Defeated","House Motion to override veto failed; Veto sustained","04/29/2024",""
+"Wisconsin","SB 377","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","05/12/2024",""
+"Wisconsin","SB 489","Curriculum censorship | Other school restrictions | Restricting student & educator rights","Defeated","Companion bill vetoed by Governor; Assembly failed to override veto","05/15/2024",""
+"Wisconsin","SB 378","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","03/12/2024",""
+"Maine","LD 678","Other school restrictions | Restricting student & educator rights","","","",""
+"Maine","LD 930","Restricting student & educator rights | School sports bans","","","",""
+"Wisconsin","SB 479","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","03/12/2024",""
+"Wisconsin","SB 438","Other anti-LGBTQ bills","Defeated","Legislative session ended","03/12/2024",""
+"Wisconsin","SB 480","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Companion bill vetoed by Governor; Assembly failed to override veto","05/15/2024",""
+"Wisconsin","AB 447","Other anti-LGBTQ bills","Defeated","Legislative session ended","03/12/2024",""
+"Wisconsin","AB 609","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","03/12/2024",""
+"Wisconsin","AB 502","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","03/12/2024",""
+"Wisconsin","AB 378","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","03/12/2024",""
+"Ohio","HB 183","Restricting student & educator rights | School facilities bans","","","",""
+"Nebraska","LB 575","Restricting student & educator rights | School facilities bans | School sports bans","","","",""
+"Tennessee","HB 1386","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","HB 878","Religious exemptions | Weakening Civil Rights Laws","Passed into Law","Signed by Governor","02/21/2024",""
+"Tennessee","SB 1110","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/25/2024",""
+"Georgia","SB 180","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","03/28/2024",""
+"Georgia","SB 88","Curriculum censorship | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","03/28/2024",""
+"Iowa","HF 290","Barriers to accurate IDs | Re-definition of sex | Weakening Civil Rights Laws","","","",""
+"Tennessee","SB 620","Curriculum censorship | Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","HB 30","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","04/25/2024",""
+"Ohio","HB 68","Healthcare age restrictions | Healthcare restrictions | ","","","",""
+"West Virginia","SB 517","Weakening Civil Rights Laws","Defeated","Legislative session ended","03/09/2024",""
+"Washington","HB 1233","Other anti-LGBTQ bills","","","",""
+"Washington","SB 5653","Curriculum censorship | Forced outing in schools | Restricting student & educator rights","","","",""
+"Puerto Rico","PS 1345","Religious exemptions | Weakening Civil Rights Laws","Advancing","First reading and referred to committee","10/03/2023",""
+"Puerto Rico","PC 1887","Religious exemptions | Weakening Civil Rights Laws","Advancing","First reading and referred to committee","10/17/2023",""
+"West Virginia","SB 103","Free speech & expression bans | ","Defeated","Legislative session ended","03/09/2024",""
+"West Virginia","SB 253","Free speech & expression bans | ","Defeated","Legislative session ended","03/09/2024",""
+"West Virginia","HB 3001","Restricting student & educator rights","Defeated","Legislative session ended","03/09/2024",""
+"West Virginia","HB 3097","Healthcare restrictions | ","Defeated","Legislative session ended","03/09/2024",""
+"West Virginia","HB 3183","Healthcare restrictions | Other anti-LGBTQ bills | Restricting student & educator rights","Defeated","Legislative session ended","03/09/2024",""
+"West Virginia","HB 3176","Free speech & expression bans | Restricting student & educator rights","Defeated","Legislative session ended","03/09/2024",""
+"West Virginia","HB 3503","Other anti-LGBTQ bills","Defeated","Legislative session ended","03/09/2024",""
+"West Virginia","SB 697","Healthcare restrictions | ","Defeated","Legislative session ended","03/09/2024",""
+"West Virginia","SB 692","Healthcare restrictions | Restricting student & educator rights","Defeated","Legislative session ended","03/09/2024",""
+"Vermont","H 183","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","05/10/2024",""
+"Vermont","H 513","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","05/10/2024",""
+"Tennessee","HB 1411","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","SB 5","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","HB 571","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","HB 1447","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","HB 1414","Curriculum censorship | Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","HB 1378","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","SB 1469","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","SB 841","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","SB 603","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","SB 1117","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","04/25/2024",""
+"South Carolina","HB 3485","Forced outing in schools | Other school restrictions | Restricting student & educator rights","Advancing","Referred to committee","01/10/2023",""
+"South Carolina","SB 364","Barriers to accurate IDs | ","Advancing","Referred to committee","01/10/2023",""
+"South Carolina","HB 3551","Forced outing in schools | Healthcare age restrictions | Healthcare restrictions | Restricting student & educator rights","Advancing","Referred to committee","01/10/2023",""
+"South Carolina","SB 274","Forced outing in schools | Healthcare age restrictions | Healthcare funding restrictions | Healthcare restrictions | Other school restrictions | Restricting student & educator rights","","","",""
+"South Carolina","SB 243","Healthcare age restrictions | Healthcare restrictions | ","Advancing","Referred to committee","01/10/2023",""
+"South Carolina","HB 3466","Other school restrictions | Restricting student & educator rights","","","",""
+"South Carolina","HB 3304","Other school restrictions | Restricting student & educator rights","Advancing","Referred to committee","01/10/2023",""
+"South Carolina","HB 3616","Drag bans | Free speech & expression bans | ","Advancing","Referred to committee","01/11/2023",""
+"South Carolina","HB 3611","Religious exemptions | Weakening Civil Rights Laws","Advancing","Referred to committee","01/11/2023",""
+"South Carolina","SB 424","Curriculum censorship | Other anti-LGBTQ bills | Other school restrictions | Restricting student & educator rights","Advancing","Referred to committee","01/19/2023",""
+"South Carolina","HB 3197","Forced outing in schools | Other school restrictions | Restricting student & educator rights","Advancing","Referred to committee","01/10/2023",""
+"South Carolina","SB 234","Forced outing in schools | Restricting student & educator rights","","","",""
+"South Carolina","HB 3801","Religious exemptions | Weakening Civil Rights Laws","Advancing","Referred to committee","01/25/2023",""
+"South Carolina","HB 3827","Curriculum censorship | Forced outing in schools | Other school restrictions | Restricting student & educator rights","Advancing","Referred to committee ","01/26/2023",""
+"South Carolina","SB 585","Drag bans | Free speech & expression bans | ","Advancing","First read and referred to committee","03/02/2023",""
+"South Carolina","SB 623","Barriers to accurate IDs | ","Advancing","First read and referred to committee","03/14/2023",""
+"Ohio","HB 6","Restricting student & educator rights | School sports bans","Advancing","Reported by committee","05/10/2023",""
+"Ohio","HB 151","Other anti-LGBTQ bills","","","",""
+"Ohio","SB 83","Other anti-LGBTQ bills","","","",""
+"New Hampshire","HB 417","Healthcare restrictions | ","Defeated","Legislative session ended","06/13/2024",""
+"New Hampshire","SB 272","Restricting student & educator rights","Defeated","Legislative session ended","06/13/2024",""
+"Nebraska","LB 371","Drag bans | Free speech & expression bans | ","","","",""
+"Nebraska","LB 810","Religious exemptions | Weakening Civil Rights Laws","","","",""
+"Michigan","HB 4539","Healthcare age restrictions | Healthcare restrictions | ","Advancing","First read and referred to committee","05/09/2023",""
+"Michigan","HB 4075","Religious exemptions | Weakening Civil Rights Laws","Advancing","Notice given to discharge committee","03/15/2023",""
+"Michigan","HB 4195","Restricting student & educator rights | School facilities bans","Advancing","First read and referred to committee","03/07/2023",""
+"Michigan","HB 4257","Healthcare age restrictions | Healthcare restrictions | ","Advancing","First read and referred to committee","03/09/2023",""
+"Michigan","HB 4345","Religious exemptions | Weakening Civil Rights Laws","Advancing","First read and referred to committee","04/11/2023",""
+"Michigan","HB 4540","Healthcare age restrictions | Healthcare restrictions | ","Advancing","First read and referred to committee","05/09/2023",""
+"Michigan","HB 4546","Restricting student & educator rights | School sports bans","Advancing","First read and referred to committee","05/11/2023",""
+"Kansas","SB 255","Restricting student & educator rights | School facilities bans","Advancing","Committee hearing","03/22/2023",""
+"Kansas","HB 2263","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","04/30/2024",""
+"Kansas","SB 149","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","04/30/2024",""
+"Kansas","SB 201","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","04/30/2024",""
+"Kansas","SB 207","Other school restrictions | Religious exemptions | Restricting student & educator rights | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/30/2024",""
+"Kansas","HB 2404","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/30/2024",""
+"Kansas","SB 12","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","04/30/2024",""
+"Kansas","SB 224","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/30/2024",""
+"Iowa","SF 110","Healthcare funding restrictions | Healthcare restrictions | Other healthcare barriers","","","",""
+"Iowa","SF 83","Curriculum censorship | Restricting student & educator rights","","","",""
+"Iowa","SF 129","Forced outing in schools | Healthcare age restrictions | Healthcare restrictions | Other anti-LGBTQ bills | Restricting student & educator rights","","","",""
+"Iowa","SF 159","Forced outing in schools | Restricting student & educator rights","","","",""
+"Iowa","HF 229","Religious exemptions | Weakening Civil Rights Laws","","","",""
+"Iowa","HF 325","Other civil rights restrictions | Public accommodation bans | Weakening Civil Rights Laws","","","",""
+"Iowa","SF 348","Drag bans | Free speech & expression bans | ","","","",""
+"Iowa","SF 212","Religious exemptions | Weakening Civil Rights Laws","","","",""
+"Iowa","HF 508","Other anti-LGBTQ bills | Religious exemptions | Weakening Civil Rights Laws","","","",""
+"Iowa","HF 482","Restricting student & educator rights | School facilities bans","","","",""
+"Iowa","HF 9","Forced outing in schools | Restricting student & educator rights","","","",""
+"Iowa","HF 190","Other civil rights restrictions | Weakening Civil Rights Laws","","","",""
+"Iowa","HSB 222","Curriculum censorship | Forced outing in schools | Other school restrictions | Restricting student & educator rights","","","",""
+"Iowa","HF 8","Curriculum censorship | Restricting student & educator rights","","","",""
+"Iowa","HF 348","Curriculum censorship | Restricting student & educator rights","","","",""
+"Iowa","HF 616","Other anti-LGBTQ bills","","","",""
+"Iowa","HF 180","Forced outing in schools | Other school restrictions | Restricting student & educator rights","","","",""
+"Iowa","SF 297","Religious exemptions | Weakening Civil Rights Laws","","","",""
+"Georgia","SB 141","Forced outing in schools | Healthcare age restrictions | Healthcare restrictions | Restricting student & educator rights","Defeated","Legislative session ended","03/28/2024",""
+"Georgia","HB 653","Forced outing in schools | Healthcare age restrictions | Healthcare restrictions | Restricting student & educator rights","Defeated","Legislative session ended","03/28/2024",""
+"Alaska","HB 27","Restricting student & educator rights | School sports bans","","","",""
+"Alaska","SB 96","Curriculum censorship | Other school restrictions | Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","05/15/2024",""
+"Wisconsin","SB 704","Healthcare restrictions | ","Defeated","Legislative session ended","03/12/2024",""
+"Wisconsin","AB 729","Healthcare restrictions | ","Defeated","Legislative session ended","03/12/2024",""
+"Hawaii","HB 508","Restricting student & educator rights | School sports bans","","","",""
+"Hawaii","HB 509","Curriculum censorship | Restricting student & educator rights","","","",""
+"Hawaii","SB 1429","Restricting student & educator rights | School sports bans","","","",""
+"Hawaii","SB 1428","Curriculum censorship | Forced outing in schools | Restricting student & educator rights","","","","https://clearinghouse.net/case/4419"
+"Hawaii","HB 891","Healthcare age restrictions | Healthcare restrictions | ","","","",""
+"Minnesota","SF 934","Restricting student & educator rights | School facilities bans | School sports bans","Defeated","Legislative session ended","05/20/2024",""
+"Minnesota","HF 3022","Curriculum censorship | Forced outing in schools | Restricting student & educator rights","Defeated","Legislative session ended","05/20/2024",""
+"Minnesota","SF 3272","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","05/20/2024",""
+"Minnesota","HF 551","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","05/20/2024",""
+"Minnesota","SF 724","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","05/20/2024",""
+"Minnesota","HF 1086","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","05/20/2024",""
+"Minnesota","SF 933","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","05/20/2024",""
+"Minnesota","HF 1903","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","05/20/2024",""
+"Minnesota","HF 3264","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","05/20/2024",""
+"Minnesota","SF 3280","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","05/20/2024",""
+"North Carolina","H 43","Healthcare age restrictions | Healthcare restrictions | ","Advancing","Referred to committee","02/06/2023",""
+"North Carolina","S 560","Healthcare age restrictions | Healthcare restrictions | ","Advancing","Referred to committee","04/05/2023",""
+"North Carolina","S 641","Religious exemptions | Weakening Civil Rights Laws","Advancing","First read and referred to committee","04/06/2023",""
+"North Carolina","H 786","Forced outing in schools | Healthcare age restrictions | Healthcare funding restrictions | Healthcare restrictions | Restricting student & educator rights","Advancing","First read and referred to committee","04/19/2023",""
+"North Carolina","H 819","Religious exemptions | Weakening Civil Rights Laws","Advancing","Reported favorably and referred to committee","04/27/2023",""
+"North Carolina","S 636","Restricting student & educator rights | School sports bans","Advancing","Senate passed as amended; House re-referred to committee","09/11/2023",""
+"Texas","SB 77","Restricting student & educator rights","Introduced","","10/27/2023",""
+"Texas","SB 12","Free speech & expression bans | ","Passed into Law","Governor signed","06/18/2023","https://www.aclutx.org/en/cases/woodlands-pride-inc-et-al-v-angela-colmenero-et-al"
+"Michigan","HJR E","Other anti-LGBTQ bills","Advancing","First read and referred to committee","06/14/2023",""
+"Alabama","SB 261","Other anti-LGBTQ bills","Passed into Law","Governor signed","06/06/2023",""
+"Rhode Island","S 959","Weakening Civil Rights Laws","Defeated","Dead","06/16/2023",""
+"Rhode Island","S 960","Barriers to accurate IDs | ","Defeated","Dead","06/16/2023",""
+"Texas","SB 1601","Free speech & expression bans | ","Defeated","Dead","05/29/2023",""
+"Alabama","SB 211","Restricting student & educator rights","Defeated","Legislative session ended","06/06/2023",""
+"Alabama","HB 354","Restricting student & educator rights","Defeated","Legislative session ended","06/06/2023",""
+"Rhode Island","SB 958","Healthcare restrictions | ","Defeated","Dead","06/16/2023",""
+"Louisiana","HB 648","Healthcare restrictions | ","Passed into Law","House and Senate override of Governor veto","07/18/2023",""
+"Alabama","HB 405","Other anti-LGBTQ bills","Defeated","Legislative session ended","06/06/2023",""
+"Alabama","HB 401","Free speech & expression bans | Restricting student & educator rights","Defeated","Legislative session ended","06/06/2023",""
+"North Carolina","H 808","Healthcare restrictions | Restricting student & educator rights","Passed into Law","House and Senate override of Governor veto","08/16/2023","https://lambdalegal.org/case/voe-v-mansfield/"
+"South Carolina","S 624","Other anti-LGBTQ bills","Advancing","First read and referred to committee","03/14/2023",""
+"Texas","HB 3082","Weakening Civil Rights Laws","Defeated","Dead","05/29/2023",""
+"Mississippi","HB 1733","Healthcare restrictions | ","Passed into Law","Governor signed","03/27/2023",""
+"Louisiana","HB 463","Healthcare restrictions | ","Defeated","Refer to substituted bill HB 648","07/18/2023",""
+"North Carolina","S 631","Restricting student & educator rights","Passed into Law","Companion bill H. 574 passed","08/16/2023",""
+"North Carolina","H 574","Restricting student & educator rights","Passed into Law","House and Senate override of Governor veto","08/16/2023",""
+"Alabama","HB 261","Restricting student & educator rights","Passed into Law","Governor signed","05/30/2023",""
+"North Carolina","S 639","Healthcare restrictions | Restricting student & educator rights","Passed into Law","Companion bill H. 808 passed","08/16/2023","https://lambdalegal.org/case/voe-v-mansfield/"
+"Idaho","HB 308","Weakening Civil Rights Laws","Advancing","Dead","04/06/2023",""
+"Louisiana","HB 466","Restricting student & educator rights","Defeated","Governor vetoed; House veto override failed","07/18/2023",""
+"Missouri","HB 15","Other anti-LGBTQ bills","Defeated","Vetoed in part by Governor","05/15/2023",""
+"Missouri","HB 13","Other anti-LGBTQ bills","Defeated","Dead","05/12/2023",""
+"Missouri","HB 12","Other anti-LGBTQ bills","Defeated","Vetoed in part by Governor","06/30/2023",""
+"Missouri","HB 11","Other anti-LGBTQ bills","Defeated","Failed to pass over partial veto","09/13/2023",""
+"Missouri","HB 10","Other anti-LGBTQ bills","Defeated","Dead","05/12/2023",""
+"Missouri","HB 9","Other anti-LGBTQ bills","Defeated","Dead","05/12/2023",""
+"Missouri","HB 8","Other anti-LGBTQ bills","Defeated","Dead","05/12/2023",""
+"Missouri","HB 7","Other anti-LGBTQ bills","Defeated","Dead","05/12/2023",""
+"Missouri","HB 6","Other anti-LGBTQ bills","Defeated","Dead","05/12/2023",""
+"Missouri","HB 5","Other anti-LGBTQ bills","Defeated","Dead","05/12/2023",""
+"Missouri","HB 4","Other anti-LGBTQ bills","Defeated","Dead","05/12/2023",""
+"Missouri","HB 3","Other anti-LGBTQ bills","Defeated","Dead","05/12/2023",""
+"Missouri","HB 2","Other anti-LGBTQ bills","Defeated","Dead","05/12/2023",""
+"Arkansas","HB 1738","Restricting student & educator rights","Defeated","Dead","05/01/2023",""
+"Missouri","HB 1333","Other anti-LGBTQ bills","Defeated","Dead","05/12/2023",""
+"Texas","HB 2659","Restricting student & educator rights | Weakening Civil Rights Laws","Defeated","Dead","05/29/2023",""
+"Texas","SB 1443","Restricting student & educator rights","Defeated","Dead","05/29/2023",""
+"Nevada","AB 374","Restricting student & educator rights","Defeated","No further action allowed","04/15/2023",""
+"Montana","SB 518","Restricting student & educator rights","Passed into Law","Governor signed","05/19/2023",""
+"Louisiana","HB 81","Restricting student & educator rights","Defeated","Governor vetoed 6/28/23; House veto override failed","07/18/2023",""
+"Texas","HB 5235","Other anti-LGBTQ bills | Restricting student & educator rights","Defeated","Dead","05/29/2023",""
+"Montana","HB 837","Restricting student & educator rights","Defeated","Missed transmittal deadline","04/06/2023",""
+"California","AB 1314","Restricting student & educator rights","Defeated","Held in Education Committee","04/10/2023",""
+"Texas","HB 5127","Other anti-LGBTQ bills","Defeated","Dead","05/29/2023",""
+"Texas","HB 5261","Restricting student & educator rights","Defeated","Dead","05/29/2023",""
+"Utah","SB 97","Other anti-LGBTQ bills","Passed into Law","Governor signed","03/14/2023",""
+"Arkansas","HB 1615","Weakening Civil Rights Laws","Passed into Law","Became act","04/12/2023",""
+"Texas","HB 2722","Restricting student & educator rights","Defeated","Dead","05/29/2023",""
+"Texas","HB 5256","Restricting student & educator rights","Defeated","Dead","05/29/2023",""
+"Texas","SB 2281","Free speech & expression bans | ","Defeated","Dead","05/29/2023",""
+"Idaho","HB 265","Free speech & expression bans | ","Defeated","Dead","04/06/2023",""
+"Texas","SB 17","Other anti-LGBTQ bills","Passed into Law","Governor signed","06/17/2023",""
+"Nevada","SB 288","Other anti-LGBTQ bills","Defeated","No further action allowed","04/15/2023",""
+"Texas","SB 2199","Weakening Civil Rights Laws","Defeated","Dead","05/29/2023",""
+"Texas","HB 4961","Restricting student & educator rights","Defeated","Dead","05/29/2023",""
+"Texas","HB 5236","Other anti-LGBTQ bills | Restricting student & educator rights","Defeated","Dead","05/29/2023",""
+"Texas","SB 8","Restricting student & educator rights","Defeated","Dead","05/29/2023",""
+"Texas","HB 4754","Healthcare restrictions | ","Defeated","Dead","05/29/2023",""
+"Texas","HB 4378","Free speech & expression bans | ","Defeated","Dead","05/29/2023",""
+"Texas","HB 4534","Restricting student & educator rights","Defeated","Dead","05/29/2023",""
+"Texas","SB 15","Restricting student & educator rights","Passed into Law","Governor signed","06/18/2023",""
+"Texas","HB 4624","Healthcare restrictions | ","Defeated","Dead","05/29/2023",""
+"Texas","HB 4129","Free speech & expression bans | ","Defeated","Dead","05/29/2023",""
+"Texas","SB 14","Healthcare restrictions | ","Passed into Law","Governor signed","06/02/2023","https://www.aclutx.org/en/cases/loe-v-texas"
+"Texas","HB 3902","Other anti-LGBTQ bills","Defeated","Dead","05/29/2023",""
+"Texas","HB 3883","Other anti-LGBTQ bills","Defeated","Dead","05/29/2023",""
+"Indiana","SB 487","Other anti-LGBTQ bills","Defeated","Dead","04/28/2023",""
+"Iowa","SF 538","Healthcare restrictions | ","Passed into Law","Governor signed","03/22/2023",""
+"Utah","SB 39","Barriers to accurate IDs | ","Passed into Law","Governor signed","03/15/2023",""
+"Florida","HB 1521","Other anti-LGBTQ bills | Public accommodation bans","Passed into Law","Governor signed","05/17/2023",""
+"Florida","SB 1674","Other anti-LGBTQ bills | Public accommodation bans | Restricting student & educator rights","Defeated","Dead","05/05/2023",""
+"Florida","HB 1421","Barriers to accurate IDs | Healthcare restrictions | Weakening Civil Rights Laws","Defeated","Dead","05/05/2023",""
+"Florida","SB 254","Healthcare restrictions | Other anti-LGBTQ bills","Passed into Law","Governor signed","05/17/2023","https://www.glad.org/cases/doe-v-ladapo/"
+"Texas","HB 3213","Other anti-LGBTQ bills","Defeated","Dead","05/29/2023",""
+"Iowa","HF 623","Healthcare restrictions | ","Defeated","SF 538 substituted and bill withdrawn","03/08/2023",""
+"Iowa","SF 482","Restricting student & educator rights","Passed into Law","Governor signed","03/22/2023",""
+"Iowa","SF 496","Restricting student & educator rights","Passed into Law","Governor signed","05/26/2023","https://lambdalegal.org/case/iowa-safe-schools-v-reynolds/"
+"Iowa","HF 622","Restricting student & educator rights","Defeated","Withdrawn","03/16/2023",""
+"Texas","HB 3147","Other anti-LGBTQ bills","Defeated","Dead","05/29/2023",""
+"Texas","HB 2862","Other anti-LGBTQ bills","Defeated","Dead","05/29/2023",""
+"Texas","HB 3164","Other anti-LGBTQ bills","Defeated","Dead","05/29/2023",""
+"Kansas","SB 228","Other anti-LGBTQ bills","Passed into Law","Senate and House override of Governor veto","04/27/2023",""
+"Missouri","HB 1258","Restricting student & educator rights | Weakening Civil Rights Laws","Defeated","Dead","05/12/2023",""
+"Iowa","HSB 208","Restricting student & educator rights","Defeated","Refer to renumbered bill HF 622","03/16/2023",""
+"Florida","SB 266","Free speech & expression bans | Restricting student & educator rights","Passed into Law","Governor signed","05/15/2023",""
+"Florida","HB 999","Free speech & expression bans | Restricting student & educator rights","Defeated","Dead","05/05/2023",""
+"Florida","SB 1320","Restricting student & educator rights","Defeated","Dead","05/05/2023",""
+"Florida","HB 1223","Restricting student & educator rights","Advancing","Died in committee","05/05/2023",""
+"Missouri","HB 1332","Healthcare restrictions | ","Defeated","Dead","05/12/2023",""
+"Iowa","HSB 214","Healthcare restrictions | ","Defeated","Bill renumbered HF 623","03/02/2023",""
+"Iowa","SSB 1197","Healthcare restrictions | ","Defeated","Bill renumbered SF 538","03/02/2023",""
+"Missouri","SB 693","Free speech & expression bans | ","Defeated","Dead","05/12/2023",""
+"Utah","HB 209","Restricting student & educator rights","Passed into Law","Governor signed","03/17/2023",""
+"Florida","HB 1069","Restricting student & educator rights","Passed into Law","Governor signed","05/17/2023",""
+"Montana","SB 458","Other anti-LGBTQ bills","Passed into Law","Governor signed","05/19/2023",""
+"Florida","HB 991","Other anti-LGBTQ bills","Advancing","Died in committee","05/05/2023",""
+"Texas","SB 1082","Barriers to accurate IDs | Other anti-LGBTQ bills","Defeated","Dead","05/29/2023",""
+"Kentucky","HB 585","Barriers to accurate IDs | ","Defeated","Dead","03/30/2023",""
+"Utah","HB 463","Restricting student & educator rights","Defeated","Passed House; passed Senate; referred to House file","03/03/2023",""
+"Idaho","SB 1071","Restricting student & educator rights","Defeated","Dead","04/06/2023",""
+"Arkansas","SB 294","Restricting student & educator rights","Passed into Law","Became act without Governor's signature","03/14/2023",""
+"Kentucky","HB 470","Barriers to accurate IDs | Healthcare restrictions | Restricting student & educator rights","Defeated","Dead","03/30/2023",""
+"Rhode Island","HB 5688","Restricting student & educator rights","Defeated","Dead","06/16/2023",""
+"Texas","SB 1029","Healthcare restrictions | ","Defeated","Dead","05/29/2023",""
+"Rhode Island","SB 391","Restricting student & educator rights","Defeated","Dead","06/16/2023",""
+"New Mexico","HB 492","Restricting student & educator rights","Defeated","Dead","03/18/2023",""
+"Montana","SB 413","Restricting student & educator rights","Defeated","Missed deadline for general bill transmittal","03/13/2023",""
+"Arkansas","HB 1468","Restricting student & educator rights","Passed into Law","Became law","04/11/2023",""
+"Iowa","SF 335","Restricting student & educator rights","Defeated","Renumbered as SF 482","03/02/2023",""
+"Iowa","SSB 1145","Restricting student & educator rights","Defeated","Refer to numbered bill  SF 496","05/26/2023",""
+"Missouri","HB 1157","Weakening Civil Rights Laws","Defeated","Dead","05/12/2023",""
+"Kentucky","SB 145","Restricting student & educator rights","Passed into Law","Governor signed","03/24/2023",""
+"Montana","SB 337","Restricting student & educator rights","Defeated","Missed deadline for general bill transmittal","03/13/2023",""
+"Utah","HB 464","Restricting student & educator rights","Defeated","House filed","03/03/2023",""
+"Arkansas","SB 270","Other anti-LGBTQ bills | Public accommodation bans","Passed into Law","Became act","04/11/2023",""
+"Idaho","HB 63","Weakening Civil Rights Laws","Defeated","Dead","04/06/2023",""
+"Montana","HB 303","Weakening Civil Rights Laws","Passed into Law","Governor signed","05/03/2023",""
+"Kentucky","SB 115","Free speech & expression bans | ","Defeated","Dead","03/30/2023",""
+"Missouri","HB 75","Restricting student & educator rights","Defeated","Dead","05/12/2023",""
+"Idaho","SB 1100","Restricting student & educator rights","Passed into Law","Governor signed","03/23/2023","https://lambdalegal.org/case/roe-v-critchfield/"
+"Missouri","SB 390","Restricting student & educator rights","Defeated","Dead","05/12/2023",""
+"Oregon","SB 897","Healthcare restrictions | ","Defeated","Dead","06/25/2023",""
+"Georgia","SB 140","Healthcare restrictions | ","Passed into Law","Governor signed","03/23/2023","https://www.acluga.org/en/cases/emma-koe-et-al-v-caylee-noggle-et-al"
+"North Dakota","HB 1526","Restricting student & educator rights","Defeated","Second reading, failed to pass","02/15/2023",""
+"North Dakota","HB 1111","Other anti-LGBTQ bills","Passed into Law","Governor signed","04/06/2023",""
+"North Dakota","HB 1474","Other anti-LGBTQ bills","Passed into Law","Governor signed","05/08/2023",""
+"North Dakota","HB 1297","Barriers to accurate IDs | ","Passed into Law","Governor signed","05/08/2023",""
+"North Dakota","SB 2188","Restricting student & educator rights","Defeated","Second read, failed to pass","02/08/2023",""
+"North Dakota","HB 1488","Restricting student & educator rights","Defeated","Dead","04/29/2023",""
+"North Dakota","HB 1489","Restricting student & educator rights","Passed into Law","Governor signed","04/11/2023",""
+"North Dakota","HB 1522","Restricting student & educator rights","Passed into Law","Governor signed","05/08/2023",""
+"North Dakota","HB 1301","Healthcare restrictions | ","Defeated","Failed to pass House","02/17/2023",""
+"Kentucky","SB 150","Healthcare restrictions | Restricting student & educator rights","Passed into Law","Governor veto overridden","03/29/2023","https://www.aclu-ky.org/en/cases/doe-v-thornbury-challenge-trans-health-care-ban"
+"Kentucky","SB 102","Restricting student & educator rights","Defeated","Dead","03/30/2023",""
+"Arizona","HB 2711","Restricting student & educator rights","Defeated","Dead","07/31/2023",""
+"Kentucky","HB 177","Restricting student & educator rights","Defeated","Dead","03/30/2023",""
+"Kentucky","HB 173","Restricting student & educator rights","Defeated","Withdrawn","03/13/2023",""
+"Kansas","SB 180","Other anti-LGBTQ bills","Passed into Law","Senate and House override of Governor veto","04/27/2023",""
+"Missouri","SB 598","Healthcare restrictions | ","Defeated","Dead","05/12/2023",""
+"Texas","HB 1952","Barriers to accurate IDs | ","Defeated","Dead","05/29/2023",""
+"Arkansas","SB 199","Healthcare restrictions | ","Passed into Law","Became act without Governor’s signature","03/16/2023",""
+"Idaho","HB 71","Healthcare restrictions | ","Passed into Law","Governor signed","04/04/2023","https://www.aclu.org/cases/poe-v-labrador"
+"Wyoming","SF 144","Healthcare restrictions | ","Defeated","Passed Senate; House Committee of the Whole did not consider","02/27/2023",""
+"Wyoming","SF 133","Restricting student & educator rights","Passed into Law","Became act without Governor’s signature","03/17/2023",""
+"Arizona","SB 1694","Other anti-LGBTQ bills","Defeated","Dead","07/31/2023",""
+"Arizona","SB 1417","Other anti-LGBTQ bills","Defeated","Dead","07/31/2023",""
+"Wyoming","HB 262","Weakening Civil Rights Laws","Defeated","Died in committee","02/07/2023",""
+"West Virginia","HB 3042","Weakening Civil Rights Laws","Passed into Law","Governor signed","03/09/2023",""
+"Tennessee","SB 1440","Other anti-LGBTQ bills","Passed into Law","Governor signed","05/17/2023","https://www.aclu-tn.org/en/press-releases/aclu-tn-files-lawsuit-strike-down-drivers-license-rule-mandating-discrimination"
+"South Dakota","HB 1125","Free speech & expression bans | ","Defeated","Tabled by committee","02/13/2023",""
+"North Dakota","HB 1333","Free speech & expression bans | ","Passed into Law","Governor signed","04/24/2023",""
+"Tennessee","HB 1269","Restricting student & educator rights","Passed into Law","Companion bill SB 466 signed by Governor","05/17/2023",""
+"Tennessee","SB 1237","Restricting student & educator rights","Passed into Law","Governor signed","04/28/2023",""
+"North Carolina","S 49","Restricting student & educator rights","Passed into Law","Senate and House override of Governor veto","08/16/2023",""
+"West Virginia","HB 2007","Healthcare restrictions | ","Passed into Law","Governor signed","03/29/2023",""
+"Texas","HB 1752","Healthcare restrictions | ","Defeated","Dead","05/29/2023",""
+"Mississippi","SB 2861","Healthcare restrictions | ","Defeated","Died in committee","01/31/2023",""
+"Texas","HB 1686","Healthcare restrictions | ","Passed into Law","Companion bill SB 14 signed by Governor","06/02/2023",""
+"Mississippi","SB 2883","Healthcare restrictions | ","Defeated","Died in committee","01/31/2023",""
+"Mississippi","HB 1258","Healthcare restrictions | ","Defeated","Died in committee","01/31/2023",""
+"Mississippi","HB 1126","Healthcare restrictions | ","Defeated","Died in committee","01/31/2023",""
+"Mississippi","SB 2770","Healthcare restrictions | ","Defeated","Died in committee","01/31/2023",""
+"Mississippi","SB 2760","Healthcare restrictions | ","Defeated","Died in committee","01/31/2023",""
+"Mississippi","HB 1124","Healthcare restrictions | ","Defeated","Died in committee","01/31/2023",""
+"Tennessee","HB 1","Healthcare restrictions | ","Passed into Law","Companion bill SB 1 signed by Governor","03/02/2023",""
+"Kansas","HB 2238","Restricting student & educator rights","Passed into Law","Governor veto overridden","04/05/2023",""
+"South Dakota","HB 1116","Free speech & expression bans | Restricting student & educator rights","Defeated","Dead","03/27/2023",""
+"Arizona","SB 1698","Free speech & expression bans | ","Defeated","Governor vetoed","06/16/2023",""
+"Tennessee","SB 466","Restricting student & educator rights","Passed into Law","Governor signed","05/17/2023",""
+"Arkansas","SB 125","Restricting student & educator rights","Passed into Law","Became law","04/11/2023",""
+"Mississippi","HB 1480","Restricting student & educator rights","Defeated","Died in committee","01/31/2023",""
+"Mississippi","HB 1476","Restricting student & educator rights","Defeated","Died in committee","01/31/2023",""
+"Mississippi","HB 1489","Restricting student & educator rights","Defeated","Died in committee","01/31/2023",""
+"Texas","SB 649","Restricting student & educator rights","Defeated","Dead","05/29/2023",""
+"Mississippi","HB 1074","Other anti-LGBTQ bills | Restricting student & educator rights","Defeated","Died in committee","01/31/2023",""
+"Maryland","HB 359","Restricting student & educator rights","Defeated","Unfavorable committee report","02/20/2023",""
+"Mississippi","SB 2764","Restricting student & educator rights","Defeated","Died in committee","01/31/2023",""
+"Arizona","SB 1700","Restricting student & educator rights","Defeated","Dead","07/31/2023",""
+"Texas","SB 625","Healthcare restrictions | ","Passed into Law","Companion bill SB 14 signed by Governor","06/02/2023",""
+"Arizona","SB 1702","Healthcare restrictions | ","Defeated","Dead","07/31/2023",""
+"Missouri","SB 42","Restricting student & educator rights","Defeated","Dead","05/12/2023",""
+"Missouri","SB 2","Restricting student & educator rights","Defeated","Dead","05/12/2023",""
+"Missouri","SB 48","Restricting student & educator rights","Defeated","Dead","05/12/2023",""
+"Missouri","HB 170","Restricting student & educator rights","Defeated","Dead","05/12/2023",""
+"Virginia","SB 791","Healthcare restrictions | ","Defeated","Passed by indefinitely by committee","02/02/2023",""
+"Missouri","SB 29","Restricting student & educator rights","Defeated","Dead","05/12/2023",""
+"Utah","HB 132","Healthcare restrictions | ","Defeated","House filed","03/03/2023",""
+"Missouri","HB 183","Restricting student & educator rights","Defeated","Dead","05/12/2023",""
+"Utah","SB 16","Healthcare restrictions | ","Passed into Law","Governor signed","01/28/2023",""
+"Missouri","HB 337","Restricting student & educator rights","Defeated","Dead","05/12/2023",""
+"Texas","SB 249","Healthcare restrictions | ","Defeated","Dead","05/29/2023",""
+"Missouri","SB 39","Restricting student & educator rights","Passed into Law","Governor signed","06/07/2023",""
+"Texas","HB 122","Healthcare restrictions | ","Defeated","Dead","05/29/2023",""
+"Oklahoma","SB 26","Restricting student & educator rights","Passed into Law","Governor signed","05/25/2023",""
+"Texas","HB 41","Healthcare restrictions | ","Defeated","Dead","05/29/2023",""
+"Missouri","SB 165","Restricting student & educator rights","Defeated","Dead","05/12/2023",""
+"Texas","SB 250","Healthcare restrictions | ","Defeated","Dead","05/29/2023",""
+"Colorado","HB 23-1098","Restricting student & educator rights","Defeated","Postponed indefinitely by committee","02/13/2023",""
+"Kentucky","HB 30","Restricting student & educator rights","Defeated","Dead","03/30/2023",""
+"Texas","HB 42","Healthcare restrictions | ","Defeated","Dead","05/29/2023",""
+"Texas","HB 1155","Restricting student & educator rights","Defeated","Dead","05/29/2023",""
+"Oregon","HB 2477","Restricting student & educator rights","Defeated","Dead","06/25/2023",""
+"Missouri","HB 634","Restricting student & educator rights","Defeated","Dead","05/12/2023",""
+"Virginia","SB 960","Healthcare restrictions | Restricting student & educator rights | Weakening Civil Rights Laws","Defeated","Passed by indefinitely by committee","02/02/2023",""
+"Texas","HB 1541","Restricting student & educator rights","Defeated","Dead","05/29/2023",""
+"Mississippi","SB 2820","Restricting student & educator rights","Defeated","Died in committee","01/31/2023",""
+"Texas","HB 1532","Healthcare restrictions | ","Defeated","Dead","05/29/2023",""
+"Tennessee","SB 1","Healthcare restrictions | ","Passed into Law","Governor signed","03/02/2023","https://www.aclu.org/cases/l-w-v-skrmetti"
+"Oregon","SB 452","Healthcare restrictions | ","Defeated","Dead","06/25/2023",""
+"Missouri","HB 916","Healthcare restrictions | ","Defeated","Dead","05/12/2023",""
+"Mississippi","SB 2058","Restricting student & educator rights","Defeated","Died in committee","01/31/2023",""
+"Mississippi","HB 1144","Restricting student & educator rights","Defeated","Died in committee","01/31/2023",""
+"Mississippi","SB 2773","Restricting student & educator rights","Defeated","Died in committee","01/31/2023",""
+"Tennessee","HB 306","Restricting student & educator rights","Passed into Law","Companion bill SB 1237 signed by Governor","04/28/2023",""
+"Oregon","SB 749","Restricting student & educator rights","Defeated","Dead","06/25/2023",""
+"North Dakota","HB 1249","Restricting student & educator rights","Passed into Law","Governor signed","04/11/2023",""
+"Arizona","SB 1040","Restricting student & educator rights","Defeated","Governor vetoed","06/08/2023",""
+"Wyoming","SF 117","Restricting student & educator rights","Defeated","Passed Senate; House did not consider for introduction","02/24/2023",""
+"Texas","HB 631","Restricting student & educator rights","Defeated","Dead","05/29/2023",""
+"North Dakota","SB 2231","Other anti-LGBTQ bills | Restricting student & educator rights","Defeated","Dead","04/29/2023",""
+"North Dakota","SB 2260","Restricting student & educator rights","Defeated","Dead","04/29/2023",""
+"Mississippi","HB 509","Restricting student & educator rights","Defeated","Died in committee","01/31/2023",""
+"Virginia","SB 1203","Healthcare restrictions | ","Defeated","Incorporated by committee into SB 791","02/02/2023",""
+"Idaho","SB 1016","Public accommodation bans","Passed into Law","Governor signed","03/27/2023",""
+"Indiana","HB 1524","Barriers to accurate IDs | ","Defeated","Dead","04/28/2023",""
+"Indiana","HB 1346","Restricting student & educator rights","Defeated","Dead","04/28/2023",""
+"North Dakota","HB 1254","Healthcare restrictions | ","Passed into Law","Governor signed","04/19/2023","https://www.genderjustice.us/work/td-v-wrigley/"
+"Indiana","HB 1608","Restricting student & educator rights","Passed into Law","Governor signed","05/04/2023","https://www.aclu-in.org/en/press-releases/aclu-indiana-challenges-law-censoring-classroom-discussions"
+"Montana","SB 99","Healthcare restrictions | ","Passed into Law","Governor signed","04/28/2023","https://www.aclu.org/cases/van-garderen-et-al-v-state-of-montana"
+"South Carolina","S 276","Other anti-LGBTQ bills","Advancing","Referred to committee","01/10/2023",""
+"Mississippi","SB 2076","Restricting student & educator rights","Defeated","Died in committee","01/31/2023",""
+"New Jersey","A 328","Weakening Civil Rights Laws","Introduced","Active","01/10/2023",""
+"Texas","SB 162","Barriers to accurate IDs | ","Defeated","Dead","05/29/2023",""
+"North Dakota","HB 1139","Barriers to accurate IDs | ","Passed into Law","Governor signed","04/10/2023",""
+"Texas","HB 708","Free speech & expression bans | ","Defeated","Dead","05/29/2023",""
+"Texas","HB 643","Free speech & expression bans | ","Defeated","Dead","05/29/2023",""
+"Tennessee","HB 9","Free speech & expression bans | ","Passed into Law","Companion bill SB 3 signed by Governor","03/02/2023","https://clearinghouse.net/doc/137435/"
+"Tennessee","SB 3","Free speech & expression bans | ","Passed into Law","Governor signed","03/02/2023",""
+"North Dakota","HB 1205","Free speech & expression bans | ","Passed into Law","Governor signed","04/25/2023",""
+"Missouri","SB 429","Free speech & expression bans | ","Defeated","Dead","05/12/2023",""
+"Missouri","HB 498","Free speech & expression bans | ","Defeated","Dead","05/12/2023",""
+"Missouri","HB 494","Free speech & expression bans | ","Defeated","Dead","05/12/2023",""
+"Montana","HB 359","Free speech & expression bans | ","Passed into Law","Governor signed","05/22/2023","https://www.publishersweekly.com/binary-data/ARTICLE_ATTACHMENT/file/000/006/6283-1.pdf"
+"Indiana","SB 413","Restricting student & educator rights","Defeated","Dead","04/28/2023",""
+"Arizona","SB 1030","Free speech & expression bans | ","Defeated","Governor vetoed","06/16/2023",""
+"Arkansas","SB 43","Free speech & expression bans | ","Passed into Law","Became act","02/27/2023",""
+"Indiana","SB 386","Restricting student & educator rights","Defeated","Dead","04/28/2023",""
+"New Jersey","S 585","Restricting student & educator rights","Advancing","Referred to committee","01/11/2023",""
+"Indiana","HB 1520","Public accommodation bans | Restricting student & educator rights","Defeated","Dead","04/28/2023",""
+"New Jersey","A 1418","Restricting student & educator rights","Advancing","Referred to committee","01/11/2023",""
+"Missouri","SB 134","Restricting student & educator rights","Defeated","Dead","05/12/2023",""
+"Indiana","HB 1589","Healthcare restrictions | ","Defeated","Dead","04/28/2023",""
+"Arizona","SB 1001","Restricting student & educator rights | Weakening Civil Rights Laws","Defeated","Governor vetoed","05/19/2023",""
+"Virginia","HB 1707","Restricting student & educator rights","Defeated","Incorporated by committee into HB 2432","02/03/2023",""
+"Indiana","HB 1569","Healthcare restrictions | ","Passed into Law","Governor signed","04/20/2023",""
+"Indiana","HB 1407","Healthcare restrictions | ","Defeated","Dead","04/28/2023",""
+"Indiana","SB 480","Healthcare restrictions | ","Passed into Law","Governor signed","04/05/2023","https://www.aclu.org/cases/k-c-v-medical-licensing-board-of-indiana"
+"Indiana","HB 1525","Healthcare restrictions | ","Defeated","Dead","04/28/2023",""
+"Virginia","SB 911","Restricting student & educator rights","Defeated","Incorporated into SB 1186","02/02/2023",""
+"Virginia","SB 962","Restricting student & educator rights","Defeated","Passed by indefinitely by committee","02/02/2023",""
+"Virginia","HB 1399","Restricting student & educator rights","Defeated","Assigned to subcommittee","01/20/2023",""
+"Texas","HB 23","Restricting student & educator rights","Defeated","Dead","05/29/2023",""
+"Oregon","SB 453","Restricting student & educator rights","Defeated","Dead","06/25/2023",""
+"Oregon","HB 2186","Restricting student & educator rights","Defeated","Dead","06/25/2023",""
+"New Jersey","S 589","Restricting student & educator rights","Advancing","Introduced and referred to committee","01/11/2023",""
+"New Jersey","A 1630","Restricting student & educator rights","Advancing","Introduced and referred to committee","01/11/2023",""
+"Missouri","SB 87","Restricting student & educator rights","Defeated","Dead","05/12/2023",""
+"Indiana","SB 351","Barriers to accurate IDs | ","Defeated","Dead","04/28/2023",""
+"Mississippi","SB 2765","Restricting student & educator rights","Defeated","Died in committee","01/31/2023",""
+"Indiana","SB 354","Restricting student & educator rights","Defeated","Dead","04/28/2023",""
+"Wyoming","SF 111","Healthcare restrictions | ","Defeated","Passed Senate; House did not consider for introduction","02/24/2023",""
+"Indiana","HB 1232","Healthcare restrictions | ","Defeated","Dead","04/28/2023",""
+"Indiana","HB 1231","Healthcare restrictions | ","Defeated","Dead","04/28/2023",""
+"Indiana","HB 1220","Healthcare restrictions | ","Defeated","Dead","04/28/2023",""
+"Indiana","HB 1118","Healthcare restrictions | ","Defeated","Dead","04/28/2023",""
+"Idaho","S 1003","Other anti-LGBTQ bills","Defeated","Dead","04/06/2023",""
+"Missouri","SB 258","Other anti-LGBTQ bills","Defeated","Dead","05/12/2023",""
+"Missouri","HB 732","Other anti-LGBTQ bills","Defeated","Dead","05/12/2023",""
+"Tennessee","HB 239","Other anti-LGBTQ bills","Passed into Law","Companion bill SB 1440 signed by Governor","05/17/2023",""
+"Texas","SB 476","Free speech & expression bans | ","Defeated","Dead","05/29/2023",""
+"Connecticut","SB 468","Restricting student & educator rights","Defeated","Dead","06/07/2023",""
+"Virginia","HB 2170","Restricting student & educator rights","Defeated","Subcommittee recommends laying on table","01/27/2023",""
+"Virginia","HB 1434","Restricting student & educator rights","Defeated","Subcommittee recommends laying on table","01/25/2023",""
+"Wyoming","HB 187","Restricting student & educator rights","Defeated","Did not consider for introduction","01/31/2023",""
+"Virginia","HB 1387","Restricting student & educator rights","Defeated","Passed House; passed by indefinitely by Senate committee","02/16/2023",""
+"Virginia","SB 1186","Restricting student & educator rights","Defeated","Passed by indefinitely by committee","02/02/2023",""
+"Connecticut","HB 6213","Restricting student & educator rights","Defeated","Dead","06/07/2023",""
+"North Dakota","HB 1473","Public accommodation bans | Restricting student & educator rights","Passed into Law","Governor signed","04/25/2023",""
+"Arkansas","HB 1156","Restricting student & educator rights","Passed into Law","Enacted","03/21/2023",""
+"Oregon","HB 3044","Restricting student & educator rights","Defeated","Dead","06/25/2023",""
+"Missouri","SB 497","Restricting student & educator rights","Defeated","Dead","05/12/2023",""
+"Missouri","HB 489","Other anti-LGBTQ bills","Defeated","Dead","05/12/2023",""
+"Virginia","HB 2432","Healthcare restrictions | Restricting student & educator rights","Defeated","Passed House; passed by indefinitely by Senate committee","02/16/2023",""
+"Texas","HB 436","Healthcare restrictions | ","Defeated","Dead","05/29/2023",""
+"Oklahoma","SB 613","Healthcare restrictions | ","Passed into Law","Governor signed","05/01/2023","https://www.aclu.org/cases/poe-v-drummond"
+"Mississippi","HB 576","Healthcare restrictions | ","Defeated","Died in committee","01/31/2023",""
+"Mississippi","HB 456","Healthcare restrictions | ","Defeated","Died in committee","01/31/2023",""
+"South Dakota","HB 1080","Healthcare restrictions | ","Passed into Law","Governor signed","02/13/2023",""
+"Utah","SB 100","Restricting student & educator rights","Passed into Law","Governor signed","02/16/2023",""
+"Utah","SB 93","Barriers to accurate IDs | ","Passed into Law","Governor signed","03/23/2023",""
+"Nebraska","LB 574","Healthcare restrictions | ","Passed into Law","Governor signed","05/22/2023","https://www.aclu.org/cases/planned-parenthood-of-the-heartland-v-hilger"
+"Texas","HB 319","Weakening Civil Rights Laws","Defeated","Dead","05/29/2023",""
+"Oklahoma","SB 404","Weakening Civil Rights Laws","Passed into Law","Governor signed","05/02/2023",""
+"Kentucky","HB 58","Weakening Civil Rights Laws","Defeated","Dead","03/30/2023",""
+"Texas","HB 1266","Free speech & expression bans | ","Defeated","Dead","05/29/2023",""
+"Arizona","SB 1026","Free speech & expression bans | ","Defeated","Governor vetoed","06/16/2023",""
+"Arizona","SB 1028","Free speech & expression bans | ","Defeated","Governor vetoed","06/16/2023",""
+"Missouri","HB 192","Restricting student & educator rights | Weakening Civil Rights Laws","Defeated","Dead","05/12/2023",""
+"Texas","SB 393","Restricting student & educator rights","Defeated","Dead","05/29/2023",""
+"Kentucky","HB 120","Healthcare restrictions | ","Defeated","Dead","03/30/2023",""
+"Missouri","SB 49","Healthcare restrictions | ","Passed into Law","Governor signed","06/07/2023","https://lambdalegal.org/case/noe-v-parson/"
+"Missouri","SB 164","Healthcare restrictions | ","Defeated","Dead","05/12/2023",""
+"Missouri","SB 236","Healthcare restrictions | ","Defeated","Dead","05/12/2023",""
+"Missouri","HB 419","Healthcare restrictions | ","Defeated","Dead","05/12/2023",""
+"Missouri","HB 463","Healthcare restrictions | ","Defeated","Dead","05/12/2023",""
+"Missouri","HB 540","Healthcare restrictions | ","Defeated","Dead","05/12/2023",""
+"Mississippi","HB 1125","Healthcare restrictions | ","Passed into Law","Governor signed","02/28/2023",""
+"Mississippi","HB 1127","Healthcare restrictions | ","Defeated","Died in committee","01/31/2023",""
+"New Jersey","S 3076","Healthcare restrictions | ","Introduced","Active","01/10/2023",""
+"Mississippi","SB 2864","Healthcare restrictions | ","Defeated","Died in committee","01/31/2023",""
+
+Data is current as of December 21 2023 
diff --git a/assets/data-leg/ACLU_2024.csv b/assets/data-leg/ACLU_2024.csv
new file mode 100644
index 00000000..b1e4b9d6
--- /dev/null
+++ b/assets/data-leg/ACLU_2024.csv
@@ -0,0 +1,536 @@
+State,Bill Name,Issues,Status,Status Detail,Status Date,In Court Link
+"New Jersey","A.775","Restricting student & educator rights | School sports bans","Introduced","","01/09/2024",""
+"Pennsylvania","HB 216","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","11/13/2024",""
+"New Jersey","S.419","Other school restrictions | Restricting student & educator rights","Introduced","Referred to committee","01/09/2024",""
+"New Jersey","A.2720","Other school restrictions | Restricting student & educator rights","Advancing","Legislative session adjourned, carries over to 2025,","12/19/2024",""
+"Virginia","H.B. 1229","Public accommodation bans | Restricting student & educator rights | School facilities bans | School sports bans","Defeated","Legislative session ended","02/22/2025",""
+"Virginia","H.B. 8","Healthcare restrictions | Other healthcare barriers | Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","02/22/2025",""
+"Virginia","S.B. 749","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","02/22/2025",""
+"Florida","H.B. 1425","Other anti-LGBTQ bills","Passed into Law","Governor signed","04/26/2024",""
+"New Jersey","A.2580","Curriculum censorship | Restricting student & educator rights","Advancing","Legislative session adjourned, carries over to 2025,","12/19/2024",""
+"New Jersey","A.531","Curriculum censorship | Restricting student & educator rights","Introduced","","01/10/2024",""
+"New Jersey","A.410","Other school restrictions | Restricting student & educator rights","Introduced","Referred to committee","01/09/2024",""
+"New Jersey","S.1329","Other school restrictions | Restricting student & educator rights","Introduced","Referred to committee","01/09/2024",""
+"Pennsylvania","HB 138","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","11/13/2024",""
+"Pennsylvania","HB 319","Curriculum censorship | Restricting student & educator rights","Defeated","Legislative session ended","11/13/2024",""
+"Pennsylvania","H.B.2157","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","11/13/2024",""
+"Pennsylvania","H.B.2421","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","11/13/2024",""
+"Pennsylvania","H.B.2546","Other anti-LGBTQ bills","Defeated","Legislative session ended","11/13/2024",""
+"Ohio","HB 8","Forced outing in schools | Restricting student & educator rights","Passed into Law","Governor signed","01/08/2025",""
+"Virginia","S.B. 723","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","02/22/2025",""
+"Virginia","S.J. 49","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Stricken in committee at request of Patron ","02/02/2024",""
+"Ohio","H.B.686","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","12/19/2024",""
+"Virginia","S.B. 68","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","02/22/2025",""
+"Virginia","S.B. 671","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","02/22/2025",""
+"Tennessee","SB 596","Religious exemptions | Weakening Civil Rights Laws","Passed into Law","Companion bill passed into law","02/21/2024",""
+"Virginia","H.B. 670","Forced outing in schools | Other anti-LGBTQ bills | Restricting student & educator rights","Defeated","Legislative session ended","02/22/2025",""
+"Virginia","H.B. 1120","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","02/22/2025",""
+"Virginia","H.J. 86","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","02/22/2025",""
+"New Hampshire","H.B.1185","Curriculum censorship | Restricting student & educator rights","Defeated","Executive Session Interim Study Report: Not Recommended for Future Legislation","10/31/2024",""
+"New Hampshire","S.B.375","Restricting student & educator rights | School facilities bans | School sports bans","Defeated","Executive Session Interim Study Report: Not Recommended for Future Legislation","10/31/2024",""
+"New Hampshire","HB 619","Curriculum censorship | Healthcare age restrictions | Healthcare restrictions | Restricting student & educator rights | School facilities bans | School sports bans","Passed into Law","Governor signed","07/19/2024",""
+"New Hampshire","H.B.1660","Healthcare funding restrictions | Healthcare restrictions | ","Defeated","Inexpedient to legislate, veto session","10/10/2024",""
+"New Hampshire","S.B.562","Other civil rights restrictions | Weakening Civil Rights Laws","Defeated","Inexpedient to legislate, veto session","10/10/2024",""
+"Virginia","S.B. 37","Forced outing in schools | Other anti-LGBTQ bills | Restricting student & educator rights","Defeated","Legislative session ended","02/22/2025",""
+"Oklahoma","HB 1466","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Failed to meet House deadline","02/29/2024",""
+"Oklahoma","S.B.455","Other anti-LGBTQ bills","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 887","Religious exemptions | Weakening Civil Rights Laws","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 788","Healthcare age restrictions | Healthcare restrictions | ","","","",""
+"Oklahoma","SB 937","Curriculum censorship | Drag bans | Free speech & expression bans | Other school restrictions | Restricting student & educator rights | School sports bans","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","HB 1377","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Failed to meet House deadline","02/29/2024",""
+"Oklahoma","SB 252","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 787","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","S.B.251","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 935","Other school restrictions | Restricting student & educator rights","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 345","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 786","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 614","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","HB 2736","Drag bans | Free speech & expression bans | ","Defeated","Failed to meet House deadline","02/29/2024",""
+"Oklahoma","HB 1780","Curriculum censorship | Restricting student & educator rights","Defeated","Failed to meet House deadline","02/29/2024",""
+"Oklahoma","HB 2186","Drag bans | Free speech & expression bans | ","Defeated","Failed to meet House deadline","02/29/2024",""
+"Oklahoma","SB 129","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","HB 2177","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Failed to meet House deadline","02/29/2024",""
+"Oklahoma","SB 408","Other anti-LGBTQ bills","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","S.B.202","Other civil rights restrictions | Re-definition of sex | Weakening Civil Rights Laws","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 932","Other school restrictions | Restricting student & educator rights","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 973","Curriculum censorship | Restricting student & educator rights","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","HB 1781","Curriculum censorship | Restricting student & educator rights","Defeated","Failed to meet House deadline","02/29/2024",""
+"Oklahoma","HB 1011","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Failed to meet House deadline","02/29/2024",""
+"Oklahoma","SB 789","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 943","Other school restrictions | Restricting student & educator rights","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 933","Drag bans | Free speech & expression bans | ","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 1004","Other anti-LGBTQ bills","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 1017","Other school restrictions | Restricting student & educator rights","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 30","Curriculum censorship | Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 250","Healthcare funding restrictions | Healthcare restrictions | ","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 878","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 1007","Restricting student & educator rights | School sports bans","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","SB 131","Curriculum censorship | Restricting student & educator rights","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Wisconsin","AB 377","Restricting student & educator rights | School sports bans","Defeated","Vetoed by Governor; Assembly failed to override veto","05/15/2024",""
+"Michigan","HB 4510","Restricting student & educator rights | School facilities bans","Introduced","Carried over","01/10/2024",""
+"South Carolina","SB 627","Healthcare age restrictions | Healthcare funding restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","05/09/2024",""
+"Kansas","HB 2427","Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","04/30/2024",""
+"New Hampshire","HB 396","Barriers to accurate IDs | ","Defeated","Veto Sustained","10/10/2024",""
+"New Hampshire","H.B.1356","Forced outing in schools | Other school restrictions | Religious exemptions | Restricting student & educator rights | Weakening Civil Rights Laws","Defeated","Inexpedient to legislate","03/07/2024",""
+"New Hampshire","H.B.1312","Other anti-LGBTQ bills","Passed into Law","Governor signed","07/19/2024",""
+"Oklahoma","HB 1449","Other anti-LGBTQ bills","Passed into Law","Governor signed","05/31/2024",""
+"New Hampshire","H.B.1205","Restricting student & educator rights | School sports bans","Passed into Law","Governor signed","07/19/2024",""
+"Idaho","H.567","Curriculum censorship | Restricting student & educator rights","Defeated","Legislative session ended","04/10/2024",""
+"Mississippi","S.B. 2722","Restricting student & educator rights | School facilities bans","Defeated","Died in committee","03/05/2024",""
+"Mississippi","H.B. 1521","Restricting student & educator rights | School facilities bans","Defeated","Died in committee","03/05/2024",""
+"New Hampshire","S.B.524","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","06/13/2024",""
+"New Hampshire","S.B.341","Forced outing in schools | Restricting student & educator rights","Defeated","Legislative session ended","06/13/2024",""
+"Massachusetts","H 509","Curriculum censorship | Restricting student & educator rights","Defeated","Legislative session ended","12/31/2024",""
+"South Carolina","HB 3728","Curriculum censorship | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","05/09/2024",""
+"Louisiana","H.B.122","Curriculum censorship | Other school restrictions | Restricting student & educator rights","Passed into Law","Governor signed","06/19/2024",""
+"Louisiana","H.B.121","Other school restrictions | Religious exemptions | Restricting student & educator rights | Weakening Civil Rights Laws","Passed into Law","Governor signed","06/19/2024",""
+"Michigan","H.B.5831","Other anti-LGBTQ bills","Defeated","Legislative session ended","12/31/2024",""
+"Delaware","S.B. 191","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","06/30/2024",""
+"West Virginia","S.B.197","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","03/09/2024",""
+"West Virginia","S.B.195","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","03/09/2024",""
+"Arizona","S.B.1451","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","06/15/2024",""
+"Washington","H.B. 1601","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","03/07/2024",""
+"West Virginia","H.B.5616","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","03/09/2024",""
+"West Virginia","H.B.5615","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","03/09/2024",""
+"Mississippi","H.B. 1953","Healthcare restrictions | Other healthcare barriers","Defeated","Died in committee","04/16/2024",""
+"Missouri","H.B. 2830","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","05/17/2024",""
+"Tennessee","H.B.2936","Forced outing in schools | Other anti-LGBTQ bills | Restricting student & educator rights","Passed into Law","Companion bill passed into law","05/28/2024",""
+"Tennessee","H.B.2310","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Passed into Law","Companion bill passed into law","05/28/2024",""
+"Tennessee","S.B.2782","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Passed into Law","Governor signed","05/28/2024",""
+"Tennessee","S.B.2749","Forced outing in schools | Other anti-LGBTQ bills | Restricting student & educator rights","Passed into Law","Governor signed","05/28/2024",""
+"Ohio","HB 245","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","12/19/2024",""
+"Delaware","S.B. 315","Healthcare age restrictions | Healthcare funding restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","06/30/2024",""
+"Louisiana","H.B.608","Other anti-LGBTQ bills | Re-definition of sex | Restricting student & educator rights | School facilities bans | Weakening Civil Rights Laws","Passed into Law","Governor signed","06/03/2024",""
+"South Carolina","H.B.4624","Forced outing in schools | Healthcare age restrictions | Healthcare funding restrictions | Healthcare restrictions | Restricting student & educator rights","Passed into Law","Governor signed","05/21/2024",""
+"Oklahoma","S.B.1677","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","05/30/2024",""
+"Missouri","H.B. 2145","Restricting student & educator rights | School sports bans","Advancing","Referred to committee","05/17/2024",""
+"Missouri","H.B. 1739","Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","05/29/2024",""
+"Missouri","H.B. 1789","Other anti-LGBTQ bills","Advancing","Referred to committee","05/17/2024",""
+"Missouri","H.B. 2885","Other school restrictions | Restricting student & educator rights","Advancing","Referred to committee","05/17/2024",""
+"Missouri","H.B. 1523","Curriculum censorship | Forced outing in schools | Restricting student & educator rights","Advancing","Referred to committee","05/17/2024",""
+"Missouri","H.B. 1849","Drag bans | Free speech & expression bans | ","Advancing","Referred to committee","05/17/2024",""
+"Missouri","H.B. 1405","Forced outing in schools | Other school restrictions | Religious exemptions | Restricting student & educator rights | Weakening Civil Rights Laws","Advancing","Referred to committee","05/17/2024",""
+"Missouri","H.B. 2300","Drag bans | Free speech & expression bans | ","Advancing","Referred to committee","05/17/2024",""
+"Missouri","H.B. 1981","Restricting student & educator rights | School sports bans","Advancing","Referred to committee","05/17/2024",""
+"Massachusetts","H 458","Curriculum censorship | Restricting student & educator rights","Defeated","Legislative session ended","12/31/2024",""
+"Wisconsin","AB 465","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Vetoed by Governor; Assembly failed to override veto","05/15/2024",""
+"Wisconsin","AB 510","Curriculum censorship | Other school restrictions | Restricting student & educator rights","Defeated","Vetoed by Governor; Assembly failed to override veto","05/15/2024",""
+"Alaska","H.B. 183","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","05/15/2024",""
+"Tennessee","H.B.2619","Healthcare restrictions | Prison healthcare restrictions","Passed into Law","Companion bill passed into law","04/29/2024",""
+"Mississippi","H.B. 1647","Other anti-LGBTQ bills","Passed into Law","Became act without Governor's signature","05/14/2024",""
+"Alaska","HB 174","Other anti-LGBTQ bills","Defeated","Legislative session ended","05/15/2024",""
+"Tennessee","H.B.2165","Forced outing in schools | Restricting student & educator rights","Passed into Law","Companion bill passed into law","05/09/2024",""
+"Tennessee","S.B.2861","Healthcare restrictions | Prison healthcare restrictions","Passed into Law","Governor signed","04/29/2024",""
+"Tennessee","S.B.1810","Forced outing in schools | Restricting student & educator rights","Passed into Law","Governor signed","05/01/2024",""
+"Missouri","H.B. 2619","Other anti-LGBTQ bills","Defeated","Legislative session ended","05/17/2024",""
+"Iowa","S.F.2435","Other anti-LGBTQ bills","Passed into Law","Governor signed","05/09/2024",""
+"Alabama","S.B.92","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","05/09/2024",""
+"Tennessee","H.B.1634","Other school restrictions | Restricting student & educator rights","Passed into Law","Companion bill passed into law","04/23/2024",""
+"Tennessee","S.B.2766","Other school restrictions | Restricting student & educator rights","Passed into Law","Governor signed","04/23/2024",""
+"Mississippi","S.B. 2753","Other school restrictions | Public accommodation bans | Re-definition of sex | Restricting student & educator rights | School facilities bans | Weakening Civil Rights Laws","Advancing","Senate and House signed enrolled bill; Due from Governor","05/13/2024",""
+"Alaska","H.B. 105","Curriculum censorship | Other school restrictions | Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","05/15/2024",""
+"Tennessee","H.B.1995","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","S.B.2780","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/25/2024",""
+"West Virginia","S.B.237","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","03/09/2024",""
+"West Virginia","H.B.5240","Other anti-LGBTQ bills","Defeated","Legislative session ended","03/09/2024",""
+"Washington","H.B. 1214","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","03/07/2024",""
+"Tennessee","S.B.1722","Free speech & expression bans | Other expression restrictions | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","H.B.1605","Free speech & expression bans | Other expression restrictions | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","04/25/2024",""
+"South Carolina","H.B.4691","Forced outing in schools | Other anti-LGBTQ bills | Restricting student & educator rights","Defeated","Legislative session ended","05/09/2024",""
+"Oklahoma","H.B.2546","Curriculum censorship | Restricting student & educator rights","Defeated","Failed to meet House deadline","02/29/2024",""
+"New Hampshire","H.B.1441","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","06/13/2024",""
+"Mississippi","S.B. 2813","Barriers to accurate IDs | Re-definition of sex | Weakening Civil Rights Laws","Defeated","Died In Committee","03/05/2024",""
+"Missouri","H.B. 1518","Other civil rights restrictions | Weakening Civil Rights Laws","Defeated","Legislative session ended","05/17/2024",""
+"Missouri","H.B. 1650","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","05/17/2024",""
+"Kentucky","S.B.208","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","04/15/2024",""
+"Idaho","H.517","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/10/2024",""
+"Iowa","H.F.2068","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","04/20/2024",""
+"Hawaii","H.B.291","Barriers to accurate IDs | ","Defeated","Legislative session ended","05/03/2024",""
+"Georgia","H.B.836","Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","03/28/2024",""
+"Georgia","H.B.936","Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","03/28/2024",""
+"Florida","H.B. 1027","Other school restrictions | Restricting student & educator rights","Defeated","Died in subcommittee","03/08/2024",""
+"Florida","S.B. 1728","Other school restrictions | Restricting student & educator rights","Defeated","Died in committee","03/08/2024",""
+"Missouri","H.B. 1520","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","05/17/2024",""
+"Illinois","H.B.5830","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","05/29/2024",""
+"Alabama","H.B.130","Curriculum censorship | Restricting student & educator rights","Defeated","Legislative session ended","05/09/2024",""
+"Minnesota","S.F.5466","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","05/20/2024",""
+"Tennessee","H.B.2169","Religious exemptions | Weakening Civil Rights Laws","Advancing","Companion bill passed into law","04/11/2024",""
+"Mississippi","H.B. 1607","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Died in Conference","04/29/2024",""
+"Minnesota","H.F.3926","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","05/20/2024",""
+"Kansas","HB 2436","Other anti-LGBTQ bills","Passed into Law","House and Senate Motion to override veto prevailed","04/29/2024",""
+"Kansas","SB 233","Healthcare age restrictions | Healthcare restrictions | ","Defeated","House Motion to override veto failed; Veto sustained","04/29/2024",""
+"Alaska","H.B. 382","Forced outing in schools | Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","05/15/2024",""
+"Arizona","S.B.1182","Restricting student & educator rights | School facilities bans","Defeated","Vetoed by Governor","04/23/2024",""
+"Alabama","H.B.111","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","05/09/2024",""
+"Wisconsin","SB 377","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","03/12/2024",""
+"Wisconsin","SB 489","Curriculum censorship | Other school restrictions | Restricting student & educator rights","Defeated","Companion bill vetoed by Governor; Assembly failed to override veto","05/15/2024",""
+"Wisconsin","SB 378","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","03/12/2024",""
+"Tennessee","S.B.1738","Religious exemptions | Weakening Civil Rights Laws","Passed into Law","Signed by Governor","04/11/2024",""
+"Maine","LD 678","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","04/17/2024",""
+"Maine","LD 930","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","04/17/2024",""
+"Arizona","S.B.1628","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Vetoed by Governor","04/16/2024",""
+"Alaska","H.B. 338","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","05/15/2024",""
+"Iowa","H.F.2704","Other anti-LGBTQ bills","Passed into Law","Companion bill passed into law","05/09/2024",""
+"South Carolina","H.B.5407","Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","05/09/2024",""
+"Wisconsin","SB 479","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","03/12/2024",""
+"Wisconsin","SB 438","Other anti-LGBTQ bills","Defeated","Legislative session ended","03/12/2024",""
+"Wisconsin","SB 480","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Companion bill vetoed by Governor; Assembly failed to override veto","05/15/2024",""
+"Wisconsin","AB 447","Other anti-LGBTQ bills","Defeated","Legislative session ended","03/12/2024",""
+"Wisconsin","S.B.922","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","03/12/2024",""
+"Wisconsin","AB 609","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","03/12/2024",""
+"Wisconsin","AB 502","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","03/12/2024",""
+"Wisconsin","AB 378","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","03/12/2024",""
+"Idaho","H.538","Forced outing in schools | Other anti-LGBTQ bills | Other school restrictions | Restricting student & educator rights","Passed into Law","Governor signed","04/08/2024",""
+"Idaho","H.421","Re-definition of sex | Weakening Civil Rights Laws","Passed into Law","Governor signed","04/09/2024",""
+"Florida","H.B. 433","Other civil rights restrictions | Weakening Civil Rights Laws","Passed into Law","Governor signed","04/11/2024",""
+"Tennessee","S.B.2350","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","H.B.1948","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/25/2024",""
+"Idaho","S.1352","Religious exemptions | Weakening Civil Rights Laws","Passed into Law","Governor signed","03/21/2024",""
+"Rhode Island","H.B.7884","Healthcare age restrictions | Healthcare funding restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","06/14/2024",""
+"Rhode Island","H.B.7727","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","06/14/2024",""
+"Ohio","HB 183","Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","12/19/2024",""
+"New Hampshire","S.B.304","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","06/13/2024",""
+"Nebraska","LB 575","Restricting student & educator rights | School facilities bans | School sports bans","Defeated","Legislative session ended","04/18/2024",""
+"Oklahoma","H.B.3214","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","05/30/2024",""
+"Mississippi","H.B. 585","Other anti-LGBTQ bills","Defeated","House passed; Died in Senate committee","04/02/2024",""
+"Iowa","S.F.2095","Religious exemptions | Weakening Civil Rights Laws","Passed into Law","Governor signed","04/02/2024",""
+"Wyoming","S.F.0099","Healthcare age restrictions | Healthcare restrictions | ","Passed into Law","Governor signed","03/22/2024",""
+"West Virginia","H.B.4233","Barriers to accurate IDs | ","Passed into Law","Governor signed","03/27/2024",""
+"Utah","H.B.157","Healthcare restrictions | Other healthcare barriers","Passed into Law","Governor signed","03/14/2024",""
+"Utah","H.B.316","Other anti-LGBTQ bills","Passed into Law","Governor signed","03/18/2024",""
+"Utah","H.B.396","Religious exemptions | Weakening Civil Rights Laws","Passed into Law","Governor signed","03/19/2024",""
+"Utah","S.B.150","Religious exemptions | Weakening Civil Rights Laws","Passed into Law","Governor signed","03/21/2024",""
+"Tennessee","HB 1386","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","HB 878","Religious exemptions | Weakening Civil Rights Laws","Passed into Law","Signed by Governor","02/21/2024",""
+"Tennessee","SB 1110","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/25/2024",""
+"Oklahoma","H.B.3022","Other anti-LGBTQ bills","Defeated","Legislative session ended","05/30/2024",""
+"New Hampshire","H.B.1664","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","06/13/2024",""
+"Kentucky","S.B.239","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/15/2024",""
+"Kentucky","H.B.304","Curriculum censorship | Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","04/15/2024",""
+"Kentucky","S.B.147","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","04/15/2024",""
+"Kentucky","H.B.47","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/15/2024",""
+"Idaho","H.578","Religious exemptions | Weakening Civil Rights Laws","Passed into Law","Governor signed","03/25/2024",""
+"Idaho","H.668","Healthcare funding restrictions | Healthcare restrictions | Other healthcare barriers | Prison healthcare restrictions","Passed into Law","Governor signed","03/27/2024",""
+"Iowa","S.F.2286","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/20/2024",""
+"Georgia","H.B.1170","Healthcare age restrictions | Healthcare restrictions | ","Advancing","Passed House and Senate as substituted","03/28/2024",""
+"Arizona","S.B.1166","Forced outing in schools | Religious exemptions | Restricting student & educator rights | Weakening Civil Rights Laws","Defeated","Legislative session ended","06/15/2024",""
+"Alabama","S.B.129","Other anti-LGBTQ bills | Other school restrictions | Restricting student & educator rights","Passed into Law","Governor signed","03/20/2024",""
+"South Carolina","S.B.1213","Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","05/09/2024",""
+"Minnesota","S.F.5144","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","05/20/2024",""
+"Minnesota","H.F.5128","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","05/20/2024",""
+"Georgia","H.B.1104","Curriculum censorship | Restricting student & educator rights | School facilities bans | School sports bans","Defeated","Legislative session ended","03/28/2024",""
+"Arizona","S.B.1005","Other anti-LGBTQ bills","Defeated","Legislative session ended","06/15/2024",""
+"Oregon","H.B.4054","Restricting student & educator rights | School sports bans","Defeated","In committee upon adjournment","03/07/2024",""
+"Oregon","H.B.4037","Forced outing in schools | Healthcare age restrictions | Healthcare restrictions | Restricting student & educator rights","Defeated","In committee upon adjournment","03/07/2024",""
+"Oregon","H.B.4143","Other anti-LGBTQ bills | Public accommodation bans | Restricting student & educator rights | School facilities bans | School sports bans","Defeated","In committee upon adjournment","03/07/2024",""
+"Iowa","S.F.2263","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/20/2024",""
+"Wyoming","S.F.0098","Healthcare restrictions | Other healthcare barriers","Defeated","Senate passed; House did not consider for introduction and legislative session ended","03/08/2024",""
+"Wyoming","S.F.0094","Other anti-LGBTQ bills","Defeated","Senate passed; House did not consider for introduction and legislative session ended","03/08/2024",""
+"Wyoming","S.F.0130","Other anti-LGBTQ bills | Other school restrictions | Restricting student & educator rights","Defeated","Passed Senate; House did not consider for introduction and legislative session ended","03/08/2024",""
+"Wyoming","S.F.0009","Curriculum censorship | Restricting student & educator rights","Passed into Law","Governor signed","03/05/2024",""
+"West Virginia","S.B.601","Public accommodation bans | Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","03/09/2024",""
+"Tennessee","H.B.2816","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","S.B.2396","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","04/25/2024",""
+"Mississippi","H.B. 1605","Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Died in committee","03/05/2024",""
+"Mississippi","S.B. 2118","Other anti-LGBTQ bills","Defeated","Died in committee","03/05/2024",""
+"Mississippi","S.B. 2237","Religious exemptions | Weakening Civil Rights Laws","Defeated","Died in committee","03/05/2024",""
+"Mississippi","H.B. 1358","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Died in committee","03/05/2024",""
+"Mississippi","S.B. 2553","Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Died in committee","03/05/2024",""
+"Mississippi","H.B. 1606","Other anti-LGBTQ bills | Other school restrictions | Re-definition of sex | Restricting student & educator rights | Weakening Civil Rights Laws","Defeated","Died in committee","03/05/2024",""
+"Mississippi","S.B. 2080","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Died in committee","03/05/2024",""
+"Mississippi","H.B. 1069","Religious exemptions | Weakening Civil Rights Laws","Defeated","Died in committee","03/05/2024",""
+"Mississippi","S.B. 2814","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Died in committee","03/05/2024",""
+"Mississippi","S.B. 2812","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Died in committee","03/05/2024",""
+"Mississippi","H.B. 176","Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Died in committee","03/05/2024",""
+"Mississippi","S.B. 2029","Healthcare funding restrictions | Healthcare restrictions | ","Defeated","Died in committee","03/05/2024",""
+"Mississippi","H.B. 1428","Public accommodation bans | Re-definition of sex | Restricting student & educator rights | School facilities bans | Weakening Civil Rights Laws","Defeated","Died in committee","03/05/2024",""
+"Mississippi","H.B. 725","Other anti-LGBTQ bills","Defeated","Died in committee","03/05/2024",""
+"Mississippi","S.B. 2594","Other anti-LGBTQ bills","Defeated","Died in committee","03/05/2024",""
+"Idaho","S.1362","Free speech & expression bans | Other expression restrictions | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","04/10/2024",""
+"Georgia","SB 180","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","03/28/2024",""
+"Minnesota","H.F.4503","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","05/20/2024",""
+"Minnesota","S.F.4616","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","05/20/2024",""
+"Utah","H.B.253","Public accommodation bans | Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","03/01/2024",""
+"Utah","H.B.303","Free speech & expression bans | Other expression restrictions | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","03/01/2024",""
+"Utah","H.B.224","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","03/01/2024",""
+"Utah","H.B.527","Other school restrictions | Religious exemptions | Restricting student & educator rights | Weakening Civil Rights Laws","Defeated","Legislative session ended","03/01/2024",""
+"Rhode Island","S.B.2423","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","06/14/2024",""
+"Missouri","H.B. 2309","Other anti-LGBTQ bills","Defeated","Legislative session ended","05/17/2024",""
+"Kentucky","S.B.336","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/15/2024",""
+"Idaho","H.669","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/10/2024",""
+"Florida","H.B. 1639","Barriers to accurate IDs | ","Defeated","Died in committee","03/08/2024",""
+"Rhode Island","S.B.2703","Healthcare age restrictions | Healthcare funding restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","06/14/2024",""
+"Rhode Island","S.B.2660","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","06/14/2024",""
+"Oklahoma","S.B.1530","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","05/30/2024",""
+"West Virginia","H.B.5297","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","03/09/2024",""
+"Missouri","S.B. 980","Other anti-LGBTQ bills","Defeated","Legislative session ended","05/17/2024",""
+"Idaho","H.520","Healthcare funding restrictions | Healthcare restrictions | Prison healthcare restrictions","Defeated","Legislative session ended","04/10/2024",""
+"Iowa","H.F.2454","Religious exemptions | Weakening Civil Rights Laws","Passed into Law","Companion bill passed into law","04/02/2024",""
+"Georgia","S.B.532","Curriculum censorship | Restricting student & educator rights","Defeated","Legislative session ended","02/29/2024",""
+"Florida","S.B. 1352","Other anti-LGBTQ bills","Passed into Law","Companion bill passed into law","04/26/2024",""
+"Idaho","H.672","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/10/2024",""
+"South Carolina","S.B.0332","Other anti-LGBTQ bills","Defeated","Legislative session ended","05/09/2024",""
+"West Virginia","S.B.870","Other anti-LGBTQ bills | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","03/09/2024",""
+"Arizona","S.C.R.1013","Forced outing in schools | Religious exemptions | Restricting student & educator rights | School facilities bans | Weakening Civil Rights Laws","Defeated","Legislative session ended","06/15/2024",""
+"Missouri","H.B. 2569","Other anti-LGBTQ bills","Defeated","Legislative session ended","05/17/2024",""
+"West Virginia","S.B.517","Barriers to accurate IDs | ","Defeated","Legislative session ended","03/09/2024",""
+"West Virginia","H.B.5656","Other anti-LGBTQ bills","Defeated","Legislative session ended","03/09/2024",""
+"Missouri","H.B. 2567","Other anti-LGBTQ bills","Defeated","Legislative session ended","05/17/2024",""
+"Idaho","S.1357","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/10/2024",""
+"Oklahoma","H.B.3120","Curriculum censorship | Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","05/30/2024",""
+"Missouri","H.B. 2448","Other anti-LGBTQ bills","Defeated","Legislative session ended","05/17/2024",""
+"Missouri","H.B. 2365","Other anti-LGBTQ bills","Defeated","Legislative session ended","05/17/2024",""
+"Kansas","H.B.2792","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","04/30/2024",""
+"Arizona","S.B.1167","Other anti-LGBTQ bills","Defeated","Legislative session ended","06/15/2024",""
+"Kentucky","H.B.652","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","04/15/2024",""
+"Minnesota","S.F.3848","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","05/20/2024",""
+"Kansas","S.B.409","Other civil rights restrictions | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/30/2024",""
+"Wyoming","H.B.0061","Curriculum censorship | Other school restrictions | Restricting student & educator rights","Defeated","Failed introduction","02/16/2024",""
+"Wyoming","H.B.0136","Restricting student & educator rights | School sports bans","Defeated","Failed introduction","02/16/2024",""
+"Wyoming","H.B.0190","Curriculum censorship | Forced outing in schools | Restricting student & educator rights","Defeated","Failed introduction","02/16/2024",""
+"Wyoming","H.B.0178","Religious exemptions | Weakening Civil Rights Laws","Defeated","Failed introduction","02/16/2024",""
+"New Hampshire","H.B.1419","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","06/13/2024",""
+"Kansas","H.B.2791","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","04/30/2024",""
+"Georgia","S.B.519","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","03/28/2024",""
+"Georgia","SB 88","Curriculum censorship | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","03/28/2024",""
+"Wyoming","H.B.0156","Healthcare restrictions | Other healthcare barriers","Defeated","Failed introduction","02/16/2024",""
+"Wyoming","H.B.0050","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Failed introduction","02/15/2024",""
+"Wyoming","H.B.0063","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Failed introduction","02/14/2024",""
+"Iowa","HF 290","Barriers to accurate IDs | Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/20/2024",""
+"Minnesota","S.F.4017","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers | Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","05/20/2024",""
+"West Virginia","S.B.515","Curriculum censorship | Forced outing in schools | Restricting student & educator rights","Defeated","Legislative session ended","03/09/2024",""
+"Missouri","H.B. 1700","Other anti-LGBTQ bills","Defeated","Legislative session ended","05/17/2024",""
+"Kentucky","H.B.9","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/15/2024",""
+"Idaho","H.560","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/10/2024",""
+"West Virginia","H.B.5243","Public accommodation bans | Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","03/09/2024",""
+"Kansas","S.B.512","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/30/2024",""
+"Iowa","S.S.B.3006","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/20/2024",""
+"Iowa","S.S.B.3084","Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","04/20/2024",""
+"Iowa","H.S.B.649","Barriers to accurate IDs | Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/20/2024",""
+"Iowa","H.S.B.614","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/20/2024",""
+"Tennessee","S.B.2747","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/25/2024",""
+"Georgia","H.B.1205","Other anti-LGBTQ bills","Defeated","Legislative session ended","03/28/2024",""
+"Maryland","H.B.0047","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","04/08/2024",""
+"Virginia","S.B. 153","Religious exemptions | Weakening Civil Rights Laws","Defeated","Stricken in committee at request of patron","02/08/2024",""
+"South Dakota","S.B.184","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","03/26/2024",""
+"Tennessee","SB 620","Curriculum censorship | Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","S.B.2560","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/25/2024",""
+"Nebraska","L.B.1330","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/18/2024",""
+"Georgia","H.B.1128","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","03/28/2024",""
+"Tennessee","H.B.2935","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","H.B.2669","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/25/2024",""
+"Iowa","H.F.2409","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/20/2024",""
+"Iowa","H.F.2389","Barriers to accurate IDs | Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/20/2024",""
+"West Virginia","H.B.5484","Curriculum censorship | Restricting student & educator rights","Defeated","Legislative session ended","03/09/2024",""
+"Oklahoma","H.B.3219","Barriers to accurate IDs | ","Defeated","Legislative session ended","05/30/2024",""
+"Florida","S.B. 1780","Other civil rights restrictions | Religious exemptions | Weakening Civil Rights Laws","Defeated","Died in committee","03/08/2024",""
+"Oklahoma","H.B.3135","Curriculum censorship | Other anti-LGBTQ bills | Restricting student & educator rights","Defeated","Failed to meet House deadline","02/29/2024",""
+"Oklahoma","H.B.3217","Free speech & expression bans | Other expression restrictions","Defeated","Legislative session ended","05/30/2024",""
+"Oklahoma","H.B.3543","Religious exemptions | Weakening Civil Rights Laws","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Iowa","S.F.2182","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","04/20/2024",""
+"Hawaii","H.B.2731","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","05/03/2024",""
+"Hawaii","H.B.1715","Forced outing in schools | Restricting student & educator rights","Defeated","Legislative session ended","05/03/2024",""
+"West Virginia","H.B.5442","Other school restrictions | Re-definition of sex | Restricting student & educator rights | Weakening Civil Rights Laws","Defeated","Legislative session ended","03/09/2024",""
+"Florida","S.B. 1120","Free speech & expression bans | Other expression restrictions","Defeated","Died in committee","03/08/2024",""
+"Georgia","S.B.438","Restricting student & educator rights | School facilities bans | School sports bans","Defeated","Legislative session ended","03/28/2024",""
+"Missouri","H.B. 1519","Healthcare restrictions | Other healthcare barriers | Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","05/17/2024",""
+"Missouri","H.B. 2355","Forced outing in schools | Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","05/17/2024",""
+"Missouri","H.B. 2357","Forced outing in schools | Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","05/17/2024",""
+"Hawaii","H.B.2708","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","05/03/2024",""
+"Illinois","H.B.4531","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","05/29/2024",""
+"Tennessee","HB 30","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","04/25/2024",""
+"South Carolina","S.B.0975","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","05/09/2024",""
+"New Hampshire","H.B.1011","Healthcare age restrictions | Healthcare restrictions | ","Introduced","Inexpedient to Legislate: MA VV 02/01/2024 HJ 3","02/01/2024",""
+"Utah","H.B.257","Other anti-LGBTQ bills | Public accommodation bans | Re-definition of sex | Restricting student & educator rights | School facilities bans | Weakening Civil Rights Laws","Passed into Law","Governor signed","01/30/2024",""
+"Arizona","S.B.1337","Other anti-LGBTQ bills","Defeated","Legislative session ended","06/15/2024",""
+"Ohio","HB 68","Healthcare age restrictions | Healthcare restrictions | ","Passed into Law","House and Senate override of Governor veto","01/24/2024",""
+"Kentucky","H.B.452","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/15/2024",""
+"New Mexico","H.B. 296","Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","02/15/2024",""
+"Kentucky","H.B.402","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","04/15/2024",""
+"Utah","H.B.261","Other anti-LGBTQ bills","Passed into Law","Governor signed","01/30/2024",""
+"Iowa","S.F.2129","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/20/2024",""
+"Georgia","H.B.1045","Curriculum censorship | Forced outing in schools | Restricting student & educator rights","Defeated","Legislative session ended","03/28/2024",""
+"Illinois","H.B.4302","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","05/29/2024",""
+"West Virginia","H.B.5041","Other anti-LGBTQ bills","Defeated","Legislative session ended","03/09/2024",""
+"Indiana","H.B.1266","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","03/08/2024",""
+"Missouri","S.B. 1256","Forced outing in schools | Other school restrictions | Religious exemptions | Restricting student & educator rights | Weakening Civil Rights Laws","Defeated","Legislative session ended","05/17/2024",""
+"Missouri","S.B. 1234","Other anti-LGBTQ bills","Defeated","Legislative session ended","05/17/2024",""
+"Missouri","S.B. 974","Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","05/17/2024",""
+"Missouri","S.B. 1187","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","05/17/2024",""
+"Missouri","S.B. 1185","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","05/17/2024",""
+"Missouri","S.B. 1314","Other anti-LGBTQ bills","Defeated","Legislative session ended","05/17/2024",""
+"Missouri","S.B. 1246","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","05/17/2024",""
+"Missouri","S.B. 1274","Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","05/17/2024",""
+"Missouri","S.B. 1024","Curriculum censorship | Restricting student & educator rights","Defeated","Legislative session ended","05/17/2024",""
+"West Virginia","H.B.4806","Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","03/09/2024",""
+"Oklahoma","S.B.1883","Religious exemptions | Weakening Civil Rights Laws","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","S.B.1880","Other school restrictions | Restricting student & educator rights","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","S.B.1731","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Missouri","H.B. 1674","Other anti-LGBTQ bills","Defeated","Legislative session ended","05/17/2024",""
+"Missouri","H.B. 2308","Other anti-LGBTQ bills | Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","05/17/2024",""
+"Indiana","S.B.0193","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","03/08/2024",""
+"Iowa","S.S.B.3094","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/20/2024",""
+"Iowa","H.F.2082","Other civil rights restrictions | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/20/2024",""
+"Arizona","H.B.2657","Curriculum censorship | Forced outing in schools | Other anti-LGBTQ bills | Restricting student & educator rights","Defeated","Legislative session ended","06/15/2024",""
+"Arizona","H.B.2655","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","06/15/2024",""
+"Oklahoma","S.B.1891","Barriers to accurate IDs | ","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","S.B.1563","Curriculum censorship | Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","S.B.1777","Healthcare funding restrictions | Healthcare restrictions | ","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","S.B.1981","Curriculum censorship | Restricting student & educator rights","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"Oklahoma","S.B.1730","Healthcare restrictions | Other healthcare barriers","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"West Virginia","H.B.4898","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","03/09/2024",""
+"Kentucky","H.B.390","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/15/2024",""
+"West Virginia","S.B.560","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","03/09/2024",""
+"West Virginia","H.B.5184","Other anti-LGBTQ bills","Defeated","Legislative session ended","03/09/2024",""
+"West Virginia","H.B.5187","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","03/09/2024",""
+"Kentucky","H.B.358","Barriers to accurate IDs | ","Defeated","Legislative session ended","04/15/2024",""
+"Oklahoma","S.B.1831","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"New Mexico","H.B. 205","Other civil rights restrictions | Weakening Civil Rights Laws","Defeated","Legislative session ended","02/15/2024",""
+"Idaho","H.419","Healthcare funding restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","04/10/2024",""
+"Hawaii","H.B.1740","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","05/03/2024",""
+"Maryland","S.B.0381","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","04/08/2024",""
+"Missouri","S.B. 728","Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","05/17/2024",""
+"Iowa","S.F.2055","Public accommodation bans","Defeated","Legislative session ended","04/20/2024",""
+"Arizona","H.B.2391","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","06/15/2024",""
+"Illinois","H.B.4122","Other civil rights restrictions | Weakening Civil Rights Laws","Defeated","Legislative session ended","05/29/2024",""
+"Florida","H.B. 901","Free speech & expression bans | Other expression restrictions","Defeated","Died in committee","03/08/2024",""
+"South Carolina","H.B.4663","Other anti-LGBTQ bills","Defeated","Legislative session ended","05/09/2024",""
+"West Virginia","H.B.5036","Other anti-LGBTQ bills","Defeated","Legislative session ended","03/09/2024",""
+"Kentucky","H.B.49","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/15/2024",""
+"Florida","H.B. 1233","Barriers to accurate IDs | Other anti-LGBTQ bills | Re-definition of sex | Weakening Civil Rights Laws","Defeated","Died in committee","03/08/2024",""
+"Florida","H.B. 1663","Other anti-LGBTQ bills","Defeated","Died in subcommittee","03/08/2024",""
+"Oklahoma","S.B.1303","Other anti-LGBTQ bills","Defeated","Failed to meet Senate deadline","02/29/2024",""
+"West Virginia","H.B.4923","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","03/09/2024",""
+"West Virginia","H.B.4922","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","03/09/2024",""
+"West Virginia","H.B.4857","Healthcare age restrictions | Healthcare funding restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","03/09/2024",""
+"West Virginia","H.B.4884","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","03/09/2024",""
+"Kansas","S.B.353","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","04/30/2024",""
+"South Carolina","S.B.0743","Curriculum censorship | Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","05/09/2024",""
+"New Jersey","A.670","Curriculum censorship | Restricting student & educator rights","Introduced","","01/10/2024",""
+"Kentucky","S.B.93","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","04/15/2024",""
+"Washington","S.B. 6026","Forced outing in schools | Religious exemptions | Restricting student & educator rights | Weakening Civil Rights Laws","Defeated","Legislative session ended","03/07/2024",""
+"Indiana","S.B.0028","Other anti-LGBTQ bills","Defeated","Legislative session ended","03/08/2024",""
+"Rhode Island","S.B.2081","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","06/14/2024",""
+"Illinois","H.B.4096","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","05/29/2024",""
+"Washington","HB 1233","Other anti-LGBTQ bills","Defeated","Legislative session ended","03/07/2024",""
+"Washington","SB 5653","Curriculum censorship | Forced outing in schools | Restricting student & educator rights","Defeated","Legislative session ended","03/07/2024",""
+"Puerto Rico","PS 1345","Religious exemptions | Weakening Civil Rights Laws","Introduced","Carried over","01/08/2024",""
+"Puerto Rico","PC 1887","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","11/19/2024",""
+"Florida","H.B. 599","Other anti-LGBTQ bills | Religious exemptions | Weakening Civil Rights Laws","Defeated","Died in subcommittee","03/08/2024",""
+"Florida","S.B. 1722","Other anti-LGBTQ bills","Defeated","Died in committee","03/08/2024",""
+"Florida","S.B. 1382","Other anti-LGBTQ bills | Religious exemptions | Weakening Civil Rights Laws","Defeated","Died in committee","03/08/2024",""
+"Indiana","H.B.1406","Other anti-LGBTQ bills","Defeated","Legislative session ended","03/08/2024",""
+"Indiana","H.B.1291","Barriers to accurate IDs | Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","03/08/2024",""
+"Missouri","S.B. 868","Forced outing in schools | Other school restrictions | Religious exemptions | Restricting student & educator rights | Weakening Civil Rights Laws","Defeated","Legislative session ended","05/17/2024",""
+"Missouri","S.B. 726","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","05/17/2024",""
+"Missouri","S.B. 776","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","05/17/2024",""
+"Missouri","S.B. 770","Curriculum censorship | Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","05/17/2024",""
+"New Jersey","S.1331","Restricting student & educator rights | School sports bans","Introduced","Pre-filed and referred to committee","01/09/2024",""
+"West Virginia","H.B.4387","Other anti-LGBTQ bills","Defeated","Legislative session ended","03/09/2024",""
+"West Virginia","H.B.4579","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","03/09/2024",""
+"West Virginia","S.B.194","Healthcare age restrictions | Healthcare funding restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","03/09/2024",""
+"West Virginia","H.B.4357","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","03/09/2024",""
+"West Virginia","H.B.4421","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","03/09/2024",""
+"West Virginia","S.B.224","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","03/09/2024",""
+"Washington","H.B. 2241","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","03/07/2024",""
+"Vermont","H 183","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","05/10/2024",""
+"Vermont","H 513","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","05/10/2024",""
+"Tennessee","HB 1411","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","SB 5","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","HB 571","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","HB 1447","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","HB 1414","Curriculum censorship | Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","HB 1378","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","SB 1469","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","SB 841","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","SB 603","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/25/2024",""
+"Tennessee","SB 1117","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","04/25/2024",""
+"South Carolina","HB 3485","Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","05/09/2024",""
+"South Carolina","SB 364","Barriers to accurate IDs | ","Defeated","Legislative session ended","05/09/2024",""
+"South Carolina","HB 3551","Forced outing in schools | Healthcare age restrictions | Healthcare restrictions | Restricting student & educator rights","Defeated","Legislative session ended","05/09/2024",""
+"South Carolina","SB 274","Forced outing in schools | Healthcare age restrictions | Healthcare funding restrictions | Healthcare restrictions | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","05/09/2024",""
+"South Carolina","SB 243","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","05/09/2024",""
+"South Carolina","HB 3466","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","05/09/2024",""
+"South Carolina","HB 3304","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","05/09/2024",""
+"South Carolina","S.J.R.0276","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","05/09/2024",""
+"South Carolina","HB 3616","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","05/09/2024",""
+"South Carolina","HB 3611","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","05/09/2024",""
+"South Carolina","SB 424","Curriculum censorship | Other anti-LGBTQ bills | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","05/09/2024",""
+"South Carolina","H.B.4535","Public accommodation bans | Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","05/09/2024",""
+"South Carolina","HB 3197","Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","05/09/2024",""
+"South Carolina","SB 234","Forced outing in schools | Restricting student & educator rights","Defeated","Legislative session ended","05/09/2024",""
+"South Carolina","HB 3801","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","05/09/2024",""
+"South Carolina","HB 3827","Curriculum censorship | Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","05/09/2024",""
+"South Carolina","SB 585","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","05/09/2024",""
+"South Carolina","SB 623","Barriers to accurate IDs | ","Defeated","Legislative session ended","05/09/2024",""
+"South Carolina","S.J.R.0624","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","05/09/2024",""
+"South Carolina","H.B.4619","Healthcare age restrictions | Healthcare funding restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","05/09/2024",""
+"South Carolina","H.B.4707","Curriculum censorship | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","05/09/2024",""
+"South Carolina","H.B.4538","Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","05/09/2024",""
+"Ohio","HB 6","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","12/19/2024",""
+"Ohio","HB 151","Other anti-LGBTQ bills","Defeated","Legislative session ended","12/19/2024",""
+"Ohio","SB 83","Other anti-LGBTQ bills","Defeated","Legislative session ended","12/19/2024",""
+"Nebraska","LB 371","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","04/18/2024",""
+"Nebraska","LB 810","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/18/2024",""
+"Michigan","H.J.R.E.","Other anti-LGBTQ bills","Introduced","Carried over","01/10/2024",""
+"Michigan","HB 4539","Healthcare age restrictions | Healthcare restrictions | ","Introduced","Carried over","01/10/2024",""
+"Michigan","HB 4075","Religious exemptions | Weakening Civil Rights Laws","Introduced","Carried over","01/10/2024",""
+"Michigan","HB 4195","Restricting student & educator rights | School facilities bans","Introduced","Carried over","01/10/2024",""
+"Michigan","HB 4257","Healthcare age restrictions | Healthcare restrictions | ","Introduced","Carried over","01/10/2024",""
+"Michigan","HB 4345","Religious exemptions | Weakening Civil Rights Laws","Introduced","Carried over","01/10/2024",""
+"Michigan","HB 4540","Healthcare age restrictions | Healthcare restrictions | ","Introduced","Carried over","01/10/2024",""
+"Michigan","HB 4546","Restricting student & educator rights | School sports bans","Introduced","Carried over","01/10/2024",""
+"Kansas","SB 255","Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","04/30/2024",""
+"Kansas","HB 2263","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","04/30/2024",""
+"Kansas","SB 149","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","04/30/2024",""
+"Kansas","SB 201","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","04/30/2024",""
+"Kansas","SB 207","Other school restrictions | Religious exemptions | Restricting student & educator rights | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/30/2024",""
+"Kansas","HB 2404","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/30/2024",""
+"Kansas","SB 12","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","04/30/2024",""
+"Kansas","SB 224","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/20/2024",""
+"Iowa","SF 110","Healthcare funding restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","04/20/2024",""
+"Iowa","SF 83","Curriculum censorship | Restricting student & educator rights","Defeated","Legislative session ended","04/20/2024",""
+"Iowa","SF 129","Forced outing in schools | Healthcare age restrictions | Healthcare restrictions | Other anti-LGBTQ bills | Restricting student & educator rights","Defeated","Legislative session ended","04/20/2024",""
+"Iowa","SF 159","Forced outing in schools | Restricting student & educator rights","Defeated","Legislative session ended","04/20/2024",""
+"Iowa","HF 229","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/20/2024",""
+"Iowa","HF 325","Other civil rights restrictions | Public accommodation bans | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/20/2024",""
+"Iowa","SF 348","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","04/20/2024",""
+"Iowa","SF 212","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/20/2024",""
+"Iowa","HF 508","Other anti-LGBTQ bills | Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/20/2024",""
+"Iowa","HF 482","Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","04/20/2024",""
+"Iowa","HF 9","Forced outing in schools | Restricting student & educator rights","Defeated","Legislative session ended","04/20/2024",""
+"Iowa","HF 190","Other civil rights restrictions | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/20/2024",""
+"Iowa","HSB 222","Curriculum censorship | Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","04/20/2024",""
+"Iowa","HF 8","Curriculum censorship | Restricting student & educator rights","Defeated","Legislative session ended","04/20/2024",""
+"Iowa","HF 348","Curriculum censorship | Restricting student & educator rights","Defeated","Legislative session ended","04/20/2024",""
+"Iowa","HF 616","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/20/2024",""
+"Iowa","HF 180","Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","04/20/2024",""
+"Iowa","SF 297","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/20/2024",""
+"Georgia","SB 141","Forced outing in schools | Healthcare age restrictions | Healthcare restrictions | Restricting student & educator rights","Defeated","Legislative session ended","03/28/2024",""
+"Georgia","HB 653","Forced outing in schools | Healthcare age restrictions | Healthcare restrictions | Restricting student & educator rights","Defeated","Legislative session ended","03/28/2024",""
+"Alaska","HB 27","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","05/15/2024",""
+"Alaska","SB 96","Curriculum censorship | Other school restrictions | Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","05/15/2024",""
+"Illinois","H.B.4355","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","05/29/2024",""
+"Hawaii","HB 508","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","05/03/2024",""
+"Hawaii","HB 509","Curriculum censorship | Restricting student & educator rights","Defeated","Legislative session ended","05/03/2024",""
+"Hawaii","SB 1429","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","05/03/2024",""
+"Hawaii","SB 1428","Curriculum censorship | Forced outing in schools | Restricting student & educator rights","Defeated","Legislative session ended","05/03/2024","https://clearinghouse.net/case/4419"
+"Hawaii","HB 891","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","05/03/2024",""
+"Minnesota","SF 934","Restricting student & educator rights | School facilities bans | School sports bans","Defeated","Legislative session ended","05/20/2024",""
+"Minnesota","HF 3022","Curriculum censorship | Forced outing in schools | Restricting student & educator rights","Defeated","Legislative session ended","05/20/2024",""
+"Minnesota","SF 3272","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","05/20/2024",""
+"Minnesota","HF 551","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","05/20/2024",""
+"Minnesota","SF 724","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","05/20/2024",""
+"Minnesota","HF 1086","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","05/20/2024",""
+"Minnesota","SF 933","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","05/20/2024",""
+"Minnesota","HF 1903","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","05/20/2024",""
+"Minnesota","HF 3264","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","05/20/2024",""
+"Minnesota","SF 3280","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","05/20/2024",""
+"North Carolina","H 43","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","12/13/2024",""
+"North Carolina","S 560","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","12/13/2024",""
+"North Carolina","S 641","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","12/13/2024",""
+"North Carolina","H 786","Forced outing in schools | Healthcare age restrictions | Healthcare funding restrictions | Healthcare restrictions | Restricting student & educator rights","Defeated","Legislative session ended","12/13/2024",""
+"North Carolina","H 819","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","12/13/2024",""
+"North Carolina","S 636","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","12/13/2024",""
+
+Data is current as of December 6 2024 
diff --git a/assets/data-leg/ACLU_2025.csv b/assets/data-leg/ACLU_2025.csv
new file mode 100644
index 00000000..dfd4b9a4
--- /dev/null
+++ b/assets/data-leg/ACLU_2025.csv
@@ -0,0 +1,564 @@
+State,Bill Name,Issues,Status,Status Detail,Status Date,In Court Link
+"Pennsylvania","S.B.9","Restricting student & educator rights | School sports bans","Advancing","Passed Senate; House re-referred to committee","07/09/2025",""
+"Oregon","H.B.2439","Other anti-LGBTQ bills | Other civil rights restrictions | Weakening Civil Rights Laws","Defeated","Legislative session ended","06/27/2025",""
+"Oregon","H.B.2037","Restricting student & educator rights | School facilities bans | School sports bans","Defeated","Legislative session ended","06/27/2025",""
+"Oregon","S.B.787","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","06/27/2025",""
+"Oregon","S.B.618","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","06/27/2025",""
+"Oregon","S.B.899","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","06/27/2025",""
+"Oregon","H.B.3330","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","06/27/2025",""
+"Oregon","S.B.1100","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","06/27/2025",""
+"Oregon","H.B.3740","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","06/27/2025",""
+"North Carolina","S442","Healthcare restrictions | Other healthcare barriers","Passed into Law","Governor signed","07/03/2025",""
+"New Jersey","A.775","Restricting student & educator rights | School sports bans","Advancing","Motion to table prevailed","06/30/2025",""
+"New Hampshire","H.B.148","Other civil rights restrictions | Weakening Civil Rights Laws","Advancing","Passed House and Senate; Senate ordered enrolled","07/02/2025",""
+"Massachusetts","H.551","Curriculum censorship | Forced outing in schools | Restricting student & educator rights","Advancing","Hearing scheduled from 11:00 AM-05:00 PM","07/21/2025",""
+"Maine","L.D. 868 (H.P. 554)","Restricting student & educator rights | School facilities bans | School sports bans","Defeated","House and Senate concurred ought not to pass","06/16/2025",""
+"Maine","L.D. 1337 (H.P. 872)","Other civil rights restrictions | Restricting student & educator rights | School sports bans | Weakening Civil Rights Laws","Defeated","House and Senate concurred ought not to pass","06/16/2025",""
+"Maine","L.D. 233 (H.P. 156)","Restricting student & educator rights | School sports bans","Defeated","Died between houses, ought not to pass","06/17/2025",""
+"Texas","S.B. 12","Other anti-LGBTQ bills | Other school restrictions | Restricting student & educator rights","Passed into Law","Governor signed","06/20/2025",""
+"Texas","H.B. 229","Other anti-LGBTQ bills","Passed into Law","Governor signed","06/20/2025",""
+"Texas","S.B. 1188","Other anti-LGBTQ bills","Passed into Law","Governor signed","06/20/2025",""
+"New Hampshire","H.B.712","Healthcare age restrictions | Healthcare restrictions | ","Advancing","Conference committee report adopted by House and Senate","06/26/2025",""
+"New Hampshire","H.B.377","Healthcare age restrictions | Healthcare restrictions | ","Advancing","Conference committee report adopted by House and Senate","06/26/2025",""
+"Iowa","S.F.220","Healthcare restrictions | Other healthcare barriers | Religious exemptions | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","05/14/2025",""
+"Florida","H.B. 731","Other anti-LGBTQ bills","Defeated","Legislative session adjourned","06/16/2025",""
+"Florida","H.B. 75","Free speech & expression bans | Other expression restrictions | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session adjourned","06/16/2025",""
+"Florida","S.B. 440","Other anti-LGBTQ bills | Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session adjourned","06/16/2025",""
+"Florida","S.B. 1710","Other anti-LGBTQ bills","Defeated","Legislative session adjourned","06/16/2025",""
+"Florida","H.B. 1307","Restricting student & educator rights | School facilities bans","Defeated","Legislative session adjourned","06/16/2025",""
+"Florida","H.B. 1495","Other anti-LGBTQ bills | Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session adjourned","06/16/2025",""
+"North Dakota","H.B. 1144","Restricting student & educator rights | School facilities bans","Passed into Law","Governor signed","05/02/2025",""
+"Nebraska","L.B.89","Public accommodation bans | Re-definition of sex | Restricting student & educator rights | School sports bans | Weakening Civil Rights Laws","Passed into Law","Governor signed","06/06/2025",""
+"Montana","H.B. 819","Free speech & expression bans | Other expression restrictions | Other school restrictions | Restricting student & educator rights","Passed into Law","Governor signed","05/13/2025",""
+"Missouri","S.B. 10","Healthcare age restrictions | Healthcare restrictions | Restricting student & educator rights | School sports bans","Advancing","Added to House Informal Calendar for third reading","06/11/2025",""
+"Maine","L.D. 1134 (S.P. 461)","Restricting student & educator rights | School sports bans","Defeated","House and Senate concurred ought not to pass","06/13/2025",""
+"Oklahoma","H.B.1224","Religious exemptions | Weakening Civil Rights Laws","Advancing","Did not meet passage requirements, dormant until carried over","05/30/2025",""
+"Nevada","A.B.56","Healthcare restrictions | Other healthcare barriers","Passed into Law","Governor signed","05/26/2025",""
+"Montana","S.B. 240","Other anti-LGBTQ bills","Defeated","Died in process","05/23/2025",""
+"Montana","S.B. 164","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Died in process","05/23/2025",""
+"Wisconsin","S.B.146","Barriers to accurate IDs | ","Advancing","Senate passed; House first read and referred to committee","05/27/2025",""
+"Wisconsin","A.B.124","Barriers to accurate IDs | ","Advancing","Reported favorably by committee as amended and re-referred to committee","05/29/2025",""
+"Texas","S.B. 1999","Other anti-LGBTQ bills | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","06/02/2025",""
+"Texas","S.B. 1073","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","06/02/2025",""
+"Texas","S.B. 2920","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","06/02/2025",""
+"Montana","S.B. 299","Forced outing in schools | Restricting student & educator rights","Advancing","House tabled in committee; died in Senate committee","05/23/2025",""
+"Michigan","H.B.4066","Restricting student & educator rights | School sports bans","Advancing","Passed House; Senate referred to committee","05/29/2025",""
+"Iowa","S.F.507","Other anti-LGBTQ bills","Advancing","Legislative session adjourned, carries over to 2026","05/14/2025",""
+"Iowa","H.F.856","Other anti-LGBTQ bills","Passed into Law","Governor signed","05/27/2025",""
+"West Virginia","S.B.154","Forced outing in schools | Restricting student & educator rights","Passed into Law","Governor signed","04/30/2025",""
+"West Virginia","S.B.474","Other school restrictions | Restricting student & educator rights","Passed into Law","Governor signed","04/30/2025",""
+"West Virginia","S.B.299","Healthcare age restrictions | Healthcare restrictions | ","Passed into Law","Governor signed","04/30/2025",""
+"Texas","S.B. 689","Other anti-LGBTQ bills","Defeated","Legislative session ended","06/02/2025",""
+"Tennessee","S.B.0937","Other anti-LGBTQ bills | Other school restrictions | Restricting student & educator rights","Passed into Law","Governor signed","05/09/2025",""
+"Tennessee","H.B.1270","Other anti-LGBTQ bills | Other school restrictions | Restricting student & educator rights","Advancing","Companion bill became law","05/15/2025",""
+"Rhode Island","S.B.305","Healthcare restrictions | Other healthcare barriers | Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session adjourned","06/20/2025",""
+"Oklahoma","S.B.658","Religious exemptions | Weakening Civil Rights Laws","Passed into Law","Governor signed","05/10/2025",""
+"Oklahoma","S.B.418","Other anti-LGBTQ bills","Passed into Law","Governor signed","05/13/2025",""
+"Montana","H.B. 734","Other school restrictions | Restricting student & educator rights","Defeated","Died in Process","05/20/2025",""
+"Montana","H.B. 730","Healthcare restrictions | Other healthcare barriers","Defeated","Died in process","05/20/2025",""
+"Montana","H.B. 754","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Died in process","05/20/2025",""
+"Montana","H.B. 675","Drag bans | Free speech & expression bans | ","Defeated","Died in process","05/20/2025",""
+"Montana","H.B. 635","Other anti-LGBTQ bills","Defeated","Died in process","05/20/2025",""
+"Montana","H.B. 682","Healthcare restrictions | Other healthcare barriers","Passed into Law","Signed by Governor","05/13/2025",""
+"Montana","H.B. 690","Healthcare restrictions | Other healthcare barriers","Passed into Law","Governor signed","05/13/2025",""
+"Georgia","S.B.1","Restricting student & educator rights | School facilities bans | School sports bans","Passed into Law","Governor signed","04/28/2025",""
+"West Virginia","S.B.456","Other civil rights restrictions | Re-definition of sex | Restricting student & educator rights | School facilities bans | Weakening Civil Rights Laws","Passed into Law","Governor signed","03/18/2025",""
+"Texas","H.B. 2354","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 2969","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","06/02/2025",""
+"Texas","S.B. 619","Healthcare restrictions | Other healthcare barriers | Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 437","Other anti-LGBTQ bills","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 370","Other anti-LGBTQ bills","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 1655","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","06/02/2025",""
+"Texas","S.B. 2943","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","06/02/2025",""
+"Oklahoma","H.B.1688","Barriers to accurate IDs | ","Passed into Law","Become law without Governor's signature","05/06/2025",""
+"Ohio","H.B.172","Healthcare age restrictions | Healthcare restrictions | ","Advancing","Committee hearing","05/21/2025",""
+"North Carolina","H606","Healthcare restrictions | Other healthcare barriers","Advancing","House passed; Senate first read and referred to committee","05/07/2025",""
+"North Carolina","H560","Healthcare restrictions | Other healthcare barriers","Advancing","Re-referred to committee","05/12/2025",""
+"New Hampshire","S.B.211","Restricting student & educator rights | School facilities bans | School sports bans","Advancing","Senate passed; House executive session scheduled","05/20/2025",""
+"Montana","S.B. 218","Healthcare restrictions | Other healthcare barriers","Passed into Law","Governor signed","05/08/2025",""
+"Missouri","H.B. 1362","Barriers to accurate IDs | ","Advancing","Referred to committee","04/29/2025",""
+"Missouri","H.B. 156","Re-definition of sex | Weakening Civil Rights Laws","Advancing","Referred to committee","05/15/2025",""
+"Missouri","H.B. 722","Drag bans | Free speech & expression bans | ","Advancing","Referred to committee","05/15/2025",""
+"Missouri","H.B. 157","Barriers to accurate IDs | ","Advancing","Referred to committee","05/15/2025",""
+"Missouri","H.B. 1053","Re-definition of sex | Weakening Civil Rights Laws","Advancing","Referred to committee","05/15/2025",""
+"Missouri","H.B. 76","Re-definition of sex | Weakening Civil Rights Laws","Advancing","Referred to committee","05/15/2025",""
+"Missouri","H.B. 1354","Restricting student & educator rights | School facilities bans | School sports bans","Advancing","Referred to committee","05/15/2025",""
+"Missouri","H.B. 1085","Curriculum censorship | Forced outing in schools | Free speech & expression bans | Other expression restrictions | Other school restrictions | Restricting student & educator rights","Advancing","Referred to committee","05/15/2025",""
+"Missouri","H.B. 1144","Healthcare restrictions | Other healthcare barriers","Advancing","Referred to committee","05/15/2025",""
+"Missouri","H.B. 562","Other anti-LGBTQ bills","Advancing","Referred to committee","05/15/2025",""
+"Missouri","H.B. 38","Other school restrictions | Religious exemptions | Restricting student & educator rights | Weakening Civil Rights Laws","Advancing","Referred to committee","05/15/2025",""
+"Massachusetts","S.350","Restricting student & educator rights | School sports bans","Advancing","Joint hearing scheduled","05/06/2025",""
+"Massachusetts","H.584","Restricting student & educator rights | School sports bans","Advancing","Joint hearing scheduled","05/06/2025",""
+"Indiana","H.B.1412","Healthcare restrictions | Other healthcare barriers","Passed into Law","Governor signed","05/01/2025",""
+"Georgia","S.B.185","Healthcare restrictions | Prison healthcare restrictions","Passed into Law","Governor signed","05/08/2025",""
+"Arkansas","H.B.1684","Forced outing in schools | Restricting student & educator rights","Defeated","Legislative session ended","04/16/2025",""
+"Arkansas","S.B.362","Other anti-LGBTQ bills","Advancing","Senate passed; House third reading failed","04/16/2025",""
+"Arizona","H.B.2438","Barriers to accurate IDs | ","Advancing","Vetoed by Governor","05/02/2025",""
+"Arizona","S.B.1586","Healthcare restrictions | Other healthcare barriers","Advancing","Vetoed by Governor","05/12/2025",""
+"Arizona","H.B.2868","Other anti-LGBTQ bills","Advancing","Vetoed by Governor","05/13/2025",""
+"Alabama","H.B.246","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","05/14/2025",""
+"Alabama","H.B.67","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","05/14/2025",""
+"Alabama","H.B.244","Curriculum censorship | Free speech & expression bans | Other expression restrictions | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","05/14/2025",""
+"Texas","H.B. 1088","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 4503","Other anti-LGBTQ bills","Defeated","Legislative session ended","06/02/2025",""
+"Texas","S.B. 240","Public accommodation bans","Defeated","Legislative session ended","06/02/2025",""
+"Texas","S.B. 2826","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","06/02/2025",""
+"Tennessee","H.B.1044","Healthcare restrictions | Other healthcare barriers | Religious exemptions | Weakening Civil Rights Laws","Advancing","Companion bill S.B.0955 became law","04/29/2025",""
+"Tennessee","S.B.0955","Healthcare restrictions | Other healthcare barriers | Religious exemptions | Weakening Civil Rights Laws","Passed into Law","Governor signed","04/24/2025",""
+"Montana","H.B. 400","Other anti-LGBTQ bills | Other school restrictions | Restricting student & educator rights","Advancing","Passed House and Senate and transmitted to Governor","04/25/2025",""
+"Massachusetts","H.D.4542","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Advancing","Referred to committee","04/14/2025",""
+"Massachusetts","H.737","Restricting student & educator rights | School sports bans","Advancing","Joint hearing scheduled for 01:00 PM","05/06/2025",""
+"Wisconsin","A.B.58","Free speech & expression bans | Other expression restrictions | Other school restrictions | Restricting student & educator rights","Advancing","Referred to committee","04/23/2025",""
+"Rhode Island","H.B.5842","Restricting student & educator rights | School sports bans","Defeated","Legislative session adjourned","06/20/2025",""
+"Ohio","H.B.190","Forced outing in schools | Other school restrictions | Restricting student & educator rights","Advancing","First read and referred to committee","04/29/2025",""
+"New Hampshire","S.B.268","Healthcare age restrictions | Healthcare restrictions | Other civil rights restrictions | Weakening Civil Rights Laws","Advancing","Senate passed; House retained in committee","04/24/2025",""
+"Montana","S.B. 437","Barriers to accurate IDs | Other anti-LGBTQ bills | Other school restrictions | Re-definition of sex | Restricting student & educator rights | Weakening Civil Rights Laws","Advancing","Signed by Senate President","04/21/2025",""
+"Montana","H.B. 655","Religious exemptions | Weakening Civil Rights Laws","Advancing","Passed House and Senate; transmitted to Governor","04/22/2025",""
+"Montana","H.B. 471","Curriculum censorship | Restricting student & educator rights","Advancing","Passed House and Senate; transmitted to Governor","04/22/2025",""
+"Arkansas","H.B.1615","Healthcare restrictions | Other healthcare barriers | Religious exemptions | Weakening Civil Rights Laws","Passed into Law","Governor signed","04/16/2025",""
+"Arkansas","S.B.486","Other anti-LGBTQ bills | Public accommodation bans | Restricting student & educator rights | School facilities bans","Passed into Law","Governor signed","04/22/2025",""
+"Arkansas","S.B.444","Healthcare restrictions | Other healthcare barriers","Passed into Law","Governor signed","04/22/2025",""
+"Arkansas","H.B.1916","Healthcare age restrictions | Healthcare restrictions | ","Passed into Law","Governor signed","04/22/2025",""
+"Texas","S.B. 406","Barriers to accurate IDs | ","Defeated","Legislative session ended","06/02/2025",""
+"Tennessee","H.B.0571","Other anti-LGBTQ bills | Other civil rights restrictions | Re-definition of sex | Restricting student & educator rights | School facilities bans | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","04/22/2025",""
+"Tennessee","S.B.0676","Healthcare restrictions | Other healthcare barriers","Advancing","Legislative session adjourned, carries over to 2026","04/22/2025",""
+"Tennessee","S.B.0468","Other anti-LGBTQ bills | Other civil rights restrictions | Re-definition of sex | Restricting student & educator rights | School facilities bans | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","04/22/2025",""
+"South Carolina","S.B.0054","Healthcare restrictions | Other healthcare barriers | Religious exemptions | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","05/28/2025",""
+"Nevada","A.B.240","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","06/02/2025",""
+"Nevada","S.B.112","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","06/02/2025",""
+"Montana","H.B. 121","Other anti-LGBTQ bills | Public accommodation bans | Restricting student & educator rights | School facilities bans","Passed into Law","Signed by Governor","03/27/2025",""
+"Minnesota","H.F.3170","Restricting student & educator rights | School sports bans","Advancing","Legislative session adjourned, carries over to 2026","05/19/2025",""
+"Louisiana","H.B.418","Other anti-LGBTQ bills","Defeated","Legislative session ended","06/12/2025",""
+"Kentucky","H.B.501","Healthcare age restrictions | Healthcare restrictions | ","Passed into Law","Became law without Governor's signature","04/10/2025",""
+"Indiana","H.B.1041","Restricting student & educator rights | School sports bans","Passed into Law","Signed by the Governor","04/16/2025",""
+"Illinois","S.B.1226","Restricting student & educator rights | School facilities bans","Advancing","Legislative session adjourned, carries over to 2026","05/31/2025",""
+"Idaho","H.239","Curriculum censorship | Restricting student & educator rights","Passed into Law","Governor signed","03/31/2025",""
+"Idaho","H.352","Curriculum censorship | Restricting student & educator rights","Passed into Law","Governor signed","03/31/2025",""
+"California","S.B.311","Other anti-LGBTQ bills","Advancing","Hearing scheduled","04/29/2025",""
+"Alaska","H.B. 40","Restricting student & educator rights | School sports bans","Advancing","Legislative session adjourned, carries over to 2026","05/20/2025",""
+"South Carolina","S.B.0540","Healthcare restrictions | Other anti-LGBTQ bills | Other healthcare barriers | Religious exemptions | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","05/28/2025",""
+"Mississippi","S.B. 2386","Healthcare funding restrictions | Healthcare restrictions | ","Advancing","Passed Senate and House; due from Governor","04/24/2025",""
+"Texas","S.B. 86","Curriculum censorship | Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","06/02/2025",""
+"Texas","S.B. 983","Curriculum censorship | Restricting student & educator rights","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 5541","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 5593","Other anti-LGBTQ bills","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 5135","Other anti-LGBTQ bills","Defeated","Legislative session ended","06/02/2025",""
+"Tennessee","H.B.0754","Healthcare restrictions | Other healthcare barriers","Advancing","Legislative session adjourned, carries over to 2026","04/22/2025",""
+"Tennessee","S.B.0472","Restricting student & educator rights | School facilities bans","Advancing","Companion bill passed into law","04/04/2025",""
+"Tennessee","H.B.0064","Restricting student & educator rights | School facilities bans","Passed into Law","Signed by Governor","04/03/2025",""
+"South Carolina","H.B.3927","Other anti-LGBTQ bills | Other school restrictions | Restricting student & educator rights","Advancing","Legislative session adjourned, carries over to 2026","05/28/2025",""
+"Puerto Rico","P.S.0001","Religious exemptions | Weakening Civil Rights Laws","Advancing","Passed House and Senate; signed by House President","04/10/2025",""
+"North Carolina","H776","Religious exemptions | Weakening Civil Rights Laws","Advancing","First read and referred to committee","04/07/2025",""
+"North Carolina","H791","Barriers to accurate IDs | Re-definition of sex | Restricting student & educator rights | School facilities bans | Weakening Civil Rights Laws","Advancing","First read and referred to committee","04/08/2025",""
+"Mississippi","H.B. 1193","Curriculum censorship | Restricting student & educator rights","Advancing","House and Senate passed; due from Governor","04/24/2025",""
+"Kentucky","H.B.4","Other school restrictions | Restricting student & educator rights","Passed into Law","House and Senate override of Governor's veto","03/27/2025",""
+"Kansas","H.B.2311","Religious exemptions | Weakening Civil Rights Laws","Passed into Law","House and Senate override of Governor's veto","04/10/2025",""
+"Iowa","S.F.473","Religious exemptions | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","05/14/2025",""
+"Illinois","H.B.4030","Re-definition of sex | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","05/31/2025",""
+"Idaho","S.1027","Other anti-LGBTQ bills","Passed into Law","Governor signed","03/24/2025",""
+"Idaho","S.1198","Other anti-LGBTQ bills","Passed into Law","Governor signed","04/04/2025",""
+"Georgia","S.B.30","Healthcare age restrictions | Healthcare restrictions | ","Advancing","Legislative session adjourned, carries over to 2026","04/04/2025",""
+"Georgia","S.B.39","Healthcare funding restrictions | Healthcare restrictions | Other healthcare barriers | Prison healthcare restrictions","Advancing","Legislative session adjourned, carries over to 2026","04/04/2025",""
+"Georgia","S.B.36","Religious exemptions | Weakening Civil Rights Laws","Passed into Law","Governor signed","04/04/2025",""
+"Arkansas","H.B.1669","Religious exemptions | Weakening Civil Rights Laws","Passed into Law","Governor signed","04/10/2025",""
+"Wyoming","H.B.0032","Re-definition of sex | Weakening Civil Rights Laws","Passed into Law","Became law without Governor's signature","03/14/2025",""
+"Wyoming","H.B.0164","Healthcare age restrictions | Healthcare restrictions | ","Passed into Law","Governor signed","03/19/2025",""
+"Wisconsin","A.B.100","Restricting student & educator rights | School facilities bans | School sports bans","Advancing","House passed; Senate first read and referred to committee","03/21/2025",""
+"Wisconsin","A.B.102","Restricting student & educator rights | School facilities bans | School sports bans","Advancing","House passed; Senate first read and referred to committee","03/21/2025",""
+"Wisconsin","A.B.103","Other school restrictions | Restricting student & educator rights","Advancing","House passed; Senate first read and referred to committee","03/21/2025",""
+"Wisconsin","A.B.104","Healthcare age restrictions | Healthcare restrictions | ","Advancing","House passed; Senate first read and referred to committee","03/27/2025",""
+"West Virginia","S.B.663","Other anti-LGBTQ bills","Advancing","Legislative session adjourned, carries over to 2026","04/12/2025",""
+"Utah","H.B.283","Healthcare age restrictions | Healthcare restrictions | Other anti-LGBTQ bills","Passed into Law","Governor signed","03/19/2025",""
+"Utah","H.B.252","Healthcare restrictions | Other anti-LGBTQ bills | Prison healthcare restrictions","Passed into Law","Governor signed","03/19/2025",""
+"Utah","S.B.74","Barriers to accurate IDs | ","Passed into Law","Governor signed","03/25/2025",""
+"Utah","H.B.77","Free speech & expression bans | Other expression restrictions | Other school restrictions | Restricting student & educator rights","Passed into Law","Became law without Governor's signature","03/27/2025",""
+"Texas","S.B. 1565","Other anti-LGBTQ bills | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 436","Other anti-LGBTQ bills","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 1704","Forced outing in schools | Restricting student & educator rights","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 2291","Barriers to accurate IDs | ","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 2342","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 2258","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 2062","Public accommodation bans | Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","06/02/2025",""
+"Texas","S.B. 810","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 2549","Barriers to accurate IDs | ","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 2548","Curriculum censorship | Restricting student & educator rights","Defeated","Legislative session ended","06/02/2025",""
+"Texas","S.B. 1953","Barriers to accurate IDs | ","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 2704","Other anti-LGBTQ bills | Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 2846","Curriculum censorship | Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 2816","Healthcare restrictions | Other healthcare barriers | Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 3075","Other anti-LGBTQ bills","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 3186","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 3431","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 3427","Other anti-LGBTQ bills","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 3399","Healthcare funding restrictions | Healthcare restrictions | Total healthcare bans","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 3411","Curriculum censorship | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 3478","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 3548","Curriculum censorship | Restricting student & educator rights","Defeated","Legislative session ended","06/02/2025",""
+"Texas","S.B. 2149","Other anti-LGBTQ bills","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 3616","Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 3817","Other anti-LGBTQ bills","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 3842","Free speech & expression bans | Other expression restrictions | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 3742","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 4002","Curriculum censorship | Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 4001","Barriers to accurate IDs | Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 4333","Other anti-LGBTQ bills","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 4311","Other anti-LGBTQ bills","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 4425","Free speech & expression bans | Other anti-LGBTQ bills | Other expression restrictions","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 4710","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 2339","Curriculum censorship | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","06/02/2025",""
+"Tennessee","H.B.1262","Other school restrictions | Restricting student & educator rights","Advancing","Legislative session adjourned, carries over to 2026","04/22/2025",""
+"Tennessee","H.B.1271","Re-definition of sex | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","04/22/2025",""
+"Tennessee","S.B.1252","Other school restrictions | Restricting student & educator rights","Advancing","Legislative session adjourned, carries over to 2026","04/22/2025",""
+"South Dakota","H.B.1259","Public accommodation bans | Restricting student & educator rights | School facilities bans","Passed into Law","Signed by Governor","03/31/2025",""
+"North Dakota","S.B. 2244","Curriculum censorship | Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","05/02/2025",""
+"New Jersey","S.419","Other school restrictions | Restricting student & educator rights","Introduced","Carried over","01/14/2025",""
+"New Jersey","A.2720","Other school restrictions | Restricting student & educator rights","Introduced","Carried over","01/14/2025",""
+"New Hampshire","H.B.620","Religious exemptions | Weakening Civil Rights Laws","Advancing","Laid on table","03/27/2025",""
+"New Hampshire","S.B.38","Other civil rights restrictions | Weakening Civil Rights Laws","Advancing","Pending motion Ought to Pass","03/27/2025",""
+"Montana","H.B. 300","Restricting student & educator rights | School facilities bans | School sports bans","Passed into Law","Signed by Governor","03/27/2025",""
+"Missouri","S.B. 704","Healthcare restrictions | Other healthcare barriers","Advancing","Second read and referred to committee","03/24/2025",""
+"Missouri","S.B. 764","Drag bans | Free speech & expression bans | ","Advancing","Second read and referred to committee","03/27/2025",""
+"Missouri","S.B. 769","Other anti-LGBTQ bills","Advancing","Second read and referred to committee","03/27/2025",""
+"Missouri","S.B. 272","Other anti-LGBTQ bills","Advancing","Reported favorably by committee","04/02/2025",""
+"Mississippi","H.B. 1609","Other anti-LGBTQ bills","Defeated","Died in committee","02/04/2025",""
+"Mississippi","H.B. 1416","Other anti-LGBTQ bills","Defeated","Died in committee","02/04/2025",""
+"Mississippi","S.B. 2223","Other anti-LGBTQ bills","Defeated","Died in committee","02/04/2025",""
+"Mississippi","S.B. 2867","Healthcare funding restrictions | Healthcare restrictions | ","Advancing","Governor's veto referred to committee","03/28/2025",""
+"Kentucky","S.B.2","Healthcare restrictions | Prison healthcare restrictions","Passed into Law","Became law without Governor's signature","03/27/2025",""
+"Kansas","S.B.76","Other school restrictions | Restricting student & educator rights","Advancing","Senate passed; Stricken from House calendar","03/21/2025",""
+"Iowa","H.F.571","Healthcare restrictions | Other healthcare barriers | Religious exemptions | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","05/14/2025",""
+"Iowa","H.F.922","Other anti-LGBTQ bills","Advancing","Legislative session adjourned, carries over to 2026","05/14/2025",""
+"Idaho","H.264","Other anti-LGBTQ bills | Restricting student & educator rights | School facilities bans","Passed into Law","Governor signed","04/02/2025",""
+"Idaho","H.59","Healthcare restrictions | Other healthcare barriers | Religious exemptions | Weakening Civil Rights Laws","Passed into Law","Governor signed","03/20/2025",""
+"Idaho","H.41","Free speech & expression bans | Other expression restrictions | Other school restrictions | Restricting student & educator rights","Passed into Law","Governor signed","03/20/2025",""
+"Florida","S.B. 100","Free speech & expression bans | Other expression restrictions | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session adjourned","06/16/2025",""
+"California","A.B.89","Restricting student & educator rights | School sports bans","Defeated","Failed in committee ","04/02/2025",""
+"California","A.B.844","Restricting student & educator rights | School facilities bans | School sports bans","Defeated","Failed in committee","04/01/2025",""
+"Arkansas","H.B.1307","Other anti-LGBTQ bills","Passed into Law","Governor signed","03/18/2025",""
+"Arkansas","H.B.1668","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","04/16/2025",""
+"Arizona","H.B.2062","Re-definition of sex | Weakening Civil Rights Laws","Advancing","Senate consent","03/18/2025",""
+"Arizona","S.B.1002","Other school restrictions | Religious exemptions | Restricting student & educator rights | Weakening Civil Rights Laws","Advancing","Senate passed; House reported favorably by committee","03/25/2025",""
+"Wisconsin","S.B.157","Healthcare age restrictions | Healthcare restrictions | ","Advancing","First read and referred to committee","03/27/2025",""
+"West Virginia","S.B.841","Curriculum censorship | Healthcare funding restrictions | Healthcare restrictions | Other anti-LGBTQ bills | Restricting student & educator rights","Advancing","Legislative session adjourned, carries over to 2026","04/12/2025",""
+"Texas","S.B. 2714","Curriculum censorship | Restricting student & educator rights","Defeated","Legislative session ended","06/02/2025",""
+"South Carolina","H.B.4302","Other anti-LGBTQ bills","Advancing","Legislative session adjourned, carries over to 2026","05/28/2025",""
+"Pennsylvania","H.B.987","Other anti-LGBTQ bills","Advancing","Referred to committee","03/24/2025",""
+"Pennsylvania","H.B.1033","Healthcare age restrictions | Healthcare restrictions | ","Advancing","Referred to committee","03/24/2025",""
+"North Carolina","S516","Barriers to accurate IDs | Other anti-LGBTQ bills | Re-definition of sex | Restricting student & educator rights | School facilities bans | Weakening Civil Rights Laws","Advancing","First read and referred to committee","03/26/2025",""
+"North Carolina","H595","Curriculum censorship | Other anti-LGBTQ bills | Restricting student & educator rights","Advancing","First read and referred to committee","04/01/2025",""
+"Minnesota","S.F.2817","Restricting student & educator rights | School sports bans","Advancing","Legislative session adjourned, carries over to 2026","05/19/2025",""
+"Minnesota","H.F.2685","Restricting student & educator rights | School sports bans","Advancing","Legislative session adjourned, carries over to 2026","05/19/2025",""
+"Kentucky","H.B.495","Healthcare funding restrictions | Healthcare restrictions | ","Passed into Law","House and Senate override of Governor's veto","03/27/2025",""
+"Illinois","H.B.4027","Restricting student & educator rights | School sports bans","Advancing","Legislative session adjourned, carries over to 2026","05/31/2025",""
+"Georgia","S.B.341","Other anti-LGBTQ bills","Advancing","Legislative session adjourned, carries over to 2026","04/04/2025",""
+"Georgia","H.B.127","Other anti-LGBTQ bills","Advancing","House passed; Senate passed as substituted","04/02/2025",""
+"Connecticut","S.B.1509","Other anti-LGBTQ bills","Defeated","Legislative session adjourned","06/04/2025",""
+"Wyoming","S.F.0044","Restricting student & educator rights | School sports bans","Passed into Law","Governor signed","03/13/2025",""
+"Wisconsin","S.B.120","Other school restrictions | Restricting student & educator rights","Advancing","Amendment offered","03/12/2025",""
+"Utah","S.B.320","Healthcare restrictions | Other healthcare barriers | Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","03/07/2025",""
+"Utah","H.B.413","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","03/07/2025",""
+"Utah","H.B.250","Other school restrictions | Religious exemptions | Restricting student & educator rights | Weakening Civil Rights Laws","Defeated","Legislative session ended","03/07/2025",""
+"Utah","H.B.401","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","03/07/2025",""
+"Texas","S.B. 1696","Barriers to accurate IDs | ","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 1521","Other anti-LGBTQ bills","Defeated","Legislative session ended","06/02/2025",""
+"Tennessee","S.B.0936","Re-definition of sex | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","04/22/2025",""
+"Missouri","S.B. 588","Other anti-LGBTQ bills","Advancing","Second read and referred to committee","03/13/2025",""
+"Missouri","S.B. 632","Public accommodation bans","Advancing","Second read and referred to committee","03/13/2025",""
+"Missouri","S.B. 597","Public accommodation bans | Restricting student & educator rights | School facilities bans","Advancing","Second read and referred to committee","03/13/2025",""
+"Missouri","S.B. 595","Restricting student & educator rights | School sports bans","Advancing","Second read and referred to committee","03/13/2025",""
+"Mississippi","S.B. 2515","Other anti-LGBTQ bills","Defeated","Died on calendar","03/12/2025",""
+"Mississippi","H.B. 188","Other anti-LGBTQ bills","Passed into Law","Signed by Governor","03/18/2025",""
+"Minnesota","H.F.1233","Restricting student & educator rights | School sports bans","Advancing","Legislative session adjourned, carries over to 2026","05/19/2025",""
+"Kentucky","S.B.132","Healthcare restrictions | Other healthcare barriers | Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","03/28/2025",""
+"Iowa","H.F.594","Other anti-LGBTQ bills","Advancing","Renumbered as HF 922; legislative session adjourned, carries over to 2026","05/14/2025",""
+"Colorado","HB25-1253","Forced outing in schools | Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers | Restricting student & educator rights","Defeated","Legislative session ended","05/07/2025",""
+"Arizona","S.B.1003","Restricting student & educator rights | School facilities bans","Advancing","Senate passed; House committee reported withdrawn","03/12/2025",""
+"West Virginia","H.B.3319","Other anti-LGBTQ bills | Other school restrictions | Restricting student & educator rights","Advancing","Legislative session adjourned, carries over to 2026","04/12/2025",""
+"Minnesota","S.F.2531","Restricting student & educator rights | School sports bans","Advancing","Legislative session adjourned, carries over to 2026","05/19/2025",""
+"Wyoming","S.F.0077","Other anti-LGBTQ bills | Other school restrictions | Restricting student & educator rights","Passed into Law","Became law without signature","02/27/2025",""
+"Wyoming","H.B.0060","Restricting student & educator rights | School sports bans","Defeated","Died in committee","03/03/2025",""
+"Wyoming","S.F.0062","Restricting student & educator rights | School facilities bans","Passed into Law","Governor signed","03/03/2025",""
+"Wyoming","H.B.0072","Public accommodation bans | Restricting student & educator rights | School facilities bans","Passed into Law","Governor signed","03/03/2025",""
+"Wyoming","H.B.0149","Religious exemptions | Weakening Civil Rights Laws","Defeated","Died in committee","03/03/2025",""
+"Wyoming","H.B.0200","Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Died in committee","03/03/2025",""
+"Wyoming","H.B.0222","Religious exemptions | Weakening Civil Rights Laws","Defeated","Died in committee","03/03/2025",""
+"Wyoming","S.F.0103","Other anti-LGBTQ bills","Advancing","Vetoed by Governor","03/04/2025",""
+"Wyoming","H.B.0207","Religious exemptions | Weakening Civil Rights Laws","Passed into Law","Governor signed","03/06/2025",""
+"West Virginia","H.B.2006","Other anti-LGBTQ bills | Re-definition of sex | Restricting student & educator rights | School facilities bans | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","04/12/2025",""
+"Utah","H.B.487","Other anti-LGBTQ bills","Advancing","Strike enacting clause","03/07/2025",""
+"Utah","H.B.521","Healthcare funding restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","03/07/2025",""
+"Texas","H.B. 239","Public accommodation bans","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 167","Other anti-LGBTQ bills","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 477","Barriers to accurate IDs | ","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 344","Curriculum censorship | Restricting student & educator rights","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 403","Other anti-LGBTQ bills","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 843","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 847","Healthcare funding restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 980","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 976","Curriculum censorship | Restricting student & educator rights","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 938","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 973","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","06/02/2025",""
+"Texas","S.B. 1393","Other anti-LGBTQ bills","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 1015","Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 1123","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 1016","Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 1075","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.B. 1014","Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","06/02/2025",""
+"Tennessee","H.B.0315","Other anti-LGBTQ bills","Advancing","Legislative session adjourned, carries over to 2026","04/22/2025",""
+"Rhode Island","S.B.270","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session adjourned","06/20/2025",""
+"Oklahoma","S.B.959","Religious exemptions | Weakening Civil Rights Laws","Advancing","Failed in committee, dormant until carried over","03/03/2025",""
+"Oklahoma","S.B.1107","Other anti-LGBTQ bills","Advancing","Failed in committee, dormant until carried over","03/03/2025",""
+"Nebraska","L.B.552","Other anti-LGBTQ bills","Defeated","Legislative session adjourned, carries over to 2026","06/02/2025",""
+"Nebraska","L.B.605","Other school restrictions | Restricting student & educator rights | School facilities bans | School sports bans","Advancing","Legislative session adjourned, carries over to 2026","06/02/2025",""
+"Missouri","H.B. 113","Restricting student & educator rights | School sports bans","Advancing","Reported favorably by committee","02/27/2025",""
+"Missouri","S.B. 493","Healthcare age restrictions | Healthcare restrictions | ","Advancing","Second read and referred to committee","02/27/2025",""
+"Missouri","H.B. 35","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Advancing","Reported favorably by committee","02/27/2025",""
+"Minnesota","S.F.916","Restricting student & educator rights | School sports bans","Advancing","Legislative session adjourned, carries over to 2026","05/19/2025",""
+"Minnesota","H.F.12","Restricting student & educator rights | School sports bans","Advancing","Legislative session adjourned, carries over to 2026","05/19/2025",""
+"Kentucky","S.B.60","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","03/28/2025",""
+"Iowa","H.F.583","Barriers to accurate IDs | Curriculum censorship | Other civil rights restrictions | Other school restrictions | Re-definition of sex | Restricting student & educator rights | Weakening Civil Rights Laws","Advancing","SF 418 substituted; withdrawn","02/27/2025",""
+"Iowa","S.F.236","Religious exemptions | Weakening Civil Rights Laws","Advancing","Renumbered as SF 473; legislative session adjourned, carries over to 2026","05/14/2025",""
+"Iowa","S.F.418","Barriers to accurate IDs | Curriculum censorship | Other civil rights restrictions | Other school restrictions | Re-definition of sex | Restricting student & educator rights | Weakening Civil Rights Laws","Passed into Law","Governor signed","02/28/2025",""
+"Iowa","S.S.B.1150","Other anti-LGBTQ bills","Advancing","Renumbered as SF 507; legislative session adjourned, carries over to 2026","05/14/2025",""
+"Iowa","H.S.B.155","Other anti-LGBTQ bills","Advancing","Renumbered as HF 856; legislative session adjourned, carries over to 2026","05/14/2025",""
+"Iowa","H.S.B.158","Drag bans | Free speech & expression bans | ","Advancing","Renumbered as HF 891; legislative session adjourned, carries over to 2026","05/14/2025",""
+"Georgia","S.B.248","Curriculum censorship | Forced outing in schools | Other school restrictions | Restricting student & educator rights","Advancing","Legislative session adjourned, carries over to 2026","04/04/2025",""
+"Georgia","H.B.267","Barriers to accurate IDs | Other civil rights restrictions | Re-definition of sex | Restricting student & educator rights | School facilities bans | School sports bans | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","04/04/2025",""
+"Georgia","S.B.57","Other anti-LGBTQ bills","Advancing","Legislative session adjourned, carries over to 2026","04/04/2025",""
+"Colorado","HB25-1255","Healthcare restrictions | Other healthcare barriers | Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","05/07/2025",""
+"Arizona","H.C.R.2042","Other anti-LGBTQ bills","Advancing","House passed; Senate second read","03/04/2025",""
+"Wisconsin","S.B.117","Restricting student & educator rights | School facilities bans | School sports bans","Advancing","First read and referred to committee","03/07/2025",""
+"Wisconsin","S.B.116","Restricting student & educator rights | School facilities bans | School sports bans","Advancing","First read and referred to committee","03/07/2025",""
+"New Jersey","A.5419","Healthcare age restrictions | Healthcare restrictions | ","Advancing","Referred to committee","03/06/2025",""
+"Minnesota","S.F.1883","Restricting student & educator rights | School sports bans","Advancing","Legislative session adjourned, carries over to 2026","05/19/2025",""
+"Minnesota","S.F.2294","Restricting student & educator rights | School facilities bans | School sports bans","Advancing","Legislative session adjourned, carries over to 2026","05/19/2025",""
+"Michigan","H.B.4190","Healthcare age restrictions | Healthcare restrictions | ","Advancing","First read and referred to committee","03/06/2025",""
+"Iowa","H.F.721","Other anti-LGBTQ bills","Advancing","Legislative session adjourned, carries over to 2026","05/14/2025",""
+"Georgia","H.B.660","Healthcare funding restrictions | Healthcare restrictions | Prison healthcare restrictions","Advancing","Legislative session adjourned, carries over to 2026","04/04/2025",""
+"Georgia","S.B.120","Other anti-LGBTQ bills | Other school restrictions | Restricting student & educator rights","Advancing","Legislative session adjourned, carries over to 2026","04/04/2025",""
+"Alabama","S.B.228","Other anti-LGBTQ bills","Defeated","Legislative session ended","05/14/2025",""
+"Alabama","H.B.418","Other anti-LGBTQ bills","Defeated","Legislative session ended","05/14/2025",""
+"Wisconsin","S.B.40","Free speech & expression bans | Other expression restrictions | Other school restrictions | Restricting student & educator rights","Advancing","First read and referred to committee","02/12/2025",""
+"West Virginia","H.B.2375","Healthcare restrictions | Other healthcare barriers","Advancing","Legislative session adjourned, carries over to 2026","04/12/2025",""
+"West Virginia","H.B.2033","Religious exemptions | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","04/12/2025",""
+"West Virginia","H.B.2072","Healthcare restrictions | Other healthcare barriers | Religious exemptions | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","04/12/2025",""
+"Utah","H.B.269","Other anti-LGBTQ bills | Public accommodation bans | Restricting student & educator rights | School facilities bans | School sports bans","Passed into Law","Governor signed","02/14/2025",""
+"Texas","S.B. 1068","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","06/02/2025",""
+"Texas","S.B. 1127","Other anti-LGBTQ bills","Defeated","Legislative session ended","06/02/2025",""
+"Texas","H.R. 144","Other anti-LGBTQ bills","Defeated","Legislative session adjourned","06/02/2025",""
+"South Dakota","H.B.1177","Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","03/31/2025",""
+"South Dakota","H.B.1260","Barriers to accurate IDs | ","Defeated","Legislative session ended","03/31/2025",""
+"Oklahoma","S.B.228","Other anti-LGBTQ bills","Advancing","Failed in committee, dormant until carried over","02/19/2025",""
+"Oklahoma","S.B.550","Drag bans | Free speech & expression bans | ","Advancing","Did not meet passage requirements, dormant until carried over","03/27/2025",""
+"North Dakota","S.B. 2392","Other anti-LGBTQ bills","Defeated","Legislative session ended","05/03/2025",""
+"Missouri","S.B. 212","Restricting student & educator rights | School facilities bans","Advancing","Reported favorably by committee","02/25/2025",""
+"Missouri","S.B. 249","Healthcare age restrictions | Healthcare restrictions | ","Advancing","Second read and referred to committee","02/13/2025",""
+"Missouri","S.B. 390","Other anti-LGBTQ bills","Advancing","Second read and referred to committee","02/17/2025",""
+"Missouri","S.B. 115","Restricting student & educator rights | School sports bans","Advancing","Reported favorably by committee","02/18/2025",""
+"Kentucky","H.B.5","Healthcare restrictions | Other anti-LGBTQ bills | Prison healthcare restrictions","Defeated","Legislative session ended","03/28/2025",""
+"Kansas","H.B.2071","Healthcare age restrictions | Healthcare restrictions | ","Advancing","Legislative session adjourned, carries over to 2026","04/11/2025",""
+"Kansas","S.B.63","Healthcare age restrictions | Healthcare restrictions | ","Passed into Law","Senate and House override of Governor's veto","02/18/2025",""
+"Iowa","H.S.B.139","Healthcare restrictions | Other healthcare barriers | Religious exemptions | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","05/14/2025",""
+"Illinois","S.B.1783","Drag bans | Free speech & expression bans | ","Advancing","Legislative session adjourned, carries over to 2026","05/31/2025",""
+"Illinois","H.B.3819","Healthcare age restrictions | Healthcare restrictions | ","Advancing","Legislative session adjourned, carries over to 2026","05/31/2025",""
+"Idaho","H.190","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/04/2025",""
+"Idaho","H.230","Drag bans | Free speech & expression bans | ","Defeated","Legislative session ended","04/04/2025",""
+"Idaho","H.138","Healthcare funding restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","04/04/2025",""
+"Colorado","HB25-1254","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","05/07/2025",""
+"California","A.B.579","Healthcare restrictions | Other anti-LGBTQ bills | Other healthcare barriers","Advancing","First read; may be heard in committee March 15","02/12/2025",""
+"California","A.B.600","Other anti-LGBTQ bills | Other school restrictions | Restricting student & educator rights","Advancing","First read; may be heard in committee March 16","02/13/2025",""
+"Iowa","H.S.B.242","Barriers to accurate IDs | Curriculum censorship | Other civil rights restrictions | Other school restrictions | Re-definition of sex | Restricting student & educator rights | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","05/14/2025",""
+"West Virginia","S.B.276","Drag bans | Free speech & expression bans | ","Advancing","Legislative session adjourned, carries over to 2026","04/12/2025",""
+"West Virginia","H.B.2005","Other school restrictions | Restricting student & educator rights","Advancing","Legislative session adjourned, carries over to 2026","04/12/2025",""
+"West Virginia","H.B.2795","Healthcare restrictions | Other anti-LGBTQ bills | Other healthcare barriers | Public accommodation bans","Advancing","Legislative session adjourned, carries over to 2026","04/12/2025",""
+"West Virginia","H.B.2962","Barriers to accurate IDs | ","Advancing","Legislative session adjourned, carries over to 2026","04/12/2025",""
+"West Virginia","S.B.507","Drag bans | Free speech & expression bans | ","Advancing","Legislative session adjourned, carries over to 2026","04/12/2025",""
+"West Virginia","H.B.2403","Healthcare age restrictions | Healthcare restrictions | ","Advancing","Legislative session adjourned, carries over to 2026","04/12/2025",""
+"West Virginia","H.B.2466","Healthcare age restrictions | Healthcare restrictions | ","Advancing","Legislative session adjourned, carries over to 2026","04/12/2025",""
+"West Virginia","H.B.2574","Other anti-LGBTQ bills","Advancing","Legislative session adjourned, carries over to 2026","04/12/2025",""
+"West Virginia","H.B.2526","Restricting student & educator rights | School facilities bans","Advancing","Legislative session adjourned, carries over to 2026","04/12/2025",""
+"South Carolina","S.B.0368","Other anti-LGBTQ bills | Other school restrictions | Restricting student & educator rights","Advancing","Legislative session adjourned, carries over to 2026","05/28/2025",""
+"New Mexico","H.B. 466","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","03/22/2025",""
+"New Mexico","H.B. 559","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","03/22/2025",""
+"New Mexico","S.B. 500","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","03/22/2025",""
+"New Mexico","S.B. 459","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","03/22/2025",""
+"New Mexico","H.B. 501","Forced outing in schools | Restricting student & educator rights","Defeated","Legislative session ended","03/22/2025",""
+"Minnesota","H.F.565","Restricting student & educator rights | School facilities bans | School sports bans","Advancing","Legislative session adjourned, carries over to 2026","05/19/2025",""
+"Minnesota","S.F.1651","Other civil rights restrictions | Public accommodation bans | Re-definition of sex | Restricting student & educator rights | School facilities bans | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","05/19/2025",""
+"Iowa","S.F.335","Other anti-LGBTQ bills | Other school restrictions | Restricting student & educator rights","Advancing","Legislative session adjourned, carries over to 2026","05/14/2025",""
+"Idaho","H.328","Healthcare funding restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","04/04/2025",""
+"Idaho","H.292","Curriculum censorship | Restricting student & educator rights","Defeated","Legislative session ended","04/04/2025",""
+"Delaware","S.B. 55","Healthcare age restrictions | Healthcare restrictions | ","Advancing","Legislative session adjourned, carries over to 2026","06/30/2025",""
+"California","A.B.1464","Other anti-LGBTQ bills","Advancing","First read 2/24, may be heard in committee","03/24/2025",""
+"Idaho","H.49","Other anti-LGBTQ bills | Public accommodation bans | Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","04/04/2025",""
+"Wyoming","H.B.0274","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","03/06/2025",""
+"Texas","S.B. 949","Other anti-LGBTQ bills","Defeated","Legislative session adjourned","06/02/2025",""
+"Tennessee","S.B.0737","Other anti-LGBTQ bills","Advancing","Legislative session adjourned, carries over to 2026","04/22/2025",""
+"Tennessee","S.B.1126","Other school restrictions | Restricting student & educator rights","Advancing","Legislative session adjourned, carries over to 2026","04/22/2025",""
+"South Dakota","H.B.1201","Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","03/31/2025",""
+"Missouri","H.B. 624","Restricting student & educator rights | School sports bans","Advancing","Reported favorably by committee","02/11/2025",""
+"Missouri","H.B. 36","Restricting student & educator rights | School sports bans","Advancing","Reported favorably by committee","02/11/2025",""
+"Missouri","H.B. 1038","Healthcare age restrictions | Healthcare restrictions | ","Advancing","Reported favorably by committee","02/11/2025",""
+"Missouri","H.B. 1081","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Advancing","Reported favorably by committee","02/11/2025",""
+"Missouri","H.B. 1016","Healthcare age restrictions | Healthcare restrictions | ","Advancing","Reported favorably by committee","02/11/2025",""
+"Missouri","S.B. 26","Other anti-LGBTQ bills","Advancing","Reported favorably by committee","02/13/2025",""
+"Missouri","S.B. 76","Other civil rights restrictions | Weakening Civil Rights Laws","Advancing","Reported favorably by committee","02/13/2025",""
+"Missouri","S.B. 75","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Advancing","Reported favorably by committee","02/13/2025",""
+"Missouri","S.B. 298","Barriers to accurate IDs | ","Advancing","Second read and referred to committee","02/13/2025",""
+"Kentucky","S.B.116","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","03/28/2025",""
+"Iowa","H.S.B.84","Curriculum censorship | Restricting student & educator rights","Advancing","Legislative session adjourned, carries over to 2026","05/14/2025",""
+"Indiana","S.B.0235","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/24/2025",""
+"Illinois","H.B.1204","Restricting student & educator rights | School sports bans","Advancing","Legislative session adjourned, carries over to 2026","05/31/2025",""
+"Colorado","HB25-1145","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","05/07/2025",""
+"Arizona","S.B.1687","Healthcare age restrictions | Healthcare funding restrictions | Healthcare restrictions | Other healthcare barriers | Prison healthcare restrictions","Advancing","Second read","02/11/2025",""
+"Alabama","S.B.79","Other anti-LGBTQ bills | Restricting student & educator rights | School facilities bans","Passed into Law","Governor signed","02/13/2025",""
+"West Virginia","S.B.278","Drag bans | Free speech & expression bans | ","Advancing","Legislative session adjourned, carries over to 2026","04/12/2025",""
+"West Virginia","H.B.2153","Religious exemptions | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","04/12/2025",""
+"West Virginia","H.B.2127","Public accommodation bans | Re-definition of sex | Restricting student & educator rights | School facilities bans | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","04/12/2025",""
+"West Virginia","S.B.207","Drag bans | Free speech & expression bans | ","Advancing","Legislative session adjourned, carries over to 2026","04/12/2025",""
+"West Virginia","H.B.2071","Forced outing in schools | Restricting student & educator rights","Advancing","Legislative session adjourned, carries over to 2026","04/12/2025",""
+"West Virginia","S.B.244","Public accommodation bans | Re-definition of sex | Restricting student & educator rights | School facilities bans | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","04/12/2025",""
+"West Virginia","S.B.279","Healthcare age restrictions | Healthcare restrictions | ","Advancing","Legislative session adjourned, carries over to 2026","04/12/2025",""
+"West Virginia","S.B.431","Drag bans | Free speech & expression bans | ","Advancing","Legislative session adjourned, carries over to 2026","04/12/2025",""
+"West Virginia","S.B.424","Other anti-LGBTQ bills | Other school restrictions | Restricting student & educator rights","Advancing","Legislative session adjourned, carries over to 2026","04/12/2025",""
+"Rhode Island","S.B.304","Restricting student & educator rights | School sports bans","Defeated","Legislative session adjourned","06/20/2025",""
+"Pennsylvania","H.B.581","Curriculum censorship | Forced outing in schools | Restricting student & educator rights","Advancing","Referred to committee","02/12/2025",""
+"New Mexico","H.B. 380","Other anti-LGBTQ bills | Restricting student & educator rights | School facilities bans","Defeated","Legislative session ended","03/22/2025",""
+"Minnesota","H.F.700","Other civil rights restrictions | Public accommodation bans | Re-definition of sex | Restricting student & educator rights | School facilities bans | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","05/19/2025",""
+"Maryland","H.B.1385","Curriculum censorship | Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","04/07/2025",""
+"Maryland","H.B.1399","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","04/07/2025",""
+"Illinois","S.B.2474","Healthcare age restrictions | Healthcare restrictions | ","Advancing","Legislative session adjourned, carries over to 2026","05/31/2025",""
+"Idaho","H.179","Curriculum censorship | Restricting student & educator rights","Defeated","Legislative session ended","04/04/2025",""
+"Wyoming","H.B.0115","Healthcare restrictions | Other healthcare barriers | Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","03/06/2025",""
+"Virginia","H.B. 2405","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","02/22/2025",""
+"Virginia","H.B. 1809","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","02/22/2025",""
+"Virginia","H.B. 2146","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","02/22/2025",""
+"Virginia","H.B. 2182","Forced outing in schools | Other anti-LGBTQ bills | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","02/22/2025",""
+"Virginia","H.B. 2605","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","02/22/2025",""
+"Virginia","H.B. 1229","Public accommodation bans | Restricting student & educator rights | School facilities bans | School sports bans","Defeated","Legislative session ended","02/22/2025",""
+"Virginia","H.B. 8","Healthcare restrictions | Other healthcare barriers | Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","02/22/2025",""
+"Texas","S.B. 116","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session adjourned","06/02/2025",""
+"Texas","S.B. 115","Healthcare funding restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session adjourned","06/02/2025",""
+"Texas","S.B. 84","Barriers to accurate IDs | Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session adjourned","06/02/2025",""
+"Texas","S.B. 753","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session adjourned","06/02/2025",""
+"Oklahoma","H.B.1219","Free speech & expression bans | Other anti-LGBTQ bills | Other expression restrictions | Other school restrictions | Restricting student & educator rights","Advancing","Did not meet passage requirements, dormant until carried over","03/27/2025",""
+"Oklahoma","H.B.1225","Barriers to accurate IDs | ","Advancing","Did not meet passage requirements, dormant until carried over","03/27/2025",""
+"Oklahoma","H.B.1344","Religious exemptions | Weakening Civil Rights Laws","Advancing","Did not meet passage requirements, dormant until carried over","03/27/2025",""
+"Oklahoma","H.B.2149","Healthcare restrictions | Other healthcare barriers","Advancing","Did not meet passage requirements, dormant until carried over","03/27/2025",""
+"Oklahoma","H.B.1964","Curriculum censorship | Other anti-LGBTQ bills | Restricting student & educator rights","Advancing","Did not meet passage requirements, dormant until carried over","03/27/2025",""
+"Oklahoma","H.B.1361","Forced outing in schools | Other school restrictions | Restricting student & educator rights","Advancing","Did not meet passage requirements, dormant until carried over","03/27/2025",""
+"Nebraska","L.B.655","Religious exemptions | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","07/02/2025",""
+"Mississippi","S.B. 2364","Other anti-LGBTQ bills","Defeated","Died in committee","02/04/2025",""
+"Mississippi","S.B. 2870","Curriculum censorship | Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Died in committee","02/04/2025",""
+"Mississippi","H.B. 1516","Curriculum censorship | Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Died in committee","02/04/2025",""
+"Mississippi","S.B. 2516","Restricting student & educator rights | School facilities bans","Defeated","Died in committee","02/04/2025",""
+"Mississippi","S.B. 2468","Other school restrictions | Restricting student & educator rights","Defeated","Died in committee","02/04/2025",""
+"Mississippi","H.B. 1385","Curriculum censorship | Other school restrictions | Restricting student & educator rights","Defeated","Died in committee","02/04/2025",""
+"Mississippi","H.B. 1060","Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Died in committee","02/04/2025",""
+"Mississippi","H.B. 1246","Other anti-LGBTQ bills","Defeated","Died in committee","02/04/2025",""
+"Mississippi","H.B. 1542","Curriculum censorship | Other anti-LGBTQ bills | Restricting student & educator rights","Defeated","Died in committee","02/04/2025",""
+"Mississippi","H.B. 1605","Restricting student & educator rights | School facilities bans","Defeated","Died in committee","02/04/2025",""
+"Mississippi","S.B. 2218","Restricting student & educator rights | School facilities bans","Defeated","Died in committee","02/04/2025",""
+"Mississippi","H.B. 1422","Religious exemptions | Weakening Civil Rights Laws","Defeated","Died in committee","02/04/2025",""
+"Mississippi","S.B. 2896","Curriculum censorship | Forced outing in schools | Restricting student & educator rights","Defeated","Died in committee","02/04/2025",""
+"Mississippi","S.B. 2370","Other anti-LGBTQ bills","Defeated","Died in committee","02/04/2025",""
+"Maryland","S.B.0588","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","04/07/2025",""
+"Maryland","H.B.0156","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","04/07/2025",""
+"Kentucky","H.B.154","Healthcare funding restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","03/28/2025",""
+"Kentucky","H.B.177","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","03/28/2025",""
+"Kentucky","H.B.163","Other anti-LGBTQ bills","Defeated","Legislative session ended","03/28/2025",""
+"Iowa","S.F.156","Public accommodation bans","Advancing","Legislative session adjourned, carries over to 2026","05/14/2025",""
+"Idaho","S.1048","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/04/2025",""
+"South Dakota","H.B.1269","Free speech & expression bans | Other expression restrictions","Defeated","Legislative session ended","03/31/2025",""
+"South Dakota","H.B.1211","Other anti-LGBTQ bills","Defeated","Legislative session ended","03/31/2025",""
+"South Carolina","S.B.0322","Other school restrictions | Restricting student & educator rights","Advancing","Legislative session adjourned, carries over to 2026","05/28/2025",""
+"Pennsylvania","S.B.213","Barriers to accurate IDs | Healthcare restrictions | Other anti-LGBTQ bills | Prison healthcare restrictions | Public accommodation bans | Re-definition of sex | Restricting student & educator rights | School facilities bans | Weakening Civil Rights Laws","Advancing","Referred to committee","02/04/2025",""
+"Minnesota","S.F.886","Re-definition of sex | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","05/19/2025",""
+"Maryland","H.B.1019","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/07/2025",""
+"Maryland","S.B.0948","Curriculum censorship | Forced outing in schools | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","04/07/2025",""
+"Kentucky","H.B.314","Other anti-LGBTQ bills","Defeated","Legislative session ended","03/28/2025",""
+"Illinois","H.B.2915","Restricting student & educator rights | School sports bans","Advancing","Legislative session adjourned, carries over to 2026","05/31/2025",""
+"Illinois","S.B.2078","Barriers to accurate IDs | Healthcare restrictions | Other anti-LGBTQ bills | Prison healthcare restrictions | Public accommodation bans | Re-definition of sex | Restricting student & educator rights | School facilities bans | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","05/31/2025",""
+"Illinois","S.B.2079","Restricting student & educator rights | School sports bans","Advancing","Legislative session adjourned, carries over to 2026","05/31/2025",""
+"Alabama","H.B.107","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","05/14/2025",""
+"Oklahoma","S.B.1049","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Advancing","Did not meet passage requirements, dormant until carried over","03/27/2025",""
+"Oklahoma","S.B.759","Curriculum censorship | Forced outing in schools | Other school restrictions | Restricting student & educator rights","Advancing","Did not meet passage requirements, dormant until carried over","03/28/2025",""
+"Oklahoma","S.B.665","Religious exemptions | Weakening Civil Rights Laws","Advancing","Did not meet passage requirements, dormant until carried over","03/27/2025",""
+"Oklahoma","S.B.591","Other school restrictions | Restricting student & educator rights","Advancing","Did not meet passage requirements, dormant until carried over","03/27/2025",""
+"Oklahoma","S.B.848","Curriculum censorship | Other school restrictions | Restricting student & educator rights","Advancing","Did not meet passage requirements, dormant until carried over","03/28/2025",""
+"Oklahoma","S.B.210","Other anti-LGBTQ bills","Advancing","Did not meet passage requirements, dormant until carried over","03/27/2025",""
+"Oklahoma","S.B.413","Curriculum censorship | Restricting student & educator rights","Advancing","Did not meet passage requirements, dormant until carried over","03/27/2025",""
+"Oklahoma","S.B.958","Healthcare restrictions | Other healthcare barriers","Advancing","Did not meet passage requirements, dormant until carried over","03/27/2025",""
+"Oklahoma","S.B.1002","Healthcare funding restrictions | Healthcare restrictions | Other healthcare barriers","Advancing","Did not meet passage requirements, dormant until carried over","03/27/2025",""
+"Oklahoma","S.B.847","Curriculum censorship | Forced outing in schools | Other school restrictions | Restricting student & educator rights","Advancing","Did not meet passage requirements, dormant until carried over","03/27/2025",""
+"Oklahoma","S.B.845","Other anti-LGBTQ bills","Advancing","Did not meet passage requirements, dormant until carried over","03/27/2025",""
+"Georgia","H.B.104","Restricting student & educator rights | School sports bans","Advancing","Legislative session adjourned, carries over to 2026","04/04/2025",""
+"Washington","H.B. 1699","Restricting student & educator rights | School sports bans","Advancing","First read and referred to committee","01/29/2025",""
+"Oklahoma","S.B.977","Drag bans | Free speech & expression bans | ","Advancing","Did not meet passage requirements, dormant until carried over","03/27/2025",""
+"New Mexico","H.B. 185","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","03/22/2025",""
+"Minnesota","S.F.716","Drag bans | Free speech & expression bans | ","Advancing","Legislative session adjourned, carries over to 2026","05/19/2025",""
+"Minnesota","S.F.744","Healthcare age restrictions | Healthcare restrictions | ","Advancing","Legislative session adjourned, carries over to 2026","05/19/2025",""
+"Minnesota","S.F.802","Restricting student & educator rights | School facilities bans | School sports bans","Advancing","Legislative session adjourned, carries over to 2026","05/19/2025",""
+"Michigan","H.B.4031","Restricting student & educator rights | School sports bans","Advancing","First read and referred to committee","01/28/2025",""
+"Michigan","H.B.4024","Restricting student & educator rights | School facilities bans","Advancing","First read and referred to committee","01/28/2025",""
+"Virginia","S.B. 749","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","02/22/2025",""
+"Virginia","S.B. 1079","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","02/22/2025",""
+"Virginia","S.B. 1074","Forced outing in schools | Healthcare age restrictions | Healthcare funding restrictions | Healthcare restrictions | Restricting student & educator rights","Defeated","Legislative session ended","02/22/2025",""
+"Missouri","S.B. 117","Forced outing in schools | Other school restrictions | Religious exemptions | Restricting student & educator rights | Weakening Civil Rights Laws","Advancing","Second read and referred to committee","01/23/2025",""
+"Kansas","S.B.16","Other anti-LGBTQ bills","Advancing","Legislative session adjourned, carries over to 2026","04/11/2025",""
+"Idaho","H.10","Free speech & expression bans | Other expression restrictions | Other school restrictions | Restricting student & educator rights","Defeated","Legislative session ended","04/04/2025",""
+"Hawaii","H.B.257","Barriers to accurate IDs | ","Advancing","Legislative session adjourned, carries over to 2026","05/02/2025",""
+"Hawaii","H.B.268","Restricting student & educator rights | School sports bans","Advancing","Legislative session adjourned, carries over to 2026","05/02/2025",""
+"Hawaii","H.B.207","Restricting student & educator rights | School sports bans","Advancing","Referred to committee","01/21/2025",""
+"Connecticut","S.B.1045","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session adjourned","06/04/2025",""
+"Connecticut","H.B.6178","Other anti-LGBTQ bills","Defeated","Legislative session adjourned","06/04/2025",""
+"Connecticut","H.B.6201","Restricting student & educator rights | School sports bans","Defeated","Legislative session adjourned","06/04/2025",""
+"Connecticut","H.B.6609","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session adjourned","06/04/2025",""
+"South Carolina","H.B.3433","Other anti-LGBTQ bills","Advancing","Legislative session adjourned, carries over to 2026","05/28/2025",""
+"South Carolina","H.B.3121","Religious exemptions | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","05/28/2025",""
+"South Carolina","H.B.3118","Curriculum censorship | Forced outing in schools | Other anti-LGBTQ bills | Restricting student & educator rights","Advancing","Legislative session adjourned, carries over to 2026","05/28/2025",""
+"South Carolina","H.B.3094","Healthcare restrictions | Other anti-LGBTQ bills | Other healthcare barriers","Advancing","Legislative session adjourned, carries over to 2026","05/28/2025",""
+"Missouri","H.B. 135","Barriers to accurate IDs | ","Advancing","Referred to committee","01/16/2025",""
+"South Carolina","S.B.0162","Barriers to accurate IDs | ","Advancing","Legislative session adjourned, carries over to 2026","05/28/2025",""
+"South Carolina","S.B.0243","Curriculum censorship | Forced outing in schools | Restricting student & educator rights","Advancing","Legislative session adjourned, carries over to 2026","05/28/2025",""
+"South Carolina","S.B.0240","Healthcare restrictions | Other anti-LGBTQ bills | Other healthcare barriers","Advancing","Legislative session adjourned, carries over to 2026","05/28/2025",""
+"Connecticut","H.B.5789","Restricting student & educator rights | School sports bans","Defeated","Legislative session adjourned","06/04/2025",""
+"South Carolina","S.B.0199","Restricting student & educator rights | School facilities bans","Advancing","Legislative session adjourned, carries over to 2026","05/28/2025",""
+"Pennsylvania","H.B.158","Restricting student & educator rights | School sports bans","Advancing","Referred to committee","01/17/2025",""
+"Indiana","S.B.0239","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/24/2025",""
+"Indiana","H.B.1528","Other anti-LGBTQ bills","Defeated","Legislative session ended","04/24/2025",""
+"Indiana","H.B.1428","Religious exemptions | Weakening Civil Rights Laws","Defeated","Legislative session ended","04/24/2025",""
+"Indiana","H.B.1456","Other anti-LGBTQ bills","Advancing","Legislative session ended","04/24/2025",""
+"Connecticut","S.B.592","Restricting student & educator rights | School sports bans","Defeated","Legislative session adjourned","06/04/2025",""
+"Connecticut","H.B.5336","Healthcare age restrictions | Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session adjourned","06/04/2025",""
+"Connecticut","H.B.5370","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session adjourned","06/04/2025",""
+"Indiana","S.B.0479","Healthcare restrictions | Other healthcare barriers","Defeated","Legislative session ended","04/24/2025",""
+"New Jersey","A.2580","Curriculum censorship | Restricting student & educator rights","Introduced","Carried over","01/14/2025",""
+"New Jersey","A.531","Curriculum censorship | Restricting student & educator rights","Introduced","Carried over","01/14/2025",""
+"New Jersey","A.410","Other school restrictions | Restricting student & educator rights","Introduced","Carried over","01/14/2025",""
+"New Jersey","S.1329","Other school restrictions | Restricting student & educator rights","Introduced","Carried over","01/14/2025",""
+"Connecticut","S.B.36","Curriculum censorship | Restricting student & educator rights","Defeated","Legislative session adjourned","06/04/2025",""
+"Illinois","H.B.1214","Healthcare age restrictions | Healthcare restrictions | ","Advancing","Legislative session adjourned, carries over to 2026","05/31/2025",""
+"Illinois","H.B.1216","Restricting student & educator rights | School sports bans","Advancing","Legislative session adjourned, carries over to 2026","05/31/2025",""
+"Illinois","H.B.1161","Other school restrictions | Restricting student & educator rights","Advancing","Legislative session adjourned, carries over to 2026","05/31/2025",""
+"Illinois","H.B.1209","Re-definition of sex | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","05/31/2025",""
+"Illinois","H.B.1117","Restricting student & educator rights | School sports bans","Advancing","Legislative session adjourned, carries over to 2026","05/31/2025",""
+"Indiana","S.B.0441","Barriers to accurate IDs | Re-definition of sex | Weakening Civil Rights Laws","Advancing","Legislative session ended","04/24/2025",""
+"Michigan","S.B.0009","Restricting student & educator rights | School facilities bans","Advancing","Referred to committee","01/08/2025",""
+"South Carolina","H.B.3263","Restricting student & educator rights | School facilities bans","Advancing","Legislative session adjourned, carries over to 2026","05/28/2025",""
+"South Carolina","H.B.3506","Re-definition of sex | Weakening Civil Rights Laws","Advancing","Legislative session adjourned, carries over to 2026","05/28/2025",""
+"South Carolina","H.B.3011","Forced outing in schools | Other anti-LGBTQ bills | Restricting student & educator rights","Advancing","Legislative session adjourned, carries over to 2026","06/28/2025",""
+"Washington","S.B. 5136","Other school restrictions | Religious exemptions | Restricting student & educator rights | Weakening Civil Rights Laws","Advancing","Unofficially first read and referred to committee","01/13/2025",""
+"Washington","H.B. 1027","Other anti-LGBTQ bills","Advancing","Unofficially first read and referred to committee","01/13/2025",""
+"Washington","H.B. 1038","Healthcare age restrictions | Healthcare restrictions | ","Advancing","Unofficially first read and referred to committee","01/13/2025",""
+"Virginia","S.B. 723","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","02/22/2025",""
+"Virginia","S.B. 68","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","02/22/2025",""
+"Virginia","S.B. 671","Healthcare age restrictions | Healthcare restrictions | ","Defeated","Legislative session ended","02/22/2025",""
+"Virginia","H.B. 670","Forced outing in schools | Other anti-LGBTQ bills | Restricting student & educator rights","Defeated","Legislative session ended","02/22/2025",""
+"Virginia","H.B. 1120","Restricting student & educator rights | School sports bans","Defeated","Legislative session ended","02/22/2025",""
+"Virginia","H.J. 86","Re-definition of sex | Weakening Civil Rights Laws","Defeated","Legislative session ended","02/22/2025",""
+"Virginia","S.B. 37","Forced outing in schools | Other anti-LGBTQ bills | Restricting student & educator rights","Defeated","Legislative session ended","02/22/2025",""
+"New Jersey","A.670","Curriculum censorship | Restricting student & educator rights","Introduced","Carried over","01/09/2025",""
+"New Jersey","S.1331","Restricting student & educator rights | School sports bans","Introduced","Carried over","01/14/2025",""
+
+Data is current as of July 11 2025 
diff --git a/assets/data-leg/HB0132-failed.txt b/assets/data-leg/HB0132-failed.txt
new file mode 100644
index 00000000..8bf8713c
--- /dev/null
+++ b/assets/data-leg/HB0132-failed.txt
@@ -0,0 +1,626 @@
+LEGISLATIVE GENERAL COUNSEL
+< Approved for Filing: C. Williams <
+<	01-22-23 8:06 PM	<
+
+H.B. 132
+1st Sub. (Buff)
+
+
+
+
+
+
+Representative Rex P. Shipp proposes the following substitute bill:
+
+
+1 PROHIBITING SEX TRANSITIONING PROCEDURES ON
+2 MINORS
+3 2023 GENERAL SESSION
+4 STATE OF UTAH
+5 Chief Sponsor: Rex P. Shipp
+6 Senate Sponsor: Wayne A. Harper
+
+7 Cosponsors:
+8 Nelson T. Abbott
+9 Cheryl K. Acton
+10 Carl R. Albrecht
+11 Bridger Bolinder
+12 Walt Brooks
+13 Jefferson S. Burton
+14 Kay J. Christofferson
+
+Joseph Elison Colin W. Jack Tim Jimenez Dan N. Johnson Quinn Kotter Trevor Lee Steven J. Lund Phil Lyman
+
+A. Cory Maloy Michael J. Petersen Thomas W. Peterson Keven J. Stratton Mark A. Strong Jordan D. Teuscher Christine F. Watkins
+
+
+15
+16 LONG TITLE
+17 General Description:
+18 This bill prohibits a health care provider from performing a medical procedure on a
+19 minor for the purpose of attempted sex transitioning or attempted sex change.
+20 Highlighted Provisions:
+21 This bill:
+22 ?	defines terms;
+23 ?	makes it unprofessional conduct for a health care provider to perform a medical
+24 procedure on a minor for the purpose of attempted sex transitioning or attempted
+
+
+
+*HB0132S01*
+
+
+25 sex change under most circumstances; and
+26 ?	makes technical changes.
+27 Money Appropriated in this Bill:
+28 None
+29 Other Special Clauses:
+30 None
+31 Utah Code Sections Affected:
+32 AMENDS:
+33 58-31b-502, as last amended by Laws of Utah 2022, Chapter 290
+34 58-67-102, as last amended by Laws of Utah 2022, Chapter 233
+35 58-67-502, as last amended by Laws of Utah 2021, Chapter 337
+36 58-68-102, as last amended by Laws of Utah 2022, Chapter 233
+37 58-68-502, as last amended by Laws of Utah 2021, Chapter 337
+38 58-70a-503, as last amended by Laws of Utah 2022, Chapter 290
+39 ENACTS:
+40 58-1-511, Utah Code Annotated 1953
+41
+42 Be it enacted by the Legislature of the state of Utah:
+43 Section 1. Section 58-1-511 is enacted to read:
+44 58-1-511. Prohibition on hormonal transgender procedures on minors.
+45 (1) As used in this section:
+46 (a) "Administration of cross-sex hormones" means administering or supplying:
+47 (i) to an individual whose biological sex at birth is female, a dose of testosterone or
+48 other androgens at levels above those normally found in an individual whose biological sex at
+49 birth is female; or
+50 (ii) to an individual whose biological sex at birth is male, a dose of estrogen or a
+51 synthetic compound with estrogenic activity or effect at levels above those normally found in
+52 an individual whose biological sex at birth is male.
+53 (b) "Health care provider" means:
+54 (i) a physician licensed under:
+55 (A) Chapter 67, Utah Medical Practice Act; or
+
+
+56 (B) Chapter 68, Utah Osteopathic Medical Practice Act;
+57 (ii) a physician assistant licensed under Chapter 70a, Utah Physician Assistant Act; or
+58 (iii) an advanced practice registered nurse licensed under Subsection 58-31b-301(e).
+59 (c) "Hormonal transgender procedure" means:
+60 (i) administration of cross-sex hormones; or
+61 (ii) performing a puberty inhibition procedure.
+62 (d) "Minor" means an individual who:
+63 (i) is less than 18 years old; and
+64 (ii) is not emancipated under Title 80, Chapter 7, Emancipation.
+65 (e) (i) "Puberty inhibition procedure" means administering or supplying, alone or in
+66 combination with aromatase inhibitors:
+67 (A) gonadotropin-releasing hormone agonists;
+68 (B) progestins; or
+69 (C) androgen receptor inhibitors.
+70 (ii) "Puberty inhibition procedure" does not include administering or supplying a
+71 treatment described in Subsection (1)(e)(i) to an individual if the treatment is medically
+72 necessary as a treatment for:
+73 (A) precocious puberty;
+74 (B) idiopathic short stature;
+75 (C) endometriosis; or
+76 (D) a sex hormone-stimulated cancer.
+77 (2) Except as provided in Subsection (3), a health care provider may not perform a
+78 hormonal transgender procedure on a minor.
+79 (3) (a) A health care provider may continue to administer cross-sex hormones to a
+80 minor if the minor:
+81 (i)  began receiving cross-sex hormones prior to May 3, 2021;
+82 (ii) has continuously received cross-sex hormones for at least two years; and
+83 (iii) affirmatively elects, in writing, to continue to receive cross-sex hormones.
+84 (b) For a minor who does not meet the criteria described in Subsection (3)(a), a health
+85 care provider who provides cross-sex hormones to the minor shall:
+86 (i) unless the minor elects to discontinue receiving cross-sex hormones by an earlier
+
+
+87 date, develop and implement a treatment plan to progressively decrease the dosage of cross-sex
+88 hormones so that cross-sex hormone treatment is ended by November 3, 2023; and
+89 (ii) consult with a mental health professional in order to monitor the minor's
+90 psychological and emotional state until November 3, 2023.
+91 Section 2. Section 58-31b-502 is amended to read:
+92 58-31b-502. Unprofessional conduct.
+93 (1) "Unprofessional conduct" includes:
+94 (a) failure to safeguard a patient's right to privacy as to the patient's person, condition,
+95 diagnosis, personal effects, or any other matter about which the licensee is privileged to know
+96 because of the licensee's or person with a certification's position or practice as a nurse or
+97 practice as a medication aide certified;
+98 (b) failure to provide nursing service or service as a medication aide certified in a
+99 manner that demonstrates respect for the patient's human dignity and unique personal character
+100 and needs without regard to the patient's race, religion, ethnic background, socioeconomic
+101 status, age, sex, or the nature of the patient's health problem;
+102 (c) engaging in sexual relations with a patient during any:
+103 (i) period when a generally recognized professional relationship exists between the
+104 person licensed or certified under this chapter and the patient; or
+105 (ii) extended period when a patient has reasonable cause to believe a professional
+106 relationship exists between the person licensed or certified under the provisions of this chapter
+107 and the patient;
+108 (d) (i) as a result of any circumstance under Subsection (1)(c), exploiting or using
+109 information about a patient or exploiting the licensee's or the person with a certification's
+110 professional relationship between the licensee or holder of a certification under this chapter and
+111 the patient; or
+112 (ii) exploiting the patient by use of the licensee's or person with a certification's
+113 knowledge of the patient obtained while acting as a nurse or a medication aide certified;
+114 (e) unlawfully obtaining, possessing, or using any prescription drug or illicit drug;
+115 (f) unauthorized taking or personal use of nursing supplies from an employer;
+116 (g) unauthorized taking or personal use of a patient's personal property;
+117 (h) unlawful or inappropriate delegation of nursing care;
+
+
+118 (i) failure to exercise appropriate supervision of persons providing patient care services
+119 under supervision of the licensed nurse;
+120 (j) employing or aiding and abetting the employment of an unqualified or unlicensed
+121 person to practice as a nurse;
+122 (k) failure to file or record any medical report as required by law, impeding or
+123 obstructing the filing or recording of such a report, or inducing another to fail to file or record
+124 such a report;
+125 (l) breach of a statutory, common law, regulatory, or ethical requirement of
+126 confidentiality with respect to a person who is a patient, unless ordered by a court;
+127 (m) failure to pay a penalty imposed by the division;
+128 (n) prescribing a Schedule II controlled substance without complying with the
+129 requirements in Section 58-31b-803, if applicable;
+130 (o) violating Section 58-31b-801;
+131 (p) violating the dispensing requirements of Section 58-17b-309 or Chapter 17b, Part
+132 8, Dispensing Medical Practitioner and Dispensing Medical Practitioner Clinic Pharmacy, if
+133 applicable;
+134 (q) falsely making an entry in, or altering, a medical record with the intent to conceal:
+135 (i) a wrongful or negligent act or omission of an individual licensed under this chapter
+136 or an individual under the direction or control of an individual licensed under this chapter; or
+137 (ii) conduct described in Subsections (1)(a) through (o) or Subsection 58-1-501(1); [or]
+138 (r) violating the requirements of Title 26, Chapter 61a, Utah Medical Cannabis Act[.];
+
+139 or
+140 (s) performing, or causing to be performed, a hormonal transgender procedure in
+141 violation of Section 58-1-511.
+
+142 (2) "Unprofessional conduct" does not include, in accordance with Title 26, Chapter
+143 61a, Utah Medical Cannabis Act, when registered as a qualified medical provider, or acting as
+144 a limited medical provider, as those terms are defined in Section 26-61a-102, recommending
+145 the use of medical cannabis.
+146 (3) Notwithstanding Subsection (2), the division, in consultation with the board and in
+147 accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, shall define
+148 unprofessional conduct for an advanced practice registered nurse described in Subsection (2).
+
+
+149 Section 3. Section 58-67-102 is amended to read:
+150 58-67-102.  Definitions.
+151 In addition to the definitions in Section 58-1-102, as used in this chapter:
+152 (1) (a) "Ablative procedure" means a procedure that is expected to excise, vaporize,
+153 disintegrate, or remove living tissue, including the use of carbon dioxide lasers and erbium:
+154 YAG lasers.
+155 (b) "Ablative procedure" does not include hair removal.
+156 (2) "ACGME" means the Accreditation Council for Graduate Medical Education of the
+157 American Medical Association.
+158 (3) "Administrative penalty" means a monetary fine or citation imposed by the division
+159 for acts or omissions determined to constitute unprofessional or unlawful conduct, in
+160 accordance with a fine schedule established by the division in collaboration with the board, as a
+161 result of an adjudicative proceeding conducted in accordance with Title 63G, Chapter 4,
+162 Administrative Procedures Act.
+163 (4) "Associate physician" means an individual licensed under Section 58-67-302.8.
+164 (5) "Attempted sex change" means an attempt or effort to change an individual's body
+165 to present that individual as being of a sex or gender that is different from the individual's
+166 biological sex at birth.
+167 (6) "Biological sex at birth" means an individual's sex, as being male or female,
+168 according to distinct reproductive roles as manifested by sex and reproductive organ anatomy,
+169 chromosomal makeup, and endogenous hormone profiles.
+170 [(5)] (7) "Board" means the Physicians Licensing Board created in Section 58-67-201.
+171 [(6)] (8) "Collaborating physician" means an individual licensed under Section
+172 58-67-302 who enters into a collaborative practice arrangement with an associate physician.
+173 [(7)] (9) "Collaborative practice arrangement" means the arrangement described in
+174	Section 58-67-807.
+175 (10) "Cosmetic breast surgical procedure" means a breast reduction surgery or a breast
+176 augmentation surgery that is performed for a purpose other than:
+177 (a) medical necessity; or
+178 (b) to address a musculoskeletal problem.
+179 [(8)] (11) (a) "Cosmetic medical device" means tissue altering energy based devices
+
+
+180 that have the potential for altering living tissue and that are used to perform ablative or
+181 nonablative procedures, such as American National Standards Institute (ANSI) designated
+182 Class IIIb and Class IV lasers, intense pulsed light, radio frequency devices, and lipolytic
+183 devices, and excludes ANSI designated Class IIIa and lower powered devices.
+184 (b) Notwithstanding Subsection [(8)(a),] (11)(a), if an ANSI designated Class IIIa and
+185 lower powered device is being used to perform an ablative procedure, the device is included in
+186 the definition of cosmetic medical device under Subsection [(8)(a).] (11)(a).
+187 [(9)] (12) "Cosmetic medical procedure":
+188 (a) includes the use of cosmetic medical devices to perform ablative or nonablative
+189 procedures; and
+190 (b) does not include a treatment of the ocular globe such as refractive surgery.
+191 [(10)] (13) "Diagnose" means:
+192 (a) to examine in any manner another person, parts of a person's body, substances,
+193 fluids, or materials excreted, taken, or removed from a person's body, or produced by a person's
+194 body, to determine the source, nature, kind, or extent of a disease or other physical or mental
+195 condition;
+196 (b) to attempt to conduct an examination or determination described under Subsection
+197	[(10)(a);] (13)(a);
+198 (c) to hold oneself out as making or to represent that one is making an examination or
+199 determination as described in Subsection [(10)(a);] (13)(a); or
+200 (d) to make an examination or determination as described in Subsection [(10)(a)]
+201 (13)(a) upon or from information supplied directly or indirectly by another person, whether or
+202 not in the presence of the person making or attempting the diagnosis or examination.
+203 [(11)] (14) "LCME" means the Liaison Committee on Medical Education of the
+204 American Medical Association.
+205 [(12)] (15) "Medical assistant" means an unlicensed individual who may perform tasks
+206 as described in Subsection 58-67-305(6).
+207 [(13)] (16) "Medically underserved area" means a geographic area in which there is a
+208 shortage of primary care health services for residents, as determined by the Department of
+209 Health.
+210 [(14)] (17) "Medically underserved population" means a specified group of people
+
+
+211 living in a defined geographic area with a shortage of primary care health services, as
+212 determined by the Department of Health.
+213 [(15)] (18) (a) (i) "Nonablative procedure" means a procedure that is expected or
+214 intended to alter living tissue, but is not intended or expected to excise, vaporize, disintegrate,
+215 or remove living tissue.
+216 (ii) Notwithstanding Subsection [(15)(a)(i)] (18)(a)(i), nonablative procedure includes
+217 hair removal.
+218 (b) "Nonablative procedure" does not include:
+219 (i) a superficial procedure as defined in Section 58-1-102;
+220 (ii) the application of permanent make-up; or
+221 (iii) the use of photo therapy and lasers for neuromusculoskeletal treatments that are
+222 performed by an individual licensed under this title who is acting within the individual's scope
+223 of practice.
+224 [(16)] (19) "Physician" means both physicians and surgeons licensed under Section
+225 58-67-301, Utah Medical Practice Act, and osteopathic physicians and surgeons licensed under
+226 Section 58-68-301, Utah Osteopathic Medical Practice Act.
+227 [(17)] (20) (a) "Practice of medicine" means:
+228 (i) to diagnose, treat, correct, administer anesthesia, or prescribe for any human
+229 disease, ailment, injury, infirmity, deformity, pain or other condition, physical or mental, real
+230 or imaginary, including to perform cosmetic medical procedures, or to attempt to do so, by any
+231 means or instrumentality, and by an individual in Utah or outside the state upon or for any
+232 human within the state;
+233 (ii) when a person not licensed as a physician directs a licensee under this chapter to
+234 withhold or alter the health care services that the licensee has ordered;
+235 (iii) to maintain an office or place of business for the purpose of doing any of the acts
+236 described in Subsection [(17)(a)] (20)(a) whether or not for compensation; or
+237 (iv) to use, in the conduct of any occupation or profession pertaining to the diagnosis or
+238 treatment of human diseases or conditions in any printed material, stationery, letterhead,
+239 envelopes, signs, or advertisements, the designation "doctor," "doctor of medicine,"
+240 "physician," "surgeon," "physician and surgeon," "Dr.," "M.D.," or any combination of these
+241 designations in any manner which might cause a reasonable person to believe the individual
+
+
+242 using the designation is a licensed physician and surgeon, and if the party using the designation
+243 is not a licensed physician and surgeon, the designation must additionally contain the
+244 description of the branch of the healing arts for which the person has a license, provided that an
+245 individual who has received an earned degree of doctor of medicine degree but is not a licensed
+246 physician and surgeon in Utah may use the designation "M.D." if it is followed by "Not
+247 Licensed" or "Not Licensed in Utah" in the same size and style of lettering.
+248 (b) The practice of medicine does not include:
+249 (i) except for an ablative medical procedure as provided in Subsection [(17)(b)(ii)]
+250 (20)(b)(ii), the conduct described in Subsection [(17)(a)(i)] (20)(a)(i)that is performed in
+251 accordance with a license issued under another chapter of this title;
+252 (ii) an ablative cosmetic medical procedure if the scope of practice for the person
+253 performing the ablative cosmetic medical procedure includes the authority to operate or
+254 perform a surgical procedure; or
+255 (iii) conduct under Subsection 58-67-501(2).
+256 [(18)] (21) "Prescription device" means an instrument, apparatus, implement, machine,
+257 contrivance, implant, in vitro reagent, or other similar or related article, and any component
+258 part or accessory, which is required under federal or state law to be prescribed by a practitioner
+259 and dispensed by or through a person or entity licensed under this chapter or exempt from
+260 licensure under this chapter.
+261 [(19)] (22) "Prescription drug" means a drug that is required by federal or state law or
+262 rule to be dispensed only by prescription or is restricted to administration only by practitioners.
+263 (23) (a) "Sex characteristic-altering surgical procedure" means, for the purpose of
+264 effectuating or facilitating an individual's attempted sex change:
+265 (i) castration, orchiectomy, penectomy, vaginoplasty, vulvoplasty, breast augmentation
+266 surgery, or facial feminization surgery on an individual whose biological sex at birth is male;
+267 (ii) mastectomy, hysterectomy, oophorectomy, metoidioplasty, phalloplasty, or chest or
+268 facial masculinization procedures on an individual whose biological sex at birth is female;
+269 (iii) any surgical procedure that is related to or necessary for a procedure described in
+270 Subsection (23)(a)(i) or (ii), that would result in the sterilization of an individual who is
+271 non-sterile; or
+272 (iv) removing any otherwise healthy or non-diseased body part or tissue.
+
+
+273 (b) "Sex characteristic-altering surgical procedure" does not include:
+274 (i) surgery or other procedures or treatments performed on an individual who:
+275 (A) is born with external biological sex characteristics that are irresolvably ambiguous;
+276 (B) is born with 46, XX chromosomes with virilization;
+277 (C) is born with 46, XY chromosomes with undervirilization;
+278 (D) has both ovarian and testicular tissue; or
+279 (E) has been diagnosed by a physician, based on genetic or biochemical testing, with a
+280 sex development disorder characterized by abnormal sex chromosome structure, sex steroid
+281 hormone production, or sex steroid hormone action for a male or female; or
+282 (ii) removing a body part:
+283 (A) because the body part is cancerous or diseased; or
+284 (B) for a reason that is medically necessary, other than to effectuate or facilitate an
+285 individual's attempted sex change.
+286 [(20)] (24) "SPEX" means the Special Purpose Examination of the Federation of State
+287 Medical Boards.
+288 [(21)] (25) "Unlawful conduct" means the same as that term is defined in Sections
+289	58-1-501 and 58-67-501.
+290 [(22)] (26) "Unprofessional conduct" means the same as that term is defined in
+291 Sections 58-1-501 and 58-67-502, and as may be further defined by division rule.
+292 Section 4. Section 58-67-502 is amended to read:
+293 58-67-502. Unprofessional conduct.
+294 (1) "Unprofessional conduct" includes, in addition to the definition in Section
+295	58-1-501:
+296 (a) using or employing the services of any individual to assist a licensee in any manner
+297 not in accordance with the generally recognized practices, standards, or ethics of the
+298 profession, state law, or division rule;
+299 (b) making a material misrepresentation regarding the qualifications for licensure under
+300	Section 58-67-302.7 or Section 58-67-302.8;
+301 (c) violating the dispensing requirements of Chapter 17b, Part 8, Dispensing Medical
+302 Practitioner and Dispensing Medical Practitioner Clinic Pharmacy, if applicable;
+303 (d) violating the requirements of Title 26, Chapter 61a, Utah Medical Cannabis Act;
+
+
+304 [or]
+305 (e) falsely making an entry in, or altering, a medical record with the intent to conceal:
+306 (i) a wrongful or negligent act or omission of an individual licensed under this chapter
+307 or an individual under the direction or control of an individual licensed under this chapter; or
+308 (ii) conduct described in Subsections (1)(a) through (d) or Subsection 58-1-501(1)[.];
+
+309 or
+310 (f) performing, or causing to be performed, upon a minor as defined in Section
+311	58-1-603:
+
+312 (i) a hormonal transgender procedure in violation of Section 58-1-511;
+
+313 (ii) a sex characteristic-altering surgical procedure; or
+314 (iii) a cosmetic breast surgical procedure.
+315 (2) "Unprofessional conduct" does not include:
+316 (a) in compliance with Section 58-85-103:
+317 (i) obtaining an investigational drug or investigational device;
+318 (ii) administering the investigational drug to an eligible patient; or
+319 (iii) treating an eligible patient with the investigational drug or investigational device;
+320 or
+321 (b) in accordance with Title 26, Chapter 61a, Utah Medical Cannabis Act:
+322 (i) when registered as a qualified medical provider or acting as a limited medical
+323 provider, as those terms are defined in Section 26-61a-102, recommending the use of medical
+324 cannabis;
+325 (ii) when registered as a pharmacy medical provider, as that term is defined in Section
+326 26-61a-102, providing pharmacy medical provider services in a medical cannabis pharmacy; or
+327 (iii) when registered as a state central patient portal medical provider, as that term is
+328 defined in Section 26-61a-102, providing state central patient portal medical provider services.
+329 (3) Notwithstanding Subsection (2)(b), the division, in consultation with the board and
+330 in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, shall define
+331 unprofessional conduct for a physician described in Subsection (2)(b).
+332 Section 5. Section 58-68-102 is amended to read:
+333 58-68-102.  Definitions.
+334 In addition to the definitions in Section 58-1-102, as used in this chapter:
+
+
+335 (1) (a) "Ablative procedure" means a procedure that is expected to excise, vaporize,
+336 disintegrate, or remove living tissue, including the use of carbon dioxide lasers and erbium:
+337 YAG lasers.
+338 (b) "Ablative procedure" does not include hair removal.
+339 (2) "ACGME" means the Accreditation Council for Graduate Medical Education of the
+340 American Medical Association.
+341 (3) "Administrative penalty" means a monetary fine imposed by the division for acts or
+342 omissions determined to constitute unprofessional or unlawful conduct, as a result of an
+343 adjudicative proceeding conducted in accordance with Title 63G, Chapter 4, Administrative
+344 Procedures Act.
+345 (4) "AOA" means the American Osteopathic Association.
+346 (5) "Associate physician" means an individual licensed under Section 58-68-302.5.
+347 (6) "Attempted sex change" means an attempt or effort to change an individual's body
+348 to present that individual as being of a sex or gender that is different from the individual's
+349 biological sex at birth.
+350 (7) "Biological sex at birth" means an individual's sex, as being male or female,
+351 according to distinct reproductive roles as manifested by sex and reproductive organ anatomy,
+352 chromosomal makeup, and endogenous hormone profiles.
+353 [(6)] (8) "Board" means the Osteopathic Physician and Surgeon's Licensing Board
+354 created in Section 58-68-201.
+355 [(7)] (9) "Collaborating physician" means an individual licensed under Section
+356 58-68-302 who enters into a collaborative practice arrangement with an associate physician.
+357 [(8)] (10) "Collaborative practice arrangement" means the arrangement described in
+358	Section 58-68-807.
+359 (11) "Cosmetic breast surgical procedure" means a breast reduction surgery or a breast
+360 augmentation surgery for reasons other than:
+361 (a) medical necessity; or
+362 (b) to address a musculoskeletal problem.
+363 [(9)] (12) (a) "Cosmetic medical device" means tissue altering energy based devices
+364 that have the potential for altering living tissue and that are used to perform ablative or
+365 nonablative procedures, such as American National Standards Institute (ANSI) designated
+
+
+366 Class IIIb and Class IV lasers, intense pulsed light, radio frequency devices, and lipolytic
+367 devices and excludes ANSI designated Class IIIa and lower powered devices.
+368 (b) Notwithstanding Subsection [(9)(a)] (12)(a), if an ANSI designated Class IIIa and
+369 lower powered device is being used to perform an ablative procedure, the device is included in
+370 the definition of cosmetic medical device under Subsection [(9)(a)] (12)(a).
+371 [(10)] (13) "Cosmetic medical procedure":
+372 (a) includes the use of cosmetic medical devices to perform ablative or nonablative
+373 procedures; and
+374 (b) does not include a treatment of the ocular globe such as refractive surgery.
+375 [(11)] (14) "Diagnose" means:
+376 (a) to examine in any manner another person, parts of a person's body, substances,
+377 fluids, or materials excreted, taken, or removed from a person's body, or produced by a person's
+378 body, to determine the source, nature, kind, or extent of a disease or other physical or mental
+379 condition;
+380 (b) to attempt to conduct an examination or determination described under Subsection
+381	[(11)(a)] (14)(a);
+382 (c) to hold oneself out as making or to represent that one is making an examination or
+383 determination as described in Subsection [(11)(a)] (14)(a); or
+384 (d) to make an examination or determination as described in Subsection [(11)(a)]
+385 (14)(a) upon or from information supplied directly or indirectly by another person, whether or
+386 not in the presence of the person making or attempting the diagnosis or examination.
+387 [(12)] (15) "Medical assistant" means an unlicensed individual who may perform tasks
+388 as described in Subsection 58-68-305(6).
+389 [(13)] (16) "Medically underserved area" means a geographic area in which there is a
+390 shortage of primary care health services for residents, as determined by the Department of
+391 Health.
+392 [(14)] (17) "Medically underserved population" means a specified group of people
+393 living in a defined geographic area with a shortage of primary care health services, as
+394 determined by the Department of Health.
+395 [(15)] (18) (a) (i) "Nonablative procedure" means a procedure that is expected or
+396 intended to alter living tissue, but is not expected or intended to excise, vaporize, disintegrate,
+
+
+397 or remove living tissue.
+398 (ii) Notwithstanding Subsection [(15)(a)(i)] (18)(a)(i), nonablative procedure includes
+399 hair removal.
+400 (b) "Nonablative procedure" does not include:
+401 (i) a superficial procedure as defined in Section 58-1-102;
+402 (ii) the application of permanent make-up; or
+403 (iii) the use of photo therapy lasers for neuromusculoskeletal treatments that are
+404 preformed by an individual licensed under this title who is acting within the individual's scope
+405 of practice.
+406 [(16)] (19) "Physician" means both physicians and surgeons licensed under Section
+407 58-67-301, Utah Medical Practice Act, and osteopathic physicians and surgeons licensed under
+408 Section 58-68-301, Utah Osteopathic Medical Practice Act.
+409 [(17)] (20) (a) "Practice of osteopathic medicine" means:
+410 (i) to diagnose, treat, correct, administer anesthesia, or prescribe for any human
+411 disease, ailment, injury, infirmity, deformity, pain, or other condition, physical or mental, real
+412 or imaginary, or to attempt to do so, by any means or instrumentality, which in whole or in part
+413 is based upon emphasis of the importance of the musculoskeletal system and manipulative
+414 therapy in the maintenance and restoration of health, by an individual in Utah or outside of the
+415 state upon or for any human within the state;
+416 (ii) when a person not licensed as a physician directs a licensee under this chapter to
+417 withhold or alter the health care services that the licensee has ordered;
+418 (iii) to maintain an office or place of business for the purpose of doing any of the acts
+419 described in Subsection [(17)(a)] (20)(a) whether or not for compensation; or
+420 (iv) to use, in the conduct of any occupation or profession pertaining to the diagnosis or
+421 treatment of human diseases or conditions, in any printed material, stationery, letterhead,
+422 envelopes, signs, or advertisements, the designation "doctor," "doctor of osteopathic medicine,"
+423 "osteopathic physician," "osteopathic surgeon," "osteopathic physician and surgeon," "Dr.,"
+424 "D.O.," or any combination of these designations in any manner which might cause a
+425 reasonable person to believe the individual using the designation is a licensed osteopathic
+426 physician, and if the party using the designation is not a licensed osteopathic physician, the
+427 designation must additionally contain the description of the branch of the healing arts for which
+
+
+428 the person has a license, provided that an individual who has received an earned degree of
+429 doctor of osteopathic medicine but is not a licensed osteopathic physician and surgeon in Utah
+430 may use the designation "D.O." if it is followed by "Not Licensed" or "Not Licensed in Utah"
+431 in the same size and style of lettering.
+432 (b) The practice of osteopathic medicine does not include:
+433 (i) except for an ablative medical procedure as provided in Subsection [(17)(b)(ii)]
+434 (20)(b)(ii), the conduct described in Subsection [(17)(a)(i)] (20)(a)(i) that is performed in
+435 accordance with a license issued under another chapter of this title;
+436 (ii) an ablative cosmetic medical procedure if the scope of practice for the person
+437 performing the ablative cosmetic medical procedure includes the authority to operate or
+438 perform a surgical procedure; or
+439 (iii) conduct under Subsection 58-68-501(2).
+440 [(18)] (21) "Prescription device" means an instrument, apparatus, implement, machine,
+441 contrivance, implant, in vitro reagent, or other similar or related article, and any component
+442 part or accessory, which is required under federal or state law to be prescribed by a practitioner
+443 and dispensed by or through a person or entity licensed under this chapter or exempt from
+444 licensure under this chapter.
+445 [(19)] (22) "Prescription drug" means a drug that is required by federal or state law or
+446 rule to be dispensed only by prescription or is restricted to administration only by practitioners.
+447 (23) (a) "Sex characteristic-altering surgical procedure" means, for the purpose of
+448 effectuating or facilitating an individual's attempted sex change:
+449 (i) castration, orchiectomy, penectomy, vaginoplasty, vulvoplasty, breast augmentation
+450 surgery, or facial feminization surgery on an individual whose biological sex at birth is male;
+451 (ii) mastectomy, hysterectomy, oophorectomy, metoidioplasty, phalloplasty, or chest or
+452 facial masculinization procedures on an individual whose biological sex at birth is female;
+453 (iii) any surgical procedure that is related to or necessary for a procedure described in
+454 Subsection (23)(a)(i) or (ii), that would result in the sterilization of an individual who is
+455 non-sterile; or
+456 (iv) removing any otherwise healthy or non-diseased body part or tissue.
+457 (b) "Sex characteristic-altering surgical procedure" does not include:
+458 (i) surgery or other procedures or treatments performed on an individual who:
+
+
+459 (A) is born with external biological sex characteristics that are irresolvably ambiguous;
+460 (B) is born with 46, XX chromosomes with virilization;
+461 (C) is born with 46, XY chromosomes with undervirilization;
+462 (D) has both ovarian and testicular tissue; or
+463 (E) has been diagnosed by a physician, based on genetic or biochemical testing, with a
+464 sex development disorder characterized by abnormal sex chromosome structure, sex steroid
+465 hormone production, or sex steroid hormone action for a male or female; or
+466 (ii) removing a body part:
+467 (A) because the body part is cancerous or diseased; or
+468 (B) for a reason that is medically necessary, other than to effectuate or facilitate an
+469 individual's attempted sex change.
+470 [(20)] (24) "SPEX" means the Special Purpose Examination of the Federation of State
+471 Medical Boards.
+472 [(21)] (25) "Unlawful conduct" means the same as that term is defined in Sections
+473	58-1-501 and 58-68-501.
+474 [(22)] (26) "Unprofessional conduct" means the same as that term is defined in
+475 Sections 58-1-501 and 58-68-502 and as may be further defined by division rule.
+476 Section 6. Section 58-68-502 is amended to read:
+477 58-68-502. Unprofessional conduct.
+478 (1) "Unprofessional conduct" includes, in addition to the definition in Section
+479	58-1-501:
+480 (a) using or employing the services of any individual to assist a licensee in any manner
+481 not in accordance with the generally recognized practices, standards, or ethics of the
+482 profession, state law, or division rule;
+483 (b) violating the dispensing requirements of Chapter 17b, Part 8, Dispensing Medical
+484 Practitioner and Dispensing Medical Practitioner Clinic Pharmacy, if applicable;
+485 (c) making a material misrepresentation regarding the qualifications for licensure under
+486	Section 58-68-302.5;
+487 (d) violating the requirements of Title 26, Chapter 61a, Utah Medical Cannabis Act;
+488 [or]
+489 (e) falsely making an entry in, or altering, a medical record with the intent to conceal:
+
+
+490 (i) a wrongful or negligent act or omission of an individual licensed under this chapter
+491 or an individual under the direction or control of an individual licensed under this chapter; or
+492 (ii) conduct described in Subsections (1)(a) through (d) or Subsection 58-1-501(1)[.];
+
+493 or
+494 (f) performing, or causing to be performed, upon a minor as defined in 58-1-511:
+
+495 (i) a hormonal transgender procedure in violation of Section 58-1-511;
+
+496 (ii) a sex characteristic-altering surgical procedure; or
+497 (iii) a cosmetic breast surgical procedure.
+498 (2) "Unprofessional conduct" does not include:
+499 (a) in compliance with Section 58-85-103:
+500 (i) obtaining an investigational drug or investigational device;
+501 (ii) administering the investigational drug to an eligible patient; or
+502 (iii) treating an eligible patient with the investigational drug or investigational device;
+503 or
+504 (b) in accordance with Title 26, Chapter 61a, Utah Medical Cannabis Act:
+505 (i) when registered as a qualified medical provider or acting as a limited medical
+506 provider, as those terms are defined in Section 26-61a-102, recommending the use of medical
+507 cannabis;
+508 (ii) when registered as a pharmacy medical provider, as that term is defined in Section
+509 26-61a-102, providing pharmacy medical provider services in a medical cannabis pharmacy; or
+510 (iii) when registered as a state central patient portal medical provider, as that term is
+511 defined in Section 26-61a-102, providing state central patient portal medical provider services.
+512 (3) Notwithstanding Subsection (2)(b), the division, in consultation with the board and
+513 in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, shall define
+514 unprofessional conduct for a physician described in Subsection (2)(b).
+515 Section 7. Section 58-70a-503 is amended to read:
+516 58-70a-503.  Unprofessional conduct.
+517 (1) "Unprofessional conduct" includes:
+518 (a) violation of a patient confidence to any person who does not have a legal right and a
+519 professional need to know the information concerning the patient;
+520 (b) knowingly prescribing, selling, giving away, or directly or indirectly administering,
+
+
+521 or offering to prescribe, sell, furnish, give away, or administer any prescription drug except for
+522 a legitimate medical purpose upon a proper diagnosis indicating use of that drug in the amounts
+523 prescribed or provided;
+524 (c) prescribing prescription drugs for oneself or administering prescription drugs to
+525 oneself, except those that have been legally prescribed for the physician assistant by a licensed
+526 practitioner and that are used in accordance with the prescription order for the condition
+527 diagnosed;
+528 (d) in a practice that has physician assistant ownership interests, failure to allow a
+529 physician the independent final decision making authority on treatment decisions for the
+530 physician's patient;
+531 (e) violating the dispensing requirements of Chapter 17b, Part 8, Dispensing Medical
+532 Practitioner and Dispensing Medical Practitioner Clinic Pharmacy, if applicable;
+533 (f) falsely making an entry in, or altering, a medical record with the intent to conceal:
+534 (i) a wrongful or negligent act or omission of an individual licensed under this chapter
+535 or an individual under the direction or control of an individual licensed under this chapter; or
+536 (ii) conduct described in Subsections (1)(a) through (e) or Subsection 58-1-501(1);
+537 [and]
+538 (g) violating the requirements of Title 26, Chapter 61a, Utah Medical Cannabis Act[.];
+
+539 or
+540 (h) performing, or causing to be performed, a hormonal transgender procedure in
+541 violation of Section 58-1-511.
+
+542 (2) (a) "Unprofessional conduct" does not include, in accordance with Title 26, Chapter
+543 61a, Utah Medical Cannabis Act, when registered as a qualified medical provider or acting as a
+544 limited medical provider, as those terms are defined in Section 26-61a-102, recommending the
+545 use of medical cannabis.
+546 (b) Notwithstanding Subsection (2)(a), the division, in consultation with the board and
+547 in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, shall define
+548 unprofessional conduct for a physician assistant described in Subsection (2)(a).
+
+
+
+
+
+
+
+
diff --git a/assets/data-leg/HB0209.txt b/assets/data-leg/HB0209.txt
new file mode 100644
index 00000000..eb60f0e9
--- /dev/null
+++ b/assets/data-leg/HB0209.txt
@@ -0,0 +1,412 @@
+Enrolled Copy	H.B. 209
+1 PARTICIPATION IN EXTRACURRICULAR ACTIVITIES
+2 AMENDMENTS
+3 2023 GENERAL SESSION
+4 STATE OF UTAH
+5 Chief Sponsor: Jordan D. Teuscher
+6 Senate Sponsor: Lincoln Fillmore
+7
+8 LONG TITLE
+9 General Description:
+10 This bill amends provisions amending student participation in extracurricular activities.
+11 Highlighted Provisions:
+12 This bill:
+13 ?	defines terms;
+14 ?	allows a private school student, a home school student, a charter school student, or
+15 an online school student to participate in extracurricular activities outside of the
+16 student's public school of residence under certain circumstances;
+17 ?	prohibits a public school from participation in an athletics association that does not
+18 collect a birth certificate or other identifying documents during the registration
+19 process;
+20 ?	allows athletes without access to a birth certificate to provide alternative
+21 documentation to an athletic association in certain circumstances; and
+22 ?	makes technical and conforming changes.
+23 Money Appropriated in this Bill:
+24 None
+25 Other Special Clauses:
+26 None
+27 Utah Code Sections Affected:
+28 AMENDS:
+29 53G-6-703, as last amended by Laws of Utah 2019, Chapter 293
+
+30 53G-6-704, as last amended by Laws of Utah 2019, Chapter 293
+31 53G-6-705, as last amended by Laws of Utah 2019, Chapter 293
+32 53G-6-1001, as enacted by Laws of Utah 2022, Chapter 478
+33 53G-7-1102, as renumbered and amended by Laws of Utah 2018, Chapter 3 34
+35 Be it enacted by the Legislature of the state of Utah:
+36 Section 1. Section 53G-6-703 is amended to read:
+37 53G-6-703.  Private school and home school students' participation in
+38 extracurricular activities in a public school.
+39 (1) As used in this section:
+40 (a) "Academic eligibility requirements" means the academic eligibility requirements
+41 that a home school student is required to meet to participate in an extracurricular activity in a
+42 public school.
+43 (b) "Association" means the same as that term is defined in Section 53G-7-1101.
+
+44 (c) "Extracurricular activity" means the same as that term is defined in Section
+45	53G-7-501.
+
+46 (d) "Initial establishment of eligibility requirements" means an association's eligibility
+47 requirements, policies, procedures, and transfer rules that a school student in grade 9 or 10
+48 must meet, and to which the student is bound, to participate on a high school sports team when
+49 the student:
+50 (i) attends the high school in which the student is selected for membership on a high
+51 school sports team; or
+52 (ii) does not attend the high school in which the student tries out for and is selected for
+53 membership on a high school sports team.
+54 [(b)] (e) "Minor" means the same as that term is defined in Section 53G-6-201.
+55 [(c)] (f) "Parent" means the same as that term is defined in Section 53G-6-201.
+56 [(d)] (g) "Principal" means the principal of the school in which a home school student
+57 participates or intends to participate in an extracurricular activity.
+
+58 (2) (a) A minor who is enrolled in a private school or a home school [shall be] is
+59 eligible to participate in an extracurricular activity at a public school as provided in this
+60 section.
+61 (b) A private school student may only participate in an extracurricular activity at a
+62 public school that is not offered by the student's private school.
+63 (c) (i) Except as provided in Subsection (2)(d), a private school student or a home
+64 school student may only participate in an extracurricular activity at:
+65 [(i)] (A) the school [within whose] with attendance boundaries within which the
+66 student's custodial parent resides; or
+67 [(ii)] (B) the school from which the student withdrew for the purpose of attending a
+68 private or home school.
+69 (ii) A private school student or a home school student retains the ability to participate
+70 in an extracurricular activity at a school described in Subsection (2)(c)(i) if the student did not
+71 initially establish the student's eligibility at another school in grade 9 or 10.
+
+72 (d) A school other than a school described in Subsection (2)(c)(i) [or (ii)] may allow a
+73 private school student or a home school student to participate in an extracurricular activity
+74 [other than:] that the public school sponsors and supports if:
+75 (i) for an interscholastic competition of athletic teams [sponsored and supported by a
+76 public school; or], the private school student or the home school student meets the initial
+77 establishment of eligibility requirements;
+78 (ii) for an interscholastic contest or competition for music, drama, or forensic groups or
+79 teams [sponsored and supported by a public school.], the private school student, subject to
+80 Subsection (2)(b), or the home school student meets the entry requirements for participation;
+81 (iii) the private school student or the home school student meets the eligibility
+82 requirements under this section; and
+83 (iv) the private school student or the home school student meets the enrollment
+84 requirements for public school in accordance with Part 4, School District Enrollment.
+85 (3) (a) Except as provided in Subsections (4) through (13), a private school student or a
+
+86 home school student [shall be] is eligible to participate in an extracurricular activity at a public
+87 school consistent with eligibility standards:
+88 (i) applied to a fully enrolled public school student;
+89 (ii) of the public school where the private school student or the home school student
+90 participates in an extracurricular activity; and
+91 (iii) for the extracurricular activity in which the private school or the home school
+92 student participates.
+93 (b) A school district or public school may not impose additional requirements on a
+94 private school student or a home school student to participate in an extracurricular activity that
+95 are not imposed on a fully enrolled public school student.
+96 (c) (i) A private school student or a home school student who participates in an
+97 extracurricular activity at a public school shall pay the same fees as required of a fully enrolled
+98 public school student to participate in an extracurricular activity.
+99 (ii) If a local school board or a charter school governing board imposes a mandatory
+100 student activity fee for a student enrolled in a public school, the fee may be imposed on a
+101 private school student or a home school student who participates in an extracurricular activity
+102 at the public school if the same benefits of paying the mandatory student activity fee that are
+103 available to a fully enrolled public school student are available to a private school student or a
+104 home school student who participates in an extracurricular activity at the public school.
+105 (4) Eligibility requirements based on school attendance are not applicable to a home
+106 school student.
+107 (5) A home school student meets academic eligibility requirements to participate in an
+108 extracurricular activity if:
+109 (a) the student is mastering the material in each course or subject being taught; and
+110 (b) the student is maintaining satisfactory progress towards achievement or promotion.
+111 (6) (a) To establish a home school student's academic eligibility, a parent, teacher, or
+112 organization providing instruction to the student shall submit an affidavit to the principal
+113 indicating the student meets academic eligibility requirements.
+
+114 (b) Upon submission of an affidavit pursuant to Subsection (6)(a), a home school
+115 student shall:
+116 (i) be considered to meet academic eligibility requirements; and
+117 (ii) retain academic eligibility for all extracurricular activities during the activity season
+118 for which the affidavit is submitted, until:
+119 (A) a panel established under Subsection (10) determines the home school student does
+120 not meet academic eligibility requirements; or
+121 (B) the person who submitted the affidavit under Subsection (6)(a) provides written
+122 notice to the school principal that the student no longer meets academic eligibility
+123 requirements.
+124 (7) (a) A home school student who loses academic eligibility pursuant to Subsection
+125 (6)(b)(ii)(B) may not participate in an extracurricular activity until the person who submitted
+126 the affidavit under Subsection (6)(a) provides written notice to the school principal that the
+127 home school student has reestablished academic eligibility.
+128 (b) If a home school student reestablishes academic eligibility pursuant to Subsection
+129 (7)(a), the home school student may participate in extracurricular activities for the remainder of
+130 the activity season for which an affidavit was submitted under Subsection (6)(a).
+131 (8) A person who has probable cause to believe a home school student does not meet
+132 academic eligibility requirements may submit an affidavit to the principal:
+133 (a) asserting the home school student does not meet academic eligibility requirements;
+134 and
+135 (b) providing information indicating that the home school student does not meet the
+136 academic eligibility requirements.
+137 (9) A principal shall review the affidavit submitted under Subsection (8), and if the
+138 principal determines it contains information which constitutes probable cause to believe a
+139 home school student may not meet academic eligibility requirements, the principal shall
+140 request a panel established pursuant to Subsection (10) to verify the student's compliance with
+141 academic eligibility requirements.
+
+142 (10) (a) A school district superintendent shall:
+143 (i) appoint a panel of three individuals to verify a home school student's compliance
+144 with academic eligibility requirements when requested by a principal pursuant to Subsection
+145 (9); and
+146 (ii) select the panel members from nominees submitted by national, state, or regional
+147 organizations whose members are home school students and parents.
+148 (b) Of the members appointed to a panel under Subsection (10)(a):
+149 (i) one member shall have experience teaching in a public school as a licensed teacher
+150 and in home schooling high school-age students;
+151 (ii) one member shall have experience teaching in a higher education institution and in
+152 home schooling; and
+153 (iii) one member shall have experience in home schooling high school-age students.
+154 (11) A panel appointed under Subsection (10):
+155 (a) shall review the affidavit submitted under Subsection (8);
+156 (b) may confer with the person who submitted the affidavit under Subsection (8);
+157 (c) shall request the home school student to submit test scores or a portfolio of work
+158 documenting the student's academic achievement to the panel;
+159 (d) shall review the test scores or portfolio of work; and
+160 (e) shall determine whether the home school student meets academic eligibility
+161 requirements.
+162 (12) A home school student who meets academic eligibility requirements pursuant to
+163 Subsection (11), retains academic eligibility for all extracurricular activities during the activity
+164 season for which an affidavit is submitted pursuant to Subsection (6).
+165 (13) (a) A panel's determination that a home school student does not comply with
+166 academic eligibility requirements is effective for an activity season and all extracurricular
+167 activities that have academic eligibility requirements.
+168 (b) A home school student who is not in compliance with academic eligibility
+169 requirements as determined by a panel appointed under Subsection (11) may seek to establish
+
+170 academic eligibility under this section for the next activity season.
+171 (14) (a) A public school student who has been declared to be academically ineligible to
+172 participate in an extracurricular activity and who subsequently enrolls in a home school shall
+173 lose eligibility for participation in the extracurricular activity until the student:
+174 (i) demonstrates academic eligibility by providing test results or a portfolio of the
+175 student's work to the school principal, provided that a student may not reestablish academic
+176 eligibility under this Subsection (14)(a) during the same activity season in which the student
+177 was declared to be academically ineligible;
+178 (ii) returns to public school and reestablishes academic eligibility; or
+179 (iii) enrolls in a private school and establishes academic eligibility.
+180 (b) A public school student who has been declared to be behaviorally ineligible to
+181 participate in an extracurricular activity and who subsequently enrolls in a home school shall
+182 lose eligibility for participation in the extracurricular activity until the student meets eligibility
+183 standards as provided in Subsection (3).
+184 (15) When selection to participate in an extracurricular activity at a public school is
+185 made on a competitive basis, a private school student [and] or a home school student [shall be]
+186 is eligible to try out for and participate in the activity as provided in this section.
+187 (16) (a) If a student exits a public school to enroll in a private school or a home school
+188 mid-semester or during an activity season, and the student desires to participate in an
+189 extracurricular activity at the public school, the public school shall issue an interim academic
+190 assessment based on the student's work in each class.
+191 (b) A student's academic eligibility to participate in an extracurricular activity under
+192 the circumstances described in Subsection (16)(a) [shall be based] is dependent on the student
+193 meeting public school academic eligibility standards at the time of exiting public school.
+194 (c) A student may appeal an academic eligibility determination made under Subsection
+195 (16)(b) in accordance with procedures for appealing a public school student's academic
+196 eligibility.
+197 Section 2. Section 53G-6-704 is amended to read:
+
+198 53G-6-704.  Charter school students' participation in extracurricular activities at
+199 other public schools.
+200 (1) As used in this section:
+201 (a) "Association" means the same as that term is defined in Section 53G-7-1101.
+
+202 (b) "Extracurricular activity" means the same as that term is defined in Section
+203	53G-7-501.
+
+204 (c) "Initial establishment of eligibility requirements" means the same as that term is
+205 defined in Section 53G-6-703.
+
+206 [(1)] (2) A charter school student is eligible to participate in an extracurricular activity
+207 not offered by the student's charter school at:
+208 (a) the school [within whose] with attendance boundaries within which the student's
+209 custodial parent resides, if, for an interscholastic competition of athletic teams, the student did
+210 not initially establish the student's eligibility at another public school in grade 9 or 10;
+211 (b) the public school from which the student withdrew for the purpose of attending a
+212 charter school; or
+213 (c) a public school that is not a charter school if the student's charter school is located
+214 on the campus of the public school or has local school board approval to locate on the campus
+215 of the public school.
+216 [(2)] (3) In addition to the public schools listed in Subsection [(1),] (2), the state board
+217 may establish rules to allow a charter school student to participate in an extracurricular activity
+218 at a public school other than a public school listed in Subsection [(1).] (2).
+219 [(3)] (4) A school other than a school described in Subsection [(1)(a), (b), or (c)] (2)
+220 may allow a charter school student to participate in [extracurricular activities other than:] an
+221 extracurricular activity a public school sponsors and supports if:
+222 (a) for interschool competitions of athletic teams [sponsored and supported by a public
+223 school; or], the charter school student meets the initial establishment of eligibility
+224 requirements;
+225 (b) for interschool contests or competitions for music, drama, or forensic groups or
+
+226 teams [sponsored and supported by a public school.], the charter school student meets the entry
+227 requirements for participation;
+228 (c) the charter school student meets the eligibility requirements under this section; and
+229 (d) the charter school student meets the enrollment requirements for public school in
+230 accordance with Part 4, School District Enrollment.
+231 [(4)] (5) A charter school student is eligible for an extracurricular [activities] activity at
+232 a public school consistent with eligibility standards as applied to full-time students of the
+233 public school.
+234 [(5)] (6) A school district or a public school may not impose additional requirements
+235 on a charter school student to participate in an extracurricular [activities] activity that are not
+236 imposed on full-time students of the public school.
+237 [(6)] (7) (a) The state board shall make rules establishing fees for charter school
+238 students' participation in an extracurricular [activities] activity at school district schools.
+239 (b) The rules shall provide that:
+240 (i) charter school students pay the same fees as other students to participate in an
+241 extracurricular [activities] activity;
+242 (ii) charter school students are eligible for fee waivers pursuant to Section 53G-7-504;
+243 (iii) for each charter school student who participates in an extracurricular activity at a
+244 school district school, the charter school shall pay a share of the school district's costs for the
+245 extracurricular activity; and
+246 (iv) a charter school's share of the costs of an extracurricular activity shall reflect state
+247 and local tax revenues expended, except capital facilities expenditures, for an extracurricular
+248 activity in a school district or a school divided by total student enrollment of the school district
+249 or the school.
+250 (c) In determining a charter school's share of the costs of an extracurricular activity
+251 under Subsections [(6)(b)(iii) and (iv)] (7)(b)(iii) and (iv), the state board may establish
+252 uniform fees statewide based on average costs statewide or average costs within a sample of
+253 school districts.
+
+254 [(7)] (8) When selection to participate in an extracurricular activity at a public school is
+255 made on a competitive basis, a charter school student is eligible to try out for and participate in
+256 the activity as provided in this section.
+257 Section 3. Section 53G-6-705 is amended to read:
+258 53G-6-705.  Online students' participation in extracurricular activities.
+259 (1) As used in this section:
+260 (a) "Association" means the same as that term is defined in Section 53G-7-1101.
+
+261 (b) "Extracurricular activity" means the same as that term is defined in Section
+262	53G-7-501.
+
+263 (c) "Initial establishment of eligibility requirements" means the same as that term is
+264 defined in Section 53G-6-703.
+
+265 [(a)] (d) "Online education" means the use of information and communication
+266 technologies to deliver educational opportunities to a student in a location other than a school.
+267 [(b)] (e) "Online student" means a student who:
+268 (i) participates in an online education program sponsored or supported by the state
+269 board, a school district, or a charter school; and
+270 (ii) generates funding for the school district or the school pursuant to Subsection
+271 53F-2-102(4) and rules of the state board.
+272 (2) An online student is eligible to participate in an extracurricular [activities] activity
+273 at:
+274 (a) the school [within whose] with attendance boundaries within which the student's
+275 custodial parent resides, if, for an interscholastic competition of athletic teams, the student did
+276 not initially establish the student's eligibility at another public school in grade 9 or 10; or
+277 (b) the public school from which the student withdrew for the purpose of participating
+278 in an online education program.
+279 (3) A public school other than a school described in Subsection [(2)(a) or (b)] (2) may
+280 allow an online student to participate in an extracurricular [activities other than] activity that
+281 the public school sponsors and supports if:
+
+282 (a) for interschool competitions of athletic teams sponsored and supported by a public
+283 school[; or], the online school student meets the initial establishment of eligibility
+284 requirements;
+285 (b) for interschool contests or competitions for music, drama, or forensic groups or
+286 teams sponsored and supported by a public school[.], the online school student meets the entry
+287 requirements for participation;
+288 (c) the online school student meets the eligibility requirements under this section; and
+289 (d) the online school student meets the enrollment requirements for public school in
+290 accordance with Part 4, School District Enrollment.
+291 (4) An online student is eligible [for] to participate in an extracurricular [activities]
+292 activity at a public school consistent with eligibility standards as applied to full-time students
+293 of the public school.
+294 (5) A school district or public school may not impose additional requirements on an
+295 online school student to participate in an extracurricular [activities] activity that are not
+296 imposed on full-time students of the public school.
+297 (6) (a) The state board shall make rules establishing fees for an online school student's
+298 participation in an extracurricular [activities] activity at school district schools.
+299 (b) The rules shall provide that:
+300 (i) online school students pay the same fees as other students to participate in an
+301 extracurricular [activities] activity;
+302 (ii) online school students are eligible for fee waivers pursuant to Section 53G-7-504;
+303 (iii) for each online school student who participates in an extracurricular activity at a
+304 school district school, the online school shall pay a share of the school district's costs for the
+305 extracurricular activity; and
+306 (iv) an online school's share of the costs of an extracurricular activity shall reflect state
+307 and local tax revenues expended, except capital facilities expenditures, for an extracurricular
+308 activity in a school district or school divided by total student enrollment of the school district
+309 or school.
+
+310 (c) In determining an online school's share of the costs of an extracurricular activity
+311 under Subsections (6)(b)(iii) and (iv), the state board may establish uniform fees statewide
+312 based on average costs statewide or average costs within a sample of school districts.
+313 (7) When selection to participate in an extracurricular activity at a public school is
+314 made on a competitive basis, an online student is eligible to try out for and participate in the
+315 activity as provided in this section.
+316 Section 4. Section 53G-6-1001 is amended to read:
+317 53G-6-1001.  Definitions.
+318 As used in this part:
+319 (1) "Athletic association" means an association, as that term is defined in Section
+320	53G-7-1101.
+321 (2) "Birth certificate" means an official record of an individual's date of birth, place of
+322 birth, sex, and parentage, including a supplementary certificate of birth or birth certificate
+323 amendment and amendment history as provided in Sections 26-2-10 and 26-2-11.
+
+324 [(2)] (3) "Commission" means the School Activity Eligibility Commission created in
+325	Section 53G-6-1003.
+326 (4) "Does not correspond with the sex designation" means that a student's sex
+327 designation for an interscholastic activity in which a student seeks participation does not
+328 correspond with the sex designation on the student's birth certificate or an amendment,
+329 including the amendment history, to the student's birth certificate that the Division of Vital
+330 Records and Statistics provides.
+331 [(3)] (5) "Female-designated" means that an interscholastic activity is designated
+332 specifically for female students.
+333 [(4)] (6) "Gender-designated" means that an interscholastic activity or facility is
+334 designated specifically for female or male students.
+335 [(5)] (7) "Gender identity" means the same as that term is defined in Section
+336	34A-5-102.
+337 [(6)] (8) "Interscholastic activity" means an activity in which a student represents the
+
+338 student's school in the activity in competition against another school.
+339 [(7)] (9) "Male-designated" means that an interscholastic activity is designated
+340 specifically for male students.
+341 [(8)] (10) "Student" means a student who is enrolled in a public school that participates
+342 in interscholastic activities.
+343 Section 5. Section 53G-7-1102 is amended to read:
+344 53G-7-1102. Public schools prohibited from membership.
+345 (1) A public school may not be a member of or pay dues to an association that:
+
+346 (a) is not in compliance [on or after July 1, 2017,] with:
+347 [(a)] (i) this part;
+348 [(b)] (ii) Title 52, Chapter 4, Open and Public Meetings Act;
+349 [(c)] (iii) Title 63G, Chapter 2, Government Records Access and Management Act; and
+350 [(d)] (iv) Title 67, Chapter 16, Utah Public Officers' and Employees' Ethics Act[.];
+
+351 (b) does not collect each student's birth certificate, as that term is defined in Section
+352 53G-6-1001, or equivalent documentation, as described in Subsection (2), to determine
+353 eligibility as a condition of the association's registration process for an athletic team, event, or
+354 category; or
+355 (c) does not require a student to provide the athlete's date of birth and sex as a
+356 condition of the registration process for an athletic team, event, or category.
+357 (2) Except as provided in Subsection (3), for a student who is homeless or not a United
+358 States citizen and who is unable to provide a birth certificate, the association may collect the
+359 student's:
+360 (a) state-issued identification document, including a driver's license or passport; or
+361 (b) federally recognized identification document, including a document that the
+362 Department of Homeland Security issues.
+363 (3) Subsection (1)(b) or (2) do not apply to an association for a student who is a
+364 homeless child or youth, as defined in the McKinney-Vento Homeless Assistance Act, 42
+365 U.S.C. Sec. 11431 et seq.
+
+366 (4) Nothing in this section limits or impairs an LEA's requirement to verify a student's
+367 initial review of eligibility to participate in an athletic team, event, or category under applicable
+368 state or federal law or state board rule, including the student's:
+369 (a) residency status;
+370 (b) age;
+371 (c) sex, verified by the student's birth certificate as that term is defined in Section
+372	53G-6-1001;
+
+373 (d) academic requirements; or
+374 (e) school enrollment capacity.
+375 [(2)] (5) Unless otherwise specified, an association's compliance with or an association
+376 employee or officer's compliance with the provisions described in Subsection (1) does not alter:
+377 (a) the association's public or private status; or
+378 (b) the public or private employment status of the employee or officer.
+
+
+
+
+
+
+
+
diff --git a/assets/data-leg/HB0257.txt b/assets/data-leg/HB0257.txt
new file mode 100644
index 00000000..766e28c5
--- /dev/null
+++ b/assets/data-leg/HB0257.txt
@@ -0,0 +1,3303 @@
+Enrolled Copy
+H.B. 257
+1
+SEX-BASED DESIGNATIONS FOR PRIVACY,
+2
+ANTI-BULLYING, AND WOMEN'S OPPORTUNITIES
+3
+2024 GENERAL SESSION
+4
+STATE OF UTAH
+5
+Chief Sponsor: Kera Birkeland
+6
+Senate Sponsor: Daniel McCay
+7
+8
+LONG TITLE
+9
+General Description:
+10
+This bill establishes a standard regarding distinctions on the basis of sex and applies the
+11
+standard in certain facilities and opportunities where designations on the basis of sex
+12
+address individual privacy, bullying, and women's opportunities.
+
+13
+Highlighted Provisions:
+14
+This bill:
+15
+< defines terms;
+16
+< defines certain terms for the entire Utah Code;
+17
+< establishes a legal standard for distinctions on the basis of sex in certain publicly
+18
+owned or controlled circumstances;
+19
+< establishes acceptable and prohibited distinctions on the basis of sex;
+20
+< enacts provisions regarding sex-designated restroom, shower, or locker room
+21
+22
+23
+24
+25
+26
+27
+28
+29
+facilities that students use within the public education system;
+< requires local education agencies to establish a privacy plan with parents and
+students in certain cases to address gender identity and fear of bullying;
+< enacts provisions regarding sex-designated shower or locker room facilities where
+the general public has an expectation of privacy;
+< establishes components of the crimes of voyeurism and criminal trespass for certain
+actions within a covered sex-designated shower or locker room;
+< requires government entities to:
+C
+report allegations of certain criminal offenses to law enforcement;
+H.B. 257
+Enrolled Copy
+30
+C
+adopt a privacy compliance plan;
+31
+C
+provide a single-occupant facility in new construction; and
+32
+C
+consider the feasibility of certain retrofit or remodel projects;
+33
+< provides indemnification for government entities for certain claims;
+34
+< requires the state auditor to investigate government entity compliance with certain
+35
+36
+37
+38
+39
+40
+41
+42
+43
+44
+45
+46
+requirements;
+< requires the attorney general to impose fines on political subdivisions that fail to
+cure noncompliance that the state auditor identifies;
+< amends certain crimes to establish a reasonable expectation of privacy in public
+restrooms, including enhanced penalties for:
+C
+committing multiple offenses concurrently within a public restroom, shower, or
+locker room; and
+C
+committing certain offenses within a public restroom, shower, or locker room
+that is designated for the opposite sex;
+< enacts a criminal offense for loitering in a restroom, shower, or locker room where
+the general public has an expectation of privacy;
+< establishes elements of the crime of emergency reporting abuse for making repeated
+47
+false reports alleging a violation of a sex-designation in a publicly owned or
+48
+controlled shower or locker room facility where the general public has an
+49
+expectation of privacy; and
+50
+51
+52
+53
+54
+< makes technical and conforming changes.
+Money Appropriated in this Bill:
+None
+Other Special Clauses:
+This bill provides a special effective date.
+
+55
+Utah Code Sections Affected:
+56
+AMENDS:
+57
+53G-6-1101, as enacted by Laws of Utah 2022, Chapter 398
+-2-
+Enrolled Copy
+H.B. 257
+58
+53G-8-211, as last amended by Laws of Utah 2023, Chapter 161
+59
+67-3-1, as last amended by Laws of Utah 2023, Chapters 16, 330, 353, and 480
+60
+67-5-1, as last amended by Laws of Utah 2023, Chapter 330
+61
+68-3-12.5, as last amended by Laws of Utah 2021, Chapter 93
+62
+76-6-206, as last amended by Laws of Utah 2023, Chapter 111
+63
+76-9-202, as last amended by Laws of Utah 2022, Chapter 161
+64
+76-9-702, as last amended by Laws of Utah 2023, Chapter 123
+65
+76-9-702.5, as last amended by Laws of Utah 2022, Chapter 185
+66
+76-9-702.7, as last amended by Laws of Utah 2023, Chapter 411
+67
+ENACTS:
+68
+63G-31-101, Utah Code Annotated 1953
+69
+63G-31-102, Utah Code Annotated 1953
+70
+63G-31-201, Utah Code Annotated 1953
+71
+63G-31-202, Utah Code Annotated 1953
+72
+63G-31-203, Utah Code Annotated 1953
+73
+63G-31-204, Utah Code Annotated 1953
+74
+63G-31-301, Utah Code Annotated 1953
+75
+63G-31-302, Utah Code Annotated 1953
+76
+63G-31-303, Utah Code Annotated 1953
+77
+63G-31-304, Utah Code Annotated 1953
+78
+63G-31-401, Utah Code Annotated 1953
+79
+63G-31-402, Utah Code Annotated 1953
+80
+76-9-702.8, Utah Code Annotated 1953
+81
+82
+Be it enacted by the Legislature of the state of Utah:
+83
+Section 1. Section 53G-6-1101 is amended to read:
+84
+53G-6-1101. Report -- Action plan.
+
+85
+(1) As used in this section:
+-3-
+H.B. 257
+86
+87
+88
+89
+90
+91
+92
+93
+94
+95
+96
+97
+98
+99
+100
+101
+102
+103
+104
+105
+106
+107
+108
+109
+Enrolled Copy
+(a) "Gender-designated interscholastic sport" means a sport that is specifically
+designated for female or male students.
+(b) "Interscholastic sport" means an activity in which a student represents the student's
+school in the sport in competition against another school.
+(c) "School" means a public school that sponsors or offers an interscholastic sport in
+which students enrolled at the school may participate.
+(d) "Title IX" means Title IX of the Education Amendments of 1972, 20 U.S.C. Sec.
+1681 et seq.
+(2) Before the beginning of each academic year, the athletic director or another
+administrator of each school shall report to the school's local governing board regarding:
+(a) the number and type of interscholastic sports available at the school, categorized by
+gender designation;
+(b) the number of students competing in a gender-designated interscholastic sport at the
+school, categorized by gender;
+(c) the amount of spending that the school devotes to each gender-designated sport,
+reported in total amount and on a per-student basis;
+(d) a comparison and evaluation of designated practice and game locations in
+gender-designated interscholastic sports;
+(e) any information regarding the school's efforts in compliance with Title 63G,
+Chapter 31, Part 2, Distinctions on the Basis of Sex, and Title IX [compliance]; and
+(f) if there is a discrepancy between male-designated and female-designated sports of
+10% or greater, an action plan that the school develops to address the discrepancy.
+(3) An LEA governing board that receives the report described in Subsection (2) shall
+review the report in a public board meeting.
+
+110
+Section 2. Section 53G-8-211 is amended to read:
+111
+53G-8-211. Responses to school-based behavior.
+
+112
+(1) As used in this section:
+113
+(a) "Evidence-based" means a program or practice that has:
+-4-
+Enrolled Copy
+114
+115
+H.B. 257
+(i) had multiple randomized control studies or a meta-analysis demonstrating that the
+program or practice is effective for a specific population;
+116
+(ii) been rated as effective by a standardized program evaluation tool; or
+117
+(iii) been approved by the state board.
+
+118
+(b) "Habitual truant" means a school-age child who:
+119
+(i) is in grade 7 or above, unless the school-age child is under 12 years old;
+120
+(ii) is subject to the requirements of Section 53G-6-202; and
+121
+(iii) (A) is truant at least 10 times during one school year; or
+122
+(B) fails to cooperate with efforts on the part of school authorities to resolve the
+123
+school-age child's attendance problem as required under Section 53G-6-206.
+
+124
+(c) "Minor" means the same as that term is defined in Section 80-1-102.
+
+125
+(d) "Mobile crisis outreach team" means the same as that term is defined in Section
+126
+62A-15-102.
+
+127
+128
+(e) "Prosecuting attorney" means the same as that term is defined in Subsections
+80-1-102(65)(b) and (c).
+
+129
+130
+(f) "Restorative justice program" means a school-based program or a program used or
+adopted by a local education agency that is designed:
+131
+132
+(i) to enhance school safety, reduce school suspensions, and limit referrals to law
+enforcement agencies and courts; and
+133
+134
+(ii) to help minors take responsibility for and repair harmful behavior that occurs in
+school.
+
+135
+(g) "School administrator" means a principal of a school.
+
+136
+(h) "School is in session" means a day during which the school conducts instruction for
+137
+which student attendance is counted toward calculating average daily membership.
+
+138
+(i) "School resource officer" means a law enforcement officer, as defined in Section
+139
+53-13-103, who contracts with, is employed by, or whose law enforcement agency contracts
+140
+with a local education agency to provide law enforcement services for the local education
+141
+agency.
+
+-5-
+H.B. 257
+Enrolled Copy
+142
+(j) "School-age child" means the same as that term is defined in Section 53G-6-201.
+
+143
+(k) (i) "School-sponsored activity" means an activity, fundraising event, club, camp,
+144
+clinic, or other event or activity that is authorized by a specific local education agency or public
+145
+school, according to LEA governing board policy, and satisfies at least one of the following
+146
+conditions:
+147
+148
+(A) the activity is managed or supervised by a local education agency or public school,
+or local education agency or public school employee;
+149
+150
+(B) the activity uses the local education agency's or public school's facilities,
+equipment, or other school resources; or
+151
+152
+(C) the activity is supported or subsidized, more than inconsequentially, by public
+funds, including the public school's activity funds or Minimum School Program dollars.
+
+153
+154
+(ii) "School-sponsored activity" includes preparation for and involvement in a public
+performance, contest, athletic competition, demonstration, display, or club activity.
+
+155
+156
+(l) (i) "Status offense" means an offense that would not be an offense but for the age of
+the offender.
+
+157
+158
+159
+160
+(ii) "Status offense" does not mean an offense that by statute is a misdemeanor or
+felony.
+(2) This section applies to a minor enrolled in school who is alleged to have committed
+an offense on school property where the student is enrolled:
+161
+(a) when school is in session; or
+162
+(b) during a school-sponsored activity.
+
+163
+(3) If a minor is alleged to have committed an offense on school property that is a class
+164
+C misdemeanor, an infraction, or a status offense, the school administrator, the school
+165
+administrator's designee, or a school resource officer may refer the minor:
+166
+(a) to an evidence-based alternative intervention, including:
+167
+(i) a mobile crisis outreach team;
+168
+(ii) a youth services center, as defined in Section 80-5-102;
+169
+(iii) a youth court or comparable restorative justice program;
+-6-
+Enrolled Copy
+170
+171
+H.B. 257
+(iv) an evidence-based alternative intervention created and developed by the school or
+school district;
+172
+(v) an evidence-based alternative intervention that is jointly created and developed by a
+173
+local education agency, the state board, the juvenile court, local counties and municipalities,
+174
+the Department of Health and Human Services; or
+175
+176
+(vi) a tobacco cessation or education program if the offense is a violation of Section
+76-10-105; or
+177
+(b) for prevention and early intervention youth services, as described in Section
+178
+80-5-201, by the Division of Juvenile Justice Services if the minor refuses to participate in an
+179
+evidence-based alternative intervention described in Subsection (3)(a).
+
+180
+(4) Except as provided in Subsection (5), if a minor is alleged to have committed an
+181
+offense on school property that is a class C misdemeanor, an infraction, or a status offense, a
+182
+school administrator, the school administrator's designee, or a school resource officer may refer
+183
+a minor to a law enforcement officer or agency or a court only if:
+184
+185
+(a) the minor allegedly committed the same offense on school property on two previous
+occasions; and
+186
+(b) the minor was referred to an evidence-based alternative intervention, or to
+187
+prevention or early intervention youth services, as described in Subsection (3) for both of the
+188
+two previous offenses.
+
+189
+(5) If a minor is alleged to have committed a traffic offense that is an infraction, a
+190
+school administrator, the school administrator's designee, or a school resource officer may refer
+191
+the minor to a law enforcement officer or agency, a prosecuting attorney, or a court for the
+192
+traffic offense.
+
+193
+(6) Notwithstanding Subsection (4), a school resource officer may:
+194
+(a) investigate possible criminal offenses and conduct, including conducting probable
+195
+cause searches;
+196
+197
+(b) consult with school administration about the conduct of a minor enrolled in a
+school;
+-7-
+H.B. 257
+198
+199
+Enrolled Copy
+(c) transport a minor enrolled in a school to a location if the location is permitted by
+law;
+200
+(d) take temporary custody of a minor in accordance with Section 80-6-201; or
+201
+(e) protect the safety of students and the school community, including the use of
+202
+reasonable and necessary physical force when appropriate based on the totality of the
+203
+circumstances.
+
+204
+(7) (a) If a minor is referred to a court or a law enforcement officer or agency under
+205
+Subsection (4), the school or the school district shall appoint a school representative to
+206
+continue to engage with the minor and the minor's family through the court process.
+
+207
+208
+209
+210
+(b) A school representative appointed under Subsection (7)(a) may not be a school
+resource officer.
+(c) A school district or school shall include the following in the school district's or
+school's referral to the court or the law enforcement officer or agency:
+211
+(i) attendance records for the minor;
+212
+(ii) a report of evidence-based alternative interventions used by the school before the
+213
+214
+215
+216
+referral, including outcomes;
+(iii) the name and contact information of the school representative assigned to actively
+participate in the court process with the minor and the minor's family;
+(iv) if the minor was referred to prevention or early intervention youth services under
+217
+Subsection (3)(b), a report from the Division of Juvenile Justice Services that demonstrates the
+218
+minor's failure to complete or participate in prevention and early intervention youth services
+219
+under Subsection (3)(b); and
+220
+(v) any other information that the school district or school considers relevant.
+
+221
+(d) A minor referred to a court under Subsection (4) may not be ordered to or placed in
+222
+secure detention, including for a contempt charge or violation of a valid court order under
+223
+Section 78A-6-353, when the underlying offense is a status offense or infraction.
+
+224
+225
+(e) If a minor is referred to a court under Subsection (4), the court may use, when
+available, the resources of the Division of Juvenile Justice Services or the Division of
+-8-
+Enrolled Copy
+226
+H.B. 257
+Substance Abuse and Mental Health to address the minor.
+
+227
+(8) If a minor is alleged to have committed an offense on school property that is a class
+228
+B misdemeanor or a class A misdemeanor, the school administrator, the school administrator's
+229
+designee, or a school resource officer may refer the minor directly to a court or to the
+230
+evidence-based alternative interventions in Subsection (3)(a).
+
+231
+(9) A school administrator, a school administrator's designee, and a school resource
+232
+officer retain the discretion described under this section in relation to Title 63G, Chapter 31,
+233
+Distinctions on the Basis of Sex.
+
+234
+Section 3. Section 63G-31-101 is enacted to read:
+235
+CHAPTER 31. Distinctions on the Basis of Sex
+236
+Part 1. General Provisions
+237
+63G-31-101. Definitions.
+
+238
+As used in this chapter:
+239
+(1) (a) "Changing room" means a space designated for multiple individuals to dress or
+240
+undress within the same space.
+
+241
+(b) "Changing room" includes:
+242
+(i) a dressing room, fitting room, locker room, or shower room; and
+243
+(ii) a restroom when a changing room contains or is attached to the restroom.
+
+244
+(2) (a) "Facility" means a publicly owned or controlled building, structure, or other
+245
+246
+247
+improvement.
+(b) "Facility" includes a subset of a publicly owned or controlled building, structure, or
+other improvement, including a restroom or locker room.
+
+248
+(3) "Government entity" means:
+249
+(a) the state; or
+250
+(b) any county, municipality, special district, special service district, or other political
+251
+subdivision or administrative unit of the state, including:
+252
+(i) a state institution of higher education as defined in Section 53B-2-101; or
+253
+(ii) a local education agency as defined in Section 53G-7-401.
+
+-9-
+H.B. 257
+Enrolled Copy
+254
+(4) "Intersex individual" means the same as that term is defined in Section 26B-8-101.
+
+255
+(5) "Men's restroom" means a restroom that is designated for the exclusive use of
+256
+males and not females.
+
+257
+(6) (a) "Open to the general public" means that a privacy space is:
+258
+(i) freely accessible to a member of the general public;
+259
+(ii) accessible to an individual who has purchased a ticket, paid an entry fee, paid a
+260
+membership fee, or otherwise paid to access the facility containing the relevant privacy space;
+261
+or
+262
+263
+(iii) accessible to a student of an institution of higher education described in Section
+52B-2-101, either freely or as described in Subsection (6)(a)(ii).
+
+264
+(b) "Open to the general public" does not include a privacy space that is:
+265
+(i) only accessible to employees of a government entity; or
+266
+(ii) any area that is not normally accessible to the public.
+
+267
+(7) "Privacy space" means a restroom or changing room within a publicly owned or
+268
+269
+270
+controlled facility, where an individual has a reasonable expectation of privacy.
+(8) "Publicly owned or controlled" means that a government entity has at least a partial
+ownership interest in or has control of a facility, program, or event.
+
+271
+(9) (a) "Restroom" means any space that includes a toilet.
+
+272
+(b) "Restroom" includes:
+273
+(i) sex-designated men's restrooms;
+274
+(ii) sex-designated women's restrooms;
+275
+(iii) unisex restrooms; and
+276
+(iv) single-occupant restrooms.
+
+277
+(10) "Sex-designated" means that a facility, program, or event is designated specifically
+278
+279
+280
+281
+for males or females and not the opposite sex.
+(11) "Single-occupant" means, in relation to a single-occupant facility or privacy space,
+that the facility or privacy space:
+(a) has floor-to-ceiling walls;
+- 10 -
+Enrolled Copy
+H.B. 257
+282
+(b) has an entirely encased and locking door; and
+283
+(c) is designated for single occupancy.
+
+284
+(12) "Unisex" means, in relation to a unisex facility or privacy space, that the facility or
+285
+privacy space:
+286
+(a) is designated for the use of both sexes; or
+287
+(b) is not sex-designated.
+
+288
+(13) "Women's restroom" means a restroom that is designated for the exclusive use of
+289
+females and not males.
+
+290
+Section 4. Section 63G-31-102 is enacted to read:
+291
+63G-31-102. Severability.
+
+292
+(1) If any provision of this chapter or the application of any provision of this part to
+293
+any person or circumstance is held invalid by a final decision of a court of competent
+294
+jurisdiction, the remainder of this chapter shall be given effect without the invalidated
+295
+provision or application.
+
+296
+(2) The provisions of this chapter are severable.
+
+297
+Section 5. Section 63G-31-201 is enacted to read:
+298
+Part 2. Distinctions on the Basis of Sex
+299
+63G-31-201. Distinctions on the basis of sex.
+
+300
+(1) A government entity may not, on the basis of sex, exclude an individual from
+301
+participation in, deny an individual from the benefits of, or subject an individual to a sex-based
+302
+distinction in or under any government or otherwise publicly owned or controlled facility,
+303
+program, or event, unless the distinction is substantially related to an important government
+304
+objective.
+
+305
+306
+(2) Each government entity shall ensure the preservation of distinctions on the basis of
+sex that protect individual privacy and competitive opportunity, as described in this chapter.
+
+307
+308
+309
+(3) (a) As used in this Subsection (3), "athletic facility" does not include a privacy
+space.
+(b) To preserve the individual privacy and competitive opportunity of females, an
+- 11 -
+H.B. 257
+Enrolled Copy
+310
+individual is not entitled to and may not access, use, or benefit from a government entity's
+311
+athletic facility, program, or event if:
+312
+(i) the facility, program, or event is designated for females; and
+313
+(ii) the individual is not female.
+
+314
+(c) To preserve the individual privacy and competitive opportunity of males, an
+315
+individual is not entitled to and may not access, use, or benefit from a government entity's
+316
+athletic facility, program, or event if:
+317
+(i) the facility, program, or event is designated for males; and
+318
+(ii) the individual is not male.
+
+319
+Section 6. Section 63G-31-202 is enacted to read:
+320
+63G-31-202. Sex-based distinctions to protect individual privacy.
+
+321
+A distinction on the basis of sex that provides separate accommodations for the sexes is
+322
+substantially related to the important government objective of protecting individual privacy,
+323
+including in the following contexts:
+324
+(1) a privacy space; and
+325
+(2) a correctional facility as defined in Section 77-16b-102.
+
+326
+Section 7. Section 63G-31-203 is enacted to read:
+327
+63G-31-203. Sex-based distinctions to protect athletic health and competitive
+328
+329
+opportunity.
+A distinction on the basis of sex to provide separate accommodations for the sexes is
+330
+substantially related to the important government objective of protecting health and
+331
+competitive opportunity in the availability or quality of an athletic venue, event, or program
+332
+within the public education system.
+
+333
+Section 8. Section 63G-31-204 is enacted to read:
+334
+63G-31-204. Prohibited sex-based distinctions.
+
+335
+The following actions within the public education system constitute a violation of
+336
+337
+Section 63G-31-201:
+(1) providing a sex-designated facility, program, or event of a higher quality to one sex
+- 12 -
+Enrolled Copy
+H.B. 257
+338
+and of a lesser quality to the opposite sex rather than ensuring equivalent quality or rotational
+339
+sharing, including the use of athletic facilities or venues;
+340
+(2) providing males or females preferred or more advantageous scheduling of facilities,
+341
+programs, or events in comparison to the opposite sex rather than ensuring equivalent
+342
+scheduling practices or rotational sharing, including the scheduling of athletic events or
+343
+practices;
+344
+345
+346
+347
+348
+(3) providing males or females with more sex-designated opportunities than the
+opposite sex in excess of a 10% disparity;
+(4) requiring males or females to participate or compete against the opposite sex in any
+sex-designated facility, program, or event; or
+(5) requiring, giving official authorization for, or knowingly allowing males or females
+349
+to use a sex-designated facility in the presence of the opposite sex.
+
+350
+Section 9. Section 63G-31-301 is enacted to read:
+351
+Part 3. Sex-based Distinctions in Privacy Spaces
+352
+63G-31-301. Sex-designated privacy spaces in public schools.
+
+353
+(1) To preserve the individual privacy of male and female students in the public
+354
+education system, a student may only access an operational sex-designated privacy space
+355
+within a public school that is designated for student use if the student's sex corresponds with
+356
+the sex designation of the privacy space.
+
+357
+(2) For a student who makes a request to use a privacy space other than the
+358
+sex-designated privacy space that corresponds with the student's sex because of the student's
+359
+gender identity, as defined in Section 34A-5-102, or reasonable fear of bullying, the local
+360
+education agency, as defined in Section 53E-1-102, shall coordinate with the student's parent or
+361
+legal guardian to develop a privacy plan that provides the student with:
+362
+(a) (i) reasonable access to a unisex or single-occupant facility; or
+363
+(ii) reasonable access to a faculty or staff restroom; or
+364
+(b) if the access described in Subsection (2)(a) is unavailable, reasonable access to
+365
+private use of an otherwise sex-designated privacy space through staggered scheduling or
+- 13 -
+H.B. 257
+366
+367
+368
+Enrolled Copy
+another policy provision that provides for temporary private access.
+(3) An LEA satisfies the LEA's duties regarding student use of a privacy space under
+this chapter if the LEA:
+369
+(a) gives notice to students of the provisions of this section;
+370
+(b) takes administrative action to address violations of and promote compliance with
+371
+this section; and
+372
+(c) develops a privacy plan in accordance with Subsection (2).
+
+373
+(4) An individual may use the following evidence as a defense to an allegation that the
+374
+375
+student is not eligible to access and use a sex-designated privacy space under Subsection (1):
+(a) the student's unamended birth certificate that corresponds with the sex designation
+376
+of privacy space, which may be supported with a review of any amendment history obtained
+377
+under Section 26B-8-125; or
+378
+379
+(b) documentation of a medical treatment or procedure that is consistent only with the
+sex designation of the privacy space.
+
+380
+(5) Subsection (1) does not apply to:
+381
+(a) a unisex or single-occupant facility; or
+382
+(b) an intersex individual.
+
+383
+Section 10. Section 63G-31-302 is enacted to read:
+384
+63G-31-302. Sex-designated changing rooms in publicly owned facilities open to
+385
+386
+the general public.
+(1) (a) Except as provided in Subsection (1)(b), to preserve the individual privacy of
+387
+males and females, an individual may only access an operational sex-designated changing room
+388
+in a government entity's facility that is open to the general public if:
+389
+(i) the individual's sex corresponds with the sex designation of the changing room; or
+390
+(ii) the individual has:
+391
+(A) legally amended the individual's birth certificate to correspond with the sex
+392
+designation of the changing room, which may be supported with a review of any amendment
+393
+history obtained under Section 26B-8-125; and
+- 14 -
+Enrolled Copy
+394
+395
+H.B. 257
+(B) undergone a primary sex characteristic surgical procedure as defined in Section
+58-67-102 to correspond with the sex designation of the changing room.
+
+396
+(b) Subsection (1)(a) does not apply to:
+397
+(i) a minor child who requires assistance to access or use the changing room that
+398
+399
+corresponds with the sex of the minor's parent, guardian, or relative;
+(ii) a dependent minor, as defined in Section 76-5-110, or a dependent adult, as defined
+400
+in Section 76-5-111 who requires assistance to access or use the changing room that
+401
+corresponds with the sex of a caretaker;
+402
+403
+404
+405
+406
+407
+408
+409
+410
+(iii) an individual providing public safety services, including law enforcement,
+emergency medical services as defined in Section 26B-4-101, and fire protection;
+(iv) an employee of a health care facility, as defined in Section 26B-2-201, to provide
+health care services to a patient of the health care facility; or
+(v) an individual whose employment duties include the maintenance or cleaning of the
+changing room.
+(2) An individual in a changing room has a reasonable expectation of privacy,
+satisfying the privacy element of the offense of voyeurism in Section 76-9-702.7.
+(3) An individual who knowingly enters a changing room in violation of Subsection (1)
+411
+commits the offense of criminal trespass under Section 76-6-206 if the individual enters or
+412
+remains in the changing room under circumstances which a reasonable person would expect to
+413
+likely cause affront or alarm to, on, or in the presence of another individual.
+
+414
+(4) The surgical provision described in Subsection (1)(a)(ii) does not shield an
+415
+individual from the offense of lewdness related to genitalia under Subsection 76-9-202(3) or
+416
+76-9-202.5(4).
+
+417
+(5) An individual may use the following evidence as a defense against an allegation
+418
+that the individual is not eligible to access and use a sex-designated changing room under
+419
+Subsection (1):
+420
+421
+(a) for an individual whose birth sex corresponds with the sex designation of the
+changing room:
+- 15 -
+H.B. 257
+Enrolled Copy
+422
+(i) an individual's unamended birth certificate that corresponds with the sex
+423
+designation of the changing room, which may be supported with a review of any amendment
+424
+history obtained under Section 26B-8-125; or
+425
+426
+427
+428
+429
+430
+431
+432
+(ii) documentation of a medical treatment or procedure that is consistent only with the
+sex designation of the changing room; or
+(b) for an individual whose birth sex does not correspond with the sex designation of
+the changing room:
+(i) the individual's amended birth certificate, which may be supported with a review of
+any amendment history obtained under Section 26B-8-125; and
+(ii) documentation that demonstrates that the individual has undergone a primary sex
+characteristic surgical procedure as defined in Section 58-67-102.
+
+433
+(6) Subsection (1) does not apply to:
+434
+(a) a unisex or single-occupant facility;
+435
+(b) a changing room that is not open to the general public; or
+436
+(c) an intersex individual.
+
+437
+Section 11. Section 63G-31-303 is enacted to read:
+438
+63G-31-303. Unisex or single-occupant facilities.
+
+439
+The availability of a unisex facility or single-occupant facility satisfies a government
+440
+entity's obligations regarding an individual who, because of the individual's gender identity, as
+441
+defined in Section 34A-5-102, or reasonable fear of bullying, is uncomfortable using:
+442
+(1) for a student, a privacy space in accordance with Section 63G-31-301; or
+443
+(2) a changing room in accordance with Section 63G-31-302.
+
+444
+Section 12. Section 63G-31-304 is enacted to read:
+445
+63G-31-304. Government entity facility compliance.
+
+446
+(1) Except as provided under Section 53G-8-211, a government entity shall contact law
+447
+enforcement if the entity receives a complaint or allegation regarding the following within a
+448
+privacy space in a facility that is open to the general public:
+449
+(a) an offense of lewdness under Section 76-9-702;
+- 16 -
+Enrolled Copy
+H.B. 257
+450
+(b) an offense of lewdness involving a child under Section 76-9-702.5;
+451
+(c) voyeurism under Section 76-9-702.7;
+452
+(d) loitering in a privacy space under Section 76-9-702.8; or
+453
+(e) for a changing room described in Section 63G-31-302, an offense of criminal
+454
+trespass under Subsection 63G-31-302(2).
+
+455
+(2) To preserve the individual privacy of males and females in privacy spaces:
+456
+(a) a government entity shall adopt a privacy compliance plan to address compliance
+457
+458
+459
+with the government entity's duties under this chapter;
+(b) for construction of a new facility, a government entity shall ensure that the new
+construction includes a single-occupant facility; and
+460
+(c) for existing privacy spaces, a government entity:
+461
+(i) shall consider the feasibility of retrofitting or remodeling to include:
+462
+(A) floor-to-ceiling walls and doors or similar privacy protections;
+463
+(B) curtains; or
+464
+(C) other methods of improving individual privacy within the facility that are
+465
+466
+467
+468
+469
+470
+comparable to the methods described in Subsections (2)(a)(i) and (ii); and
+(ii) may reduce the number of fixtures that state law requires by up to 20% to provide
+adequate space for the retrofitting or remodeling described in Subsection (2)(a).
+(3) A government entity shall ensure sufficient sex-designated privacy spaces through
+compliance with Sections 15A-3-112 and 15A-3-304 regarding unisex facilities.
+Section 13. Section 63G-31-401 is enacted to read:
+471
+Part 4. Enforcement and Indemnification
+472
+63G-31-401. Government entity noncompliance.
+
+473
+(1) The state auditor shall:
+474
+(a) establish a process to receive and investigate alleged violations of this chapter by a
+475
+government entity;
+476
+(b) provide notice to the relevant government entity of:
+477
+(i) each alleged violation of this chapter by the government entity;
+- 17 -
+H.B. 257
+478
+479
+480
+481
+482
+483
+484
+485
+Enrolled Copy
+(ii) each violation that the state auditor determines to be substantiated, including an
+opportunity to cure the violation not to exceed 30 calendar days; and
+(c) if a government entity fails to cure a violation in accordance with Subsection
+(1)(b)(ii), report the government entity's failure to:
+(i) for a political subdivision as defined in Section 63G-7-102, the attorney general for
+enforcement under Subsection (2); and
+(ii) for a state entity as defined in Section 67-4-2, the Legislative Management
+Committee.
+
+486
+(2) (a) The attorney general shall:
+487
+(i) enforce this chapter against a political subdivision upon referral by the state auditor
+488
+under Subsection (1)(c) by imposing a fine of up to $10,000 per violation per day; and
+489
+(ii) deposit fines under Subsection (2)(a) into the General Fund.
+
+490
+(b) A political subdivision may seek judicial review of a fine that the attorney general
+491
+492
+493
+imposes under this section to determine whether the fine is clearly erroneous.
+(3) A local education agency is not in violation of this chapter for a lawful application
+of Section 53G-8-211.
+
+494
+Section 14. Section 63G-31-402 is enacted to read:
+495
+63G-31-402. Indemnification.
+
+496
+The attorney general shall defend, indemnify, and hold harmless a government entity
+497
+acting under color of state law to enforce this chapter for any claims or damages, including
+498
+court costs and attorney fees that:
+499
+(1) arise as a result of this chapter; and
+500
+(2) are not covered by the government entity's insurance policies or any coverage
+501
+agreement that the State Risk Management Fund issues.
+
+502
+Section 15. Section 67-3-1 is amended to read:
+503
+67-3-1. Functions and duties.
+
+504
+(1) (a) The state auditor is the auditor of public accounts and is independent of any
+505
+executive or administrative officers of the state.
+
+- 18 -
+Enrolled Copy
+506
+507
+508
+509
+H.B. 257
+(b) The state auditor is not limited in the selection of personnel or in the determination
+of the reasonable and necessary expenses of the state auditor's office.
+(2) The state auditor shall examine and certify annually in respect to each fiscal year,
+financial statements showing:
+510
+(a) the condition of the state's finances;
+511
+(b) the revenues received or accrued;
+512
+(c) expenditures paid or accrued;
+513
+(d) the amount of unexpended or unencumbered balances of the appropriations to the
+514
+agencies, departments, divisions, commissions, and institutions; and
+515
+(e) the cash balances of the funds in the custody of the state treasurer.
+
+516
+(3) (a) The state auditor shall:
+517
+(i) audit each permanent fund, each special fund, the General Fund, and the accounts of
+518
+any department of state government or any independent agency or public corporation as the law
+519
+requires, as the auditor determines is necessary, or upon request of the governor or the
+520
+Legislature;
+521
+522
+(ii) perform the audits in accordance with generally accepted auditing standards and
+other auditing procedures as promulgated by recognized authoritative bodies; and
+523
+(iii) as the auditor determines is necessary, conduct the audits to determine:
+524
+(A) honesty and integrity in fiscal affairs;
+525
+(B) accuracy and reliability of financial statements;
+526
+(C) effectiveness and adequacy of financial controls; and
+527
+(D) compliance with the law.
+
+528
+(b) If any state entity receives federal funding, the state auditor shall ensure that the
+529
+530
+531
+532
+533
+audit is performed in accordance with federal audit requirements.
+(c) (i) The costs of the federal compliance portion of the audit may be paid from an
+appropriation to the state auditor from the General Fund.
+(ii) If an appropriation is not provided, or if the federal government does not
+specifically provide for payment of audit costs, the costs of the federal compliance portions of
+- 19 -
+H.B. 257
+Enrolled Copy
+534
+the audit shall be allocated on the basis of the percentage that each state entity's federal funding
+535
+bears to the total federal funds received by the state.
+
+536
+(iii) The allocation shall be adjusted to reflect any reduced audit time required to audit
+537
+funds passed through the state to local governments and to reflect any reduction in audit time
+538
+obtained through the use of internal auditors working under the direction of the state auditor.
+
+539
+(4) (a) Except as provided in Subsection (4)(b), the state auditor shall, in addition to
+540
+financial audits, and as the auditor determines is necessary, conduct performance and special
+541
+purpose audits, examinations, and reviews of any entity that receives public funds, including a
+542
+determination of any or all of the following:
+543
+(i) the honesty and integrity of all the entity's fiscal affairs;
+544
+(ii) whether the entity's administrators have faithfully complied with legislative intent;
+545
+(iii) whether the entity's operations have been conducted in an efficient, effective, and
+546
+547
+548
+549
+550
+551
+552
+cost-efficient manner;
+(iv) whether the entity's programs have been effective in accomplishing the intended
+objectives; and
+(v) whether the entity's management, control, and information systems are adequate,
+effective, and secure.
+(b) The auditor may not conduct performance and special purpose audits,
+examinations, and reviews of any entity that receives public funds if the entity:
+553
+(i) has an elected auditor; and
+554
+(ii) has, within the entity's last budget year, had the entity's financial statements or
+555
+performance formally reviewed by another outside auditor.
+
+556
+(5) The state auditor:
+557
+(a) shall administer any oath or affirmation necessary to the performance of the duties
+558
+of the auditor's office; and
+559
+(b) may:
+560
+(i) subpoena witnesses and documents, whether electronic or otherwise; and
+561
+(ii) examine into any matter that the auditor considers necessary.
+
+- 20 -
+Enrolled Copy
+562
+H.B. 257
+(6) The state auditor may require all persons who have had the disposition or
+563
+management of any property of this state or its political subdivisions to submit statements
+564
+regarding the property at the time and in the form that the auditor requires.
+
+565
+(7) The state auditor shall:
+566
+(a) except where otherwise provided by law, institute suits in Salt Lake County in
+567
+relation to the assessment, collection, and payment of revenues against:
+568
+569
+(i) persons who by any means have become entrusted with public money or property
+and have failed to pay over or deliver the money or property; and
+570
+(ii) all debtors of the state;
+571
+(b) collect and pay into the state treasury all fees received by the state auditor;
+572
+(c) perform the duties of a member of all boards of which the state auditor is a member
+573
+by the constitution or laws of the state, and any other duties that are prescribed by the
+574
+constitution and by law;
+575
+(d) stop the payment of the salary of any state official or state employee who:
+576
+(i) refuses to settle accounts or provide required statements about the custody and
+577
+disposition of public funds or other state property;
+578
+(ii) refuses, neglects, or ignores the instruction of the state auditor or any controlling
+579
+board or department head with respect to the manner of keeping prescribed accounts or funds;
+580
+or
+581
+582
+583
+584
+(iii) fails to correct any delinquencies, improper procedures, and errors brought to the
+official's or employee's attention;
+(e) establish accounting systems, methods, and forms for public accounts in all taxing
+or fee-assessing units of the state in the interest of uniformity, efficiency, and economy;
+585
+(f) superintend the contractual auditing of all state accounts;
+586
+(g) subject to Subsection (8)(a), withhold state allocated funds or the disbursement of
+587
+property taxes from a state or local taxing or fee-assessing unit, if necessary, to ensure that
+588
+officials and employees in those taxing units comply with state laws and procedures in the
+589
+budgeting, expenditures, and financial reporting of public funds;
+- 21 -
+H.B. 257
+590
+Enrolled Copy
+(h) subject to Subsection (9), withhold the disbursement of tax money from any county,
+591
+if necessary, to ensure that officials and employees in the county comply with Section
+592
+59-2-303.1; and
+593
+(i) withhold state allocated funds or the disbursement of property taxes from a local
+594
+government entity or a limited purpose entity, as those terms are defined in Section 67-1a-15 if
+595
+the state auditor finds the withholding necessary to ensure that the entity registers and
+596
+maintains the entity's registration with the lieutenant governor, in accordance with Section
+597
+67-1a-15.
+
+598
+(8) (a) Except as otherwise provided by law, the state auditor may not withhold funds
+599
+under Subsection (7)(g) until a state or local taxing or fee-assessing unit has received formal
+600
+written notice of noncompliance from the auditor and has been given 60 days to make the
+601
+specified corrections.
+
+602
+(b) If, after receiving notice under Subsection (8)(a), a state or independent local
+603
+fee-assessing unit that exclusively assesses fees has not made corrections to comply with state
+604
+laws and procedures in the budgeting, expenditures, and financial reporting of public funds, the
+605
+state auditor:
+606
+(i) shall provide a recommended timeline for corrective actions;
+607
+(ii) may prohibit the state or local fee-assessing unit from accessing money held by the
+608
+609
+state; and
+(iii) may prohibit a state or local fee-assessing unit from accessing money held in an
+610
+account of a financial institution by filing an action in district court requesting an order of the
+611
+court to prohibit a financial institution from providing the fee-assessing unit access to an
+612
+account.
+
+613
+(c) The state auditor shall remove a limitation on accessing funds under Subsection
+614
+(8)(b) upon compliance with state laws and procedures in the budgeting, expenditures, and
+615
+financial reporting of public funds.
+
+616
+617
+(d) If a local taxing or fee-assessing unit has not adopted a budget in compliance with
+state law, the state auditor:
+- 22 -
+Enrolled Copy
+618
+619
+(i) shall provide notice to the taxing or fee-assessing unit of the unit's failure to
+comply;
+620
+621
+(ii) may prohibit the taxing or fee-assessing unit from accessing money held by the
+state; and
+622
+623
+(iii) may prohibit a taxing or fee-assessing unit from accessing money held in an
+account of a financial institution by:
+624
+625
+H.B. 257
+(A) contacting the taxing or fee-assessing unit's financial institution and requesting that
+the institution prohibit access to the account; or
+626
+(B) filing an action in district court requesting an order of the court to prohibit a
+627
+financial institution from providing the taxing or fee-assessing unit access to an account.
+
+628
+(e) If the local taxing or fee-assessing unit adopts a budget in compliance with state
+629
+law, the state auditor shall eliminate a limitation on accessing funds described in Subsection
+630
+(8)(d).
+
+631
+(9) The state auditor may not withhold funds under Subsection (7)(h) until a county has
+632
+received formal written notice of noncompliance from the auditor and has been given 60 days
+633
+to make the specified corrections.
+
+634
+(10) (a) The state auditor may not withhold funds under Subsection (7)(i) until the state
+635
+auditor receives a notice of non-registration, as that term is defined in Section 67-1a-15.
+
+636
+(b) If the state auditor receives a notice of non-registration, the state auditor may
+637
+prohibit the local government entity or limited purpose entity, as those terms are defined in
+638
+Section 67-1a-15, from accessing:
+639
+(i) money held by the state; and
+640
+(ii) money held in an account of a financial institution by:
+641
+(A) contacting the entity's financial institution and requesting that the institution
+642
+643
+644
+645
+prohibit access to the account; or
+(B) filing an action in district court requesting an order of the court to prohibit a
+financial institution from providing the entity access to an account.
+(c) The state auditor shall remove the prohibition on accessing funds described in
+- 23 -
+H.B. 257
+Enrolled Copy
+646
+Subsection (10)(b) if the state auditor received a notice of registration, as that term is defined in
+647
+Section 67-1a-15, from the lieutenant governor.
+
+648
+649
+(11) Notwithstanding Subsection (7)(g), (7)(h), (7)(i), (8)(b), (8)(d), or (10)(b), the
+state auditor:
+650
+(a) shall authorize a disbursement by a local government entity or limited purpose
+651
+entity, as those terms are defined in Section 67-1a-15, or a state or local taxing or fee-assessing
+652
+unit if the disbursement is necessary to:
+653
+654
+(i) avoid a major disruption in the operations of the local government entity, limited
+purpose entity, or state or local taxing or fee-assessing unit; or
+655
+(ii) meet debt service obligations; and
+656
+(b) may authorize a disbursement by a local government entity, limited purpose entity,
+657
+or state or local taxing or fee-assessing unit as the state auditor determines is appropriate.
+
+658
+(12) (a) The state auditor may seek relief under the Utah Rules of Civil Procedure to
+659
+take temporary custody of public funds if an action is necessary to protect public funds from
+660
+being improperly diverted from their intended public purpose.
+
+661
+(b) If the state auditor seeks relief under Subsection (12)(a):
+662
+(i) the state auditor is not required to exhaust the procedures in Subsection (7) or (8);
+663
+664
+and
+(ii) the state treasurer may hold the public funds in accordance with Section 67-4-1 if a
+665
+court orders the public funds to be protected from improper diversion from their public
+666
+purpose.
+
+667
+(13) The state auditor shall:
+668
+(a) establish audit guidelines and procedures for audits of local mental health and
+669
+substance abuse authorities and their contract providers, conducted pursuant to Title 17,
+670
+Chapter 43, Part 2, Local Substance Abuse Authorities, Title 17, Chapter 43, Part 3, Local
+671
+Mental Health Authorities, Title 26B, Chapter 5, Health Care - Substance Use and Mental
+672
+Health, and Title 51, Chapter 2a, Accounting Reports from Political Subdivisions, Interlocal
+673
+Organizations, and Other Local Entities Act; and
+- 24 -
+Enrolled Copy
+H.B. 257
+674
+(b) ensure that those guidelines and procedures provide assurances to the state that:
+675
+(i) state and federal funds appropriated to local mental health authorities are used for
+676
+677
+mental health purposes;
+(ii) a private provider under an annual or otherwise ongoing contract to provide
+678
+comprehensive mental health programs or services for a local mental health authority is in
+679
+compliance with state and local contract requirements and state and federal law;
+680
+681
+(iii) state and federal funds appropriated to local substance abuse authorities are used
+for substance abuse programs and services; and
+682
+(iv) a private provider under an annual or otherwise ongoing contract to provide
+683
+comprehensive substance abuse programs or services for a local substance abuse authority is in
+684
+compliance with state and local contract requirements, and state and federal law.
+
+685
+(14) (a) The state auditor may, in accordance with the auditor's responsibilities for
+686
+political subdivisions of the state as provided in Title 51, Chapter 2a, Accounting Reports from
+687
+Political Subdivisions, Interlocal Organizations, and Other Local Entities Act, initiate audits or
+688
+investigations of any political subdivision that are necessary to determine honesty and integrity
+689
+in fiscal affairs, accuracy and reliability of financial statements, effectiveness, and adequacy of
+690
+financial controls and compliance with the law.
+
+691
+(b) If the state auditor receives notice under Subsection 11-41-104(7) from the
+692
+Governor's Office of Economic Opportunity on or after July 1, 2024, the state auditor may
+693
+initiate an audit or investigation of the public entity subject to the notice to determine
+694
+compliance with Section 11-41-103.
+
+695
+696
+697
+698
+(15) (a) The state auditor may not audit work that the state auditor performed before
+becoming state auditor.
+(b) If the state auditor has previously been a responsible official in state government
+whose work has not yet been audited, the Legislature shall:
+699
+(i) designate how that work shall be audited; and
+700
+(ii) provide additional funding for those audits, if necessary.
+
+701
+(16) The state auditor shall:
+- 25 -
+H.B. 257
+702
+Enrolled Copy
+(a) with the assistance, advice, and recommendations of an advisory committee
+703
+appointed by the state auditor from among special district boards of trustees, officers, and
+704
+employees and special service district boards, officers, and employees:
+705
+(i) prepare a Uniform Accounting Manual for Special Districts that:
+706
+(A) prescribes a uniform system of accounting and uniform budgeting and reporting
+707
+procedures for special districts under Title 17B, Limited Purpose Local Government Entities -
+708
+Special Districts, and special service districts under Title 17D, Chapter 1, Special Service
+709
+District Act;
+710
+(B) conforms with generally accepted accounting principles; and
+711
+(C) prescribes reasonable exceptions and modifications for smaller districts to the
+712
+uniform system of accounting, budgeting, and reporting;
+713
+714
+(ii) maintain the manual under this Subsection (16)(a) so that the manual continues to
+reflect generally accepted accounting principles;
+715
+716
+(iii) conduct a continuing review and modification of procedures in order to improve
+them;
+717
+(iv) prepare and supply each district with suitable budget and reporting forms; and
+718
+(v) (A) prepare instructional materials, conduct training programs, and render other
+719
+services considered necessary to assist special districts and special service districts in
+720
+implementing the uniform accounting, budgeting, and reporting procedures; and
+721
+722
+(B) ensure that any training described in Subsection (16)(a)(v)(A) complies with Title
+63G, Chapter 22, State Training and Certification Requirements; and
+723
+(b) continually analyze and evaluate the accounting, budgeting, and reporting practices
+724
+and experiences of specific special districts and special service districts selected by the state
+725
+auditor and make the information available to all districts.
+
+726
+(17) (a) The following records in the custody or control of the state auditor are
+727
+protected records under Title 63G, Chapter 2, Government Records Access and Management
+728
+Act:
+729
+(i) records that would disclose information relating to allegations of personal
+- 26 -
+Enrolled Copy
+H.B. 257
+730
+misconduct, gross mismanagement, or illegal activity of a past or present governmental
+731
+employee if the information or allegation cannot be corroborated by the state auditor through
+732
+other documents or evidence, and the records relating to the allegation are not relied upon by
+733
+the state auditor in preparing a final audit report;
+734
+(ii) records and audit workpapers to the extent the workpapers would disclose the
+735
+identity of an individual who during the course of an audit, communicated the existence of any
+736
+waste of public funds, property, or manpower, or a violation or suspected violation of a law,
+737
+rule, or regulation adopted under the laws of this state, a political subdivision of the state, or
+738
+any recognized entity of the United States, if the information was disclosed on the condition
+739
+that the identity of the individual be protected;
+740
+(iii) before an audit is completed and the final audit report is released, records or drafts
+741
+circulated to an individual who is not an employee or head of a governmental entity for the
+742
+individual's response or information;
+743
+744
+(iv) records that would disclose an outline or part of any audit survey plans or audit
+program; and
+745
+(v) requests for audits, if disclosure would risk circumvention of an audit.
+
+746
+(b) The provisions of Subsections (17)(a)(i), (ii), and (iii) do not prohibit the disclosure
+747
+of records or information that relate to a violation of the law by a governmental entity or
+748
+employee to a government prosecutor or peace officer.
+
+749
+(c) The provisions of this Subsection (17) do not limit the authority otherwise given to
+750
+the state auditor to classify a document as public, private, controlled, or protected under Title
+751
+63G, Chapter 2, Government Records Access and Management Act.
+
+752
+(d) (i) As used in this Subsection (17)(d), "record dispute" means a dispute between the
+753
+state auditor and the subject of an audit performed by the state auditor as to whether the state
+754
+auditor may release a record, as defined in Section 63G-2-103, to the public that the state
+755
+auditor gained access to in the course of the state auditor's audit but which the subject of the
+756
+audit claims is not subject to disclosure under Title 63G, Chapter 2, Government Records
+757
+Access and Management Act.
+
+- 27 -
+H.B. 257
+758
+Enrolled Copy
+(ii) The state auditor may submit a record dispute to the State Records Committee,
+759
+created in Section 63G-2-501, for a determination of whether the state auditor may, in
+760
+conjunction with the state auditor's release of an audit report, release to the public the record
+761
+that is the subject of the record dispute.
+
+762
+(iii) The state auditor or the subject of the audit may seek judicial review of a State
+763
+Records Committee determination under Subsection (17)(d)(ii), as provided in Section
+764
+63G-2-404.
+
+765
+(18) If the state auditor conducts an audit of an entity that the state auditor has
+766
+previously audited and finds that the entity has not implemented a recommendation made by
+767
+the state auditor in a previous audit, the state auditor shall notify the Legislative Management
+768
+Committee through the Legislative Management Committee's audit subcommittee that the
+769
+entity has not implemented that recommendation.
+
+770
+771
+(19) The state auditor shall, with the advice and consent of the Senate, appoint the state
+privacy officer described in Section 67-3-13.
+
+772
+(20) Except as provided in Subsection (21), the state auditor shall report, or ensure that
+773
+another government entity reports, on the financial, operational, and performance metrics for
+774
+the state system of higher education and the state system of public education, including metrics
+775
+in relation to students, programs, and schools within those systems.
+
+776
+777
+778
+779
+780
+781
+782
+783
+784
+785
+(21) (a) Notwithstanding Subsection (20), the state auditor shall conduct regular audits
+of:
+(i) the scholarship granting organization for the Special Needs Opportunity Scholarship
+Program, created in Section 53E-7-402;
+(ii) the State Board of Education for the Carson Smith Scholarship Program, created in
+Section 53F-4-302; and
+(iii) the scholarship program manager for the Utah Fits All Scholarship Program,
+created in Section 53F-6-402.
+(b) Nothing in this subsection limits or impairs the authority of the State Board of
+Education to administer the programs described in Subsection (21)(a).
+
+- 28 -
+Enrolled Copy
+H.B. 257
+786
+(22) The state auditor shall, based on the information posted by the Office of
+787
+Legislative Research and General Counsel under Subsection 36-12-12.1(2), for each policy,
+788
+track and post the following information on the state auditor's website:
+789
+(a) the information posted under Subsections 36-12-12.1(2)(a) through (e);
+790
+(b) an indication regarding whether the policy is timely adopted, adopted late, or not
+791
+792
+adopted;
+(c) an indication regarding whether the policy complies with the requirements
+793
+established by law for the policy; and
+794
+(d) a link to the policy.
+
+795
+(23) (a) A legislator may request that the state auditor conduct an inquiry to determine
+796
+whether a government entity, government official, or government employee has complied with
+797
+a legal obligation directly imposed, by statute, on the government entity, government official,
+798
+or government employee.
+
+799
+800
+801
+802
+803
+804
+(b) The state auditor may, upon receiving a request under Subsection (23)(a), conduct
+the inquiry requested.
+(c) If the state auditor conducts the inquiry described in Subsection (23)(b), the state
+auditor shall post the results of the inquiry on the state auditor's website.
+(d) The state auditor may limit the inquiry described in this Subsection (23) to a simple
+determination, without conducting an audit, regarding whether the obligation was fulfilled.
+
+805
+(24) The state auditor shall:
+806
+(a) ensure compliance with Title 63G, Chapter 31, Distinctions on the Basis of Sex, in
+807
+808
+809
+accordance with Section 63G-31-401; and
+(b) report to the Legislative Management Committee, upon request, regarding the state
+auditor's actions under this Subsection (24).
+
+810
+Section 16. Section 67-5-1 is amended to read:
+811
+67-5-1. General duties.
+
+812
+(1) The attorney general shall:
+813
+(a) perform all duties in a manner consistent with the attorney-client relationship under
+- 29 -
+H.B. 257
+814
+815
+Enrolled Copy
+Section 67-5-17;
+(b) except as provided in Sections 10-3-928 and 17-18a-403, attend the Supreme Court
+816
+and the Court of Appeals of this state, and all courts of the United States, and prosecute or
+817
+defend all causes to which the state or any officer, board, or commission of the state in an
+818
+official capacity is a party, and take charge, as attorney, of all civil legal matters in which the
+819
+state is interested;
+820
+821
+822
+823
+(c) after judgment on any cause referred to in Subsection (1)(b), direct the issuance of
+process as necessary to execute the judgment;
+(d) account for, and pay over to the proper officer, all money that comes into the
+attorney general's possession that belongs to the state;
+824
+(e) keep a file of all cases in which the attorney general is required to appear, including
+825
+any documents and papers showing the court in which the cases have been instituted and tried,
+826
+and whether they are civil or criminal, and:
+827
+(i) if civil, the nature of the demand, the stage of proceedings, and, when prosecuted to
+828
+judgment, a memorandum of the judgment and of any process issued if satisfied, and if not
+829
+satisfied, documentation of the return of the sheriff;
+830
+(ii) if criminal, the nature of the crime, the mode of prosecution, the stage of
+831
+proceedings, and, when prosecuted to sentence, a memorandum of the sentence and of the
+832
+execution, if the sentence has been executed, and, if not executed, the reason for the delay or
+833
+prevention; and
+834
+(iii) deliver this information to the attorney general's successor in office;
+835
+(f) exercise supervisory powers over the district and county attorneys of the state in all
+836
+matters pertaining to the duties of the district and county attorneys' offices, including the
+837
+authority described in Subsection (2);
+838
+839
+(g) give the attorney general's opinion in writing and without fee, when required, upon
+any question of law relating to the office of the requester:
+840
+(i) in accordance with Section 67-5-1.1, to the Legislature or either house;
+841
+(ii) to any state officer, board, or commission; and
+- 30 -
+Enrolled Copy
+H.B. 257
+842
+(iii) to any county attorney or district attorney;
+843
+(h) when required by the public service or directed by the governor, assist any county,
+844
+845
+district, or city attorney in the discharge of county, district, or city attorney's duties;
+(i) purchase in the name of the state, under the direction of the state Board of
+846
+Examiners, any property offered for sale under execution issued upon judgments in favor of or
+847
+for the use of the state, and enter satisfaction in whole or in part of the judgments as the
+848
+consideration of the purchases;
+849
+(j) when the property of a judgment debtor in any judgment mentioned in Subsection
+850
+(1)(i) has been sold under a prior judgment, or is subject to any judgment, lien, or encumbrance
+851
+taking precedence of the judgment in favor of the state, redeem the property, under the
+852
+direction of the state Board of Examiners, from the prior judgment, lien, or encumbrance, and
+853
+pay all money necessary for the redemption, upon the order of the state Board of Examiners,
+854
+out of any money appropriated for these purposes;
+855
+(k) when in the attorney general's opinion it is necessary for the collection or
+856
+enforcement of any judgment, institute and prosecute on behalf of the state any action or
+857
+proceeding necessary to set aside and annul all conveyances fraudulently made by the judgment
+858
+debtors, and pay the cost necessary to the prosecution, when allowed by the state Board of
+859
+Examiners, out of any money not otherwise appropriated;
+860
+(l) discharge the duties of a member of all official boards of which the attorney general
+861
+is or may be made a member by the Utah Constitution or by the laws of the state, and other
+862
+duties prescribed by law;
+863
+(m) institute and prosecute proper proceedings in any court of the state or of the United
+864
+States to restrain and enjoin corporations organized under the laws of this or any other state or
+865
+territory from acting illegally or in excess of their corporate powers or contrary to public
+866
+policy, and in proper cases forfeit their corporate franchises, dissolve the corporations, and
+867
+wind up their affairs;
+868
+869
+(n) institute investigations for the recovery of all real or personal property that may
+have escheated or should escheat to the state, and for that purpose, subpoena any persons
+- 31 -
+H.B. 257
+Enrolled Copy
+870
+before any of the district courts to answer inquiries and render accounts concerning any
+871
+property, examine all books and papers of any corporations, and when any real or personal
+872
+property is discovered that should escheat to the state, institute suit in the district court of the
+873
+county where the property is situated for its recovery, and escheat that property to the state;
+874
+875
+876
+877
+878
+879
+880
+(o) administer the Children's Justice Center as a program to be implemented in various
+counties pursuant to Sections 67-5b-101 through 67-5b-107;
+(p) assist the Constitutional Defense Council as provided in Title 63C, Chapter 4a,
+Constitutional and Federalism Defense Act;
+(q) pursue any appropriate legal action to implement the state's public lands policy
+established in Section 63C-4a-103;
+(r) investigate and prosecute violations of all applicable state laws relating to fraud in
+881
+connection with the state Medicaid program and any other medical assistance program
+882
+administered by the state, including violations of Title 26B, Chapter 3, Part 11, Utah False
+883
+Claims Act;
+884
+(s) investigate and prosecute complaints of abuse, neglect, or exploitation of patients:
+885
+(i) in health care facilities that receive payments under the state Medicaid program;
+886
+(ii) in board and care facilities, as defined in the federal Social Security Act, 42 U.S.C.
+
+887
+888
+889
+890
+891
+Sec. 1396b(q)(4)(B), regardless of the source of payment to the board and care facility; and
+(iii) who are receiving medical assistance under the Medicaid program as defined in
+Section 26B-3-101 in a noninstitutional or other setting;
+(t) (i) report at least twice per year to the Legislative Management Committee on any
+pending or anticipated lawsuits, other than eminent domain lawsuits, that might:
+892
+(A) cost the state more than $500,000; or
+893
+(B) require the state to take legally binding action that would cost more than $500,000
+894
+895
+896
+897
+to implement; and
+(ii) if the meeting is closed, include an estimate of the state's potential financial or
+other legal exposure in that report;
+(u) (i) submit a written report to the committees described in Subsection (1)(u)(ii) that
+- 32 -
+Enrolled Copy
+H.B. 257
+898
+summarizes any lawsuit or decision in which a court or the Office of the Attorney General has
+899
+determined that a state statute is unconstitutional or unenforceable since the attorney general's
+900
+last report under this Subsection (1)(u), including any:
+901
+(A) settlements reached;
+902
+(B) consent decrees entered;
+903
+(C) judgments issued;
+904
+(D) preliminary injunctions issued;
+905
+(E) temporary restraining orders issued; or
+906
+(F) formal or informal policies of the Office of the Attorney General to not enforce a
+907
+908
+law; and
+(ii) at least 30 days before the Legislature's May and November interim meetings,
+909
+submit the report described in Subsection (1)(u)(i) to:
+910
+(A) the Legislative Management Committee;
+911
+(B) the Judiciary Interim Committee; and
+912
+(C) the Law Enforcement and Criminal Justice Interim Committee;
+913
+(v) if the attorney general operates the Office of the Attorney General or any portion of
+914
+the Office of the Attorney General as an internal service fund agency in accordance with
+915
+Section 67-5-4, submit to the rate committee established in Section 67-5-34:
+916
+(i) a proposed rate and fee schedule in accordance with Subsection 67-5-34(4); and
+917
+(ii) any other information or analysis requested by the rate committee;
+918
+(w) before the end of each calendar year, create an annual performance report for the
+919
+920
+921
+922
+Office of the Attorney General and post the report on the attorney general's website;
+(x) ensure that any training required under this chapter complies with Title 63G,
+Chapter 22, State Training and Certification Requirements;
+(y) notify the legislative general counsel in writing within three business days after the
+923
+day on which the attorney general is officially notified of a claim, regardless of whether the
+924
+claim is filed in state or federal court, that challenges:
+925
+(i) the constitutionality of a state statute;
+- 33 -
+H.B. 257
+Enrolled Copy
+926
+(ii) the validity of legislation; or
+927
+(iii) any action of the Legislature; [and]
+928
+(z) (i) notwithstanding Title 63G, Chapter 6a, Utah Procurement Code, provide a
+929
+special advisor to the Office of the Governor and the Office of the Attorney General in matters
+930
+relating to Native American and tribal issues to:
+931
+(A) establish outreach to the tribes and affected counties and communities; and
+932
+(B) foster better relations and a cooperative framework; and
+933
+(ii) annually report to the Executive Offices and Criminal Justice Appropriations
+934
+Subcommittee regarding:
+935
+(A) the status of the work of the special advisor described in Subsection (1)(z)(i); and
+936
+(B) whether the need remains for the ongoing appropriation to fund the special advisor
+937
+938
+939
+940
+941
+942
+described in Subsection (1)(z)(i)[.]; and
+(aa) (i) enforce compliance with Title 63G, Chapter 31, Distinctions on the Basis of
+Sex, in accordance with Section 63G-31-401; and
+(ii) report to the Legislative Management Committee, upon request, regarding the
+attorney general's enforcement under this Subsection (1)(aa).
+(2) (a) The attorney general may require a district attorney or county attorney of the
+943
+state to, upon request, report on the status of public business entrusted to the district or county
+944
+attorney's charge.
+
+945
+946
+947
+(b) The attorney general may review investigation results de novo and file criminal
+charges, if warranted, in any case involving a first degree felony, if:
+(i) a law enforcement agency submits investigation results to the county attorney or
+948
+district attorney of the jurisdiction where the incident occurred and the county attorney or
+949
+district attorney:
+950
+(A) declines to file criminal charges; or
+951
+(B) fails to screen the case for criminal charges within six months after the law
+952
+953
+enforcement agency's submission of the investigation results; and
+(ii) after consultation with the county attorney or district attorney of the jurisdiction
+- 34 -
+Enrolled Copy
+H.B. 257
+954
+where the incident occurred, the attorney general reasonably believes action by the attorney
+955
+general would not interfere with an ongoing investigation or prosecution by the county attorney
+956
+or district attorney of the jurisdiction where the incident occurred.
+
+957
+(c) If the attorney general decides to conduct a review under Subsection (2)(b), the
+958
+district attorney, county attorney, and law enforcement agency shall, within 14 days after the
+959
+day on which the attorney general makes a request, provide the attorney general with:
+960
+961
+962
+963
+(i) all information relating to the investigation, including all reports, witness lists,
+witness statements, and other documents created or collected in relation to the investigation;
+(ii) all recordings, photographs, and other physical or digital media created or collected
+in relation to the investigation;
+964
+(iii) access to all evidence gathered or collected in relation to the investigation; and
+965
+(iv) the identification of, and access to, all officers or other persons who have
+966
+967
+information relating to the investigation.
+(d) If a district attorney, county attorney, or law enforcement agency fails to timely
+968
+comply with Subsection (2)(c), the attorney general may seek a court order compelling
+969
+compliance.
+
+970
+(e) If the attorney general seeks a court order under Subsection (2)(d), the court shall
+971
+grant the order unless the district attorney, county attorney, or law enforcement agency shows
+972
+good cause and a compelling interest for not complying with Subsection (2)(c).
+
+973
+Section 17. Section 68-3-12.5 is amended to read:
+974
+68-3-12.5. Definitions for Utah Code.
+
+975
+(1) The definitions listed in this section apply to the Utah Code, unless:
+976
+(a) the definition is inconsistent with the manifest intent of the Legislature or repugnant
+977
+978
+979
+to the context of the statute; or
+(b) a different definition is expressly provided for the respective title, chapter, part,
+section, or subsection.
+
+980
+(2) "Adjudicative proceeding" means:
+981
+(a) an action by a board, commission, department, officer, or other administrative unit
+- 35 -
+H.B. 257
+Enrolled Copy
+982
+of the state that determines the legal rights, duties, privileges, immunities, or other legal
+983
+interests of one or more identifiable persons, including an action to grant, deny, revoke,
+984
+suspend, modify, annul, withdraw, or amend an authority, right, or license; and
+985
+(b) judicial review of an action described in Subsection (2)(a).
+
+986
+(3) "Administrator" includes "executor" when the subject matter justifies the use.
+
+987
+(4) "Advisory board," "advisory commission," and "advisory council" mean a board,
+988
+commission, committee, or council that:
+989
+(a) is created by, and whose duties are provided by, statute or executive order;
+990
+(b) performs its duties only under the supervision of another person as provided by
+991
+992
+993
+994
+995
+996
+997
+statute; and
+(c) provides advice and makes recommendations to another person that makes policy
+for the benefit of the general public.
+(5) "Armed forces" means the United States Army, Navy, Air Force, Marine Corps,
+Space Force, and Coast Guard.
+(6) "City" includes, depending on population, a metro township as defined in Section
+10-3c-102.
+
+998
+(7) "County executive" means:
+999
+(a) the county commission, in the county commission or expanded county commission
+1000
+form of government established under Title 17, Chapter 52a, Changing Forms of County
+1001
+Government;
+1002
+1003
+1004
+1005
+(b) the county executive, in the county executive-council optional form of government
+authorized by Section 17-52a-203; or
+(c) the county manager, in the council-manager optional form of government
+authorized by Section 17-52a-204.
+
+1006
+(8) "County legislative body" means:
+1007
+(a) the county commission, in the county commission or expanded county commission
+1008
+form of government established under Title 17, Chapter 52a, Changing Forms of County
+1009
+Government;
+- 36 -
+Enrolled Copy
+1010
+1011
+(b) the county council, in the county executive-council optional form of government
+authorized by Section 17-52a-203; and
+1012
+1013
+H.B. 257
+(c) the county council, in the council-manager optional form of government authorized
+by Section 17-52a-204.
+
+1014
+(9) "Depose" means to make a written statement made under oath or affirmation.
+
+1015
+(10) (a) "Equal" means, with respect to biological sex, of the same value.
+
+1016
+(b) "Equal" does not mean, with respect to biological sex:
+1017
+(i) a characteristic of being the same or identical; or
+1018
+(ii) a requirement that biological sexes be ignored or co-mingled in every circumstance.
+
+1019
+[(10)] (11) "Executor" includes "administrator" when the subject matter justifies the
+1020
+use.
+
+1021
+(12) "Father" means a parent who is of the male sex.
+
+1022
+(13) "Female" means the characteristic of an individual whose biological reproductive
+1023
+system is of the general type that functions in a way that could produce ova.
+
+1024
+[(11)] (14) "Guardian" includes a person who:
+1025
+(a) qualifies as a guardian of a minor or incapacitated person pursuant to testamentary
+1026
+or court appointment; or
+1027
+(b) is appointed by a court to manage the estate of a minor or incapacitated person.
+
+1028
+[(12)] (15) "Highway" includes:
+1029
+(a) a public bridge;
+1030
+(b) a county way;
+1031
+(c) a county road;
+1032
+(d) a common road; and
+1033
+(e) a state road.
+
+1034
+[(13)] (16) "Intellectual disability" means a significant, subaverage general intellectual
+1035
+functioning that:
+1036
+(a) exists concurrently with deficits in adaptive behavior; and
+1037
+(b) is manifested during the developmental period as defined in the current edition of
+- 37 -
+H.B. 257
+Enrolled Copy
+1038
+the Diagnostic and Statistical Manual of Mental Disorders, published by the American
+1039
+Psychiatric Association.
+
+1040
+[(14)] (17) "Intermediate care facility for people with an intellectual disability" means
+1041
+an intermediate care facility for the mentally retarded, as defined in Title XIX of the Social
+1042
+Security Act.
+
+1043
+[(15)] (18) "Land" includes:
+1044
+(a) land;
+1045
+(b) a tenement;
+1046
+(c) a hereditament;
+1047
+(d) a water right;
+1048
+(e) a possessory right; and
+1049
+(f) a claim.
+
+1050
+(19) "Male" means the characteristic of an individual whose biological reproductive
+1051
+system is of the general type that functions to fertilize the ova of a female.
+
+1052
+(20) "Man" means an adult human male.
+
+1053
+[(16)] (21) "Month" means a calendar month, unless otherwise expressed.
+
+1054
+(22) "Mother" means a parent who is of the female sex.
+
+1055
+[(17)] (23) "Oath" includes "affirmation."
+1056
+[(18)] (24) "Person" means:
+1057
+(a) an individual;
+1058
+(b) an association;
+1059
+(c) an institution;
+1060
+(d) a corporation;
+1061
+(e) a company;
+1062
+(f) a trust;
+1063
+(g) a limited liability company;
+1064
+(h) a partnership;
+1065
+(i) a political subdivision;
+- 38 -
+Enrolled Copy
+1066
+1067
+H.B. 257
+(j) a government office, department, division, bureau, or other body of government;
+and
+1068
+(k) any other organization or entity.
+
+1069
+[(19)] (25) "Personal property" includes:
+1070
+(a) money;
+1071
+(b) goods;
+1072
+(c) chattels;
+1073
+(d) effects;
+1074
+(e) evidences of a right in action;
+1075
+(f) a written instrument by which a pecuniary obligation, right, or title to property is
+1076
+created, acknowledged, transferred, increased, defeated, discharged, or diminished; and
+1077
+(g) a right or interest in an item described in Subsections [(19)(a)] (25)(a) through (f).
+
+1078
+[(20)] (26) "Personal representative," "executor," and "administrator" include:
+1079
+(a) an executor;
+1080
+(b) an administrator;
+1081
+(c) a successor personal representative;
+1082
+(d) a special administrator; and
+1083
+(e) a person who performs substantially the same function as a person described in
+1084
+1085
+1086
+Subsections [(20)(a)] (26)(a) through (d) under the law governing the person's status.
+[(21)] (27) "Policy board," "policy commission," or "policy council" means a board,
+commission, or council that:
+1087
+(a) is authorized to make policy for the benefit of the general public;
+1088
+(b) is created by, and whose duties are provided by, the constitution or statute; and
+1089
+(c) performs its duties according to its own rules without supervision other than under
+1090
+1091
+1092
+1093
+the general control of another person as provided by statute.
+[(22)] (28) "Population" is shown by the most recent state or national census, unless
+expressly provided otherwise.
+[(23)] (29) "Process" means a writ or summons issued in the course of a judicial
+- 39 -
+H.B. 257
+1094
+Enrolled Copy
+proceeding.
+
+1095
+[(24)] (30) "Property" includes both real and personal property.
+
+1096
+[(25)] (31) "Real estate" or "real property" includes:
+1097
+(a) land;
+1098
+(b) a tenement;
+1099
+(c) a hereditament;
+1100
+(d) a water right;
+1101
+(e) a possessory right; and
+1102
+(f) a claim.
+
+1103
+[(26)] (32) "Review board," "review commission," and "review council" mean a board,
+1104
+1105
+1106
+commission, committee, or council that:
+(a) is authorized to approve policy made for the benefit of the general public by another
+body or person;
+1107
+(b) is created by, and whose duties are provided by, statute; and
+1108
+(c) performs its duties according to its own rules without supervision other than under
+1109
+the general control of another person as provided by statute.
+
+1110
+[(27)] (33) "Road" includes:
+1111
+(a) a public bridge;
+1112
+(b) a county way;
+1113
+(c) a county road;
+1114
+(d) a common road; and
+1115
+(e) a state road.
+
+1116
+(34) "Sex" means, in relation to an individual, the individual's biological sex, either
+1117
+male or female, at birth, according to distinct reproductive roles as manifested by:
+1118
+(a) sex and reproductive organ anatomy;
+1119
+(b) chromosomal makeup; and
+1120
+(c) endogenous hormone profiles.
+
+1121
+[(28)] (35) "Signature" includes a name, mark, or sign written with the intent to
+- 40 -
+Enrolled Copy
+1122
+H.B. 257
+authenticate an instrument or writing.
+
+1123
+[(29)] (36) "State," when applied to the different parts of the United States, includes a
+1124
+state, district, or territory of the United States.
+
+1125
+[(30)] (37) "Swear" includes "affirm."
+1126
+[(31)] (38) "Testify" means to make an oral statement under oath or affirmation.
+
+1127
+[(32)] (39) "Town" includes, depending on population, a metro township as defined in
+1128
+Section 10-3c-102.
+
+1129
+[(33)] (40) "Uniformed services" means:
+1130
+(a) the armed forces;
+1131
+(b) the commissioned corps of the National Oceanic and Atmospheric Administration;
+1132
+and
+1133
+(c) the commissioned corps of the United States Public Health Service.
+
+1134
+[(34)] (41) "United States" includes each state, district, and territory of the United
+1135
+States of America.
+
+1136
+[(35)] (42) "Utah Code" means the 1953 recodification of the Utah Code, as amended,
+1137
+unless the text expressly references a portion of the 1953 recodification of the Utah Code as it
+1138
+existed:
+1139
+(a) on the day on which the 1953 recodification of the Utah Code was enacted; or
+1140
+(b) (i) after the day described in Subsection [(35)(a)] (42)(a); and
+1141
+(ii) before the most recent amendment to the referenced portion of the 1953
+1142
+1143
+1144
+recodification of the Utah Code.
+[(36)] (43) "Vessel," when used with reference to shipping, includes a steamboat, canal
+boat, and every structure adapted to be navigated from place to place.
+
+1145
+[(37)] (44) (a) "Veteran" means an individual who:
+1146
+(i) has served in the United States Armed Forces for at least 180 days:
+1147
+(A) on active duty; or
+1148
+(B) in a reserve component, to include the National Guard; or
+1149
+(ii) has incurred an actual service-related injury or disability while in the United States
+- 41 -
+H.B. 257
+1150
+Enrolled Copy
+Armed Forces regardless of whether the individual completed 180 days; and
+1151
+(iii) was separated or retired under conditions characterized as honorable or general.
+
+1152
+(b) This definition is not intended to confer eligibility for benefits.
+
+1153
+[(38)] (45) "Will" includes a codicil.
+
+1154
+(46) "Woman" means an adult human female.
+
+1155
+[(39)] (47) "Writ" means an order or precept in writing, issued in the name of:
+1156
+(a) the state;
+1157
+(b) a court; or
+1158
+(c) a judicial officer.
+
+1159
+[(40)] (48) "Writing" includes:
+1160
+(a) printing;
+1161
+(b) handwriting; and
+1162
+(c) information stored in an electronic or other medium if the information is retrievable
+1163
+in a perceivable format.
+
+1164
+Section 18. Section 76-6-206 is amended to read:
+1165
+76-6-206. Criminal trespass.
+
+1166
+(1) (a) As used in this section:
+1167
+(i) "Enter" means intrusion of the entire body or the entire unmanned aircraft.
+
+1168
+(ii) "Graffiti" means the same as that term is defined in Section 76-6-101.
+
+1169
+(iii) "Remain unlawfully," as that term relates to an unmanned aircraft, means
+1170
+remaining on or over private property when:
+1171
+1172
+1173
+1174
+(A) the private property or any portion of the private property is not open to the public;
+and
+(B) the person operating the unmanned aircraft is not otherwise authorized to fly the
+unmanned aircraft over the private property or any portion of the private property.
+
+1175
+(b) Terms defined in Sections 76-1-101.5 and 76-6-201 apply to this section.
+
+1176
+(2) An actor commits criminal trespass if, under circumstances not amounting to
+1177
+burglary as defined in Section 76-6-202, 76-6-203, or 76-6-204 or a violation of Section
+- 42 -
+Enrolled Copy
+1178
+76-10-2402 regarding commercial obstruction:
+1179
+1180
+(a) the actor enters or remains unlawfully on or causes an unmanned aircraft to enter
+and remain unlawfully over property and:
+1181
+1182
+H.B. 257
+(i) intends to cause annoyance or injury to any person or damage to any property,
+including the use of graffiti;
+1183
+(ii) intends to commit any crime, other than theft or a felony; or
+1184
+(iii) is reckless as to whether the actor's or unmanned aircraft's presence will cause fear
+1185
+for the safety of another;
+1186
+(b) knowing the actor's or unmanned aircraft's entry or presence is unlawful, the actor
+1187
+enters or remains on or causes an unmanned aircraft to enter or remain unlawfully over
+1188
+property to which notice against entering is given by:
+1189
+1190
+(i) personal communication to the actor by the owner or someone with apparent
+authority to act for the owner;
+1191
+(ii) fencing or other enclosure obviously designed to exclude intruders; or
+1192
+(iii) posting of signs reasonably likely to come to the attention of intruders; [or]
+1193
+(c) the actor enters a condominium unit in violation of [Subsection] Section
+1194
+57-8-7(8)[.]; or
+1195
+1196
+(d) the actor enters a sex-designated changing room in violation of Subsection
+63G-31-302(3).
+
+1197
+1198
+(3) (a) Except as provided in Subsection (3)(b), a violation of Subsection (2)(a) [or],
+(b), or (d) is a class B misdemeanor.
+
+1199
+(b) [If] The following is a class A misdemeanor:
+1200
+(i) if a violation of Subsection (2)(a) or (b) is committed in a dwelling[, the violation is
+1201
+a class A misdemeanor.];
+1202
+1203
+(ii) if a violation of Subsection (2)(d) is committed while also committing the offense
+of:
+1204
+(A) lewdness under Section 76-9-702;
+1205
+(B) lewdness involving a child under Section 76-9-702.5;
+- 43 -
+H.B. 257
+Enrolled Copy
+1206
+(C) voyeurism under Section 76-9-702.7; or
+1207
+(D) loitering in a privacy space under Section 76-9-702.8; or
+1208
+(iii) if a violation of Subsection (2)(d) is committed in a sex-designated privacy space,
+1209
+as defined in Section 76-9-702.8, that is not designated for individuals of the actor's sex.
+
+1210
+(c) A violation of Subsection (2)(c) is an infraction.
+
+1211
+(4) It is a defense to prosecution under this section that:
+1212
+(a) the property was at the time open to the public; and
+1213
+(b) the defendant complied with all lawful conditions imposed on access to or
+1214
+1215
+1216
+1217
+1218
+remaining on the property.
+(5) In addition to an order for restitution under Section 77-38b-205, an actor who
+commits a violation of Subsection (2) may also be liable for:
+(a) statutory damages in the amount of three times the value of damages resulting from
+the violation of Subsection (2) or $500, whichever is greater; and
+1219
+(b) reasonable attorney fees not to exceed $250, and court costs.
+
+1220
+(6) Civil damages under Subsection (5) may be collected in a separate action by the
+1221
+property owner or the owner's assignee.
+
+1222
+Section 19. Section 76-9-202 is amended to read:
+1223
+76-9-202. Emergency reporting -- Interference -- False report.
+
+1224
+(1) As used in this section:
+1225
+(a) "Emergency" means a situation in which property or human life is in jeopardy and
+1226
+the prompt summoning of aid is essential to the preservation of human life or property.
+
+1227
+(b) "Party line" means a subscriber's line or telephone circuit:
+1228
+(i) that consists of two or more connected main telephone stations; and
+1229
+(ii) where each telephone station has a distinctive ring or telephone number.
+
+1230
+(2) An actor is guilty of emergency reporting abuse if the actor:
+1231
+(a) intentionally refuses to yield or surrender the use of a party line or a public pay
+1232
+telephone to another individual upon being informed that the telephone is needed to report a
+1233
+fire or summon police, medical, or other aid in case of emergency, unless the telephone is
+- 44 -
+Enrolled Copy
+1234
+1235
+1236
+1237
+H.B. 257
+likewise being used for an emergency call;
+(b) asks for or requests the use of a party line or a public pay telephone on the pretext
+that an emergency exists, knowing that no emergency exists;
+(c) reports an emergency or causes an emergency to be reported to any public, private,
+1238
+or volunteer entity whose purpose is to respond to fire, police, or medical emergencies, when
+1239
+the actor knows the reported emergency does not exist; [or]
+1240
+(d) makes a false report, or intentionally aids, abets, or causes a third party to make a
+1241
+false report, to an emergency response service, including a law enforcement dispatcher or a 911
+1242
+emergency response service, if the false report claims that:
+1243
+(i) an ongoing emergency exists;
+1244
+(ii) the emergency described in Subsection (2)(d)(i) currently involves, or involves an
+1245
+1246
+1247
+1248
+imminent threat of, serious bodily injury, serious physical injury, or death; and
+(iii) the emergency described in Subsection (2)(d)(i) is occurring at a specified
+location[.]; or
+(e) makes a false report after having previously made a false report, or intentionally
+1249
+aides, abets, or causes a third party to make a false report, to an emergency response service,
+1250
+including a law enforcement dispatcher or a 911 emergency response service, alleging a
+1251
+violation of Section 63G-31-302 regarding a sex-designated changing room.
+
+1252
+(3) (a) A violation of Subsection (2)(a) or (b) is a class C misdemeanor.
+
+1253
+(b) A violation of Subsection (2)(c) is a class B misdemeanor, except as provided
+1254
+1255
+1256
+under Subsection (3)(c).
+(c) A violation of Subsection (2)(c) is a second degree felony if the report is regarding
+a weapon of mass destruction, as defined in Section 76-10-401.
+
+1257
+(d) A violation of Subsection (2)(d):
+1258
+(i) except as provided in Subsection (3)(d)(ii), is a third degree felony; or
+1259
+(ii) is a second degree felony if:
+1260
+(A) while acting in response to the report, the emergency responder causes physical
+1261
+injury to an individual at the location described in Subsection (2)(d)(iii); or
+- 45 -
+H.B. 257
+1262
+Enrolled Copy
+(B) the actor makes the false report or aids, abets, or causes a third party to make the
+1263
+false report with intent to ambush, attack, or otherwise harm a responding law enforcement
+1264
+officer or emergency responder.
+
+1265
+(e) A violation of Subsection (2)(e) is a class B misdemeanor.
+
+1266
+(4) (a) In addition to any other penalty authorized by law, a court shall order an actor
+1267
+1268
+1269
+1270
+1271
+1272
+convicted of a violation of this section to reimburse:
+(i) any federal, state, or local unit of government, or any private business, organization,
+individual, or entity for all expenses and losses incurred in responding to the violation; and
+(ii) an individual described in Subsection (3)(d)(ii) for the costs for the treatment of the
+physical injury and any psychological injury caused by the offense.
+(b) The court may order that the defendant pay less than the full amount of the costs
+1273
+described in Subsection (4)(a) only if the court states on the record the reasons why the
+1274
+reimbursement would be inappropriate.
+
+1275
+Section 20. Section 76-9-702 is amended to read:
+1276
+76-9-702. Lewdness.
+
+1277
+(1) A person is guilty of lewdness if the person under circumstances not amounting to
+1278
+rape, object rape, forcible sodomy, forcible sexual abuse, aggravated sexual assault, sexual
+1279
+abuse of a minor, unlawful sexual conduct with a 16- or 17-year-old, custodial sexual relations
+1280
+under Section 76-5-412, custodial sexual misconduct under Section 76-5-412.2, custodial
+1281
+sexual relations with youth receiving state services under Section 76-5-413, custodial sexual
+1282
+misconduct with youth receiving state services under Section 76-5-413.2, or an attempt to
+1283
+commit any of these offenses, performs any of the following acts in a public place or under
+1284
+circumstances which the person should know will likely cause affront or alarm to, on, or in the
+1285
+presence of another who is 14 years old or older:
+1286
+(a) an act of sexual intercourse or sodomy;
+1287
+(b) exposes his or her genitals, the female breast below the top of the areola, the
+1288
+1289
+buttocks, the anus, or the pubic area;
+(c) masturbates; or
+- 46 -
+Enrolled Copy
+H.B. 257
+1290
+(d) any other act of lewdness.
+
+1291
+(2) (a) A person convicted the first or second time of a violation of Subsection (1) is
+1292
+1293
+1294
+guilty of a class B misdemeanor, except under Subsection (2)(b).
+(b) A person convicted of a violation of Subsection (1) is guilty of a third degree felony
+if at the time of the violation:
+1295
+(i) the person is a sex offender as defined in Section 77-27-21.7;
+1296
+(ii) the person has been previously convicted two or more times of violating Subsection
+1297
+1298
+1299
+(1); [or]
+(iii) the person has previously been convicted of a violation of Subsection (1) and has
+also previously been convicted of a violation of Section 76-9-702.5[.];
+1300
+(iv) the person commits the offense of lewdness while also committing the offense of:
+1301
+(A) criminal trespass in a sex-designated changing room under Subsection
+1302
+76-6-206(2)(d);
+1303
+(B) lewdness involving a child under Section 76-9-702.5;
+1304
+(C) voyeurism under Section 76-9-702.7; or
+1305
+(D) loitering in a privacy space under Section 76-9-702.8; or
+1306
+(v) the person commits the offense of lewdness in a sex-designated privacy space, as
+1307
+1308
+defined in Section 76-9-702.8, that is not designated for individuals of the actor's sex.
+(c) (i) For purposes of this Subsection (2) and Subsection 77-41-102(18), a plea of
+1309
+guilty or nolo contendere to a charge under this section that is held in abeyance under Title 77,
+1310
+Chapter 2a, Pleas in Abeyance, is the equivalent of a conviction.
+
+1311
+1312
+(ii) This Subsection (2)(c) also applies if the charge under this Subsection (2) has been
+subsequently reduced or dismissed in accordance with the plea in abeyance agreement.
+
+1313
+(3) (a) As used in this Subsection (3):
+1314
+(i) "Common area of a privacy space" means any area of a privacy space other than:
+1315
+(A) a toilet stall with a closed door;
+1316
+(B) immediately in front of a urinal during use; or
+1317
+(C) a shower stall with a closed door or other closed covering.
+
+- 47 -
+H.B. 257
+Enrolled Copy
+1318
+(ii) "Privacy space" means the same as that term is defined in Section 76-9-702.8.
+
+1319
+(b) The common area of a privacy space constitutes a public place or circumstance
+1320
+described in Subsection (1) where an act or an attempted act described in Subsection (1)
+1321
+constitutes lewdness.
+
+1322
+(c) Within the common area of a dressing room, fitting room, locker room, changing
+1323
+facility, or any other space designated for multiple individuals to dress or undress within the
+1324
+same space, exposing, displaying, or otherwise uncovering genitalia that does not correspond
+1325
+with the sex designation of the changing room constitutes an act or an attempted act described
+1326
+in Subsection (1) that constitutes lewdness.
+
+1327
+[(3)] (4) A woman's breast feeding, including breast feeding in any location where the
+1328
+woman otherwise may rightfully be, does not under any circumstance constitute a lewd act,
+1329
+irrespective of whether or not the breast is covered during or incidental to feeding.
+
+1330
+Section 21. Section 76-9-702.5 is amended to read:
+1331
+76-9-702.5. Lewdness involving a child.
+
+1332
+(1) As used in this section[,]:
+1333
+(a) "[in] In the presence of" includes within visual contact through an electronic device.
+
+1334
+(b) "Common area of a privacy space" means the same as that term is defined in
+1335
+Section 76-9-702.
+
+1336
+(c) "Privacy space" means the same as that term is defined in Section 76-9-702.8.
+
+1337
+(2) A person is guilty of lewdness involving a child if the person under circumstances
+1338
+not amounting to rape of a child, object rape of a child, sodomy upon a child, sexual abuse of a
+1339
+child, aggravated sexual abuse of a child, or an attempt to commit any of those offenses,
+1340
+intentionally or knowingly:
+1341
+(a) does any of the following in the presence of a child who is under 14 years of age:
+1342
+(i) performs an act of sexual intercourse or sodomy;
+1343
+(ii) exposes his or her genitals, the female breast below the top of the areola, the
+1344
+1345
+buttocks, the anus, or the pubic area:
+(A) in a public place; or
+- 48 -
+Enrolled Copy
+1346
+1347
+H.B. 257
+(B) in a private place under circumstances the person should know will likely cause
+affront or alarm or with the intent to arouse or gratify the sexual desire of the actor or the child;
+1348
+(iii) masturbates; or
+1349
+(iv) performs any other act of lewdness; or
+1350
+(b) under circumstances not amounting to sexual exploitation of a child under Section
+1351
+76-5b-201 or aggravated sexual exploitation of a child under Section 76-5b-201.1, causes a
+1352
+child under the age of 14 years to expose his or her genitals, anus, or breast, if female, to the
+1353
+actor, with the intent to arouse or gratify the sexual desire of the actor or the child.
+
+1354
+1355
+(3) (a) Lewdness involving a child is a class A misdemeanor, except under Subsection
+(3)(b).
+
+1356
+(b) Lewdness involving a child is a third degree felony if at the time of the violation:
+1357
+(i) the person is a sex offender as defined in Section 77-27-21.7; [or]
+1358
+(ii) the person has previously been convicted of a violation of this section[.];
+1359
+(iii) the person commits the offense of lewdness involving a child while also
+1360
+1361
+1362
+committing the offense of:
+(A) criminal trespass in a sex-designated changing room under Subsection
+76-6-206(2)(d);
+1363
+(B) lewdness under Section 76-9-702;
+1364
+(C) voyeurism under Section 76-9-702.7; or
+1365
+(D) loitering in a privacy space under Section 76-9-702.8; or
+1366
+(iv) the person commits the offense of lewdness involving a child in a sex-designated
+1367
+privacy space, as defined in Section 76-9-702.8, that is not designated for individuals of the
+1368
+actor's sex.
+
+1369
+(4) (a) The common area of a privacy space constitutes a public place or circumstance
+1370
+described in Subsection (1) where an act or an attempted act described in Subsection (1)
+1371
+constitutes lewdness involving a child.
+
+1372
+1373
+(b) Within the common area of a government entity's dressing room, fitting room,
+locker room, changing facility, or any other space designated for multiple individuals to dress
+- 49 -
+H.B. 257
+Enrolled Copy
+1374
+or undress within the same space, exposing, displaying, or otherwise uncovering genitalia that
+1375
+does not correspond with the sex designation of the changing room constitutes an act or an
+1376
+attempted act described in Subsection (1) that constitutes lewdness involving a child.
+
+1377
+Section 22. Section 76-9-702.7 is amended to read:
+1378
+76-9-702.7. Voyeurism offenses -- Penalties.
+
+1379
+(1) A person is guilty of voyeurism who intentionally uses any type of technology to
+1380
+1381
+secretly or surreptitiously record, by video, photograph, or other means, an individual:
+(a) for the purpose of viewing any portion of the individual's body regarding which the
+1382
+individual has a reasonable expectation of privacy, whether or not that portion of the body is
+1383
+covered with clothing;
+1384
+(b) without the knowledge or consent of the individual; and
+1385
+(c) under circumstances in which the individual has a reasonable expectation of
+1386
+1387
+1388
+privacy.
+(2) (a) [A] Except as provided in Subsection (2)(b), a violation of Subsection (1) is a
+class A misdemeanor[, except that].
+
+1389
+(b) The following is a third degree felony:
+1390
+(i) a violation of Subsection (1) committed against a child under 14 years of age [is a
+1391
+third degree felony.];
+1392
+(ii) a violation of Subsection (1) committed while also committing the offense of:
+1393
+(A) criminal trespass in a sex-designated changing room under Subsection
+1394
+76-6-206(2)(d);
+1395
+(B) lewdness under Section 76-9-702;
+1396
+(C) lewdness involving a child under Section 76-9-702.5; or
+1397
+(D) loitering in a privacy space under Section 76-9-702.8; or
+1398
+(iii) a violation of Subsection (1) in a sex-designated privacy space, as defined in
+1399
+1400
+1401
+Section 76-9-702.8, that is not designated for individuals of the actor's sex.
+(3) Distribution or sale of any images, including in print, electronic, magnetic, or
+digital format, obtained under Subsection (1) by transmission, display, or dissemination is a
+- 50 -
+Enrolled Copy
+H.B. 257
+1402
+third degree felony, except that if the violation of this Subsection (3) includes images of a child
+1403
+under 14 years of age, the violation is a second degree felony.
+
+1404
+(4) A person is guilty of voyeurism who, under circumstances not amounting to a
+1405
+violation of Subsection (1), views or attempts to view an individual, with or without the use of
+1406
+any instrumentality:
+1407
+(a) with the intent of viewing any portion of the individual's body regarding which the
+1408
+individual has a reasonable expectation of privacy, whether or not that portion of the body is
+1409
+covered with clothing;
+1410
+(b) without the knowledge or consent of the individual; and
+1411
+(c) under circumstances in which the individual has a reasonable expectation of
+1412
+1413
+1414
+privacy.
+(5) (a) [A] Except as provided in Subsection (5)(b), a violation of Subsection (4) is a
+class B misdemeanor[, except that].
+
+1415
+(b) The following is a class A misdemeanor:
+1416
+(i) a violation of Subsection (4) committed against a child under 14 years of age is a
+1417
+class A misdemeanor[.];
+1418
+(ii) a violation of Subsection (4) committed while also committing the offense of:
+1419
+(A) criminal trespass in a sex-designated changing room under Subsection
+1420
+76-6-206(2)(d);
+1421
+(B) lewdness under Section 76-9-702;
+1422
+(C) lewdness involving a child under Section 76-9-702.5; or
+1423
+(D) loitering in a privacy space under Section 76-9-702.8; or
+1424
+(iii) a violation of Subsection (4) committed in a sex-designated privacy space, as
+1425
+1426
+1427
+defined in Section 76-9-702.8, that is not designated for individuals of the actor's sex.
+(6) For purposes of this section, an individual has a reasonable expectation of privacy
+within a public restroom.
+
+1428
+Section 23. Section 76-9-702.8 is enacted to read:
+1429
+76-9-702.8. Loitering in a privacy space.
+
+- 51 -
+H.B. 257
+Enrolled Copy
+1430
+(1) As used in this section:
+1431
+(a) "Privacy space" means the following in which an individual has a reasonable
+1432
+expectation of privacy:
+1433
+(i) a restroom or any other space that includes a toilet;
+1434
+(ii) a dressing room, fitting room, locker room, changing facility, or any other space
+1435
+designated for multiple individuals to dress or undress within the same space; or
+1436
+(iii) any room or space that includes a shower.
+
+1437
+(b) "Sex-designated" means that a facility, program, or event is designated specifically
+1438
+for males or females and not the opposite sex.
+
+1439
+1440
+(2) An actor commits the offense of unlawfully loitering in a privacy space if the actor
+intentionally or knowingly remains unlawfully in a privacy space.
+
+1441
+1442
+(3) (a) Except as provided in Subsection (3)(b), a violation of Subsection (2) is a class
+B misdemeanor.
+
+1443
+1444
+(b) A violation of Subsection (4) is a class A misdemeanor if the actor commits the
+offense:
+1445
+(i) while also committing the offense of:
+1446
+(A) criminal trespass in a sex-designated changing room under Subsection
+1447
+76-6-206(2)(d);
+1448
+(B) lewdness under Section 76-9-702;
+1449
+(C) lewdness involving a child under Section 76-9-702.5; or
+1450
+(D) voyeurism under Section 76-9-702.7; or
+1451
+(ii) in a sex-designated privacy space that is not designated for individuals of the actor's
+1452
+sex.
+
+1453
+Section 24. Effective date.
+
+1454
+(1) Except as provided in Subsection (2), if approved by two-thirds of all the members
+1455
+elected to each house, this bill takes effect upon approval by the governor, or the day following
+1456
+the constitutional time limit of Utah Constitution, Article VII, Section 8, without the governor's
+1457
+signature, or in the case of a veto, the date of veto override.
+
+- 52 -
+Enrolled Copy
+H.B. 257
+1458
+(2) The actions affecting the following sections take effect on May 1, 2024:
+1459
+(a) Section 63G-31-401;
+1460
+(b) Section 67-3-1; and
+1461
+(c) Section 67-5-1.
+
+- 53 -
+
\ No newline at end of file
diff --git a/assets/data-leg/HB0269-Enrolled.txt b/assets/data-leg/HB0269-Enrolled.txt
new file mode 100644
index 00000000..48ce7724
--- /dev/null
+++ b/assets/data-leg/HB0269-Enrolled.txt
@@ -0,0 +1,315 @@
+Enr lled C py	H B 269
+
+Pri a y Pr tecti ns in Se	designated Are
+2025 GENERAL SESSION STATE OF UTAH
+Chief Sp nsor Stephanie Griciu
+Se	te Sp n	r Brady Br	r
+2
+3 LONG TITLE
+4 G n ral D	cription
+5 Thi bill	difie p ovi i	ga di g e	de ig	ted p iv cy p	e i	du atio  a d
+6 gov rnment facilitie
+7 Highlight d Pro isions
+8 Thi bill
+9 d fine term
+0		eq i e the Ut h Bo d of Highe Ed		tio to p o ide g id	e eg di g t de t hou ing that degree granting in tituti n	n r ontrol
+2 p	id	d fi iti	l h	g f	p	fit	pti	t	d b	d	th	p	f
+3 o p ofit edu	tio	l i	tituti	ceptio  to the Ut h F i Hou i g Act
+4 n rr	an e ception for	prohibition  n e	b	ed di tinction to pply  nly to a
+5 d t	i	tio	f th S hool A ti ity Eligibility C	i  io	d	t d	t
+6 p rticip ti n in	ert in g nder de ignated inter chola tic ctivity
+7 a  a  big	di al t	t	t d	t ti	p	i i	f	tai  li t	f
+8 e ide	e uppo ti g	i dividu l  acce	t  ce t i	e	de ig ated p iv cy p	e
+9 am nd pr vi ion regarding gov rnment entity f cility c mpli nce t	pe ify	hich
+20	go	t	tity b	t i  d ti
+2 require degree gr nting in titution to c mply	ith ex de ign ti n in a  igning
+22 t d nt t  d	lling  nit	ithin th in tit ti n	d	ign t d t d nt h	ing and
+23 ke tech ic l a d co fo	i g ch	g
+24 Money Appropriated in thi Bill
+25 N
+26 Othe Special Clauses
+27 Thi bill provide	pecial effective date
+
+28 Ut h C d Secti	Affected
+29 AMENDS
+30 53B 1 118 (Effective 06/01/25)	enacted by L	of Utah 2024 Ch pter 3
+3 53G 6 1005 (Effecti e upon go ernor s appro al) a	a t d by L	f Ut h 2022
+32 Chapte 478
+33 57 21 3 (Effective 06/01/25) a la t amended by L w	f Ut h 2024 Chapter 200
+34 63G 31 101 (Effecti e 06/01/25)	t d by La	f Utah 2024 Ch pt	2
+35 63G 31 201 (Effective upo  gove	o s app oval) a e acted by L w of Ut h 2024
+36 Chapter 2
+37 63G 31 202 (Effecti e 06/01/25)	t d by La	f Utah 2024 Ch pt	2
+38 63G 31 301 (Effective upo  gove	o s app oval) a e acted by L w of Ut h 2024
+39 Chapter 2
+40 63G 31 302 (Effecti e upon go ernor s appro al)	t d by L	f Ut h 2024
+4 Chapte 2
+42 63G 31 304 (Effective 06/01/25)	en cted by Law of Utah 2024 Ch pter 2
+43 ENACTS
+44 53B 1 411 (Effective 06/01/25) Ut h Code A	tated  953
+45 63G 31 305 (Effective 06/01/25) Ut h Code Ann tated  953
+46
+47 B it enacted by the L gi lat	of th state of Utah
+48 S	tion	Section 53B 1 118 i amend d t  re d
+49 53B 1 118 (Effecti e 06/01/25) Prohibited discriminatory practices
+50 Rest ictio s	Ca	pus cli	ate su vey	E ceptio s
+5 ( ) A u ed in thi	e tion
+52 ( )	I  p	t	t g	t i t	t	g	t l p	p	l ti g t [ ]
+53 (i)	thletic c	petitio  o athleti	afety i  p blic edu	tio	o [ ]
+54 (ii) privacy including omplian e with Title 63G Chapt r 3	Di tinction on th 
+55 B	i	f S	
+56 (b)	P	o al ide tity h  a te i ti	i dividu l	ce colo	eth icity	e
+57 e u l  rientation national  rigin religi n or gender identity
+58 ( )(i)	P	hibit d di	i  i	t	y p	ti	g gi g i	i t i i g	p li y
+59 p	edu e p a ti e p	g a	offi e i itiative o	equi ed t ai i g that ba ed o
+60 n indi idu l  per onal id ntity h racteri tic
+6 (A) p o  ot	th diff	ti l t	t	t of	i di id	l	itho t	i  p	t	t
+
+
+62

g	t i t	t
63

(B) i flue	e the e  ploy  e t de i i	f	i dividu l othe tha  th	ugh the
64

u e  f neutral hiring proce  e with regard to per	n l identity char cteri tic
65

a d i  a	d	ith f d	l la
66

(C) i flue	e a  i dividual  ad  i  io  t	dv	ce	t i	g  du ti	f
67

an in titution the publi educ ti n y tem	r n	demi progr m or
68

(D) i fl	i di id	l  p  ti ip ti	i	i	tit ti	p	d	p bli
69

educatio	y te	p	o ed p og a
70
(ii)
Prohibited di crimin tory practice al	mean eng ging in or m intaining a
7

p li y p	d	p	ti	p	g	ffi	i iti ti	q i  d t  i i g that
72

(A)	e t that o e pe  o al ide tity ch  acte i tic i i he e tly upe io o
73

inf rior to an ther per	n l identity har	teri ti
74

(B)	t th t	i di id	l by  i t	f th i di id	l  p	l id	tity
75

h  acte i tic	i i he	tly p ivileg d opp	ed	i t	i t	pp e  ive o
76

a vi tim wheth r c n ci u ly or un on ci u ly
77

(C)	t th t	i di id	l h	ld b di	i  i	t d g i	t i	i l ti	f Titl
78

VI Title VII	d Title IX	ec ive dv	e t e t  e t be adva	d o	eceive
79

benefici l treatment becau e of the individual  per onal identity ch racteri tic

+80
(D)

t
th t	i di id	l
l h
t
i d t
i	d by th i di id	l
8

pe
o
l ide tity cha  ct  i ti




82 (E)	ert that an individu l by  irtue of the individual  per onal identity
+83 h	t  i ti	b	p	ibility f	ti	itt d i  th p	t by  th
+84 i dividual with the	e pe  o al ide tity ch  acte i tic
+85 (F) a  ert th t an individual h uld f el di c mf rt guilt angui h or  ther
+
+86

p y h l gi	l di t	l ly b	f th i di id	l  p
l id	tity
87

h  acte i tic

88
(G)
ert that meritocra y i inherently r	i t  r e i t

89
(H)
t th t	i	p liti	l t	t	i h	tly	i	f p
90

elatio	hip a d t uggl	a	g	ci l g	up
9
(I)
prom te re entment betwe n or re entment of individu l by virtue  f their
92

p	l id	tity h	t  i ti
93
(J)
a	ibe v lue	l	o ethic l ode	p ivilege	belief to a  i dividual
94

bec u e of the individu l  r ce col r ethnicity	e u l ori ntati n
95

ti	l	igi	o g	d	id	tity

+
+96

(K)	id	a  i di id al  p	l id	tity ha	t  i ti	i  d t	i i g
97

eceipt of tate fi a	i l aid o othe	tate fi	cial	i t	ce i cludi g
98

chol r hip award  r tuition waiver or
99

(L) i	f	d t	a	d di	ity	q ity	d i	l	i
00

(iii)	P ohibited di c i  i	t	y p actice d e	t i clude p li ie o p ocedu e
0

required by t t or feder l la	in luding law rel ting to pr hibit d
02

di	i  i	ti	h  a	t
03

(d)	Stude t uc e	d uppo t	ea	ffice divi io	e  ploy	t po itio
04

other unit  f n in tit ti n e t bli hed  r maintained t  provid	upport guidanc
05

d	that q ip all t d	t	i	l di g ll t d	t at high	i k  f	t
06

c	pleti g a	tific te o deg ee with	pe ie	e a d  ppo tu itie fo	ucce	i
07

e	h t dent  ac demic and c reer go l	and with ut e cluding individual on the
08

b	i	f	i di id	l  p	l id	tity h	t  i ti
09

(e)	Title VI	ea	Title VI of the Civil Right Act of  964 42 U S C Sec 2000d t
0

eq


(f)	Titl VII	Titl VII  f th Ci il Right A t  f  964 42 U S C S	2000	t
2

eq
3

(g)	Title IX me n Title IX of the Educ ti n Amendment	f  972 20 U S C S
4

68	t	q
5
(2)
A  i	titutio	ay  ot
6

(a) engage in prohibited di crimin t ry pra ti e
7

(b) t k	p	t	p	iti	pi i	bj	t d	ib d i  S b	ti
8

67 27	07( )(b)(ii)
9

(c) e tabli h or m intain n offi e divi ion empl yment po ition or other unit  f n
20

i	tit ti	t bli h d t  i  pl	t d	l p pl	p	t	p	p li i
2

p	edu e	p	ti	p og a	o i iti tive	ega di g p ohibited di c i  i	to y
22

pr ctice	r
23

(d)	pl y	ig	pl y	thi d p  ty	h	d ti	f	i	tit ti	i	l d
24

c o di ati g c eati g devel pi g de ig i g i  pl	e ti g o g	i i g pla	i g
25

pr m ting p li ie	progr mming training practice	ctivitie	and pr	edure
26

l ti g t  p	hibit d di	i  i	t	y p	ti
27
(3)
A  i	titutio	h ll
28

(a) en ure that ll tudent h ve acce	t  program pr viding tudent u ce	and
29

ppo t

+
+30

(b) p bli h th titl	a d yll bi  f ll	a dat	y	i a	la	k h p
3

d t ai i g	io	o  the i	tituti	web ite i	o li	d t ba e	dily
32

e r h ble by the publi
33

( ) a	lly t ai	pl y	th	pa  ti	f p	l p liti	l ad	y f
34

i	titutio	bu i	d e  ploy  e t activitie
35

(d) dev l p trategie	including inviting peaker	to prom te viewpoint div r ity	nd
36

( )	tabli h p li i	a d p	d	t  i	l d	pp	t	iti	f	d	ti	a d	h
37

o  f ee peech a d civic educ tio
38
(4)
Beginning  n or before July	2025 the b ard h ll report t  th Higher Education
39

App	p i ti	S b	itt	th	tat	d all	ti	f pp	p i t d f	d f
40

tude t uc e	d uppo t
4
(5)
Th Legi l ture hall in a line item appr pri ti n appropriate ongoing funding t
42

pp	t	i	tit ti	t d	t	d	pp	t p	g	i	d	ith thi
43

e tio
44
(6)(
) On  r bef re J nu ry	2025 the b ard hall c ntract with a third p rty
45

t	t	i	d	ith Titl 63G Ch pt	6	Ut h P	t C d	t
46

o duct a	pu e p	io  cli  ate u vey of e ch i	titutio
47

(i) t	e	tudent f	ulty	nd t ff perception of and e perience with an
48

i	tit ti	p	i	t th t	th	t d	t	f	lty	b
49

a d taff	b	pe c ptio	f	d e pe ie	e with a  i	tituti	a  pu

+50

envir
nment
and

5
(ii)
th t

th
t d	t
f
lty
b
d t ff
b
p
pti
f
52 a d e p  ie	with a  pu policy a d p  ctice ega di g f e d	f peech a d
+53 ac demic fre dom t the in titution
+54 (b) Th b	d h ll	ll	t th	lt	f	h	p	p	i	li	t	y	d
+55 Sub ecti	(6) a d ub  it the	ult to the Office of Legi lative R	e  ch a d
+56 Gener l C un el b ginning  n  r bef re July
+
+57	(7)( ) Th Offi	f L gi l ti	R	h	d G
l C
l h ll p
id

y
58 epo t o  the d t	ollected f o	the a  pu e
+59 Education Interim Committee on or before
p e  i
li  ate u v
y
to the


+60
(i) N
b
1
2027 f	p	t
i	d i  y
2025 2026
d 2027
6
(ii) N v
b

2030 fo	epo t
eceived i  yea
2028 2029
d 2030 a d
62
(iii) N vemb r
2033 for report received in year 203	2032
nd 2033
63
(b) O	b f	No
b	2035 th Offi	f L gi l ti	R
h	d G	l

+
+64
C	l hall p	id a	p  h	i	p	t  f th	p	p	i	li  at
65
vey to the Edu atio  I te i	Co	ittee
66
(8) Nothing in thi	ection require an individual t  re pond to a	mpu expr	ion climate
67
y
68
(9) Nothi g i  thi	ectio  li  it	p	hibit	i	titutio	uth	ity to	t bli h policie
69
th t
70
(a) a	a y t	ply	ith t t	f d	l l	i	l di g la	l ti g t
7
p	hibit d di	i  i atio	ha a	e t
72
(b) require di	lo ure of an employee  a ademic re e rch cla  ro m teaching or
73
k
74
(c)	equi e f	e  pl y  e t te u e o p o  oti	t  di cl	o di cu	the pplic	t
75
(i) re earch
76
(ii) t	hi g g	d
77
(iii)	ti tic	e ti
78
(iv) p dagogi al appr ache or e perience with tudent of all le rning bilitie
79
( 0) Thi	ti	d	t pply t
80
(a)	equi e  e t	ece  a y f	thletic	d acc editatio  c	plia ce
8
(b)	demi re e r h
82
( )	d	i	t	hi g i  th	l
83
(d)	g	t that w uld othe wi e equi e
84
(i)	department office divi i n or other unit of an in titution to engag in
85
p	hibit d di	i  i	t	y p	ti	if th g	t h	b	i	d	d pp	d by
86
th i	tituti	b a d of t u t	o
87
(ii)	n in titution to engage in	prohibited di crimin t ry pra ti e if the gr nt ha
88
b	i	d	d pp	d by th b	d
89
(e)	equi e  e t	ece  a y f	i	titutio  to e t bli h o	ai t i  eligibility f	y
90
federal progr m or
9
(f) p i	t	h l	hip	d  i i t	d by	i	tit ti
92
(	) N t  ith ta di g a y  the p ovi io  of thi pa t the U ive  ity  f Ut h	ay t ke	y
93
action required for th Univer ity of Utah t  c mply with the term of an agreement
94
t	d i t  b t	th U i	ity  f Ut h	d th Ut I di	T ib b f	J ly	2024
95
( 2)(a) Begi	i g o  July	2025 th boa d h ll o du t a bie	ial eview  f
96
in tituti n of higher edu ation  compliance with thi	tion a f llow
97
(i) fo 2025 o	h i	tit ti	of high	d	tio	d

+98 (ii) f	2026	d	y y a aft	h lf  f th d g	g	ti g i	tit ti	f
+99 high	educ tio  a d o e half  f the te h i al college
+
+200
(b)
If the board identifi	vi lation of thi
ecti n the b ard hall

20

(i)	b f	30 day	ft	th d y
hi h th b a d id	tifi	th
i lati
202

wo k	ith the i	titutio  to	eate
e  edi ti	pla	a d

203

(ii) pr vide th in tituti n  80 day	fter the day of the creation  f the remedi ti n
204

pl	t	th	i lati
205
(
3) O  o b fo e N ve  be	of each ye	the bo  d h ll p ep  e a d ub  it a epo t to
206

the High r Edu	tion Appr pri ti n Subc mmittee  n
207

(a) th	i	p	d a h i	tit ti	plia	d t	i ati
208

(b) if a viol ti	i ide tifi d the e  ediatio  pl	d p og e	u de Sub	tio  ( 2)(b)
209
(
4) On or b fore Decemb r	of each y ar the Higher Educ tion Appropri ti n
2
0


S b	itt	h ll
2



(a)	epo t the fi di g u de Sub ectio	(4)	d ( 3) to the Legi l tu e a d
2
2


(b) make appr pri ti n rec mmendation ab ut n in titution  compliance with thi
2
3


ti
2
4
(
5)
The Legi latu e	y withh ld futu e tate pp op i ti	t  a  i	tituti	that f il t
2
5


ure a viol ti n  f thi	e tion within the time pr vided under Sub e tion (12)(b)
2
6
(
6)
Th b	d h ll	k	l	i	d	ith Titl 63G Ch pt	3 Ut h
2
7


Ad  i i t ati e Rule  aki g A t to e t bli h	p ocedu e fo	epti g	d p oce  i g
2
8


an individual  complaint ag in t an in titution for an ll ged vi lation  f thi	ecti n
2
9


S	ti	2  S	ti	53B 1 411 i	t d t	d
220	53B 1 411 (Effective 06/01/25) Bo	d guid	ce to deg ee g a ti g i stit tio s

+22
on
tud
t hou ing

222

Th b
d h ll
k p li i
th
i
p
id t
h d g
g
ti g i	tit ti
223 guid	ce eg  di g the i	titutio	tude t h u i g i cludi g 
+224 ( )  ompli n e with the requirement for e	de ignated dwelling unit within the
+225 i	tit ti	t d	t h	i g	th	t	d fi	d i  S	ti	63G 3	305	d th
+226 p ovi i	f dwelli g u it th t a e	t	de ig ated a d
+227 (2) pr	ti e to n ure individu l privacy within th in tituti n	tudent hou ing 
+228 S	ti	3  S	ti	53G 6 1005 i	d d t	d
+229 53G 6 1005 (Effective upon governor	pproval) Rea onable accommodations
+230 Nothing in thi p rt prohibit an athl ti a  ociation LEA	r chool from adopting
+23 bl	f ty	d p i	y	l	d p li i	th t d	ig	t f	iliti	i	l di g	t oo
+
+232 h	fa iliti	a d d	i g f	iliti	[ p	id d th t] if th	l	d p li i	d	ib d i
+233 thi	ecti	ff	d e	o able acc	odatio	b	ed o  g	de ide tity to all tude t  i 
+234 c mpli nce	ith Title 63G Ch pter 3	Di tincti n	n the Ba i of Sex
+235 S	ti	4  S	ti	57 21 3 i a	d d t	d
+236 57 21 3 (Effective 06/01/25) E e	ptio	Sale by p iv te i dividuals
+237 Nonprofit organizati	Noncommercial tr n acti n
+238 ( ) Thi	hapt	d	t pply t  a i gl  fa  ily d	lli g	it	ld	t d by it
+239 if
+240 (a) the owner do	not own an intere t in four or more ingle f mily dwelling unit held
+24 f	l	l a	t th	a	ti
+242 (b) du i g a 24	o th pe iod th ow e d e	t ell two o	e i gle fa  ily
+243 dwelling unit in	hich th owner	a n t re iding or wa not th mo t recent
+
+244

id	t t th
ti

f
l

245
(c)
the ow e do

ot
et
i  o u e the facilitie o
vic	of a e l e t t b oke

+246

ale p r on and
247

(d) th	d	t	di	i  i	t	y h	i g p	ti	d	S b	ti	57 2	5
248

(2) i  the ale o	e t l of the dwelli g
249
(2)
Thi chapt r doe not pply t  a dwelling or	t mp r ry  r perman nt re iden e f	ility
250

if
25

(a) the di c i  i	ti	i by e 	defi ed i  Se ti	68 3	2 5  e ual	ie t tio
252

gender identity or famili l t tu f r r a	n	f per	n l mode ty  r privacy or in
253

th f	th	f	ligi	i	tit ti	f	i	f	ligi	ight	d	th
254

Fi  t A  e d	t  f the U ited St te C	tituti	o the Ut h Co	titutio	a d
255

(b) the d elling or the temporary or perm nent re idence fa ility i
256

(i)	p	t d by	p	fit	h  it bl	g	i	ti
257

(ii)	w	d by ope  ted by o u de co t  ct	ith	eligi u	ga i	ti	a eligiou
258

a  oci ti n a religiou educational in titution	r	religiou	o iety
259

(iii)	d by	p	t d by	d	t	t	ith	ffili t	f	tity d	ib d
260

i  Sub e ti	(2)(b)(ii) o
26

(iv) owned by  r  perated by a per on und r c ntr	t with an ntity de cribed in
262

S b	ti	(2)(b)(ii)
263
(3)
Thi chapt	cept f	Sub ectio  57 2	5(2) doe	ot pply t  the e tal of a o	i
264

a ingle f mily dwelling by an  wn r	cupant of the ingle family d elling to an ther
265

p	o  if

+
+266
(a) th d	lli g i d	ig	d f	pa	y by f	f	fa  ili	d
267
(b) the	e o	upa t e ide i  o e  f the u it
268
(4)( )(i) Unl	member hip in a r ligion i r	tri ted by race color	x or nati nal
269
igi	thi	hapt	d	t p	hibit a	tity d	ib d i  S b	ti	(4)(a)(ii)
270
f o
27
(A) limiting the	le rental	r occupan y  f a dw lling or temporary or
272
p	a	t	id	f	ility th	tity	p  at	f	p i	ily
273
c	e ci l pu p	to pe  o	of th	e eligi
274
(B) giving preference to per on of the ame religion	hen elling r nting	r
275
l	ti g	p	t f	d	lli g	a t	p	a y	p	a	t	id
276
facility th e tity o	o	pe  te fo p i	ily  o co	e cial pu po e
277
(ii)
The foll wing entitie
re entitled t  the e
emption
de cribed in Sub ection
278

(4)( )(i)



279	(A)	eligiou o ga i	ti	a  ociatio

iety


280	(B) a nonprofit in titution  r  rganiz ti
n
p rated
upervi ed
r ontrolled by  r
28	i	j	ti	ith	ligi	g	i	ti	i ti	i ty
+282 (b)(i) Thi	h pte do	ot p ohibit	e tity de	ibed i  Sub e tio  (4)(b)(ii) f o
+283 (A) limiting the	le rental	r occupan y  f a dw lling or a tempor ry or
+284 p	t	id	f	ility th	tity	p	t	t  p	f
+285 p  ti ula	eligio	e	e ual o ie t ti	o ge d	ide tity o
+286 (B) giving preference to per on of	particular religi n	e u l ori ntation or
+287 g	d	id	tity	h	lli g	ti g	l	ti g	p	t f	d	lli g
+288 a te  po a y o pe	e t e id	ce facility the e tity ow	o ope  t
+289 (ii) The foll wing entitie	re entitled t  the e emption de cribed in Sub ection
+290	(4)(b)(i)
+29	(A)	e tity de	ib d i  Sub e tio  (4)( )(ii) a d
+292 (B) a per on who  wn	dwelling or a temp rary  r permanent re idence facility
+293 th t i	d	t	t	ith	tity d	ib d i  S b	ti	(4)( )(ii)
+294 (5)( ) If the c	ditio	of Sub ectio  (5)(b)	e	et thi chapt	doe	ot p	hibit a
+295 private club n t open to the publi	in luding a fraternity or or rity a	iated	ith
+296 i	tit ti	f high	d	ti	f
+
+297	(i) li  iti g the e tal o o
upa cy  f l dgi g to	e  be

298	(ii) giving preference t  it
member


299	(b) Thi S b	tio  (5) ppli
ly if th p i	t	l b	o op
t
th lodgi g

+300	i	id	t t  it p i  a y p	p	d	t f	ial p	p
+30	(6) Thi chapt	doe	ot p	hibit di ti	ti	ba ed o  i	bility t  fulfill the te	a d
+302 onditi n	including finan i l oblig ti n	f	lea e rent l gre ment c ntr	t of
+303 p	ha	al	tgag	t	t d	d	th	fi a	i g ag	t
+304 (7) Thi chapt	doe	ot p	hibit a  o p ofit du atio al i	tituti	 i	ludi g a
+305 degree gr nting in titution of higher educ ti n li ted in Sub ecti n 53B	02( )( )
+306
f

307
(a)
equi i g it	i gle tude t to live i
a dwelli g
te  po a y o pe
e t
308 re iden e f	ility that i owned by	perated by	r under ontract with the n npr fit
+309 d	ti	l i	tit ti
+
+3
0
(b)
eg egati g a d  elli g	te  po	y o pe	a e t e ide	e f	ility that i	ed
3


by oper ted by or under contr ct	ith the nonprofit du ational in tituti n on the
3
2

b	i	f		d fi	d i  S	ti	68 3	2 5	g  dl	f g	d	id	tity 	f	ili l
3
3

tat	o b th
3
4

(i) for re	n	f per onal mod	ty  r priv	y or
3
5

(ii) i  th f	th	f	ligi	i	tit ti	f	i	f	ligi	ight	d
3
6

th Fi  t A	d  e t of the U ited State Co	titutio  o the Utah C	tituti
3
7
(c)
otherwi e	i ting another p r on in making a d elling	r	tempor ry or
3
8
p
t
id
f	ility
il bl t
t d	t
g  g t d b	i
y
3
9
be pe
itt
d by





320	(i) regulation implementing the federal F ir Hou ing Amendment A t of  988
32
(ii) Titl IX  f th Ed
ti
A
d
t
f  972
322
(iii) othe applicable law





323 (8) Thi chapt r doe not pr hibit any rea	n ble local	t te or feder l re triction
+324 g  di g th	i	b	f	p	t p	itt d t	py	d	lli g
+325 (9) A p ovi i	of thi chapte th t pe tai	to f	ili l t tu doe	ot pply to the
+326 e i ten e development	ale rent l adverti ement	r fin ncing  f n apartm nt
+327 pl	d	i i	th	h	i g d	l p	t d	ig	t d	h	i g f	ld
+328 pe  o	a defi ed by Title VIII of the Civil Right A t of  968	a  e ded
+329 S	tion 5  Section 63G 31 101 i amended t  read
+330 63G 31 101 (Effective 06/01/25) Definitio s
+33	A u ed i  thi	h pte
+332 ( )( )	Changing r om mean	pace de ignated for multiple individual to dre	r
+333 d	ithi  th	p
+
+
+334
(b)	Cha gi g	i	l d
335
(i)	d e  i g o	fitti g oo	l	ke	oo	howe	o	a d
336
(ii)	re tr om wh n	h nging room ontain	r i	tt ched to the r	tro m
337
(2)( )	F	ility	a	a p bli ly	d	t	ll d b ildi g	t	t	th
338
i  p ove	t
339
(b)	F	ility include a ub et of	publicly owned or ontroll d building	tru tur	r
340
th	i  p	t i	l di g	t	l	k
34
(3)	Gove	e t e tity	ea	[ ] the a  e a th t t	i defi ed i  Secti	63G 2	03 
342
[( ) the tate	r]
343
[(b) a y	ty	i ip lity	p	ial di t i t	p	i l	i	di t i t	th	p liti	l
344
  bdivi io  o ad  i i t  tive u it  f the tate i cludi g ]
345
[(i) a tate in titution of higher educ ti n	defined in S	tion 53B 2	0	r]
346
[(ii)  l	l d	ti	g	y	d fi	d i  S	ti	53G 7 40  ]
347
(4)	I te  e  i dividual	ea	the	e a that te	i defi ed i  Sectio  26B 8	0
348
(5)	Men  r	tro m mean a re tr om th t i de ignated f r the e	lu iv u e  f male and
349
t f	l
350
(6)( )	Ope  to the ge e al publi	ea	that	p ivacy pace i
35
(i) freely acce  ible to	member of the gener l public
352
(ii)	ibl t	i di id	l	h  h	p	h	d	ti k t p id	t y f	p id
353
b	hip fee o othe wi e paid to	e	the fa ility c	t i i g the eleva t
354
priv cy p	e or
355
(iii)	ibl t	t d	t  f	i	tit ti	f high	d	ti	d	ib d i  S	ti
356
52B 2	0 [ ]
357
(A) either freely or a de	ribed in Sub	tion (6)( )(ii)[ ]  or
358

(B)   ithi	t d	t h	i g	d fi	d i  S	ti	63G 3	305 
359
(b)
Ope  to the ge	al publi	doe	ot i clude	p ivacy p ce th t i
360

(i)	nly cc	ible to mpl y	of a gov rnment entity or
36

(ii)	y	th t i	t	lly	ibl t  th p bli

+362 (7)	P iv	y pace	ea	a e t oo	o cha gi g oo	withi	publicly ow ed o
+363 ontroll d fa ility	here an individu l ha a rea onable	pe tation of priv	y
+364 (8)	P bli ly	d	t	ll d	th t	g	t	tity h	t l	t	p  ti l
+
+365
ow e  hip i t
e t i  o
h	c	t ol of	f cility p og
eve t
366
(9)( )	Re tr om
mean
ny pace that in lude a t ilet

367
(b)	R	t	o
i	l d



+368 (i)	d	ig	t d	t
+369 (ii)	e	d	ig	ted w	e	e t o
+370 (iii) uni ex re tr om	and
+37 (i )	i gl	pa t	t
+372 ( 0)	Se	de ig	t d	e	th t	f cility p og	o eve t i de ig ated pecifi ally fo
+373 m le	r fem le	nd n t the opp	ite ex
+374 (	)	Si gl	p	t	a	i	lati	t  a i gl	pa t fa ility	p i a y p	th t
+375 the facility o p ivacy pace
+376 (a) h	flo r t	ceiling	all
+377 (b) ha a	ti  ly	a	d a d l	ki g d	d
+378 (c) i de ig	ted fo	i gle  ccup	y
+379 ( 2)  Unam nded birth certifi ate mean	birth certificate 
+380 ( )   ith	d	t hi t	y	
+38 (b) with a  a	d  e t hi to y that 
+382 (i) do	not include gender rel ted mendment	or
+383 (ii) i	l d	g	d	l t d	d	t th t	ly 
+384 (A) co	t a  e	o o  i  io	ulti g f o	a c ive e	e o u d
+385 Sub ecti n 26B 8	07(2) or
+386 (B)	t	i id	tifi	ti	f bi th	f	i t	i di id	l	d
+387 Sub ecti	26B 8	07(3) 
+388 [( 2)] ( 3)	Uni e	mean	in relation to a uni e  facility or privacy pace th t the facility
+389 p i	y p
+
+390
(a) i de ig
ted fo the u
of b th e e	o

39
(b) i not e
de ign t d


392
[( 3)] ( 4)	W
t
t
th t i d	ig	t d f
th
l	i
f
393
fe  ale a d
ot	ale





394 S	tion 6  Section 63G 31 201 i amended t  read
+395 63G 31 201 (Effective upon governor s approval) Distinctions on the basis of
+396 sex
+397 ( ) A g v rnment entity m y not on the b	i of e	e clud an individual from
+398 p  ti ip ti	i	d	y	i di id	l f	th b	fit	f	bj	t	i di id	l t
+399 e	ba ed di ti cti	i  o u de	y g ve	t	the wi	publicly o	ed o
+400 ontroll d fa ility pr gram or ev nt unl	the di tin tion i	ub t ntially related to n
+40	i  po t	t go	t obj	ti
+
+
+402
(2) Ea h g	t	tity hall	th p	ti	f di ti	ti	th b	i	f
403
th t p	tect i dividu l p ivacy a d c	petitive opp	tu ity a de c ibed i  thi chapte
404
(3)( ) A u ed in thi Sub ection (3)	thletic fa ility do	n t include a priv cy p	e
405
(b) T  p	th i di id	l p i a y a d	p titi	pp	t	ity  f f	l	a
406
i dividual i	t e titl d to a d	ay	t acce	u	be efit f o	a gov	e t
407
entity  athletic facility program	r event if
408
(i) th fa ility p	g a	t i d	ig	t d f	f	al	a d
409
(ii) the i di idu l i	t fe  ale
4
0
(c)
T  pre erv the individual pri a y and comp
titive  pportunity  f male	an

4


i di id al i	t	titl d t  a d	ay	t a
b	fit f	a g
t
4
2

e tity  athletic facility p og a	eve t if


4
3

(i) the fa ility pr gram or ev nt i de ign t
d for m le	nd

4
4

(ii) th i di id	l i	t	l


4
5
(4)
[Notwith ta di g ]Sub ectio
( ) th	ugh (3)[ thi	h pte do	] a d Sub ectio 
4
6

63G 3	204(4) do not apply t

4
7

( )  d t	i	ti	f th S h
l A ti ity Eligibility C	i  i	t d i  S	ti
4 8	53G 6	003  ega di g a tude t	thleti eligibility
+4 9	(b) [in the c nte t of] the participation of a tudent[ who]  if the tudent h	obt ined the
+420	ligibility pp	l  f th	i  i	d	S b	ti	53G 6	004(2)[ t  p  ti ip t ]
+42 i  a ge de de ig ated i te	h l	tic a tivity th t d e	t co e p	d with the
+422 de ignation on the tudent  birth certificate	th	e term	re defined in Secti n
+423 53G 6	00
+424 S	tio  7  Sectio  63G 31 202 i a  e ded t	ead
+425 63G 31 202 (Effective 06/01/25) S x ba	d di ti	tions to protect individual
+426 privacy
+427 A di ti cti	o  the b	i of e  that p	vide	pa  t acc	od tio	fo the	e i
+428 ub t ntially related to the import nt g v rnment obj	tive  f pr tecting indi idu l priv cy
+429 i	l di g i  th f ll	i g	t	t
+430 ( ) a p iv cy p	e [	d]
+43 (2) a c rrection l facility a defined in Se tion 77	6b	02[ ]  and
+432	(3) 	lti	p	y	d	ig	t d p bli ly	d d	lli g 
+433	S	tio  8  Sectio  63G 31 301 i a  e ded t	ead
+434	63G 31 301 (Effective upon governor	pproval) Sex de ignated privacy p ces
+435	in public schools
+
+
+436
( ) T  p	th i di id al p i	y  f	al	d f	l	t d	t i  th p bli	d	ti
437
y te	a tude t	ay o ly	e	a	pe atio al e	de ig ated p iv cy p	e withi
438
public cho l th t i de ignated f r tudent u e if the tudent	ex corre p nd with the
439
d	ig	ti	f th p i a y p
440
(2) Fo a tude t who	ke a eque t to u e a p i a y pace othe th	the e	de ig ated
44
privacy p ce th t orre pond with the tudent	ex becau e of the tudent  gender
442
id	tity a d fi	d i  S	ti	34A 5	02	bl f a	f b llyi g th l	al
443
educatio	ge cy	defi ed i  Se ti	53E	02	h ll o	di ate with th	tud	t
444
p rent  r l gal gu rdi n to develop	privacy pl n th t pro ide the tudent with
445
(a)(i)	a	abl a	t	i	i gl	p	t f	ility
446
(ii)	ea o able	e	to	faculty o	t ff	t oo
447
(b) if the a ce	de cribed in Sub ecti n (2)(a) i unav il ble rea onable	e	to
448	p i	t	f	th	i	d	ig	t d p i	y p	th	gh t gg	d
+449	cheduli g o a oth	policy p ovi i	th t p	vide f	te  p	a y p iv t acce
+450	(3) An LEA ati fie the LEA  dutie regarding tudent u e of	privacy pace under thi
+45	h pt	if th LEA
+452	(a) give	tice t	tude t	f the p ovi io	of thi	ectio
+
+453
(b)
t ke
admini tr tive ction to ddre
viol ti n	f nd promote complian e with thi
454

ti
d

455

(c) d vel p a p ivacy pla  i  a co d	ce with Sub e tio  (2)
456
(4)
An individual may u e[ the f llowing evidence]	a d fen e t	n allegation th t the
457

t d	t i	t ligibl t	d	d	ig	t d p i	y p	d	S b	ti
458

( )[ ]
459

[( )] the tudent  unamended birth certifi ate that c rre pond with the e  de ign ti n
460

f p i	y p	hi h	y b	pp	t d	ith	i	f	y	d	t hi t	y
46

obt i ed u de Sectio  26B 8	25[ o ]
462

[(b) d	ument ti n of a medical treatment or proc dure that i con i tent  nly with the
463

	d	ig	ti	f th p i	y p	]
464
(5)
Sub ecti	( ) doe	ot pply to
465

(a) a uni e  or ingl  o	upant facility	r
466

(b)	i t	i di id	l
467

S	tio  9  Sectio  63G 31 302 i a  e ded t	ead
468

63G 31 302 (Effective upon governor	pproval) Sex de ignated changing
469	rooms in publicly owned facilities open to the general public
+
+470	( )( ) E	pt a p	id d i  S b	ti	( )(b) t  p	th i di id	l p i	y  f
+47 le	d fe	l	a  i dividual	ay o ly	e	pe atio al e	de ig ated
+472 h nging ro m in	g vernm nt entity  facility th t i op n t  th gener l public if
+473 (i) th i di id al	p	d	ith th	d	ig ati	f th	ha gi g
+474 (ii) the i di idu l h
+475 (A) legally mended th individu l  birth certificate to c rre pond with th	ex
+476 d	ig ati	f th	ha gi g	hi h	ay b	pp	t d	ith	i	f
+477 a y a  e d  e t hi to y obtai ed u d	Secti	26B 8	25 a d
+478 (B) underg ne a prim ry e  ch racteri tic urgi al procedure a defin d in
+
+479
S	ti
58 67	02 t
p
d	ith th
d	ig
ati	f th	h	gi g
480
oo





48 (b) Sub ection ( )(a) do	not apply t
+482 (i)	i	hild	h	q i	i t	t	th	h	gi g	th t
+483 c	e po d with the e	f the	i o	pa e t gu  dia	elative
+484 (ii)	dependent minor a d fin d in Section 76 5	0 or	dependent adult
+485 d fi	d i  S	ti	76 5	h	q i	i t	t	th	h	gi g
+486 oo	th t co e po d with the e  of a c  etak
+487 (iii)	n indi idu l providing publi	afety ervi e	in luding law enforcem nt
+488 g	y	di	l	i	d fi	d i  S	ti	26B 4	0	d fi	p	t	ti
+489 (iv) a  e  ployee  f	he lth c	f cility	defi ed i  Secti	26B 2 20	t  p ovide
+490 h alth c re ervice to a patient of the health are facility	r
+
+49
( )	i di id	l	h
pl y	t d
ti	i	l
d th
i t
l
i g  f
492
th ch	gi g oo







+493
(2)
An individual in a changing r om ha a re	n ble e pect ti n of privacy	ati fying the
494

p i	y l	t  f th	ff	f	y	i	i  S	ti	76 9 702 7
495
(3)
A  i dividual who k	wi gly e te	a ch	gi g	o	i  viol ti	of Sub e ti	( )
496

ommit th offen e of riminal tre pa	under Section 76 6 206 if the individual enter
497

i	i  th	h	gi g	d	i	t	hi h	bl p	ld
498

e pect t  likely c u	aff o t	l	to o	o i  the p e e	e  f	othe i dividual
499
(4)
Th	urgical provi ion de cribed in Sub ection ( )(a)(ii) doe not hield an individual
500

f	th	ff	f l	d	l t d t  g	it li	d	S b	ti	76 9 702(3)
50

76 9 702 5(4)


502
(5)
An individual may u e th f llowing evidence
defen e
gain t n llegation that the
503	i di id	l i	ot ligibl to	d	d	ig	t d h	gi g oo	d
+
+504	S b	ti	( )
+505	(a) f	i di idu l wh	e bi th e  c	e po d with the e  de ig	ti	of the
+
+506
changing ro m[ ]

507
[(i)] a  i di id	l
a	d d bi th
tifi at th t
p
d
ith th
508	d	ig	ti	of the ha gi g o	hich	y be uppo ted with a eview  f	y
+509	amendment hi tory obtained und r Secti n 26B 8	25 or
+
+5
0

[(ii) d	t ti	f a	di al t  at	t	p	d	that i	i t	t	ly	ith
5


th	de ig atio  of th ch	gi g oo	o ]
5
2

(b) for an individual who e birth e  doe not orre p nd with the e  de ign tion of the
5
3

ha gi g
5
4

(i) the i dividual	e ded bi th ce tificate	hich	y be upp	ted with a eview
5
5

of any mendm nt hi t ry obtain d under S	tion 26B 8	25	nd
5
6

(ii) d	t ti	th t d	t  t	th t th i di id	l h	d  g	p i	y
5
7

cha acte i tic u gi al p ocedu e	defi ed i  Secti	58 67	02
5
8
(6)
Sub ecti n ( ) doe not pply to

+5 9
( )
i
i gl
p	t f	ility

520
(b)
h	gi
g o
that i	ot  p	t  th
ge e
l public o

+52


(c) an inter e  indi idu l

522


S	ti	0  S	ti	63G 31 304 i	d d t	d

523


63G 31 304 (Effective 06/01/25) Gove	e t	tity facility co	plia c

524
(
)
E	pt	pr vided under Se tion 53G 8 2	government entity hall contact l
w
525


f	t if th	tity	i	pl i t	ll g ti	g  di g th f ll	i
g
526


ithi  a p iv	y pa e i  a fa ility that i ope  to the ge	al publi

527


(a) an offen e of lewdne	under Se tion 76 9 702

528


(b)	ff	f l	d	i	l i g	hild	d	S	ti	76 9 702 5


+529
(c)
v y u i	u de Sectio  76 9 702 7


530
(d)
l itering in a pri a y pace under S	tion 76 9 702 8
r

53
( )
f	h	gi g	d	ib d i  S	ti	63G 3	302

ff
f	i  i
l
532

t e pa	u de Sub	tio  63G 3	302(2)




533	(2) To pr	erve the individual priv	y  f male and fem le in priv cy p	e
+534	( )	g	t	tity th t h	d  i i t  ti	t	l	t	gi	f	ility
+535	with a p ivacy pace that i	pe  to the ge	al publi  h ll d pt	p ivacy
+
+536
c mplianc pl n t  addre
c mpli nce	ith the go ernment entity  dutie under thi
537
h pt


+
+538

(b) f	t	ti	f a	f	ility[ a]  ith a p i a y pa	that i	p	t  th g	al
539

publi	the gove	e t e tity th t h	uth	ity ove	o	t ucti	e  odeli g of
540

the f	ility  h ll en ure that the new on tructi n include a ingle	ccup nt f cility
54

d
542

(c) f	e i ti g p ivacy p ce	[a] the gove	e t e tity that ha autho ity  ve 
543

c n truction  r rem deling  f the fa ility that c nt in the privacy pace
544

(i)	hall	id	th f a ibility  f	t	fitti g	d li g t  i	l d
545

(A) fl o t	ceili g w ll	d d o	i  il	p iv	y p	tectio
546

(B) curtain	r
547

(C)	th	th d	f i  p	i g i di id	l p i a y	ithi  th fa ility th t a
548

o  p  able to the	thod d	c ibed i  Sub e tio	(2)(a)(i)	d (ii)	d
549

(ii) may reduce the number of fi ture th t t te l	require by up t  20% to pr vide
550

d q	t	p	f	th	t	fitti g	d li g d	ib d i  S b	ti	(2)( )
55
(3)
[A] The g ve	e t	tity  ith utho ity ega di g the de ig	f	facility with 
552

privacy p ce th t i open t  the gener l public  h ll en ure ufficient e	de ignated
553

p i	y p	th	gh	pli	ith S	ti	5A 3	2	d  5A 3 304	g  di g
554
u i e  f	iliti

555
S	tion
S	tion 63G 31 305 i	n cted t  re d
556

63G 31 305 (Effecti e 06/01/25) Highe education student housi g

557
( )
A u ed i  thi	e tio 

558

(a)  Degree gr nting in titution m an the ame a th t term i defined in Secti n

559

53B	0  5 

560

(b)	D  elli g u it	ea	the a  e a th t t	i defi ed i  Se ti	5A 5	02

56

(c)  Student h u ing mean hou ing th t a degr e granting in titution publi ly  wn	r

562

	t	l 

563
(2)
To p	e ve the i dividual p iv	y  f	ale a d fe	le	deg e  g a ti g i	titutio 

564

th t pr vide	tud nt hou ing m y only rent to a  ign or otherwi e place n individu l

565

i	d	lli g	it th t i	d	ig	t d	ithi  th i	tit ti	t d	t h	i g if th

566


+i dividual	e  c	e po d with the e  de ig	tio  of the dwelli g u it	ithi  the

567

in tituti n	tudent hou ing 

568
(3)
A  i di id	l	y	th f ll	i g	id	d f	g i	t	ll g ti	th t th

569

i dividual i	ot ligible fo	ti g	ig	e t	place  e t i	e	de ig	t d

570


+dwelling unit under Sub e ti n (2) an individu l  unamend d birth certifi ate th t

57

o	p	d	ith th	d	ig	ti	of th d	lli g	it	hi h	y b	pp	t d	ith


+572 a	i	f	y a	d	t hi t	y  bt i	d	d	S	ti	26B 8	25
+573 (4) Sub ecti	(2) doe	ot pply to 
+574 (a) dw lling unit	ithin tudent hou ing that the in titution de ign te	uni ex or
+575 	 i gl	pa t	
+576 (b) 	i te  e  i dividual 
+577 (5) Nothing in thi	ection prohibit	degree gr nting in tituti n from offering	dwelling
+578 it i	t d	t h	i g that i	t	d	ig	t d if th i	tit ti	ly a  ig	pla
+579 a  i dividual i  the dwelli g u it	h	eek	dwelli g u it that i	ot e	de ig	ted 
+580 S	tion  2  Effective Date
+58 ( ) E	pt	p	id d i  S b	ti	(2) thi bill tak	ff	t J	2025
+582 (2)( ) The	tio	affe ti g	tio	de c ibed i  Sub ectio  (2)(b) take eff	t 
+583 (i)   cept a provided in Sub	tion (2)( )(ii) May 7 2025 or
+584 (ii) if pp	d by t	thi d	f ll	b	l	t d t	h h	
+585 (A) up	pp oval by the gove	o 
+586 (B) with ut the governor	ignature the d y follo ing the on titutional time
+587 li  it  f Ut h C	tit ti	A ti l VII S	ti	8	
+588 (C) i  the c	e of a v to the date  f veto ove ide 
+589 (b) Sub ection (2)(a) ppli	t  the acti n	ffecting the following ecti n 
+590 (i) S	ti	63G 3	30  (Effecti e up	go e nor s appro al) 
+59 (ii) Secti	53G 6	005 (Effective up	gove	o	app oval) 
+592	(iii) Section 63G 3	20  (Effective up n g vernor	approval)	nd
+593	(i ) S	ti	63G 3	302 (Effecti e upon go erno	ppro al) 
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
diff --git a/assets/data-leg/SB0016.txt b/assets/data-leg/SB0016.txt
new file mode 100644
index 00000000..7047f906
--- /dev/null
+++ b/assets/data-leg/SB0016.txt
@@ -0,0 +1,742 @@
+Enrolled Copy	S.B. 16
+
+
+1 TRANSGENDER MEDICAL TREATMENTS AND PROCEDURES
+2 AMENDMENTS
+3 2023 GENERAL SESSION
+4 STATE OF UTAH
+5 Chief Sponsor: Michael S. Kennedy
+6 House Sponsor: Katy Hall
+7
+8 LONG TITLE
+9 General Description:
+10 This bill enacts provisions regarding transgender medical treatments and procedures.
+11 Highlighted Provisions:
+12 This bill:
+13 ?	defines terms;
+14 ?	requires the Department of Health and Human Services to conduct a systematic
+15 review of the medical evidence regarding hormonal transgender treatments and
+16 provide recommendations to the Legislature;
+17 ?	requires the Division of Professional Licensing to create a certification for
+18 providing hormonal transgender treatments;
+19 ?	requires a health care provider to meet certain requirements before providing a
+20 hormonal transgender treatment;
+21 ?	prohibits a health care provider from providing a hormonal transgender treatment to
+22 new patients who were not diagnosed with gender dysphoria before a certain date;
+23 ?	prohibits performing sex characteristic surgical procedures on a minor for the
+24 purpose of effectuating a sex change;
+25 ?	specifies that an individual may bring a medical malpractice action related to certain
+26 medical treatments and procedures;
+27 ?	specifies that an individual may disaffirm consent under certain circumstances;
+28 ?	allows an individual to bring a medical malpractice action for treatment provided to
+
+29 the individual as a minor if the individual later disaffirms consent;
+30 ?	extends the medical malpractice statute of limitations related to providing certain
+31 medical treatments and procedures; and
+32 ?	makes technical changes.
+33 Money Appropriated in this Bill:
+34 None
+35 Other Special Clauses:
+36 This bill provides a special effective date.
+37 This bill provides revisor instructions.
+38 Utah Code Sections Affected:
+39 AMENDS:
+40 58-67-102, as last amended by Laws of Utah 2022, Chapter 233
+41 58-67-502, as last amended by Laws of Utah 2021, Chapter 337
+42 58-68-102, as last amended by Laws of Utah 2022, Chapter 233
+43 58-68-502, as last amended by Laws of Utah 2021, Chapter 337
+44 ENACTS:
+45 26B-1-214, Utah Code Annotated 1953
+46 58-1-603, Utah Code Annotated 1953
+47 58-1-603.1, Utah Code Annotated 1953
+48 78B-3-427, Utah Code Annotated 1953
+49 Utah Code Sections Affected by Revisor Instructions:
+50 58-1-603.1, Utah Code Annotated 1953
+51 78B-3-427, Utah Code Annotated 1953
+52
+53 Be it enacted by the Legislature of the state of Utah:
+54 Section 1. Section 26B-1-214 is enacted to read:
+55 26B-1-214. Systematic medical evidence review of hormonal transgender
+
+56 treatments.
+57 (1) As used in this section, "hormonal transgender treatment" means the same as that
+58 term is defined in Section 58-1-603.
+
+59 (2) The department, in consultation with the Division of Professional Licensing created
+60 in Section 58-1-103, the Physicians Licensing Board created in Section 58-67-201, the
+61 Osteopathic Physician and Surgeon's Licensing Board created in Section 58-68-201, the
+62 University of Utah, and a non-profit hospital system with multiple hospitals in Utah and
+63 experience in specialty pediatric care, shall conduct a systematic medical evidence review
+64 regarding the provision of hormonal transgender treatments to minors.
+65 (3) The purpose of the systematic medical evidence review is to provide the Legislature
+66 with recommendations to consider when deciding whether to lift the moratorium described in
+67 Section 58-1-603.1.
+
+68 (4) The systematic medical evidence review shall:
+69 (a) analyze hormonal transgender treatments that are prescribed to a minor with gender
+70 dysphoria, including:
+71 (i) analyzing any effects and side effects of the treatment; and
+72 (ii) whether each treatment has been approved by the federal Food and Drug
+73 Administration to treat gender dysphoria;
+74 (b) review the scientific literature regarding hormonal transgender treatments in
+75 minors, including short-term and long-term impacts, literature from other countries, and rates
+76 of desistence and time to desistence where applicable;
+77 (c) review the quality of evidence cited in any scientific literature including to analyze
+78 and report on the quality of the data based on techniques such as peer review, selection bias,
+79 self-selection bias, randomization, sample size, and other applicable best research practices;
+80 (d) include high quality clinical research assessing the short-term and long-term
+81 benefits and harms of hormonal transgender treatments prescribed to minors with gender
+82 dysphoria and the short-term and long-term benefits and harms of interrupting the natural
+
+83 puberty and development processes of the child;
+84 (e) specify the conditions under which the department recommends that a treatment not
+85 be permitted;
+86 (f) recommend what information a minor and the minor's parent should understand
+87 before consenting to a hormonal transgender treatment;
+88 (g) recommend the best practices a health care provider should follow to provide the
+89 information described in Subsection (4)(f);
+90 (h) describe the assumptions and value determinations used to reach a
+91 recommendation; and
+92 (i) include any other information the department, in consultation with the entities
+93 described in Subsection (2), determines would assist the Legislature in enacting legislation
+94 related to the provision of hormonal transgender treatment to minors.
+95 (5) Upon the completion of the systematic medical evidence review, the department
+96 shall provide the systematic medical evidence review to the Health and Human Services
+97 Interim Committee.
+98 Section 2. Section 58-1-603 is enacted to read:
+99 58-1-603. Hormonal transgender treatment on minors -- Requirements.
+100 (1) As used in this section:
+101 (a) "Approved organization" means an organization with expertise regarding
+102 transgender health care for minors that is approved by the division.
+103 (b) "Biological sex at birth" means an individual's sex, as being male or female,
+104 according to distinct reproductive roles as manifested by sex and reproductive organ anatomy,
+105 chromosomal makeup, and endogenous hormone profiles.
+106 (c) "Disorder of sexual development" means a sexual development disorder where an
+107 individual:
+108 (i) is born with external biological sex characteristics that are irresolvably ambiguous;
+109 (ii) is born with 46, XX chromosomes with virilization;
+
+110 (iii) is born with 46, XY chromosomes with undervirilization;
+111 (iv) has both ovarian and testicular tissue; or
+112 (v) has been diagnosed by a physician, based on genetic or biochemical testing, with
+113 abnormal:
+114 (A) sex chromosome structure;
+115 (B) sex steroid hormone production; or
+116 (C) sex steroid hormone action for a male or female.
+117 (d) "Health care provider" means:
+118 (i) a physician;
+119 (ii) a physician assistant licensed under Chapter 70a, Utah Physician Assistant Act; or
+120 (iii) an advanced practice registered nurse licensed under Subsection 58-31b-301(2)(e).
+121 (e) (i) "Hormonal transgender treatment" means administering, prescribing, or
+122 supplying for effectuating or facilitating an individual's attempted sex change:
+123 (A) to an individual whose biological sex at birth is female, a dose of testosterone or
+124 other androgens at levels above those normally found in an individual whose biological sex at
+125 birth is female;
+126 (B) to an individual whose biological sex at birth is male, a dose of estrogen or a
+127 synthetic compound with estrogenic activity or effect at levels above those normally found in
+128 an individual whose biological sex at birth is male; or
+129 (C) a puberty inhibition drug.
+130 (ii) "Hormonal transgender treatment" does not include administering, prescribing, or
+131 supplying a substance described in Subsection (1)(e)(i) to an individual if the treatment is
+132 medically necessary as a treatment for:
+133 (A) precocious puberty;
+134 (B) endometriosis;
+135 (C) a menstrual, ovarian, or uterine disorder;
+136 (D) a sex-hormone stimulated cancer; or
+
+137 (E) a disorder of sexual development.
+138 (f) "Mental health professional" means any of the following:
+139 (i) a physician who is board certified for a psychiatry specialization recognized by the
+140 American Board of Medical Specialists or the American Osteopathic Association's Bureau of
+141 Osteopathic Specialists;
+142 (ii) a psychologist licensed under Chapter 61, Psychologist Licensing Act;
+143 (iii) a clinical social worker licensed under Chapter 60, Part 2, Social Worker
+144 Licensing Act;
+145 (iv) a marriage and family therapist licensed under Chapter 60, Part 3, Marriage and
+146 Family Therapist Licensing Act; or
+147 (v) a clinical mental health counselor licensed under Chapter 60, Part 4, Clinical
+148 Mental Health Counselor Licensing Act.
+149 (g) "Minor" means an individual who is less than 18 years old.
+150 (h) "Physician" means an individual licensed under:
+151 (i) Chapter 67, Utah Medical Practice Act; or
+152 (ii) Chapter 68, Utah Osteopathic Medical Practice Act.
+153 (i) "Puberty inhibition drug" means any of the following alone or in combination with
+154 aromatase inhibitors:
+155 (i) gonadotropin-releasing hormone agonists; or
+156 (ii) androgen receptor inhibitors.
+157 (j) "Transgender treatment certification" means a certification described in Subsection
+158	(2).
+159	(2) (a) The division shall create a transgender treatment certification on or before July
+160	1, 2023.
+161 (b) The division may issue the transgender treatment certification to an individual if the
+162 individual:
+163 (i) is a health care provider or a mental health professional; and
+
+164 (ii) has completed at least 40 hours of education related to transgender health care for
+165 minors from an approved organization.
+166 (c) The division may renew a transgender treatment certification:
+167 (i) at the time an individual renews the individual's license; and
+168 (ii) if the individual has completed at least 20 hours of continuing education related to
+169 transgender health care for minors from an approved organization during the individual's
+170 continuing education cycle.
+171 (d) Beginning January 1, 2024, providing a hormonal transgender treatment to a minor
+172 without a transgender treatment certification is unprofessional conduct.
+173 (3) (a) A health care provider may provide a hormonal transgender treatment to a
+174 minor only if the health care provider has been treating the minor for gender dysphoria for at
+175 least six months.
+176 (b) Beginning July 1, 2023, before providing a hormonal transgender treatment to a
+177 minor described in Subsection (3)(a), a health care provider shall:
+178 (i) determine if the minor has other physical or mental health conditions, identify and
+179 document any condition, and consider whether treating those conditions before treating the
+180 gender dysphoria would provide the minor the best long-term outcome;
+181 (ii) consider whether an alternative medical treatment or behavioral intervention to
+182 treat the minor's gender dysphoria would provide the minor the best long-term outcome;
+183 (iii) document in the medical record that:
+184 (A) the health care provider has complied with Subsections (3)(b)(i) and (ii); and
+185 (B) providing the hormonal transgender treatment will likely result in the best
+186 long-term outcome for the minor;
+187 (iv) obtain written consent from:
+188 (A) the minor; and
+189 (B) the minor's parent or guardian unless the minor is emancipated;
+190 (v) discuss with the minor:
+
+191 (A) the risks of the hormonal transgender treatment;
+192 (B) the minor's short-term and long-term expectations regarding the effect that the
+193 hormonal transgender treatment will have on the minor; and
+194 (C) the likelihood that the hormonal transgender treatment will meet the short-term and
+195 long-term expectations described in Subsection (3)(b)(v)(B);
+196 (vi) unless the minor is emancipated, discuss with the minor's parent or guardian:
+197 (A) the risks of the hormonal transgender treatment;
+198 (B) the minor's short-term and long-term expectations regarding the effect that the
+199 hormonal transgender treatment will have on the minor;
+200 (C) the parent or guardian's short-term and long-term expectations regarding the effect
+201 that the hormonal transgender treatment will have on the minor; and
+202 (D) the likelihood that the hormonal transgender treatment will meet the short-term and
+203 long-term expectations described in Subsections (3)(b)(vi)(B) and (C);
+204 (vii) document in the medical record that the health care provider has provided the
+205 information described in Subsections (3)(b)(viii) and (ix);
+206 (viii) provide the minor the following information if providing the minor a puberty
+207 inhibition drug:
+208 (A) puberty inhibition drugs are not approved by the FDA for the treatment of gender
+209 dysphoria;
+210 (B) possible adverse outcomes of puberty blockers are known to include diminished
+211 bone density, pseudotumor cerebri and long term adult sexual dysfunction;
+212 (C) research on the long-term risks to children of prolonged treatment with puberty
+213 blockers for the treatment of gender dysphoria has not yet occurred; and
+214 (D) the full effects of puberty blockers on brain development and cognition are
+215 unknown;
+216 (ix) provide the minor the following information if providing a cross-sex hormone as
+217 described in Subsection (1)(e)(i)(A) or (B):
+
+218 (A) the use of cross-sex hormones in males is associated with risks that include blood
+219 clots, gallstones, coronary artery disease, heart attacks, tumors of the pituitary gland, strokes,
+220 elevated levels of triglycerides in the blood, breast cancer, and irreversible infertility; and
+221 (B) the use of cross-sex hormones in females is associated with risks of erythrocytosis,
+222 severe liver dysfunction, coronary artery disease, hypertension, and increased risk of breast and
+223 uterine cancers; and
+224 (x) upon the completion of any relevant information privacy release, obtain a mental
+225 health evaluation of the minor as described in Subsection (4).
+226 (4) The mental health evaluation shall:
+227 (a) be performed by a mental health professional who:
+228 (i) beginning January 1, 2024, has a current transgender treatment certification; and
+229 (ii) is not the health care provider that is recommending or providing the hormonal
+230 transgender treatment;
+231 (b) contain a determination regarding whether the minor suffers from gender dysphoria
+232 in accordance with the fifth edition of the Diagnostic and Statistical Manual of Mental
+233 Disorders;
+234 (c) confirm that the minor and the mental health professional have had at least three
+235 therapy sessions; and
+236 (d) document all of the minor's mental health diagnoses and any significant life events
+237 that may be contributing to the diagnoses.
+238 (5) A violation of Subsection (3) is unprofessional conduct.
+239 Section 3. Section 58-1-603.1 is enacted to read:
+240 58-1-603.1. Hormonal transgender treatment moratorium.
+241 (1) As used in this section:
+242 (a) "Health care provider" means the same as that term is defined in Section 58-1-603.
+
+243 (b) "Hormonal transgender treatment" means the same as that term is defined in
+244	Section 58-1-603.
+
+
+245 (2) A health care provider may not provide a hormonal transgender treatment to a
+246 patient who:
+247 (a) is a minor as defined in Section 58-1-603; and
+248 (b) is not diagnosed with gender dysphoria before the effective date of this bill.
+249 (3) A violation of Subsection (2) is unprofessional conduct.
+250 Section 4. Section 58-67-102 is amended to read:
+251 58-67-102.  Definitions.
+252 In addition to the definitions in Section 58-1-102, as used in this chapter:
+253 (1) (a) "Ablative procedure" means a procedure that is expected to excise, vaporize,
+254 disintegrate, or remove living tissue, including the use of carbon dioxide lasers and erbium:
+255 YAG lasers.
+256 (b) "Ablative procedure" does not include hair removal.
+257 (2) "ACGME" means the Accreditation Council for Graduate Medical Education of the
+258 American Medical Association.
+259 (3) "Administrative penalty" means a monetary fine or citation imposed by the division
+260 for acts or omissions determined to constitute unprofessional or unlawful conduct, in
+261 accordance with a fine schedule established by the division in collaboration with the board, as a
+262 result of an adjudicative proceeding conducted in accordance with Title 63G, Chapter 4,
+263 Administrative Procedures Act.
+264 (4) "Associate physician" means an individual licensed under Section 58-67-302.8.
+265 (5) "Attempted sex change" means an attempt or effort to change an individual's body
+266 to present that individual as being of a sex or gender that is different from the individual's
+267 biological sex at birth.
+268 (6) "Biological sex at birth" means an individual's sex, as being male or female,
+269 according to distinct reproductive roles as manifested by:
+270 (a) sex and reproductive organ anatomy;
+271 (b) chromosomal makeup; and
+
+272 (c) endogenous hormone profiles.
+273 [(5)] (7) "Board" means the Physicians Licensing Board created in Section 58-67-201.
+274 [(6)] (8) "Collaborating physician" means an individual licensed under Section
+275 58-67-302 who enters into a collaborative practice arrangement with an associate physician.
+276 [(7)] (9) "Collaborative practice arrangement" means the arrangement described in
+277	Section 58-67-807.
+278 [(8)] (10) (a) "Cosmetic medical device" means tissue altering energy based devices
+279 that have the potential for altering living tissue and that are used to perform ablative or
+280 nonablative procedures, such as American National Standards Institute (ANSI) designated
+281 Class IIIb and Class IV lasers, intense pulsed light, radio frequency devices, and lipolytic
+282 devices, and excludes ANSI designated Class IIIa and lower powered devices.
+283 (b) Notwithstanding Subsection [(8)(a)] (10)(a), if an ANSI designated Class IIIa and
+284 lower powered device is being used to perform an ablative procedure, the device is included in
+285 the definition of cosmetic medical device under Subsection [(8)(a)] (10)(a).
+286 [(9)] (11) "Cosmetic medical procedure":
+287 (a) includes the use of cosmetic medical devices to perform ablative or nonablative
+288 procedures; and
+289 (b) does not include a treatment of the ocular globe such as refractive surgery.
+290 [(10)] (12) "Diagnose" means:
+291 (a) to examine in any manner another person, parts of a person's body, substances,
+292 fluids, or materials excreted, taken, or removed from a person's body, or produced by a person's
+293 body, to determine the source, nature, kind, or extent of a disease or other physical or mental
+294 condition;
+295 (b) to attempt to conduct an examination or determination described under Subsection
+296	[(10)(a);] (12)(a);
+297 (c) to hold oneself out as making or to represent that one is making an examination or
+298 determination as described in Subsection [(10)(a);] (12)(a); or
+
+299 (d) to make an examination or determination as described in Subsection [(10)(a)]
+300 (12)(a) upon or from information supplied directly or indirectly by another person, whether or
+301 not in the presence of the person making or attempting the diagnosis or examination.
+302 [(11)] (13) "LCME" means the Liaison Committee on Medical Education of the
+303 American Medical Association.
+304 [(12)] (14) "Medical assistant" means an unlicensed individual who may perform tasks
+305 as described in Subsection 58-67-305(6).
+306 [(13)] (15) "Medically underserved area" means a geographic area in which there is a
+307 shortage of primary care health services for residents, as determined by the Department of
+308 Health and Human Services.
+309 [(14)] (16) "Medically underserved population" means a specified group of people
+310 living in a defined geographic area with a shortage of primary care health services, as
+311 determined by the Department of Health and Human Services.
+312 [(15)] (17) (a) (i) "Nonablative procedure" means a procedure that is expected or
+313 intended to alter living tissue, but is not intended or expected to excise, vaporize, disintegrate,
+314 or remove living tissue.
+315 (ii) Notwithstanding Subsection [(15)(a)(i),] (17)(a)(i) nonablative procedure includes
+316 hair removal.
+317 (b) "Nonablative procedure" does not include:
+318 (i) a superficial procedure as defined in Section 58-1-102;
+319 (ii) the application of permanent make-up; or
+320 (iii) the use of photo therapy and lasers for neuromusculoskeletal treatments that are
+321 performed by an individual licensed under this title who is acting within the individual's scope
+322 of practice.
+323 [(16)] (18) "Physician" means both physicians and surgeons licensed under Section
+324 58-67-301, Utah Medical Practice Act, and osteopathic physicians and surgeons licensed under
+325 Section 58-68-301, Utah Osteopathic Medical Practice Act.
+
+326 [(17)] (19) (a) "Practice of medicine" means:
+327 (i) to diagnose, treat, correct, administer anesthesia, or prescribe for any human
+328 disease, ailment, injury, infirmity, deformity, pain or other condition, physical or mental, real
+329 or imaginary, including to perform cosmetic medical procedures, or to attempt to do so, by any
+330 means or instrumentality, and by an individual in Utah or outside the state upon or for any
+331 human within the state;
+332 (ii) when a person not licensed as a physician directs a licensee under this chapter to
+333 withhold or alter the health care services that the licensee has ordered;
+334 (iii) to maintain an office or place of business for the purpose of doing any of the acts
+335 described in Subsection [(17)(a)] (19)(a)(i) or (ii) whether or not for compensation; or
+336 (iv) to use, in the conduct of any occupation or profession pertaining to the diagnosis or
+337 treatment of human diseases or conditions in any printed material, stationery, letterhead,
+338 envelopes, signs, or advertisements, the designation "doctor," "doctor of medicine,"
+339 "physician," "surgeon," "physician and surgeon," "Dr.," "M.D.," or any combination of these
+340 designations in any manner which might cause a reasonable person to believe the individual
+341 using the designation is a licensed physician and surgeon, and if the party using the designation
+342 is not a licensed physician and surgeon, the designation must additionally contain the
+343 description of the branch of the healing arts for which the person has a license, provided that an
+344 individual who has received an earned degree of doctor of medicine degree but is not a licensed
+345 physician and surgeon in Utah may use the designation "M.D." if it is followed by "Not
+346 Licensed" or "Not Licensed in Utah" in the same size and style of lettering.
+347 (b) The practice of medicine does not include:
+348 (i) except for an ablative medical procedure as provided in Subsection [(17)(b)(ii),]
+349 (19)(b)(ii) the conduct described in Subsection [(17)(a)(i)] (19)(a)(i) that is performed in
+350 accordance with a license issued under another chapter of this title;
+351 (ii) an ablative cosmetic medical procedure if the scope of practice for the person
+352 performing the ablative cosmetic medical procedure includes the authority to operate or
+
+353 perform a surgical procedure; or
+354 (iii) conduct under Subsection 58-67-501(2).
+355 [(18)] (20) "Prescription device" means an instrument, apparatus, implement, machine,
+356 contrivance, implant, in vitro reagent, or other similar or related article, and any component
+357 part or accessory, which is required under federal or state law to be prescribed by a practitioner
+358 and dispensed by or through a person or entity licensed under this chapter or exempt from
+359 licensure under this chapter.
+360 [(19)] (21) "Prescription drug" means a drug that is required by federal or state law or
+361 rule to be dispensed only by prescription or is restricted to administration only by practitioners.
+362 (22) (a) "Primary sex characteristic surgical procedure" means any of the following if
+363 done for the purpose of effectuating or facilitating an individual's attempted sex change:
+364 (i) for an individual whose biological sex at birth is male, castration, orchiectomy,
+365 penectomy, vaginoplasty, or vulvoplasty;
+366 (ii) for an individual whose biological sex at birth is female, hysterectomy,
+367 oophorectomy, metoidioplasty, or phalloplasty; or
+368 (iii) any surgical procedure that is related to or necessary for a procedure described in
+369 Subsection (22)(a)(i) or (ii), that would result in the sterilization of an individual who is not
+370 sterile.
+371 (b) "Primary sex characteristic surgical procedure" does not include:
+372 (i) surgery or other procedures or treatments performed on an individual who:
+373 (A) is born with external biological sex characteristics that are irresolvably ambiguous;
+374 (B) is born with 46, XX chromosomes with virilization;
+375 (C) is born with 46, XY chromosomes with undervirilization;
+376 (D) has both ovarian and testicular tissue; or
+377 (E) has been diagnosed by a physician, based on genetic or biochemical testing, with a
+378 sex development disorder characterized by abnormal sex chromosome structure, sex steroid
+379 hormone production, or sex steroid hormone action for a male or female; or
+
+380 (ii) removing a body part:
+381 (A) because the body part is cancerous or diseased; or
+382 (B) for a reason that is medically necessary, other than to effectuate or facilitate an
+383 individual's attempted sex change.
+384 (23) (a) "Secondary sex characteristic surgical procedure" means any of the following
+385 if done for the purpose of effectuating or facilitating an individual's attempted sex change:
+386 (i) for an individual whose biological sex at birth is male, breast augmentation surgery,
+387 chest feminization surgery, or facial feminization surgery; or
+388 (ii) for an individual whose biological sex at birth is female, mastectomy, breast
+389 reduction surgery, chest masculinization surgery, or facial masculinization surgery.
+390 (b) "Secondary sex characteristic surgical procedure" does not include:
+391 (i) surgery or other procedures or treatments performed on an individual who:
+392 (A) is born with external biological sex characteristics that are irresolvably ambiguous;
+393 (B) is born with 46, XX chromosomes with virilization;
+394 (C) is born with 46, XY chromosomes with undervirilization;
+395 (D) has both ovarian and testicular tissue; or
+396 (E) has been diagnosed by a physician, based on genetic or biochemical testing, with a
+397 sex development disorder characterized by abnormal sex chromosome structure, sex steroid
+398 hormone production, or sex steroid hormone action for a male or female; or
+399 (ii) removing a body part:
+400 (A) because the body part is cancerous or diseased; or
+401 (B) for a reason that is medically necessary, other than to effectuate or facilitate an
+402 individual's attempted sex change.
+403 [(20)] (24) "SPEX" means the Special Purpose Examination of the Federation of State
+404 Medical Boards.
+405 [(21)] (25) "Unlawful conduct" means the same as that term is defined in Sections
+406	58-1-501 and 58-67-501.
+
+407 [(22)] (26) "Unprofessional conduct" means the same as that term is defined in
+408 Sections 58-1-501 and 58-67-502, and as may be further defined by division rule.
+409 Section 5. Section 58-67-502 is amended to read:
+410 58-67-502. Unprofessional conduct.
+411 (1) "Unprofessional conduct" includes, in addition to the definition in Section
+412	58-1-501:
+413	(a) using or employing the services of any individual to assist a licensee in any manner
+414	not in accordance with the generally recognized practices, standards, or ethics of the
+415	profession, state law, or division rule;
+416	(b) making a material misrepresentation regarding the qualifications for licensure under
+417	Section 58-67-302.7 or [Section] 58-67-302.8;
+418 (c) violating the dispensing requirements of Chapter 17b, Part 8, Dispensing Medical
+419 Practitioner and Dispensing Medical Practitioner Clinic Pharmacy, if applicable;
+420 (d) violating the requirements of Title 26, Chapter 61a, Utah Medical Cannabis Act;
+421 [or]
+422 (e) falsely making an entry in, or altering, a medical record with the intent to conceal:
+423 (i) a wrongful or negligent act or omission of an individual licensed under this chapter
+424 or an individual under the direction or control of an individual licensed under this chapter; or
+425 (ii) conduct described in Subsections (1)(a) through (d) or Subsection 58-1-501(1)[.];
+
+426 or
+427 (f) performing, or causing to be performed, upon an individual who is less than 18
+428 years old:
+429 (i) a primary sex characteristic surgical procedure; or
+430 (ii) a secondary sex characteristic surgical procedure.
+431 (2) "Unprofessional conduct" does not include:
+432 (a) in compliance with Section 58-85-103:
+433 (i) obtaining an investigational drug or investigational device;
+
+434 (ii) administering the investigational drug to an eligible patient; or
+435 (iii) treating an eligible patient with the investigational drug or investigational device;
+436 or
+437 (b) in accordance with Title 26, Chapter 61a, Utah Medical Cannabis Act:
+438 (i) when registered as a qualified medical provider or acting as a limited medical
+439 provider, as those terms are defined in Section 26-61a-102, recommending the use of medical
+440 cannabis;
+441 (ii) when registered as a pharmacy medical provider, as that term is defined in Section
+442 26-61a-102, providing pharmacy medical provider services in a medical cannabis pharmacy; or
+443 (iii) when registered as a state central patient portal medical provider, as that term is
+444 defined in Section 26-61a-102, providing state central patient portal medical provider services.
+445 (3) Notwithstanding Subsection (2)(b), the division, in consultation with the board and
+446 in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, shall define
+447 unprofessional conduct for a physician described in Subsection (2)(b).
+448 Section 6. Section 58-68-102 is amended to read:
+449 58-68-102.  Definitions.
+450 In addition to the definitions in Section 58-1-102, as used in this chapter:
+451 (1) (a) "Ablative procedure" means a procedure that is expected to excise, vaporize,
+452 disintegrate, or remove living tissue, including the use of carbon dioxide lasers and erbium:
+453 YAG lasers.
+454 (b) "Ablative procedure" does not include hair removal.
+455 (2) "ACGME" means the Accreditation Council for Graduate Medical Education of the
+456 American Medical Association.
+457 (3) "Administrative penalty" means a monetary fine imposed by the division for acts or
+458 omissions determined to constitute unprofessional or unlawful conduct, as a result of an
+459 adjudicative proceeding conducted in accordance with Title 63G, Chapter 4, Administrative
+460 Procedures Act.
+
+461 (4) "AOA" means the American Osteopathic Association.
+462 (5) "Associate physician" means an individual licensed under Section 58-68-302.5.
+463 (6) "Attempted sex change" means an attempt or effort to change an individual's body
+464 to present that individual as being of a sex or gender that is different from the individual's
+465 biological sex at birth.
+466 (7) "Biological sex at birth" means an individual's sex, as being male or female,
+467 according to distinct reproductive roles as manifested by:
+468 (a) sex and reproductive organ anatomy;
+469 (b) chromosomal makeup; and
+470 (c) endogenous hormone profiles.
+471 [(6)] (8) "Board" means the Osteopathic Physician and Surgeon's Licensing Board
+472 created in Section 58-68-201.
+473 [(7)] (9) "Collaborating physician" means an individual licensed under Section
+474 58-68-302 who enters into a collaborative practice arrangement with an associate physician.
+475 [(8)] (10) "Collaborative practice arrangement" means the arrangement described in
+476	Section 58-68-807.
+477 [(9)] (11) (a) "Cosmetic medical device" means tissue altering energy based devices
+478 that have the potential for altering living tissue and that are used to perform ablative or
+479 nonablative procedures, such as American National Standards Institute (ANSI) designated
+480 Class IIIb and Class IV lasers, intense pulsed light, radio frequency devices, and lipolytic
+481 devices and excludes ANSI designated Class IIIa and lower powered devices.
+482 (b) Notwithstanding Subsection [(9)(a)] (11)(a), if an ANSI designated Class IIIa and
+483 lower powered device is being used to perform an ablative procedure, the device is included in
+484 the definition of cosmetic medical device under Subsection [(9)(a)] (11)(a).
+485 [(10)] (12) "Cosmetic medical procedure":
+486 (a) includes the use of cosmetic medical devices to perform ablative or nonablative
+487 procedures; and
+
+488 (b) does not include a treatment of the ocular globe such as refractive surgery.
+489 [(11)] (13) "Diagnose" means:
+490 (a) to examine in any manner another person, parts of a person's body, substances,
+491 fluids, or materials excreted, taken, or removed from a person's body, or produced by a person's
+492 body, to determine the source, nature, kind, or extent of a disease or other physical or mental
+493 condition;
+494 (b) to attempt to conduct an examination or determination described under Subsection
+495	[(11)(a)] (13)(a);
+496 (c) to hold oneself out as making or to represent that one is making an examination or
+497 determination as described in Subsection [(11)(a)] (13)(a); or
+498 (d) to make an examination or determination as described in Subsection [(11)(a)]
+499 (13)(a) upon or from information supplied directly or indirectly by another person, whether or
+500 not in the presence of the person making or attempting the diagnosis or examination.
+501 [(12)] (14) "Medical assistant" means an unlicensed individual who may perform tasks
+502 as described in Subsection 58-68-305(6).
+503 [(13)] (15) "Medically underserved area" means a geographic area in which there is a
+504 shortage of primary care health services for residents, as determined by the Department of
+505 Health and Human Services.
+506 [(14)] (16) "Medically underserved population" means a specified group of people
+507 living in a defined geographic area with a shortage of primary care health services, as
+508 determined by the Department of Health and Human Services.
+509 [(15)] (17) (a) (i) "Nonablative procedure" means a procedure that is expected or
+510 intended to alter living tissue, but is not expected or intended to excise, vaporize, disintegrate,
+511 or remove living tissue.
+512 (ii) Notwithstanding Subsection [(15)(a)(i)] (17)(a)(i), nonablative procedure includes
+513 hair removal.
+514 (b) "Nonablative procedure" does not include:
+
+515 (i) a superficial procedure as defined in Section 58-1-102;
+516 (ii) the application of permanent make-up; or
+517 (iii) the use of photo therapy lasers for neuromusculoskeletal treatments that are
+518 [preformed] performed by an individual licensed under this title who is acting within the
+519 individual's scope of practice.
+520 [(16)] (18) "Physician" means both physicians and surgeons licensed under Section
+521 58-67-301, Utah Medical Practice Act, and osteopathic physicians and surgeons licensed under
+522 Section 58-68-301, Utah Osteopathic Medical Practice Act.
+523 [(17)] (19) (a) "Practice of osteopathic medicine" means:
+524 (i) to diagnose, treat, correct, administer anesthesia, or prescribe for any human
+525 disease, ailment, injury, infirmity, deformity, pain, or other condition, physical or mental, real
+526 or imaginary, or to attempt to do so, by any means or instrumentality, which in whole or in part
+527 is based upon emphasis of the importance of the musculoskeletal system and manipulative
+528 therapy in the maintenance and restoration of health, by an individual in Utah or outside of the
+529 state upon or for any human within the state;
+530 (ii) when a person not licensed as a physician directs a licensee under this chapter to
+531 withhold or alter the health care services that the licensee has ordered;
+532 (iii) to maintain an office or place of business for the purpose of doing any of the acts
+533 described in Subsection [(17)(a)] (19)(a)(i) or (ii) whether or not for compensation; or
+534 (iv) to use, in the conduct of any occupation or profession pertaining to the diagnosis or
+535 treatment of human diseases or conditions, in any printed material, stationery, letterhead,
+536 envelopes, signs, or advertisements, the designation "doctor," "doctor of osteopathic medicine,"
+537 "osteopathic physician," "osteopathic surgeon," "osteopathic physician and surgeon," "Dr.,"
+538 "D.O.," or any combination of these designations in any manner which might cause a
+539 reasonable person to believe the individual using the designation is a licensed osteopathic
+540 physician, and if the party using the designation is not a licensed osteopathic physician, the
+541 designation must additionally contain the description of the branch of the healing arts for which
+
+542 the person has a license, provided that an individual who has received an earned degree of
+543 doctor of osteopathic medicine but is not a licensed osteopathic physician and surgeon in Utah
+544 may use the designation "D.O." if it is followed by "Not Licensed" or "Not Licensed in Utah"
+545 in the same size and style of lettering.
+546 (b) The practice of osteopathic medicine does not include:
+547 (i) except for an ablative medical procedure as provided in Subsection [(17)(b)(ii)]
+548 (19)(b)(ii), the conduct described in Subsection [(17)(a)(i)] (19)(a)(i) that is performed in
+549 accordance with a license issued under another chapter of this title;
+550 (ii) an ablative cosmetic medical procedure if the scope of practice for the person
+551 performing the ablative cosmetic medical procedure includes the authority to operate or
+552 perform a surgical procedure; or
+553 (iii) conduct under Subsection 58-68-501(2).
+554 [(18)] (20) "Prescription device" means an instrument, apparatus, implement, machine,
+555 contrivance, implant, in vitro reagent, or other similar or related article, and any component
+556 part or accessory, which is required under federal or state law to be prescribed by a practitioner
+557 and dispensed by or through a person or entity licensed under this chapter or exempt from
+558 licensure under this chapter.
+559 [(19)] (21) "Prescription drug" means a drug that is required by federal or state law or
+560 rule to be dispensed only by prescription or is restricted to administration only by practitioners.
+561 (22) (a) "Primary sex characteristic surgical procedure" means any of the following if
+562 done for the purpose of effectuating or facilitating an individual's attempted sex change:
+563 (i) for an individual whose biological sex at birth is male, castration, orchiectomy,
+564 penectomy, vaginoplasty, or vulvoplasty;
+565 (ii) for an individual whose biological sex at birth is female, hysterectomy,
+566 oophorectomy, metoidioplasty, or phalloplasty; or
+567 (iii) any surgical procedure that is related to or necessary for a procedure described in
+568 Subsection (22)(a)(i) or (ii), that would result in the sterilization of an individual who is not
+
+569 sterile.
+570 (b) "Primary sex characteristic surgical procedure" does not include:
+571 (i) surgery or other procedures or treatments performed on an individual who:
+572 (A) is born with external biological sex characteristics that are irresolvably ambiguous;
+573 (B) is born with 46, XX chromosomes with virilization;
+574 (C) is born with 46, XY chromosomes with undervirilization;
+575 (D) has both ovarian and testicular tissue; or
+576 (E) has been diagnosed by a physician, based on genetic or biochemical testing, with a
+577 sex development disorder characterized by abnormal sex chromosome structure, sex steroid
+578 hormone production, or sex steroid hormone action for a male or female; or
+579 (ii) removing a body part:
+580 (A) because the body part is cancerous or diseased; or
+581 (B) for a reason that is medically necessary, other than to effectuate or facilitate an
+582 individual's attempted sex change.
+583 (23) (a) "Secondary sex characteristic surgical procedure" means any of the following
+584 if done for the purpose of effectuating or facilitating an individual's attempted sex change:
+585 (i) for an individual whose biological sex at birth is male, breast augmentation surgery,
+586 chest feminization surgery, or facial feminization surgery; or
+587 (ii) for an individual whose biological sex at birth is female, mastectomy, breast
+588 reduction surgery, chest masculinization surgery, or facial masculinization surgery.
+589 (b) "Secondary sex characteristic surgical procedure" does not include:
+590 (i) surgery or other procedures or treatments performed on an individual who:
+591 (A) is born with external biological sex characteristics that are irresolvably ambiguous;
+592 (B) is born with 46, XX chromosomes with virilization;
+593 (C) is born with 46, XY chromosomes with undervirilization;
+594 (D) has both ovarian and testicular tissue; or
+595 (E) has been diagnosed by a physician, based on genetic or biochemical testing, with a
+
+596 sex development disorder characterized by abnormal sex chromosome structure, sex steroid
+597 hormone production, or sex steroid hormone action for a male or female; or
+598 (ii) removing a body part:
+599 (A) because the body part is cancerous or diseased; or
+600 (B) for a reason that is medically necessary, other than to effectuate or facilitate an
+601 individual's attempted sex change.
+602 [(20)] (24) "SPEX" means the Special Purpose Examination of the Federation of State
+603 Medical Boards.
+604 [(21)] (25) "Unlawful conduct" means the same as that term is defined in Sections
+605	58-1-501 and 58-68-501.
+606 [(22)] (26) "Unprofessional conduct" means the same as that term is defined in
+607 Sections 58-1-501 and 58-68-502 and as may be further defined by division rule.
+608 Section 7. Section 58-68-502 is amended to read:
+609 58-68-502. Unprofessional conduct.
+610 (1) "Unprofessional conduct" includes, in addition to the definition in Section
+611	58-1-501:
+612 (a) using or employing the services of any individual to assist a licensee in any manner
+613 not in accordance with the generally recognized practices, standards, or ethics of the
+614 profession, state law, or division rule;
+615 (b) violating the dispensing requirements of Chapter 17b, Part 8, Dispensing Medical
+616 Practitioner and Dispensing Medical Practitioner Clinic Pharmacy, if applicable;
+617 (c) making a material misrepresentation regarding the qualifications for licensure under
+618	Section 58-68-302.5;
+619 (d) violating the requirements of Title 26, Chapter 61a, Utah Medical Cannabis Act;
+620 [or]
+621 (e) falsely making an entry in, or altering, a medical record with the intent to conceal:
+622 (i) a wrongful or negligent act or omission of an individual licensed under this chapter
+
+623 or an individual under the direction or control of an individual licensed under this chapter; or
+624 (ii) conduct described in Subsections (1)(a) through (d) or Subsection 58-1-501(1)[.];
+
+625 or
+626 (f) performing, or causing to be performed, upon an individual who is less than 18
+627 years old:
+628 (i) a primary sex characteristic surgical procedure; or
+629 (ii) a secondary sex characteristic surgical procedure.
+630 (2) "Unprofessional conduct" does not include:
+631 (a) in compliance with Section 58-85-103:
+632 (i) obtaining an investigational drug or investigational device;
+633 (ii) administering the investigational drug to an eligible patient; or
+634 (iii) treating an eligible patient with the investigational drug or investigational device;
+635 or
+636 (b) in accordance with Title 26, Chapter 61a, Utah Medical Cannabis Act:
+637 (i) when registered as a qualified medical provider or acting as a limited medical
+638 provider, as those terms are defined in Section 26-61a-102, recommending the use of medical
+639 cannabis;
+640 (ii) when registered as a pharmacy medical provider, as that term is defined in Section
+641 26-61a-102, providing pharmacy medical provider services in a medical cannabis pharmacy; or
+642 (iii) when registered as a state central patient portal medical provider, as that term is
+643 defined in Section 26-61a-102, providing state central patient portal medical provider services.
+644 (3) Notwithstanding Subsection (2)(b), the division, in consultation with the board and
+645 in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, shall define
+646 unprofessional conduct for a physician described in Subsection (2)(b).
+647 Section 8. Section 78B-3-427 is enacted to read:
+648 78B-3-427. Transgender procedures upon a minor -- Right of action -- Informed
+649 consent requirements -- Statute of limitations.
+
+650 (1) As used in this section:
+651 (a) "Hormonal transgender treatment" means the same as that term is defined in
+652	Section 58-1-603.
+
+653 (b) "Minor" means the same as that term is defined in Section 58-1-603.
+
+654 (2) (a) Notwithstanding any other provision of law, a malpractice action against a
+655 health care provider may be brought against a health care provider for damages arising from:
+656 (i) providing a hormonal transgender treatment to a minor without complying with the
+657 requirements described in Section 58-1-603;
+
+658 (ii) negligence in providing a hormonal transgender treatment to a minor; or
+659 (iii) providing a treatment or procedure described in Subsection (2)(b)(ii) to a minor
+660 without the minor's consent including if the minor disaffirms consent under Subsection (3).
+661 (3) (a) Notwithstanding any other provision of law, an individual who gave informed
+662 consent as a minor or for whom consent was given under Section 78B-3-406, may disaffirm the
+663 consent if:
+664 (i) the treatment at issue began after the effective date of this bill;
+665 (ii) the consent was provided for any of the following:
+666 (A) a hormonal transgender treatment;
+667 (B) a primary sex characteristic surgical procedure as defined in Section 58-67-102; or
+668 (C) a secondary sex characteristic surgical procedure as defined in Section 58-67-102;
+
+669 (iii) under the totality of the circumstances, a health care provider would have reason to
+670 believe that the minor, or a similarly situated minor, could later regret having given consent;
+671 (iv) the individual suffered a permanent physical injury; and
+672 (v) the consent is disaffirmed in writing before the individual reaches the age of 25
+673 years old.
+674 (b) A disaffirmation of consent under this Subsection (3) relates back to the day the
+675 original consent was given.
+676 (4) Notwithstanding any other provision of law, a malpractice action against a health
+
+677 care provider described in Subsection (2)(a) may be brought before the patient is 25 years old if
+678 the treatment at issue in the malpractice action began, occurred, or continued on or after the
+679 effective date of this bill.
+680 (5) Sections 78B-3-404 and 78B-3-406 do not apply to an action described in this
+681 section.
+
+682 Section 9. Effective date.
+683 If approved by two-thirds of all the members elected to each house, this bill takes effect
+
+684 upon approval by the governor, or the day following the constitutional time limit of Utah
+685 Constitution, Article VII, Section 8, without the governor's signature, or in the case of a veto,
+686 the date of veto override.
+687 Section 10. Revisor instructions.
+688 The Legislature intends that the Office of Legislative Research and General Counsel, in
+689 preparing the Utah Code database for publication, replace each instance of the phrase "the
+690 effective date of this bill" with the bill's actual effective date in the following Utah Code
+691 sections:
+692	(1) Section 58-1-603.1; and
+693	(2) Section 78B-3-427.
+
+
+
+
+
+
+
+
+
diff --git a/assets/data-leg/SB0039.txt b/assets/data-leg/SB0039.txt
new file mode 100644
index 00000000..6febfca0
--- /dev/null
+++ b/assets/data-leg/SB0039.txt
@@ -0,0 +1,2031 @@
+Enrolled Copy	S.B. 39
+
+
+1 HEALTH AND HUMAN SERVICES RECODIFICATION -
+2 HEALTH CARE ASSISTANCE AND DATA
+3 2023 GENERAL SESSION
+4 STATE OF UTAH
+5 Chief Sponsor: Jacob L. Anderegg
+6 House Sponsor: Raymond P. Ward
+7
+8 LONG TITLE
+9 General Description:
+10 This bill recodifies portions of the Utah Health Code and Utah Human Services Code.
+11 Highlighted Provisions:
+12 This bill:
+13 ?	recodifies provisions regarding:
+14 •	health care administration and assistance; and
+15 •	vital statistics, health data, and the Utah Medical Examiner; and
+16 ?	makes technical and corresponding changes.
+17 Money Appropriated in this Bill:
+18 None
+19 Other Special Clauses:
+20 This bill provides a coordination clause.
+21 This bill provides revisor instructions.
+22 Utah Code Sections Affected:
+23 AMENDS:
+24 26B-3-101, as enacted by Laws of Utah 2022, Chapter 255
+25 26B-8-101, as enacted by Laws of Utah 2022, Chapter 255
+26 RENUMBERS AND AMENDS:
+27 26B-3-102, (Renumbered from 26-18-2.1, as last amended by Laws of Utah 2019,
+28 Chapter 393)
+
+
+29 26B-3-103, (Renumbered from 26-18-2.2, as last amended by Laws of Utah 2019,
+30 Chapter 393)
+31 26B-3-104, (Renumbered from 26-18-2.3, as last amended by Laws of Utah 2020,
+32 Chapter 225)
+33 26B-3-105, (Renumbered from 26-18-2.4, as last amended by Laws of Utah 2022,
+34 Chapter 255)
+35 26B-3-106, (Renumbered from 26-18-2.5, as last amended by Laws of Utah 2019,
+36 Chapter 393)
+37 26B-3-107, (Renumbered from 26-18-2.6, as last amended by Laws of Utah 2021,
+38 Chapter 234)
+39 26B-3-108, (Renumbered from 26-18-3, as last amended by Laws of Utah 2021,
+40 Chapter 422)
+41 26B-3-109, (Renumbered from 26-18-3.1, as last amended by Laws of Utah 2020,
+42 Chapter 225)
+43 26B-3-110, (Renumbered from 26-18-3.5, as last amended by Laws of Utah 2019,
+44 Chapter 393)
+45 26B-3-111, (Renumbered from 26-18-3.6, as last amended by Laws of Utah 2019,
+46 Chapter 393)
+47 26B-3-112, (Renumbered from 26-18-3.8, as last amended by Laws of Utah 2020, Sixth
+48 Special Session, Chapter 3)
+49 26B-3-113, (Renumbered from 26-18-3.9, as last amended by Laws of Utah 2020, Fifth
+50 Special Session, Chapter 4)
+51 26B-3-114, (Renumbered from 26-18-4, as last amended by Laws of Utah 2013,
+52 Chapter 167)
+53 26B-3-115, (Renumbered from 26-18-5, as last amended by Laws of Utah 2020,
+54 Chapter 225)
+55 26B-3-116, (Renumbered from 26-18-5.5, as enacted by Laws of Utah 2022, Chapter
+
+
+
+
+56
469)
57
26B-3-117, (Renumbered from 26-18-6, as enacted by Laws of Utah 1981, Chapter
58
126)
59
26B-3-118, (Renumbered from 26-18-7, as last amended by Laws of Utah 1988,
60
Chapter 21)
61
26B-3-119, (Renumbered from 26-18-8, as last amended by Laws of Utah 2020,
62
Chapter 225)
63
26B-3-120, (Renumbered from 26-18-9, as enacted by Laws of Utah 1981, Chapter
64
126)
65
26B-3-121, (Renumbered from 26-18-11, as last amended by Laws of Utah 2019,
66
Chapter 393)
67
26B-3-122, (Renumbered from 26-18-13, as last amended by Laws of Utah 2017,
68
Chapter 241)
69
26B-3-123, (Renumbered from 26-18-13.5, as last amended by Laws of Utah 2019,
70
Chapter 249)
71
26B-3-124, (Renumbered from 26-18-15, as last amended by Laws of Utah 2021,
72
Chapter 163)
73
26B-3-125, (Renumbered from 26-18-16, as enacted by Laws of Utah 2012, Chapter
74
155)
75
26B-3-126, (Renumbered from 26-18-17, as enacted by Laws of Utah 2013, Chapter
76
53)
77
26B-3-127, (Renumbered from 26-18-18, as last amended by Laws of Utah 2019,
78
Chapter 393)
79
26B-3-128, (Renumbered from 26-18-19, as last amended by Laws of Utah 2016,
80
Chapter 114)
81
26B-3-129, (Renumbered from 26-18-20, as last amended by Laws of Utah 2022,
82
Chapter 443)

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

+
+
+110 Chapter 275)
+111 26B-3-203, (Renumbered from 26-18-405.5, as last amended by Laws of Utah 2022,
+112 Chapter 149)
+113 26B-3-204, (Renumbered from 26-18-408, as last amended by Laws of Utah 2020,
+114 Fifth Special Session, Chapter 4)
+115 26B-3-205, (Renumbered from 26-18-409, as enacted by Laws of Utah 2014, Chapter
+116	174)
+117 26B-3-206, (Renumbered from 26-18-410, as last amended by Laws of Utah 2022,
+118 Chapter 226)
+119 26B-3-207, (Renumbered from 26-18-411, as last amended by Laws of Utah 2022,
+120 Chapter 394)
+121 26B-3-208, (Renumbered from 26-18-413, as last amended by Laws of Utah 2020,
+122 Chapter 225)
+123 26B-3-209, (Renumbered from 26-18-414, as enacted by Laws of Utah 2017, Chapter
+124	307)
+125 26B-3-210, (Renumbered from 26-18-415, as last amended by Laws of Utah 2019,
+126 Chapters 1 and 393)
+127 26B-3-211, (Renumbered from 26-18-416, as last amended by Laws of Utah 2020,
+128 Chapter 354)
+129 26B-3-212, (Renumbered from 26-18-417, as last amended by Laws of Utah 2019,
+130 Chapter 393)
+131 26B-3-213, (Renumbered from 26-18-418, as last amended by Laws of Utah 2020,
+132 Chapter 303)
+133 26B-3-214, (Renumbered from 26-18-419, as enacted by Laws of Utah 2019, Chapter
+134	172)
+135	26B-3-215, (Renumbered from 26-18-420, as enacted by Laws of Utah 2020, Chapter
+136	187)
+
+
+137
26B-3-216, (Renumbered from 26-18-420.1, as enacted by Laws of Utah 2021, Chapter
138
133)
139
26B-3-217, (Renumbered from 26-18-421, as enacted by Laws of Utah 2020, Chapter
140
159)
141
26B-3-218, (Renumbered from 26-18-422, as enacted by Laws of Utah 2020, Chapter
142
188)
143
26B-3-219, (Renumbered from 26-18-423, as enacted by Laws of Utah 2020, Chapter
144
303)
145
26B-3-220, (Renumbered from 26-18-424, as enacted by Laws of Utah 2021, Chapter
146
76)
147
26B-3-221, (Renumbered from 26-18-425, as enacted by Laws of Utah 2021, Chapter
148
27)
149
26B-3-222, (Renumbered from 26-18-426, as enacted by Laws of Utah 2021, Chapter
150
212)
151
26B-3-223, (Renumbered from 26-18-428, as enacted by Laws of Utah 2022, Chapter
152
394)
153
26B-3-224, (Renumbered from 26-18-429, as enacted by Laws of Utah 2022, Chapter
154
253)
155
26B-3-301, (Renumbered from 26-18-101, as last amended by Laws of Utah 2004,
156
Chapter 280)
157
26B-3-302, (Renumbered from 26-18-102, as last amended by Laws of Utah 2010,
158
Chapters 286 and 324)
159
26B-3-303, (Renumbered from 26-18-103, as last amended by Laws of Utah 2020,
160
Chapter 225)
161
26B-3-304, (Renumbered from 26-18-104, as last amended by Laws of Utah 2008,
162
Chapter 382)
163
26B-3-305, (Renumbered from 26-18-105, as last amended by Laws of Utah 2010,

+
+
+164 Chapter 205)
+165 26B-3-306, (Renumbered from 26-18-106, as enacted by Laws of Utah 1992, Chapter
+166	273)
+167 26B-3-307, (Renumbered from 26-18-107, as last amended by Laws of Utah 2019,
+168 Chapter 349)
+169 26B-3-308, (Renumbered from 26-18-108, as enacted by Laws of Utah 1992, Chapter
+170	273)
+171	26B-3-309, (Renumbered from 26-18-109, as enacted by Laws of Utah 1992, Chapter
+172	273)
+173 26B-3-310, (Renumbered from 26-18-502, as last amended by Laws of Utah 2021,
+174 Chapter 274)
+175 26B-3-311, (Renumbered from 26-18-503, as last amended by Laws of Utah 2022,
+176 Chapter 274)
+177 26B-3-312, (Renumbered from 26-18-504, as last amended by Laws of Utah 2017,
+178 Chapter 443)
+179 26B-3-313, (Renumbered from 26-18-505, as last amended by Laws of Utah 2017,
+180 Chapter 443)
+181 26B-3-401, (Renumbered from 26-35a-103, as last amended by Laws of Utah 2018,
+182 Chapter 39)
+183 26B-3-402, (Renumbered from 26-35a-102, as last amended by Laws of Utah 2011,
+184 Chapter 366)
+185 26B-3-403, (Renumbered from 26-35a-104, as last amended by Laws of Utah 2017,
+186 Chapter 443)
+187 26B-3-404, (Renumbered from 26-35a-105, as enacted by Laws of Utah 2004, Chapter
+188	284)
+189 26B-3-405, (Renumbered from 26-35a-107, as last amended by Laws of Utah 2017,
+190 Chapter 443)
+
+
+191 26B-3-406, (Renumbered from 26-35a-108, as last amended by Laws of Utah 2011,
+192 Chapter 366)
+193 26B-3-501, (Renumbered from 26-36b-103, as last amended by Laws of Utah 2019,
+194 Chapter 1)
+195 26B-3-502, (Renumbered from 26-36b-102, as last amended by Laws of Utah 2018,
+196 Chapter 384)
+197 26B-3-503, (Renumbered from 26-36b-201, as last amended by Laws of Utah 2018,
+198 Chapters 384 and 468)
+199 26B-3-504, (Renumbered from 26-36b-202, as last amended by Laws of Utah 2019,
+200 Chapter 393)
+201 26B-3-505, (Renumbered from 26-36b-203, as last amended by Laws of Utah 2018,
+202 Chapters 384 and 468)
+203 26B-3-506, (Renumbered from 26-36b-204, as last amended by Laws of Utah 2020,
+204 Chapter 225)
+205 26B-3-507, (Renumbered from 26-36b-205, as last amended by Laws of Utah 2020,
+206 Chapter 225)
+207 26B-3-508, (Renumbered from 26-36b-206, as last amended by Laws of Utah 2018,
+208 Chapters 384 and 468)
+209 26B-3-509, (Renumbered from 26-36b-207, as last amended by Laws of Utah 2018,
+210 Chapters 384 and 468)
+211 26B-3-510, (Renumbered from 26-36b-209, as last amended by Laws of Utah 2018,
+212 Chapters 384 and 468)
+213 26B-3-511, (Renumbered from 26-36b-210, as last amended by Laws of Utah 2018,
+214 Chapters 384 and 468)
+215 26B-3-512, (Renumbered from 26-36b-211, as last amended by Laws of Utah 2018,
+216 Chapters 384 and 468)
+217 26B-3-601, (Renumbered from 26-36c-102, as last amended by Laws of Utah 2019,
+
+
+
+218 Chapter 1)
+219 26B-3-602, (Renumbered from 26-36c-103, as enacted by Laws of Utah 2018, Chapter
+220	468)
+221 26B-3-603, (Renumbered from 26-36c-201, as last amended by Laws of Utah 2019,
+222 Chapter 1)
+223 26B-3-604, (Renumbered from 26-36c-202, as last amended by Laws of Utah 2019,
+224 Chapter 393)
+225 26B-3-605, (Renumbered from 26-36c-203, as last amended by Laws of Utah 2019,
+226 Chapter 1)
+227 26B-3-606, (Renumbered from 26-36c-204, as last amended by Laws of Utah 2020,
+228 Chapter 225)
+229 26B-3-607, (Renumbered from 26-36c-205, as last amended by Laws of Utah 2019,
+230 Chapter 136)
+231 26B-3-608, (Renumbered from 26-36c-206, as last amended by Laws of Utah 2019,
+232 Chapter 1)
+233 26B-3-609, (Renumbered from 26-36c-207, as enacted by Laws of Utah 2018, Chapter
+234	468)
+235	26B-3-610, (Renumbered from 26-36c-208, as last amended by Laws of Utah 2019,
+236	Chapter 1)
+237	26B-3-611, (Renumbered from 26-36c-209, as last amended by Laws of Utah 2019,
+238	Chapter 1)
+239	26B-3-612, (Renumbered from 26-36c-210, as last amended by Laws of Utah 2019,
+240	Chapter 136)
+241	26B-3-701, (Renumbered from 26-36d-103, as repealed and reenacted by Laws of Utah
+242	2019, Chapter 455)
+243	26B-3-702, (Renumbered from 26-36d-102, as repealed and reenacted by Laws of Utah
+244	2019, Chapter 455)
+
+
+245	26B-3-703, (Renumbered from 26-36d-201, as repealed and reenacted by Laws of Utah
+246	2019, Chapter 455)
+247	26B-3-704, (Renumbered from 26-36d-202, as repealed and reenacted by Laws of Utah
+248	2019, Chapter 455)
+249	26B-3-705, (Renumbered from 26-36d-203, as repealed and reenacted by Laws of Utah
+250	2019, Chapter 455)
+251	26B-3-706, (Renumbered from 26-36d-204, as repealed and reenacted by Laws of Utah
+252	2019, Chapter 455)
+253	26B-3-707, (Renumbered from 26-36d-205, as repealed and reenacted by Laws of Utah
+254	2019, Chapter 455)
+255	26B-3-708, (Renumbered from 26-36d-206, as repealed and reenacted by Laws of Utah
+256	2019, Chapter 455)
+257	26B-3-709, (Renumbered from 26-36d-208, as repealed and reenacted by Laws of Utah
+258	2019, Chapter 455)
+259	26B-3-801, (Renumbered from 26-37a-102, as last amended by Laws of Utah 2016,
+260	Chapter 348)
+261	26B-3-802, (Renumbered from 26-37a-103, as enacted by Laws of Utah 2015, Chapter
+262	440)
+263	26B-3-803, (Renumbered from 26-37a-104, as enacted by Laws of Utah 2015, Chapter
+264	440)
+265	26B-3-804, (Renumbered from 26-37a-105, as enacted by Laws of Utah 2015, Chapter
+266	440)
+267	26B-3-805, (Renumbered from 26-37a-106, as enacted by Laws of Utah 2015, Chapter
+268	440)
+269	26B-3-806, (Renumbered from 26-37a-108, as enacted by Laws of Utah 2015, Chapter
+270	440)
+271 26B-3-901, (Renumbered from 26-40-102, as last amended by Laws of Utah 2019,
+
+
+
+272 Chapter 393)
+273 26B-3-902, (Renumbered from 26-40-103, as last amended by Laws of Utah 2019,
+274 Chapter 393)
+275 26B-3-903, (Renumbered from 26-40-105, as last amended by Laws of Utah 2019,
+276 Chapter 393)
+277 26B-3-904, (Renumbered from 26-40-106, as last amended by Laws of Utah 2021,
+278 Chapter 175)
+279 26B-3-905, (Renumbered from 26-40-107, as enacted by Laws of Utah 1998, Chapter
+280	360)
+281 26B-3-906, (Renumbered from 26-40-108, as last amended by Laws of Utah 2010,
+282 Chapter 391)
+283 26B-3-907, (Renumbered from 26-40-109, as last amended by Laws of Utah 2013,
+284 Chapter 167)
+285 26B-3-908, (Renumbered from 26-40-110, as last amended by Laws of Utah 2019,
+286 Chapter 393)
+287 26B-3-909, (Renumbered from 26-40-115, as last amended by Laws of Utah 2020,
+288 Chapters 32 and 152)
+289 26B-3-1001, (Renumbered from 26-19-102, as renumbered and amended by Laws of
+290 Utah 2018, Chapter 443)
+291 26B-3-1002, (Renumbered from 26-19-103, as renumbered and amended by Laws of
+292 Utah 2018, Chapter 443)
+293 26B-3-1003, (Renumbered from 26-19-201, as last amended by Laws of Utah 2021,
+294 Chapter 300)
+295 26B-3-1004, (Renumbered from 26-19-301, as renumbered and amended by Laws of
+296 Utah 2018, Chapter 443)
+297 26B-3-1005, (Renumbered from 26-19-302, as last amended by Laws of Utah 2020,
+298 Chapter 354)
+
+
+299 26B-3-1006, (Renumbered from 26-19-303, as renumbered and amended by Laws of
+300 Utah 2018, Chapter 443)
+301 26B-3-1007, (Renumbered from 26-19-304, as renumbered and amended by Laws of
+302 Utah 2018, Chapter 443)
+303 26B-3-1008, (Renumbered from 26-19-305, as renumbered and amended by Laws of
+304 Utah 2018, Chapter 443)
+305 26B-3-1009, (Renumbered from 26-19-401, as last amended by Laws of Utah 2021,
+306 Chapter 300)
+307 26B-3-1010, (Renumbered from 26-19-402, as renumbered and amended by Laws of
+308 Utah 2018, Chapter 443)
+309 26B-3-1011, (Renumbered from 26-19-403, as renumbered and amended by Laws of
+310 Utah 2018, Chapter 443)
+311 26B-3-1012, (Renumbered from 26-19-404, as enacted by Laws of Utah 2018, Chapter
+312	443)
+313	26B-3-1013, (Renumbered from 26-19-405, as renumbered and amended by Laws of
+314	Utah 2018, Chapter 443)
+315	26B-3-1014, (Renumbered from 26-19-406, as renumbered and amended by Laws of
+316	Utah 2018, Chapter 443)
+317	26B-3-1015, (Renumbered from 26-19-501, as enacted by Laws of Utah 2018, Chapter
+318	443)
+319	26B-3-1016, (Renumbered from 26-19-502, as enacted by Laws of Utah 2018, Chapter
+320	443)
+321	26B-3-1017, (Renumbered from 26-19-503, as enacted by Laws of Utah 2018, Chapter
+322	443)
+323	26B-3-1018, (Renumbered from 26-19-504, as enacted by Laws of Utah 2018, Chapter
+324	443)
+325	26B-3-1019, (Renumbered from 26-19-505, as enacted by Laws of Utah 2018, Chapter
+
+
+
+
+326
443)
327
26B-3-1020, (Renumbered from 26-19-506, as enacted by Laws of Utah 2018, Chapter
328
443)
329
26B-3-1021, (Renumbered from 26-19-507, as enacted by Laws of Utah 2018, Chapter
330
443)
331
26B-3-1022, (Renumbered from 26-19-508, as enacted by Laws of Utah 2018, Chapter
332
443)
333
26B-3-1023, (Renumbered from 26-19-509, as enacted by Laws of Utah 2018, Chapter
334
443)
335
26B-3-1024, (Renumbered from 26-19-601, as renumbered and amended by Laws of
336
Utah 2018, Chapter 443)
337
26B-3-1025, (Renumbered from 26-19-602, as renumbered and amended by Laws of
338
Utah 2018, Chapter 443)
339
26B-3-1026, (Renumbered from 26-19-603, as renumbered and amended by Laws of
340
Utah 2018, Chapter 443)
341
26B-3-1027, (Renumbered from 26-19-604, as renumbered and amended by Laws of
342
Utah 2018, Chapter 443)
343
26B-3-1028, (Renumbered from 26-19-605, as renumbered and amended by Laws of
344
Utah 2018, Chapter 443)
345
26B-3-1101, (Renumbered from 26-20-2, as last amended by Laws of Utah 2007,
346
Chapter 48)
347
26B-3-1102, (Renumbered from 26-20-3, as last amended by Laws of Utah 2011,
348
Chapter 297)
349
26B-3-1103, (Renumbered from 26-20-4, as repealed and reenacted by Laws of Utah
350
2007, Chapter 48)
351
26B-3-1104, (Renumbered from 26-20-5, as last amended by Laws of Utah 2007,
352
Chapter 48)

+
+353 26B-3-1105, (Renumbered from 26-20-6, as last amended by Laws of Utah 2011,
+354 Chapter 297)
+355 26B-3-1106, (Renumbered from 26-20-7, as last amended by Laws of Utah 2007,
+356 Chapter 48)
+357 26B-3-1107, (Renumbered from 26-20-8, as last amended by Laws of Utah 2011,
+358 Chapter 297)
+359 26B-3-1108, (Renumbered from 26-20-9, as last amended by Laws of Utah 2007,
+360 Chapter 48)
+361 26B-3-1109, (Renumbered from 26-20-9.5, as last amended by Laws of Utah 2011,
+362 Chapter 297)
+363 26B-3-1110, (Renumbered from 26-20-10, as last amended by Laws of Utah 1998,
+364 Chapter 192)
+365 26B-3-1111, (Renumbered from 26-20-11, as enacted by Laws of Utah 1986, Chapter
+366	46)
+367 26B-3-1112, (Renumbered from 26-20-12, as last amended by Laws of Utah 2011,
+368 Chapter 297)
+369 26B-3-1113, (Renumbered from 26-20-13, as last amended by Laws of Utah 2007,
+370 Chapter 48)
+371 26B-3-1114, (Renumbered from 26-20-14, as last amended by Laws of Utah 2011,
+372 Chapter 297)
+373 26B-3-1115, (Renumbered from 26-20-15, as enacted by Laws of Utah 2007, Chapter
+374	48)
+375	26B-8-102, (Renumbered from 26-2-3, as last amended by Laws of Utah 2017, Chapter
+376	22)
+377 26B-8-103, (Renumbered from 26-2-4, as last amended by Laws of Utah 2022,
+378 Chapters 231 and 365)
+379 26B-8-104, (Renumbered from 26-2-5, as last amended by Laws of Utah 2019, Chapter
+
+
+
+
+380
349)
381
26B-8-105, (Renumbered from 26-2-5.5, as last amended by Laws of Utah 1995,
382
Chapter 202)
383
26B-8-106, (Renumbered from 26-2-6, as last amended by Laws of Utah 1995, Chapter
384
202)
385
26B-8-107, (Renumbered from 26-2-7, as last amended by Laws of Utah 2022, Chapter
386
231)
387
26B-8-108, (Renumbered from 26-2-8, as last amended by Laws of Utah 1995, Chapter
388
202)
389
26B-8-109, (Renumbered from 26-2-9, as last amended by Laws of Utah 1995, Chapter
390
202)
391
26B-8-110, (Renumbered from 26-2-10, as last amended by Laws of Utah 2021,
392
Chapter 65)
393
26B-8-111, (Renumbered from 26-2-11, as last amended by Laws of Utah 1995,
394
Chapter 202)
395
26B-8-112, (Renumbered from 26-2-12.5, as last amended by Laws of Utah 2022,
396
Chapters 255 and 335)
397
26B-8-113, (Renumbered from 26-2-12.6, as last amended by Laws of Utah 2022,
398
Chapters 255 and 365)
399
26B-8-114, (Renumbered from 26-2-13, as last amended by Laws of Utah 2021,
400
Chapters 11 and 297)
401
26B-8-115, (Renumbered from 26-2-14, as last amended by Laws of Utah 1995,
402
Chapter 202)
403
26B-8-116, (Renumbered from 26-2-14.1, as enacted by Laws of Utah 2002, Chapter
404
69)
405
26B-8-117, (Renumbered from 26-2-14.2, as enacted by Laws of Utah 2002, Chapter
406
69)

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

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

+462 Chapter 414)
+463 26B-8-212, (Renumbered from 26-4-12, as last amended by Laws of Utah 2011,
+464 Chapter 297)
+465 26B-8-213, (Renumbered from 26-4-13, as last amended by Laws of Utah 2001,
+466 Chapter 278)
+467 26B-8-214, (Renumbered from 26-4-14, as last amended by Laws of Utah 2021,
+468 Chapter 297)
+469 26B-8-215, (Renumbered from 26-4-15, as enacted by Laws of Utah 1981, Chapter
+470	126)
+471 26B-8-216, (Renumbered from 26-4-16, as last amended by Laws of Utah 2007,
+472 Chapter 144)
+473 26B-8-217, (Renumbered from 26-4-17, as last amended by Laws of Utah 2022,
+474 Chapter 255)
+475 26B-8-218, (Renumbered from 26-4-18, as enacted by Laws of Utah 1981, Chapter
+476	126)
+477	26B-8-219, (Renumbered from 26-4-19, as last amended by Laws of Utah 1993,
+478	Chapter 38)
+479	26B-8-220, (Renumbered from 26-4-20, as last amended by Laws of Utah 2011,
+480	Chapter 297)
+481	26B-8-221, (Renumbered from 26-4-21, as last amended by Laws of Utah 1997,
+482	Chapter 372)
+483	26B-8-222, (Renumbered from 26-4-22, as enacted by Laws of Utah 1981, Chapter
+484	126)
+485	26B-8-223, (Renumbered from 26-4-23, as enacted by Laws of Utah 1981, Chapter
+486	126)
+487	26B-8-224, (Renumbered from 26-4-24, as last amended by Laws of Utah 1997,
+
+
+
+
+488
Chapter 375)
489
26B-8-225, (Renumbered from 26-4-25, as repealed and reenacted by Laws of Utah
490
2015, Chapter 72)
491
26B-8-226, (Renumbered from 26-4-26, as enacted by Laws of Utah 1997, Chapter
492
232)
493
26B-8-227, (Renumbered from 26-4-27, as enacted by Laws of Utah 1998, Chapter
494
153)
495
26B-8-228, (Renumbered from 26-4-28, as last amended by Laws of Utah 2013,
496
Chapter 167)
497
26B-8-229, (Renumbered from 26-4-28.5, as enacted by Laws of Utah 2017, Chapter
498
346)
499
26B-8-230, (Renumbered from 26-4-29, as last amended by Laws of Utah 2010,
500
Chapter 218)
501
26B-8-231, (Renumbered from 26-4-30, as enacted by Laws of Utah 2020, Chapter
502
201)
503
26B-8-232, (Renumbered from 26-23a-2, as last amended by Laws of Utah 1996,
504
Chapter 23)
505
26B-8-301, (Renumbered from 26-28-102, as enacted by Laws of Utah 2007, Chapter
506
60)
507
26B-8-302, (Renumbered from 26-28-103, as enacted by Laws of Utah 2007, Chapter
508
60)
509
26B-8-303, (Renumbered from 26-28-104, as enacted by Laws of Utah 2007, Chapter
510
60)
511
26B-8-304, (Renumbered from 26-28-105, as last amended by Laws of Utah 2011,
512
Chapter 297)
513
26B-8-305, (Renumbered from 26-28-106, as last amended by Laws of Utah 2011,
514
Chapter 297)

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

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

+
+569 26B-8-410, (Renumbered from 26-3-11, as last amended by Laws of Utah 2005,
+570 Chapter 243)
+571 26B-8-411, (Renumbered from 26-1-37, as last amended by Laws of Utah 2019,
+572 Chapter 105)
+573 26B-8-501, (Renumbered from 26-33a-102, as last amended by Laws of Utah 2022,
+574 Chapter 255)
+575 26B-8-502, (Renumbered from 26-33a-105, as enacted by Laws of Utah 1990, Chapter
+576	305)
+577 26B-8-503, (Renumbered from 26-33a-106, as last amended by Laws of Utah 1996,
+578 Chapter 201)
+579 26B-8-504, (Renumbered from 26-33a-106.1, as last amended by Laws of Utah 2022,
+580 Chapter 321)
+581 26B-8-505, (Renumbered from 26-33a-106.5, as last amended by Laws of Utah 2019,
+582 Chapter 370)
+583 26B-8-506, (Renumbered from 26-33a-107, as last amended by Laws of Utah 2016,
+584 Chapter 74)
+585 26B-8-507, (Renumbered from 26-33a-108, as last amended by Laws of Utah 1996,
+586 Chapter 201)
+587 26B-8-508, (Renumbered from 26-33a-109, as last amended by Laws of Utah 2021,
+588 Chapter 277)
+589 26B-8-509, (Renumbered from 26-33a-110, as enacted by Laws of Utah 1990, Chapter
+590	305)
+591	26B-8-510, (Renumbered from 26-33a-111, as last amended by Laws of Utah 2011,
+592	Chapter 297)
+593	26B-8-511, (Renumbered from 26-33a-115, as enacted by Laws of Utah 2013, Chapter
+594	102)
+595	26B-8-512, (Renumbered from 26-33a-116, as enacted by Laws of Utah 2019, Chapter
+
+
+
+596	287)
+597	26B-8-513, (Renumbered from 26-33a-117, as enacted by Laws of Utah 2020, Chapter
+598	181)
+599	26B-8-514, (Renumbered from 26-70-102, as enacted by Laws of Utah 2022, Chapter
+600	327)
+601 Utah Code Sections Affected by Coordination Clause:
+602 26-2-2, as last amended by Laws of Utah 2022, Chapter 415
+603 26-2-11, as last amended by Laws of Utah 1995, Chapter 202
+604 26B-8-101, as enacted by Laws of Utah 2022, Chapter 255
+605 26B-8-111, Utah Code Annotated 1953
+606
+607 Be it enacted by the Legislature of the state of Utah:
+608 Section 1. Section 26B-3-101 is amended to read:
+609 CHAPTER 3. HEALTH CARE - ADMINISTRATION AND ASSISTANCE
+610 Part 1. Health Care Assistance
+611 26B-3-101.  Definitions.
+612 [Reserved]
+613 As used in this chapter:
+614 (1) "Applicant" means any person who requests assistance under the medical programs
+615 of the state.
+616 (2) "CMS" means the Centers for Medicare and Medicaid Services within the United
+617 States Department of Health and Human Services.
+618 (3) "Division" means the Division of Integrated Healthcare within the department,
+619 established under Section 26B-3-102.
+
+620 (4) "Enrollee" or "member" means an individual whom the department has determined
+621 to be eligible for assistance under the Medicaid program.
+622 (5) "Medicaid program" means the state program for medical assistance for persons
+
+
+623 who are eligible under the state plan adopted pursuant to Title XIX of the federal Social
+624 Security Act.
+625 (6) "Medical assistance" means services furnished or payments made to or on behalf of
+626 a member.
+627 (7) (a) "Passenger vehicle" means a self-propelled, two-axle vehicle intended primarily
+628 for operation on highways and used by an applicant or recipient to meet basic transportation
+629 needs and has a fair market value below 40% of the applicable amount of the federal luxury
+630 passenger automobile tax established in 26 U.S.C. Sec. 4001 and adjusted annually for
+631 inflation.
+632 (b) "Passenger vehicle" does not include:
+633 (i) a commercial vehicle, as defined in Section 41-1a-102;
+
+634 (ii) an off-highway vehicle, as defined in Section 41-1a-102; or
+635 (iii) a motor home, as defined in Section 13-14-102.
+
+636 (8) "PPACA" means the same as that term is defined in Section 31A-1-301.
+
+637 (9) "Recipient" means a person who has received medical assistance under the
+638 Medicaid program.
+639 Section 2. Section 26B-3-102, which is renumbered from Section 26-18-2.1 is
+640 renumbered and amended to read:
+641	[26-18-2.1].	26B-3-102. Division -- Creation.
+642 There is created, within the department, the Division of [Medicaid and Health
+643 Financing] Integrated Healthcare which shall be responsible for implementing, organizing, and
+644 maintaining the Medicaid program and the Children's Health Insurance Program established in
+645 Section [26-40-103] 26B-3-902, in accordance with the provisions of this chapter and
+646 applicable federal law.
+647 Section 3. Section 26B-3-103, which is renumbered from Section 26-18-2.2 is
+648 renumbered and amended to read:
+649 [26-18-2.2].	26B-3-103. State Medicaid director -- Appointment --
+
+
+
+650 Responsibilities.
+651 (1) The state Medicaid director shall be appointed by the governor, after consultation
+652 with the executive director, with the advice and consent of the Senate.
+653 (2) The state Medicaid director may employ other employees as necessary to
+654 implement the provisions of this chapter, and shall:
+655 [(1)] (a) administer the responsibilities of the division as set forth in this chapter;
+656 [(2)] (b) administer the division's budget; and
+657 [(3)] (c) establish and maintain a state plan for the Medicaid program in compliance
+658 with federal law and regulations.
+659 Section 4. Section 26B-3-104, which is renumbered from Section 26-18-2.3 is
+660 renumbered and amended to read:
+661 [26-18-2.3].	26B-3-104. Division responsibilities -- Emphasis -- Periodic
+662 assessment.
+663 (1) In accordance with the requirements of Title XIX of the Social Security Act and
+664 applicable federal regulations, the division is responsible for the effective and impartial
+665 administration of this chapter in an efficient, economical manner. The division shall:
+666 (a) establish, on a statewide basis, a program to safeguard against unnecessary or
+667 inappropriate use of Medicaid services, excessive payments, and unnecessary or inappropriate
+668 hospital admissions or lengths of stay;
+669 (b) deny any provider claim for services that fail to meet criteria established by the
+670 division concerning medical necessity or appropriateness; and
+671 (c) place its emphasis on high quality care to recipients in the most economical and
+672 cost-effective manner possible, with regard to both publicly and privately provided services.
+673 (2) The division shall implement and utilize cost-containment methods, where
+674 possible, which may include:
+675 (a) prepayment and postpayment review systems to determine if utilization is
+676 reasonable and necessary;
+
+
+677 (b) preadmission certification of nonemergency admissions;
+678 (c) mandatory outpatient, rather than inpatient, surgery in appropriate cases;
+679 (d) second surgical opinions;
+680 (e) procedures for encouraging the use of outpatient services;
+681 (f) consistent with Sections [26-18-2.4] 26B-3-105 and 58-17b-606, a Medicaid drug
+682 program;
+683 (g) coordination of benefits; and
+684 (h) review and exclusion of providers who are not cost effective or who have abused
+685 the Medicaid program, in accordance with the procedures and provisions of federal law and
+686 regulation.
+687 (3) The state Medicaid director shall periodically assess the cost effectiveness and
+688 health implications of the existing Medicaid program, and consider alternative approaches to
+689 the provision of covered health and medical services through the Medicaid program, in order to
+690 reduce unnecessary or unreasonable utilization.
+691 (4) (a) The department shall ensure Medicaid program integrity by conducting internal
+692 audits of the Medicaid program for efficiencies, best practices, and cost avoidance.
+693 (b) The department shall coordinate with the Office of the Inspector General for
+694 Medicaid Services created in Section 63A-13-201 to implement Subsection (2) and to address
+695 Medicaid fraud, waste, or abuse as described in Section 63A-13-202.
+696 Section 5. Section 26B-3-105, which is renumbered from Section 26-18-2.4 is
+697 renumbered and amended to read:
+698 [26-18-2.4].	26B-3-105. Medicaid drug program -- Preferred drug list.
+699 (1) A Medicaid drug program developed by the department under Subsection
+700	[26-18-2.3] 26B-3-104(2)(f):
+701 (a) shall, notwithstanding Subsection [26-18-2.3] 26B-3-104(1)(b), be based on clinical
+702 and cost-related factors which include medical necessity as determined by a provider in
+703 accordance with administrative rules established by the Drug Utilization Review Board;
+
+
+
+704 (b) may include therapeutic categories of drugs that may be exempted from the drug
+705 program;
+706 (c) may include placing some drugs, except the drugs described in Subsection (2), on a
+707 preferred drug list:
+708 (i) to the extent determined appropriate by the department; and
+709 (ii) in the manner described in Subsection (3) for psychotropic drugs;
+710 (d) notwithstanding the requirements of [Part 2,] Sections 26B-3-302 through
+711 26B-3-309 regarding the Drug Utilization Review Board, and except as provided in Subsection
+712 (3), shall immediately implement the prior authorization requirements for a nonpreferred drug
+713 that is in the same therapeutic class as a drug that is:
+714 (i) on the preferred drug list on the date that this act takes effect; or
+715 (ii) added to the preferred drug list after this act takes effect; and
+716 (e) except as prohibited by Subsections 58-17b-606(4) and (5), shall establish the prior
+717 authorization requirements established under Subsections (1)(c) and (d) which shall permit a
+718 health care provider or the health care provider's agent to obtain a prior authorization override
+719 of the preferred drug list through the department's pharmacy prior authorization review process,
+720 and which shall:
+721 (i) provide either telephone or fax approval or denial of the request within 24 hours of
+722 the receipt of a request that is submitted during normal business hours of Monday through
+723 Friday from 8 a.m. to 5 p.m.;
+724 (ii) provide for the dispensing of a limited supply of a requested drug as determined
+725 appropriate by the department in an emergency situation, if the request for an override is
+726 received outside of the department's normal business hours; and
+727 (iii) require the health care provider to provide the department with documentation of
+728 the medical need for the preferred drug list override in accordance with criteria established by
+729 the department in consultation with the Pharmacy and Therapeutics Committee.
+730 (2) (a) [For purposes of] As used in this Subsection (2):
+
+
+731 (i) "Immunosuppressive drug":
+732 (A) means a drug that is used in immunosuppressive therapy to inhibit or prevent
+733 activity of the immune system to aid the body in preventing the rejection of transplanted organs
+734 and tissue; and
+735 (B) does not include drugs used for the treatment of autoimmune disease or diseases
+736 that are most likely of autoimmune origin.
+737 (ii) "Stabilized" means a health care provider has documented in the patient's medical
+738 chart that a patient has achieved a stable or steadfast medical state within the past 90 days using
+739 a particular psychotropic drug.
+740 (b) A preferred drug list developed under the provisions of this section may not include
+741 an immunosuppressive drug.
+742 (c) (i) The state Medicaid program shall reimburse for a prescription for an
+743 immunosuppressive drug as written by the health care provider for a patient who has undergone
+744 an organ transplant.
+745 (ii) For purposes of Subsection 58-17b-606(4), and with respect to patients who have
+746 undergone an organ transplant, the prescription for a particular immunosuppressive drug as
+747 written by a health care provider meets the criteria of demonstrating to the department a
+748 medical necessity for dispensing the prescribed immunosuppressive drug.
+749 (d) Notwithstanding the requirements of [Part 2,] Sections 26B-3-302 through
+750 26B-3-309 regarding the Drug Utilization Review Board, the state Medicaid drug program may
+751 not require the use of step therapy for immunosuppressive drugs without the written or oral
+752 consent of the health care provider and the patient.
+753 (e) The department may include a sedative hypnotic on a preferred drug list in
+754 accordance with Subsection (2)(f).
+755 (f) The department shall grant a prior authorization for a sedative hypnotic that is not
+756 on the preferred drug list under Subsection (2)(e), if the health care provider has documentation
+757 related to one of the following conditions for the Medicaid client:
+
+
+
+758 (i) a trial and failure of at least one preferred agent in the drug class, including the
+759 name of the preferred drug that was tried, the length of therapy, and the reason for the
+760 discontinuation;
+761 (ii) detailed evidence of a potential drug interaction between current medication and
+762 the preferred drug;
+763 (iii) detailed evidence of a condition or contraindication that prevents the use of the
+764 preferred drug;
+765 (iv) objective clinical evidence that a patient is at high risk of adverse events due to a
+766 therapeutic interchange with a preferred drug;
+767 (v) the patient is a new or previous Medicaid client with an existing diagnosis
+768 previously stabilized with a nonpreferred drug; or
+769 (vi) other valid reasons as determined by the department.
+770 (g) A prior authorization granted under Subsection (2)(f) is valid for one year from the
+771 date the department grants the prior authorization and shall be renewed in accordance with
+772 Subsection (2)(f).
+773 (3) (a) [For purposes of] As used in this Subsection (3), "psychotropic drug" means the
+774 following classes of drugs:
+775 (i) atypical anti-psychotic;
+776 (ii) anti-depressant;
+777 (iii) anti-convulsant/mood stabilizer;
+778 (iv) anti-anxiety; and
+779 (v) attention deficit hyperactivity disorder stimulant.
+780 (b) (i) The department shall develop a preferred drug list for psychotropic drugs.
+781 (ii) Except as provided in Subsection (3)(d), a preferred drug list for psychotropic
+782 drugs developed under this section shall allow a health care provider to override the preferred
+783 drug list by writing "dispense as written" on the prescription for the psychotropic drug.
+784 (iii) A health care provider may not override Section 58-17b-606 by writing "dispense
+
+
+785 as written" on a prescription.
+786 (c) The department, and a Medicaid accountable care organization that is responsible
+787 for providing behavioral health, shall:
+788 (i) establish a system to:
+789 (A) track health care provider prescribing patterns for psychotropic drugs;
+790 (B) educate health care providers who are not complying with the preferred drug list;
+791 and
+792 (C) implement peer to peer education for health care providers whose prescribing
+793 practices continue to not comply with the preferred drug list; and
+794 (ii) determine whether health care provider compliance with the preferred drug list is at
+795 least:
+796 (A) 55% of prescriptions by July 1, 2017;
+797 (B) 65% of prescriptions by July 1, 2018; and
+798 (C) 75% of prescriptions by July 1, 2019.
+799 (d) Beginning October 1, 2019, the department shall eliminate the dispense as written
+800 override for the preferred drug list, and shall implement a prior authorization system for
+801 psychotropic drugs, in accordance with Subsection (2)(f), if by July 1, 2019, the department has
+802 not realized annual savings from implementing the preferred drug list for psychotropic drugs of
+803 at least $750,000 General Fund savings.
+804 Section 6. Section 26B-3-106, which is renumbered from Section 26-18-2.5 is
+805 renumbered and amended to read:
+806 [26-18-2.5].	26B-3-106. Simplified enrollment and renewal process for Medicaid
+807 and other state medical programs -- Financial institutions.
+808 (1) The department may apply for grants and accept donations to make technology
+809 system improvements necessary to implement a simplified enrollment and renewal process for
+810 the Medicaid program, Utah Premium Partnership, and Primary Care Network Demonstration
+811 Project programs.
+
+
+
+812 (2) (a) The department may enter into an agreement with a financial institution doing
+813 business in the state to develop and operate a data match system to identify an applicant's or
+814 enrollee's assets that:
+815 (i) uses automated data exchanges to the maximum extent feasible; and
+816 (ii) requires a financial institution each month to provide the name, record address,
+817 Social Security number, other taxpayer identification number, or other identifying information
+818 for each applicant or enrollee who maintains an account at the financial institution.
+819 (b) The department may pay a reasonable fee to a financial institution for compliance
+820 with this Subsection (2), as provided in Section 7-1-1006.
+821 (c) A financial institution may not be liable under any federal or state law to any person
+822 for any disclosure of information or action taken in good faith under this Subsection (2).
+823 (d) The department may disclose a financial record obtained from a financial institution
+824 under this section only for the purpose of, and to the extent necessary in, verifying eligibility as
+825 provided in this section and Section [26-40-105] 26B-3-903.
+826 Section 7. Section 26B-3-107, which is renumbered from Section 26-18-2.6 is
+827 renumbered and amended to read:
+828	[26-18-2.6].	26B-3-107. Dental benefits.
+829 (1) (a) Except as provided in Subsection (8), the division may establish a competitive
+830 bid process to bid out Medicaid dental benefits under this chapter.
+831 (b) The division may bid out the Medicaid dental benefits separately from other
+832 program benefits.
+833 (2) The division shall use the following criteria to evaluate dental bids:
+834 (a) ability to manage dental expenses;
+835 (b) proven ability to handle dental insurance;
+836 (c) efficiency of claim paying procedures;
+837 (d) provider contracting, discounts, and adequacy of network; and
+838 (e) other criteria established by the department.
+
+
+839 (3) The division shall request bids for the program's benefits at least once every five
+840 years.
+841 (4) The division's contract with dental plans for the program's benefits shall include
+842 risk sharing provisions in which the dental plan must accept 100% of the risk for any difference
+843 between the division's premium payments per client and actual dental expenditures.
+844 (5) The division may not award contracts to:
+845 (a) more than three responsive bidders under this section; or
+846 (b) an insurer that does not have a current license in the state.
+847 (6) (a) The division may cancel the request for proposals if:
+848 (i) there are no responsive bidders; or
+849 (ii) the division determines that accepting the bids would increase the program's costs.
+850 (b) If the division cancels a request for proposal or a contract that results from a request
+851 for proposal described in Subsection (6)(a), the division shall report to the Health and Human
+852 Services Interim Committee regarding the reasons for the decision.
+853 (7) Title 63G, Chapter 6a, Utah Procurement Code, shall apply to this section.
+854 (8) (a) The division may:
+855 (i) establish a dental health care delivery system and payment reform pilot program for
+856 Medicaid dental benefits to increase access to cost effective and quality dental health care by
+857 increasing the number of dentists available for Medicaid dental services; and
+858 (ii) target specific Medicaid populations or geographic areas in the state.
+859 (b) The pilot program shall establish compensation models for dentists and dental
+860 hygienists that:
+861 (i) increase access to quality, cost effective dental care; and
+862 (ii) use funds from the Division of Family Health and Preparedness that are available to
+863 reimburse dentists for educational loans in exchange for the dentist agreeing to serve Medicaid
+864 and under-served populations.
+865 (c) The division may amend the state plan and apply to the Secretary of the United
+
+
+
+866 States Department of Health and Human Services for waivers or pilot programs if necessary to
+867 establish the new dental care delivery and payment reform model.
+868 (d) The division shall evaluate the pilot program's effect on the cost of dental care and
+869 access to dental care for the targeted Medicaid populations.
+870 (9) (a) As used in this Subsection (9), "dental hygienist" means an individual who is
+871 licensed as a dental hygienist under Section 58-69-301.
+872 (b) The department shall reimburse a dental hygienist for dental services performed in
+873 a public health setting and in accordance with Subsection (9)(c) beginning on the earlier of:
+874 (i) January 1, 2023; or
+875 (ii) 30 days after the date on which the replacement of the department's Medicaid
+876 Management Information System software is complete.
+877 (c) The department shall reimburse a dental hygienist directly for a service provided
+878 through the Medicaid program if:
+879 (i) the dental hygienist requests to be reimbursed directly; and
+880 (ii) the dental hygienist provides the service within the scope of practice described in
+881	Section 58-69-801.
+882 (d) Before November 30 of each year in which the department reimburses dental
+883 hygienists in accordance with Subsection (9)(c), the department shall report to the Health and
+884 Human Services Interim Committee, for the previous fiscal year:
+885 (i) the number and geographic distribution of dental hygienists who requested to be
+886 reimbursed directly;
+887 (ii) the total number of Medicaid enrollees who were served by a dental hygienist who
+888 were reimbursed under this Subsection (9);
+889 (iii) the total amount reimbursed directly to dental hygienists under this Subsection (9);
+890 (iv) the specific services and billing codes that are reimbursed under this Subsection
+891	(9); and
+892 (v) the aggregate amount reimbursed for each service and billing code described in
+
+
+893 Subsection (9)(d)(iv).
+894 (e) (i) Except as provided in this Subsection (9), nothing in this Subsection (9) shall be
+895 interpreted as expanding or otherwise altering the limitations and scope of practice for a dental
+896 hygienist.
+897 (ii) A dental hygienist may only directly bill and receive compensation for billing codes
+898 that fall within the scope of practice of a dental hygienist.
+899 Section 8. Section 26B-3-108, which is renumbered from Section 26-18-3 is
+900 renumbered and amended to read:
+901 [26-18-3].	26B-3-108. Administration of Medicaid program by department --
+902 Reporting to the Legislature -- Disciplinary measures and sanctions -- Funds collected --
+903 Eligibility standards -- Internal audits -- Health opportunity accounts.
+904 (1) The department shall be the single state agency responsible for the administration
+905 of the Medicaid program in connection with the United States Department of Health and
+906 Human Services pursuant to Title XIX of the Social Security Act.
+907 (2) (a) The department shall implement the Medicaid program through administrative
+908 rules in conformity with this chapter, Title 63G, Chapter 3, Utah Administrative Rulemaking
+909 Act, the requirements of Title XIX, and applicable federal regulations.
+910 (b) The rules adopted under Subsection (2)(a) shall include, in addition to other rules
+911 necessary to implement the program:
+912 (i) the standards used by the department for determining eligibility for Medicaid
+913 services;
+914 (ii) the services and benefits to be covered by the Medicaid program;
+915 (iii) reimbursement methodologies for providers under the Medicaid program; and
+916 (iv) a requirement that:
+917 (A) a person receiving Medicaid services shall participate in the electronic exchange of
+918 clinical health records established in accordance with Section [26-1-37] 26B-8-411 unless the
+919 individual opts out of participation;
+
+
+
+920 (B) prior to enrollment in the electronic exchange of clinical health records the enrollee
+921 shall receive notice of enrollment in the electronic exchange of clinical health records and the
+922 right to opt out of participation at any time; and
+923 (C) beginning July 1, 2012, when the program sends enrollment or renewal information
+924 to the enrollee and when the enrollee logs onto the program's website, the enrollee shall receive
+925 notice of the right to opt out of the electronic exchange of clinical health records.
+926 (3) (a) The department shall, in accordance with Subsection (3)(b), report to the Social
+927 Services Appropriations Subcommittee when the department:
+928 (i) implements a change in the Medicaid State Plan;
+929 (ii) initiates a new Medicaid waiver;
+930 (iii) initiates an amendment to an existing Medicaid waiver;
+931 (iv) applies for an extension of an application for a waiver or an existing Medicaid
+932 waiver;
+933 (v) applies for or receives approval for a change in any capitation rate within the
+934 Medicaid program; or
+935 (vi) initiates a rate change that requires public notice under state or federal law.
+936 (b) The report required by Subsection (3)(a) shall:
+937 (i) be submitted to the Social Services Appropriations Subcommittee prior to the
+938 department implementing the proposed change; and
+939 (ii) include:
+940 (A) a description of the department's current practice or policy that the department is
+941 proposing to change;
+942 (B) an explanation of why the department is proposing the change;
+943 (C) the proposed change in services or reimbursement, including a description of the
+944 effect of the change;
+945 (D) the effect of an increase or decrease in services or benefits on individuals and
+946 families;
+
+
+947 (E) the degree to which any proposed cut may result in cost-shifting to more expensive
+948 services in health or human service programs; and
+949 (F) the fiscal impact of the proposed change, including:
+950 (I) the effect of the proposed change on current or future appropriations from the
+951 Legislature to the department;
+952 (II) the effect the proposed change may have on federal matching dollars received by
+953 the state Medicaid program;
+954 (III) any cost shifting or cost savings within the department's budget that may result
+955 from the proposed change; and
+956 (IV) identification of the funds that will be used for the proposed change, including any
+957 transfer of funds within the department's budget.
+958 (4) Any rules adopted by the department under Subsection (2) are subject to review and
+959 reauthorization by the Legislature in accordance with Section 63G-3-502.
+960 (5) The department may, in its discretion, contract with [the Department of Human
+961 Services or] other qualified agencies for services in connection with the administration of the
+962 Medicaid program, including:
+963 (a) the determination of the eligibility of individuals for the program;
+964 (b) recovery of overpayments; and
+965 (c) consistent with Section [26-20-13] 26B-3-1113, and to the extent permitted by law
+966 and quality control services, enforcement of fraud and abuse laws.
+967 (6) The department shall provide, by rule, disciplinary measures and sanctions for
+968 Medicaid providers who fail to comply with the rules and procedures of the program, provided
+969 that sanctions imposed administratively may not extend beyond:
+970 (a) termination from the program;
+971 (b) recovery of claim reimbursements incorrectly paid; and
+972 (c) those specified in Section 1919 of Title XIX of the federal Social Security Act.
+973 (7) (a) Funds collected as a result of a sanction imposed under Section 1919 of Title
+
+
+
+
+974
XIX of the federal Social Security Act shall be deposited in the General Fund as dedicated
975
credits to be used by the division in accordance with the requirements of Section 1919 of Title
976
XIX of the federal Social Security Act.
977
(b) In accordance with Section 63J-1-602.2, sanctions collected under this Subsection
978
(7) are nonlapsing.
979
(8) (a) In determining whether an applicant or recipient is eligible for a service or
980
benefit under this part or [Chapter 40] Part 9, Utah Children's Health Insurance [Act] Program,
981
the department shall, if Subsection (8)(b) is satisfied, exclude from consideration one passenger
982
vehicle designated by the applicant or recipient.
983
(b) Before Subsection (8)(a) may be applied:
984
(i) the federal government shall:
985
(A) determine that Subsection (8)(a) may be implemented within the state's existing
986
public assistance-related waivers as of January 1, 1999;
987
(B) extend a waiver to the state permitting the implementation of Subsection (8)(a); or
988
(C) determine that the state's waivers that permit dual eligibility determinations for
989
cash assistance and Medicaid are no longer valid; and
990
(ii) the department shall determine that Subsection (8)(a) can be implemented within
991
existing funding.
992
(9) (a) [For purposes of] As used in this Subsection (9):
993
(i) "aged, blind, or has a disability" means an aged, blind, or disabled individual, as
994
defined in 42 U.S.C. Sec. 1382c(a)(1); and
995
(ii) "spend down" means an amount of income in excess of the allowable income
996
standard that shall be paid in cash to the department or incurred through the medical services
997
not paid by Medicaid.
998
(b) In determining whether an applicant or recipient who is aged, blind, or has a
999
disability is eligible for a service or benefit under this chapter, the department shall use 100%
1000
of the federal poverty level as:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

+
+1541
(2)
This section applies to:
1542
(a)
a managed care organization that contracts with the Medicaid program; and
1543
(b)
a provider who is reimbursed for health care services under the Medicaid program.
1544
(3)
The Medicaid program shall reimburse for telemedicine services at the same rate

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

+
+1973
Medicaid program, including ways the department may address issues regarding:
1974
(i) filing of claims;
1975
(ii) authorization and reauthorization for treatment services;
1976
(iii) reimbursement rates; and
1977
(iv) other issues identified by the department, behavioral health services providers, or
1978
Medicaid managed care organizations;
1979
(c) ways to improve delivery of behavioral health services to enrollees, including
1980
changes to statute or administrative rule; and
1981
(d) wraparound service coverage for enrollees who need specific, nonclinical services
1982
to ensure a path to success.
1983
Section 39. Section 26B-3-139, which is renumbered from Section 26-18-603 is
1984
renumbered and amended to read:

+1985	[26-18-603].	26B-3-139. Adjudicative proceedings related to Medicaid
+1986	funds.
+
+1987
(1) If a proceeding of the department, under Title 63G, Chapter 4, Administrative
1988
Procedures Act, relates in any way to recovery of Medicaid funds:
1989
(a) the presiding officer shall be designated by the executive director of the department
1990
and report directly to the executive director or, in the discretion of the executive director, report
1991
directly to the director of the Office of Internal Audit; and
1992
(b) the decision of the presiding officer is the recommended decision to the executive
1993
director of the department or a designee of the executive director who is not in the division.
1994
(2) Subsection (1) does not apply to hearings conducted by the Department of
1995
Workforce Services relating to medical assistance eligibility determinations.
1996
(3) If a proceeding of the department, under Title 63G, Chapter 4, Administrative
1997
Procedures Act, relates in any way to Medicaid or Medicaid funds, the following may attend
1998
and present evidence or testimony at the proceeding:
1999
(a) the director of the Office of Internal Audit, or the director's designee; and

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

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

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

+
+2081
section that the person knows is false, misleading, or fraudulent.
2082
(b) A violation of Subsection [(3)] (4)(a) is a third degree felony.
2083
(5) The division and the Department of Workforce Services shall:
2084
(a) cooperate with the Division of Child and Family Services in regard to an adoption
2085
assistance interstate compact; and
2086
(b) comply with an adoption assistance interstate compact.
2087
Section 42. Section 26B-3-201, which is renumbered from Section 26-18-403 is
2088
renumbered and amended to read:
2089
+2090
Part 2. Medicaid Waivers
+[26-18-403].	26B-3-201. Medicaid waiver for independent foster care
2091
adolescents.
2092
(1) [For purposes of] As used in this section, an "independent foster care adolescent"
2093
includes any individual who reached 18 years [of age] old while in the custody of the[ Division
2094
of Child and Family Services, or the Department of Human Services] department if the
2095
[Division of Child and Family Services] department was the primary case manager, or a
2096
federally recognized Indian tribe.
2097
(2) An independent foster care adolescent is eligible, when funds are available, for
2098
Medicaid coverage until the individual reaches 21 years [of age] old.
2099
(3) Before July 1, 2006, the division shall submit a state Medicaid Plan amendment to
2100
[the Center For Medicaid Services] CMS to provide medical coverage for independent foster
2101
care adolescents effective fiscal year 2006-07.
2102
Section 43. Section 26B-3-202, which is renumbered from Section 26-18-405 is
2103
renumbered and amended to read:

+2104	[26-18-405].	26B-3-202. Waivers to maximize replacement of
+2105	fee-for-service delivery model -- Cost of mandated program changes.
+2106		(1) The department shall develop a waiver program in the Medicaid program to replace 2107	the fee-for-service delivery model with one or more risk-based delivery models.
+
+
+
+
+2108
(2) The waiver program shall:
2109
(a) restructure the program's provider payment provisions to reward health care
2110
providers for delivering the most appropriate services at the lowest cost and in ways that,
2111
compared to services delivered before implementation of the waiver program, maintain or
2112
improve recipient health status;
2113
(b) restructure the program's cost sharing provisions and other incentives to reward
2114
recipients for personal efforts to:
2115
(i) maintain or improve their health status; and
2116
(ii) use providers that deliver the most appropriate services at the lowest cost;
2117
(c) identify the evidence-based practices and measures, risk adjustment methodologies,
2118
payment systems, funding sources, and other mechanisms necessary to reward providers for
2119
delivering the most appropriate services at the lowest cost, including mechanisms that:
2120
(i) pay providers for packages of services delivered over entire episodes of illness
2121
rather than for individual services delivered during each patient encounter; and
2122
(ii) reward providers for delivering services that make the most positive contribution to
2123
a recipient's health status;
2124
(d) limit total annual per-patient-per-month expenditures for services delivered through
2125
fee-for-service arrangements to total annual per-patient-per-month expenditures for services
2126
delivered through risk-based arrangements covering similar recipient populations and services;
2127
and
2128
(e) except as provided in Subsection (4), limit the rate of growth in
2129
per-patient-per-month General Fund expenditures for the program to the rate of growth in
2130
General Fund expenditures for all other programs, when the rate of growth in the General Fund
2131
expenditures for all other programs is greater than zero.
2132
(3) To the extent possible, the department shall operate the waiver program with the
2133
input of stakeholder groups representing those who will be affected by the waiver program.
2134
(4) (a) For purposes of this Subsection (4), "mandated program change" shall be

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

+2537	[26-18-415].	26B-3-210. Medicaid waiver expansion.
+2538	(1) As used in this section:
+2539	(a) "Federal poverty level" means the same as that term is defined in Section
+
+
+
+
+2540
[26-18-411] 26B-3-207.
2541
(b) "Medicaid waiver expansion" means an expansion of the Medicaid program in
2542
accordance with this section.
2543
(2) (a) Before January 1, 2019, the department shall apply to CMS for approval of a
2544
waiver or state plan amendment to implement the Medicaid waiver expansion.
2545
(b) The Medicaid waiver expansion shall:
2546
(i) expand Medicaid coverage to eligible individuals whose income is below 95% of
2547
the federal poverty level;
2548
(ii) obtain maximum federal financial participation under 42 U.S.C. Sec. 1396d(y) for
2549
enrolling an individual in the Medicaid program;
2550
(iii) provide Medicaid benefits through the state's Medicaid accountable care
2551
organizations in areas where a Medicaid accountable care organization is implemented;
2552
(iv) integrate the delivery of behavioral health services and physical health services
2553
with Medicaid accountable care organizations in select geographic areas of the state that
2554
choose an integrated model;
2555
(v) include a path to self-sufficiency, including work activities as defined in 42 U.S.C.
2556
Sec. 607(d), for qualified adults;
2557
(vi) require an individual who is offered a private health benefit plan by an employer to
2558
enroll in the employer's health plan;
2559
(vii) sunset in accordance with Subsection (5)(a); and
2560
(viii) permit the state to close enrollment in the Medicaid waiver expansion if the
2561
department has insufficient funding to provide services to additional eligible individuals.
2562
(3) If the Medicaid waiver described in Subsection (2)(a) is approved, the department
2563
may only pay the state portion of costs for the Medicaid waiver expansion with appropriations
2564
from:
2565
(a) the Medicaid Expansion Fund, created in Section [26-36b-208] 26B-1-315;
2566
(b) county contributions to the non-federal share of Medicaid expenditures; and

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

+
+3053	[26-18-429].	26B-3-224. Medicaid waiver for increased integrated health
+
+3054
care reimbursement.
3055
(1) As used in this section:
3056
(a) "Integrated health care setting" means a health care or behavioral health care setting
3057
that provides integrated physical and behavioral health care services.
3058
(b) "Local mental health authority" means a local mental health authority described in
3059
Section 17-43-301.
3060
(2) The department shall develop a proposal to allow the state Medicaid program to
3061
reimburse a local mental health authority for covered physical health care services provided in
3062
an integrated health care setting to Medicaid eligible individuals.
3063
(3) Before December 31, 2022, the department shall apply for a Medicaid waiver or a
3064
state plan amendment with CMS to implement the proposal described in Subsection (2).
3065
(4) If the waiver or state plan amendment described in Subsection (3) is approved, the
3066
department shall:
3067
(a) implement the proposal described in Subsection (2); and
3068
(b) while the waiver or state plan amendment is in effect, submit a report to the Health
3069
and Human Services Interim Committee each year before November 30 detailing:
3070
(i) the number of patients served under the waiver or state plan amendment;
3071
(ii) the cost of the waiver or state plan amendment; and
3072
(iii) any benefits of the waiver or state plan amendment.
3073
Section 66. Section 26B-3-301, which is renumbered from Section 26-18-101 is
3074
renumbered and amended to read:
3075
Part 3. Administration of Medicaid Programs: Drug Utilization Review and
3076
Long Term Care Facility Certification
3077
[26-18-101].	26B-3-301. Definitions.
3078
As used in this part:
3079
(1) "Appropriate and medically necessary" means, regarding drug prescribing,

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

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

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

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

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

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

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

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

+3294	[26-18-105].	26B-3-305. Drug prior approval program.
+3295	(1) A drug prior approval program approved or implemented by the board shall meet
+
+
+
+
+3296
the following conditions:
3297
(a) except as provided in Subsection (2), a drug may not be placed on prior approval
3298
for other than medical reasons;
3299
(b) the board shall hold a public hearing at least 30 days prior to placing a drug on prior
3300
approval;
3301
(c) notwithstanding the provisions of Section 52-4-202, the board shall provide not less
3302
than 14 days' notice to the public before holding a public hearing under Subsection (1)(b);
3303
(d) the board shall consider written and oral comments submitted by interested parties
3304
prior to or during the hearing held in accordance with Subsection (1)(b);
3305
(e) the board shall provide evidence that placing a drug class on prior approval:
3306
(i) will not impede quality of recipient care; and
3307
(ii) that the drug class is subject to clinical abuse or misuse;
3308
(f) the board shall reconsider its decision to place a drug on prior approval:
3309
(i) no later than nine months after any drug class is placed on prior approval; and
3310
(ii) at a public hearing with notice as provided in Subsection (1)(b);
3311
(g) the program shall provide an approval or denial of a request for prior approval:
3312
(i) by either:
3313
(A) fax;
3314
(B) telephone; or
3315
(C) electronic transmission;
3316
(ii) at least Monday through Friday, except for state holidays; and
3317
(iii) within 24 hours after receipt of the prior approval request;
3318
(h) the program shall provide for the dispensing of at least a 72-hour supply of the drug
3319
on the prior approval program:
3320
(i) in an emergency situation; or
3321
(ii) on weekends or state holidays;
3322
(i) the program may be applied to allow acceptable medical use of a drug on prior

+
+3323
approval for appropriate off-label indications; and
3324
(j) before placing a drug class on the prior approval program, the board shall:
3325
(i) determine that the requirements of Subsections (1)(a) through (i) have been met;
3326
and
3327
(ii) by majority vote, place the drug class on prior approval.
3328
(2) The board may, only after complying with Subsections (1)(b) through (j), consider
3329
the cost:
3330
(a) of a drug when placing a drug on the prior approval program; and
3331
(b) associated with including, or excluding a drug from the prior approval process,
3332
including:
3333
(i) potential side effects associated with a drug; or
3334
(ii) potential hospitalizations or other complications that may occur as a result of a
3335
drug's inclusion on the prior approval process.
3336
Section 71. Section 26B-3-306, which is renumbered from Section 26-18-106 is
3337
renumbered and amended to read:

+3338	[26-18-106].	26B-3-306. Advisory committees.
+3339		The board may establish advisory committees to assist it in carrying out its duties under 3340	[this part] Sections 26B-3-302 through 26B-3-309.
+3341		Section 72. Section 26B-3-307, which is renumbered from Section 26-18-107 is 3342	renumbered and amended to read:
+3343	[26-18-107].	26B-3-307. Retrospective and prospective DUR.
+
+3344
(1) The board, in cooperation with the division, shall include in its state plan the
3345
creation and implementation of a retrospective and prospective DUR program for Medicaid
3346
outpatient drugs to ensure that prescriptions are appropriate, medically necessary, and not likely
3347
to result in adverse medical outcomes.
3348
(2) The retrospective and prospective DUR program shall be operated under guidelines
3349
established by the board under Subsections (3) and (4).

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

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

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

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

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

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

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

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

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

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

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

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

+
+
+
+3674
(ii) effective on the date of the transfer as reported under Subsection (2)(a)(iii)(B).
3675
(b) For purposes of Section [26-18-502] 26B-3-310, the division shall approve
3676
Medicaid certification for the receiving nursing care facility program or entity:
3677
(i) in accordance with the formula established in Subsection (3)(c); and
3678
(ii) if:
3679
(A) the nursing care facility seeks Medicaid certification for the transferred licenses
3680
within the time limit required by Subsection (3)(f); and
3681
(B) the nursing care facility program meets other requirements for Medicaid
3682
certification under Subsection (3)(e).
3683
(c) A license for a Medicaid bed may not be approved for Medicaid certification
3684
without meeting the requirements of Sections [26-18-502 and 26-18-503] 26B-3-310 and
3685
26B-3-311 if:
3686
(i) the license for a Medicaid bed is transferred under this section but the receiving
3687
entity does not obtain Medicaid certification for the licensed bed within the time required by
3688
Subsection (3)(f); or
3689
(ii) the license for a Medicaid bed is transferred under this section but the license is no
3690
longer eligible for Medicaid certification.
3691
Section 79. Section 26B-3-401, which is renumbered from Section 26-35a-103 is
3692
renumbered and amended to read:
3693
Part 4. Nursing Care Facility Assessment
3694
[26-35a-103].	26B-3-401. Definitions.
3695
As used in this [chapter] part:
3696
(1) (a) "Nursing care facility" means:
3697
(i) a nursing care facility [described in Subsection 26-21-2(17)] as defined in Section
3698
26B-2-201;
3699
(ii) beginning January 1, 2006, a designated swing bed in:
3700
(A) a general acute hospital as defined in [Subsection 26-21-2(11)] Section 26B-2-201;

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

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

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

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

+
+3809
provisions of Subsection [26-35a-104] 26B-3-403(1)(b); and
3810
(2) may be different than the uniform rate established for other nursing care facilities.
3811
Section 85. Section 26B-3-501, which is renumbered from Section 26-36b-103 is
3812
renumbered and amended to read:
3813
Part 5. Inpatient Hospital Assessment
3814
[26-36b-103].	26B-3-501. Definitions.
3815
As used in this [chapter] part:
3816
(1) "Assessment" means the inpatient hospital assessment established by this [chapter]
3817
part.
3818
(2) "CMS" means the Centers for Medicare and Medicaid Services within the United
3819
States Department of Health and Human Services.
3820
(3) "Discharges" means the number of total hospital discharges reported on:
3821
(a) Worksheet S-3 Part I, column 15, lines 14, 16, and 17 of the 2552-10 Medicare cost
3822
report for the applicable assessment year; or
3823
(b) a similar report adopted by the department by administrative rule, if the report
3824
under Subsection (3)(a) is no longer available.
3825
(4) "Division" means the Division of [Health Care Financing] Integrated Healthcare
3826
within the department.
3827
(5) "Enhancement waiver program" means the program established by the Primary
3828
Care Network enhancement waiver program described in Section [26-18-416] 26B-3-211.
3829
(6) "Health coverage improvement program" means the health coverage improvement
3830
program described in Section [26-18-411] 26B-3-207.
3831
(7) "Hospital share" means the hospital share described in Section [26-36b-203]
3832
26B-3-505.
3833
(8) "Medicaid accountable care organization" means a managed care organization, as
3834
defined in 42 C.F.R. Sec. 438, that contracts with the department under the provisions of
3835
Section [26-18-405] 26B-3-202.

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

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

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

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

+
+
+
+3944
year.

3945

(3) Private hospitals shall be assessed under this [chapter] part for:
3946

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

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

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

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

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

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

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

+
+4133	the fiscal year that the assessment is suspended.
+4134		Section 97. Section 26B-3-601, which is renumbered from Section 26-36c-102 is 4135	renumbered and amended to read:
+4136	Part 6. Medicaid Expansion Hospital Assessment
+4137	[26-36c-102].	26B-3-601. Definitions.
+
+4138
As used in this [chapter] part:
4139
(1) "Assessment" means the Medicaid expansion hospital assessment established by
4140
this [chapter] part.
4141
(2) "CMS" means the Centers for Medicare and Medicaid Services within the United
4142
States Department of Health and Human Services.
4143
(3) "Discharges" means the number of total hospital discharges reported on:
4144
(a) Worksheet S-3 Part I, column 15, lines 14, 16, and 17 of the 2552-10 Medicare cost
4145
report for the applicable assessment year; or
4146
(b) a similar report adopted by the department by administrative rule, if the report
4147
under Subsection (3)(a) is no longer available.
4148
(4) "Division" means the Division of [Health Care Financing] Integrated Healthcare
4149
within the department.
4150
(5) "Hospital share" means the hospital share described in Section [26-36c-203]
4151
26B-3-605.
4152
(6) "Medicaid accountable care organization" means a managed care organization, as
4153
defined in 42 C.F.R. Sec. 438, that contracts with the department under the provisions of
4154
Section [26-18-405] 26B-3-202.
4155
(7) "Medicaid Expansion Fund" means the Medicaid Expansion Fund created in
4156
Section [26-36b-208] 26B-1-315.
4157
(8) "Medicaid waiver expansion" means the same as that term is defined in Section
4158
[26-18-415] 26B-3-210.
4159
(9) "Medicare cost report" means CMS-2552-10, the cost report for electronic filing of

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

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

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

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

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

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

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

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

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

+
+4403
(2) If the assessment is suspended under Subsection (1):
4404
(a) the division may not collect any assessment or intergovernmental transfer under this
4405
[chapter] part;
4406
(b) the division shall disburse money in the Medicaid Expansion Fund that was derived
4407
from assessments imposed by this [chapter] part in accordance with the requirements in
4408
Subsection [26-36b-208] 26B-1-315(4), to the extent federal matching is not reduced by CMS
4409
due to the repeal of the assessment; and
4410
(c) the division shall refund any money remaining in the Medicaid Expansion Fund
4411
after the disbursement described in Subsection (2)(b) that was derived from assessments
4412
imposed by this [chapter] part to the hospitals in proportion to the amount paid by each hospital
4413
for the last three fiscal years.
4414
Section 109. Section 26B-3-701, which is renumbered from Section 26-36d-103 is
4415
renumbered and amended to read:
4416
Part 7. Hospital Provider Assessment
4417
[26-36d-103].	26B-3-701. Definitions.
4418
As used in this [chapter] part:
4419
(1) "Accountable care organization" means a managed care organization, as defined in
4420
42 C.F.R. Sec. 438, that contracts with the department under the provisions of Section
4421
[26-18-405] 26B-3-202.
4422
(2) "Assessment" means the Medicaid hospital provider assessment established by this
4423
[chapter] part.
4424
(3) "Discharges" means the number of total hospital discharges reported on Worksheet
4425
S-3 Part I, column 15, lines 12, 14, and 14.01 of the 2552-96 Medicare Cost Report or on
4426
Worksheet S-3 Part I, column 15, lines 14, 16, and 17 of the 2552-10 Medicare Cost Report for
4427
the applicable assessment year.
4428
(4) "Division" means the Division of [Health Care Financing] Integrated Healthcare of
4429
the department.

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

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

+
+
+4484	renumbered and amended to read:
+
+4485
[26-36d-202].
26B-3-704. Assessment, collection, and payment of hospital
4486
provider assessment.

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

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

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

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

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

+
+4619
appropriated for fiscal year 2008;
4620
(iii) a division change in rules that reduces any of the following below July 1, 2011,
4621
payments:
4622
(A) aggregate hospital inpatient payments;
4623
(B) adjustment payment rates; or
4624
(C) any cost settlement protocol; or
4625
(iv) a division change in rules that reduces the aggregate outpatient payments below
4626
July 1, 2011, payments; and
4627
(d) the sunset of this [chapter] part in accordance with Section 63I-1-226.
4628
(2) If the assessment is repealed under Subsection (1), money in the fund that was
4629
derived from assessments imposed by this [chapter] part, before the determination made under
4630
Subsection (1), shall be disbursed under Section [26-36d-205] 26B-3-707 to the extent federal
4631
matching is not reduced due to the impermissibility of the assessments. Any funds remaining in
4632
the special revenue fund shall be refunded to the hospitals in proportion to the amount paid by
4633
each hospital.
4634
Section 118. Section 26B-3-801, which is renumbered from Section 26-37a-102 is
4635
renumbered and amended to read:
4636
Part 8. Ambulance Service Provider Assessment
4637
[26-37a-102].	26B-3-801. Definitions.
4638
As used in this [chapter] part:
4639
(1) "Ambulance service provider" means:
4640
(a) an ambulance provider as defined in Section [26-8a-102] 26B-4-101; or
4641
(b) a non-911 service provider as defined in Section [26-8a-102] 26B-4-101.
4642
(2) "Assessment" means the Medicaid ambulance service provider assessment
4643
established by this [chapter] part.
4644
(3) "Division" means the Division of [Health Care Financing] Integrated Healthcare
4645
within the department.

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

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

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

+
+4727
(b) any funds remaining in the special revenue fund shall be refunded to each
4728
ambulance service provider in proportion to the amount paid by the ambulance service
4729
provider.
4730
Section 124. Section 26B-3-901, which is renumbered from Section 26-40-102 is
4731
renumbered and amended to read:
4732
Part 9. Utah Children's Health Insurance Program
4733
[26-40-102].
26B-3-901. Definitions.
4734
As used in this [chapter] part:
4735
(1) "Child" means [a person who is under 19 years of age] an individual who is
4736
younger than 19 years old.
4737
(2) "Eligible child" means a child who qualifies for enrollment in the program as
4738
provided in Section [26-40-105] 26B-3-903.
4739
(3) "Member" means a child enrolled in the program.
4740
(4) "Plan" means the department's plan submitted to the United States Department of
4741
Health and Human Services pursuant to 42 U.S.C. Sec. 1397ff.
4742
(5) "Program" means the Utah Children's Health Insurance Program created by this
4743
[chapter] part.
4744
Section 125. Section 26B-3-902, which is renumbered from Section 26-40-103 is
4745
renumbered and amended to read:
4746
[26-40-103].
26B-3-902. Creation and administration of the Utah
4747
Children's Health Insurance Program.
4748
(1) There is created the Utah Children's Health Insurance Program to be administered
4749
by the department in accordance with the provisions of:
4750
(a) this [chapter] part; and
4751
(b) the State Children's Health Insurance Program, 42 U.S.C. Sec. 1397aa et seq.
4752
(2) The department shall:
4753
(a) prepare and submit the state's children's health insurance plan before May 1, 1998,

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

+4778	[26-40-105].	26B-3-903. Eligibility.
+4779	(1) A child is eligible to enroll in the program if the child: 4780	(a) is a bona fide Utah resident;
+
+
+4781
(b) is a citizen or legal resident of the United States;
4782
(c) is under 19 years of age;
4783
(d) does not have access to or coverage under other health insurance, including any
4784
coverage available through a parent or legal guardian's employer;
4785
(e) is ineligible for Medicaid benefits;
4786
(f) resides in a household whose gross family income, as defined by rule, is at or below
4787
200% of the federal poverty level; and
4788
(g) is not an inmate of a public institution or a patient in an institution for mental
4789
diseases.
4790
(2) A child who qualifies for enrollment in the program under Subsection (1) may not
4791
be denied enrollment due to a diagnosis or pre-existing condition.
4792
(3) (a) The department shall determine eligibility and send notification of the eligibility
4793
decision within 30 days after receiving the application for coverage.
4794
(b) If the department cannot reach a decision because the applicant fails to take a
4795
required action, or because there is an administrative or other emergency beyond the
4796
department's control, the department shall:
4797
(i) document the reason for the delay in the applicant's case record; and
4798
(ii) inform the applicant of the status of the application and time frame for completion.
4799
(4) The department may not close enrollment in the program for a child who is eligible
4800
to enroll in the program under the provisions of Subsection (1).
4801
(5) The program shall:
4802
(a) apply for grants to make technology system improvements necessary to implement
4803
a simplified enrollment and renewal process in accordance with Subsection (5)(b); and
4804
(b) if funding is available, implement a simplified enrollment and renewal process.
4805
Section 127. Section 26B-3-904, which is renumbered from Section 26-40-106 is
4806
renumbered and amended to read:
4807
[26-40-106].
26B-3-904. Program benefits.

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

+
+4835
[26-40-107].
26B-3-905. Limitation of benefits.
4836
Abortion is not a covered benefit, except as provided in 42 U.S.C. Sec. 1397ee.
4837
Section 129. Section 26B-3-906, which is renumbered from Section 26-40-108 is
4838
renumbered and amended to read:
4839
[26-40-108].
26B-3-906. Funding.
4840
(1) The program shall be funded by federal matching funds received under, together
4841
with state matching funds required by, 42 U.S.C. Sec. 1397ee.
4842
(2) Program expenditures in the following categories may not exceed 10% in the
4843
aggregate of all federal payments pursuant to 42 U.S.C. Sec. 1397ee:
4844
(a) other forms of child health assistance for children with gross family incomes below
4845
200% of the federal poverty level;
4846
(b) other health services initiatives to improve low-income children's health;
4847
(c) outreach program expenditures; and
4848
(d) administrative costs.
4849
Section 130. Section 26B-3-907, which is renumbered from Section 26-40-109 is
4850
renumbered and amended to read:

+4851	[26-40-109].	26B-3-907. Evaluation.
+4852		The department shall develop performance measures and annually evaluate the 4853	program's performance.
+4854		Section 131. Section 26B-3-908, which is renumbered from Section 26-40-110 is 4855	renumbered and amended to read:
+4856	[26-40-110].	26B-3-908. Managed care -- Contracting for services.
+
+4857
(1) Program benefits provided to a member under the program, as described in Section
4858
[26-40-106] 26B-3-904, shall be delivered by a managed care organization if the department
4859
determines that adequate services are available where the member lives or resides.
4860
(2) The department may contract with a managed care organization to provide program
4861
benefits. The department shall evaluate a potential contract with a managed care organization

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

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

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

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

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

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

+
+4997
cover medical expenses of a spouse or dependent child by court or administrative order.
4998
(16) "Trust" shall have the same meaning as provided in Section 75-1-201.
4999
Section 134. Section 26B-3-1002, which is renumbered from Section 26-19-103 is
5000
renumbered and amended to read:

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

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

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

+5077	[26-19-303].	26B-3-1006. Availability of insurance policy.
+
+
+
+
+5078
If the third party does not pay the department's claim or lien within 30 days from the
5079
date the claim or lien is received, the third party shall:
5080
(1) provide a written explanation if the claim is denied;
5081
(2) specifically describe and request any additional information from the department
5082
that is necessary to process the claim; and
5083
(3) provide the department or its agent a copy of any relevant or applicable insurance
5084
or benefit policy.
5085
Section 139. Section 26B-3-1007, which is renumbered from Section 26-19-304 is
5086
renumbered and amended to read:
5087
[26-19-304].
26B-3-1007. Employee benefit plans.
5088
As allowed pursuant to 29 U.S.C. [Section] Sec. 1144, an employee benefit plan may
5089
not include any provision that has the effect of limiting or excluding coverage or payment for
5090
any health care for an individual who would otherwise be covered or entitled to benefits or
5091
services under the terms of the employee benefit plan based on the fact that the individual is
5092
eligible for or is provided services under the state plan.
5093
Section 140. Section 26B-3-1008, which is renumbered from Section 26-19-305 is
5094
renumbered and amended to read:
5095
[26-19-305].
26B-3-1008. Statute of limitations -- Survival of right of
5096
action -- Insurance policy not to limit time allowed for recovery.
5097
(1) (a) Subject to Subsection (6), action commenced by the department under this
5098
[chapter] part against a health insurance entity shall be commenced within:
5099
(i) subject to Subsection (7), six years after the day on which the department submits
5100
the claim for recovery or payment for the health care item or service upon which the action is
5101
based; or
5102
(ii) six months after the date of the last payment for medical assistance, whichever is
5103
later.
5104
(b) An action against any other third party, the recipient, or anyone to whom the

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

+5131	[26-19-401].	26B-3-1009. Recovery of medical assistance from third party
+
+
+
+
+5132
-- Lien -- Notice -- Action -- Compromise or waiver -- Recipient's right to action
5133
protected.
5134
(1) (a) Except as provided in Subsection (1)(c), if the department provides or becomes
5135
obligated to provide medical assistance to a recipient that a third-party is obligated to pay for,
5136
the department may recover the medical assistance directly from the third-party.
5137
(b) (i) A claim under Subsection (1)(a) or Section [26-19-201] 26B-3-1003 to recover
5138
medical assistance provided to a recipient is a lien against any proceeds payable to or on behalf
5139
of the recipient by the third-party.
5140
(ii) The lien described in Subsection (1)(b)(i) has priority over all other claims to the
5141
proceeds, except claims for attorney fees and costs authorized under Subsection [26-19-403]
5142
26B-3-1011(2)(c)(ii).
5143
(c) (i) The department may not recover medical assistance under Subsection (1)(a) if:
5144
(A) the third-party is obligated to pay the recipient for an injury to the recipient's child
5145
that occurred while the child was in the physical custody of the child's foster parent;
5146
(B) the child's injury is a physical or mental impairment that requires ongoing medical
5147
attention, or limits activities of daily living, for at least one year;
5148
(C) the third-party's payment to the recipient is placed in a trust, annuity, financial
5149
account, or other financial instrument for the benefit of the child; and
5150
(D) the recipient makes reasonable efforts to mitigate any other medical assistance
5151
costs for the recipient to the state.
5152
(ii) The department is responsible for any repayment to the federal government related
5153
to the medical assistance the department is prohibited from recovering under Subsection
5154
(1)(c)(i).
5155
(2) (a) The department shall mail or deliver written notice of the department's claim or
5156
lien to the third-party at the third-party's principal place of business or last-known address.
5157
(b) The notice shall include:
5158
(i) the recipient's name;

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

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

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

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

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

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

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

+
+
+5348		Section 146. Section 26B-3-1014, which is renumbered from Section 26-19-406 is 5349	renumbered and amended to read:
+5350
[26-19-406].
26B-3-1014. Recovery from recipient of incorrectly provided
5351
medical assistance.

5352
The department may:

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

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

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

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

+5446	[26-19-504].	26B-3-1018. Final notice of intent to impose a TEFRA lien. 5447	(1) The department may issue a final notice of intent to impose a TEFRA lien on real 5448  property if:
+5449	(a) a preliminary notice of intent relating to the property is served in accordance with 5450  Section [26-19-503] 26B-3-1017;
+5451		(b) it is at least 30 days after the day on which the preliminary notice of intent was 5452	served; and
+5453		(c) the department has not received documentation or other evidence that adequately 5454	establishes that a TEFRA lien may not be imposed on the real property.
+5455	(2) The final notice of intent to impose a TEFRA lien on real property shall:
+
+
+
+
+5456
(a) be served in person, or by certified mail, on the individual described in Subsection
5457
[26-19-501] 26B-3-1015(1), who owns the property, and, if the department is aware that the
5458
individual has a legally authorized representative, on the representative;
5459
(b) indicate that the department has complied with the requirements for filing the final
5460
notice of intent under Subsection (1);
5461
(c) include a statement indicating that, according to the department's records, the
5462
individual:
5463
(i) meets the criteria described in Subsections [26-19-501] 26B-3-1015(1)(a) and (b);
5464
(ii) has been an inpatient in a care facility for a period of at least 180 days immediately
5465
preceding the day on which the department provides the notice to the individual; and
5466
(iii) is legally presumed to be in a condition where it cannot reasonably be expected
5467
that the individual will be discharged from the care facility and return to the individual's home;
5468
(d) indicate that the department intends to impose a TEFRA lien on real property
5469
belonging to the individual;
5470
(e) describe the real property that the TEFRA lien will apply to;
5471
(f) describe the current amount of, and purpose of, the TEFRA lien;
5472
(g) indicate that the amount of the lien may continue to increase as the individual
5473
continues to receive medical assistance;
5474
(h) describe the circumstances under which a TEFRA lien is required to be released;
5475
(i) describe the circumstances under which the department may seek to recover the
5476
lien;
5477
(j) describe the right of the individual to challenge the decision of the department in an
5478
adjudicative proceeding; and
5479
(k) indicate that failure by the individual to successfully challenge the decision of the
5480
department will result in the TEFRA lien being imposed.
5481
Section 151. Section 26B-3-1019, which is renumbered from Section 26-19-505 is
5482
renumbered and amended to read:

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

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

+
+5537	[26-19-601].	26B-3-1024. Legal recognition of electronic claims records.
+
+5538
Pursuant to Title 46, Chapter 4, Uniform Electronic Transactions Act:
5539
(1) a claim submitted to the department for payment may not be denied legal effect,
5540
enforceability, or admissibility as evidence in any court in any civil action because it is in
5541
electronic form; and
5542
(2) a third party shall accept an electronic record of payments by the department for
5543
medical services on behalf of a recipient as evidence in support of the department's claim.
5544
Section 157. Section 26B-3-1025, which is renumbered from Section 26-19-602 is
5545
renumbered and amended to read:
5546	[26-19-602].	26B-3-1025. Direct payment to the department by third
+5547	party.
+
+5548
(1) Any third party required to make payment to the department pursuant to this
5549
[chapter] part shall make the payment directly to the department or its designee.
5550
(2) The department may negotiate a payment or payment instrument it receives in
5551
connection with Subsection (1) without the cosignature or other participation of the recipient or
5552
any other party.
5553
Section 158. Section 26B-3-1026, which is renumbered from Section 26-19-603 is
5554
renumbered and amended to read:
5555	[26-19-603].	26B-3-1026. Attorney general or county attorney to
+5556	represent department.
+5557		The attorney general or a county attorney shall represent the department in any action 5558	commenced under this [chapter] part.
+5559		Section 159. Section 26B-3-1027, which is renumbered from Section 26-19-604 is 5560	renumbered and amended to read:
+5561	[26-19-604].	26B-3-1027. Department's right to attorney fees and costs. 5562	In any action brought by the department under this [chapter] part in which it prevails, 5563   the department shall recover along with the principal sum and interest, a reasonable attorney
+
+
+
+5564	fee and costs incurred.
+5565		Section 160. Section 26B-3-1028, which is renumbered from Section 26-19-605 is 5566	renumbered and amended to read:
+5567	[26-19-605].	26B-3-1028. Application of provisions contrary to federal
+
+5568
law prohibited.
5569
In no event shall any provision contained in this [chapter] part be applied contrary to
5570
existing federal law.
5571
Section 161. Section 26B-3-1101, which is renumbered from Section 26-20-2 is
5572
renumbered and amended to read:
5573
Part 11. Utah False Claims Act
5574
[26-20-2].	26B-3-1101. Definitions.
5575
As used in this [chapter] part:
5576
(1) "Benefit" means the receipt of money, goods, or any other thing of pecuniary value.
5577
(2) "Claim" means any request or demand for money or property:
5578
(a) made to any:
5579
(i) employee, officer, or agent of the state;
5580
(ii) contractor with the state; or
5581
(iii) grantee or other recipient, whether or not under contract with the state; and
5582
(b) if:
5583
(i) any portion of the money or property requested or demanded was issued from or
5584
provided by the state; or
5585
(ii) the state will reimburse the contractor, grantee, or other recipient for any portion of
5586
the money or property.
5587
(3) "False statement" or "false representation" means a wholly or partially untrue
5588
statement or representation which is:
5589
(a) knowingly made; and
5590
(b) a material fact with respect to the claim.

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

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

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

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

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

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

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

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

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

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

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

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

+
+5915		Section 175. Section 26B-3-1115, which is renumbered from Section 26-20-15 is 5916	renumbered and amended to read:
+5917	[26-20-15].	26B-3-1115. Limitation of actions -- Civil acts antedating this
+
+5918
section -- Civil burden of proof -- Estoppel -- Joint civil liability -- Venue.
5919
(1) An action under this [chapter] part may not be brought after the later of:
5920
(a) six years after the date on which the violation was committed; or
5921
(b) three years after the date an official of the state charged with responsibility to act in
5922
the circumstances discovers the violation, but in no event more than 10 years after the date on
5923
which the violation was committed.
5924
(2) A civil action brought under this [chapter] part may be brought for acts occurring
5925
prior to the effective date of this section if the limitations period set forth in Subsection (1) has
5926
not lapsed.
5927
(3) In any civil action brought under this [chapter] part the state shall be required to
5928
prove by a preponderance of evidence, all essential elements of the cause of action including
5929
damages.
5930
(4) Notwithstanding any other provision of law, a final judgment rendered in favor of
5931
the state in any criminal proceeding under this [chapter] part, whether upon a verdict after trial
5932
or upon a plea of guilty or nolo contendere, shall estop the defendant from denying the essential
5933
elements of the offense in any civil action under this [chapter] part which involves the same
5934
transaction.
5935
(5) Civil liability under this [chapter] part shall be joint and several for a violation
5936
committed by two or more persons.
5937
(6) Any action brought by the state under this [chapter] part shall be brought in district
5938
court in Salt Lake County or in any county where the defendant resides or does business.
5939
Section 176. Section 26B-8-101 is amended to read:
5940
CHAPTER 8. HEALTH DATA, VITAL STATISTICS, AND UTAH MEDICAL
5941
EXAMINER

+
+
+
+5942
Part 1. Vital Statistics
5943
26B-8-101.  Definitions.
5944
[Reserved]
5945
As used in this part:
5946
(1) "Adoption document" means an adoption-related document filed with the office, a
5947
petition for adoption, a decree of adoption, an original birth certificate, or evidence submitted
5948
in support of a supplementary birth certificate.
5949
(2) "Certified nurse midwife" means an individual who:
5950
(a) is licensed to practice as a certified nurse midwife under Title 58, Chapter 44a,
5951
Nurse Midwife Practice Act; and
5952
(b) has completed an education program regarding the completion of a certificate of
5953
death developed by the department by rule made in accordance with Title 63G, Chapter 3, Utah
5954
Administrative Rulemaking Act.
5955
(3) "Custodial funeral service director" means a funeral service director who:
5956
(a) is employed by a licensed funeral establishment; and
5957
(b) has custody of a dead body.
5958
(4) "Dead body" means a human body or parts of a human body from the condition of
5959
which it reasonably may be concluded that death occurred.
5960
(5) "Decedent" means the same as a dead body.
5961
(6) "Dead fetus" means a product of human conception, other than those circumstances
5962
described in Subsection 76-7-301(1):
5963
(a) of 20 weeks' gestation or more, calculated from the date the last normal menstrual
5964
period began to the date of delivery; and
5965
(b) that was not born alive.
5966
(7) "Declarant father" means a male who claims to be the genetic father of a child, and,
5967
along with the biological mother, signs a voluntary declaration of paternity to establish the
5968
child's paternity.

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

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

+
+6023
dissolution of marriage, or annulment;
6024
(b) amendments to any of the registered certificates or reports described in Subsection
6025
(24)(a);
6026

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

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

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

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

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

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

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

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

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

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

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

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

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

+
+
+
+6374

(i) the certificate of death shall be completed and filed in accordance with this section;
6375
and

6376

(ii) the place where the dead body is found shall be shown as the place of death.
6377

(b) If the date of death is unknown, the date shall be determined by approximation.
6378

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

+
+
+
+6968
or deceased; or
6969
(b) furnish or process a certificate of birth or certified copy of a certificate of birth with
6970
the knowledge or intention that it be used for the purpose of deception by a person other than
6971
the person to whom the certificate of birth relates.
6972
(2) The specific criminal violations and the criminal penalty under this section take
6973
precedence over any more general criminal offense as described in Section [26-23-5]
6974
26B-8-133.
6975
Section 210. Section 26B-8-201, which is renumbered from Section 26-4-2 is
6976
renumbered and amended to read:
6977
Part 2. Utah Medical Examiner
6978
[26-4-2].	26B-8-201. Definitions.
6979
As used in this [chapter] part:
6980
(1) "Dead body" means the same as that term is defined in Section [26-2-2] 26B-8-101.
6981
(2) (a) "Death by violence" means death that resulted by the decedent's exposure to
6982
physical, mechanical, or chemical forces.
6983
(b) "Death by violence" includes death that appears to have been due to homicide,
6984
death that occurred during or in an attempt to commit rape, mayhem, kidnapping, robbery,
6985
burglary, housebreaking, extortion, or blackmail accompanied by threats of violence, assault
6986
with a dangerous weapon, assault with intent to commit any offense punishable by
6987
imprisonment for more than one year, arson punishable by imprisonment for more than one
6988
year, or any attempt to commit any of the foregoing offenses.
6989
(3) "Immediate relative" means an individual's spouse, child, parent, sibling,
6990
grandparent, or grandchild.
6991
(4) "Health care professional" means any of the following while acting in a
6992
professional capacity:
6993
(a) a physician licensed under Title 58, Chapter 67, Utah Medical Practice Act, or Title
6994
58, Chapter 68, Utah Osteopathic Medical Practice Act;

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

+7694	[26-28-102].	26B-8-301. Definitions.
+7695	As used in this [chapter] part:
+7696	(1) "Adult" means an individual who is at least 18 years [of age] old.
+
+
+7697
(2) "Agent" means an individual:
7698
(a) authorized to make health care decisions on the principal's behalf by a power of
7699
attorney for health care; or
7700
(b) expressly authorized to make an anatomical gift on the principal's behalf by any
7701
other record signed by the principal.
7702
(3) "Anatomical gift" means a donation of all or part of a human body to take effect
7703
after the donor's death for the purpose of transplantation, therapy, research, or education.
7704
(4) "Decedent" means:
7705
(a) a deceased individual whose body or part is or may be the source of an anatomical
7706
gift; and
7707
(b) includes:
7708
(i) a stillborn infant; and
7709
(ii) subject to restrictions imposed by law other than this [chapter] part, a fetus.
7710
(5) (a) "Disinterested witness" means:
7711
(i) a witness other than the spouse, child, parent, sibling, grandchild, grandparent, or
7712
guardian of the individual who makes, amends, revokes, or refuses to make an anatomical gift;
7713
or
7714
(ii) another adult who exhibited special care and concern for the individual.
7715
(b) "Disinterested witness" does not include a person to which an anatomical gift could
7716
pass under Section [26-28-111] 26B-8-310.
7717
(6) "Document of gift" means a donor card or other record used to make an anatomical
7718
gift. The term includes a statement or symbol on a driver license, identification card, or donor
7719
registry.
7720
(7) "Donor" means an individual whose body or part is the subject of an anatomical
7721
gift.
7722
(8) "Donor registry" means a database that contains records of anatomical gifts and
7723
amendments to or revocations of anatomical gifts.

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

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

+
+
+
+7778
appropriate organization that is licensed, accredited, or regulated under federal or state law; and
7779
(b) includes an enucleator.
7780
(30) "Tissue" means a portion of the human body other than an organ or an eye. The
7781
term does not include blood unless the blood is donated for the purpose of research or
7782
education.
7783
(31) "Tissue bank" means a person that is licensed, accredited, or regulated under
7784
federal or state law to engage in the recovery, screening, testing, processing, storage, or
7785
distribution of tissue.
7786
(32) "Transplant hospital" means a hospital that furnishes organ transplants and other
7787
medical and surgical specialty services required for the care of transplant patients.
7788
Section 243. Section 26B-8-302, which is renumbered from Section 26-28-103 is
7789
renumbered and amended to read:

+7790	[26-28-103].	26B-8-302. Applicability.
+7791		This [chapter] part applies to an anatomical gift or amendment to, revocation of, or 7792	refusal to make an anatomical gift, whenever made.
+7793		Section 244. Section 26B-8-303, which is renumbered from Section 26-28-104 is 7794	renumbered and amended to read:
+7795	[26-28-104].	26B-8-303. Who may make anatomical gift before donor's
+7796	death.
+
+7797
Subject to Section [26-28-108] 26B-8-307, an anatomical gift of a donor's body or part
7798
may be made during the life of the donor for the purpose of transplantation, therapy, research,
7799
or education in the manner provided in Section [26-28-105] 26B-8-304 by:
7800
(1) the donor, if the donor is an adult or if the donor is a minor and is:
7801
(a) emancipated; or
7802
(b) authorized under state law to apply for a driver license because the donor is at least
7803
15 years [of age] old;
7804
(2) an agent of the donor, unless the power of attorney for health care or other record

+
+7805
prohibits the agent from making an anatomical gift;
7806
(3) a parent of the donor, if the donor is an unemancipated minor; or
7807
(4) the donor's guardian.
7808
Section 245. Section 26B-8-304, which is renumbered from Section 26-28-105 is
7809
renumbered and amended to read:

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

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

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

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

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

+
+
+
+7940
(i) an adult who exhibited special care and concern for the decedent; and
7941
(j) any other person having the authority to dispose of the decedent's body.
7942
(2) If there is more than one member of a class listed in Subsection (1)(a), (c), (d), (e),
7943
(f), (g), or (j) entitled to make an anatomical gift, an anatomical gift may be made by a member
7944
of the class unless that member or a person to which the gift may pass under Section
7945
[26-28-111] 26B-8-310 knows of an objection by another member of the class. If an objection
7946
is known, the gift may be made only by a majority of the members of the class who are
7947
reasonably available.
7948
(3) A person may not make an anatomical gift if, at the time of the decedent's death, a
7949
person in a prior class under Subsection (1) is reasonably available to make or to object to the
7950
making of an anatomical gift.
7951
Section 250. Section 26B-8-309, which is renumbered from Section 26-28-110 is
7952
+7953
renumbered and amended to read:
+[26-28-110].	26B-8-309. Manner of making, amending, or revoking
7954
anatomical gift of decedent's body or part.
7955
(1) A person authorized to make an anatomical gift under Section [26-28-109]
7956
26B-8-308 may make an anatomical gift by a document of gift signed by the person making the
7957
gift or by that person's oral communication that is electronically recorded or is
7958
contemporaneously reduced to a record and signed by the individual receiving the oral
7959
communication.
7960
(2) Subject to Subsection (3), an anatomical gift by a person authorized under Section
7961
[26-28-109] 26B-8-308 may be amended or revoked orally or in a record by any member of a
7962
prior class who is reasonably available. If more than one member of the prior class is
7963
reasonably available, the gift made by a person authorized under Section [26-28-109]
7964
26B-8-308 may be:
7965
(a) amended only if a majority of the reasonably available members agree to the
7966
amending of the gift; or

+
+7967
(b) revoked only if a majority of the reasonably available members agree to the
7968
revoking of the gift or if they are equally divided as to whether to revoke the gift.
7969
(3) A revocation under Subsection (2) is effective only if, before an incision has been
7970
made to remove a part from the donor's body or before invasive procedures have begun to
7971
prepare the recipient, the procurement organization, transplant hospital, or physician or
7972
technician knows of the revocation.
7973
Section 251. Section 26B-8-310, which is renumbered from Section 26-28-111 is
7974
renumbered and amended to read:
7975
[26-28-111].	26B-8-310. Persons that may receive anatomical gift --
7976
Purpose of anatomical gift.
7977
(1) An anatomical gift may be made to the following persons named in the document
7978
of gift:
7979
(a) a hospital, accredited medical school, dental school, college, university, organ
7980
procurement organization, or other appropriate person, for research or education;
7981
(b) subject to Subsection (2), an individual designated by the person making the
7982
anatomical gift if the individual is the recipient of the part; or
7983
(c) an eye bank or tissue bank.
7984
(2) If an anatomical gift to an individual under Subsection (1)(b) cannot be
7985
transplanted into the individual, the part passes in accordance with Subsection (7) in the
7986
absence of an express, contrary indication by the person making the anatomical gift.
7987
(3) If an anatomical gift of one or more specific parts or of all parts is made in a
7988
document of gift that does not name a person described in Subsection (1) but identifies the
7989
purpose for which an anatomical gift may be used, the following rules apply:
7990
(a) If the part is an eye and the gift is for the purpose of transplantation or therapy, the
7991
gift passes to the appropriate eye bank.
7992
(b) If the part is tissue and the gift is for the purpose of transplantation or therapy, the
7993
gift passes to the appropriate tissue bank.

+
+
+
+7994
(c) If the part is an organ and the gift is for the purpose of transplantation or therapy,
7995
the gift passes to the appropriate organ procurement organization as custodian of the organ.
7996
(d) If the part is an organ, an eye, or tissue and the gift is for the purpose of research or
7997
education, the gift passes to the appropriate procurement organization.
7998
(4) For the purpose of Subsection (3), if there is more than one purpose of an
7999
anatomical gift set forth in the document of gift but the purposes are not set forth in any
8000
priority, the gift shall be used for transplantation or therapy, if suitable. If the gift cannot be
8001
used for transplantation or therapy, the gift may be used for research or education.
8002
(5) If an anatomical gift of one or more specific parts is made in a document of gift that
8003
does not name a person described in Subsection (1) and does not identify the purpose of the
8004
gift, the gift may be used only for transplantation or therapy, and the gift passes in accordance
8005
with Subsection (7).
8006
(6) If a document of gift specifies only a general intent to make an anatomical gift by
8007
words such as "donor," "organ donor," or "body donor," or by a symbol or statement of similar
8008
import, the gift may be used only for transplantation or therapy, and the gift passes in
8009
accordance with Subsection (7).
8010
(7) For purposes of Subsections (2), (5), and this Subsection (7), the following rules
8011
apply:
8012
(a) If the part is an eye, the gift passes to the appropriate eye bank.
8013
(b) If the part is tissue, the gift passes to the appropriate tissue bank.
8014
(c) If the part is an organ, the gift passes to the appropriate organ procurement
8015
organization as custodian of the organ.
8016
(8) An anatomical gift of an organ for transplantation or therapy, other than an
8017
anatomical gift under Subsection (1)(b), passes to the organ procurement organization as
8018
custodian of the organ.
8019
(9) If an anatomical gift does not pass pursuant to Subsections (2) through (8) or the
8020
decedent's body or part is not used for transplantation, therapy, research, or education, custody

+
+8021
of the body or part passes to the person under obligation to dispose of the body or part.
8022
(10) A person may not accept an anatomical gift if the person knows that the gift was
8023
not effectively made under Section [26-28-105 or 26-28-110] 26B-8-304 or 26B-8-309 or if the
8024
person knows that the decedent made a refusal under Section [26-28-107] 26B-8-306 that was
8025
not revoked. For purposes of this Subsection (10), if a person knows that an anatomical gift
8026
was made on a document of gift, the person is considered to know of any amendment or
8027
revocation of the gift or any refusal to make an anatomical gift on the same document of gift.
8028
(11) Except as otherwise provided in Subsection (1)(b), nothing in this [chapter] part
8029
affects the allocation of organs for transplantation or therapy.
8030
Section 252. Section 26B-8-311, which is renumbered from Section 26-28-112 is
8031
renumbered and amended to read:
8032
[26-28-112].
26B-8-311. Search and notification.
8033
(1) The following persons shall make a reasonable search of an individual who the
8034
person reasonably believes is dead or near death for a document of gift or other information
8035
identifying the individual as a donor or as an individual who made a refusal:
8036
(a) a law enforcement officer, firefighter, paramedic, or other emergency rescuer
8037
finding the individual;
8038
(b) if no other source of the information is immediately available, a hospital, as soon as
8039
practical after the individual's arrival at the hospital; and
8040
(c) a law enforcement officer, firefighter, emergency medical services provider, or
8041
other emergency rescuer who finds an individual who is deceased at the scene of a motor
8042
vehicle accident, when the deceased individual is transported from the scene of the accident to
8043
a funeral establishment licensed under Title 58, Chapter 9, Funeral Services Licensing Act:
8044
(i) the law enforcement officer, firefighter, emergency medical services provider, or
8045
other emergency rescuer shall as soon as reasonably possible, notify the appropriate organ
8046
procurement organization, tissue bank, or eye bank of:
8047
(A) the identity of the deceased individual, if known;

+
+
+
+8048
(B) information, if known, pertaining to the deceased individual's legal next-of-kin in
8049
accordance with Section [26-28-109] 26B-8-308; and
8050
(C) the name and location of the funeral establishment which received custody of and
8051
transported the deceased individual; and
8052
(ii) the funeral establishment receiving custody of the deceased individual under this
8053
Subsection (1)(c) may not embalm the body of the deceased individual until:
8054
(A) the funeral establishment receives notice from the organ procurement organization,
8055
tissue bank, or eye bank that the readily available persons listed as having priority in Section
8056
[26-28-109] 26B-8-308 have been informed by the organ procurement organization of the
8057
option to make or refuse to make an anatomical gift in accordance with Section [26-28-104]
8058
26B-8-303, with reasonable discretion and sensitivity appropriate to the circumstances of the
8059
family;
8060
(B) in accordance with federal law, prior approval for embalming has been obtained
8061
from a family member or other authorized person; and
8062
(C) the period of time in which embalming is prohibited under Subsection (1)(c)(ii)
8063
may not exceed 24 hours after death.
8064
(2) If a document of gift or a refusal to make an anatomical gift is located by the search
8065
required by Subsection (1)(a) and the individual or deceased individual to whom it relates is
8066
taken to a hospital, the person responsible for conducting the search shall send the document of
8067
gift or refusal to the hospital.
8068
(3) A person is not subject to criminal or civil liability for failing to discharge the
8069
duties imposed by this section but may be subject to administrative sanctions.
8070
Section 253. Section 26B-8-312, which is renumbered from Section 26-28-113 is
8071
renumbered and amended to read:

+8072	[26-28-113].	26B-8-312. Delivery of document of gift not required -- Right
+8073	to examine.
+8074	(1) A document of gift need not be delivered during the donor's lifetime to be effective.
+
+
+8075
(2) Upon or after an individual's death, a person in possession of a document of gift or
8076
a refusal to make an anatomical gift with respect to the individual shall allow examination and
8077
copying of the document of gift or refusal by a person authorized to make or object to the
8078
making of an anatomical gift with respect to the individual or by a person to which the gift
8079
could pass under Section [26-28-111] 26B-8-310.
8080
Section 254. Section 26B-8-313, which is renumbered from Section 26-28-114 is
8081
+8082
renumbered and amended to read:
+[26-28-114].	26B-8-313. Rights and duties of procurement organization
8083
and others.
8084
(1) When a hospital refers an individual at or near death to a procurement organization,
8085
the organization shall make a reasonable search of the records of the Department of Public
8086
Safety and any donor registry that it knows exists for the geographical area in which the
8087
individual resides to ascertain whether the individual has made an anatomical gift.
8088
(2) A procurement organization shall be allowed reasonable access to information in
8089
the records of the Department of Public Safety to ascertain whether an individual at or near
8090
death is a donor.
8091
(3) When a hospital refers an individual at or near death to a procurement organization,
8092
the organization may conduct any reasonable examination necessary to ensure the medical
8093
suitability of a part that is or could be the subject of an anatomical gift for transplantation,
8094
therapy, research, or education from a donor or a prospective donor. During the examination
8095
period, measures necessary to ensure the medical suitability of the part may not be withdrawn
8096
unless the hospital or procurement organization knows that the individual expressed a contrary
8097
intent.
8098
(4) Unless prohibited by law other than this [chapter] part, at any time after a donor's
8099
death, the person to which a part passes under Section [26-28-111] 26B-8-310 may conduct
8100
any reasonable examination necessary to ensure the medical suitability of the body or part for
8101
its intended purpose.

+
+
+
+8102
(5) Unless prohibited by law other than this [chapter] part, an examination under
8103
Subsection (3) or (4) may include an examination of all medical and dental records of the
8104
donor or prospective donor.
8105
(6) Upon the death of a minor who was a donor or had signed a refusal, unless a
8106
procurement organization knows the minor is emancipated, the procurement organization shall
8107
conduct a reasonable search for the parents of the minor and provide the parents with an
8108
opportunity to revoke or amend the anatomical gift or revoke the refusal.
8109
(7) Upon referral by a hospital under Subsection (1), a procurement organization shall
8110
make a reasonable search for any person listed in Section [26-28-109] 26B-8-308 having
8111
priority to make an anatomical gift on behalf of a prospective donor. If a procurement
8112
organization receives information that an anatomical gift to any other person was made,
8113
amended, or revoked, it shall promptly advise the other person of all relevant information.
8114
(8) Subject to Subsection [26-28-111] 26B-8-310(9) and Section [26-28-123]
8115
26B-8-322, the rights of the person to which a part passes under Section [26-28-111]
8116
26B-8-310 are superior to the rights of all others with respect to the part. The person may
8117
accept or reject an anatomical gift in whole or in part. Subject to the terms of the document of
8118
gift and this [chapter] part, a person that accepts an anatomical gift of an entire body may allow
8119
embalming, burial or cremation, and use of remains in a funeral service. If the gift is of a part,
8120
the person to which the part passes under Section [26-28-111] 26B-8-310, upon the death of
8121
the donor and before embalming, burial, or cremation, shall cause the part to be removed
8122
without unnecessary mutilation.
8123
(9) Neither the physician or physician assistant who attends the decedent at death nor
8124
the physician or physician assistant who determines the time of the decedent's death may
8125
participate in the procedures for removing or transplanting a part from the decedent.
8126
(10) A physician, physician assistant, or technician may remove a donated part from
8127
the body of a donor that the physician, physician assistant, or technician is qualified to remove.
8128
Section 255. Section 26B-8-314, which is renumbered from Section 26-28-115 is

+
+8129	renumbered and amended to read:
+8130	[26-28-115].	26B-8-314. Coordination of procurement and use.
+8131		Each hospital in this state shall enter into agreements or affiliations with procurement 8132	organizations for coordination of procurement and use of anatomical gifts.
+8133		Section 256. Section 26B-8-315, which is renumbered from Section 26-28-116 is 8134	renumbered and amended to read:
+8135	[26-28-116].	26B-8-315. Sale or purchase of parts prohibited.
+
+8136
(1) Except as otherwise provided in Subsection (2), a person that for valuable
8137
consideration, knowingly purchases or sells a part for transplantation or therapy if removal of a
8138
part from an individual is intended to occur after the individual's death commits a third degree
8139
felony.
8140
(2) A person may charge a reasonable amount for the removal, processing,
8141
preservation, quality control, storage, transportation, implantation, or disposal of a part.
8142
Section 257. Section 26B-8-316, which is renumbered from Section 26-28-117 is
8143
renumbered and amended to read:
8144
[26-28-117].
26B-8-316. Other prohibited acts.
8145
A person that, in order to obtain a financial gain, intentionally falsifies, forges,
8146
conceals, defaces, or obliterates a document of gift, an amendment, or revocation of a
8147
document of gift, or a refusal commits a third degree felony.
8148
Section 258. Section 26B-8-317, which is renumbered from Section 26-28-118 is
8149
renumbered and amended to read:
8150
[26-28-118].
26B-8-317. Immunity.
8151
(1) A person that acts in accordance with this [chapter] part or with the applicable
8152
anatomical gift law of another state, or attempts in good faith to do so, is not liable for the act
8153
in a civil action, criminal prosecution, or administrative proceeding.
8154
(2) Neither the person making an anatomical gift nor the donor's estate is liable for any
8155
injury or damage that results from the making or use of the gift.

+
+
+
+8156
(3) In determining whether an anatomical gift has been made, amended, or revoked
8157
under this [chapter] part, a person may rely upon representations of an individual listed in
8158
Subsection [26-28-109] 26B-8-308(1)(b), (c), (d), (e), (f), (g), (h), (i), or (j) relating to the
8159
individual's relationship to the donor or prospective donor unless the person knows that the
8160
representation is untrue.
8161
Section 259. Section 26B-8-318, which is renumbered from Section 26-28-119 is
8162
renumbered and amended to read:

+8163	[26-28-119].	26B-8-318. Law governing validity -- Choice of law as to
+8164	execution of document of gift -- Presumption of validity.
+
+8165
(1)
A document of gift is valid if executed in accordance with:
8166
(a)
this [chapter] part;
8167
(b)
the laws of the state or country where it was executed; or
8168
(c)
the laws of the state or country where the person making the anatomical gift was
8169
domiciled, has a place of residence, or was a national at the time the document of gift was
8170
executed.
8171
(2) If a document of gift is valid under this section, the law of this state governs the
8172
interpretation of the document of gift.
8173
(3) A person may presume that a document of gift or amendment of an anatomical gift
8174
is valid unless that person knows that it was not validly executed or was revoked.
8175
Section 260. Section 26B-8-319, which is renumbered from Section 26-28-120 is
8176
renumbered and amended to read:
8177
[26-28-120].
26B-8-319. Donor registry.
8178
(1) The Department of Public Safety may establish or contract for the establishment of
8179
a donor registry.
8180
(2) The Driver License Division of the Department of Public Safety shall cooperate
8181
with a person that administers any donor registry that this state establishes, contracts for, or
8182
recognizes for the purpose of transferring to the donor registry all relevant information

+
+8183
regarding a donor's making, amendment to, or revocation of an anatomical gift.
8184
(3) A donor registry shall:
8185
(a) allow a donor or other person authorized under Section [26-28-104] 26B-8-303 to
8186
include on the donor registry a statement or symbol that the donor has made, amended, or
8187
revoked an anatomical gift;
8188
(b) be accessible to a procurement organization to allow it to obtain relevant
8189
information on the donor registry to determine, at or near death of the donor or a prospective
8190
donor, whether the donor or prospective donor has made, amended, or revoked an anatomical
8191
gift; and
8192
(c) be accessible for purposes of Subsections (3)(a) and (b) seven days a week on a
8193
24-hour basis.
8194
(4) Personally identifiable information on a donor registry about a donor or prospective
8195
donor may not be used or disclosed without the express consent of the donor, prospective
8196
donor, or person that made the anatomical gift for any purpose other than to determine, at or
8197
near death of the donor or prospective donor, whether the donor or prospective donor has
8198
made, amended, or revoked an anatomical gift.
8199
(5) This section does not prohibit any person from creating or maintaining a donor
8200
registry that is not established by or under contract with the state. Any such registry shall
8201
comply with Subsections (3) and (4).
8202
Section 261. Section 26B-8-320, which is renumbered from Section 26-28-121 is
8203
+8204
renumbered and amended to read:
+[26-28-121].	26B-8-320. Effect of anatomical gift on advance health care
8205
directive.
8206
(1) As used in this section:
8207
(a) "Advance health care directive" means a power of attorney for health care or a
8208
record signed or authorized by a prospective donor containing the prospective donor's direction
8209
concerning a health care decision for the prospective donor.

+
+
+
+8210
(b) "Declaration" means a record signed by a prospective donor specifying the
8211
circumstances under which a life support system may be withheld or withdrawn from the
8212
prospective donor.
8213
(c) "Health care decision" means any decision regarding the health care of the
8214
prospective donor.
8215
(2) If a prospective donor has a declaration or advance health care directive and the
8216
terms of the declaration or directive and the express or implied terms of a potential anatomical
8217
gift are in conflict with regard to the administration of measures necessary to ensure the
8218
medical suitability of a part for transplantation or therapy, the prospective donor's attending
8219
physician and prospective donor shall confer to resolve the conflict. If the prospective donor is
8220
incapable of resolving the conflict, an agent acting under the prospective donor's declaration or
8221
directive, or if no declaration or directive exists or the agent is not reasonably available,
8222
another person authorized by a law other than this [chapter] part to make a health care decision
8223
on behalf of the prospective donor, shall act for the donor to resolve the conflict. The conflict
8224
shall be resolved as expeditiously as possible. Information relevant to the resolution of the
8225
conflict may be obtained from the appropriate procurement organization and any other person
8226
authorized to make an anatomical gift for the prospective donor under Section [26-28-109]
8227
26B-8-308. Before resolution of the conflict, measures necessary to ensure the medical
8228
suitability of the part may not be withheld or withdrawn from the prospective donor if
8229
withholding or withdrawing the measures is not contraindicated by appropriate end of life care.
8230
Section 262. Section 26B-8-321, which is renumbered from Section 26-28-122 is
8231
renumbered and amended to read:
8232
[26-28-122].	26B-8-321. Cooperation between medical examiner and
8233
procurement organization.
8234
(1) A medical examiner shall cooperate with procurement organizations to maximize
8235
the opportunity to recover anatomical gifts for the purpose of transplantation, therapy, research,
8236
or education.

+
+8237
(2) If a medical examiner receives notice from a procurement organization that an
8238
anatomical gift might be available or was made with respect to a decedent whose body is under
8239
the jurisdiction of the medical examiner and a postmortem examination is going to be
8240
performed, unless the medical examiner denies recovery in accordance with Section
8241
[26-28-123] 26B-8-322, the medical examiner or designee shall conduct a postmortem
8242
examination of the body or the part in a manner and within a period compatible with its
8243
preservation for the purposes of the gift.
8244
(3) A part may not be removed from the body of a decedent under the jurisdiction of a
8245
medical examiner for transplantation, therapy, research, or education unless the part is the
8246
subject of an anatomical gift. The body of a decedent under the jurisdiction of the medical
8247
examiner may not be delivered to a person for research or education unless the body is the
8248
subject of an anatomical gift. This Subsection (3) does not preclude a medical examiner from
8249
performing the medicolegal investigation upon the body or parts of a decedent under the
8250
jurisdiction of the medical examiner.
8251
Section 263. Section 26B-8-322, which is renumbered from Section 26-28-123 is
8252
+8253
renumbered and amended to read:
+[26-28-123].	26B-8-322. Facilitation of anatomical gift from decedent
8254
whose body is under jurisdiction of medical examiner.
8255
(1) Upon request of a procurement organization, a medical examiner shall release to
8256
the procurement organization the name, contact information, and available medical and social
8257
history of a decedent whose body is under the jurisdiction of the medical examiner. If the
8258
decedent's body or part is medically suitable for transplantation, therapy, research, or education,
8259
the medical examiner shall release postmortem examination results to the procurement
8260
organization. The procurement organization may make a subsequent disclosure of the
8261
postmortem examination results or other information received from the medical examiner only
8262
if relevant to transplantation or therapy.
8263
(2) The medical examiner may conduct a medicolegal examination by reviewing all

+
+
+
+8264
medical records, laboratory test results, x-rays, other diagnostic results, and other information
8265
that any person possesses about a donor or prospective donor whose body is under the
8266
jurisdiction of the medical examiner which the medical examiner determines may be relevant
8267
to the investigation.
8268
(3) A person that has any information requested by a medical examiner pursuant to
8269
Subsection (2) shall provide that information as expeditiously as possible to allow the medical
8270
examiner to conduct the medicolegal investigation within a period compatible with the
8271
preservation of parts for the purpose of transplantation, therapy, research, or education.
8272
(4) If an anatomical gift has been or might be made of a part of a decedent whose body
8273
is under the jurisdiction of the medical examiner and a postmortem examination is not
8274
required, or the medical examiner determines that a postmortem examination is required but
8275
that the recovery of the part that is the subject of an anatomical gift will not interfere with the
8276
examination, the medical examiner and procurement organization shall cooperate in the timely
8277
removal of the part from the decedent for the purpose of transplantation, therapy, research, or
8278
education.
8279
(5) If an anatomical gift of a part from the decedent under the jurisdiction of the
8280
medical examiner has been or might be made, but the medical examiner initially believes that
8281
the recovery of the part could interfere with the postmortem investigation into the decedent's
8282
cause or manner of death, the medical examiner shall consult with the procurement
8283
organization or physician or technician designated by the procurement organization about the
8284
proposed recovery. After consultation, the medical examiner may allow the recovery.
8285
(6) Following the consultation under Subsection (5), in the absence of mutually agreed
8286
upon protocols to resolve conflict between the medical examiner and the procurement
8287
organization, if the medical examiner intends to deny recovery, the medical examiner or
8288
designee, at the request of the procurement organization, may attend the removal procedure for
8289
the part before making a final determination not to allow the procurement organization to
8290
recover the part. During the removal procedure, the medical examiner or designee may allow

+
+8291
recovery by the procurement organization to proceed, or, if the medical examiner or designee
8292
reasonably believes that the part may be involved in determining the decedent's cause or
8293
manner of death, deny recovery by the procurement organization.
8294
(7) If the medical examiner or designee denies recovery under Subsection (6), the
8295
medical examiner or designee shall:
8296
(a) explain in a record the specific reasons for not allowing recovery of the part;
8297
(b) include the specific reasons in the records of the medical examiner; and
8298
(c) provide a record with the specific reasons to the procurement organization.
8299
(8) If the medical examiner or designee allows recovery of a part under Subsection (4),
8300
(5), or (6), the procurement organization, upon request, shall cause the physician or technician
8301
who removes the part to provide the medical examiner with a record describing the condition
8302
of the part, a biopsy, a photograph, and any other information and observations that would
8303
assist in the postmortem examination.
8304
(9) If a medical examiner or designee is required to be present at a removal procedure
8305
under Subsection (6), upon request the procurement organization requesting the recovery of the
8306
part shall reimburse the medical examiner or designee for the additional costs incurred in
8307
complying with Subsection (6).
8308
Section 264. Section 26B-8-323, which is renumbered from Section 26-28-124 is
8309
+8310
renumbered and amended to read:
+[26-28-124].	26B-8-323. Uniformity of application and construction.
8311
In applying and construing [this] the uniform act in this part, consideration shall be
8312
given to the need to promote uniformity of the law with respect to its subject matter among
8313
states that enact it.
8314
Section 265. Section 26B-8-324, which is renumbered from Section 26-28-125 is
8315
renumbered and amended to read:
8316
[26-28-125].	26B-8-324. Relation to Electronic Signatures in Global and
8317
National Commerce Act.

+
+
+
+8318
This act modifies, limits, and supersedes the Electronic Signatures in Global and
8319
National Commerce Act, 15 U.S.C. [Section] Sec. 7001 et seq., but does not modify, limit or
8320
supersede Section 101(a) of that act, 15 U.S.C. [Section] Sec. 7001, or authorize electronic
8321
delivery of any of the notices described in Section 103(b) of that act, 15 U.S.C. [Section] Sec.
8322
7003(b).
8323
Section 266. Section 26B-8-401, which is renumbered from Section 26-3-1 is
8324
renumbered and amended to read:
8325
Part 4. Health Statistics
8326
[26-3-1].	26B-8-401. Definitions.
8327
As used in this [chapter] part:
8328
(1) "Disclosure" or "disclose" means the communication of health data to any
8329
individual or organization outside the department.
8330
(2) "Health data" means any information, except vital records as defined in Section
8331
[26-2-2] 26B-8-101, relating to the health status of individuals, the availability of health
8332
resources and services, and the use and cost of these resources and services.
8333
(3) "Identifiable health data" means any item, collection, or grouping of health data
8334
which makes the individual supplying it or described in it identifiable.
8335
(4) "Individual" means a natural person.
8336
(5) "Organization" means any corporation, association, partnership, agency,
8337
department, unit, or other legally constituted institution or entity, or part of any of these.
8338
(6) "Research and statistical purposes" means the performance of activities relating to
8339
health data, including:
8340
(a) describing the group characteristics of individuals or organizations;
8341
(b) analyzing the interrelationships among the various characteristics of individuals or
8342
organizations;
8343
(c) the conduct of statistical procedures or studies to improve the quality of health data;
8344
(d) the design of sample surveys and the selection of samples of individuals or

+
+8345
organizations;
8346
(e) the preparation and publication of reports describing these matters; and
8347
(f) other related functions.
8348
Section 267. Section 26B-8-402, which is renumbered from Section 26-3-2 is
8349
renumbered and amended to read:
8350
[26-3-2].	26B-8-402. Powers of department to collect and maintain health
8351
data.
8352
The department may on a voluntary basis, except when there is specific legal authority
8353
to compel reporting of health data:
8354
(1) collect and maintain health data on:
8355
(a) the extent, nature, and impact of illness and disability on the population of the state;
8356
(b) the determinants of health and health hazards;
8357
(c) health resources, including the extent of available manpower and resources;
8358
(d) utilization of health care;
8359
(e) health care costs and financing; or
8360
(f) other health or health-related matters;
8361
(2) undertake and support research, demonstrations, and evaluations respecting new or
8362
improved methods for obtaining current data on the matters referred to in Subsection (1) of this
8363
section; and
8364
(3) collect health data under other authorities and on behalf of other governmental or
8365
not-for-profit organizations.
8366
Section 268. Section 26B-8-403, which is renumbered from Section 26-3-4 is
8367
renumbered and amended to read:
8368
[26-3-4].	26B-8-403. Quality and publication of statistics.
8369
The department shall:
8370
(1) take such actions as may be necessary to assure that statistics developed under this
8371
[chapter] part are of high quality, timely, and comprehensive, as well as specific, standardized,

+
+
+8372	and adequately analyzed and indexed; and
+8373		(2) publish, make available, and disseminate such statistics on as wide a basis as 8374	practicable.
+8375		Section 269. Section 26B-8-404, which is renumbered from Section 26-3-5 is 8376	renumbered and amended to read:
+8377	[26-3-5].	26B-8-404. Coordination of health data collection activities.
+8378		(1) The department shall coordinate health data activities within the state to eliminate 8379	unnecessary duplication of data collection and maximize the usefulness of data collected.
+8380		(2) Except as specifically provided, this [chapter] part does not independently provide 8381	authority for the department to compel the reporting of information.
+8382		Section 270. Section 26B-8-405, which is renumbered from Section 26-3-6 is 8383	renumbered and amended to read:
+8384	[26-3-6].	26B-8-405. Uniform standards -- Powers of department.
+
+8385
The department may:
8386
(1) participate and cooperate with state, local, and federal agencies and other
8387
organizations in the design and implementation of uniform standards for the management of
8388
health information at the federal, state, and local levels; and
8389
(2) undertake and support research, development, demonstrations, and evaluations that
8390
support uniform health information standards.
8391
Section 271. Section 26B-8-406, which is renumbered from Section 26-3-7 is
8392
renumbered and amended to read:
8393
[26-3-7].	26B-8-406. Disclosure of health data -- Limitations.
8394
The department may not [disclose] make a disclosure of any identifiable health data
8395
unless:
8396
(1) one of the following persons has consented to the disclosure:
8397
(a) the individual;
8398
(b) the next-of-kin if the individual is deceased;

+
+8399
(c) the parent or legal guardian if the individual is a minor or mentally incompetent; or
8400
(d) a person holding a power of attorney covering such matters on behalf of the
8401
individual;
8402
(2) the disclosure is to a governmental entity in this or another state or the federal
8403
government, provided that:
8404
(a) the data will be used for a purpose for which they were collected by the department;
8405
and
8406
(b) the recipient enters into a written agreement satisfactory to the department agreeing
8407
to protect such data in accordance with the requirements of this [chapter] part and department
8408
rule and not permit further disclosure without prior approval of the department;
8409
(3) the disclosure is to an individual or organization, for a specified period, solely for
8410
bona fide research and statistical purposes, determined in accordance with department rules,
8411
and the department determines that the data are required for the research and statistical
8412
purposes proposed and the requesting individual or organization enters into a written
8413
agreement satisfactory to the department to protect the data in accordance with this [chapter]
8414
part and department rule and not permit further disclosure without prior approval of the
8415
department;
8416
(4) the disclosure is to a governmental entity for the purpose of conducting an audit,
8417
evaluation, or investigation of the department and such governmental entity agrees not to use
8418
those data for making any determination affecting the rights, benefits, or entitlements of any
8419
individual to whom the health data relates;
8420
(5) the disclosure is of specific medical or epidemiological information to authorized
8421
personnel within the department, local health departments, public health authorities, official
8422
health agencies in other states, the United States Public Health Service, the Centers for Disease
8423
Control and Prevention (CDC), or agencies responsible to enforce quarantine, when necessary
8424
to continue patient services or to undertake public health efforts to control communicable,
8425
infectious, acute, chronic, or any other disease or health hazard that the department considers to

+
+
+
+8426
be dangerous or important or that may affect the public health;
8427
(6) (a) the disclosure is of specific medical or epidemiological information to a "health
8428
care provider" as defined in Section 78B-3-403, health care personnel, or public health
8429
personnel who has a legitimate need to have access to the information in order to assist the
8430
patient or to protect the health of others closely associated with the patient; and
8431
(b) this Subsection (6) does not create a duty to warn third parties;
8432
(7) the disclosure is necessary to obtain payment from an insurer or other third-party
8433
payor in order for the department to obtain payment or to coordinate benefits for a patient; or
8434
(8) the disclosure is to the subject of the identifiable health data.
8435
Section 272. Section 26B-8-407, which is renumbered from Section 26-3-8 is
8436
renumbered and amended to read:
8437
[26-3-8].	26B-8-407. Disclosure of health data -- Discretion of department.
8438
(1) Any disclosure provided for in Section [26-3-7] 26B-8-406 shall be made at the
8439
discretion of the department[, except that the].
8440
(2) Notwithstanding Subsection (1), the disclosure provided for in Subsection [26-3-7]
8441
26B-8-406(4) shall be made when the requirements of that paragraph are met.
8442
Section 273. Section 26B-8-408, which is renumbered from Section 26-3-9 is
8443
renumbered and amended to read:
8444
[26-3-9].	26B-8-408. Health data not subject to subpoena or compulsory
8445
process -- Exception.
8446
Identifiable health data obtained in the course of activities undertaken or supported
8447
under this [chapter] part may not be subject to discovery, subpoena, or similar compulsory
8448
process in any civil or criminal, judicial, administrative, or legislative proceeding, nor shall any
8449
individual or organization with lawful access to identifiable health data under the provisions of
8450
this [chapter] part be compelled to testify with regard to such health data, except that data
8451
pertaining to a party in litigation may be subject to subpoena or similar compulsory process in
8452
an action brought by or on behalf of such individual to enforce any liability arising under this

+
+8453	[chapter] part.
+8454		Section 274. Section 26B-8-409, which is renumbered from Section 26-3-10 is 8455	renumbered and amended to read:
+8456	[26-3-10].	26B-8-409. Department measures to protect security of health data.
+
+8457
The department shall protect the security of identifiable health data by use of the
8458
following measures and any other measures adopted by rule:
8459
(1) limit access to identifiable health data to authorized individuals who have received
8460
training in the handling of such data;
8461
(2) designate a person to be responsible for physical security;
8462
(3) develop and implement a system for monitoring security; and
8463
(4) review periodically all identifiable health data to determine whether identifying
8464
characteristics should be removed from the data.
8465
Section 275. Section 26B-8-410, which is renumbered from Section 26-3-11 is
8466
renumbered and amended to read:
8467
[26-3-11].	26B-8-410. Relation to other provisions.
8468
Because [Chapter 2, Utah Vital Statistics Act, Chapter 4, Utah Medical Examiner Act,
8469
Chapter 6, Utah Communicable Disease Control Act, and Chapter 33a, Utah Health Data
8470
Authority Act] the following parts contain specific provisions regarding collection and
8471
disclosure of data, the provisions of this [chapter] part do not apply to data that is subject to
8472
[those chapters.] the following parts:
8473
(1) Part 1, Vital Statistics;
8474
(2) Part 2, Utah Medical Examiner; and
8475
(3) Sections 26B-7-201 through 26B-7-223.
8476
Section 276. Section 26B-8-411, which is renumbered from Section 26-1-37 is
8477
renumbered and amended to read:
8478
[26-1-37].	26B-8-411. Duty to establish standards for the electronic exchange
8479
of clinical health information -- Immunity.

+
+
+
+8480
(1) [For purposes of] As used in this section:
8481
(a) "Affiliate" means an organization that directly or indirectly through one or more
8482
intermediaries controls, is controlled by, or is under common control with another
8483
organization.
8484
(b) "Clinical health information" shall be defined by the department by administrative
8485
rule adopted in accordance with Subsection (2).
8486
(c) "Electronic exchange":
8487
(i) includes:
8488
(A) the electronic transmission of clinical health data via Internet or extranet; and
8489
(B) physically moving clinical health information from one location to another using
8490
magnetic tape, disk, or compact disc media; and
8491
(ii) does not include exchange of information by telephone or fax.
8492
(d) "Health care provider" means a licensing classification that is either:
8493
(i) licensed under Title 58, Occupations and Professions, to provide health care; or
8494
(ii) licensed under [Chapter 21] Chapter 2, Part 2, Health Care Facility Licensing and
8495
Inspection [Act].
8496
(e) "Health care system" shall include:
8497
(i) affiliated health care providers;
8498
(ii) affiliated third party payers; and
8499
(iii) other arrangement between organizations or providers as described by the
8500
department by administrative rule.
8501
(f) "Qualified network" means an entity that:
8502
(i) is a non-profit organization;
8503
(ii) is accredited by the Electronic Healthcare Network Accreditation Commission, or
8504
another national accrediting organization recognized by the department; and
8505
(iii) performs the electronic exchange of clinical health information among multiple
8506
health care providers not under common control, multiple third party payers not under common

+
+8507
control, the department, and local health departments.
8508
(g) "Third party payer" means:
8509
(i) all insurers offering health insurance who are subject to Section 31A-22-614.5; and
8510
(ii) the state Medicaid program.
8511
(2) (a) [In addition to the duties listed in Section 26-1-30, the] The department shall[,]
8512
make rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to:
8513
(i) define:
8514
(A) "clinical health information" subject to this section; and
8515
(B) "health system arrangements between providers or organizations" as described in
8516
Subsection (1)(e)(iii); and
8517
(ii) adopt standards for the electronic exchange of clinical health information between
8518
health care providers and third party payers that are for treatment, payment, health care
8519
operations, or public health reporting, as provided for in 45 C.F.R. Parts 160, 162, and 164,
8520
Health Insurance Reform: Security Standards.
8521
(b) The department shall coordinate its rule making authority under the provisions of
8522
this section with the rule making authority of the Insurance Department under Section
8523
31A-22-614.5.
8524
(c) The department shall establish procedures for developing the rules adopted under
8525
this section, which ensure that the Insurance Department is given the opportunity to comment
8526
on proposed rules.
8527
(3) (a) Except as provided in Subsection (3)(e), a health care provider or third party
8528
payer in Utah is required to use the standards adopted by the department under the provisions
8529
of Subsection (2) if the health care provider or third party payer elects to engage in an
8530
electronic exchange of clinical health information with another health care provider or third
8531
party payer.
8532
(b) A health care provider or third party payer may [disclose] make a disclosure of
8533
information to the department or a local health department, by electronic exchange of clinical

+
+
+
+8534
health information, as permitted by Subsection 45 C.F.R. Sec. 164.512(b).
8535
(c) When functioning in its capacity as a health care provider or payer, the department
8536
or a local health department may [disclose] make a disclosure of clinical health information by
8537
electronic exchange to another health care provider or third party payer.
8538
(d) An electronic exchange of clinical health information by a health care provider, a
8539
third party payer, the department, a local health department, or a qualified network is a
8540
disclosure for treatment, payment, or health care operations if it complies with Subsection
8541
(3)(a) or (c) and is for treatment, payment, or health care operations, as those terms are defined
8542
in 45 C.F.R. Parts 160, 162, and 164.
8543
(e) A health care provider or third party payer is not required to use the standards
8544
adopted by the department under the provisions of Subsection (2) if the health care provider or
8545
third party payer engage in the electronic exchange of clinical health information within a
8546
particular health care system.
8547
(4) Nothing in this section shall limit the number of networks eligible to engage in the
8548
electronic data interchange of clinical health information using the standards adopted by the
8549
department under Subsection (2)(a)(ii).
8550
(5) (a) The department, a local health department, a health care provider, a third party
8551
payer, or a qualified network is not subject to civil liability for a disclosure of clinical health
8552
information if the disclosure is in accordance with:
8553
(i) Subsection (3)(a); and
8554
(ii) Subsection (3)(b), (c), or (d).
8555
(b) The department, a local health department, a health care provider, a third party
8556
payer, or a qualified network that accesses or reviews clinical health information from or
8557
through the electronic exchange in accordance with the requirements in this section is not
8558
subject to civil liability for the access or review.
8559
(6) Within a qualified network, information generated or [disclosed] for which a
8560
disclosure is made in the electronic exchange of clinical health information is not subject to

+
+8561	discovery, use, or receipt in evidence in any legal proceeding of any kind or character. 8562		Section 277. Section 26B-8-501, which is renumbered from Section 26-33a-102 is 8563	renumbered and amended to read:
+8564	Part 5. Utah Health Data Authority
+8565	[26-33a-102].	26B-8-501. Definitions.
+
+8566
As used in this [chapter] part:
8567
(1) "Committee" means the Health Data Committee created [by Section 26B-1-204] in
8568
Section 26B-1-413.
8569
(2) "Control number" means a number assigned by the committee to an individual's
8570
health data as an identifier so that the health data can be disclosed or used in research and
8571
statistical analysis without readily identifying the individual.
8572
(3) "Data supplier" means a health care facility, health care provider, self-funded
8573
employer, third-party payor, health maintenance organization, or government department which
8574
could reasonably be expected to provide health data under this [chapter] part.
8575
(4) "Disclosure" or "disclose" means the communication of health care data to any
8576
individual or organization outside the committee, its staff, and contracting agencies.
8577
(5) (a) "Health care facility" means a facility that is licensed by the department under
8578
[Title 26, Chapter 21] Chapter 2, Part 2, Health Care Facility Licensing and Inspection [Act].
8579
(b) In accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, the
8580
committee, with the concurrence of the department, may by rule add, delete, or modify the list
8581
of facilities that come within this definition for purposes of this [chapter] part.
8582
(6) "Health care provider" means [any person, partnership, association, corporation, or
8583
other facility or institution that renders or causes to be rendered health care or professional
8584
services as a physician, physician assistant, registered nurse, licensed practical nurse,
8585
nurse-midwife, dentist, dental hygienist, optometrist, clinical laboratory technologist,
8586
pharmacist, physical therapist, podiatric physician, psychologist, chiropractic physician,
8587
naturopathic physician, osteopathic physician, osteopathic physician and surgeon, audiologist,

+
+
+
+8588
speech pathologist, certified social worker, social service worker, social service aide, marriage
8589
and family counselor, or practitioner of obstetrics, and others rendering similar care and
8590
services relating to or arising out of the health needs of persons or groups of persons, and
8591
officers, employees, or agents of any of the above acting in the course and scope of their
8592
employment] the same as that term is defined in Section 78B-3-403.
8593
(7) "Health data" means information relating to the health status of individuals, health
8594
services delivered, the availability of health manpower and facilities, and the use and costs of
8595
resources and services to the consumer, except vital records as defined in Section [26-2-2]
8596
26B-8-101 shall be excluded.
8597
(8) "Health maintenance organization" [has the meaning set forth] means the same as
8598
that term is defined in Section 31A-8-101.
8599
(9) "Identifiable health data" means any item, collection, or grouping of health data that
8600
makes the individual supplying or described in the health data identifiable.
8601
(10) "Organization" means any corporation, association, partnership, agency,
8602
department, unit, or other legally constituted institution or entity, or part thereof.
8603
(11) "Research and statistical analysis" means activities using health data analysis
8604
including:
8605
(a) describing the group characteristics of individuals or organizations;
8606
(b) analyzing the noncompliance among the various characteristics of individuals or
8607
organizations;
8608
(c) conducting statistical procedures or studies to improve the quality of health data;
8609
(d) designing sample surveys and selecting samples of individuals or organizations;
8610
and
8611
(e) preparing and publishing reports describing these matters.
8612
(12) "Self-funded employer" means an employer who provides for the payment of
8613
health care services for employees directly from the employer's funds, thereby assuming the
8614
financial risks rather than passing them on to an outside insurer through premium payments.

+
+8615
(13) "Plan" means the plan developed and adopted by the Health Data Committee
8616
under Section [26-33a-104] 26B-1-413.
8617
(14) "Third party payor" means:
8618
(a) an insurer offering a health benefit plan, as defined by Section 31A-1-301, to at
8619
least 2,500 enrollees in the state;
8620
(b) a nonprofit health service insurance corporation licensed under Title 31A, Chapter
8621
7, Nonprofit Health Service Insurance Corporations;
8622
(c) a program funded or administered by Utah for the provision of health care services,
8623
including the Medicaid and medical assistance programs described in [Chapter 18, Medical
8624
Assistance Act] Chapter 3, Part 1, Health Care Assistance; and
8625
(d) a corporation, organization, association, entity, or person:
8626
(i) which administers or offers a health benefit plan to at least 2,500 enrollees in the
8627
state; and
8628
(ii) which is required by administrative rule adopted by the department in accordance
8629
with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to supply health data to the
8630
committee.
8631
Section 278. Section 26B-8-502, which is renumbered from Section 26-33a-105 is
8632
renumbered and amended to read:
8633
[26-33a-105].	26B-8-502. Executive secretary -- Appointment -- Powers.
8634
(1) An executive secretary shall be appointed by the executive director, with the
8635
approval of the committee, and shall serve under the administrative direction of the executive
8636
director.
8637
(2) The executive secretary shall:
8638
(a) employ full-time employees necessary to carry out this [chapter] part;
8639
(b) supervise the development of a draft health data plan for the committee's review,
8640
modification, and approval; and
8641
(c) supervise and conduct the staff functions of the committee in order to assist the

+
+
+8642	committee in meeting its responsibilities under this [chapter] part.
+8643		Section 279. Section 26B-8-503, which is renumbered from Section 26-33a-106 is 8644	renumbered and amended to read:
+8645	[26-33a-106].	26B-8-503. Limitations on use of health data.
+
+8646
The committee may not use the health data provided to it by third-party payors, health
8647
care providers, or health care facilities to make recommendations with regard to a single health
8648
care provider or health care facility, or a group of health care providers or health care facilities.
8649
Section 280. Section 26B-8-504, which is renumbered from Section 26-33a-106.1 is
8650
renumbered and amended to read:
8651
[26-33a-106.1].	26B-8-504. Health care cost and reimbursement data.
8652
(1) The committee shall, as funding is available:
8653
(a) establish a plan for collecting data from data suppliers to determine measurements
8654
of cost and reimbursements for risk-adjusted episodes of health care;
8655
(b) share data regarding insurance claims and an individual's and small employer
8656
group's health risk factor and characteristics of insurance arrangements that affect claims and
8657
usage with the Insurance Department, only to the extent necessary for:
8658
(i) risk adjusting; and
8659
(ii) the review and analysis of health insurers' premiums and rate filings; and
8660
(c) assist the Legislature and the public with awareness of, and the promotion of,
8661
transparency in the health care market by reporting on:
8662
(i) geographic variances in medical care and costs as demonstrated by data available to
8663
the committee; and
8664
(ii) rate and price increases by health care providers:
8665
(A) that exceed the Consumer Price Index - Medical as provided by the United States
8666
Bureau of Labor Statistics;
8667
(B) as calculated yearly from June to June; and
8668
(C) as demonstrated by data available to the committee;

+
+8669
(d) provide on at least a monthly basis, enrollment data collected by the committee to a
8670
not-for-profit, broad-based coalition of state health care insurers and health care providers that
8671
are involved in the standardized electronic exchange of health data as described in Section
8672
31A-22-614.5, to the extent necessary:
8673
(i) for the department or the Medicaid Office of the Inspector General to determine
8674
insurance enrollment of an individual for the purpose of determining Medicaid third party
8675
liability;
8676
(ii) for an insurer that is a data supplier, to determine insurance enrollment of an
8677
individual for the purpose of coordination of health care benefits; and
8678
(iii) for a health care provider, to determine insurance enrollment for a patient for the
8679
purpose of claims submission by the health care provider;
8680
(e) coordinate with the State Emergency Medical Services Committee to publish data
8681
regarding air ambulance charges under Section [26-8a-203] 26B-4-106;
8682
(f) share data collected under this [chapter] part with the state auditor for use in the
8683
health care price transparency tool described in Section 67-3-11; and
8684
(g) publish annually a report on primary care spending within Utah.
8685
(2) A data supplier is not liable for a breach of or unlawful disclosure of the data
8686
caused by an entity that obtains data in accordance with Subsection (1).
8687
(3) The plan adopted under Subsection (1) shall include:
8688
(a) the type of data that will be collected;
8689
(b) how the data will be evaluated;
8690
(c) how the data will be used;
8691
(d) the extent to which, and how the data will be protected; and
8692
(e) who will have access to the data.
8693
Section 281. Section 26B-8-505, which is renumbered from Section 26-33a-106.5 is
8694
renumbered and amended to read:
8695
[26-33a-106.5].	26B-8-505. Comparative analyses.

+
+
+
+8696
(1) The committee may publish compilations or reports that compare and identify
8697
health care providers or data suppliers from the data it collects under this [chapter] part or from
8698
any other source.
8699
(2) (a) Except as provided in Subsection (7)(c), the committee shall publish
8700
compilations or reports from the data it collects under this [chapter] part or from any other
8701
source which:
8702
(i) contain the information described in Subsection (2)(b); and
8703
(ii) compare and identify by name at least a majority of the health care facilities, health
8704
care plans, and institutions in the state.
8705
(b) Except as provided in Subsection (7)(c), the report required by this Subsection (2)
8706
shall:
8707
(i) be published at least annually;
8708
(ii) list, as determined by the committee, the median paid amount for at least the top 50
8709
medical procedures performed in the state by volume;
8710
(iii) describe the methodology approved by the committee to determine the amounts
8711
described in Subsection (2)(b)(ii); and
8712
(iv) contain comparisons based on at least the following factors:
8713
(A) nationally or other generally recognized quality standards;
8714
(B) charges; and
8715
(C) nationally recognized patient safety standards.
8716
(3) (a) The committee may contract with a private, independent analyst to evaluate the
8717
standard comparative reports of the committee that identify, compare, or rank the performance
8718
of data suppliers by name.
8719
(b) The evaluation described in this Subsection (3) shall include a validation of
8720
statistical methodologies, limitations, appropriateness of use, and comparisons using standard
8721
health services research practice.
8722
(c) The independent analyst described in Subsection (3)(a) shall be experienced in

+
+8723
analyzing large databases from multiple data suppliers and in evaluating health care issues of
8724
cost, quality, and access.
8725
(d) The results of the analyst's evaluation shall be released to the public before the
8726
standard comparative analysis upon which it is based may be published by the committee.
8727
(4) [In] The committee, with the concurrence of the department, shall make rules in
8728
accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, [the committee,
8729
with the concurrence of the department, shall adopt by rule] to adopt a timetable for the
8730
collection and analysis of data from multiple types of data suppliers.
8731
(5) The comparative analysis required under Subsection (2) shall be available free of
8732
charge and easily accessible to the public.
8733
(6) (a) The department shall include in the report required by Subsection (2)(b), or
8734
include in a separate report, comparative information on commonly recognized or generally
8735
agreed upon measures of cost and quality identified in accordance with Subsection (7), for:
8736
(i) routine and preventive care; and
8737
(ii) the treatment of diabetes, heart disease, and other illnesses or conditions as
8738
determined by the committee.
8739
(b) The comparative information required by Subsection (6)(a) shall be based on data
8740
collected under Subsection (2) and clinical data that may be available to the committee, and
8741
shall compare:
8742
(i) results for health care facilities or institutions;
8743
(ii) results for health care providers by geographic regions of the state;
8744
(iii) a clinic's aggregate results for a physician who practices at a clinic with five or
8745
more physicians; and
8746
(iv) a geographic region's aggregate results for a physician who practices at a clinic
8747
with less than five physicians, unless the physician requests physician-level data to be
8748
published on a clinic level.
8749
(c) The department:

+
+
+
+8750
(i) may publish information required by this Subsection (6) directly or through one or
8751
more nonprofit, community-based health data organizations; and
8752
(ii) may use a private, independent analyst under Subsection (3)(a) in preparing the
8753
report required by this section.
8754
(d) A report published by the department under this Subsection (6):
8755
(i) is subject to the requirements of Section [26-33a-107] 26B-8-506; and
8756
(ii) shall, prior to being published by the department, be submitted to a neutral,
8757
non-biased entity with a broad base of support from health care payers and health care
8758
providers in accordance with Subsection (7) for the purpose of validating the report.
8759
(7) (a) The Health Data Committee shall, through the department, for purposes of
8760
Subsection (6)(a), use the quality measures that are developed and agreed upon by a neutral,
8761
non-biased entity with a broad base of support from health care payers and health care
8762
providers.
8763
(b) If the entity described in Subsection (7)(a) does not submit the quality measures,
8764
the department may select the appropriate number of quality measures for purposes of the
8765
report required by Subsection (6).
8766
(c) (i) For purposes of the reports published on or after July 1, 2014, the department
8767
may not compare individual facilities or clinics as described in Subsections (6)(b)(i) through
8768
(iv) if the department determines that the data available to the department can not be
8769
appropriately validated, does not represent nationally recognized measures, does not reflect the
8770
mix of cases seen at a clinic or facility, or is not sufficient for the purposes of comparing
8771
providers.
8772
(ii) The department shall report to the Legislature's Health and Human Services Interim
8773
Committee prior to making a determination not to publish a report under Subsection (7)(c)(i).
8774
Section 282. Section 26B-8-506, which is renumbered from Section 26-33a-107 is
8775
renumbered and amended to read:
8776
[26-33a-107].	26B-8-506. Limitations on release of reports.

+
+8777
The committee may not release a compilation or report that compares and identifies
8778
health care providers or data suppliers unless it:
8779
(1) allows the data supplier and the health care provider to verify the accuracy of the
8780
information submitted to the committee and submit to the committee any corrections of errors
8781
with supporting evidence and comments within a reasonable period of time to be established by
8782
rule, with the concurrence of the department, made in accordance with Title 63G, Chapter 3,
8783
Utah Administrative Rulemaking Act;
8784
(2) corrects data found to be in error; and
8785
(3) allows the data supplier a reasonable amount of time prior to publication to review
8786
the committee's interpretation of the data and prepare a response.
8787
Section 283. Section 26B-8-507, which is renumbered from Section 26-33a-108 is
8788
renumbered and amended to read:
8789
[26-33a-108].	26B-8-507. Disclosure of identifiable health data prohibited.
8790
(1) (a) All information, reports, statements, memoranda, or other data received by the
8791
committee are strictly confidential.
8792
(b) Any use, release, or publication of the information shall be done in such a way that
8793
no person is identifiable except as provided in Sections [26-33a-107] 26B-8-506 and
8794
[26-33a-109] 26B-8-508.
8795
(2) No member of the committee may be held civilly liable by reason of having
8796
released or published reports or compilations of data supplied to the committee, so long as the
8797
publication or release is in accordance with the requirements of Subsection (1).
8798
(3) No person, corporation, or entity may be held civilly liable for having provided data
8799
to the committee in accordance with this [chapter] part.
8800
Section 284. Section 26B-8-508, which is renumbered from Section 26-33a-109 is
8801
renumbered and amended to read:
8802
[26-33a-109].	26B-8-508. Exceptions to prohibition on disclosure of
8803
identifiable health data.

+
+
+
+8804
(1)
The committee may not disclose any identifiable health data unless:
8805
(a)
the individual has authorized the disclosure;
8806
(b)
the disclosure is to the department or a public health authority in accordance with
8807
Subsection (2); or
8808
(c) the disclosure complies with the provisions of:
8809
(i) Subsection (3);
8810
(ii) insurance enrollment and coordination of benefits under Subsection [26-33a-106.1]
8811
26B-8-504(1)(d); or
8812
(iii) risk adjusting under Subsection [26-33a-106.1] 26B-8-504(1)(b).
8813
(2) The committee may disclose identifiable health data to the department or a public
8814
health authority under Subsection (1)(b) if:
8815
(a) the department or the public health authority has clear statutory authority to possess
8816
the identifiable health data; and
8817
(b) the disclosure is solely for use:
8818
(i) in the Utah Statewide Immunization Information System operated by the
8819
department;
8820
(ii) in the Utah Cancer Registry operated by the University of Utah, in collaboration
8821
with the department; or
8822
(iii) by the medical examiner, as defined in Section [26-4-2] 26B-8-201, or the medical
8823
examiner's designee.
8824
(3) The committee shall consider the following when responding to a request for
8825
disclosure of information that may include identifiable health data:
8826
(a) whether the request comes from a person after that person has received approval to
8827
do the specific research or statistical work from an institutional review board; and
8828
(b) whether the requesting entity complies with the provisions of Subsection (4).
8829
(4) A request for disclosure of information that may include identifiable health data
8830
shall:

+
+8831
(a) be for a specified period; or
8832
(b) be solely for bona fide research or statistical purposes as determined in accordance
8833
with administrative rules adopted by the department in accordance with Title 63G, Chapter 3,
8834
Utah Administrative Rulemaking Act, which shall require:
8835
(i) the requesting entity to demonstrate to the department that the data is required for
8836
the research or statistical purposes proposed by the requesting entity; and
8837
(ii) the requesting entity to enter into a written agreement satisfactory to the department
8838
to protect the data in accordance with this [chapter] part or other applicable law.
8839
(5) A person accessing identifiable health data pursuant to Subsection (4) may not
8840
further disclose the identifiable health data:
8841
(a) without prior approval of the department; and
8842
(b) unless the identifiable health data is disclosed or identified by control number only.
8843
(6) Identifiable health data that has been designated by a data supplier as being subject
8844
to regulation under 42 C.F.R. Part 2, Confidentiality of Substance Use Disorder Patient
8845
Records, may only be used or disclosed in accordance with applicable federal regulations.
8846
Section 285. Section 26B-8-509, which is renumbered from Section 26-33a-110 is
8847
renumbered and amended to read:
8848
[26-33a-110].	26B-8-509. Penalties.
8849
(1) Any use, release, or publication of health care data contrary to the provisions of
8850
Sections [26-33a-108 and 26-33a-109] 26B-8-507 and 26B-8-508 is a class A misdemeanor.
8851
(2) Subsection (1) does not relieve the person or organization responsible for that use,
8852
release, or publication from civil liability.
8853
Section 286. Section 26B-8-510, which is renumbered from Section 26-33a-111 is
8854
renumbered and amended to read:
8855
[26-33a-111].	26B-8-510. Health data not subject to subpoena or
8856
compulsory process -- Exception.
8857
Identifiable health data obtained in the course of activities undertaken or supported

+
+
+
+8858
under this [chapter] part are not subject to subpoena or similar compulsory process in any civil
8859
or criminal, judicial, administrative, or legislative proceeding, nor shall any individual or
8860
organization with lawful access to identifiable health data under the provisions of this [chapter]
8861
part be compelled to testify with regard to such health data, except that data pertaining to a
8862
party in litigation may be subject to subpoena or similar compulsory process in an action
8863
brought by or on behalf of such individual to enforce any liability arising under this [chapter]
8864
part.
8865
Section 287. Section 26B-8-511, which is renumbered from Section 26-33a-115 is
8866
renumbered and amended to read:
8867
[26-33a-115].	26B-8-511. Consumer-focused health care delivery and
8868
payment reform demonstration project.
8869
(1) The Legislature finds that:
8870
(a) current health care delivery and payment systems do not provide system wide
8871
incentives for the competitive delivery and pricing of health care services to consumers;
8872
(b) there is a compelling state interest to encourage consumers to seek high quality, low
8873
cost care and educate themselves about health care options;
8874
(c) some health care providers and health care payers have developed
8875
consumer-focused ideas for health care delivery and payment system reform, but lack the
8876
critical number of patient lives and payer involvement to accomplish system-wide
8877
consumer-focused reform; and
8878
(d) there is a compelling state interest to encourage as many health care providers and
8879
health care payers to join together and coordinate efforts at consumer-focused health care
8880
delivery and payment reform that would provide to consumers enrolled in a high-deductible
8881
health plan:
8882
(i) greater choice in health care options;
8883
(ii) improved services through competition; and
8884
(iii) more affordable options for care.

+
+8885
(2) (a) The department shall meet with health care providers and health care payers for
8886
the purpose of coordinating a demonstration project for consumer-based health care delivery
8887
and payment reform.
8888
(b) Participation in the coordination efforts is voluntary, but encouraged.
8889
(3) The department, in order to facilitate the coordination of a demonstration project
8890
for consumer-based health care delivery and payment reform, shall convene and consult with
8891
pertinent entities including:
8892
(a) the Utah Insurance Department;
8893
(b) the Office of Consumer [Health] Services;
8894
(c) the Utah Medical Association;
8895
(d) the Utah Hospital Association; and
8896
(e) neutral, non-biased third parties with an established record for broad based,
8897
multi-provider and multi-payer quality assurance efforts and data collection.
8898
(4) The department shall supervise the efforts by entities under Subsection (3)
8899
regarding:
8900
(a) applying for and obtaining grant funding and other financial assistance that may be
8901
available for demonstrating consumer-based improvements to health care delivery and
8902
payment;
8903
(b) obtaining and analyzing information and data related to current health system
8904
utilization and costs to consumers; and
8905
(c) consulting with those health care providers and health care payers who elect to
8906
participate in the consumer-based health delivery and payment demonstration project.
8907
[(5) The executive director shall report to the Health System Reform Task Force by
8908
January 1, 2015, regarding the progress toward coordination of consumer-focused health care
8909
system payment and delivery reform.]
8910
Section 288. Section 26B-8-512, which is renumbered from Section 26-33a-116 is
8911
renumbered and amended to read:

+
+
+
+8912
[26-33a-116].
26B-8-512. Health care billing data.
8913
(1) Subject to Subsection (2), the department shall make aggregate data produced
8914
under this [chapter] part available to the public through a standardized application program
8915
interface format.
8916
(2) (a) The department shall ensure that data made available to the public under
8917
Subsection (1):
8918
(i) does not contain identifiable health data of a patient; and
8919
(ii) meets state and federal data privacy requirements, including the requirements of
8920
Section [26-33a-107] 26B-8-506.
8921
(b) The department may not release any data under Subsection (1) that may be
8922
identifiable health data of a patient.
8923
Section 289. Section 26B-8-513, which is renumbered from Section 26-33a-117 is
8924
renumbered and amended to read:
8925
[26-33a-117].	26B-8-513. Identifying potential overuse of
8926
non-evidence-based health care.
8927
(1) The department shall, in accordance with Title 63G, Chapter 6a, Utah Procurement
8928
Code, contract with an entity to provide a nationally-recognized health waste calculator that:
8929
(a) uses principles such as the principles of the Choosing Wisely initiative of the
8930
American Board of Internal Medicine Foundation; and
8931
(b) is approved by the committee.
8932
(2) The department shall use the calculator described in Subsection (1) to:
8933
(a) analyze the data in the state's All Payer Claims Database; and
8934
(b) flag data entries that the calculator identifies as potential overuse of non-
8935
evidence-based health care.
8936
(3) The department, or a third party organization that the department contracts with in
8937
accordance with Title 63G, Chapter 6a, Utah Procurement Code, shall:
8938
(a) analyze the data described in Subsection (2)(b);

+
+8939
(b) review current scientific literature about medical services that are best practice;
8940
(c) review current scientific literature about eliminating duplication in health care;
8941
(d) solicit input from Utah health care providers, health systems, insurers, and other
8942
stakeholders regarding duplicative health care quality initiatives and instances of
8943
non-alignment in metrics used to measure health care quality that are required by different
8944
health systems;
8945
(e) solicit input from Utah health care providers, health systems, insurers, and other
8946
stakeholders on methods to avoid overuse of non-evidence-based health care; and
8947
(f) present the results of the analysis, research, and input described in Subsections
8948
(3)(a) through (e) to the committee.
8949
(4) The committee shall:
8950
(a) make recommendations for action and opportunities for improvement based on the
8951
results described in Subsection (3)(f);
8952
(b) make recommendations on methods to bring into alignment the various health care
8953
quality metrics different entities in the state use; and
8954
(c) identify priority issues and recommendations to include in an annual report.
8955
(5) The department, or the third party organization described in Subsection (3) shall:
8956
(a) compile the report described in Subsection (4)(c); and
8957
(b) submit the report to the committee for approval.
8958
(6) Beginning in 2021, on or before November 1 each year, the department shall
8959
submit the report approved in Subsection (5)(b) to the Health and Human Services Interim
8960
Committee.
8961
Section 290. Section 26B-8-514, which is renumbered from Section 26-70-102 is
8962
renumbered and amended to read:

+8963	[26-70-102].	26B-8-514. Standard health record access form.
+8964	(1) As used in this section:
+8965	(a) "HIPAA" means the Health Insurance Portability and Accountability Act of 1996,
+
+
+
+
+8966
Pub. L. No. 104-191, 110 Stat. 1936, as amended.
8967
(b) "Patient" means the individual whose information is being requested.
8968
(c) "Personal representative" means an individual described in 45 C.F.R. Sec.
8969
164.502(g).
8970
[(1)] (2) Before December 31, 2022, the department shall create a standard form that:
8971
(a) is compliant with HIPAA and 42 C.F.R. Part 2; and
8972
(b) a patient or a patient's personal representative may use to request that a copy of the
8973
patient's health records be sent to any of the following:
8974
(i) the patient;
8975
(ii) the patient's personal representative;
8976
(iii) the patient's attorney; or
8977
(iv) a third party authorized by the patient.
8978
[(2)] (3) The form described in Subsection (2) shall include fields for:
8979
(a) the patient's name;
8980
(b) the patient's date of birth;
8981
(c) the patient's phone number;
8982
(d) the patient's address;
8983
(e) (i) the patient's signature and date of signature, which may not require notarization;
8984
or
8985
(ii) the signature of the patient's personal representative and date of signature, which
8986
may not require notarization;
8987
(f) the name, address, and phone number of the person to which the information will be
8988
disclosed;
8989
(g) the records requested, including whether the patient is requesting paper or
8990
electronic records;
8991
(h) the duration of time the authorization is valid; and
8992
(i) the dates of service requested.

+
+8993
[(3)] (4) The form described in Subsection (2) shall include the following options for
8994
the field described in Subsection [(2)] (3)(g):
8995
(a) history and physical examination records;
8996
(b) treatment plans;
8997
(c) emergency room records;
8998
(d) radiology and lab reports;
8999
(e) operative reports;
9000
(f) pathology reports;
9001
(g) consultations;
9002
(h) discharge summary;
9003
(i) outpatient clinic records and progress notes;
9004
(j) behavioral health evaluation;
9005
(k) behavioral health discharge summary;
9006
(l) mental health therapy records;
9007
(m) financial information including an itemized billing statement;
9008
(n) health insurance claim form;
9009
(o) billing form; and
9010
(p) other.
9011
Section 291.  Coordinating S.B. 39 with S.B. 93 -- Substantive and technical
9012
amendments.
9013
If this S.B. 39 and S.B. 93, Birth Certificate Modifications, both pass and become law,
9014
it is the intent of the Legislature that on May 3, 2023, the Office of Legislative Research and
9015
General Counsel prepare the Utah Code database for publication by:
9016
(1) in Section 26B-8-101 in this bill:
9017
(a) enacting the amendment to Subsection 26-2-2(2) in S.B. 93 as a new Subsection
9018
26B-8-101(2) in this S.B. 39 that reads:
9019
"(2) "Biological sex at birth" means an individual's sex, as being male or female,

+
+
+
+9020
according to distinct reproductive roles as manifested by sex and reproductive organ anatomy,
9021
chromosomal makeup, and endogenous hormone profiles.";
9022
(b) enacting the amendment to Subsection 26-2-2(14) in S.B. 93 as a new Subsection
9023
26B-8-101(14) in this S.B. 39 that reads:
9024
"(14) "Intersex individual" means an individual who:
9025
(a) is born with external biological sex characteristics that are irresolvably ambiguous;
9026
(b) is born with 46, XX chromosomes with virilization;
9027
(c) is born with 46, XY chromosomes with undervirilization;
9028
(d) has both ovarian and testicular tissue; or
9029
(e) has been diagnosed by a physician, based on genetic or biochemical testing, with
9030
abnormal:
9031
(i) sex chromosome structure;
9032
(ii) sex steroid hormone production; or
9033
(iii) sex steroid hormone action for a male or female."; and
9034
(c) renumbering the subsections in Section 26B-8-101 accordingly; and
9035
(2) renumbering Section 26-2-11 in S.B. 93 to Section 26B-8-111.
9036
Section 292. Revisor instructions.
9037
The Legislature intends that the Office of Legislative Research and General Counsel, in
9038
preparing the Utah Code database for publication:
9039
(1) not enroll this bill if any of the following bills do not pass:
9040
(a) S.B. 38, Health and Human Services Recodification - Administration, Licensing,
9041
and Recovery Services;
9042
(b) S.B. 40, Health and Human Services Recodification - Health Care Delivery and
9043
Repeals; or
9044
(c) S.B. 41, Health and Human Services Recodification - Prevention, Supports,
9045
Substance Use and Mental Health; and
9046
(2) in any new language added to the Utah Code by legislation passed during the 2023

+
+9047	General Session, replace any references to Title 26 or 62A with the renumbered reference as it 9048	is renumbered in this bill.
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
diff --git a/assets/data-leg/SB0093.txt b/assets/data-leg/SB0093.txt
new file mode 100644
index 00000000..e00b7b30
--- /dev/null
+++ b/assets/data-leg/SB0093.txt
@@ -0,0 +1,279 @@
+Enrolled Copy	S.B. 93
+
+
+1 BIRTH CERTIFICATE MODIFICATIONS
+2 2023 GENERAL SESSION
+3 STATE OF UTAH
+4 Chief Sponsor: Daniel McCay
+5 House Sponsor: Brady Brammer
+6
+7 LONG TITLE
+8 General Description:
+9 This bill enacts provisions regarding amending birth certificates.
+10 Highlighted Provisions:
+11 This bill:
+12 ?	modifies the rulemaking authority of the Department of Health and Human Services
+13 (department) regarding when an error or omission to a vital record may be
+14 corrected;
+15 ?	allows the department to amend a birth certificate without a court order under
+16 certain circumstances;
+17 ?	creates the procedure a court must follow to grant a petition to amend the sex
+18 designation of a birth certificate;
+19 ?	requires the court to appoint a guardian ad litem before granting a petition to amend
+20 the sex designation of a birth certificate;
+21 ?	requires the department to issue an amended birth certificate that does not identify
+22 the fields that were amended; and
+23 ?	requires the department to issue an amendment history with a birth certificate.
+24 Money Appropriated in this Bill:
+25 None
+26 Other Special Clauses:
+27 This bill provides a special effective date.
+28 This bill provides a coordination clause.
+
+29 Utah Code Sections Affected:
+30 AMENDS:
+31 26-2-2, as last amended by Laws of Utah 2022, Chapter 415
+32 26-2-7, as last amended by Laws of Utah 2022, Chapter 231
+33 REPEALS AND REENACTS:
+34 26-2-11, as last amended by Laws of Utah 1995, Chapter 202
+35
+36 Be it enacted by the Legislature of the state of Utah:
+37 Section 1. Section 26-2-2 is amended to read:
+38 26-2-2.  Definitions.
+39 As used in this chapter:
+40 (1) "Adoption document" means an adoption-related document filed with the office, a
+41 petition for adoption, a decree of adoption, an original birth certificate, or evidence submitted
+42 in support of a supplementary birth certificate.
+43 (2) "Biological sex at birth" means an individual's sex, as being male or female,
+44 according to distinct reproductive roles as manifested by sex and reproductive organ anatomy,
+45 chromosomal makeup, and endogenous hormone profiles.
+46 [(2)] (3) "Certified nurse midwife" means an individual who:
+47 (a) is licensed to practice as a certified nurse midwife under Title 58, Chapter 44a,
+48 Nurse Midwife Practice Act; and
+49 (b) has completed an education program regarding the completion of a certificate of
+50 death developed by the department by rule made in accordance with Title 63G, Chapter 3, Utah
+51 Administrative Rulemaking Act.
+52 [(3)] (4) "Custodial funeral service director" means a funeral service director who:
+53 (a) is employed by a licensed funeral establishment; and
+54 (b) has custody of a dead body.
+55 [(4)] (5) "Dead body" or "decedent" means a human body or parts of the human body
+
+56 from the condition of which it reasonably may be concluded that death occurred.
+57 [(5)] (6) "Dead fetus" means a product of human conception, other than those
+58 circumstances described in Subsection 76-7-301(1):
+59 (a) of 20 weeks' gestation or more, calculated from the date the last normal menstrual
+60 period began to the date of delivery; and
+61 (b) that was not born alive.
+62 [(6)] (7) "Declarant father" means a male who claims to be the genetic father of a child,
+63 and, along with the biological mother, signs a voluntary declaration of paternity to establish the
+64 child's paternity.
+65 [(7)] (8) "Dispositioner" means:
+66 (a) a person designated in a written instrument, under Subsection 58-9-602(1), as
+67 having the right and duty to control the disposition of the decedent, if the person voluntarily
+68 acts as the dispositioner; or
+69 (b) the next of kin of the decedent, if:
+70 (i) (A) a person has not been designated as described in Subsection [(7)] (8)(a); or
+71 (B) the person described in Subsection [(7)] (8)(a) is unable or unwilling to exercise
+72 the right and duty described in Subsection [(7)] (8)(a); and
+73 (ii) the next of kin voluntarily acts as the dispositioner.
+74 [(8)] (9) "Fetal remains" means:
+75 (a) an aborted fetus as that term is defined in Section 26-21-33; or
+76 (b) a miscarried fetus as that term is defined in Section 26-21-34.
+77 [(9)] (10) "File" means the submission of a completed certificate or other similar
+78 document, record, or report as provided under this chapter for registration by the state registrar
+79 or a local registrar.
+80 [(10)] (11) "Funeral service director" means the same as that term is defined in Section
+81	58-9-102.
+82	[(11)] (12) "Health care facility" means the same as that term is defined in Section
+
+83	26-21-2.
+84 [(12)] (13) "Health care professional" means a physician, physician assistant, nurse
+85 practitioner, or certified nurse midwife.
+86 (14) "Intersex individual" means an individual who:
+87 (a) is born with external biological sex characteristics that are irresolvably ambiguous;
+88 (b) is born with 46, XX chromosomes with virilization;
+89 (c) is born with 46, XY chromosomes with undervirilization;
+90 (d) has both ovarian and testicular tissue; or
+91 (e) has been diagnosed by a physician, based on genetic or biochemical testing, with
+92 abnormal:
+93 (i) sex chromosome structure;
+94 (ii) sex steroid hormone production; or
+95 (iii) sex steroid hormone action for a male or female.
+96 [(13)] (15) "Licensed funeral establishment" means:
+97 (a) if located in Utah, a funeral service establishment, as that term is defined in Section
+98 58-9-102, that is licensed under Title 58, Chapter 9, Funeral Services Licensing Act; or
+99 (b) if located in a state, district, or territory of the United States other than Utah, a
+100 funeral service establishment that complies with the licensing laws of the jurisdiction where the
+101 establishment is located.
+102 [(14)] (16) "Live birth" means the birth of a child who shows evidence of life after the
+103 child is entirely outside of the mother.
+104 [(15)] (17) "Local registrar" means a person appointed under Subsection 26-2-3(3)(b).
+105 [(16)] (18) "Nurse practitioner" means an individual who:
+106 (a) is licensed to practice as an advanced practice registered nurse under Title 58,
+107 Chapter 31b, Nurse Practice Act; and
+108 (b) has completed an education program regarding the completion of a certificate of
+109 death developed by the department by administrative rule made in accordance with Title 63G,
+
+110 Chapter 3, Utah Administrative Rulemaking Act.
+111 [(17)] (19) "Office" means the Office of Vital Records and Statistics within the
+112 Department of Health, operating under Title 26, Chapter 2, Utah Vital Statistics Act.
+113 [(18)] (20) "Physician" means a person licensed to practice as a physician or osteopath
+114 in this state under Title 58, Chapter 67, Utah Medical Practice Act, or Title 58, Chapter 68,
+115 Utah Osteopathic Medical Practice Act.
+116 [(19)] (21) "Physician assistant" means an individual who:
+117 (a) is licensed to practice as a physician assistant under Title 58, Chapter 70a, Utah
+118 Physician Assistant Act; and
+119 (b) has completed an education program regarding the completion of a certificate of
+120 death developed by the department by administrative rule made in accordance with Title 63G,
+121 Chapter 3, Utah Administrative Rulemaking Act.
+122 [(20)] (22) "Presumed father" means the father of a child conceived or born during a
+123 marriage as defined in Section 30-1-17.2.
+124 [(21)] (23) "Registration" or "register" means acceptance by the local or state registrar
+125 of a certificate and incorporation of the certificate into the permanent records of the state.
+126 [(22)] (24) "State registrar" means the state registrar of vital records appointed under
+127	Subsection 26-2-3(2)(e).
+128 [(23)] (25) "Vital records" means:
+129 (a) registered certificates or reports of birth, death, fetal death, marriage, divorce,
+130 dissolution of marriage, or annulment;
+131 (b) amendments to any of the registered certificates or reports described in Subsection
+132	[(23)] (25)(a);
+133 (c) an adoption document; and
+134 (d) other similar documents.
+135 [(24)] (26) "Vital statistics" means the data derived from registered certificates and
+136 reports of birth, death, fetal death, induced termination of pregnancy, marriage, divorce,
+
+137 dissolution of marriage, or annulment.
+138 Section 2. Section 26-2-7 is amended to read:
+139 26-2-7.  Correction of errors or omissions in vital records -- Conflicting birth and
+140 foundling certificates -- Administrative birth certificate amendment -- Rulemaking.
+141 (1) In accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking
+142 Act, the department may make rules:
+143 [(1)] (a) governing applications to correct alleged errors or omissions on any vital
+144 record;
+145 [(2)] (b) establishing procedures to resolve conflicting birth and foundling certificates;
+146 [and]
+147 [(3)] (c) allowing for the correction and reissuance of a vital record that was originally
+148 created omitting a diacritical mark[.]; and
+149 (d) notwithstanding any other provision of law, allowing for the change of a child's
+150 name on the child's birth certificate within one year from the day the child is born.
+151 (2) For a birth certificate, the department may correct an error or omission under
+152 Subsection (1)(a) if:
+153 (a) the error or omission is a result of a scrivener's error or a data entry error; and
+154 (b) the department receives:
+155 (i) (A) an affidavit from the applicant attesting that there is an error on the birth
+156 certificate;
+157 (B) supporting documentation from the health care facility or attending health care
+158 provider; and
+159 (C) an affidavit from the health care facility or health care provider described in
+160 Subsection (2)(b)(i)(B) attesting to the accuracy of the supporting documentation; or
+161 (ii) documentation deemed sufficient by the state registrar to establish the facts of the
+162 error or omission.
+163 (3) The department may amend a birth certificate's sex designation for an intersex
+
+164 individual at the request of the individual or the guardian of the individual if:
+165 (a) the sex designation indicating the biological sex at birth of the individual was
+166 misidentified on the original certificate due to the individual's condition; and
+167 (b) the department receives:
+168 (i) a correction affidavit attesting the individual is intersex;
+169 (ii) chromosomal, molecular, karyotypic, DNA, or genetic testing results that confirm
+170 the individual is intersex; and
+171 (iii) an affidavit from the health care facility, health care professional, or laboratory
+172 testing facility that conducted the test or analyzed the test results, attesting to the test results
+173 and accuracy.
+174 Section 3. Section 26-2-11 is repealed and reenacted to read:
+175 26-2-11.  Birth certificate name or sex designation change -- Registration of court
+176 order and amendment of birth certificate.
+177 (1) An individual may obtain a court order in accordance with Title 42, Names, to
+178 change the name on the individual's birth certificate.
+179 (2) (a) A court may grant a petition ordering a sex designation change on a birth
+180 certificate if the court determines by clear and convincing evidence that the individual seeking
+181 the sex designation change:
+182 (i) is not involved in any kind of lawsuit;
+183 (ii) is not on probation or parole;
+184 (iii) is not seeking the amendment:
+185 (A) to commit a crime;
+186 (B) to interfere with the rights of others;
+187 (C) to avoid creditors;
+188 (D) to influence the sentence, fine, or conditions of imprisonment in a criminal case;
+189 (E) to commit fraud on the public; or
+190 (F) for any other fraudulent purpose;
+
+191 (iv) has transitioned from the sex designation of the biological sex at birth to the sex
+192 sought in the petition;
+193 (v) has outwardly expressed as the sex sought in the petition in a consistent and
+194 uniform manner for at least six months; and
+195 (vi) suffers from clinically significant distress or impairment due to the current sex
+196 designation on the birth certificate.
+197 (b) The court shall consider the following when making the determination described in
+198 Subsection (2)(a)(iv):
+199 (i) evidence of medical history, care, or treatment related to sex transitioning; and
+200 (ii) evidence that the sex sought in the petition is sincerely held and part of the
+201 individual's core identity.
+202 (3) (a) (i) When determining whether to grant a sex designation change for a child who
+203 is at least 15 years and six months old, unless the child is emancipated, the court shall appoint,
+204 notwithstanding Subsection 78A-2-703(1), a guardian ad litem for the child.
+205 (ii) Notwithstanding Subsection 78A-2-703(7), the child's parent or guardian is
+206 responsible for the costs of the guardian ad litem's services unless the court determines the
+207 parent or guardian is indigent in accordance with Section 78A-2-302.
+
+208 (b) The guardian ad litem shall provide the court relevant evidence, whether submitted
+209 by the child or other sources of evidence, regarding the following:
+210 (i) whether the child is capable of making decisions with long-term consequences
+211 independently of the child's parent or guardian;
+212 (ii) whether the child is mature and capable of appreciating the implications of the
+213 decision to change the sex designation on the child's birth certificate; and
+214 (iii) whether the child meets the other requirements of this section.
+215 (c) The guardian of a child described in Subsection (3)(a) shall:
+216 (i) give notice of the proceeding to any known parent of the child; and
+217 (ii) provide the court with a declaration of the status of any divorce or custody matter
+
+218 pertaining to the child, including the case name, case number, court, judge, and current status
+219 of the case.
+220 (d) The court shall:
+221 (i) consider any objection given by a parent;
+222 (ii) close the hearing on a petition for a sex designation change;
+223 (iii) receive all evidence; and
+224 (iv) make a determination as to whether:
+225 (A) all of the requirements of Subsection (2) have been met; and
+226 (B) the evidence supports a finding by clear and convincing evidence that the sex
+227 designation change is in the best interest of the child and would not create a risk of harm to the
+228 minor.
+229 (4) (a) A court may not grant a petition for a sex designation change if:
+230 (i) the birth certificate is for a child who is younger than 15 years and six months old;
+231 or
+232 (ii) the child's parent or guardian with legal custody has not given permission.
+233 (b) An order granting a sex designation change under this section is not effective until
+234 the individual is at least 16 years old.
+235 (5) A petition for a sex designation under this section may be combined with a petition
+236 under Title 42, Names.
+237 (6) (a) Upon the receipt of a certified order granting a birth certificate amendment, any
+238 required application, and an appropriate fee, the department shall issue:
+239 (i) a birth certificate that does not indicate which fields were amended unless requested
+240 by the individual; and
+241 (ii) an amendment history of the birth certificate, including the fields of the birth
+242 certificate that have been amended and the date of the amendment.
+243 (b) The department shall retain a record of all amendments to a birth certificate,
+244 including any amendment history issued by the department.
+
+245 (7) The provisions of this section are severable.
+246 (8) This section only applies to birth certificates issued by the state.
+247 Section 4. Effective date.
+248 If approved by two-thirds of all the members elected to each house, this bill takes effect
+249 upon approval by the governor, or the day following the constitutional time limit of Utah
+250 Constitution, Article VII, Section 8, without the governor's signature, or in the case of a veto,
+251 the date of veto override.
+252 Section 5.  Coordinating S.B. 93 with H.B. 209 -- Substantive and technical
+253 amendments.
+254 If this S.B. 93 and H.B. 209, Participation in Extracurricular Activities Amendments,
+255 both pass and become law, it is the intent of the Legislature that the Office of Legislative
+256 Research and General Counsel shall prepare the Utah Code database for publication by
+257 replacing each reference to "birth certificate" in Section 53G-7-1102 with "birth certificate and
+258 birth certificate amendment history".
+
+
+
+
+
+
+
+
diff --git a/assets/data-leg/clean_line_0016_df.csv b/assets/data-leg/clean_line_0016_df.csv
new file mode 100644
index 00000000..e81d15cd
--- /dev/null
+++ b/assets/data-leg/clean_line_0016_df.csv
@@ -0,0 +1,743 @@
+text
+enrolled copy s b
+
+
+transgender medical treatments and procedures
+amendments
+general session
+state of utah
+chief sponsor michael s kennedy
+house sponsor katy hall
+
+long title
+general description
+this bill enacts provisions regarding transgender medical treatments and procedures
+highlighted provisions
+this bill
+defines terms
+requires the department of health and human services to conduct a systematic
+review of the medical evidence regarding hormonal transgender treatments and
+provide recommendations to the legislature
+requires the division of professional licensing to create a certification for
+providing hormonal transgender treatments
+requires a health care provider to meet certain requirements before providing a
+hormonal transgender treatment
+prohibits a health care provider from providing a hormonal transgender treatment to
+new patients who were not diagnosed with gender dysphoria before a certain date
+prohibits performing sex characteristic surgical procedures on a minor for the
+purpose of effectuating a sex change
+specifies that an individual may bring a medical malpractice action related to certain
+medical treatments and procedures
+specifies that an individual may disaffirm consent under certain circumstances
+allows an individual to bring a medical malpractice action for treatment provided to
+
+the individual as a minor if the individual later disaffirms consent
+extends the medical malpractice statute of limitations related to providing certain
+medical treatments and procedures and
+makes technical changes
+money appropriated in this bill
+none
+other special clauses
+this bill provides a special effective date
+this bill provides revisor instructions
+utah code sections affected
+amends
+as last amended by laws of utah chapter
+as last amended by laws of utah chapter
+as last amended by laws of utah chapter
+as last amended by laws of utah chapter
+enacts
+b utah code annotated
+utah code annotated
+utah code annotated
+b utah code annotated
+utah code sections affected by revisor instructions
+utah code annotated
+b utah code annotated
+
+be it enacted by the legislature of the state of utah
+section section b is enacted to read
+b systematic medical evidence review of hormonal transgender
+
+treatments
+as used in this section hormonal transgender treatment means the same as that
+term is defined in section
+
+the department in consultation with the division of professional licensing created
+in section the physicians licensing board created in section the
+osteopathic physician and surgeon s licensing board created in section the
+university of utah and a non profit hospital system with multiple hospitals in utah and
+experience in specialty pediatric care shall conduct a systematic medical evidence review
+regarding the provision of hormonal transgender treatments to minors
+the purpose of the systematic medical evidence review is to provide the legislature
+with recommendations to consider when deciding whether to lift the moratorium described in
+section
+
+the systematic medical evidence review shall
+a analyze hormonal transgender treatments that are prescribed to a minor with gender
+dysphoria including
+i analyzing any effects and side effects of the treatment and
+ii whether each treatment has been approved by the federal food and drug
+administration to treat gender dysphoria
+b review the scientific literature regarding hormonal transgender treatments in
+minors including short term and long term impacts literature from other countries and rates
+of desistence and time to desistence where applicable
+c review the quality of evidence cited in any scientific literature including to analyze
+and report on the quality of the data based on techniques such as peer review selection bias
+self selection bias randomization sample size and other applicable best research practices
+d include high quality clinical research assessing the short term and long term
+benefits and harms of hormonal transgender treatments prescribed to minors with gender
+dysphoria and the short term and long term benefits and harms of interrupting the natural
+
+puberty and development processes of the child
+e specify the conditions under which the department recommends that a treatment not
+be permitted
+f recommend what information a minor and the minor s parent should understand
+before consenting to a hormonal transgender treatment
+g recommend the best practices a health care provider should follow to provide the
+information described in subsection f
+h describe the assumptions and value determinations used to reach a
+recommendation and
+i include any other information the department in consultation with the entities
+described in subsection determines would assist the legislature in enacting legislation
+related to the provision of hormonal transgender treatment to minors
+upon the completion of the systematic medical evidence review the department
+shall provide the systematic medical evidence review to the health and human services
+interim committee
+section section is enacted to read
+hormonal transgender treatment on minors requirements
+as used in this section
+a approved organization means an organization with expertise regarding
+transgender health care for minors that is approved by the division
+b biological sex at birth means an individual s sex as being male or female
+according to distinct reproductive roles as manifested by sex and reproductive organ anatomy
+chromosomal makeup and endogenous hormone profiles
+c disorder of sexual development means a sexual development disorder where an
+individual
+i is born with external biological sex characteristics that are irresolvably ambiguous
+ii is born with xx chromosomes with virilization
+
+iii is born with xy chromosomes with undervirilization
+iv has both ovarian and testicular tissue or
+v has been diagnosed by a physician based on genetic or biochemical testing with
+abnormal
+a sex chromosome structure
+b sex steroid hormone production or
+c sex steroid hormone action for a male or female
+d health care provider means
+i a physician
+ii a physician assistant licensed under chapter a utah physician assistant act or
+iii an advanced practice registered nurse licensed under subsection b e
+e i hormonal transgender treatment means administering prescribing or
+supplying for effectuating or facilitating an individual s attempted sex change
+a to an individual whose biological sex at birth is female a dose of testosterone or
+other androgens at levels above those normally found in an individual whose biological sex at
+birth is female
+b to an individual whose biological sex at birth is male a dose of estrogen or a
+synthetic compound with estrogenic activity or effect at levels above those normally found in
+an individual whose biological sex at birth is male or
+c a puberty inhibition drug
+ii hormonal transgender treatment does not include administering prescribing or
+supplying a substance described in subsection e i to an individual if the treatment is
+medically necessary as a treatment for
+a precocious puberty
+b endometriosis
+c a menstrual ovarian or uterine disorder
+d a sex hormone stimulated cancer or
+
+e a disorder of sexual development
+f mental health professional means any of the following
+i a physician who is board certified for a psychiatry specialization recognized by the
+american board of medical specialists or the american osteopathic association s bureau of
+osteopathic specialists
+ii a psychologist licensed under chapter psychologist licensing act
+iii a clinical social worker licensed under chapter part social worker
+licensing act
+iv a marriage and family therapist licensed under chapter part marriage and
+family therapist licensing act or
+v a clinical mental health counselor licensed under chapter part clinical
+mental health counselor licensing act
+g minor means an individual who is less than years old
+h physician means an individual licensed under
+i chapter utah medical practice act or
+ii chapter utah osteopathic medical practice act
+i puberty inhibition drug means any of the following alone or in combination with
+aromatase inhibitors
+i gonadotropin releasing hormone agonists or
+ii androgen receptor inhibitors
+j transgender treatment certification means a certification described in subsection
+
+a the division shall create a transgender treatment certification on or before july
+
+b the division may issue the transgender treatment certification to an individual if the
+individual
+i is a health care provider or a mental health professional and
+
+ii has completed at least hours of education related to transgender health care for
+minors from an approved organization
+c the division may renew a transgender treatment certification
+i at the time an individual renews the individual s license and
+ii if the individual has completed at least hours of continuing education related to
+transgender health care for minors from an approved organization during the individual s
+continuing education cycle
+d beginning january providing a hormonal transgender treatment to a minor
+without a transgender treatment certification is unprofessional conduct
+a a health care provider may provide a hormonal transgender treatment to a
+minor only if the health care provider has been treating the minor for gender dysphoria for at
+least six months
+b beginning july before providing a hormonal transgender treatment to a
+minor described in subsection a a health care provider shall
+i determine if the minor has other physical or mental health conditions identify and
+document any condition and consider whether treating those conditions before treating the
+gender dysphoria would provide the minor the best long term outcome
+ii consider whether an alternative medical treatment or behavioral intervention to
+treat the minor s gender dysphoria would provide the minor the best long term outcome
+iii document in the medical record that
+a the health care provider has complied with subsections b i and ii and
+b providing the hormonal transgender treatment will likely result in the best
+long term outcome for the minor
+iv obtain written consent from
+a the minor and
+b the minor s parent or guardian unless the minor is emancipated
+v discuss with the minor
+
+a the risks of the hormonal transgender treatment
+b the minor s short term and long term expectations regarding the effect that the
+hormonal transgender treatment will have on the minor and
+c the likelihood that the hormonal transgender treatment will meet the short term and
+long term expectations described in subsection b v b
+vi unless the minor is emancipated discuss with the minor s parent or guardian
+a the risks of the hormonal transgender treatment
+b the minor s short term and long term expectations regarding the effect that the
+hormonal transgender treatment will have on the minor
+c the parent or guardian s short term and long term expectations regarding the effect
+that the hormonal transgender treatment will have on the minor and
+d the likelihood that the hormonal transgender treatment will meet the short term and
+long term expectations described in subsections b vi b and c
+vii document in the medical record that the health care provider has provided the
+information described in subsections b viii and ix
+viii provide the minor the following information if providing the minor a puberty
+inhibition drug
+a puberty inhibition drugs are not approved by the fda for the treatment of gender
+dysphoria
+b possible adverse outcomes of puberty blockers are known to include diminished
+bone density pseudotumor cerebri and long term adult sexual dysfunction
+c research on the long term risks to children of prolonged treatment with puberty
+blockers for the treatment of gender dysphoria has not yet occurred and
+d the full effects of puberty blockers on brain development and cognition are
+unknown
+ix provide the minor the following information if providing a cross sex hormone as
+described in subsection e i a or b
+
+a the use of cross sex hormones in males is associated with risks that include blood
+clots gallstones coronary artery disease heart attacks tumors of the pituitary gland strokes
+elevated levels of triglycerides in the blood breast cancer and irreversible infertility and
+b the use of cross sex hormones in females is associated with risks of erythrocytosis
+severe liver dysfunction coronary artery disease hypertension and increased risk of breast and
+uterine cancers and
+x upon the completion of any relevant information privacy release obtain a mental
+health evaluation of the minor as described in subsection
+the mental health evaluation shall
+a be performed by a mental health professional who
+i beginning january has a current transgender treatment certification and
+ii is not the health care provider that is recommending or providing the hormonal
+transgender treatment
+b contain a determination regarding whether the minor suffers from gender dysphoria
+in accordance with the fifth edition of the diagnostic and statistical manual of mental
+disorders
+c confirm that the minor and the mental health professional have had at least three
+therapy sessions and
+d document all of the minor s mental health diagnoses and any significant life events
+that may be contributing to the diagnoses
+a violation of subsection is unprofessional conduct
+section section is enacted to read
+hormonal transgender treatment moratorium
+as used in this section
+a health care provider means the same as that term is defined in section
+
+b hormonal transgender treatment means the same as that term is defined in
+section
+
+
+a health care provider may not provide a hormonal transgender treatment to a
+patient who
+a is a minor as defined in section and
+b is not diagnosed with gender dysphoria before the effective date of this bill
+a violation of subsection is unprofessional conduct
+section section is amended to read
+definitions
+in addition to the definitions in section as used in this chapter
+a ablative procedure means a procedure that is expected to excise vaporize
+disintegrate or remove living tissue including the use of carbon dioxide lasers and erbium
+yag lasers
+b ablative procedure does not include hair removal
+acgme means the accreditation council for graduate medical education of the
+american medical association
+administrative penalty means a monetary fine or citation imposed by the division
+for acts or omissions determined to constitute unprofessional or unlawful conduct in
+accordance with a fine schedule established by the division in collaboration with the board as a
+result of an adjudicative proceeding conducted in accordance with title g chapter
+administrative procedures act
+associate physician means an individual licensed under section
+attempted sex change means an attempt or effort to change an individual s body
+to present that individual as being of a sex or gender that is different from the individual s
+biological sex at birth
+biological sex at birth means an individual s sex as being male or female
+according to distinct reproductive roles as manifested by
+a sex and reproductive organ anatomy
+b chromosomal makeup and
+
+c endogenous hormone profiles
+board means the physicians licensing board created in section
+collaborating physician means an individual licensed under section
+who enters into a collaborative practice arrangement with an associate physician
+collaborative practice arrangement means the arrangement described in
+section
+a cosmetic medical device means tissue altering energy based devices
+that have the potential for altering living tissue and that are used to perform ablative or
+nonablative procedures such as american national standards institute ansi designated
+class iiib and class iv lasers intense pulsed light radio frequency devices and lipolytic
+devices and excludes ansi designated class iiia and lower powered devices
+b notwithstanding subsection a a if an ansi designated class iiia and
+lower powered device is being used to perform an ablative procedure the device is included in
+the definition of cosmetic medical device under subsection a a
+cosmetic medical procedure
+a includes the use of cosmetic medical devices to perform ablative or nonablative
+procedures and
+b does not include a treatment of the ocular globe such as refractive surgery
+diagnose means
+a to examine in any manner another person parts of a person s body substances
+fluids or materials excreted taken or removed from a person s body or produced by a person s
+body to determine the source nature kind or extent of a disease or other physical or mental
+condition
+b to attempt to conduct an examination or determination described under subsection
+a a
+c to hold oneself out as making or to represent that one is making an examination or
+determination as described in subsection a a or
+
+d to make an examination or determination as described in subsection a
+a upon or from information supplied directly or indirectly by another person whether or
+not in the presence of the person making or attempting the diagnosis or examination
+lcme means the liaison committee on medical education of the
+american medical association
+medical assistant means an unlicensed individual who may perform tasks
+as described in subsection
+medically underserved area means a geographic area in which there is a
+shortage of primary care health services for residents as determined by the department of
+health and human services
+medically underserved population means a specified group of people
+living in a defined geographic area with a shortage of primary care health services as
+determined by the department of health and human services
+a i nonablative procedure means a procedure that is expected or
+intended to alter living tissue but is not intended or expected to excise vaporize disintegrate
+or remove living tissue
+ii notwithstanding subsection a i a i nonablative procedure includes
+hair removal
+b nonablative procedure does not include
+i a superficial procedure as defined in section
+ii the application of permanent make up or
+iii the use of photo therapy and lasers for neuromusculoskeletal treatments that are
+performed by an individual licensed under this title who is acting within the individual s scope
+of practice
+physician means both physicians and surgeons licensed under section
+utah medical practice act and osteopathic physicians and surgeons licensed under
+section utah osteopathic medical practice act
+
+a practice of medicine means
+i to diagnose treat correct administer anesthesia or prescribe for any human
+disease ailment injury infirmity deformity pain or other condition physical or mental real
+or imaginary including to perform cosmetic medical procedures or to attempt to do so by any
+means or instrumentality and by an individual in utah or outside the state upon or for any
+human within the state
+ii when a person not licensed as a physician directs a licensee under this chapter to
+withhold or alter the health care services that the licensee has ordered
+iii to maintain an office or place of business for the purpose of doing any of the acts
+described in subsection a a i or ii whether or not for compensation or
+iv to use in the conduct of any occupation or profession pertaining to the diagnosis or
+treatment of human diseases or conditions in any printed material stationery letterhead
+envelopes signs or advertisements the designation doctor doctor of medicine
+physician surgeon physician and surgeon dr m d or any combination of these
+designations in any manner which might cause a reasonable person to believe the individual
+using the designation is a licensed physician and surgeon and if the party using the designation
+is not a licensed physician and surgeon the designation must additionally contain the
+description of the branch of the healing arts for which the person has a license provided that an
+individual who has received an earned degree of doctor of medicine degree but is not a licensed
+physician and surgeon in utah may use the designation m d if it is followed by not
+licensed or not licensed in utah in the same size and style of lettering
+b the practice of medicine does not include
+i except for an ablative medical procedure as provided in subsection b ii
+b ii the conduct described in subsection a i a i that is performed in
+accordance with a license issued under another chapter of this title
+ii an ablative cosmetic medical procedure if the scope of practice for the person
+performing the ablative cosmetic medical procedure includes the authority to operate or
+
+perform a surgical procedure or
+iii conduct under subsection
+prescription device means an instrument apparatus implement machine
+contrivance implant in vitro reagent or other similar or related article and any component
+part or accessory which is required under federal or state law to be prescribed by a practitioner
+and dispensed by or through a person or entity licensed under this chapter or exempt from
+licensure under this chapter
+prescription drug means a drug that is required by federal or state law or
+rule to be dispensed only by prescription or is restricted to administration only by practitioners
+a primary sex characteristic surgical procedure means any of the following if
+done for the purpose of effectuating or facilitating an individual s attempted sex change
+i for an individual whose biological sex at birth is male castration orchiectomy
+penectomy vaginoplasty or vulvoplasty
+ii for an individual whose biological sex at birth is female hysterectomy
+oophorectomy metoidioplasty or phalloplasty or
+iii any surgical procedure that is related to or necessary for a procedure described in
+subsection a i or ii that would result in the sterilization of an individual who is not
+sterile
+b primary sex characteristic surgical procedure does not include
+i surgery or other procedures or treatments performed on an individual who
+a is born with external biological sex characteristics that are irresolvably ambiguous
+b is born with xx chromosomes with virilization
+c is born with xy chromosomes with undervirilization
+d has both ovarian and testicular tissue or
+e has been diagnosed by a physician based on genetic or biochemical testing with a
+sex development disorder characterized by abnormal sex chromosome structure sex steroid
+hormone production or sex steroid hormone action for a male or female or
+
+ii removing a body part
+a because the body part is cancerous or diseased or
+b for a reason that is medically necessary other than to effectuate or facilitate an
+individual s attempted sex change
+a secondary sex characteristic surgical procedure means any of the following
+if done for the purpose of effectuating or facilitating an individual s attempted sex change
+i for an individual whose biological sex at birth is male breast augmentation surgery
+chest feminization surgery or facial feminization surgery or
+ii for an individual whose biological sex at birth is female mastectomy breast
+reduction surgery chest masculinization surgery or facial masculinization surgery
+b secondary sex characteristic surgical procedure does not include
+i surgery or other procedures or treatments performed on an individual who
+a is born with external biological sex characteristics that are irresolvably ambiguous
+b is born with xx chromosomes with virilization
+c is born with xy chromosomes with undervirilization
+d has both ovarian and testicular tissue or
+e has been diagnosed by a physician based on genetic or biochemical testing with a
+sex development disorder characterized by abnormal sex chromosome structure sex steroid
+hormone production or sex steroid hormone action for a male or female or
+ii removing a body part
+a because the body part is cancerous or diseased or
+b for a reason that is medically necessary other than to effectuate or facilitate an
+individual s attempted sex change
+spex means the special purpose examination of the federation of state
+medical boards
+unlawful conduct means the same as that term is defined in sections
+and
+
+unprofessional conduct means the same as that term is defined in
+sections and and as may be further defined by division rule
+section section is amended to read
+unprofessional conduct
+unprofessional conduct includes in addition to the definition in section
+
+a using or employing the services of any individual to assist a licensee in any manner
+not in accordance with the generally recognized practices standards or ethics of the
+profession state law or division rule
+b making a material misrepresentation regarding the qualifications for licensure under
+section or section
+c violating the dispensing requirements of chapter b part dispensing medical
+practitioner and dispensing medical practitioner clinic pharmacy if applicable
+d violating the requirements of title chapter a utah medical cannabis act
+or
+e falsely making an entry in or altering a medical record with the intent to conceal
+i a wrongful or negligent act or omission of an individual licensed under this chapter
+or an individual under the direction or control of an individual licensed under this chapter or
+ii conduct described in subsections a through d or subsection
+
+or
+f performing or causing to be performed upon an individual who is less than
+years old
+i a primary sex characteristic surgical procedure or
+ii a secondary sex characteristic surgical procedure
+unprofessional conduct does not include
+a in compliance with section
+i obtaining an investigational drug or investigational device
+
+ii administering the investigational drug to an eligible patient or
+iii treating an eligible patient with the investigational drug or investigational device
+or
+b in accordance with title chapter a utah medical cannabis act
+i when registered as a qualified medical provider or acting as a limited medical
+provider as those terms are defined in section a recommending the use of medical
+cannabis
+ii when registered as a pharmacy medical provider as that term is defined in section
+a providing pharmacy medical provider services in a medical cannabis pharmacy or
+iii when registered as a state central patient portal medical provider as that term is
+defined in section a providing state central patient portal medical provider services
+notwithstanding subsection b the division in consultation with the board and
+in accordance with title g chapter utah administrative rulemaking act shall define
+unprofessional conduct for a physician described in subsection b
+section section is amended to read
+definitions
+in addition to the definitions in section as used in this chapter
+a ablative procedure means a procedure that is expected to excise vaporize
+disintegrate or remove living tissue including the use of carbon dioxide lasers and erbium
+yag lasers
+b ablative procedure does not include hair removal
+acgme means the accreditation council for graduate medical education of the
+american medical association
+administrative penalty means a monetary fine imposed by the division for acts or
+omissions determined to constitute unprofessional or unlawful conduct as a result of an
+adjudicative proceeding conducted in accordance with title g chapter administrative
+procedures act
+
+aoa means the american osteopathic association
+associate physician means an individual licensed under section
+attempted sex change means an attempt or effort to change an individual s body
+to present that individual as being of a sex or gender that is different from the individual s
+biological sex at birth
+biological sex at birth means an individual s sex as being male or female
+according to distinct reproductive roles as manifested by
+a sex and reproductive organ anatomy
+b chromosomal makeup and
+c endogenous hormone profiles
+board means the osteopathic physician and surgeon s licensing board
+created in section
+collaborating physician means an individual licensed under section
+who enters into a collaborative practice arrangement with an associate physician
+collaborative practice arrangement means the arrangement described in
+section
+a cosmetic medical device means tissue altering energy based devices
+that have the potential for altering living tissue and that are used to perform ablative or
+nonablative procedures such as american national standards institute ansi designated
+class iiib and class iv lasers intense pulsed light radio frequency devices and lipolytic
+devices and excludes ansi designated class iiia and lower powered devices
+b notwithstanding subsection a a if an ansi designated class iiia and
+lower powered device is being used to perform an ablative procedure the device is included in
+the definition of cosmetic medical device under subsection a a
+cosmetic medical procedure
+a includes the use of cosmetic medical devices to perform ablative or nonablative
+procedures and
+
+b does not include a treatment of the ocular globe such as refractive surgery
+diagnose means
+a to examine in any manner another person parts of a person s body substances
+fluids or materials excreted taken or removed from a person s body or produced by a person s
+body to determine the source nature kind or extent of a disease or other physical or mental
+condition
+b to attempt to conduct an examination or determination described under subsection
+a a
+c to hold oneself out as making or to represent that one is making an examination or
+determination as described in subsection a a or
+d to make an examination or determination as described in subsection a
+a upon or from information supplied directly or indirectly by another person whether or
+not in the presence of the person making or attempting the diagnosis or examination
+medical assistant means an unlicensed individual who may perform tasks
+as described in subsection
+medically underserved area means a geographic area in which there is a
+shortage of primary care health services for residents as determined by the department of
+health and human services
+medically underserved population means a specified group of people
+living in a defined geographic area with a shortage of primary care health services as
+determined by the department of health and human services
+a i nonablative procedure means a procedure that is expected or
+intended to alter living tissue but is not expected or intended to excise vaporize disintegrate
+or remove living tissue
+ii notwithstanding subsection a i a i nonablative procedure includes
+hair removal
+b nonablative procedure does not include
+
+i a superficial procedure as defined in section
+ii the application of permanent make up or
+iii the use of photo therapy lasers for neuromusculoskeletal treatments that are
+preformed performed by an individual licensed under this title who is acting within the
+individual s scope of practice
+physician means both physicians and surgeons licensed under section
+utah medical practice act and osteopathic physicians and surgeons licensed under
+section utah osteopathic medical practice act
+a practice of osteopathic medicine means
+i to diagnose treat correct administer anesthesia or prescribe for any human
+disease ailment injury infirmity deformity pain or other condition physical or mental real
+or imaginary or to attempt to do so by any means or instrumentality which in whole or in part
+is based upon emphasis of the importance of the musculoskeletal system and manipulative
+therapy in the maintenance and restoration of health by an individual in utah or outside of the
+state upon or for any human within the state
+ii when a person not licensed as a physician directs a licensee under this chapter to
+withhold or alter the health care services that the licensee has ordered
+iii to maintain an office or place of business for the purpose of doing any of the acts
+described in subsection a a i or ii whether or not for compensation or
+iv to use in the conduct of any occupation or profession pertaining to the diagnosis or
+treatment of human diseases or conditions in any printed material stationery letterhead
+envelopes signs or advertisements the designation doctor doctor of osteopathic medicine
+osteopathic physician osteopathic surgeon osteopathic physician and surgeon dr
+d o or any combination of these designations in any manner which might cause a
+reasonable person to believe the individual using the designation is a licensed osteopathic
+physician and if the party using the designation is not a licensed osteopathic physician the
+designation must additionally contain the description of the branch of the healing arts for which
+
+the person has a license provided that an individual who has received an earned degree of
+doctor of osteopathic medicine but is not a licensed osteopathic physician and surgeon in utah
+may use the designation d o if it is followed by not licensed or not licensed in utah
+in the same size and style of lettering
+b the practice of osteopathic medicine does not include
+i except for an ablative medical procedure as provided in subsection b ii
+b ii the conduct described in subsection a i a i that is performed in
+accordance with a license issued under another chapter of this title
+ii an ablative cosmetic medical procedure if the scope of practice for the person
+performing the ablative cosmetic medical procedure includes the authority to operate or
+perform a surgical procedure or
+iii conduct under subsection
+prescription device means an instrument apparatus implement machine
+contrivance implant in vitro reagent or other similar or related article and any component
+part or accessory which is required under federal or state law to be prescribed by a practitioner
+and dispensed by or through a person or entity licensed under this chapter or exempt from
+licensure under this chapter
+prescription drug means a drug that is required by federal or state law or
+rule to be dispensed only by prescription or is restricted to administration only by practitioners
+a primary sex characteristic surgical procedure means any of the following if
+done for the purpose of effectuating or facilitating an individual s attempted sex change
+i for an individual whose biological sex at birth is male castration orchiectomy
+penectomy vaginoplasty or vulvoplasty
+ii for an individual whose biological sex at birth is female hysterectomy
+oophorectomy metoidioplasty or phalloplasty or
+iii any surgical procedure that is related to or necessary for a procedure described in
+subsection a i or ii that would result in the sterilization of an individual who is not
+
+sterile
+b primary sex characteristic surgical procedure does not include
+i surgery or other procedures or treatments performed on an individual who
+a is born with external biological sex characteristics that are irresolvably ambiguous
+b is born with xx chromosomes with virilization
+c is born with xy chromosomes with undervirilization
+d has both ovarian and testicular tissue or
+e has been diagnosed by a physician based on genetic or biochemical testing with a
+sex development disorder characterized by abnormal sex chromosome structure sex steroid
+hormone production or sex steroid hormone action for a male or female or
+ii removing a body part
+a because the body part is cancerous or diseased or
+b for a reason that is medically necessary other than to effectuate or facilitate an
+individual s attempted sex change
+a secondary sex characteristic surgical procedure means any of the following
+if done for the purpose of effectuating or facilitating an individual s attempted sex change
+i for an individual whose biological sex at birth is male breast augmentation surgery
+chest feminization surgery or facial feminization surgery or
+ii for an individual whose biological sex at birth is female mastectomy breast
+reduction surgery chest masculinization surgery or facial masculinization surgery
+b secondary sex characteristic surgical procedure does not include
+i surgery or other procedures or treatments performed on an individual who
+a is born with external biological sex characteristics that are irresolvably ambiguous
+b is born with xx chromosomes with virilization
+c is born with xy chromosomes with undervirilization
+d has both ovarian and testicular tissue or
+e has been diagnosed by a physician based on genetic or biochemical testing with a
+
+sex development disorder characterized by abnormal sex chromosome structure sex steroid
+hormone production or sex steroid hormone action for a male or female or
+ii removing a body part
+a because the body part is cancerous or diseased or
+b for a reason that is medically necessary other than to effectuate or facilitate an
+individual s attempted sex change
+spex means the special purpose examination of the federation of state
+medical boards
+unlawful conduct means the same as that term is defined in sections
+and
+unprofessional conduct means the same as that term is defined in
+sections and and as may be further defined by division rule
+section section is amended to read
+unprofessional conduct
+unprofessional conduct includes in addition to the definition in section
+
+a using or employing the services of any individual to assist a licensee in any manner
+not in accordance with the generally recognized practices standards or ethics of the
+profession state law or division rule
+b violating the dispensing requirements of chapter b part dispensing medical
+practitioner and dispensing medical practitioner clinic pharmacy if applicable
+c making a material misrepresentation regarding the qualifications for licensure under
+section
+d violating the requirements of title chapter a utah medical cannabis act
+or
+e falsely making an entry in or altering a medical record with the intent to conceal
+i a wrongful or negligent act or omission of an individual licensed under this chapter
+
+or an individual under the direction or control of an individual licensed under this chapter or
+ii conduct described in subsections a through d or subsection
+
+or
+f performing or causing to be performed upon an individual who is less than
+years old
+i a primary sex characteristic surgical procedure or
+ii a secondary sex characteristic surgical procedure
+unprofessional conduct does not include
+a in compliance with section
+i obtaining an investigational drug or investigational device
+ii administering the investigational drug to an eligible patient or
+iii treating an eligible patient with the investigational drug or investigational device
+or
+b in accordance with title chapter a utah medical cannabis act
+i when registered as a qualified medical provider or acting as a limited medical
+provider as those terms are defined in section a recommending the use of medical
+cannabis
+ii when registered as a pharmacy medical provider as that term is defined in section
+a providing pharmacy medical provider services in a medical cannabis pharmacy or
+iii when registered as a state central patient portal medical provider as that term is
+defined in section a providing state central patient portal medical provider services
+notwithstanding subsection b the division in consultation with the board and
+in accordance with title g chapter utah administrative rulemaking act shall define
+unprofessional conduct for a physician described in subsection b
+section section b is enacted to read
+b transgender procedures upon a minor right of action informed
+consent requirements statute of limitations
+
+as used in this section
+a hormonal transgender treatment means the same as that term is defined in
+section
+
+b minor means the same as that term is defined in section
+
+a notwithstanding any other provision of law a malpractice action against a
+health care provider may be brought against a health care provider for damages arising from
+i providing a hormonal transgender treatment to a minor without complying with the
+requirements described in section
+
+ii negligence in providing a hormonal transgender treatment to a minor or
+iii providing a treatment or procedure described in subsection b ii to a minor
+without the minor s consent including if the minor disaffirms consent under subsection
+a notwithstanding any other provision of law an individual who gave informed
+consent as a minor or for whom consent was given under section b may disaffirm the
+consent if
+i the treatment at issue began after the effective date of this bill
+ii the consent was provided for any of the following
+a a hormonal transgender treatment
+b a primary sex characteristic surgical procedure as defined in section or
+c a secondary sex characteristic surgical procedure as defined in section
+
+iii under the totality of the circumstances a health care provider would have reason to
+believe that the minor or a similarly situated minor could later regret having given consent
+iv the individual suffered a permanent physical injury and
+v the consent is disaffirmed in writing before the individual reaches the age of
+years old
+b a disaffirmation of consent under this subsection relates back to the day the
+original consent was given
+notwithstanding any other provision of law a malpractice action against a health
+
+care provider described in subsection a may be brought before the patient is years old if
+the treatment at issue in the malpractice action began occurred or continued on or after the
+effective date of this bill
+sections b and b do not apply to an action described in this
+section
+
+section effective date
+if approved by two thirds of all the members elected to each house this bill takes effect
+
+upon approval by the governor or the day following the constitutional time limit of utah
+constitution article vii section without the governor s signature or in the case of a veto
+the date of veto override
+section revisor instructions
+the legislature intends that the office of legislative research and general counsel in
+preparing the utah code database for publication replace each instance of the phrase the
+effective date of this bill with the bill s actual effective date in the following utah code
+sections
+section and
+section b
+
+
+
+
+
+
+
+
+
diff --git a/assets/data-leg/clean_line_0039_df.csv b/assets/data-leg/clean_line_0039_df.csv
new file mode 100644
index 00000000..5a4c5f98
--- /dev/null
+++ b/assets/data-leg/clean_line_0039_df.csv
@@ -0,0 +1,16303 @@
+text
+enrolled copy s b
+
+
+health and human services recodification
+health care assistance and data
+general session
+state of utah
+chief sponsor jacob l anderegg
+house sponsor raymond p ward
+
+long title
+general description
+this bill recodifies portions of the utah health code and utah human services code
+highlighted provisions
+this bill
+recodifies provisions regarding
+health care administration and assistance and
+vital statistics health data and the utah medical examiner and
+makes technical and corresponding changes
+money appropriated in this bill
+none
+other special clauses
+this bill provides a coordination clause
+this bill provides revisor instructions
+utah code sections affected
+amends
+b as enacted by laws of utah chapter
+b as enacted by laws of utah chapter
+renumbers and amends
+b renumbered from as last amended by laws of utah
+chapter
+
+
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah sixth
+special session chapter
+b renumbered from as last amended by laws of utah fifth
+special session chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as enacted by laws of utah chapter
+
+
+
+
+b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter
+
+b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah
+
+
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+fifth special session chapter
+b renumbered from as enacted by laws of utah chapter
+
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as enacted by laws of utah chapter
+
+b renumbered from as last amended by laws of utah
+chapters and
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as enacted by laws of utah chapter
+
+b renumbered from as enacted by laws of utah chapter
+
+
+
+b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah
+
+
+chapter
+b renumbered from as enacted by laws of utah chapter
+
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as enacted by laws of utah chapter
+
+b renumbered from as enacted by laws of utah chapter
+
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from a as last amended by laws of utah
+chapter
+b renumbered from a as last amended by laws of utah
+chapter
+b renumbered from a as last amended by laws of utah
+chapter
+b renumbered from a as enacted by laws of utah chapter
+
+b renumbered from a as last amended by laws of utah
+chapter
+
+
+b renumbered from a as last amended by laws of utah
+chapter
+b renumbered from b as last amended by laws of utah
+chapter
+b renumbered from b as last amended by laws of utah
+chapter
+b renumbered from b as last amended by laws of utah
+chapters and
+b renumbered from b as last amended by laws of utah
+chapter
+b renumbered from b as last amended by laws of utah
+chapters and
+b renumbered from b as last amended by laws of utah
+chapter
+b renumbered from b as last amended by laws of utah
+chapter
+b renumbered from b as last amended by laws of utah
+chapters and
+b renumbered from b as last amended by laws of utah
+chapters and
+b renumbered from b as last amended by laws of utah
+chapters and
+b renumbered from b as last amended by laws of utah
+chapters and
+b renumbered from b as last amended by laws of utah
+chapters and
+b renumbered from c as last amended by laws of utah
+
+
+
+chapter
+b renumbered from c as enacted by laws of utah chapter
+
+b renumbered from c as last amended by laws of utah
+chapter
+b renumbered from c as last amended by laws of utah
+chapter
+b renumbered from c as last amended by laws of utah
+chapter
+b renumbered from c as last amended by laws of utah
+chapter
+b renumbered from c as last amended by laws of utah
+chapter
+b renumbered from c as last amended by laws of utah
+chapter
+b renumbered from c as enacted by laws of utah chapter
+
+b renumbered from c as last amended by laws of utah
+chapter
+b renumbered from c as last amended by laws of utah
+chapter
+b renumbered from c as last amended by laws of utah
+chapter
+b renumbered from d as repealed and reenacted by laws of utah
+chapter
+b renumbered from d as repealed and reenacted by laws of utah
+chapter
+
+
+b renumbered from d as repealed and reenacted by laws of utah
+chapter
+b renumbered from d as repealed and reenacted by laws of utah
+chapter
+b renumbered from d as repealed and reenacted by laws of utah
+chapter
+b renumbered from d as repealed and reenacted by laws of utah
+chapter
+b renumbered from d as repealed and reenacted by laws of utah
+chapter
+b renumbered from d as repealed and reenacted by laws of utah
+chapter
+b renumbered from d as repealed and reenacted by laws of utah
+chapter
+b renumbered from a as last amended by laws of utah
+chapter
+b renumbered from a as enacted by laws of utah chapter
+
+b renumbered from a as enacted by laws of utah chapter
+
+b renumbered from a as enacted by laws of utah chapter
+
+b renumbered from a as enacted by laws of utah chapter
+
+b renumbered from a as enacted by laws of utah chapter
+
+b renumbered from as last amended by laws of utah
+
+
+
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as enacted by laws of utah chapter
+
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapters and
+b renumbered from as renumbered and amended by laws of
+utah chapter
+b renumbered from as renumbered and amended by laws of
+utah chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as renumbered and amended by laws of
+utah chapter
+b renumbered from as last amended by laws of utah
+chapter
+
+
+b renumbered from as renumbered and amended by laws of
+utah chapter
+b renumbered from as renumbered and amended by laws of
+utah chapter
+b renumbered from as renumbered and amended by laws of
+utah chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as renumbered and amended by laws of
+utah chapter
+b renumbered from as renumbered and amended by laws of
+utah chapter
+b renumbered from as enacted by laws of utah chapter
+
+b renumbered from as renumbered and amended by laws of
+utah chapter
+b renumbered from as renumbered and amended by laws of
+utah chapter
+b renumbered from as enacted by laws of utah chapter
+
+b renumbered from as enacted by laws of utah chapter
+
+b renumbered from as enacted by laws of utah chapter
+
+b renumbered from as enacted by laws of utah chapter
+
+b renumbered from as enacted by laws of utah chapter
+
+
+
+
+b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as repealed and reenacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter
+
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as enacted by laws of utah chapter
+
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as enacted by laws of utah chapter
+
+b renumbered from as last amended by laws of utah chapter
+
+b renumbered from as last amended by laws of utah
+chapters and
+b renumbered from as last amended by laws of utah chapter
+
+
+
+
+b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter
+
+b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah
+
+
+
+chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as enacted by laws of utah chapter
+
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as enacted by laws of utah chapter
+
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as enacted by laws of utah chapter
+
+b renumbered from as enacted by laws of utah chapter
+
+b renumbered from as last amended by laws of utah
+
+
+
+
+chapter b renumbered from as repealed and reenacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter
+
+chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah
+
+
+
+chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter
+
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from as last amended by laws of utah
+chapter
+b renumbered from a as last amended by laws of utah
+chapter
+b renumbered from a as enacted by laws of utah chapter
+
+b renumbered from a as last amended by laws of utah
+chapter
+b renumbered from a as last amended by laws of utah
+chapter
+b renumbered from a as last amended by laws of utah
+chapter
+b renumbered from a as last amended by laws of utah
+chapter
+b renumbered from a as last amended by laws of utah
+chapter
+b renumbered from a as last amended by laws of utah
+chapter
+b renumbered from a as enacted by laws of utah chapter
+
+b renumbered from a as last amended by laws of utah
+chapter
+b renumbered from a as enacted by laws of utah chapter
+
+b renumbered from a as enacted by laws of utah chapter
+
+
+
+
+b renumbered from a as enacted by laws of utah chapter
+
+b renumbered from as enacted by laws of utah chapter
+
+utah code sections affected by coordination clause
+as last amended by laws of utah chapter
+as last amended by laws of utah chapter
+b as enacted by laws of utah chapter
+b utah code annotated
+
+be it enacted by the legislature of the state of utah
+section section b is amended to read
+chapter health care administration and assistance
+part health care assistance
+b definitions
+reserved
+as used in this chapter
+applicant means any person who requests assistance under the medical programs
+of the state
+cms means the centers for medicare and medicaid services within the united
+states department of health and human services
+division means the division of integrated healthcare within the department
+established under section b
+
+enrollee or member means an individual whom the department has determined
+to be eligible for assistance under the medicaid program
+medicaid program means the state program for medical assistance for persons
+
+
+who are eligible under the state plan adopted pursuant to title xix of the federal social
+security act
+medical assistance means services furnished or payments made to or on behalf of
+a member
+a passenger vehicle means a self propelled two axle vehicle intended primarily
+for operation on highways and used by an applicant or recipient to meet basic transportation
+needs and has a fair market value below of the applicable amount of the federal luxury
+passenger automobile tax established in u s c sec and adjusted annually for
+inflation
+b passenger vehicle does not include
+i a commercial vehicle as defined in section a
+
+ii an off highway vehicle as defined in section a or
+iii a motor home as defined in section
+
+ppaca means the same as that term is defined in section a
+
+recipient means a person who has received medical assistance under the
+medicaid program
+section section b which is renumbered from section is
+renumbered and amended to read
+b division creation
+there is created within the department the division of medicaid and health
+financing integrated healthcare which shall be responsible for implementing organizing and
+maintaining the medicaid program and the children s health insurance program established in
+section b in accordance with the provisions of this chapter and
+applicable federal law
+section section b which is renumbered from section is
+renumbered and amended to read
+b state medicaid director appointment
+
+
+
+responsibilities
+the state medicaid director shall be appointed by the governor after consultation
+with the executive director with the advice and consent of the senate
+the state medicaid director may employ other employees as necessary to
+implement the provisions of this chapter and shall
+a administer the responsibilities of the division as set forth in this chapter
+b administer the division s budget and
+c establish and maintain a state plan for the medicaid program in compliance
+with federal law and regulations
+section section b which is renumbered from section is
+renumbered and amended to read
+b division responsibilities emphasis periodic
+assessment
+in accordance with the requirements of title xix of the social security act and
+applicable federal regulations the division is responsible for the effective and impartial
+administration of this chapter in an efficient economical manner the division shall
+a establish on a statewide basis a program to safeguard against unnecessary or
+inappropriate use of medicaid services excessive payments and unnecessary or inappropriate
+hospital admissions or lengths of stay
+b deny any provider claim for services that fail to meet criteria established by the
+division concerning medical necessity or appropriateness and
+c place its emphasis on high quality care to recipients in the most economical and
+cost effective manner possible with regard to both publicly and privately provided services
+the division shall implement and utilize cost containment methods where
+possible which may include
+a prepayment and postpayment review systems to determine if utilization is
+reasonable and necessary
+
+
+b preadmission certification of nonemergency admissions
+c mandatory outpatient rather than inpatient surgery in appropriate cases
+d second surgical opinions
+e procedures for encouraging the use of outpatient services
+f consistent with sections b and b a medicaid drug
+program
+g coordination of benefits and
+h review and exclusion of providers who are not cost effective or who have abused
+the medicaid program in accordance with the procedures and provisions of federal law and
+regulation
+the state medicaid director shall periodically assess the cost effectiveness and
+health implications of the existing medicaid program and consider alternative approaches to
+the provision of covered health and medical services through the medicaid program in order to
+reduce unnecessary or unreasonable utilization
+a the department shall ensure medicaid program integrity by conducting internal
+audits of the medicaid program for efficiencies best practices and cost avoidance
+b the department shall coordinate with the office of the inspector general for
+medicaid services created in section a to implement subsection and to address
+medicaid fraud waste or abuse as described in section a
+section section b which is renumbered from section is
+renumbered and amended to read
+b medicaid drug program preferred drug list
+a medicaid drug program developed by the department under subsection
+b f
+a shall notwithstanding subsection b b be based on clinical
+and cost related factors which include medical necessity as determined by a provider in
+accordance with administrative rules established by the drug utilization review board
+
+
+
+b may include therapeutic categories of drugs that may be exempted from the drug
+program
+c may include placing some drugs except the drugs described in subsection on a
+preferred drug list
+i to the extent determined appropriate by the department and
+ii in the manner described in subsection for psychotropic drugs
+d notwithstanding the requirements of part sections b through
+b regarding the drug utilization review board and except as provided in subsection
+shall immediately implement the prior authorization requirements for a nonpreferred drug
+that is in the same therapeutic class as a drug that is
+i on the preferred drug list on the date that this act takes effect or
+ii added to the preferred drug list after this act takes effect and
+e except as prohibited by subsections b and shall establish the prior
+authorization requirements established under subsections c and d which shall permit a
+health care provider or the health care provider s agent to obtain a prior authorization override
+of the preferred drug list through the department s pharmacy prior authorization review process
+and which shall
+i provide either telephone or fax approval or denial of the request within hours of
+the receipt of a request that is submitted during normal business hours of monday through
+friday from a m to p m
+ii provide for the dispensing of a limited supply of a requested drug as determined
+appropriate by the department in an emergency situation if the request for an override is
+received outside of the department s normal business hours and
+iii require the health care provider to provide the department with documentation of
+the medical need for the preferred drug list override in accordance with criteria established by
+the department in consultation with the pharmacy and therapeutics committee
+a for purposes of as used in this subsection
+
+
+i immunosuppressive drug
+a means a drug that is used in immunosuppressive therapy to inhibit or prevent
+activity of the immune system to aid the body in preventing the rejection of transplanted organs
+and tissue and
+b does not include drugs used for the treatment of autoimmune disease or diseases
+that are most likely of autoimmune origin
+ii stabilized means a health care provider has documented in the patient s medical
+chart that a patient has achieved a stable or steadfast medical state within the past days using
+a particular psychotropic drug
+b a preferred drug list developed under the provisions of this section may not include
+an immunosuppressive drug
+c i the state medicaid program shall reimburse for a prescription for an
+immunosuppressive drug as written by the health care provider for a patient who has undergone
+an organ transplant
+ii for purposes of subsection b and with respect to patients who have
+undergone an organ transplant the prescription for a particular immunosuppressive drug as
+written by a health care provider meets the criteria of demonstrating to the department a
+medical necessity for dispensing the prescribed immunosuppressive drug
+d notwithstanding the requirements of part sections b through
+b regarding the drug utilization review board the state medicaid drug program may
+not require the use of step therapy for immunosuppressive drugs without the written or oral
+consent of the health care provider and the patient
+e the department may include a sedative hypnotic on a preferred drug list in
+accordance with subsection f
+f the department shall grant a prior authorization for a sedative hypnotic that is not
+on the preferred drug list under subsection e if the health care provider has documentation
+related to one of the following conditions for the medicaid client
+
+
+
+i a trial and failure of at least one preferred agent in the drug class including the
+name of the preferred drug that was tried the length of therapy and the reason for the
+discontinuation
+ii detailed evidence of a potential drug interaction between current medication and
+the preferred drug
+iii detailed evidence of a condition or contraindication that prevents the use of the
+preferred drug
+iv objective clinical evidence that a patient is at high risk of adverse events due to a
+therapeutic interchange with a preferred drug
+v the patient is a new or previous medicaid client with an existing diagnosis
+previously stabilized with a nonpreferred drug or
+vi other valid reasons as determined by the department
+g a prior authorization granted under subsection f is valid for one year from the
+date the department grants the prior authorization and shall be renewed in accordance with
+subsection f
+a for purposes of as used in this subsection psychotropic drug means the
+following classes of drugs
+i atypical anti psychotic
+ii anti depressant
+iii anti convulsant mood stabilizer
+iv anti anxiety and
+v attention deficit hyperactivity disorder stimulant
+b i the department shall develop a preferred drug list for psychotropic drugs
+ii except as provided in subsection d a preferred drug list for psychotropic
+drugs developed under this section shall allow a health care provider to override the preferred
+drug list by writing dispense as written on the prescription for the psychotropic drug
+iii a health care provider may not override section b by writing dispense
+
+
+as written on a prescription
+c the department and a medicaid accountable care organization that is responsible
+for providing behavioral health shall
+i establish a system to
+a track health care provider prescribing patterns for psychotropic drugs
+b educate health care providers who are not complying with the preferred drug list
+and
+c implement peer to peer education for health care providers whose prescribing
+practices continue to not comply with the preferred drug list and
+ii determine whether health care provider compliance with the preferred drug list is at
+least
+a of prescriptions by july
+b of prescriptions by july and
+c of prescriptions by july
+d beginning october the department shall eliminate the dispense as written
+override for the preferred drug list and shall implement a prior authorization system for
+psychotropic drugs in accordance with subsection f if by july the department has
+not realized annual savings from implementing the preferred drug list for psychotropic drugs of
+at least general fund savings
+section section b which is renumbered from section is
+renumbered and amended to read
+b simplified enrollment and renewal process for medicaid
+and other state medical programs financial institutions
+the department may apply for grants and accept donations to make technology
+system improvements necessary to implement a simplified enrollment and renewal process for
+the medicaid program utah premium partnership and primary care network demonstration
+project programs
+
+
+
+a the department may enter into an agreement with a financial institution doing
+business in the state to develop and operate a data match system to identify an applicant s or
+enrollee s assets that
+i uses automated data exchanges to the maximum extent feasible and
+ii requires a financial institution each month to provide the name record address
+social security number other taxpayer identification number or other identifying information
+for each applicant or enrollee who maintains an account at the financial institution
+b the department may pay a reasonable fee to a financial institution for compliance
+with this subsection as provided in section
+c a financial institution may not be liable under any federal or state law to any person
+for any disclosure of information or action taken in good faith under this subsection
+d the department may disclose a financial record obtained from a financial institution
+under this section only for the purpose of and to the extent necessary in verifying eligibility as
+provided in this section and section b
+section section b which is renumbered from section is
+renumbered and amended to read
+b dental benefits
+a except as provided in subsection the division may establish a competitive
+bid process to bid out medicaid dental benefits under this chapter
+b the division may bid out the medicaid dental benefits separately from other
+program benefits
+the division shall use the following criteria to evaluate dental bids
+a ability to manage dental expenses
+b proven ability to handle dental insurance
+c efficiency of claim paying procedures
+d provider contracting discounts and adequacy of network and
+e other criteria established by the department
+
+
+the division shall request bids for the program s benefits at least once every five
+years
+the division s contract with dental plans for the program s benefits shall include
+risk sharing provisions in which the dental plan must accept of the risk for any difference
+between the division s premium payments per client and actual dental expenditures
+the division may not award contracts to
+a more than three responsive bidders under this section or
+b an insurer that does not have a current license in the state
+a the division may cancel the request for proposals if
+i there are no responsive bidders or
+ii the division determines that accepting the bids would increase the program s costs
+b if the division cancels a request for proposal or a contract that results from a request
+for proposal described in subsection a the division shall report to the health and human
+services interim committee regarding the reasons for the decision
+title g chapter a utah procurement code shall apply to this section
+a the division may
+i establish a dental health care delivery system and payment reform pilot program for
+medicaid dental benefits to increase access to cost effective and quality dental health care by
+increasing the number of dentists available for medicaid dental services and
+ii target specific medicaid populations or geographic areas in the state
+b the pilot program shall establish compensation models for dentists and dental
+hygienists that
+i increase access to quality cost effective dental care and
+ii use funds from the division of family health and preparedness that are available to
+reimburse dentists for educational loans in exchange for the dentist agreeing to serve medicaid
+and under served populations
+c the division may amend the state plan and apply to the secretary of the united
+
+
+
+states department of health and human services for waivers or pilot programs if necessary to
+establish the new dental care delivery and payment reform model
+d the division shall evaluate the pilot program s effect on the cost of dental care and
+access to dental care for the targeted medicaid populations
+a as used in this subsection dental hygienist means an individual who is
+licensed as a dental hygienist under section
+b the department shall reimburse a dental hygienist for dental services performed in
+a public health setting and in accordance with subsection c beginning on the earlier of
+i january or
+ii days after the date on which the replacement of the department s medicaid
+management information system software is complete
+c the department shall reimburse a dental hygienist directly for a service provided
+through the medicaid program if
+i the dental hygienist requests to be reimbursed directly and
+ii the dental hygienist provides the service within the scope of practice described in
+section
+d before november of each year in which the department reimburses dental
+hygienists in accordance with subsection c the department shall report to the health and
+human services interim committee for the previous fiscal year
+i the number and geographic distribution of dental hygienists who requested to be
+reimbursed directly
+ii the total number of medicaid enrollees who were served by a dental hygienist who
+were reimbursed under this subsection
+iii the total amount reimbursed directly to dental hygienists under this subsection
+iv the specific services and billing codes that are reimbursed under this subsection
+and
+v the aggregate amount reimbursed for each service and billing code described in
+
+
+subsection d iv
+e i except as provided in this subsection nothing in this subsection shall be
+interpreted as expanding or otherwise altering the limitations and scope of practice for a dental
+hygienist
+ii a dental hygienist may only directly bill and receive compensation for billing codes
+that fall within the scope of practice of a dental hygienist
+section section b which is renumbered from section is
+renumbered and amended to read
+b administration of medicaid program by department
+reporting to the legislature disciplinary measures and sanctions funds collected
+eligibility standards internal audits health opportunity accounts
+the department shall be the single state agency responsible for the administration
+of the medicaid program in connection with the united states department of health and
+human services pursuant to title xix of the social security act
+a the department shall implement the medicaid program through administrative
+rules in conformity with this chapter title g chapter utah administrative rulemaking
+act the requirements of title xix and applicable federal regulations
+b the rules adopted under subsection a shall include in addition to other rules
+necessary to implement the program
+i the standards used by the department for determining eligibility for medicaid
+services
+ii the services and benefits to be covered by the medicaid program
+iii reimbursement methodologies for providers under the medicaid program and
+iv a requirement that
+a a person receiving medicaid services shall participate in the electronic exchange of
+clinical health records established in accordance with section b unless the
+individual opts out of participation
+
+
+
+b prior to enrollment in the electronic exchange of clinical health records the enrollee
+shall receive notice of enrollment in the electronic exchange of clinical health records and the
+right to opt out of participation at any time and
+c beginning july when the program sends enrollment or renewal information
+to the enrollee and when the enrollee logs onto the program s website the enrollee shall receive
+notice of the right to opt out of the electronic exchange of clinical health records
+a the department shall in accordance with subsection b report to the social
+services appropriations subcommittee when the department
+i implements a change in the medicaid state plan
+ii initiates a new medicaid waiver
+iii initiates an amendment to an existing medicaid waiver
+iv applies for an extension of an application for a waiver or an existing medicaid
+waiver
+v applies for or receives approval for a change in any capitation rate within the
+medicaid program or
+vi initiates a rate change that requires public notice under state or federal law
+b the report required by subsection a shall
+i be submitted to the social services appropriations subcommittee prior to the
+department implementing the proposed change and
+ii include
+a a description of the department s current practice or policy that the department is
+proposing to change
+b an explanation of why the department is proposing the change
+c the proposed change in services or reimbursement including a description of the
+effect of the change
+d the effect of an increase or decrease in services or benefits on individuals and
+families
+
+
+e the degree to which any proposed cut may result in cost shifting to more expensive
+services in health or human service programs and
+f the fiscal impact of the proposed change including
+i the effect of the proposed change on current or future appropriations from the
+legislature to the department
+ii the effect the proposed change may have on federal matching dollars received by
+the state medicaid program
+iii any cost shifting or cost savings within the department s budget that may result
+from the proposed change and
+iv identification of the funds that will be used for the proposed change including any
+transfer of funds within the department s budget
+any rules adopted by the department under subsection are subject to review and
+reauthorization by the legislature in accordance with section g
+the department may in its discretion contract with the department of human
+services or other qualified agencies for services in connection with the administration of the
+medicaid program including
+a the determination of the eligibility of individuals for the program
+b recovery of overpayments and
+c consistent with section b and to the extent permitted by law
+and quality control services enforcement of fraud and abuse laws
+the department shall provide by rule disciplinary measures and sanctions for
+medicaid providers who fail to comply with the rules and procedures of the program provided
+that sanctions imposed administratively may not extend beyond
+a termination from the program
+b recovery of claim reimbursements incorrectly paid and
+c those specified in section of title xix of the federal social security act
+a funds collected as a result of a sanction imposed under section of title
+
+
+
+
+xix of the federal social security act shall be deposited in the general fund as dedicated credits to be used by the division in accordance with the requirements of section of title xix of the federal social security act b in accordance with section j sanctions collected under this subsection are nonlapsing a in determining whether an applicant or recipient is eligible for a service or benefit under this part or chapter part utah children s health insurance act program the department shall if subsection b is satisfied exclude from consideration one passenger vehicle designated by the applicant or recipient b before subsection a may be applied i the federal government shall a determine that subsection a may be implemented within the state s existing public assistance related waivers as of january b extend a waiver to the state permitting the implementation of subsection a or c determine that the state s waivers that permit dual eligibility determinations for cash assistance and medicaid are no longer valid and ii the department shall determine that subsection a can be implemented within existing funding a for purposes of as used in this subsection i aged blind or has a disability means an aged blind or disabled individual as defined in u s c sec c a and ii spend down means an amount of income in excess of the allowable income standard that shall be paid in cash to the department or incurred through the medical services not paid by medicaid b in determining whether an applicant or recipient who is aged blind or has a disability is eligible for a service or benefit under this chapter the department shall use of the federal poverty level as
+
+i the allowable income standard for eligibility for services or benefits and ii the allowable income standard for eligibility as a result of spend down the department shall conduct internal audits of the medicaid program a the department may apply for and if approved implement a demonstration program for health opportunity accounts as provided for in u s c sec u b a health opportunity account established under subsection a shall be an alternative to the existing benefits received by an individual eligible to receive medicaid under this chapter c subsection a is not intended to expand the coverage of the medicaid program a i the department shall apply for and if approved implement an amendment to the state plan under this subsection for benefits for a medically needy pregnant women b medically needy children and c medically needy parents and caretaker relatives ii the department may implement the eligibility standards of subsection b for eligibility determinations made on or after the date of the approval of the amendment to the state plan b in determining whether an applicant is eligible for benefits described in subsection a i the department shall i disregard resources held in an account in the savings plan created under title b chapter a utah educational savings plan if the beneficiary of the account is a under the age of and b living with the account owner as that term is defined in section b a or temporarily absent from the residence of the account owner and ii include the withdrawals from an account in the utah educational savings plan as resources for a benefit determination if the withdrawal was not used for qualified higher education costs as that term is defined in section b a
+
+
+
+a the department may not deny or terminate eligibility for medicaid solely because an individual is i incarcerated and ii not an inmate as defined in section b subsection a does not require the medicaid program to provide coverage for any services for an individual while the individual is incarcerated the department is a party to and may intervene at any time in any judicial or administrative action a to which the department of workforce services is a party and b that involves medical assistance under this chapter i title chapter medical assistance act or ii title chapter utah children s health insurance act section section b which is renumbered from section is renumbered and amended to read b medicaid expansion the purpose of this section is to expand the coverage of the medicaid program to persons who are in categories traditionally not served by that program within appropriations from the legislature the department may amend the state plan for medical assistance to provide for eligibility for medicaid a on or after july for children to years old who live in households below the federal poverty income guideline and b on or after july for persons who have incomes below the federal poverty income guideline and who are aged blind or have a disability a within appropriations from the legislature on or after july the medicaid program may provide for eligibility for persons who have incomes below the federal poverty income guideline b in order to meet the provisions of this subsection the department may seek
+
+approval for a demonstration project under u s c sec from the secretary of the united states department of health and human services the medicaid program shall provide for eligibility for persons as required by subsection b services available for persons described in this section shall include required medicaid services and may include one or more optional medicaid services if those services are funded by the legislature the department may also require persons described in subsections through to meet an asset test section section b which is renumbered from section is renumbered and amended to read b copayments by recipients employer sponsored plans the department shall selectively provide for enrollment fees premiums deductions cost sharing or other similar charges to be paid by recipients their spouses and parents within the limitations of federal law and regulation beginning may within appropriations by the legislature and as a means to increase health care coverage among the uninsured the department shall take steps to promote increased participation in employer sponsored health insurance including a maximizing the health insurance premium subsidy provided under the state s demonstration waiver by i ensuring that state funds are matched by federal funds to the greatest extent allowable and ii as the department determines appropriate seeking federal approval to do one or more of the following a eliminate or otherwise modify the annual enrollment fee b eliminate or otherwise modify the schedule used to determine the level of subsidy provided to an enrollee each year c reduce the maximum number of participants allowable under the subsidy program
+
+
+or
+d otherwise modify the program in a manner that promotes enrollment in employer sponsored health insurance and
+b exploring the use of other options including the development of a waiver under the medicaid health insurance flexibility demonstration initiative or other federal authority
+section section b which is renumbered from section is renumbered and amended to read
+b income and resources from institutionalized spouses
+
+as used in this section a community spouse means the spouse of an institutionalized spouse b i community spouse monthly income allowance means an amount by which the minimum monthly maintenance needs allowance for the spouse exceeds the amount of monthly income otherwise available to the community spouse determined without regard to the allowance except as provided in subsection b ii ii if a court has entered an order against an institutionalized spouse for monthly income for the support of the community spouse the community spouse monthly income allowance for the spouse may not be less than the amount of the monthly income so ordered c community spouse resource allowance is the amount of combined resources that are protected for a community spouse living in the community which the division shall establish by rule made in accordance with title g chapter utah administrative rulemaking act based on the amounts established by the united states department of health and human services d excess shelter allowance for a community spouse means the amount by which the sum of the spouse s expense for rent or mortgage payment taxes and insurance and in the case of condominium or cooperative required maintenance charge for the community spouse s principal residence and the spouse s actual expenses for electricity natural gas and water utilities or at the discretion of the department the federal standard utility allowance under
+
+snap as defined in section a exceeds of the amount described in subsection e family member means a minor dependent child dependent parents or dependent sibling of the institutionalized spouse or community spouse who are residing with the community spouse f i institutionalized spouse means a person who is residing in a nursing facility and is married to a spouse who is not in a nursing facility ii an institutionalized spouse does not include a person who is not likely to reside in a nursing facility for at least consecutive days g nursing care facility means the same as that term is defined in section b the division shall comply with this section when determining eligibility for medical assistance for an institutionalized spouse for services furnished during a calendar year beginning on or after january the community spouse resource allowance shall be increased by the division by an amount as determined annually by cms the division shall compute as of the beginning of the first continuous period of institutionalization of the institutionalized spouse a the total value of the resources to the extent either the institutionalized spouse or the community spouse has an ownership interest and b a spousal share which is of the resources described in subsection a at the request of an institutionalized spouse or a community spouse at the beginning of the first continuous period of institutionalization of the institutionalized spouse and upon the receipt of relevant documentation of resources the division shall promptly assess and document the total value described in subsection a and shall provide a copy of that assessment and documentation to each spouse and shall retain a copy of the assessment when the division provides a copy of the assessment it shall include a notice stating that the spouse
+
+
+
+may request a hearing under subsection when determining eligibility for medical assistance under this chapter a except as provided in subsection b all resources held by either the institutionalized spouse community spouse or both are considered to be available to the institutionalized spouse b resources are considered to be available to the institutionalized spouse only to the extent that the amount of those resources exceeds the community spouse resource allowance at the time of application for medical assistance under this chapter a the division may not find an institutionalized spouse to be ineligible for medical assistance by reason of resources determined under subsection to be available for the cost of care when i the institutionalized spouse has assigned to the state any rights to support from the community spouse ii except as provided in subsection b the institutionalized spouse lacks the ability to execute an assignment due to physical or mental impairment or iii the division determines that denial of medical assistance would cause an undue burden b subsection a ii does not prevent the division from seeking a court order for an assignment of support during the continuous period in which an institutionalized spouse is in an institution and after the month in which an institutionalized spouse is eligible for medical assistance the resources of the community spouse may not be considered to be available to the institutionalized spouse when an institutionalized spouse is determined to be eligible for medical assistance in determining the amount of the spouse s income that is to be applied monthly for the cost of care in the nursing care facility the division shall deduct from the spouse s monthly income the following amounts in the following order
+
+a a personal needs allowance the amount of which is determined by the division b a community spouse monthly income allowance but only to the extent that the income of the institutionalized spouse is made available to or for the benefit of the community spouse c a family allowance for each family member equal to at least of the amount that the amount described in subsection a exceeds the amount of the family member s monthly income and d amounts for incurred expenses for the medical or remedial care for the institutionalized spouse the division shall establish a minimum monthly maintenance needs allowance for each community spouse that includes a an amount established by the division by rule made in accordance with title g chapter utah administrative rulemaking act based on the amounts established by the united states department of health and human services and b an excess shelter allowance a an institutionalized spouse or a community spouse may request a hearing with respect to the determinations described in subsections e i through v if an application for medical assistance has been made on behalf of the institutionalized spouse b a hearing under this subsection regarding the community spouse resource allowance shall be held by the division within days from the date of the request for the hearing c if either spouse establishes that the community spouse needs income above the level otherwise provided by the minimum monthly maintenance needs allowance due to exceptional circumstances resulting in significant financial duress there shall be substituted for the minimum monthly maintenance needs allowance provided under subsection an amount adequate to provide additional income as is necessary d if either spouse establishes that the community spouse resource allowance in
+
+
+
+relation to the amount of income generated by the allowance is inadequate to raise the community spouse s income to the minimum monthly maintenance needs allowance there shall be substituted for the community spouse resource allowance an amount adequate to provide a minimum monthly maintenance needs allowance e a hearing may be held under this subsection if either the institutionalized spouse or community spouse is dissatisfied with a determination of i the community spouse monthly income allowance ii the amount of monthly income otherwise available to the community spouse iii the computation of the spousal share of resources under subsection iv the attribution of resources under subsection or v the determination of the community spouse resource allocation a an institutionalized spouse may transfer an amount equal to the community spouse resource allowance but only to the extent the resources of the institutionalized spouse are transferred to or for the sole benefit of the community spouse b the transfer under subsection a shall be made as soon as practicable after the date of the initial determination of eligibility taking into account the time necessary to obtain a court order under subsection c c chapter medical benefits recovery act part medical benefits recovery does not apply if a court has entered an order against an institutionalized spouse for the support of the community spouse section section b which is renumbered from section is renumbered and amended to read b maximizing use of premium assistance programs utah s premium partnership for health insurance a the department shall seek to maximize the use of medicaid and children s health insurance program funds for assistance in the purchase of private health insurance coverage for medicaid eligible and non medicaid eligible individuals
+
+b the department s efforts to expand the use of premium assistance shall i include as necessary seeking federal approval under all medicaid and children s health insurance program premium assistance provisions of federal law including provisions of the patient protection and affordable care act public law ppaca ii give priority to but not be limited to expanding the state s utah premium partnership for health insurance program including as required under subsection and iii encourage the enrollment of all individuals within a household in the same plan where possible including enrollment in a plan that allows individuals within the household transitioning out of medicaid to retain the same network and benefits they had while enrolled in medicaid the department shall seek federal approval of an amendment to the state s utah premium partnership for health insurance program to adjust the eligibility determination for single adults and parents who have an offer of employer sponsored insurance the amendment shall a be within existing appropriations for the utah premium partnership for health insurance program and b provide that adults who are up to of the federal poverty level are eligible for premium subsidies in the utah premium partnership for health insurance program for the fiscal year the department shall seek authority to increase the maximum premium subsidy per month for adults under the utah premium partnership for health insurance program to beginning with the fiscal year and in each subsequent fiscal year the department may increase premium subsidies for single adults and parents who have an offer of employer sponsored insurance to keep pace with the increase in insurance premium costs subject to appropriation of additional funding section section b which is renumbered from section is renumbered and amended to read
+
+
+b expanding the medicaid program
+
+as used in this section a cms means the centers for medicare and medicaid services in the united states department of health and human services b a federal poverty level means the same as that term is defined in section b c b medicaid expansion means an expansion of the medicaid program in accordance with this section d c medicaid expansion fund means the medicaid expansion fund created in section b b a as set forth in subsections through eligibility criteria for the medicaid program shall be expanded to cover additional low income individuals b the department shall continue to seek approval from cms to implement the medicaid waiver expansion as defined in section b c the department may implement any provision described in subsections b b iii through viii in a medicaid expansion if the department receives approval from cms to implement that provision the department shall expand the medicaid program in accordance with this subsection if the department a receives approval from cms to i expand medicaid coverage to eligible individuals whose income is below of the federal poverty level ii obtain maximum federal financial participation under u s c sec d b for enrolling an individual in the medicaid expansion under this subsection and iii permit the state to close enrollment in the medicaid expansion under this subsection if the department has insufficient funds to provide services to new enrollment under the medicaid expansion under this subsection
+
+b pays the state portion of costs for the medicaid expansion under this subsection with funds from i the medicaid expansion fund ii county contributions to the nonfederal share of medicaid expenditures or iii any other contributions funds or transfers from a nonstate agency for medicaid expenditures and c closes the medicaid program to new enrollment under the medicaid expansion under this subsection if the department projects that the cost of the medicaid expansion under this subsection will exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act a the department shall expand the medicaid program in accordance with this subsection if the department i receives approval from cms to a expand medicaid coverage to eligible individuals whose income is below of the federal poverty level b obtain maximum federal financial participation under u s c sec d y for enrolling an individual in the medicaid expansion under this subsection and c permit the state to close enrollment in the medicaid expansion under this subsection if the department has insufficient funds to provide services to new enrollment under the medicaid expansion under this subsection ii pays the state portion of costs for the medicaid expansion under this subsection with funds from a the medicaid expansion fund b county contributions to the nonfederal share of medicaid expenditures or c any other contributions funds or transfers from a nonstate agency for medicaid expenditures and
+
+
+
+iii closes the medicaid program to new enrollment under the medicaid expansion under this subsection if the department projects that the cost of the medicaid expansion under this subsection will exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act b the department shall submit a waiver an amendment to an existing waiver or a state plan amendment to cms to i administer federal funds for the medicaid expansion under this subsection according to a per capita cap developed by the department that includes an annual inflationary adjustment accounts for differences in cost among categories of medicaid expansion enrollees and provides greater flexibility to the state than the current medicaid payment model ii limit in certain circumstances as defined by the department the ability of a qualified entity to determine presumptive eligibility for medicaid coverage for an individual enrolled in a medicaid expansion under this subsection iii impose a lock out period if an individual enrolled in a medicaid expansion under this subsection violates certain program requirements as defined by the department iv allow an individual enrolled in a medicaid expansion under this subsection to remain in the medicaid program for up to a month certification period as defined by the department and v allow federal medicaid funds to be used for housing support for eligible enrollees in the medicaid expansion under this subsection a i if cms does not approve a waiver to expand the medicaid program in accordance with subsection a on or before january the department shall develop proposals to implement additional flexibilities and cost controls including cost sharing tools within a medicaid expansion under this subsection through a request to cms for a waiver or state plan amendment ii the request for a waiver or state plan amendment described in subsection a i
+
+shall include a a path to self sufficiency for qualified adults in the medicaid expansion that includes employment and training as defined in u s c sec d and b a requirement that an individual who is offered a private health benefit plan by an employer to enroll in the employer s health plan iii the department shall submit the request for a waiver or state plan amendment developed under subsection a i on or before march b notwithstanding sections b and j and in accordance with this subsection eligibility for the medicaid program shall be expanded to include all persons in the optional medicaid expansion population under the patient protection and affordable care act pub l no ppaca and the health care education reconciliation act of pub l no and related federal regulations and guidance on the earlier of i the day on which cms approves a waiver to implement the provisions described in subsections a ii a and b or ii july c the department shall seek a waiver or an amendment to an existing waiver from federal law to i implement each provision described in subsections b b iii through viii in a medicaid expansion under this subsection ii limit in certain circumstances as defined by the department the ability of a qualified entity to determine presumptive eligibility for medicaid coverage for an individual enrolled in a medicaid expansion under this subsection and iii impose a lock out period if an individual enrolled in a medicaid expansion under this subsection violates certain program requirements as defined by the department d the eligibility criteria in this subsection shall be construed to include all individuals eligible for the health coverage improvement program under section
+
+
+
+b e the department shall pay the state portion of costs for a medicaid expansion under this subsection entirely from i the medicaid expansion fund ii county contributions to the nonfederal share of medicaid expenditures or iii any other contributions funds or transfers from a nonstate agency for medicaid expenditures f if the costs of the medicaid expansion under this subsection exceed the funds available under subsection e i the department may reduce or eliminate optional medicaid services under this chapter and ii savings as determined by the department from the reduction or elimination of optional medicaid services under subsection f i shall be deposited into the medicaid expansion fund and iii the department may submit to cms a request for waivers or an amendment of existing waivers from federal law necessary to implement budget controls within the medicaid program to address the deficiency g if the costs of the medicaid expansion under this subsection are projected by the department to exceed the funds available in the current fiscal year under subsection e including savings resulting from any action taken under subsection f i the governor shall direct the department of health department of human services department and department of workforce services to reduce commitments and expenditures by an amount sufficient to offset the deficiency a proportionate to the share of total current fiscal year general fund appropriations for each of those agencies and b up to of each agency s total current fiscal year general fund appropriations ii the division of finance shall reduce allotments to the department of health
+
+department of human services department and department of workforce services by a percentage a proportionate to the amount of the deficiency and b up to of each agency s total current fiscal year general fund appropriations and iii the division of finance shall deposit the total amount from the reduced allotments described in subsection g ii into the medicaid expansion fund the department shall maximize federal financial participation in implementing this section including by seeking to obtain any necessary federal approvals or waivers notwithstanding sections and a county does not have to provide matching funds to the state for the cost of providing medicaid services to newly enrolled individuals who qualify for medicaid coverage under a medicaid expansion the department shall report to the social services appropriations subcommittee on or before november of each year that a medicaid expansion is operational a the number of individuals who enrolled in the medicaid expansion b costs to the state for the medicaid expansion c estimated costs to the state for the medicaid expansion for the current and following fiscal years d recommendations to control costs of the medicaid expansion and e as calculated in accordance with subsections b b and c b the state s net cost of the qualified medicaid expansion section section b which is renumbered from section is renumbered and amended to read b department standards for eligibility under medicaid funds for abortions a the department may develop standards and administer policies relating to eligibility under the medicaid program as long as they are consistent with subsection
+
+
+
+b b an applicant receiving medicaid assistance may be limited to particular types of care or services or to payment of part or all costs of care determined to be medically necessary the department may not provide any funds for medical hospital or other medical expenditures or medical services to otherwise eligible persons where the purpose of the assistance is to perform an abortion unless the life of the mother would be endangered if an abortion were not performed any employee of the department who authorizes payment for an abortion contrary to the provisions of this section is guilty of a class b misdemeanor and subject to forfeiture of office any person or organization that under the guise of other medical treatment provides an abortion under auspices of the medicaid program is guilty of a third degree felony and subject to forfeiture of license to practice medicine or authority to provide medical services and treatment section section b which is renumbered from section is renumbered and amended to read b contracts for provision of medical services federal provisions modifying department rules compliance with social security act the department may contract with other public or private agencies to purchase or provide medical services in connection with the programs of the division where these programs are used by other government entities contracts shall provide that other government entities in compliance with state and federal law regarding intergovernmental transfers transfer the state matching funds to the department in amounts sufficient to satisfy needs of the specified program contract terms shall include provisions for maintenance administration and service costs if a federal legislative or executive provision requires modifications or revisions in
+
+an eligibility factor established under this chapter as a condition for participation in medical assistance the department may modify or change its rules as necessary to qualify for participation the provisions of this section do not apply to department rules governing abortion the department shall comply with all pertinent requirements of the social security act and all orders rules and regulations adopted thereunder when required as a condition of participation in benefits under the social security act section section b which is renumbered from section is renumbered and amended to read b liability insurance required the medicaid program may not reimburse a home health agency as defined in section b for home health services provided to an enrollee unless the home health agency has liability coverage of at least per incident or an amount established by department rule made in accordance with title g chapter utah administrative rulemaking act section section b which is renumbered from section is renumbered and amended to read b federal aid authority of executive director the executive director with the approval of the governor may bind the state to any executive or legislative provisions promulgated or enacted by the federal government which invite the state to participate in the distribution disbursement or administration of any fund or service advanced offered or contributed in whole or in part by the federal government for purposes consistent with the powers and duties of the department such funds shall be used as provided in this chapter and be administered by the department for purposes related to medical assistance programs section section b which is renumbered from section is
+
+
+renumbered and amended to read
+b medical vendor rates
+
+medical vendor payments made to providers of services for and in behalf of recipient households shall be based upon predetermined rates from standards developed by the division in cooperation with providers of services for each type of service purchased by the division as far as possible the rates paid for services shall be established in advance of the fiscal year for which funds are to be requested section section b which is renumbered from section is renumbered and amended to read b enforcement of public assistance statutes the department shall enforce or contract for the enforcement of sections a a a a a and a to the extent that these sections pertain to benefits conferred or administered by the division under this chapter to the extent allowed under federal law or regulation the department may contract for services covered in section a insofar as that section pertains to benefits conferred or administered by the division under this chapter section section b which is renumbered from section is renumbered and amended to read b prohibited acts of state or local employees of medicaid program violation a misdemeanor each state or local employee responsible for the expenditure of funds under the state medicaid program each individual who formerly was such an officer or employee and each partner of such an officer or employee is prohibited for a period of one year after termination of such responsibility from committing any act the commission of which by an officer or employee of the united states government an individual who was such an officer or employee or a partner of such an officer or employee is prohibited by section or section
+
+of title united states code violation of this section is a class a misdemeanor section section b which is renumbered from section is renumbered and amended to read b rural hospitals for purposes of as used in this section rural hospital means a hospital located outside of a standard metropolitan statistical area as designated by the united states bureau of the census for purposes of the medicaid program the division of medicaid and health financing division may not discriminate among rural hospitals on the basis of size section section b which is renumbered from section is renumbered and amended to read b telemedicine reimbursement rulemaking a as used in this section communication by telemedicine is considered face to face contact between a health care provider and a patient under the state s medical assistance program if i the communication by telemedicine meets the requirements of administrative rules adopted in accordance with subsection and ii the health care services are eligible for reimbursement under the state s medical assistance program b this subsection applies to any managed care organization that contracts with the state s medical assistance program the reimbursement rate for telemedicine services approved under this section a shall be subject to reimbursement policies set by the state plan and b may be based on i a monthly reimbursement rate ii a daily reimbursement rate or
+
+
+
+iii an encounter rate the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act which establish a the particular telemedicine services that are considered face to face encounters for reimbursement purposes under the state s medical assistance program and b the reimbursement methodology for the telemedicine services designated under subsection a section section b which is renumbered from section is renumbered and amended to read b reimbursement of telemedicine services and telepsychiatric consultations as used in this section a telehealth services means the same as that term is defined in section b b telemedicine services means the same as that term is defined in section b c telepsychiatric consultation means a consultation between a physician and a board certified psychiatrist both of whom are licensed to engage in the practice of medicine in the state that utilizes i the health records of the patient provided from the patient or the referring physician ii a written evidence based patient questionnaire and iii telehealth services that meet industry security and privacy standards including compliance with the a health insurance portability and accountability act and b health information technology for economic and clinical health act pub l no stat as amended
+
+this section applies to a a managed care organization that contracts with the medicaid program and b a provider who is reimbursed for health care services under the medicaid program the medicaid program shall reimburse for telemedicine services at the same rate
+that the medicaid program reimburses for other health care services
+the medicaid program shall reimburse for telepsychiatric consultations at a rate set by the medicaid program
+section section b which is renumbered from section is renumbered and amended to read
+b process to promote health insurance coverage for
+
+children the department in collaboration with the department of workforce services and the state board of education shall develop a process to promote health insurance coverage for a child in school when a the child applies for free or reduced price school lunch b a child enrolls in or registers in school and c other appropriate school related opportunities the department in collaboration with the department of workforce services shall promote and facilitate the enrollment of children identified under subsection without health insurance in the utah children s health insurance program the medicaid program or the utah premium partnership for health insurance program section section b which is renumbered from section is renumbered and amended to read b medicaid continuous eligibility promoting payment and delivery reform in accordance with subsection and within appropriations from the legislature the department may amend the state medicaid plan to
+
+
+
+a create continuous eligibility for up to months for an individual who has qualified for the state medicaid program b provide incentives in managed care contracts for an individual to obtain appropriate care in appropriate settings and c require the managed care system to accept the risk of managing the medicaid population assigned to the plan amendment in return for receiving the benefits of providing quality and cost effective care if the department amends the state medicaid plan under subsection a or b the department a shall ensure that the plan amendment i is cost effective for the state medicaid program ii increases the quality and continuity of care for recipients and iii calculates and transfers administrative savings from continuous enrollment from the department of workforce services to the department of health department and b may limit the plan amendment under subsection a or b to select geographic areas or specific medicaid populations the department may seek approval for a state plan amendment waiver or a demonstration project from the secretary of the united states department of health and human services if necessary to implement a plan amendment under subsection a or b section section b which is renumbered from section is renumbered and amended to read b patient notice of health care provider privacy practices a for purposes of this section i health care provider means a health care provider as defined in section b who a receives payment for medical services from the medicaid program established in this chapter or the children s health insurance program established in chapter utah
+
+children s health insurance act section b and b submits a patient s personally identifiable information to the medicaid eligibility database or the children s health insurance program eligibility database ii hipaa means c f r parts and health insurance portability and accountability act of as amended b beginning july this section applies to the medicaid program the children s health insurance program created in chapter utah children s health insurance act section b and a health care provider a health care provider shall as part of the notice of privacy practices required by hipaa provide notice to the patient or the patient s personal representative that the health care provider either has or may submit personally identifiable information about the patient to the medicaid eligibility database and the children s health insurance program eligibility database the medicaid program and the children s health insurance program may not give a health care provider access to the medicaid eligibility database or the children s health insurance program eligibility database unless the health care provider s notice of privacy practices complies with subsection the department may adopt an administrative rule to establish uniform language for the state requirement regarding notice of privacy practices to patients required under subsection section section b which is renumbered from section is renumbered and amended to read b optional medicaid expansion the department and the governor may not expand the state s medicaid program under ppaca unless a the department expands medicaid in accordance with section b or b i the governor or the governor s designee has reported the intention to expand the
+
+
+
+state medicaid program under ppaca to the legislature in compliance with the legislative review process in section b and ii the governor submits the request for expansion of the medicaid program for optional populations to the legislature under the high impact federal funds request process required by section j a the department shall request approval from cms for waivers from federal statutory and regulatory law necessary to implement the health coverage improvement program under section b b the health coverage improvement program under section b is not subject to the requirements in subsection section section b which is renumbered from section is renumbered and amended to read b medicaid vision services request for proposals the department may select one or more contractors in accordance with title g chapter a utah procurement code to provide vision services to the medicaid populations that are eligible for vision services as described in department rules without restricting provider participation and within existing appropriations from the legislature section section b which is renumbered from section is renumbered and amended to read b review of claims audit and investigation procedures a the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act and in consultation with providers and health care professionals subject to audit and investigation under the state medicaid program to establish procedures for audits and investigations that are fair and consistent with the duties of the department as the single state agency responsible for the administration of the medicaid program under section b and title xix of the social security act b if the providers and health care professionals do not agree with the rules proposed
+
+enrolled copy s b health and human services recodification health care assistance and data general session state of utah chief sponsor jacob l anderegg house sponsor raymond p ward long title general description this bill recodifies portions of the utah health code and utah human services code highlighted provisions this bill recodifies provisions regarding health care administration and assistance and vital statistics health data and the utah medical examiner and makes technical and corresponding changes money appropriated in this bill none other special clauses this bill provides a coordination clause this bill provides revisor instructions utah code sections affected amends b as enacted by laws of utah chapter b as enacted by laws of utah chapter renumbers and amends b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah sixth special session chapter b renumbered from as last amended by laws of utah fifth special session chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah fifth special session chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from c as last amended by laws of utah chapter b renumbered from c as enacted by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as enacted by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as repealed and reenacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as repealed and reenacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter utah code sections affected by coordination clause as last amended by laws of utah chapter as last amended by laws of utah chapter b as enacted by laws of utah chapter b utah code annotated be it enacted by the legislature of the state of utah section section b is amended to read chapter health care administration and assistance part health care assistance b definitions reserved as used in this chapter applicant means any person who requests assistance under the medical programs of the state cms means the centers for medicare and medicaid services within the united states department of health and human services division means the division of integrated healthcare within the department established under section b enrollee or member means an individual whom the department has determined to be eligible for assistance under the medicaid program medicaid program means the state program for medical assistance for persons who are eligible under the state plan adopted pursuant to title xix of the federal social security act medical assistance means services furnished or payments made to or on behalf of a member a passenger vehicle means a self propelled two axle vehicle intended primarily for operation on highways and used by an applicant or recipient to meet basic transportation needs and has a fair market value below of the applicable amount of the federal luxury passenger automobile tax established in u s c sec and adjusted annually for inflation b passenger vehicle does not include i a commercial vehicle as defined in section a ii an off highway vehicle as defined in section a or iii a motor home as defined in section ppaca means the same as that term is defined in section a recipient means a person who has received medical assistance under the medicaid program section section b which is renumbered from section is renumbered and amended to read b division creation there is created within the department the division of medicaid and health financing integrated healthcare which shall be responsible for implementing organizing and maintaining the medicaid program and the children s health insurance program established in section b in accordance with the provisions of this chapter and applicable federal law section section b which is renumbered from section is renumbered and amended to read b state medicaid director appointment responsibilities the state medicaid director shall be appointed by the governor after consultation with the executive director with the advice and consent of the senate the state medicaid director may employ other employees as necessary to implement the provisions of this chapter and shall a administer the responsibilities of the division as set forth in this chapter b administer the division s budget and c establish and maintain a state plan for the medicaid program in compliance with federal law and regulations section section b which is renumbered from section is renumbered and amended to read b division responsibilities emphasis periodic assessment in accordance with the requirements of title xix of the social security act and applicable federal regulations the division is responsible for the effective and impartial administration of this chapter in an efficient economical manner the division shall a establish on a statewide basis a program to safeguard against unnecessary or inappropriate use of medicaid services excessive payments and unnecessary or inappropriate hospital admissions or lengths of stay b deny any provider claim for services that fail to meet criteria established by the division concerning medical necessity or appropriateness and c place its emphasis on high quality care to recipients in the most economical and cost effective manner possible with regard to both publicly and privately provided services the division shall implement and utilize cost containment methods where possible which may include a prepayment and postpayment review systems to determine if utilization is reasonable and necessary b preadmission certification of nonemergency admissions c mandatory outpatient rather than inpatient surgery in appropriate cases d second surgical opinions e procedures for encouraging the use of outpatient services f consistent with sections b and b a medicaid drug program g coordination of benefits and h review and exclusion of providers who are not cost effective or who have abused the medicaid program in accordance with the procedures and provisions of federal law and regulation the state medicaid director shall periodically assess the cost effectiveness and health implications of the existing medicaid program and consider alternative approaches to the provision of covered health and medical services through the medicaid program in order to reduce unnecessary or unreasonable utilization a the department shall ensure medicaid program integrity by conducting internal audits of the medicaid program for efficiencies best practices and cost avoidance b the department shall coordinate with the office of the inspector general for medicaid services created in section a to implement subsection and to address medicaid fraud waste or abuse as described in section a section section b which is renumbered from section is renumbered and amended to read b medicaid drug program preferred drug list a medicaid drug program developed by the department under subsection b f a shall notwithstanding subsection b b be based on clinical and cost related factors which include medical necessity as determined by a provider in accordance with administrative rules established by the drug utilization review board b may include therapeutic categories of drugs that may be exempted from the drug program c may include placing some drugs except the drugs described in subsection on a preferred drug list i to the extent determined appropriate by the department and ii in the manner described in subsection for psychotropic drugs d notwithstanding the requirements of part sections b through b regarding the drug utilization review board and except as provided in subsection shall immediately implement the prior authorization requirements for a nonpreferred drug that is in the same therapeutic class as a drug that is i on the preferred drug list on the date that this act takes effect or ii added to the preferred drug list after this act takes effect and e except as prohibited by subsections b and shall establish the prior authorization requirements established under subsections c and d which shall permit a health care provider or the health care provider s agent to obtain a prior authorization override of the preferred drug list through the department s pharmacy prior authorization review process and which shall i provide either telephone or fax approval or denial of the request within hours of the receipt of a request that is submitted during normal business hours of monday through friday from a m to p m ii provide for the dispensing of a limited supply of a requested drug as determined appropriate by the department in an emergency situation if the request for an override is received outside of the department s normal business hours and iii require the health care provider to provide the department with documentation of the medical need for the preferred drug list override in accordance with criteria established by the department in consultation with the pharmacy and therapeutics committee a for purposes of as used in this subsection i immunosuppressive drug a means a drug that is used in immunosuppressive therapy to inhibit or prevent activity of the immune system to aid the body in preventing the rejection of transplanted organs and tissue and b does not include drugs used for the treatment of autoimmune disease or diseases that are most likely of autoimmune origin ii stabilized means a health care provider has documented in the patient s medical chart that a patient has achieved a stable or steadfast medical state within the past days using a particular psychotropic drug b a preferred drug list developed under the provisions of this section may not include an immunosuppressive drug c i the state medicaid program shall reimburse for a prescription for an immunosuppressive drug as written by the health care provider for a patient who has undergone an organ transplant ii for purposes of subsection b and with respect to patients who have undergone an organ transplant the prescription for a particular immunosuppressive drug as written by a health care provider meets the criteria of demonstrating to the department a medical necessity for dispensing the prescribed immunosuppressive drug d notwithstanding the requirements of part sections b through b regarding the drug utilization review board the state medicaid drug program may not require the use of step therapy for immunosuppressive drugs without the written or oral consent of the health care provider and the patient e the department may include a sedative hypnotic on a preferred drug list in accordance with subsection f f the department shall grant a prior authorization for a sedative hypnotic that is not on the preferred drug list under subsection e if the health care provider has documentation related to one of the following conditions for the medicaid client i a trial and failure of at least one preferred agent in the drug class including the name of the preferred drug that was tried the length of therapy and the reason for the discontinuation ii detailed evidence of a potential drug interaction between current medication and the preferred drug iii detailed evidence of a condition or contraindication that prevents the use of the preferred drug iv objective clinical evidence that a patient is at high risk of adverse events due to a therapeutic interchange with a preferred drug v the patient is a new or previous medicaid client with an existing diagnosis previously stabilized with a nonpreferred drug or vi other valid reasons as determined by the department g a prior authorization granted under subsection f is valid for one year from the date the department grants the prior authorization and shall be renewed in accordance with subsection f a for purposes of as used in this subsection psychotropic drug means the following classes of drugs i atypical anti psychotic ii anti depressant iii anti convulsant mood stabilizer iv anti anxiety and v attention deficit hyperactivity disorder stimulant b i the department shall develop a preferred drug list for psychotropic drugs ii except as provided in subsection d a preferred drug list for psychotropic drugs developed under this section shall allow a health care provider to override the preferred drug list by writing dispense as written on the prescription for the psychotropic drug iii a health care provider may not override section b by writing dispense as written on a prescription c the department and a medicaid accountable care organization that is responsible for providing behavioral health shall i establish a system to a track health care provider prescribing patterns for psychotropic drugs b educate health care providers who are not complying with the preferred drug list and c implement peer to peer education for health care providers whose prescribing practices continue to not comply with the preferred drug list and ii determine whether health care provider compliance with the preferred drug list is at least a of prescriptions by july b of prescriptions by july and c of prescriptions by july d beginning october the department shall eliminate the dispense as written override for the preferred drug list and shall implement a prior authorization system for psychotropic drugs in accordance with subsection f if by july the department has not realized annual savings from implementing the preferred drug list for psychotropic drugs of at least general fund savings section section b which is renumbered from section is renumbered and amended to read b simplified enrollment and renewal process for medicaid and other state medical programs financial institutions the department may apply for grants and accept donations to make technology system improvements necessary to implement a simplified enrollment and renewal process for the medicaid program utah premium partnership and primary care network demonstration project programs a the department may enter into an agreement with a financial institution doing business in the state to develop and operate a data match system to identify an applicant s or enrollee s assets that i uses automated data exchanges to the maximum extent feasible and ii requires a financial institution each month to provide the name record address social security number other taxpayer identification number or other identifying information for each applicant or enrollee who maintains an account at the financial institution b the department may pay a reasonable fee to a financial institution for compliance with this subsection as provided in section c a financial institution may not be liable under any federal or state law to any person for any disclosure of information or action taken in good faith under this subsection d the department may disclose a financial record obtained from a financial institution under this section only for the purpose of and to the extent necessary in verifying eligibility as provided in this section and section b section section b which is renumbered from section is renumbered and amended to read b dental benefits a except as provided in subsection the division may establish a competitive bid process to bid out medicaid dental benefits under this chapter b the division may bid out the medicaid dental benefits separately from other program benefits the division shall use the following criteria to evaluate dental bids a ability to manage dental expenses b proven ability to handle dental insurance c efficiency of claim paying procedures d provider contracting discounts and adequacy of network and e other criteria established by the department the division shall request bids for the program s benefits at least once every five years the division s contract with dental plans for the program s benefits shall include risk sharing provisions in which the dental plan must accept of the risk for any difference between the division s premium payments per client and actual dental expenditures the division may not award contracts to a more than three responsive bidders under this section or b an insurer that does not have a current license in the state a the division may cancel the request for proposals if i there are no responsive bidders or ii the division determines that accepting the bids would increase the program s costs b if the division cancels a request for proposal or a contract that results from a request for proposal described in subsection a the division shall report to the health and human services interim committee regarding the reasons for the decision title g chapter a utah procurement code shall apply to this section a the division may i establish a dental health care delivery system and payment reform pilot program for medicaid dental benefits to increase access to cost effective and quality dental health care by increasing the number of dentists available for medicaid dental services and ii target specific medicaid populations or geographic areas in the state b the pilot program shall establish compensation models for dentists and dental hygienists that i increase access to quality cost effective dental care and ii use funds from the division of family health and preparedness that are available to reimburse dentists for educational loans in exchange for the dentist agreeing to serve medicaid and under served populations c the division may amend the state plan and apply to the secretary of the united states department of health and human services for waivers or pilot programs if necessary to establish the new dental care delivery and payment reform model d the division shall evaluate the pilot program s effect on the cost of dental care and access to dental care for the targeted medicaid populations a as used in this subsection dental hygienist means an individual who is licensed as a dental hygienist under section b the department shall reimburse a dental hygienist for dental services performed in a public health setting and in accordance with subsection c beginning on the earlier of i january or ii days after the date on which the replacement of the department s medicaid management information system software is complete c the department shall reimburse a dental hygienist directly for a service provided through the medicaid program if i the dental hygienist requests to be reimbursed directly and ii the dental hygienist provides the service within the scope of practice described in section d before november of each year in which the department reimburses dental hygienists in accordance with subsection c the department shall report to the health and human services interim committee for the previous fiscal year i the number and geographic distribution of dental hygienists who requested to be reimbursed directly ii the total number of medicaid enrollees who were served by a dental hygienist who were reimbursed under this subsection iii the total amount reimbursed directly to dental hygienists under this subsection iv the specific services and billing codes that are reimbursed under this subsection and v the aggregate amount reimbursed for each service and billing code described in subsection d iv e i except as provided in this subsection nothing in this subsection shall be interpreted as expanding or otherwise altering the limitations and scope of practice for a dental hygienist ii a dental hygienist may only directly bill and receive compensation for billing codes that fall within the scope of practice of a dental hygienist section section b which is renumbered from section is renumbered and amended to read b administration of medicaid program by department reporting to the legislature disciplinary measures and sanctions funds collected eligibility standards internal audits health opportunity accounts the department shall be the single state agency responsible for the administration of the medicaid program in connection with the united states department of health and human services pursuant to title xix of the social security act a the department shall implement the medicaid program through administrative rules in conformity with this chapter title g chapter utah administrative rulemaking act the requirements of title xix and applicable federal regulations b the rules adopted under subsection a shall include in addition to other rules necessary to implement the program i the standards used by the department for determining eligibility for medicaid services ii the services and benefits to be covered by the medicaid program iii reimbursement methodologies for providers under the medicaid program and iv a requirement that a a person receiving medicaid services shall participate in the electronic exchange of clinical health records established in accordance with section b unless the individual opts out of participation b prior to enrollment in the electronic exchange of clinical health records the enrollee shall receive notice of enrollment in the electronic exchange of clinical health records and the right to opt out of participation at any time and c beginning july when the program sends enrollment or renewal information to the enrollee and when the enrollee logs onto the program s website the enrollee shall receive notice of the right to opt out of the electronic exchange of clinical health records a the department shall in accordance with subsection b report to the social services appropriations subcommittee when the department i implements a change in the medicaid state plan ii initiates a new medicaid waiver iii initiates an amendment to an existing medicaid waiver iv applies for an extension of an application for a waiver or an existing medicaid waiver v applies for or receives approval for a change in any capitation rate within the medicaid program or vi initiates a rate change that requires public notice under state or federal law b the report required by subsection a shall i be submitted to the social services appropriations subcommittee prior to the department implementing the proposed change and ii include a a description of the department s current practice or policy that the department is proposing to change b an explanation of why the department is proposing the change c the proposed change in services or reimbursement including a description of the effect of the change d the effect of an increase or decrease in services or benefits on individuals and families e the degree to which any proposed cut may result in cost shifting to more expensive services in health or human service programs and f the fiscal impact of the proposed change including i the effect of the proposed change on current or future appropriations from the legislature to the department ii the effect the proposed change may have on federal matching dollars received by the state medicaid program iii any cost shifting or cost savings within the department s budget that may result from the proposed change and iv identification of the funds that will be used for the proposed change including any transfer of funds within the department s budget any rules adopted by the department under subsection are subject to review and reauthorization by the legislature in accordance with section g the department may in its discretion contract with the department of human services or other qualified agencies for services in connection with the administration of the medicaid program including a the determination of the eligibility of individuals for the program b recovery of overpayments and c consistent with section b and to the extent permitted by law and quality control services enforcement of fraud and abuse laws the department shall provide by rule disciplinary measures and sanctions for medicaid providers who fail to comply with the rules and procedures of the program provided that sanctions imposed administratively may not extend beyond a termination from the program b recovery of claim reimbursements incorrectly paid and c those specified in section of title xix of the federal social security act a funds collected as a result of a sanction imposed under section of title xix of the federal social security act shall be deposited in the general fund as dedicated credits to be used by the division in accordance with the requirements of section of title xix of the federal social security act b in accordance with section j sanctions collected under this subsection are nonlapsing a in determining whether an applicant or recipient is eligible for a service or benefit under this part or chapter part utah children s health insurance act program the department shall if subsection b is satisfied exclude from consideration one passenger vehicle designated by the applicant or recipient b before subsection a may be applied i the federal government shall a determine that subsection a may be implemented within the state s existing public assistance related waivers as of january b extend a waiver to the state permitting the implementation of subsection a or c determine that the state s waivers that permit dual eligibility determinations for cash assistance and medicaid are no longer valid and ii the department shall determine that subsection a can be implemented within existing funding a for purposes of as used in this subsection i aged blind or has a disability means an aged blind or disabled individual as defined in u s c sec c a and ii spend down means an amount of income in excess of the allowable income standard that shall be paid in cash to the department or incurred through the medical services not paid by medicaid b in determining whether an applicant or recipient who is aged blind or has a disability is eligible for a service or benefit under this chapter the department shall use of the federal poverty level as i the allowable income standard for eligibility for services or benefits and ii the allowable income standard for eligibility as a result of spend down the department shall conduct internal audits of the medicaid program a the department may apply for and if approved implement a demonstration program for health opportunity accounts as provided for in u s c sec u b a health opportunity account established under subsection a shall be an alternative to the existing benefits received by an individual eligible to receive medicaid under this chapter c subsection a is not intended to expand the coverage of the medicaid program a i the department shall apply for and if approved implement an amendment to the state plan under this subsection for benefits for a medically needy pregnant women b medically needy children and c medically needy parents and caretaker relatives ii the department may implement the eligibility standards of subsection b for eligibility determinations made on or after the date of the approval of the amendment to the state plan b in determining whether an applicant is eligible for benefits described in subsection a i the department shall i disregard resources held in an account in the savings plan created under title b chapter a utah educational savings plan if the beneficiary of the account is a under the age of and b living with the account owner as that term is defined in section b a or temporarily absent from the residence of the account owner and ii include the withdrawals from an account in the utah educational savings plan as resources for a benefit determination if the withdrawal was not used for qualified higher education costs as that term is defined in section b a a the department may not deny or terminate eligibility for medicaid solely because an individual is i incarcerated and ii not an inmate as defined in section b subsection a does not require the medicaid program to provide coverage for any services for an individual while the individual is incarcerated the department is a party to and may intervene at any time in any judicial or administrative action a to which the department of workforce services is a party and b that involves medical assistance under this chapter i title chapter medical assistance act or ii title chapter utah children s health insurance act section section b which is renumbered from section is renumbered and amended to read b medicaid expansion the purpose of this section is to expand the coverage of the medicaid program to persons who are in categories traditionally not served by that program within appropriations from the legislature the department may amend the state plan for medical assistance to provide for eligibility for medicaid a on or after july for children to years old who live in households below the federal poverty income guideline and b on or after july for persons who have incomes below the federal poverty income guideline and who are aged blind or have a disability a within appropriations from the legislature on or after july the medicaid program may provide for eligibility for persons who have incomes below the federal poverty income guideline b in order to meet the provisions of this subsection the department may seek approval for a demonstration project under u s c sec from the secretary of the united states department of health and human services the medicaid program shall provide for eligibility for persons as required by subsection b services available for persons described in this section shall include required medicaid services and may include one or more optional medicaid services if those services are funded by the legislature the department may also require persons described in subsections through to meet an asset test section section b which is renumbered from section is renumbered and amended to read b copayments by recipients employer sponsored plans the department shall selectively provide for enrollment fees premiums deductions cost sharing or other similar charges to be paid by recipients their spouses and parents within the limitations of federal law and regulation beginning may within appropriations by the legislature and as a means to increase health care coverage among the uninsured the department shall take steps to promote increased participation in employer sponsored health insurance including a maximizing the health insurance premium subsidy provided under the state s demonstration waiver by i ensuring that state funds are matched by federal funds to the greatest extent allowable and ii as the department determines appropriate seeking federal approval to do one or more of the following a eliminate or otherwise modify the annual enrollment fee b eliminate or otherwise modify the schedule used to determine the level of subsidy provided to an enrollee each year c reduce the maximum number of participants allowable under the subsidy program or d otherwise modify the program in a manner that promotes enrollment in employer sponsored health insurance and b exploring the use of other options including the development of a waiver under the medicaid health insurance flexibility demonstration initiative or other federal authority section section b which is renumbered from section is renumbered and amended to read b income and resources from institutionalized spouses as used in this section a community spouse means the spouse of an institutionalized spouse b i community spouse monthly income allowance means an amount by which the minimum monthly maintenance needs allowance for the spouse exceeds the amount of monthly income otherwise available to the community spouse determined without regard to the allowance except as provided in subsection b ii ii if a court has entered an order against an institutionalized spouse for monthly income for the support of the community spouse the community spouse monthly income allowance for the spouse may not be less than the amount of the monthly income so ordered c community spouse resource allowance is the amount of combined resources that are protected for a community spouse living in the community which the division shall establish by rule made in accordance with title g chapter utah administrative rulemaking act based on the amounts established by the united states department of health and human services d excess shelter allowance for a community spouse means the amount by which the sum of the spouse s expense for rent or mortgage payment taxes and insurance and in the case of condominium or cooperative required maintenance charge for the community spouse s principal residence and the spouse s actual expenses for electricity natural gas and water utilities or at the discretion of the department the federal standard utility allowance under snap as defined in section a exceeds of the amount described in subsection e family member means a minor dependent child dependent parents or dependent sibling of the institutionalized spouse or community spouse who are residing with the community spouse f i institutionalized spouse means a person who is residing in a nursing facility and is married to a spouse who is not in a nursing facility ii an institutionalized spouse does not include a person who is not likely to reside in a nursing facility for at least consecutive days g nursing care facility means the same as that term is defined in section b the division shall comply with this section when determining eligibility for medical assistance for an institutionalized spouse for services furnished during a calendar year beginning on or after january the community spouse resource allowance shall be increased by the division by an amount as determined annually by cms the division shall compute as of the beginning of the first continuous period of institutionalization of the institutionalized spouse a the total value of the resources to the extent either the institutionalized spouse or the community spouse has an ownership interest and b a spousal share which is of the resources described in subsection a at the request of an institutionalized spouse or a community spouse at the beginning of the first continuous period of institutionalization of the institutionalized spouse and upon the receipt of relevant documentation of resources the division shall promptly assess and document the total value described in subsection a and shall provide a copy of that assessment and documentation to each spouse and shall retain a copy of the assessment when the division provides a copy of the assessment it shall include a notice stating that the spouse may request a hearing under subsection when determining eligibility for medical assistance under this chapter a except as provided in subsection b all resources held by either the institutionalized spouse community spouse or both are considered to be available to the institutionalized spouse b resources are considered to be available to the institutionalized spouse only to the extent that the amount of those resources exceeds the community spouse resource allowance at the time of application for medical assistance under this chapter a the division may not find an institutionalized spouse to be ineligible for medical assistance by reason of resources determined under subsection to be available for the cost of care when i the institutionalized spouse has assigned to the state any rights to support from the community spouse ii except as provided in subsection b the institutionalized spouse lacks the ability to execute an assignment due to physical or mental impairment or iii the division determines that denial of medical assistance would cause an undue burden b subsection a ii does not prevent the division from seeking a court order for an assignment of support during the continuous period in which an institutionalized spouse is in an institution and after the month in which an institutionalized spouse is eligible for medical assistance the resources of the community spouse may not be considered to be available to the institutionalized spouse when an institutionalized spouse is determined to be eligible for medical assistance in determining the amount of the spouse s income that is to be applied monthly for the cost of care in the nursing care facility the division shall deduct from the spouse s monthly income the following amounts in the following order a a personal needs allowance the amount of which is determined by the division b a community spouse monthly income allowance but only to the extent that the income of the institutionalized spouse is made available to or for the benefit of the community spouse c a family allowance for each family member equal to at least of the amount that the amount described in subsection a exceeds the amount of the family member s monthly income and d amounts for incurred expenses for the medical or remedial care for the institutionalized spouse the division shall establish a minimum monthly maintenance needs allowance for each community spouse that includes a an amount established by the division by rule made in accordance with title g chapter utah administrative rulemaking act based on the amounts established by the united states department of health and human services and b an excess shelter allowance a an institutionalized spouse or a community spouse may request a hearing with respect to the determinations described in subsections e i through v if an application for medical assistance has been made on behalf of the institutionalized spouse b a hearing under this subsection regarding the community spouse resource allowance shall be held by the division within days from the date of the request for the hearing c if either spouse establishes that the community spouse needs income above the level otherwise provided by the minimum monthly maintenance needs allowance due to exceptional circumstances resulting in significant financial duress there shall be substituted for the minimum monthly maintenance needs allowance provided under subsection an amount adequate to provide additional income as is necessary d if either spouse establishes that the community spouse resource allowance in relation to the amount of income generated by the allowance is inadequate to raise the community spouse s income to the minimum monthly maintenance needs allowance there shall be substituted for the community spouse resource allowance an amount adequate to provide a minimum monthly maintenance needs allowance e a hearing may be held under this subsection if either the institutionalized spouse or community spouse is dissatisfied with a determination of i the community spouse monthly income allowance ii the amount of monthly income otherwise available to the community spouse iii the computation of the spousal share of resources under subsection iv the attribution of resources under subsection or v the determination of the community spouse resource allocation a an institutionalized spouse may transfer an amount equal to the community spouse resource allowance but only to the extent the resources of the institutionalized spouse are transferred to or for the sole benefit of the community spouse b the transfer under subsection a shall be made as soon as practicable after the date of the initial determination of eligibility taking into account the time necessary to obtain a court order under subsection c c chapter medical benefits recovery act part medical benefits recovery does not apply if a court has entered an order against an institutionalized spouse for the support of the community spouse section section b which is renumbered from section is renumbered and amended to read b maximizing use of premium assistance programs utah s premium partnership for health insurance a the department shall seek to maximize the use of medicaid and children s health insurance program funds for assistance in the purchase of private health insurance coverage for medicaid eligible and non medicaid eligible individuals b the department s efforts to expand the use of premium assistance shall i include as necessary seeking federal approval under all medicaid and children s health insurance program premium assistance provisions of federal law including provisions of the patient protection and affordable care act public law ppaca ii give priority to but not be limited to expanding the state s utah premium partnership for health insurance program including as required under subsection and iii encourage the enrollment of all individuals within a household in the same plan where possible including enrollment in a plan that allows individuals within the household transitioning out of medicaid to retain the same network and benefits they had while enrolled in medicaid the department shall seek federal approval of an amendment to the state s utah premium partnership for health insurance program to adjust the eligibility determination for single adults and parents who have an offer of employer sponsored insurance the amendment shall a be within existing appropriations for the utah premium partnership for health insurance program and b provide that adults who are up to of the federal poverty level are eligible for premium subsidies in the utah premium partnership for health insurance program for the fiscal year the department shall seek authority to increase the maximum premium subsidy per month for adults under the utah premium partnership for health insurance program to beginning with the fiscal year and in each subsequent fiscal year the department may increase premium subsidies for single adults and parents who have an offer of employer sponsored insurance to keep pace with the increase in insurance premium costs subject to appropriation of additional funding section section b which is renumbered from section is renumbered and amended to read b expanding the medicaid program as used in this section a cms means the centers for medicare and medicaid services in the united states department of health and human services b a federal poverty level means the same as that term is defined in section b c b medicaid expansion means an expansion of the medicaid program in accordance with this section d c medicaid expansion fund means the medicaid expansion fund created in section b b a as set forth in subsections through eligibility criteria for the medicaid program shall be expanded to cover additional low income individuals b the department shall continue to seek approval from cms to implement the medicaid waiver expansion as defined in section b c the department may implement any provision described in subsections b b iii through viii in a medicaid expansion if the department receives approval from cms to implement that provision the department shall expand the medicaid program in accordance with this subsection if the department a receives approval from cms to i expand medicaid coverage to eligible individuals whose income is below of the federal poverty level ii obtain maximum federal financial participation under u s c sec d b for enrolling an individual in the medicaid expansion under this subsection and iii permit the state to close enrollment in the medicaid expansion under this subsection if the department has insufficient funds to provide services to new enrollment under the medicaid expansion under this subsection b pays the state portion of costs for the medicaid expansion under this subsection with funds from i the medicaid expansion fund ii county contributions to the nonfederal share of medicaid expenditures or iii any other contributions funds or transfers from a nonstate agency for medicaid expenditures and c closes the medicaid program to new enrollment under the medicaid expansion under this subsection if the department projects that the cost of the medicaid expansion under this subsection will exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act a the department shall expand the medicaid program in accordance with this subsection if the department i receives approval from cms to a expand medicaid coverage to eligible individuals whose income is below of the federal poverty level b obtain maximum federal financial participation under u s c sec d y for enrolling an individual in the medicaid expansion under this subsection and c permit the state to close enrollment in the medicaid expansion under this subsection if the department has insufficient funds to provide services to new enrollment under the medicaid expansion under this subsection ii pays the state portion of costs for the medicaid expansion under this subsection with funds from a the medicaid expansion fund b county contributions to the nonfederal share of medicaid expenditures or c any other contributions funds or transfers from a nonstate agency for medicaid expenditures and iii closes the medicaid program to new enrollment under the medicaid expansion under this subsection if the department projects that the cost of the medicaid expansion under this subsection will exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act b the department shall submit a waiver an amendment to an existing waiver or a state plan amendment to cms to i administer federal funds for the medicaid expansion under this subsection according to a per capita cap developed by the department that includes an annual inflationary adjustment accounts for differences in cost among categories of medicaid expansion enrollees and provides greater flexibility to the state than the current medicaid payment model ii limit in certain circumstances as defined by the department the ability of a qualified entity to determine presumptive eligibility for medicaid coverage for an individual enrolled in a medicaid expansion under this subsection iii impose a lock out period if an individual enrolled in a medicaid expansion under this subsection violates certain program requirements as defined by the department iv allow an individual enrolled in a medicaid expansion under this subsection to remain in the medicaid program for up to a month certification period as defined by the department and v allow federal medicaid funds to be used for housing support for eligible enrollees in the medicaid expansion under this subsection a i if cms does not approve a waiver to expand the medicaid program in accordance with subsection a on or before january the department shall develop proposals to implement additional flexibilities and cost controls including cost sharing tools within a medicaid expansion under this subsection through a request to cms for a waiver or state plan amendment ii the request for a waiver or state plan amendment described in subsection a i shall include a a path to self sufficiency for qualified adults in the medicaid expansion that includes employment and training as defined in u s c sec d and b a requirement that an individual who is offered a private health benefit plan by an employer to enroll in the employer s health plan iii the department shall submit the request for a waiver or state plan amendment developed under subsection a i on or before march b notwithstanding sections b and j and in accordance with this subsection eligibility for the medicaid program shall be expanded to include all persons in the optional medicaid expansion population under the patient protection and affordable care act pub l no ppaca and the health care education reconciliation act of pub l no and related federal regulations and guidance on the earlier of i the day on which cms approves a waiver to implement the provisions described in subsections a ii a and b or ii july c the department shall seek a waiver or an amendment to an existing waiver from federal law to i implement each provision described in subsections b b iii through viii in a medicaid expansion under this subsection ii limit in certain circumstances as defined by the department the ability of a qualified entity to determine presumptive eligibility for medicaid coverage for an individual enrolled in a medicaid expansion under this subsection and iii impose a lock out period if an individual enrolled in a medicaid expansion under this subsection violates certain program requirements as defined by the department d the eligibility criteria in this subsection shall be construed to include all individuals eligible for the health coverage improvement program under section b e the department shall pay the state portion of costs for a medicaid expansion under this subsection entirely from i the medicaid expansion fund ii county contributions to the nonfederal share of medicaid expenditures or iii any other contributions funds or transfers from a nonstate agency for medicaid expenditures f if the costs of the medicaid expansion under this subsection exceed the funds available under subsection e i the department may reduce or eliminate optional medicaid services under this chapter and ii savings as determined by the department from the reduction or elimination of optional medicaid services under subsection f i shall be deposited into the medicaid expansion fund and iii the department may submit to cms a request for waivers or an amendment of existing waivers from federal law necessary to implement budget controls within the medicaid program to address the deficiency g if the costs of the medicaid expansion under this subsection are projected by the department to exceed the funds available in the current fiscal year under subsection e including savings resulting from any action taken under subsection f i the governor shall direct the department of health department of human services department and department of workforce services to reduce commitments and expenditures by an amount sufficient to offset the deficiency a proportionate to the share of total current fiscal year general fund appropriations for each of those agencies and b up to of each agency s total current fiscal year general fund appropriations ii the division of finance shall reduce allotments to the department of health department of human services department and department of workforce services by a percentage a proportionate to the amount of the deficiency and b up to of each agency s total current fiscal year general fund appropriations and iii the division of finance shall deposit the total amount from the reduced allotments described in subsection g ii into the medicaid expansion fund the department shall maximize federal financial participation in implementing this section including by seeking to obtain any necessary federal approvals or waivers notwithstanding sections and a county does not have to provide matching funds to the state for the cost of providing medicaid services to newly enrolled individuals who qualify for medicaid coverage under a medicaid expansion the department shall report to the social services appropriations subcommittee on or before november of each year that a medicaid expansion is operational a the number of individuals who enrolled in the medicaid expansion b costs to the state for the medicaid expansion c estimated costs to the state for the medicaid expansion for the current and following fiscal years d recommendations to control costs of the medicaid expansion and e as calculated in accordance with subsections b b and c b the state s net cost of the qualified medicaid expansion section section b which is renumbered from section is renumbered and amended to read b department standards for eligibility under medicaid funds for abortions a the department may develop standards and administer policies relating to eligibility under the medicaid program as long as they are consistent with subsection b b an applicant receiving medicaid assistance may be limited to particular types of care or services or to payment of part or all costs of care determined to be medically necessary the department may not provide any funds for medical hospital or other medical expenditures or medical services to otherwise eligible persons where the purpose of the assistance is to perform an abortion unless the life of the mother would be endangered if an abortion were not performed any employee of the department who authorizes payment for an abortion contrary to the provisions of this section is guilty of a class b misdemeanor and subject to forfeiture of office any person or organization that under the guise of other medical treatment provides an abortion under auspices of the medicaid program is guilty of a third degree felony and subject to forfeiture of license to practice medicine or authority to provide medical services and treatment section section b which is renumbered from section is renumbered and amended to read b contracts for provision of medical services federal provisions modifying department rules compliance with social security act the department may contract with other public or private agencies to purchase or provide medical services in connection with the programs of the division where these programs are used by other government entities contracts shall provide that other government entities in compliance with state and federal law regarding intergovernmental transfers transfer the state matching funds to the department in amounts sufficient to satisfy needs of the specified program contract terms shall include provisions for maintenance administration and service costs if a federal legislative or executive provision requires modifications or revisions in an eligibility factor established under this chapter as a condition for participation in medical assistance the department may modify or change its rules as necessary to qualify for participation the provisions of this section do not apply to department rules governing abortion the department shall comply with all pertinent requirements of the social security act and all orders rules and regulations adopted thereunder when required as a condition of participation in benefits under the social security act section section b which is renumbered from section is renumbered and amended to read b liability insurance required the medicaid program may not reimburse a home health agency as defined in section b for home health services provided to an enrollee unless the home health agency has liability coverage of at least per incident or an amount established by department rule made in accordance with title g chapter utah administrative rulemaking act section section b which is renumbered from section is renumbered and amended to read b federal aid authority of executive director the executive director with the approval of the governor may bind the state to any executive or legislative provisions promulgated or enacted by the federal government which invite the state to participate in the distribution disbursement or administration of any fund or service advanced offered or contributed in whole or in part by the federal government for purposes consistent with the powers and duties of the department such funds shall be used as provided in this chapter and be administered by the department for purposes related to medical assistance programs section section b which is renumbered from section is renumbered and amended to read b medical vendor rates medical vendor payments made to providers of services for and in behalf of recipient households shall be based upon predetermined rates from standards developed by the division in cooperation with providers of services for each type of service purchased by the division as far as possible the rates paid for services shall be established in advance of the fiscal year for which funds are to be requested section section b which is renumbered from section is renumbered and amended to read b enforcement of public assistance statutes the department shall enforce or contract for the enforcement of sections a a a a a and a to the extent that these sections pertain to benefits conferred or administered by the division under this chapter to the extent allowed under federal law or regulation the department may contract for services covered in section a insofar as that section pertains to benefits conferred or administered by the division under this chapter section section b which is renumbered from section is renumbered and amended to read b prohibited acts of state or local employees of medicaid program violation a misdemeanor each state or local employee responsible for the expenditure of funds under the state medicaid program each individual who formerly was such an officer or employee and each partner of such an officer or employee is prohibited for a period of one year after termination of such responsibility from committing any act the commission of which by an officer or employee of the united states government an individual who was such an officer or employee or a partner of such an officer or employee is prohibited by section or section of title united states code violation of this section is a class a misdemeanor section section b which is renumbered from section is renumbered and amended to read b rural hospitals for purposes of as used in this section rural hospital means a hospital located outside of a standard metropolitan statistical area as designated by the united states bureau of the census for purposes of the medicaid program the division of medicaid and health financing division may not discriminate among rural hospitals on the basis of size section section b which is renumbered from section is renumbered and amended to read b telemedicine reimbursement rulemaking a as used in this section communication by telemedicine is considered face to face contact between a health care provider and a patient under the state s medical assistance program if i the communication by telemedicine meets the requirements of administrative rules adopted in accordance with subsection and ii the health care services are eligible for reimbursement under the state s medical assistance program b this subsection applies to any managed care organization that contracts with the state s medical assistance program the reimbursement rate for telemedicine services approved under this section a shall be subject to reimbursement policies set by the state plan and b may be based on i a monthly reimbursement rate ii a daily reimbursement rate or iii an encounter rate the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act which establish a the particular telemedicine services that are considered face to face encounters for reimbursement purposes under the state s medical assistance program and b the reimbursement methodology for the telemedicine services designated under subsection a section section b which is renumbered from section is renumbered and amended to read b reimbursement of telemedicine services and telepsychiatric consultations as used in this section a telehealth services means the same as that term is defined in section b b telemedicine services means the same as that term is defined in section b c telepsychiatric consultation means a consultation between a physician and a board certified psychiatrist both of whom are licensed to engage in the practice of medicine in the state that utilizes i the health records of the patient provided from the patient or the referring physician ii a written evidence based patient questionnaire and iii telehealth services that meet industry security and privacy standards including compliance with the a health insurance portability and accountability act and b health information technology for economic and clinical health act pub l no stat as amended this section applies to a a managed care organization that contracts with the medicaid program and b a provider who is reimbursed for health care services under the medicaid program the medicaid program shall reimburse for telemedicine services at the same rate that the medicaid program reimburses for other health care services the medicaid program shall reimburse for telepsychiatric consultations at a rate set by the medicaid program section section b which is renumbered from section is renumbered and amended to read b process to promote health insurance coverage for children the department in collaboration with the department of workforce services and the state board of education shall develop a process to promote health insurance coverage for a child in school when a the child applies for free or reduced price school lunch b a child enrolls in or registers in school and c other appropriate school related opportunities the department in collaboration with the department of workforce services shall promote and facilitate the enrollment of children identified under subsection without health insurance in the utah children s health insurance program the medicaid program or the utah premium partnership for health insurance program section section b which is renumbered from section is renumbered and amended to read b medicaid continuous eligibility promoting payment and delivery reform in accordance with subsection and within appropriations from the legislature the department may amend the state medicaid plan to a create continuous eligibility for up to months for an individual who has qualified for the state medicaid program b provide incentives in managed care contracts for an individual to obtain appropriate care in appropriate settings and c require the managed care system to accept the risk of managing the medicaid population assigned to the plan amendment in return for receiving the benefits of providing quality and cost effective care if the department amends the state medicaid plan under subsection a or b the department a shall ensure that the plan amendment i is cost effective for the state medicaid program ii increases the quality and continuity of care for recipients and iii calculates and transfers administrative savings from continuous enrollment from the department of workforce services to the department of health department and b may limit the plan amendment under subsection a or b to select geographic areas or specific medicaid populations the department may seek approval for a state plan amendment waiver or a demonstration project from the secretary of the united states department of health and human services if necessary to implement a plan amendment under subsection a or b section section b which is renumbered from section is renumbered and amended to read b patient notice of health care provider privacy practices a for purposes of this section i health care provider means a health care provider as defined in section b who a receives payment for medical services from the medicaid program established in this chapter or the children s health insurance program established in chapter utah children s health insurance act section b and b submits a patient s personally identifiable information to the medicaid eligibility database or the children s health insurance program eligibility database ii hipaa means c f r parts and health insurance portability and accountability act of as amended b beginning july this section applies to the medicaid program the children s health insurance program created in chapter utah children s health insurance act section b and a health care provider a health care provider shall as part of the notice of privacy practices required by hipaa provide notice to the patient or the patient s personal representative that the health care provider either has or may submit personally identifiable information about the patient to the medicaid eligibility database and the children s health insurance program eligibility database the medicaid program and the children s health insurance program may not give a health care provider access to the medicaid eligibility database or the children s health insurance program eligibility database unless the health care provider s notice of privacy practices complies with subsection the department may adopt an administrative rule to establish uniform language for the state requirement regarding notice of privacy practices to patients required under subsection section section b which is renumbered from section is renumbered and amended to read b optional medicaid expansion the department and the governor may not expand the state s medicaid program under ppaca unless a the department expands medicaid in accordance with section b or b i the governor or the governor s designee has reported the intention to expand the state medicaid program under ppaca to the legislature in compliance with the legislative review process in section b and ii the governor submits the request for expansion of the medicaid program for optional populations to the legislature under the high impact federal funds request process required by section j a the department shall request approval from cms for waivers from federal statutory and regulatory law necessary to implement the health coverage improvement program under section b b the health coverage improvement program under section b is not subject to the requirements in subsection section section b which is renumbered from section is renumbered and amended to read b medicaid vision services request for proposals the department may select one or more contractors in accordance with title g chapter a utah procurement code to provide vision services to the medicaid populations that are eligible for vision services as described in department rules without restricting provider participation and within existing appropriations from the legislature section section b which is renumbered from section is renumbered and amended to read b review of claims audit and investigation procedures a the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act and in consultation with providers and health care professionals subject to audit and investigation under the state medicaid program to establish procedures for audits and investigations that are fair and consistent with the duties of the department as the single state agency responsible for the administration of the medicaid program under section b and title xix of the social security act b if the providers and health care professionals do not agree with the rules proposed or adopted by the department under subsection a the providers or health care professionals may i request a hearing for the proposed administrative rule or seek any other remedies under the provisions of title g chapter utah administrative rulemaking act and ii request a review of the rule by the legislature s administrative rules review and general oversight committee created in section g the department shall a notify and educate providers and health care professionals subject to audit and investigation under the medicaid program of the providers and health care professionals responsibilities and rights under the administrative rules adopted by the department under the provisions of this section b ensure that the department or any entity that contracts with the department to conduct audits i has on staff or contracts with a medical or dental professional who is experienced in the treatment billing and coding procedures used by the type of provider being audited and ii uses the services of the appropriate professional described in subsection b i if
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+enrolled copy s b health and human services recodification health care assistance and data general session state of utah chief sponsor jacob l anderegg house sponsor raymond p ward long title general description this bill recodifies portions of the utah health code and utah human services code highlighted provisions this bill recodifies provisions regarding health care administration and assistance and vital statistics health data and the utah medical examiner and makes technical and corresponding changes money appropriated in this bill none other special clauses this bill provides a coordination clause this bill provides revisor instructions utah code sections affected amends b as enacted by laws of utah chapter b as enacted by laws of utah chapter renumbers and amends b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah sixth special session chapter b renumbered from as last amended by laws of utah fifth special session chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah fifth special session chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from c as last amended by laws of utah chapter b renumbered from c as enacted by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as enacted by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as repealed and reenacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as repealed and reenacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter utah code sections affected by coordination clause as last amended by laws of utah chapter as last amended by laws of utah chapter b as enacted by laws of utah chapter b utah code annotated be it enacted by the legislature of the state of utah section section b is amended to read chapter health care administration and assistance part health care assistance b definitions reserved as used in this chapter applicant means any person who requests assistance under the medical programs of the state cms means the centers for medicare and medicaid services within the united states department of health and human services division means the division of integrated healthcare within the department established under section b enrollee or member means an individual whom the department has determined to be eligible for assistance under the medicaid program medicaid program means the state program for medical assistance for persons who are eligible under the state plan adopted pursuant to title xix of the federal social security act medical assistance means services furnished or payments made to or on behalf of a member a passenger vehicle means a self propelled two axle vehicle intended primarily for operation on highways and used by an applicant or recipient to meet basic transportation needs and has a fair market value below of the applicable amount of the federal luxury passenger automobile tax established in u s c sec and adjusted annually for inflation b passenger vehicle does not include i a commercial vehicle as defined in section a ii an off highway vehicle as defined in section a or iii a motor home as defined in section ppaca means the same as that term is defined in section a recipient means a person who has received medical assistance under the medicaid program section section b which is renumbered from section is renumbered and amended to read b division creation there is created within the department the division of medicaid and health financing integrated healthcare which shall be responsible for implementing organizing and maintaining the medicaid program and the children s health insurance program established in section b in accordance with the provisions of this chapter and applicable federal law section section b which is renumbered from section is renumbered and amended to read b state medicaid director appointment responsibilities the state medicaid director shall be appointed by the governor after consultation with the executive director with the advice and consent of the senate the state medicaid director may employ other employees as necessary to implement the provisions of this chapter and shall a administer the responsibilities of the division as set forth in this chapter b administer the division s budget and c establish and maintain a state plan for the medicaid program in compliance with federal law and regulations section section b which is renumbered from section is renumbered and amended to read b division responsibilities emphasis periodic assessment in accordance with the requirements of title xix of the social security act and applicable federal regulations the division is responsible for the effective and impartial administration of this chapter in an efficient economical manner the division shall a establish on a statewide basis a program to safeguard against unnecessary or inappropriate use of medicaid services excessive payments and unnecessary or inappropriate hospital admissions or lengths of stay b deny any provider claim for services that fail to meet criteria established by the division concerning medical necessity or appropriateness and c place its emphasis on high quality care to recipients in the most economical and cost effective manner possible with regard to both publicly and privately provided services the division shall implement and utilize cost containment methods where possible which may include a prepayment and postpayment review systems to determine if utilization is reasonable and necessary b preadmission certification of nonemergency admissions c mandatory outpatient rather than inpatient surgery in appropriate cases d second surgical opinions e procedures for encouraging the use of outpatient services f consistent with sections b and b a medicaid drug program g coordination of benefits and h review and exclusion of providers who are not cost effective or who have abused the medicaid program in accordance with the procedures and provisions of federal law and regulation the state medicaid director shall periodically assess the cost effectiveness and health implications of the existing medicaid program and consider alternative approaches to the provision of covered health and medical services through the medicaid program in order to reduce unnecessary or unreasonable utilization a the department shall ensure medicaid program integrity by conducting internal audits of the medicaid program for efficiencies best practices and cost avoidance b the department shall coordinate with the office of the inspector general for medicaid services created in section a to implement subsection and to address medicaid fraud waste or abuse as described in section a section section b which is renumbered from section is renumbered and amended to read b medicaid drug program preferred drug list a medicaid drug program developed by the department under subsection b f a shall notwithstanding subsection b b be based on clinical and cost related factors which include medical necessity as determined by a provider in accordance with administrative rules established by the drug utilization review board b may include therapeutic categories of drugs that may be exempted from the drug program c may include placing some drugs except the drugs described in subsection on a preferred drug list i to the extent determined appropriate by the department and ii in the manner described in subsection for psychotropic drugs d notwithstanding the requirements of part sections b through b regarding the drug utilization review board and except as provided in subsection shall immediately implement the prior authorization requirements for a nonpreferred drug that is in the same therapeutic class as a drug that is i on the preferred drug list on the date that this act takes effect or ii added to the preferred drug list after this act takes effect and e except as prohibited by subsections b and shall establish the prior authorization requirements established under subsections c and d which shall permit a health care provider or the health care provider s agent to obtain a prior authorization override of the preferred drug list through the department s pharmacy prior authorization review process and which shall i provide either telephone or fax approval or denial of the request within hours of the receipt of a request that is submitted during normal business hours of monday through friday from a m to p m ii provide for the dispensing of a limited supply of a requested drug as determined appropriate by the department in an emergency situation if the request for an override is received outside of the department s normal business hours and iii require the health care provider to provide the department with documentation of the medical need for the preferred drug list override in accordance with criteria established by the department in consultation with the pharmacy and therapeutics committee a for purposes of as used in this subsection i immunosuppressive drug a means a drug that is used in immunosuppressive therapy to inhibit or prevent activity of the immune system to aid the body in preventing the rejection of transplanted organs and tissue and b does not include drugs used for the treatment of autoimmune disease or diseases that are most likely of autoimmune origin ii stabilized means a health care provider has documented in the patient s medical chart that a patient has achieved a stable or steadfast medical state within the past days using a particular psychotropic drug b a preferred drug list developed under the provisions of this section may not include an immunosuppressive drug c i the state medicaid program shall reimburse for a prescription for an immunosuppressive drug as written by the health care provider for a patient who has undergone an organ transplant ii for purposes of subsection b and with respect to patients who have undergone an organ transplant the prescription for a particular immunosuppressive drug as written by a health care provider meets the criteria of demonstrating to the department a medical necessity for dispensing the prescribed immunosuppressive drug d notwithstanding the requirements of part sections b through b regarding the drug utilization review board the state medicaid drug program may not require the use of step therapy for immunosuppressive drugs without the written or oral consent of the health care provider and the patient e the department may include a sedative hypnotic on a preferred drug list in accordance with subsection f f the department shall grant a prior authorization for a sedative hypnotic that is not on the preferred drug list under subsection e if the health care provider has documentation related to one of the following conditions for the medicaid client i a trial and failure of at least one preferred agent in the drug class including the name of the preferred drug that was tried the length of therapy and the reason for the discontinuation ii detailed evidence of a potential drug interaction between current medication and the preferred drug iii detailed evidence of a condition or contraindication that prevents the use of the preferred drug iv objective clinical evidence that a patient is at high risk of adverse events due to a therapeutic interchange with a preferred drug v the patient is a new or previous medicaid client with an existing diagnosis previously stabilized with a nonpreferred drug or vi other valid reasons as determined by the department g a prior authorization granted under subsection f is valid for one year from the date the department grants the prior authorization and shall be renewed in accordance with subsection f a for purposes of as used in this subsection psychotropic drug means the following classes of drugs i atypical anti psychotic ii anti depressant iii anti convulsant mood stabilizer iv anti anxiety and v attention deficit hyperactivity disorder stimulant b i the department shall develop a preferred drug list for psychotropic drugs ii except as provided in subsection d a preferred drug list for psychotropic drugs developed under this section shall allow a health care provider to override the preferred drug list by writing dispense as written on the prescription for the psychotropic drug iii a health care provider may not override section b by writing dispense as written on a prescription c the department and a medicaid accountable care organization that is responsible for providing behavioral health shall i establish a system to a track health care provider prescribing patterns for psychotropic drugs b educate health care providers who are not complying with the preferred drug list and c implement peer to peer education for health care providers whose prescribing practices continue to not comply with the preferred drug list and ii determine whether health care provider compliance with the preferred drug list is at least a of prescriptions by july b of prescriptions by july and c of prescriptions by july d beginning october the department shall eliminate the dispense as written override for the preferred drug list and shall implement a prior authorization system for psychotropic drugs in accordance with subsection f if by july the department has not realized annual savings from implementing the preferred drug list for psychotropic drugs of at least general fund savings section section b which is renumbered from section is renumbered and amended to read b simplified enrollment and renewal process for medicaid and other state medical programs financial institutions the department may apply for grants and accept donations to make technology system improvements necessary to implement a simplified enrollment and renewal process for the medicaid program utah premium partnership and primary care network demonstration project programs a the department may enter into an agreement with a financial institution doing business in the state to develop and operate a data match system to identify an applicant s or enrollee s assets that i uses automated data exchanges to the maximum extent feasible and ii requires a financial institution each month to provide the name record address social security number other taxpayer identification number or other identifying information for each applicant or enrollee who maintains an account at the financial institution b the department may pay a reasonable fee to a financial institution for compliance with this subsection as provided in section c a financial institution may not be liable under any federal or state law to any person for any disclosure of information or action taken in good faith under this subsection d the department may disclose a financial record obtained from a financial institution under this section only for the purpose of and to the extent necessary in verifying eligibility as provided in this section and section b section section b which is renumbered from section is renumbered and amended to read b dental benefits a except as provided in subsection the division may establish a competitive bid process to bid out medicaid dental benefits under this chapter b the division may bid out the medicaid dental benefits separately from other program benefits the division shall use the following criteria to evaluate dental bids a ability to manage dental expenses b proven ability to handle dental insurance c efficiency of claim paying procedures d provider contracting discounts and adequacy of network and e other criteria established by the department the division shall request bids for the program s benefits at least once every five years the division s contract with dental plans for the program s benefits shall include risk sharing provisions in which the dental plan must accept of the risk for any difference between the division s premium payments per client and actual dental expenditures the division may not award contracts to a more than three responsive bidders under this section or b an insurer that does not have a current license in the state a the division may cancel the request for proposals if i there are no responsive bidders or ii the division determines that accepting the bids would increase the program s costs b if the division cancels a request for proposal or a contract that results from a request for proposal described in subsection a the division shall report to the health and human services interim committee regarding the reasons for the decision title g chapter a utah procurement code shall apply to this section a the division may i establish a dental health care delivery system and payment reform pilot program for medicaid dental benefits to increase access to cost effective and quality dental health care by increasing the number of dentists available for medicaid dental services and ii target specific medicaid populations or geographic areas in the state b the pilot program shall establish compensation models for dentists and dental hygienists that i increase access to quality cost effective dental care and ii use funds from the division of family health and preparedness that are available to reimburse dentists for educational loans in exchange for the dentist agreeing to serve medicaid and under served populations c the division may amend the state plan and apply to the secretary of the united states department of health and human services for waivers or pilot programs if necessary to establish the new dental care delivery and payment reform model d the division shall evaluate the pilot program s effect on the cost of dental care and access to dental care for the targeted medicaid populations a as used in this subsection dental hygienist means an individual who is licensed as a dental hygienist under section b the department shall reimburse a dental hygienist for dental services performed in a public health setting and in accordance with subsection c beginning on the earlier of i january or ii days after the date on which the replacement of the department s medicaid management information system software is complete c the department shall reimburse a dental hygienist directly for a service provided through the medicaid program if i the dental hygienist requests to be reimbursed directly and ii the dental hygienist provides the service within the scope of practice described in section d before november of each year in which the department reimburses dental hygienists in accordance with subsection c the department shall report to the health and human services interim committee for the previous fiscal year i the number and geographic distribution of dental hygienists who requested to be reimbursed directly ii the total number of medicaid enrollees who were served by a dental hygienist who were reimbursed under this subsection iii the total amount reimbursed directly to dental hygienists under this subsection iv the specific services and billing codes that are reimbursed under this subsection and v the aggregate amount reimbursed for each service and billing code described in subsection d iv e i except as provided in this subsection nothing in this subsection shall be interpreted as expanding or otherwise altering the limitations and scope of practice for a dental hygienist ii a dental hygienist may only directly bill and receive compensation for billing codes that fall within the scope of practice of a dental hygienist section section b which is renumbered from section is renumbered and amended to read b administration of medicaid program by department reporting to the legislature disciplinary measures and sanctions funds collected eligibility standards internal audits health opportunity accounts the department shall be the single state agency responsible for the administration of the medicaid program in connection with the united states department of health and human services pursuant to title xix of the social security act a the department shall implement the medicaid program through administrative rules in conformity with this chapter title g chapter utah administrative rulemaking act the requirements of title xix and applicable federal regulations b the rules adopted under subsection a shall include in addition to other rules necessary to implement the program i the standards used by the department for determining eligibility for medicaid services ii the services and benefits to be covered by the medicaid program iii reimbursement methodologies for providers under the medicaid program and iv a requirement that a a person receiving medicaid services shall participate in the electronic exchange of clinical health records established in accordance with section b unless the individual opts out of participation b prior to enrollment in the electronic exchange of clinical health records the enrollee shall receive notice of enrollment in the electronic exchange of clinical health records and the right to opt out of participation at any time and c beginning july when the program sends enrollment or renewal information to the enrollee and when the enrollee logs onto the program s website the enrollee shall receive notice of the right to opt out of the electronic exchange of clinical health records a the department shall in accordance with subsection b report to the social services appropriations subcommittee when the department i implements a change in the medicaid state plan ii initiates a new medicaid waiver iii initiates an amendment to an existing medicaid waiver iv applies for an extension of an application for a waiver or an existing medicaid waiver v applies for or receives approval for a change in any capitation rate within the medicaid program or vi initiates a rate change that requires public notice under state or federal law b the report required by subsection a shall i be submitted to the social services appropriations subcommittee prior to the department implementing the proposed change and ii include a a description of the department s current practice or policy that the department is proposing to change b an explanation of why the department is proposing the change c the proposed change in services or reimbursement including a description of the effect of the change d the effect of an increase or decrease in services or benefits on individuals and families e the degree to which any proposed cut may result in cost shifting to more expensive services in health or human service programs and f the fiscal impact of the proposed change including i the effect of the proposed change on current or future appropriations from the legislature to the department ii the effect the proposed change may have on federal matching dollars received by the state medicaid program iii any cost shifting or cost savings within the department s budget that may result from the proposed change and iv identification of the funds that will be used for the proposed change including any transfer of funds within the department s budget any rules adopted by the department under subsection are subject to review and reauthorization by the legislature in accordance with section g the department may in its discretion contract with the department of human services or other qualified agencies for services in connection with the administration of the medicaid program including a the determination of the eligibility of individuals for the program b recovery of overpayments and c consistent with section b and to the extent permitted by law and quality control services enforcement of fraud and abuse laws the department shall provide by rule disciplinary measures and sanctions for medicaid providers who fail to comply with the rules and procedures of the program provided that sanctions imposed administratively may not extend beyond a termination from the program b recovery of claim reimbursements incorrectly paid and c those specified in section of title xix of the federal social security act a funds collected as a result of a sanction imposed under section of title xix of the federal social security act shall be deposited in the general fund as dedicated credits to be used by the division in accordance with the requirements of section of title xix of the federal social security act b in accordance with section j sanctions collected under this subsection are nonlapsing a in determining whether an applicant or recipient is eligible for a service or benefit under this part or chapter part utah children s health insurance act program the department shall if subsection b is satisfied exclude from consideration one passenger vehicle designated by the applicant or recipient b before subsection a may be applied i the federal government shall a determine that subsection a may be implemented within the state s existing public assistance related waivers as of january b extend a waiver to the state permitting the implementation of subsection a or c determine that the state s waivers that permit dual eligibility determinations for cash assistance and medicaid are no longer valid and ii the department shall determine that subsection a can be implemented within existing funding a for purposes of as used in this subsection i aged blind or has a disability means an aged blind or disabled individual as defined in u s c sec c a and ii spend down means an amount of income in excess of the allowable income standard that shall be paid in cash to the department or incurred through the medical services not paid by medicaid b in determining whether an applicant or recipient who is aged blind or has a disability is eligible for a service or benefit under this chapter the department shall use of the federal poverty level as i the allowable income standard for eligibility for services or benefits and ii the allowable income standard for eligibility as a result of spend down the department shall conduct internal audits of the medicaid program a the department may apply for and if approved implement a demonstration program for health opportunity accounts as provided for in u s c sec u b a health opportunity account established under subsection a shall be an alternative to the existing benefits received by an individual eligible to receive medicaid under this chapter c subsection a is not intended to expand the coverage of the medicaid program a i the department shall apply for and if approved implement an amendment to the state plan under this subsection for benefits for a medically needy pregnant women b medically needy children and c medically needy parents and caretaker relatives ii the department may implement the eligibility standards of subsection b for eligibility determinations made on or after the date of the approval of the amendment to the state plan b in determining whether an applicant is eligible for benefits described in subsection a i the department shall i disregard resources held in an account in the savings plan created under title b chapter a utah educational savings plan if the beneficiary of the account is a under the age of and b living with the account owner as that term is defined in section b a or temporarily absent from the residence of the account owner and ii include the withdrawals from an account in the utah educational savings plan as resources for a benefit determination if the withdrawal was not used for qualified higher education costs as that term is defined in section b a a the department may not deny or terminate eligibility for medicaid solely because an individual is i incarcerated and ii not an inmate as defined in section b subsection a does not require the medicaid program to provide coverage for any services for an individual while the individual is incarcerated the department is a party to and may intervene at any time in any judicial or administrative action a to which the department of workforce services is a party and b that involves medical assistance under this chapter i title chapter medical assistance act or ii title chapter utah children s health insurance act section section b which is renumbered from section is renumbered and amended to read b medicaid expansion the purpose of this section is to expand the coverage of the medicaid program to persons who are in categories traditionally not served by that program within appropriations from the legislature the department may amend the state plan for medical assistance to provide for eligibility for medicaid a on or after july for children to years old who live in households below the federal poverty income guideline and b on or after july for persons who have incomes below the federal poverty income guideline and who are aged blind or have a disability a within appropriations from the legislature on or after july the medicaid program may provide for eligibility for persons who have incomes below the federal poverty income guideline b in order to meet the provisions of this subsection the department may seek approval for a demonstration project under u s c sec from the secretary of the united states department of health and human services the medicaid program shall provide for eligibility for persons as required by subsection b services available for persons described in this section shall include required medicaid services and may include one or more optional medicaid services if those services are funded by the legislature the department may also require persons described in subsections through to meet an asset test section section b which is renumbered from section is renumbered and amended to read b copayments by recipients employer sponsored plans the department shall selectively provide for enrollment fees premiums deductions cost sharing or other similar charges to be paid by recipients their spouses and parents within the limitations of federal law and regulation beginning may within appropriations by the legislature and as a means to increase health care coverage among the uninsured the department shall take steps to promote increased participation in employer sponsored health insurance including a maximizing the health insurance premium subsidy provided under the state s demonstration waiver by i ensuring that state funds are matched by federal funds to the greatest extent allowable and ii as the department determines appropriate seeking federal approval to do one or more of the following a eliminate or otherwise modify the annual enrollment fee b eliminate or otherwise modify the schedule used to determine the level of subsidy provided to an enrollee each year c reduce the maximum number of participants allowable under the subsidy program or d otherwise modify the program in a manner that promotes enrollment in employer sponsored health insurance and b exploring the use of other options including the development of a waiver under the medicaid health insurance flexibility demonstration initiative or other federal authority section section b which is renumbered from section is renumbered and amended to read b income and resources from institutionalized spouses as used in this section a community spouse means the spouse of an institutionalized spouse b i community spouse monthly income allowance means an amount by which the minimum monthly maintenance needs allowance for the spouse exceeds the amount of monthly income otherwise available to the community spouse determined without regard to the allowance except as provided in subsection b ii ii if a court has entered an order against an institutionalized spouse for monthly income for the support of the community spouse the community spouse monthly income allowance for the spouse may not be less than the amount of the monthly income so ordered c community spouse resource allowance is the amount of combined resources that are protected for a community spouse living in the community which the division shall establish by rule made in accordance with title g chapter utah administrative rulemaking act based on the amounts established by the united states department of health and human services d excess shelter allowance for a community spouse means the amount by which the sum of the spouse s expense for rent or mortgage payment taxes and insurance and in the case of condominium or cooperative required maintenance charge for the community spouse s principal residence and the spouse s actual expenses for electricity natural gas and water utilities or at the discretion of the department the federal standard utility allowance under snap as defined in section a exceeds of the amount described in subsection e family member means a minor dependent child dependent parents or dependent sibling of the institutionalized spouse or community spouse who are residing with the community spouse f i institutionalized spouse means a person who is residing in a nursing facility and is married to a spouse who is not in a nursing facility ii an institutionalized spouse does not include a person who is not likely to reside in a nursing facility for at least consecutive days g nursing care facility means the same as that term is defined in section b the division shall comply with this section when determining eligibility for medical assistance for an institutionalized spouse for services furnished during a calendar year beginning on or after january the community spouse resource allowance shall be increased by the division by an amount as determined annually by cms the division shall compute as of the beginning of the first continuous period of institutionalization of the institutionalized spouse a the total value of the resources to the extent either the institutionalized spouse or the community spouse has an ownership interest and b a spousal share which is of the resources described in subsection a at the request of an institutionalized spouse or a community spouse at the beginning of the first continuous period of institutionalization of the institutionalized spouse and upon the receipt of relevant documentation of resources the division shall promptly assess and document the total value described in subsection a and shall provide a copy of that assessment and documentation to each spouse and shall retain a copy of the assessment when the division provides a copy of the assessment it shall include a notice stating that the spouse may request a hearing under subsection when determining eligibility for medical assistance under this chapter a except as provided in subsection b all resources held by either the institutionalized spouse community spouse or both are considered to be available to the institutionalized spouse b resources are considered to be available to the institutionalized spouse only to the extent that the amount of those resources exceeds the community spouse resource allowance at the time of application for medical assistance under this chapter a the division may not find an institutionalized spouse to be ineligible for medical assistance by reason of resources determined under subsection to be available for the cost of care when i the institutionalized spouse has assigned to the state any rights to support from the community spouse ii except as provided in subsection b the institutionalized spouse lacks the ability to execute an assignment due to physical or mental impairment or iii the division determines that denial of medical assistance would cause an undue burden b subsection a ii does not prevent the division from seeking a court order for an assignment of support during the continuous period in which an institutionalized spouse is in an institution and after the month in which an institutionalized spouse is eligible for medical assistance the resources of the community spouse may not be considered to be available to the institutionalized spouse when an institutionalized spouse is determined to be eligible for medical assistance in determining the amount of the spouse s income that is to be applied monthly for the cost of care in the nursing care facility the division shall deduct from the spouse s monthly income the following amounts in the following order a a personal needs allowance the amount of which is determined by the division b a community spouse monthly income allowance but only to the extent that the income of the institutionalized spouse is made available to or for the benefit of the community spouse c a family allowance for each family member equal to at least of the amount that the amount described in subsection a exceeds the amount of the family member s monthly income and d amounts for incurred expenses for the medical or remedial care for the institutionalized spouse the division shall establish a minimum monthly maintenance needs allowance for each community spouse that includes a an amount established by the division by rule made in accordance with title g chapter utah administrative rulemaking act based on the amounts established by the united states department of health and human services and b an excess shelter allowance a an institutionalized spouse or a community spouse may request a hearing with respect to the determinations described in subsections e i through v if an application for medical assistance has been made on behalf of the institutionalized spouse b a hearing under this subsection regarding the community spouse resource allowance shall be held by the division within days from the date of the request for the hearing c if either spouse establishes that the community spouse needs income above the level otherwise provided by the minimum monthly maintenance needs allowance due to exceptional circumstances resulting in significant financial duress there shall be substituted for the minimum monthly maintenance needs allowance provided under subsection an amount adequate to provide additional income as is necessary d if either spouse establishes that the community spouse resource allowance in relation to the amount of income generated by the allowance is inadequate to raise the community spouse s income to the minimum monthly maintenance needs allowance there shall be substituted for the community spouse resource allowance an amount adequate to provide a minimum monthly maintenance needs allowance e a hearing may be held under this subsection if either the institutionalized spouse or community spouse is dissatisfied with a determination of i the community spouse monthly income allowance ii the amount of monthly income otherwise available to the community spouse iii the computation of the spousal share of resources under subsection iv the attribution of resources under subsection or v the determination of the community spouse resource allocation a an institutionalized spouse may transfer an amount equal to the community spouse resource allowance but only to the extent the resources of the institutionalized spouse are transferred to or for the sole benefit of the community spouse b the transfer under subsection a shall be made as soon as practicable after the date of the initial determination of eligibility taking into account the time necessary to obtain a court order under subsection c c chapter medical benefits recovery act part medical benefits recovery does not apply if a court has entered an order against an institutionalized spouse for the support of the community spouse section section b which is renumbered from section is renumbered and amended to read b maximizing use of premium assistance programs utah s premium partnership for health insurance a the department shall seek to maximize the use of medicaid and children s health insurance program funds for assistance in the purchase of private health insurance coverage for medicaid eligible and non medicaid eligible individuals b the department s efforts to expand the use of premium assistance shall i include as necessary seeking federal approval under all medicaid and children s health insurance program premium assistance provisions of federal law including provisions of the patient protection and affordable care act public law ppaca ii give priority to but not be limited to expanding the state s utah premium partnership for health insurance program including as required under subsection and iii encourage the enrollment of all individuals within a household in the same plan where possible including enrollment in a plan that allows individuals within the household transitioning out of medicaid to retain the same network and benefits they had while enrolled in medicaid the department shall seek federal approval of an amendment to the state s utah premium partnership for health insurance program to adjust the eligibility determination for single adults and parents who have an offer of employer sponsored insurance the amendment shall a be within existing appropriations for the utah premium partnership for health insurance program and b provide that adults who are up to of the federal poverty level are eligible for premium subsidies in the utah premium partnership for health insurance program for the fiscal year the department shall seek authority to increase the maximum premium subsidy per month for adults under the utah premium partnership for health insurance program to beginning with the fiscal year and in each subsequent fiscal year the department may increase premium subsidies for single adults and parents who have an offer of employer sponsored insurance to keep pace with the increase in insurance premium costs subject to appropriation of additional funding section section b which is renumbered from section is renumbered and amended to read b expanding the medicaid program as used in this section a cms means the centers for medicare and medicaid services in the united states department of health and human services b a federal poverty level means the same as that term is defined in section b c b medicaid expansion means an expansion of the medicaid program in accordance with this section d c medicaid expansion fund means the medicaid expansion fund created in section b b a as set forth in subsections through eligibility criteria for the medicaid program shall be expanded to cover additional low income individuals b the department shall continue to seek approval from cms to implement the medicaid waiver expansion as defined in section b c the department may implement any provision described in subsections b b iii through viii in a medicaid expansion if the department receives approval from cms to implement that provision the department shall expand the medicaid program in accordance with this subsection if the department a receives approval from cms to i expand medicaid coverage to eligible individuals whose income is below of the federal poverty level ii obtain maximum federal financial participation under u s c sec d b for enrolling an individual in the medicaid expansion under this subsection and iii permit the state to close enrollment in the medicaid expansion under this subsection if the department has insufficient funds to provide services to new enrollment under the medicaid expansion under this subsection b pays the state portion of costs for the medicaid expansion under this subsection with funds from i the medicaid expansion fund ii county contributions to the nonfederal share of medicaid expenditures or iii any other contributions funds or transfers from a nonstate agency for medicaid expenditures and c closes the medicaid program to new enrollment under the medicaid expansion under this subsection if the department projects that the cost of the medicaid expansion under this subsection will exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act a the department shall expand the medicaid program in accordance with this subsection if the department i receives approval from cms to a expand medicaid coverage to eligible individuals whose income is below of the federal poverty level b obtain maximum federal financial participation under u s c sec d y for enrolling an individual in the medicaid expansion under this subsection and c permit the state to close enrollment in the medicaid expansion under this subsection if the department has insufficient funds to provide services to new enrollment under the medicaid expansion under this subsection ii pays the state portion of costs for the medicaid expansion under this subsection with funds from a the medicaid expansion fund b county contributions to the nonfederal share of medicaid expenditures or c any other contributions funds or transfers from a nonstate agency for medicaid expenditures and iii closes the medicaid program to new enrollment under the medicaid expansion under this subsection if the department projects that the cost of the medicaid expansion under this subsection will exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act b the department shall submit a waiver an amendment to an existing waiver or a state plan amendment to cms to i administer federal funds for the medicaid expansion under this subsection according to a per capita cap developed by the department that includes an annual inflationary adjustment accounts for differences in cost among categories of medicaid expansion enrollees and provides greater flexibility to the state than the current medicaid payment model ii limit in certain circumstances as defined by the department the ability of a qualified entity to determine presumptive eligibility for medicaid coverage for an individual enrolled in a medicaid expansion under this subsection iii impose a lock out period if an individual enrolled in a medicaid expansion under this subsection violates certain program requirements as defined by the department iv allow an individual enrolled in a medicaid expansion under this subsection to remain in the medicaid program for up to a month certification period as defined by the department and v allow federal medicaid funds to be used for housing support for eligible enrollees in the medicaid expansion under this subsection a i if cms does not approve a waiver to expand the medicaid program in accordance with subsection a on or before january the department shall develop proposals to implement additional flexibilities and cost controls including cost sharing tools within a medicaid expansion under this subsection through a request to cms for a waiver or state plan amendment ii the request for a waiver or state plan amendment described in subsection a i shall include a a path to self sufficiency for qualified adults in the medicaid expansion that includes employment and training as defined in u s c sec d and b a requirement that an individual who is offered a private health benefit plan by an employer to enroll in the employer s health plan iii the department shall submit the request for a waiver or state plan amendment developed under subsection a i on or before march b notwithstanding sections b and j and in accordance with this subsection eligibility for the medicaid program shall be expanded to include all persons in the optional medicaid expansion population under the patient protection and affordable care act pub l no ppaca and the health care education reconciliation act of pub l no and related federal regulations and guidance on the earlier of i the day on which cms approves a waiver to implement the provisions described in subsections a ii a and b or ii july c the department shall seek a waiver or an amendment to an existing waiver from federal law to i implement each provision described in subsections b b iii through viii in a medicaid expansion under this subsection ii limit in certain circumstances as defined by the department the ability of a qualified entity to determine presumptive eligibility for medicaid coverage for an individual enrolled in a medicaid expansion under this subsection and iii impose a lock out period if an individual enrolled in a medicaid expansion under this subsection violates certain program requirements as defined by the department d the eligibility criteria in this subsection shall be construed to include all individuals eligible for the health coverage improvement program under section b e the department shall pay the state portion of costs for a medicaid expansion under this subsection entirely from i the medicaid expansion fund ii county contributions to the nonfederal share of medicaid expenditures or iii any other contributions funds or transfers from a nonstate agency for medicaid expenditures f if the costs of the medicaid expansion under this subsection exceed the funds available under subsection e i the department may reduce or eliminate optional medicaid services under this chapter and ii savings as determined by the department from the reduction or elimination of optional medicaid services under subsection f i shall be deposited into the medicaid expansion fund and iii the department may submit to cms a request for waivers or an amendment of existing waivers from federal law necessary to implement budget controls within the medicaid program to address the deficiency g if the costs of the medicaid expansion under this subsection are projected by the department to exceed the funds available in the current fiscal year under subsection e including savings resulting from any action taken under subsection f i the governor shall direct the department of health department of human services department and department of workforce services to reduce commitments and expenditures by an amount sufficient to offset the deficiency a proportionate to the share of total current fiscal year general fund appropriations for each of those agencies and b up to of each agency s total current fiscal year general fund appropriations ii the division of finance shall reduce allotments to the department of health department of human services department and department of workforce services by a percentage a proportionate to the amount of the deficiency and b up to of each agency s total current fiscal year general fund appropriations and iii the division of finance shall deposit the total amount from the reduced allotments described in subsection g ii into the medicaid expansion fund the department shall maximize federal financial participation in implementing this section including by seeking to obtain any necessary federal approvals or waivers notwithstanding sections and a county does not have to provide matching funds to the state for the cost of providing medicaid services to newly enrolled individuals who qualify for medicaid coverage under a medicaid expansion the department shall report to the social services appropriations subcommittee on or before november of each year that a medicaid expansion is operational a the number of individuals who enrolled in the medicaid expansion b costs to the state for the medicaid expansion c estimated costs to the state for the medicaid expansion for the current and following fiscal years d recommendations to control costs of the medicaid expansion and e as calculated in accordance with subsections b b and c b the state s net cost of the qualified medicaid expansion section section b which is renumbered from section is renumbered and amended to read b department standards for eligibility under medicaid funds for abortions a the department may develop standards and administer policies relating to eligibility under the medicaid program as long as they are consistent with subsection b b an applicant receiving medicaid assistance may be limited to particular types of care or services or to payment of part or all costs of care determined to be medically necessary the department may not provide any funds for medical hospital or other medical expenditures or medical services to otherwise eligible persons where the purpose of the assistance is to perform an abortion unless the life of the mother would be endangered if an abortion were not performed any employee of the department who authorizes payment for an abortion contrary to the provisions of this section is guilty of a class b misdemeanor and subject to forfeiture of office any person or organization that under the guise of other medical treatment provides an abortion under auspices of the medicaid program is guilty of a third degree felony and subject to forfeiture of license to practice medicine or authority to provide medical services and treatment section section b which is renumbered from section is renumbered and amended to read b contracts for provision of medical services federal provisions modifying department rules compliance with social security act the department may contract with other public or private agencies to purchase or provide medical services in connection with the programs of the division where these programs are used by other government entities contracts shall provide that other government entities in compliance with state and federal law regarding intergovernmental transfers transfer the state matching funds to the department in amounts sufficient to satisfy needs of the specified program contract terms shall include provisions for maintenance administration and service costs if a federal legislative or executive provision requires modifications or revisions in an eligibility factor established under this chapter as a condition for participation in medical assistance the department may modify or change its rules as necessary to qualify for participation the provisions of this section do not apply to department rules governing abortion the department shall comply with all pertinent requirements of the social security act and all orders rules and regulations adopted thereunder when required as a condition of participation in benefits under the social security act section section b which is renumbered from section is renumbered and amended to read b liability insurance required the medicaid program may not reimburse a home health agency as defined in section b for home health services provided to an enrollee unless the home health agency has liability coverage of at least per incident or an amount established by department rule made in accordance with title g chapter utah administrative rulemaking act section section b which is renumbered from section is renumbered and amended to read b federal aid authority of executive director the executive director with the approval of the governor may bind the state to any executive or legislative provisions promulgated or enacted by the federal government which invite the state to participate in the distribution disbursement or administration of any fund or service advanced offered or contributed in whole or in part by the federal government for purposes consistent with the powers and duties of the department such funds shall be used as provided in this chapter and be administered by the department for purposes related to medical assistance programs section section b which is renumbered from section is renumbered and amended to read b medical vendor rates medical vendor payments made to providers of services for and in behalf of recipient households shall be based upon predetermined rates from standards developed by the division in cooperation with providers of services for each type of service purchased by the division as far as possible the rates paid for services shall be established in advance of the fiscal year for which funds are to be requested section section b which is renumbered from section is renumbered and amended to read b enforcement of public assistance statutes the department shall enforce or contract for the enforcement of sections a a a a a and a to the extent that these sections pertain to benefits conferred or administered by the division under this chapter to the extent allowed under federal law or regulation the department may contract for services covered in section a insofar as that section pertains to benefits conferred or administered by the division under this chapter section section b which is renumbered from section is renumbered and amended to read b prohibited acts of state or local employees of medicaid program violation a misdemeanor each state or local employee responsible for the expenditure of funds under the state medicaid program each individual who formerly was such an officer or employee and each partner of such an officer or employee is prohibited for a period of one year after termination of such responsibility from committing any act the commission of which by an officer or employee of the united states government an individual who was such an officer or employee or a partner of such an officer or employee is prohibited by section or section of title united states code violation of this section is a class a misdemeanor section section b which is renumbered from section is renumbered and amended to read b rural hospitals for purposes of as used in this section rural hospital means a hospital located outside of a standard metropolitan statistical area as designated by the united states bureau of the census for purposes of the medicaid program the division of medicaid and health financing division may not discriminate among rural hospitals on the basis of size section section b which is renumbered from section is renumbered and amended to read b telemedicine reimbursement rulemaking a as used in this section communication by telemedicine is considered face to face contact between a health care provider and a patient under the state s medical assistance program if i the communication by telemedicine meets the requirements of administrative rules adopted in accordance with subsection and ii the health care services are eligible for reimbursement under the state s medical assistance program b this subsection applies to any managed care organization that contracts with the state s medical assistance program the reimbursement rate for telemedicine services approved under this section a shall be subject to reimbursement policies set by the state plan and b may be based on i a monthly reimbursement rate ii a daily reimbursement rate or iii an encounter rate the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act which establish a the particular telemedicine services that are considered face to face encounters for reimbursement purposes under the state s medical assistance program and b the reimbursement methodology for the telemedicine services designated under subsection a section section b which is renumbered from section is renumbered and amended to read b reimbursement of telemedicine services and telepsychiatric consultations as used in this section a telehealth services means the same as that term is defined in section b b telemedicine services means the same as that term is defined in section b c telepsychiatric consultation means a consultation between a physician and a board certified psychiatrist both of whom are licensed to engage in the practice of medicine in the state that utilizes i the health records of the patient provided from the patient or the referring physician ii a written evidence based patient questionnaire and iii telehealth services that meet industry security and privacy standards including compliance with the a health insurance portability and accountability act and b health information technology for economic and clinical health act pub l no stat as amended this section applies to a a managed care organization that contracts with the medicaid program and b a provider who is reimbursed for health care services under the medicaid program the medicaid program shall reimburse for telemedicine services at the same rate that the medicaid program reimburses for other health care services the medicaid program shall reimburse for telepsychiatric consultations at a rate set by the medicaid program section section b which is renumbered from section is renumbered and amended to read b process to promote health insurance coverage for children the department in collaboration with the department of workforce services and the state board of education shall develop a process to promote health insurance coverage for a child in school when a the child applies for free or reduced price school lunch b a child enrolls in or registers in school and c other appropriate school related opportunities the department in collaboration with the department of workforce services shall promote and facilitate the enrollment of children identified under subsection without health insurance in the utah children s health insurance program the medicaid program or the utah premium partnership for health insurance program section section b which is renumbered from section is renumbered and amended to read b medicaid continuous eligibility promoting payment and delivery reform in accordance with subsection and within appropriations from the legislature the department may amend the state medicaid plan to a create continuous eligibility for up to months for an individual who has qualified for the state medicaid program b provide incentives in managed care contracts for an individual to obtain appropriate care in appropriate settings and c require the managed care system to accept the risk of managing the medicaid population assigned to the plan amendment in return for receiving the benefits of providing quality and cost effective care if the department amends the state medicaid plan under subsection a or b the department a shall ensure that the plan amendment i is cost effective for the state medicaid program ii increases the quality and continuity of care for recipients and iii calculates and transfers administrative savings from continuous enrollment from the department of workforce services to the department of health department and b may limit the plan amendment under subsection a or b to select geographic areas or specific medicaid populations the department may seek approval for a state plan amendment waiver or a demonstration project from the secretary of the united states department of health and human services if necessary to implement a plan amendment under subsection a or b section section b which is renumbered from section is renumbered and amended to read b patient notice of health care provider privacy practices a for purposes of this section i health care provider means a health care provider as defined in section b who a receives payment for medical services from the medicaid program established in this chapter or the children s health insurance program established in chapter utah children s health insurance act section b and b submits a patient s personally identifiable information to the medicaid eligibility database or the children s health insurance program eligibility database ii hipaa means c f r parts and health insurance portability and accountability act of as amended b beginning july this section applies to the medicaid program the children s health insurance program created in chapter utah children s health insurance act section b and a health care provider a health care provider shall as part of the notice of privacy practices required by hipaa provide notice to the patient or the patient s personal representative that the health care provider either has or may submit personally identifiable information about the patient to the medicaid eligibility database and the children s health insurance program eligibility database the medicaid program and the children s health insurance program may not give a health care provider access to the medicaid eligibility database or the children s health insurance program eligibility database unless the health care provider s notice of privacy practices complies with subsection the department may adopt an administrative rule to establish uniform language for the state requirement regarding notice of privacy practices to patients required under subsection section section b which is renumbered from section is renumbered and amended to read b optional medicaid expansion the department and the governor may not expand the state s medicaid program under ppaca unless a the department expands medicaid in accordance with section b or b i the governor or the governor s designee has reported the intention to expand the state medicaid program under ppaca to the legislature in compliance with the legislative review process in section b and ii the governor submits the request for expansion of the medicaid program for optional populations to the legislature under the high impact federal funds request process required by section j a the department shall request approval from cms for waivers from federal statutory and regulatory law necessary to implement the health coverage improvement program under section b b the health coverage improvement program under section b is not subject to the requirements in subsection section section b which is renumbered from section is renumbered and amended to read b medicaid vision services request for proposals the department may select one or more contractors in accordance with title g chapter a utah procurement code to provide vision services to the medicaid populations that are eligible for vision services as described in department rules without restricting provider participation and within existing appropriations from the legislature section section b which is renumbered from section is renumbered and amended to read b review of claims audit and investigation procedures a the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act and in consultation with providers and health care professionals subject to audit and investigation under the state medicaid program to establish procedures for audits and investigations that are fair and consistent with the duties of the department as the single state agency responsible for the administration of the medicaid program under section b and title xix of the social security act b if the providers and health care professionals do not agree with the rules proposed or adopted by the department under subsection a the providers or health care professionals may i request a hearing for the proposed administrative rule or seek any other remedies under the provisions of title g chapter utah administrative rulemaking act and ii request a review of the rule by the legislature s administrative rules review and general oversight committee created in section g the department shall a notify and educate providers and health care professionals subject to audit and investigation under the medicaid program of the providers and health care professionals responsibilities and rights under the administrative rules adopted by the department under the provisions of this section b ensure that the department or any entity that contracts with the department to conduct audits i has on staff or contracts with a medical or dental professional who is experienced in the treatment billing and coding procedures used by the type of provider being audited and ii uses the services of the appropriate professional described in subsection b i if the provider who is the subject of the audit disputes the findings of the audit c ensure that a finding of overpayment or underpayment to a provider is not based on extrapolation as defined in section a unless i there is a determination that the level of payment error involving the provider exceeds a error rate a for a sample of claims for a particular service code and b over a three year period of time ii documented education intervention has failed to correct the level of payment error and iii the value of the claims for the provider in aggregate exceeds in reimbursement for a particular service code on an annual basis and d require that any entity with which the office contracts for the purpose of conducting an audit of a service provider shall be paid on a flat fee basis for identifying both overpayments and underpayments a if the department or a contractor on behalf of the department i intends to implement the use of extrapolation as a method of auditing claims the department shall prior to adopting the extrapolation method of auditing report its intent to use extrapolation to the social services appropriations subcommittee and ii determines subsections c i through iii are applicable to a provider the department or the contractor may use extrapolation only for the service code associated with the findings under subsections c i through iii b i if extrapolation is used under this section a provider may at the provider s option appeal the results of the audit based on a each individual claim or b the extrapolation sample ii nothing in this section limits a provider s right to appeal the audit under title g general government title g chapter administrative procedures act the medicaid program and its manual or rules or other laws or rules that may provide remedies to providers section section b which is renumbered from section is renumbered and amended to read b medicaid intergovernmental transfer report approval requirements as used in this section a i intergovernmental transfer means the transfer of public funds from a a local government entity to another nonfederal governmental entity or b from a nonfederal government owned health care facility regulated under chapter health care facility licensing and inspection act chapter part health care facility licensing and inspection to another nonfederal governmental entity ii intergovernmental transfer does not include a the transfer of public funds from one state agency to another state agency or b a transfer of funds from the university of utah hospitals and clinics b i intergovernmental transfer program means a federally approved reimbursement program or category that is authorized by the medicaid state plan or waiver authority for intergovernmental transfers ii intergovernmental transfer program does not include the addition of a provider to an existing intergovernmental transfer program c local government entity means a county city town special service district local district or local education agency as that term is defined in section j d non state government entity means a hospital authority hospital district health care district special service district county or city a an entity that receives federal medicaid dollars from the department as a result of an intergovernmental transfer shall on or before august and on or before august each year thereafter provide the department with i information regarding the payments funded with the intergovernmental transfer as authorized by and consistent with state and federal law ii information regarding the entity s ability to repay federal funds to the extent required by the department in the contract for the intergovernmental transfer and iii other information reasonably related to the intergovernmental transfer that may be required by the department in the contract for the intergovernmental transfer b on or before october and on or before october each subsequent year the department shall prepare a report for the executive appropriations committee that includes i the amount of each intergovernmental transfer under subsection a ii a summary of changes to cms regulations and practices that are known by the department regarding federal funds related to an intergovernmental transfer program and iii other information the department gathers about the intergovernmental transfer under subsection a the department shall not create a new intergovernmental transfer program after july unless the department reports to the executive appropriations committee in accordance with section j before submitting the new intergovernmental transfer program for federal approval the report shall include information required by subsection j d and the analysis required in subsections a and b a the department shall enter into new nursing care facility non state government owned upper payment limit program contracts and contract amendments adding new nursing care facilities and new non state government entity operators in accordance with this subsection b i if the nursing care facility expects to receive less than in federal funds each year from the nursing care facility non state government owned upper payment limit program excluding seed funding and administrative fees paid by the non state government entity the department shall enter into a nursing care facility non state government owned upper payment limit program contract with the non state government entity operator of the nursing care facility ii if the nursing care facility expects to receive between and in federal funds each year from the nursing care facility non state government owned upper payment limit program excluding seed funding and administrative fees paid by the non state government entity the department shall enter into a nursing care facility non state government owned upper payment limit program contract with the non state government entity operator of the nursing care facility after receiving the approval of the executive appropriations committee iii if the nursing care facility expects to receive more than in federal funds each year from the nursing care facility non state government owned upper payment limit program excluding seed funding and administrative fees paid by the non state government entity the department may not approve the application without obtaining approval from the legislature and the governor c a non state government entity may not participate in the nursing care facility non state government owned upper payment limit program unless the non state government entity is a special service district county or city that operates a hospital or holds a license under chapter health care facility licensing and inspection act chapter part health care facility licensing and inspection d each non state government entity that participates in the nursing care facility non state government owned upper payment limit program shall certify to the department that i the non state government entity is a local government entity that is able to make an intergovernmental transfer under applicable state and federal law ii the non state government entity has sufficient public funds or other permissible sources of seed funding that comply with the requirements in c f r part subpart b iii the funds received from the nursing care facility non state government owned upper payment limit program are a for each nursing care facility available for patient care until the end of the non state government entity s fiscal year and b used exclusively for operating expenses for nursing care facility operations patient care capital expenses rent royalties and other operating expenses and iv the non state government entity has completed all licensing enrollment and other forms and documents required by federal and state law to register a change of ownership with the department and with cms the department shall add a nursing care facility to an existing nursing care facility non state government owned upper payment limit program contract if a the nursing care facility is managed by or affiliated with the same non state government entity that also manages one or more nursing care facilities that are included in an existing nursing care facility non state government owned upper payment limit program contract and b the non state government entity makes the certification described in subsection d ii the department may not increase the percentage of the administrative fee paid by a non state government entity to the department under the nursing care facility non state government owned upper payment limit program the department may not condition participation in the nursing care facility non state government owned upper payment limit program on a a requirement that the department be allowed to direct or determine the types of patients that a non state government entity will treat or the course of treatment for a patient in a non state government nursing care facility or b a requirement that a non state government entity or nursing care facility post a bond purchase insurance or create a reserve account of any kind the non state government entity shall have the primary responsibility for ensuring compliance with subsection d ii a the department may not enter into a new nursing care facility non state government owned upper payment limit program contract before january b subsection a does not apply to i a new nursing care facility non state government owned upper payment limit program contract that was included in the federal funds request summary under section j for fiscal year or ii a nursing care facility that is operated or managed by the same company as a nursing care facility that was included in the federal funds request summary under section j for fiscal year section section b which is renumbered from section is renumbered and amended to read b screening brief intervention and referral to treatment medicaid reimbursement as used in this section a controlled substance prescriber means a controlled substance prescriber as that term is defined in section who i has a record of having completed sbirt training in accordance with subsection before providing the sbirt services and ii is a medicaid enrolled health care provider b sbirt means the same as that term is defined in section the department shall reimburse a controlled substance prescriber who provides sbirt services to a medicaid enrollee who is years of age old or older for the sbirt services section section b which is renumbered from section is renumbered and amended to read b prescribing policies for opioid prescriptions the department may implement a prescribing policy for certain opioid prescriptions that is substantially similar to the prescribing policies required in section a the department may amend the state program and apply for waivers for the state program if necessary to implement subsection section section b which is renumbered from section is renumbered and amended to read b reimbursement for long acting reversible contraception immediately following childbirth as used in this section long acting reversible contraception means a contraception method that requires administration less than once per month including a an intrauterine device and b a contraceptive implant the division shall separately identify and reimburse from other labor and delivery services within the medicaid program the provision and insertion of long acting reversible contraception immediately after childbirth section section b which is renumbered from section is renumbered and amended to read b coverage of exome sequence testing as used in this section exome sequence testing means a genomic technique for sequencing the genome of an individual for diagnostic purposes the medicaid program shall reimburse for exome sequence testing a for an enrollee who i is younger than years of age old and ii who remains undiagnosed after exhausting all other appropriate diagnostic related tests b performed by a nationally recognized provider with significant experience in exome sequence testing c that is medically necessary and d at a rate set by the medicaid program section section b which is renumbered from section is renumbered and amended to read b reimbursement for nonemergency secured behavioral health transport providers the department may not reimburse a nonemergency secured behavioral health transport provider that is designated under section a b section section b which is renumbered from section is renumbered and amended to read b children s health care coverage program as used in this section a chip means the children s health insurance program created in section b b program means the children s health care coverage program created in subsection a there is created the children s health care coverage program within the department b the purpose of the program is to i promote health insurance coverage for children in accordance with section b ii conduct research regarding families who are eligible for medicaid and chip to determine awareness and understanding of available coverage iii analyze trends in disenrollment and identify reasons that families may not be renewing enrollment including any barriers in the process of renewing enrollment iv administer surveys to recently enrolled chip and children s medicaid enrollees to identify a how the enrollees learned about coverage and b any barriers during the application process v develop promotional material regarding chip and children s medicaid eligibility including outreach through social media video production and other media platforms vi identify ways that the eligibility website for enrollment in chip and children s medicaid can be redesigned to increase accessibility and enhance the user experience vii identify outreach opportunities including partnerships with community organizations including a schools b small businesses c unemployment centers d parent teacher associations and e youth athlete clubs and associations and viii develop messaging to increase awareness of coverage options that are available through the department a the department may not delegate implementation of the program to a private entity b notwithstanding subsection a the department may contract with a media agency to conduct the activities described in subsection b iv and vii section section b which is renumbered from section is renumbered and amended to read b reimbursement for diabetes prevention program as used in this section dpp means the national diabetes prevention program developed by the united states centers for disease control and prevention beginning july the medicaid program shall reimburse a provider for an enrollee s participation in the dpp if the enrollee a meets the dpp s eligibility requirements and b has not previously participated in the dpp after july while enrolled in the medicaid program subject to appropriation the medicaid program may set the rate for reimbursement the department may apply for a state plan amendment if necessary to implement this section a on or after july but before october the department shall provide a written report regarding the efficacy of the dpp and reimbursement under this section to the health and human services interim committee b the report described in subsection a shall include i the total number of enrollees with a prediabetic condition as of july ii the total number of enrollees as of july with a diagnosis of type diabetes iii the total number of enrollees who participated in the dpp iv the total cost incurred by the state to implement this section and v any conclusions that can be drawn regarding the impact of the dpp on the rate of type diabetes for enrollees section section b which is renumbered from section is renumbered and amended to read b behavioral health delivery working group as used in this section targeted adult medicaid program means the same as that term is defined in section b on or before may the department shall convene a working group to collaborate with the department on a establishing specific and measurable metrics regarding i compliance of managed care organizations in the state with federal medicaid managed care requirements ii timeliness and accuracy of authorization and claims processing in accordance with medicaid policy and contract requirements iii reimbursement by managed care organizations in the state to providers to maintain adequacy of access to care iv availability of care management services to meet the needs of medicaid eligible individuals enrolled in the plans of managed care organizations in the state and v timeliness of resolution for disputes between a managed care organization and the managed care organization s providers and enrollees b improving the delivery of behavioral health services in the medicaid program c proposals to implement the delivery system adjustments authorized under subsection b and d issues that are identified by managed care organizations behavioral health service providers and the department the working group convened under subsection shall a meet quarterly and b consist of at least the following individuals i the executive director or the executive director s designee ii for each medicaid accountable care organization with which the department contracts an individual selected by the accountable care organization iii five individuals selected by the department to represent various types of behavioral health services providers including at a minimum individuals who represent providers who provide the following types of services a acute inpatient behavioral health treatment b residential treatment c intensive outpatient or partial hospitalization treatment and d general outpatient treatment iv a representative of an association that represents behavioral health treatment providers in the state designated by the utah behavioral healthcare council convened by the utah association of counties v a representative of an organization representing behavioral health organizations vi the chair of the utah substance use and mental health advisory council created in section m vii a representative of an association that represents local authorities who provide public behavioral health care designated by the department viii one member of the senate appointed by the president of the senate and ix one member of the house of representatives appointed by the speaker of the house of representatives the working group convened under this section shall recommend to the department a specific and measurable metrics under subsection a b how physical and behavioral health services may be integrated for the targeted adult medicaid program including ways the department may address issues regarding i filing of claims ii authorization and reauthorization for treatment services iii reimbursement rates and iv other issues identified by the department behavioral health services providers or medicaid managed care organizations c ways to improve delivery of behavioral health services to enrollees including changes to statute or administrative rule and d wraparound service coverage for enrollees who need specific nonclinical services to ensure a path to success section section b which is renumbered from section is renumbered and amended to read b adjudicative proceedings related to medicaid funds if a proceeding of the department under title g chapter administrative procedures act relates in any way to recovery of medicaid funds a the presiding officer shall be designated by the executive director of the department and report directly to the executive director or in the discretion of the executive director report directly to the director of the office of internal audit and b the decision of the presiding officer is the recommended decision to the executive director of the department or a designee of the executive director who is not in the division subsection does not apply to hearings conducted by the department of workforce services relating to medical assistance eligibility determinations if a proceeding of the department under title g chapter administrative procedures act relates in any way to medicaid or medicaid funds the following may attend and present evidence or testimony at the proceeding a the director of the office of internal audit or the director s designee and b the inspector general of medicaid services or the inspector general s designee in relation to a proceeding of the department under title g chapter administrative procedures act a person may not outside of the actual proceeding attempt to influence the decision of the presiding officer section section b which is renumbered from section is renumbered and amended to read b medical assistance accountability division duties reporting as used in this section a abuse means i an action or practice that a is inconsistent with sound fiscal business or medical practices and b results or may result in unnecessary medicaid related costs or other medical or hospital assistance costs or ii reckless or negligent upcoding b fraud means intentional or knowing i deception misrepresentation or upcoding in relation to medicaid funds costs claims reimbursement or practice or ii deception or misrepresentation in relation to medical or hospital assistance funds costs claims reimbursement or practice c upcoding means assigning an inaccurate billing code for a service that is payable or reimbursable by medicaid funds if the correct billing code for the service taking into account reasonable opinions derived from official published coding definitions would result in a lower medicaid payment or reimbursement d waste means overutilization of resources or inappropriate payment the division shall a develop and implement procedures relating to medicaid funds and medical or hospital assistance funds to ensure that providers do not receive a i duplicate payments for the same goods or services b ii payment for goods or services by resubmitting a claim for which i a payment has been disallowed on the grounds that payment would be a violation of federal or state law administrative rule or the state plan and ii b the decision to disallow the payment has become final c iii payment for goods or services provided after a recipient s death including payment for pharmaceuticals or long term care or d iv payment for transporting an unborn infant b consult with the centers for medicaid and medicare services cms other states and the office of inspector general of medicaid services to determine and implement best practices for discovering and eliminating fraud waste and abuse of medicaid funds and medical or hospital assistance funds c actively seek repayment from providers for improperly used or paid a i medicaid funds and b ii medical or hospital assistance funds d coordinate track and keep records of all division efforts to obtain repayment of the funds described in subsection c and the results of those efforts e keep medicaid pharmaceutical costs as low as possible by actively seeking to obtain pharmaceuticals at the lowest price possible including on a quarterly basis for the pharmaceuticals that represent the highest of state medicaid expenditures for pharmaceuticals and on an annual basis for the remaining pharmaceuticals a i tracking changes in the price of pharmaceuticals b ii checking the availability and price of generic drugs c iii reviewing and updating the state s maximum allowable cost list and d iv comparing pharmaceutical costs of the state medicaid program to available pharmacy price lists and f provide training on an annual basis to the employees of the division who make decisions on billing codes or who are in the best position to observe and identify upcoding in order to avoid and detect upcoding section section b which is renumbered from section is renumbered and amended to read b medical assistance from division or department of workforce services and compliance under adoption assistance interstate compact penalty for fraudulent claim as used in this section a adoption assistance means the same as that term is defined in section b adoption assistance agreement means the same as that term is defined in section c adoption assistance interstate compact means an agreement executed by the division of child and family services with any other state in accordance with section a a child who is a resident of this state and is the subject of an adoption assistance interstate compact is entitled to receive medical assistance from the division and the department of workforce services by filing a certified copy of the child s adoption assistance agreement with the division or the department of workforce services b the adoptive parent of the child described in subsection a shall annually provide the division or the department of workforce services with evidence verifying that the adoption assistance agreement is still effective the department of workforce services shall consider the recipient of medical assistance under this section as the department of workforce services does any other recipient of medical assistance under an adoption assistance agreement executed by the division of child and family services a a person may not submit a claim for payment or reimbursement under this section that the person knows is false misleading or fraudulent b a violation of subsection a is a third degree felony the division and the department of workforce services shall a cooperate with the division of child and family services in regard to an adoption assistance interstate compact and b comply with an adoption assistance interstate compact section section b which is renumbered from section is renumbered and amended to read part medicaid waivers b medicaid waiver for independent foster care adolescents for purposes of as used in this section an independent foster care adolescent includes any individual who reached years of age old while in the custody of the division of child and family services or the department of human services department if the division of child and family services department was the primary case manager or a federally recognized indian tribe an independent foster care adolescent is eligible when funds are available for medicaid coverage until the individual reaches years of age old before july the division shall submit a state medicaid plan amendment to the center for medicaid services cms to provide medical coverage for independent foster care adolescents effective fiscal year section section b which is renumbered from section is renumbered and amended to read b waivers to maximize replacement of fee for service delivery model cost of mandated program changes the department shall develop a waiver program in the medicaid program to replace the fee for service delivery model with one or more risk based delivery models the waiver program shall a restructure the program s provider payment provisions to reward health care providers for delivering the most appropriate services at the lowest cost and in ways that compared to services delivered before implementation of the waiver program maintain or improve recipient health status b restructure the program s cost sharing provisions and other incentives to reward recipients for personal efforts to i maintain or improve their health status and ii use providers that deliver the most appropriate services at the lowest cost c identify the evidence based practices and measures risk adjustment methodologies payment systems funding sources and other mechanisms necessary to reward providers for delivering the most appropriate services at the lowest cost including mechanisms that i pay providers for packages of services delivered over entire episodes of illness rather than for individual services delivered during each patient encounter and ii reward providers for delivering services that make the most positive contribution to a recipient s health status d limit total annual per patient per month expenditures for services delivered through fee for service arrangements to total annual per patient per month expenditures for services delivered through risk based arrangements covering similar recipient populations and services and e except as provided in subsection limit the rate of growth in per patient per month general fund expenditures for the program to the rate of growth in general fund expenditures for all other programs when the rate of growth in the general fund expenditures for all other programs is greater than zero to the extent possible the department shall operate the waiver program with the input of stakeholder groups representing those who will be affected by the waiver program a for purposes of this subsection mandated program change shall be determined by the department in consultation with the medicaid accountable care organizations and may include a change to the state medicaid program that is required by state or federal law state or federal guidance policy or the state medicaid plan b a mandated program change shall be included in the base budget for the medicaid program for the fiscal year in which the medicaid program adopted the mandated program change c the mandated program change is not subject to the limit on the rate of growth in per patient per month general fund expenditures for the program established in subsection e until the fiscal year following the fiscal year in which the medicaid program adopted the mandated program change a managed care organization or a pharmacy benefit manager that provides a pharmacy benefit to an enrollee shall establish a unique group number payment classification number or bank identification number for each medicaid managed care organization plan for which the managed care organization or pharmacy benefit manager provides a pharmacy benefit section section b which is renumbered from section is renumbered and amended to read b base budget appropriations for medicaid accountable care organizations and behavioral health plans forecast of behavioral health services cost as used in this section a aco means an accountable care organization that contracts with the state s medicaid program for i physical health services or ii integrated physical and behavioral health services b base budget means the same as that term is defined in legislative rule c behavioral health plan means a managed care or fee for service delivery system that contracts with or is operated by the department to provide behavioral health services to medicaid eligible individuals d behavioral health services means mental health or substance use treatment or services e general fund growth factor means the amount determined by dividing the next fiscal year ongoing general fund revenue estimate by current fiscal year ongoing appropriations from the general fund f next fiscal year ongoing general fund revenue estimate means the next fiscal year ongoing general fund revenue estimate identified by the executive appropriations committee in accordance with legislative rule for use by the office of the legislative fiscal analyst in preparing budget recommendations g pmpm means per member per month funding if the general fund growth factor is less than the next fiscal year base budget shall subject to subsection include an appropriation to the department in an amount necessary to ensure that the next fiscal year pmpm for acos and behavioral health plans equals the current fiscal year pmpm for the acos and behavioral health plans multiplied by if the general fund growth factor is greater than or equal to but less than the next fiscal year base budget shall subject to subsection include an appropriation to the department in an amount necessary to ensure that the next fiscal year pmpm for acos and behavioral health plans equals the current fiscal year pmpm for the acos and behavioral health plans multiplied by the general fund growth factor if the general fund growth factor is greater than or equal to the next fiscal year base budget shall subject to subsection include an appropriation to the department in an amount necessary to ensure that the next fiscal year pmpm for acos and behavioral health plans is greater than or equal to the current fiscal year pmpm for the acos and behavioral health plans multiplied by and less than or equal to the current fiscal year pmpm for the acos and behavioral health plans multiplied by the general fund growth factor the appropriations provided to the department for behavioral health plans under this section shall be reduced by the amount contributed by counties in the current fiscal year for behavioral health plans in accordance with subsections k and a x in order for the department to estimate the impact of subsections through before identification of the next fiscal year ongoing general fund revenue estimate the governor s office of planning and budget shall in cooperation with the office of the legislative fiscal analyst develop an estimate of ongoing general fund revenue for the next fiscal year and provide the estimate to the department no later than november of each year the office of the legislative fiscal analyst shall include an estimate of the cost of behavioral health services in any state medicaid funding or savings forecast that is completed in coordination with the department and the governor s office of planning and budget section section b which is renumbered from section is renumbered and amended to read b incentives to appropriately use emergency department services a this section applies to the medicaid program and to the utah children s health insurance program created in chapter utah children s health insurance act section b b as used in this section i managed care organization means a comprehensive full risk managed care delivery system that contracts with the medicaid program or the children s health insurance program to deliver health care through a managed care plan ii managed care plan means a risk based delivery service model authorized by section b and administered by a managed care organization iii non emergent care a means use of the emergency department to receive health care that is non emergent as defined by the department by administrative rule adopted in accordance with title g chapter utah administrative rulemaking act and the emergency medical treatment and active labor act and b does not mean the medical services provided to an individual required by the emergency medical treatment and active labor act including services to conduct a medical screening examination to determine if the recipient has an emergent or non emergent condition iv professional compensation means payment made for services rendered to a medicaid recipient by an individual licensed to provide health care services v super utilizer means a medicaid recipient who has been identified by the recipient s managed care organization as a person who uses the emergency department excessively as defined by the managed care organization a a managed care organization may in accordance with subsections b and c i audit emergency department services provided to a recipient enrolled in the managed care plan to determine if non emergent care was provided to the recipient and ii establish differential payment for emergent and non emergent care provided in an emergency department b i the differential payments under subsection a ii do not apply to professional compensation for services rendered in an emergency department ii except in cases of suspected fraud waste and abuse a managed care organization s audit of payment under subsection a i is limited to the month period of time after the date on which the medical services were provided to the recipient if fraud waste or abuse is alleged the managed care organization s audit of payment under subsection a i is limited to three years after the date on which the medical services were provided to the recipient c the audits and differential payments under subsections a and b apply to services provided to a recipient on or after july a managed care organization shall a use the savings under subsection to maintain and improve access to primary care and urgent care services for all medicaid or chip recipients enrolled in the managed care plan b provide viable alternatives for increasing primary care provider reimbursement rates to incentivize after hours primary care access for recipients and c report to the department on how the managed care organization complied with this subsection the department may a through administrative rule adopted by the department develop quality measurements that evaluate a managed care organization s delivery of i appropriate emergency department services to recipients enrolled in the managed care plan ii expanded primary care and urgent care for recipients enrolled in the managed care plan with consideration of the managed care organization s a delivery of primary care urgent care and after hours care through means other than the emergency department b recipient access to primary care providers and community health centers including evening and weekend access and c other innovations for expanding access to primary care and iii quality of care for the managed care plan members b compare the quality measures developed under subsection a for each managed care organization and c develop by administrative rule an algorithm to determine assignment of new unassigned recipients to specific managed care plans based on the plan s performance in relation to the quality measures developed pursuant to subsection a section section b which is renumbered from section is renumbered and amended to read b long term care insurance partnership as used in this section a qualified long term care insurance contract is as defined in u s c sec b b b qualified long term care insurance partnership is as defined in u s c sec p b c iii c state plan amendment means an amendment to the state medicaid plan drafted by the department in compliance with this section no later than july the department shall seek federal approval of a state plan amendment that creates a qualified long term care insurance partnership the department may make rules to comply with federal laws and regulations relating to qualified long term care insurance partnerships and qualified long term care insurance contracts section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for children with disabilities and complex medical needs as used in this section a additional eligibility criteria means the additional eligibility criteria set by the department under subsection e b complex medical condition means a physical condition of an individual that i results in severe functional limitations for the individual and ii is likely to a last at least months or b result in death c program means the program for children with complex medical conditions created in subsection d qualified child means a child who i is less than years old ii is diagnosed with a complex medical condition iii has a condition that meets the definition of disability in u s c sec and iv meets the additional eligibility criteria the department shall apply for a medicaid home and community based waiver with cms to implement within the state medicaid program the program described in subsection if the waiver described in subsection is approved the department shall offer a program that a as funding permits provides treatment for qualified children b if approved by cms and as funding permits beginning in fiscal year provides on an ongoing basis treatment for more qualified children than the program provided treatment for during fiscal year and c accepts applications for the program on an ongoing basis i d requires periodic reevaluations of an enrolled child s eligibility and other applicants or eligible children waiting for services in the program based on the additional eligibility criteria and ii e at the time of reevaluation allows the department to disenroll a child based on the prioritization described in subsection a and additional eligibility criteria the department shall a establish by rule made in accordance with title g chapter utah administrative rulemaking act criteria to prioritize qualified children s participation in the program based on the following factors in the following priority order i the complexity of a qualified child s medical condition and ii the financial needs of the qualified child and the qualified child s family b convene a public process to determine the benefits and services to offer a qualified child under the program c evaluate on an ongoing basis the cost and effectiveness of the program d if funding for the program is reduced develop an evaluation process to reduce the number of children served based on the participation criteria established under subsection a and e establish by rule made in accordance with title g chapter utah administrative rulemaking act additional eligibility criteria based on the factors described in subsections a i and ii section section b which is renumbered from section is renumbered and amended to read b health coverage improvement program eligibility annual report expansion of eligibility for adults with dependent children as used in this section a adult in the expansion population means an individual who i is described in u s c sec a a a i viii and ii is not otherwise eligible for medicaid as a mandatory categorically needy individual b enhancement waiver program means the primary care network enhancement waiver program described in section b c federal poverty level means the poverty guidelines established by the secretary of the united states department of health and human services under u s c sec d health coverage improvement program means the health coverage improvement program described in subsections through e homeless i means an individual who is chronically homeless as determined by the department and ii includes someone who was chronically homeless and is currently living in supported housing for the chronically homeless f income eligibility ceiling means the percent of federal poverty level i established by the state in an appropriations act adopted pursuant to title j chapter budgetary procedures act and ii under which an individual may qualify for medicaid coverage in accordance with this section g targeted adult medicaid program means the program implemented by the department under subsections through beginning july the department shall amend the state medicaid plan to allow temporary residential treatment for substance abuse use for the traditional medicaid population in a short term non institutional hour facility without a bed capacity limit that provides rehabilitation services that are medically necessary and in accordance with an individualized treatment plan as approved by cms and as long as the county makes the required match under section beginning july the department shall amend the state medicaid plan to increase the income eligibility ceiling to a percentage of the federal poverty level designated by the department based on appropriations for the program for an individual with a dependent child before july the division shall submit to cms a request for waivers or an amendment of existing waivers from federal statutory and regulatory law necessary for the state to implement the health coverage improvement program in the medicaid program in accordance with this section a an adult in the expansion population is eligible for medicaid if the adult meets the income eligibility and other criteria established under subsection b an adult who qualifies under subsection shall receive medicaid coverage i through the traditional fee for service medicaid model in counties without medicaid accountable care organizations or the state s medicaid accountable care organization delivery system where implemented and subject to section b ii except as provided in subsection b iii for behavioral health through the counties in accordance with sections and iii that subject to section b integrates behavioral health services and physical health services with medicaid accountable care organizations in select geographic areas of the state that choose an integrated model and iv that permits temporary residential treatment for substance abuse use in a short term non institutional hour facility without a bed capacity limit as approved by cms that provides rehabilitation services that are medically necessary and in accordance with an individualized treatment plan a an individual is eligible for the health coverage improvement program under subsection if i at the time of enrollment the individual s annual income is below the income eligibility ceiling established by the state under subsection f and ii the individual meets the eligibility criteria established by the department under subsection b b based on available funding and approval from cms the department shall select the criteria for an individual to qualify for the medicaid program under subsection a ii based on the following priority i a chronically homeless individual ii if funding is available an individual a involved in the justice system through probation parole or court ordered treatment and b in need of substance abuse use treatment or mental health treatment as determined by the department or iii if funding is available an individual in need of substance abuse use treatment or mental health treatment as determined by the department
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+enrolled copy s b health and human services recodification health care assistance and data general session state of utah chief sponsor jacob l anderegg house sponsor raymond p ward long title general description this bill recodifies portions of the utah health code and utah human services code highlighted provisions this bill recodifies provisions regarding health care administration and assistance and vital statistics health data and the utah medical examiner and makes technical and corresponding changes money appropriated in this bill none other special clauses this bill provides a coordination clause this bill provides revisor instructions utah code sections affected amends b as enacted by laws of utah chapter b as enacted by laws of utah chapter renumbers and amends b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah sixth special session chapter b renumbered from as last amended by laws of utah fifth special session chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah fifth special session chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from c as last amended by laws of utah chapter b renumbered from c as enacted by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as enacted by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as repealed and reenacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as repealed and reenacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter utah code sections affected by coordination clause as last amended by laws of utah chapter as last amended by laws of utah chapter b as enacted by laws of utah chapter b utah code annotated be it enacted by the legislature of the state of utah section section b is amended to read chapter health care administration and assistance part health care assistance b definitions reserved as used in this chapter applicant means any person who requests assistance under the medical programs of the state cms means the centers for medicare and medicaid services within the united states department of health and human services division means the division of integrated healthcare within the department established under section b enrollee or member means an individual whom the department has determined to be eligible for assistance under the medicaid program medicaid program means the state program for medical assistance for persons who are eligible under the state plan adopted pursuant to title xix of the federal social security act medical assistance means services furnished or payments made to or on behalf of a member a passenger vehicle means a self propelled two axle vehicle intended primarily for operation on highways and used by an applicant or recipient to meet basic transportation needs and has a fair market value below of the applicable amount of the federal luxury passenger automobile tax established in u s c sec and adjusted annually for inflation b passenger vehicle does not include i a commercial vehicle as defined in section a ii an off highway vehicle as defined in section a or iii a motor home as defined in section ppaca means the same as that term is defined in section a recipient means a person who has received medical assistance under the medicaid program section section b which is renumbered from section is renumbered and amended to read b division creation there is created within the department the division of medicaid and health financing integrated healthcare which shall be responsible for implementing organizing and maintaining the medicaid program and the children s health insurance program established in section b in accordance with the provisions of this chapter and applicable federal law section section b which is renumbered from section is renumbered and amended to read b state medicaid director appointment responsibilities the state medicaid director shall be appointed by the governor after consultation with the executive director with the advice and consent of the senate the state medicaid director may employ other employees as necessary to implement the provisions of this chapter and shall a administer the responsibilities of the division as set forth in this chapter b administer the division s budget and c establish and maintain a state plan for the medicaid program in compliance with federal law and regulations section section b which is renumbered from section is renumbered and amended to read b division responsibilities emphasis periodic assessment in accordance with the requirements of title xix of the social security act and applicable federal regulations the division is responsible for the effective and impartial administration of this chapter in an efficient economical manner the division shall a establish on a statewide basis a program to safeguard against unnecessary or inappropriate use of medicaid services excessive payments and unnecessary or inappropriate hospital admissions or lengths of stay b deny any provider claim for services that fail to meet criteria established by the division concerning medical necessity or appropriateness and c place its emphasis on high quality care to recipients in the most economical and cost effective manner possible with regard to both publicly and privately provided services the division shall implement and utilize cost containment methods where possible which may include a prepayment and postpayment review systems to determine if utilization is reasonable and necessary b preadmission certification of nonemergency admissions c mandatory outpatient rather than inpatient surgery in appropriate cases d second surgical opinions e procedures for encouraging the use of outpatient services f consistent with sections b and b a medicaid drug program g coordination of benefits and h review and exclusion of providers who are not cost effective or who have abused the medicaid program in accordance with the procedures and provisions of federal law and regulation the state medicaid director shall periodically assess the cost effectiveness and health implications of the existing medicaid program and consider alternative approaches to the provision of covered health and medical services through the medicaid program in order to reduce unnecessary or unreasonable utilization a the department shall ensure medicaid program integrity by conducting internal audits of the medicaid program for efficiencies best practices and cost avoidance b the department shall coordinate with the office of the inspector general for medicaid services created in section a to implement subsection and to address medicaid fraud waste or abuse as described in section a section section b which is renumbered from section is renumbered and amended to read b medicaid drug program preferred drug list a medicaid drug program developed by the department under subsection b f a shall notwithstanding subsection b b be based on clinical and cost related factors which include medical necessity as determined by a provider in accordance with administrative rules established by the drug utilization review board b may include therapeutic categories of drugs that may be exempted from the drug program c may include placing some drugs except the drugs described in subsection on a preferred drug list i to the extent determined appropriate by the department and ii in the manner described in subsection for psychotropic drugs d notwithstanding the requirements of part sections b through b regarding the drug utilization review board and except as provided in subsection shall immediately implement the prior authorization requirements for a nonpreferred drug that is in the same therapeutic class as a drug that is i on the preferred drug list on the date that this act takes effect or ii added to the preferred drug list after this act takes effect and e except as prohibited by subsections b and shall establish the prior authorization requirements established under subsections c and d which shall permit a health care provider or the health care provider s agent to obtain a prior authorization override of the preferred drug list through the department s pharmacy prior authorization review process and which shall i provide either telephone or fax approval or denial of the request within hours of the receipt of a request that is submitted during normal business hours of monday through friday from a m to p m ii provide for the dispensing of a limited supply of a requested drug as determined appropriate by the department in an emergency situation if the request for an override is received outside of the department s normal business hours and iii require the health care provider to provide the department with documentation of the medical need for the preferred drug list override in accordance with criteria established by the department in consultation with the pharmacy and therapeutics committee a for purposes of as used in this subsection i immunosuppressive drug a means a drug that is used in immunosuppressive therapy to inhibit or prevent activity of the immune system to aid the body in preventing the rejection of transplanted organs and tissue and b does not include drugs used for the treatment of autoimmune disease or diseases that are most likely of autoimmune origin ii stabilized means a health care provider has documented in the patient s medical chart that a patient has achieved a stable or steadfast medical state within the past days using a particular psychotropic drug b a preferred drug list developed under the provisions of this section may not include an immunosuppressive drug c i the state medicaid program shall reimburse for a prescription for an immunosuppressive drug as written by the health care provider for a patient who has undergone an organ transplant ii for purposes of subsection b and with respect to patients who have undergone an organ transplant the prescription for a particular immunosuppressive drug as written by a health care provider meets the criteria of demonstrating to the department a medical necessity for dispensing the prescribed immunosuppressive drug d notwithstanding the requirements of part sections b through b regarding the drug utilization review board the state medicaid drug program may not require the use of step therapy for immunosuppressive drugs without the written or oral consent of the health care provider and the patient e the department may include a sedative hypnotic on a preferred drug list in accordance with subsection f f the department shall grant a prior authorization for a sedative hypnotic that is not on the preferred drug list under subsection e if the health care provider has documentation related to one of the following conditions for the medicaid client i a trial and failure of at least one preferred agent in the drug class including the name of the preferred drug that was tried the length of therapy and the reason for the discontinuation ii detailed evidence of a potential drug interaction between current medication and the preferred drug iii detailed evidence of a condition or contraindication that prevents the use of the preferred drug iv objective clinical evidence that a patient is at high risk of adverse events due to a therapeutic interchange with a preferred drug v the patient is a new or previous medicaid client with an existing diagnosis previously stabilized with a nonpreferred drug or vi other valid reasons as determined by the department g a prior authorization granted under subsection f is valid for one year from the date the department grants the prior authorization and shall be renewed in accordance with subsection f a for purposes of as used in this subsection psychotropic drug means the following classes of drugs i atypical anti psychotic ii anti depressant iii anti convulsant mood stabilizer iv anti anxiety and v attention deficit hyperactivity disorder stimulant b i the department shall develop a preferred drug list for psychotropic drugs ii except as provided in subsection d a preferred drug list for psychotropic drugs developed under this section shall allow a health care provider to override the preferred drug list by writing dispense as written on the prescription for the psychotropic drug iii a health care provider may not override section b by writing dispense as written on a prescription c the department and a medicaid accountable care organization that is responsible for providing behavioral health shall i establish a system to a track health care provider prescribing patterns for psychotropic drugs b educate health care providers who are not complying with the preferred drug list and c implement peer to peer education for health care providers whose prescribing practices continue to not comply with the preferred drug list and ii determine whether health care provider compliance with the preferred drug list is at least a of prescriptions by july b of prescriptions by july and c of prescriptions by july d beginning october the department shall eliminate the dispense as written override for the preferred drug list and shall implement a prior authorization system for psychotropic drugs in accordance with subsection f if by july the department has not realized annual savings from implementing the preferred drug list for psychotropic drugs of at least general fund savings section section b which is renumbered from section is renumbered and amended to read b simplified enrollment and renewal process for medicaid and other state medical programs financial institutions the department may apply for grants and accept donations to make technology system improvements necessary to implement a simplified enrollment and renewal process for the medicaid program utah premium partnership and primary care network demonstration project programs a the department may enter into an agreement with a financial institution doing business in the state to develop and operate a data match system to identify an applicant s or enrollee s assets that i uses automated data exchanges to the maximum extent feasible and ii requires a financial institution each month to provide the name record address social security number other taxpayer identification number or other identifying information for each applicant or enrollee who maintains an account at the financial institution b the department may pay a reasonable fee to a financial institution for compliance with this subsection as provided in section c a financial institution may not be liable under any federal or state law to any person for any disclosure of information or action taken in good faith under this subsection d the department may disclose a financial record obtained from a financial institution under this section only for the purpose of and to the extent necessary in verifying eligibility as provided in this section and section b section section b which is renumbered from section is renumbered and amended to read b dental benefits a except as provided in subsection the division may establish a competitive bid process to bid out medicaid dental benefits under this chapter b the division may bid out the medicaid dental benefits separately from other program benefits the division shall use the following criteria to evaluate dental bids a ability to manage dental expenses b proven ability to handle dental insurance c efficiency of claim paying procedures d provider contracting discounts and adequacy of network and e other criteria established by the department the division shall request bids for the program s benefits at least once every five years the division s contract with dental plans for the program s benefits shall include risk sharing provisions in which the dental plan must accept of the risk for any difference between the division s premium payments per client and actual dental expenditures the division may not award contracts to a more than three responsive bidders under this section or b an insurer that does not have a current license in the state a the division may cancel the request for proposals if i there are no responsive bidders or ii the division determines that accepting the bids would increase the program s costs b if the division cancels a request for proposal or a contract that results from a request for proposal described in subsection a the division shall report to the health and human services interim committee regarding the reasons for the decision title g chapter a utah procurement code shall apply to this section a the division may i establish a dental health care delivery system and payment reform pilot program for medicaid dental benefits to increase access to cost effective and quality dental health care by increasing the number of dentists available for medicaid dental services and ii target specific medicaid populations or geographic areas in the state b the pilot program shall establish compensation models for dentists and dental hygienists that i increase access to quality cost effective dental care and ii use funds from the division of family health and preparedness that are available to reimburse dentists for educational loans in exchange for the dentist agreeing to serve medicaid and under served populations c the division may amend the state plan and apply to the secretary of the united states department of health and human services for waivers or pilot programs if necessary to establish the new dental care delivery and payment reform model d the division shall evaluate the pilot program s effect on the cost of dental care and access to dental care for the targeted medicaid populations a as used in this subsection dental hygienist means an individual who is licensed as a dental hygienist under section b the department shall reimburse a dental hygienist for dental services performed in a public health setting and in accordance with subsection c beginning on the earlier of i january or ii days after the date on which the replacement of the department s medicaid management information system software is complete c the department shall reimburse a dental hygienist directly for a service provided through the medicaid program if i the dental hygienist requests to be reimbursed directly and ii the dental hygienist provides the service within the scope of practice described in section d before november of each year in which the department reimburses dental hygienists in accordance with subsection c the department shall report to the health and human services interim committee for the previous fiscal year i the number and geographic distribution of dental hygienists who requested to be reimbursed directly ii the total number of medicaid enrollees who were served by a dental hygienist who were reimbursed under this subsection iii the total amount reimbursed directly to dental hygienists under this subsection iv the specific services and billing codes that are reimbursed under this subsection and v the aggregate amount reimbursed for each service and billing code described in subsection d iv e i except as provided in this subsection nothing in this subsection shall be interpreted as expanding or otherwise altering the limitations and scope of practice for a dental hygienist ii a dental hygienist may only directly bill and receive compensation for billing codes that fall within the scope of practice of a dental hygienist section section b which is renumbered from section is renumbered and amended to read b administration of medicaid program by department reporting to the legislature disciplinary measures and sanctions funds collected eligibility standards internal audits health opportunity accounts the department shall be the single state agency responsible for the administration of the medicaid program in connection with the united states department of health and human services pursuant to title xix of the social security act a the department shall implement the medicaid program through administrative rules in conformity with this chapter title g chapter utah administrative rulemaking act the requirements of title xix and applicable federal regulations b the rules adopted under subsection a shall include in addition to other rules necessary to implement the program i the standards used by the department for determining eligibility for medicaid services ii the services and benefits to be covered by the medicaid program iii reimbursement methodologies for providers under the medicaid program and iv a requirement that a a person receiving medicaid services shall participate in the electronic exchange of clinical health records established in accordance with section b unless the individual opts out of participation b prior to enrollment in the electronic exchange of clinical health records the enrollee shall receive notice of enrollment in the electronic exchange of clinical health records and the right to opt out of participation at any time and c beginning july when the program sends enrollment or renewal information to the enrollee and when the enrollee logs onto the program s website the enrollee shall receive notice of the right to opt out of the electronic exchange of clinical health records a the department shall in accordance with subsection b report to the social services appropriations subcommittee when the department i implements a change in the medicaid state plan ii initiates a new medicaid waiver iii initiates an amendment to an existing medicaid waiver iv applies for an extension of an application for a waiver or an existing medicaid waiver v applies for or receives approval for a change in any capitation rate within the medicaid program or vi initiates a rate change that requires public notice under state or federal law b the report required by subsection a shall i be submitted to the social services appropriations subcommittee prior to the department implementing the proposed change and ii include a a description of the department s current practice or policy that the department is proposing to change b an explanation of why the department is proposing the change c the proposed change in services or reimbursement including a description of the effect of the change d the effect of an increase or decrease in services or benefits on individuals and families e the degree to which any proposed cut may result in cost shifting to more expensive services in health or human service programs and f the fiscal impact of the proposed change including i the effect of the proposed change on current or future appropriations from the legislature to the department ii the effect the proposed change may have on federal matching dollars received by the state medicaid program iii any cost shifting or cost savings within the department s budget that may result from the proposed change and iv identification of the funds that will be used for the proposed change including any transfer of funds within the department s budget any rules adopted by the department under subsection are subject to review and reauthorization by the legislature in accordance with section g the department may in its discretion contract with the department of human services or other qualified agencies for services in connection with the administration of the medicaid program including a the determination of the eligibility of individuals for the program b recovery of overpayments and c consistent with section b and to the extent permitted by law and quality control services enforcement of fraud and abuse laws the department shall provide by rule disciplinary measures and sanctions for medicaid providers who fail to comply with the rules and procedures of the program provided that sanctions imposed administratively may not extend beyond a termination from the program b recovery of claim reimbursements incorrectly paid and c those specified in section of title xix of the federal social security act a funds collected as a result of a sanction imposed under section of title xix of the federal social security act shall be deposited in the general fund as dedicated credits to be used by the division in accordance with the requirements of section of title xix of the federal social security act b in accordance with section j sanctions collected under this subsection are nonlapsing a in determining whether an applicant or recipient is eligible for a service or benefit under this part or chapter part utah children s health insurance act program the department shall if subsection b is satisfied exclude from consideration one passenger vehicle designated by the applicant or recipient b before subsection a may be applied i the federal government shall a determine that subsection a may be implemented within the state s existing public assistance related waivers as of january b extend a waiver to the state permitting the implementation of subsection a or c determine that the state s waivers that permit dual eligibility determinations for cash assistance and medicaid are no longer valid and ii the department shall determine that subsection a can be implemented within existing funding a for purposes of as used in this subsection i aged blind or has a disability means an aged blind or disabled individual as defined in u s c sec c a and ii spend down means an amount of income in excess of the allowable income standard that shall be paid in cash to the department or incurred through the medical services not paid by medicaid b in determining whether an applicant or recipient who is aged blind or has a disability is eligible for a service or benefit under this chapter the department shall use of the federal poverty level as i the allowable income standard for eligibility for services or benefits and ii the allowable income standard for eligibility as a result of spend down the department shall conduct internal audits of the medicaid program a the department may apply for and if approved implement a demonstration program for health opportunity accounts as provided for in u s c sec u b a health opportunity account established under subsection a shall be an alternative to the existing benefits received by an individual eligible to receive medicaid under this chapter c subsection a is not intended to expand the coverage of the medicaid program a i the department shall apply for and if approved implement an amendment to the state plan under this subsection for benefits for a medically needy pregnant women b medically needy children and c medically needy parents and caretaker relatives ii the department may implement the eligibility standards of subsection b for eligibility determinations made on or after the date of the approval of the amendment to the state plan b in determining whether an applicant is eligible for benefits described in subsection a i the department shall i disregard resources held in an account in the savings plan created under title b chapter a utah educational savings plan if the beneficiary of the account is a under the age of and b living with the account owner as that term is defined in section b a or temporarily absent from the residence of the account owner and ii include the withdrawals from an account in the utah educational savings plan as resources for a benefit determination if the withdrawal was not used for qualified higher education costs as that term is defined in section b a a the department may not deny or terminate eligibility for medicaid solely because an individual is i incarcerated and ii not an inmate as defined in section b subsection a does not require the medicaid program to provide coverage for any services for an individual while the individual is incarcerated the department is a party to and may intervene at any time in any judicial or administrative action a to which the department of workforce services is a party and b that involves medical assistance under this chapter i title chapter medical assistance act or ii title chapter utah children s health insurance act section section b which is renumbered from section is renumbered and amended to read b medicaid expansion the purpose of this section is to expand the coverage of the medicaid program to persons who are in categories traditionally not served by that program within appropriations from the legislature the department may amend the state plan for medical assistance to provide for eligibility for medicaid a on or after july for children to years old who live in households below the federal poverty income guideline and b on or after july for persons who have incomes below the federal poverty income guideline and who are aged blind or have a disability a within appropriations from the legislature on or after july the medicaid program may provide for eligibility for persons who have incomes below the federal poverty income guideline b in order to meet the provisions of this subsection the department may seek approval for a demonstration project under u s c sec from the secretary of the united states department of health and human services the medicaid program shall provide for eligibility for persons as required by subsection b services available for persons described in this section shall include required medicaid services and may include one or more optional medicaid services if those services are funded by the legislature the department may also require persons described in subsections through to meet an asset test section section b which is renumbered from section is renumbered and amended to read b copayments by recipients employer sponsored plans the department shall selectively provide for enrollment fees premiums deductions cost sharing or other similar charges to be paid by recipients their spouses and parents within the limitations of federal law and regulation beginning may within appropriations by the legislature and as a means to increase health care coverage among the uninsured the department shall take steps to promote increased participation in employer sponsored health insurance including a maximizing the health insurance premium subsidy provided under the state s demonstration waiver by i ensuring that state funds are matched by federal funds to the greatest extent allowable and ii as the department determines appropriate seeking federal approval to do one or more of the following a eliminate or otherwise modify the annual enrollment fee b eliminate or otherwise modify the schedule used to determine the level of subsidy provided to an enrollee each year c reduce the maximum number of participants allowable under the subsidy program or d otherwise modify the program in a manner that promotes enrollment in employer sponsored health insurance and b exploring the use of other options including the development of a waiver under the medicaid health insurance flexibility demonstration initiative or other federal authority section section b which is renumbered from section is renumbered and amended to read b income and resources from institutionalized spouses as used in this section a community spouse means the spouse of an institutionalized spouse b i community spouse monthly income allowance means an amount by which the minimum monthly maintenance needs allowance for the spouse exceeds the amount of monthly income otherwise available to the community spouse determined without regard to the allowance except as provided in subsection b ii ii if a court has entered an order against an institutionalized spouse for monthly income for the support of the community spouse the community spouse monthly income allowance for the spouse may not be less than the amount of the monthly income so ordered c community spouse resource allowance is the amount of combined resources that are protected for a community spouse living in the community which the division shall establish by rule made in accordance with title g chapter utah administrative rulemaking act based on the amounts established by the united states department of health and human services d excess shelter allowance for a community spouse means the amount by which the sum of the spouse s expense for rent or mortgage payment taxes and insurance and in the case of condominium or cooperative required maintenance charge for the community spouse s principal residence and the spouse s actual expenses for electricity natural gas and water utilities or at the discretion of the department the federal standard utility allowance under snap as defined in section a exceeds of the amount described in subsection e family member means a minor dependent child dependent parents or dependent sibling of the institutionalized spouse or community spouse who are residing with the community spouse f i institutionalized spouse means a person who is residing in a nursing facility and is married to a spouse who is not in a nursing facility ii an institutionalized spouse does not include a person who is not likely to reside in a nursing facility for at least consecutive days g nursing care facility means the same as that term is defined in section b the division shall comply with this section when determining eligibility for medical assistance for an institutionalized spouse for services furnished during a calendar year beginning on or after january the community spouse resource allowance shall be increased by the division by an amount as determined annually by cms the division shall compute as of the beginning of the first continuous period of institutionalization of the institutionalized spouse a the total value of the resources to the extent either the institutionalized spouse or the community spouse has an ownership interest and b a spousal share which is of the resources described in subsection a at the request of an institutionalized spouse or a community spouse at the beginning of the first continuous period of institutionalization of the institutionalized spouse and upon the receipt of relevant documentation of resources the division shall promptly assess and document the total value described in subsection a and shall provide a copy of that assessment and documentation to each spouse and shall retain a copy of the assessment when the division provides a copy of the assessment it shall include a notice stating that the spouse may request a hearing under subsection when determining eligibility for medical assistance under this chapter a except as provided in subsection b all resources held by either the institutionalized spouse community spouse or both are considered to be available to the institutionalized spouse b resources are considered to be available to the institutionalized spouse only to the extent that the amount of those resources exceeds the community spouse resource allowance at the time of application for medical assistance under this chapter a the division may not find an institutionalized spouse to be ineligible for medical assistance by reason of resources determined under subsection to be available for the cost of care when i the institutionalized spouse has assigned to the state any rights to support from the community spouse ii except as provided in subsection b the institutionalized spouse lacks the ability to execute an assignment due to physical or mental impairment or iii the division determines that denial of medical assistance would cause an undue burden b subsection a ii does not prevent the division from seeking a court order for an assignment of support during the continuous period in which an institutionalized spouse is in an institution and after the month in which an institutionalized spouse is eligible for medical assistance the resources of the community spouse may not be considered to be available to the institutionalized spouse when an institutionalized spouse is determined to be eligible for medical assistance in determining the amount of the spouse s income that is to be applied monthly for the cost of care in the nursing care facility the division shall deduct from the spouse s monthly income the following amounts in the following order a a personal needs allowance the amount of which is determined by the division b a community spouse monthly income allowance but only to the extent that the income of the institutionalized spouse is made available to or for the benefit of the community spouse c a family allowance for each family member equal to at least of the amount that the amount described in subsection a exceeds the amount of the family member s monthly income and d amounts for incurred expenses for the medical or remedial care for the institutionalized spouse the division shall establish a minimum monthly maintenance needs allowance for each community spouse that includes a an amount established by the division by rule made in accordance with title g chapter utah administrative rulemaking act based on the amounts established by the united states department of health and human services and b an excess shelter allowance a an institutionalized spouse or a community spouse may request a hearing with respect to the determinations described in subsections e i through v if an application for medical assistance has been made on behalf of the institutionalized spouse b a hearing under this subsection regarding the community spouse resource allowance shall be held by the division within days from the date of the request for the hearing c if either spouse establishes that the community spouse needs income above the level otherwise provided by the minimum monthly maintenance needs allowance due to exceptional circumstances resulting in significant financial duress there shall be substituted for the minimum monthly maintenance needs allowance provided under subsection an amount adequate to provide additional income as is necessary d if either spouse establishes that the community spouse resource allowance in relation to the amount of income generated by the allowance is inadequate to raise the community spouse s income to the minimum monthly maintenance needs allowance there shall be substituted for the community spouse resource allowance an amount adequate to provide a minimum monthly maintenance needs allowance e a hearing may be held under this subsection if either the institutionalized spouse or community spouse is dissatisfied with a determination of i the community spouse monthly income allowance ii the amount of monthly income otherwise available to the community spouse iii the computation of the spousal share of resources under subsection iv the attribution of resources under subsection or v the determination of the community spouse resource allocation a an institutionalized spouse may transfer an amount equal to the community spouse resource allowance but only to the extent the resources of the institutionalized spouse are transferred to or for the sole benefit of the community spouse b the transfer under subsection a shall be made as soon as practicable after the date of the initial determination of eligibility taking into account the time necessary to obtain a court order under subsection c c chapter medical benefits recovery act part medical benefits recovery does not apply if a court has entered an order against an institutionalized spouse for the support of the community spouse section section b which is renumbered from section is renumbered and amended to read b maximizing use of premium assistance programs utah s premium partnership for health insurance a the department shall seek to maximize the use of medicaid and children s health insurance program funds for assistance in the purchase of private health insurance coverage for medicaid eligible and non medicaid eligible individuals b the department s efforts to expand the use of premium assistance shall i include as necessary seeking federal approval under all medicaid and children s health insurance program premium assistance provisions of federal law including provisions of the patient protection and affordable care act public law ppaca ii give priority to but not be limited to expanding the state s utah premium partnership for health insurance program including as required under subsection and iii encourage the enrollment of all individuals within a household in the same plan where possible including enrollment in a plan that allows individuals within the household transitioning out of medicaid to retain the same network and benefits they had while enrolled in medicaid the department shall seek federal approval of an amendment to the state s utah premium partnership for health insurance program to adjust the eligibility determination for single adults and parents who have an offer of employer sponsored insurance the amendment shall a be within existing appropriations for the utah premium partnership for health insurance program and b provide that adults who are up to of the federal poverty level are eligible for premium subsidies in the utah premium partnership for health insurance program for the fiscal year the department shall seek authority to increase the maximum premium subsidy per month for adults under the utah premium partnership for health insurance program to beginning with the fiscal year and in each subsequent fiscal year the department may increase premium subsidies for single adults and parents who have an offer of employer sponsored insurance to keep pace with the increase in insurance premium costs subject to appropriation of additional funding section section b which is renumbered from section is renumbered and amended to read b expanding the medicaid program as used in this section a cms means the centers for medicare and medicaid services in the united states department of health and human services b a federal poverty level means the same as that term is defined in section b c b medicaid expansion means an expansion of the medicaid program in accordance with this section d c medicaid expansion fund means the medicaid expansion fund created in section b b a as set forth in subsections through eligibility criteria for the medicaid program shall be expanded to cover additional low income individuals b the department shall continue to seek approval from cms to implement the medicaid waiver expansion as defined in section b c the department may implement any provision described in subsections b b iii through viii in a medicaid expansion if the department receives approval from cms to implement that provision the department shall expand the medicaid program in accordance with this subsection if the department a receives approval from cms to i expand medicaid coverage to eligible individuals whose income is below of the federal poverty level ii obtain maximum federal financial participation under u s c sec d b for enrolling an individual in the medicaid expansion under this subsection and iii permit the state to close enrollment in the medicaid expansion under this subsection if the department has insufficient funds to provide services to new enrollment under the medicaid expansion under this subsection b pays the state portion of costs for the medicaid expansion under this subsection with funds from i the medicaid expansion fund ii county contributions to the nonfederal share of medicaid expenditures or iii any other contributions funds or transfers from a nonstate agency for medicaid expenditures and c closes the medicaid program to new enrollment under the medicaid expansion under this subsection if the department projects that the cost of the medicaid expansion under this subsection will exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act a the department shall expand the medicaid program in accordance with this subsection if the department i receives approval from cms to a expand medicaid coverage to eligible individuals whose income is below of the federal poverty level b obtain maximum federal financial participation under u s c sec d y for enrolling an individual in the medicaid expansion under this subsection and c permit the state to close enrollment in the medicaid expansion under this subsection if the department has insufficient funds to provide services to new enrollment under the medicaid expansion under this subsection ii pays the state portion of costs for the medicaid expansion under this subsection with funds from a the medicaid expansion fund b county contributions to the nonfederal share of medicaid expenditures or c any other contributions funds or transfers from a nonstate agency for medicaid expenditures and iii closes the medicaid program to new enrollment under the medicaid expansion under this subsection if the department projects that the cost of the medicaid expansion under this subsection will exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act b the department shall submit a waiver an amendment to an existing waiver or a state plan amendment to cms to i administer federal funds for the medicaid expansion under this subsection according to a per capita cap developed by the department that includes an annual inflationary adjustment accounts for differences in cost among categories of medicaid expansion enrollees and provides greater flexibility to the state than the current medicaid payment model ii limit in certain circumstances as defined by the department the ability of a qualified entity to determine presumptive eligibility for medicaid coverage for an individual enrolled in a medicaid expansion under this subsection iii impose a lock out period if an individual enrolled in a medicaid expansion under this subsection violates certain program requirements as defined by the department iv allow an individual enrolled in a medicaid expansion under this subsection to remain in the medicaid program for up to a month certification period as defined by the department and v allow federal medicaid funds to be used for housing support for eligible enrollees in the medicaid expansion under this subsection a i if cms does not approve a waiver to expand the medicaid program in accordance with subsection a on or before january the department shall develop proposals to implement additional flexibilities and cost controls including cost sharing tools within a medicaid expansion under this subsection through a request to cms for a waiver or state plan amendment ii the request for a waiver or state plan amendment described in subsection a i shall include a a path to self sufficiency for qualified adults in the medicaid expansion that includes employment and training as defined in u s c sec d and b a requirement that an individual who is offered a private health benefit plan by an employer to enroll in the employer s health plan iii the department shall submit the request for a waiver or state plan amendment developed under subsection a i on or before march b notwithstanding sections b and j and in accordance with this subsection eligibility for the medicaid program shall be expanded to include all persons in the optional medicaid expansion population under the patient protection and affordable care act pub l no ppaca and the health care education reconciliation act of pub l no and related federal regulations and guidance on the earlier of i the day on which cms approves a waiver to implement the provisions described in subsections a ii a and b or ii july c the department shall seek a waiver or an amendment to an existing waiver from federal law to i implement each provision described in subsections b b iii through viii in a medicaid expansion under this subsection ii limit in certain circumstances as defined by the department the ability of a qualified entity to determine presumptive eligibility for medicaid coverage for an individual enrolled in a medicaid expansion under this subsection and iii impose a lock out period if an individual enrolled in a medicaid expansion under this subsection violates certain program requirements as defined by the department d the eligibility criteria in this subsection shall be construed to include all individuals eligible for the health coverage improvement program under section b e the department shall pay the state portion of costs for a medicaid expansion under this subsection entirely from i the medicaid expansion fund ii county contributions to the nonfederal share of medicaid expenditures or iii any other contributions funds or transfers from a nonstate agency for medicaid expenditures f if the costs of the medicaid expansion under this subsection exceed the funds available under subsection e i the department may reduce or eliminate optional medicaid services under this chapter and ii savings as determined by the department from the reduction or elimination of optional medicaid services under subsection f i shall be deposited into the medicaid expansion fund and iii the department may submit to cms a request for waivers or an amendment of existing waivers from federal law necessary to implement budget controls within the medicaid program to address the deficiency g if the costs of the medicaid expansion under this subsection are projected by the department to exceed the funds available in the current fiscal year under subsection e including savings resulting from any action taken under subsection f i the governor shall direct the department of health department of human services department and department of workforce services to reduce commitments and expenditures by an amount sufficient to offset the deficiency a proportionate to the share of total current fiscal year general fund appropriations for each of those agencies and b up to of each agency s total current fiscal year general fund appropriations ii the division of finance shall reduce allotments to the department of health department of human services department and department of workforce services by a percentage a proportionate to the amount of the deficiency and b up to of each agency s total current fiscal year general fund appropriations and iii the division of finance shall deposit the total amount from the reduced allotments described in subsection g ii into the medicaid expansion fund the department shall maximize federal financial participation in implementing this section including by seeking to obtain any necessary federal approvals or waivers notwithstanding sections and a county does not have to provide matching funds to the state for the cost of providing medicaid services to newly enrolled individuals who qualify for medicaid coverage under a medicaid expansion the department shall report to the social services appropriations subcommittee on or before november of each year that a medicaid expansion is operational a the number of individuals who enrolled in the medicaid expansion b costs to the state for the medicaid expansion c estimated costs to the state for the medicaid expansion for the current and following fiscal years d recommendations to control costs of the medicaid expansion and e as calculated in accordance with subsections b b and c b the state s net cost of the qualified medicaid expansion section section b which is renumbered from section is renumbered and amended to read b department standards for eligibility under medicaid funds for abortions a the department may develop standards and administer policies relating to eligibility under the medicaid program as long as they are consistent with subsection b b an applicant receiving medicaid assistance may be limited to particular types of care or services or to payment of part or all costs of care determined to be medically necessary the department may not provide any funds for medical hospital or other medical expenditures or medical services to otherwise eligible persons where the purpose of the assistance is to perform an abortion unless the life of the mother would be endangered if an abortion were not performed any employee of the department who authorizes payment for an abortion contrary to the provisions of this section is guilty of a class b misdemeanor and subject to forfeiture of office any person or organization that under the guise of other medical treatment provides an abortion under auspices of the medicaid program is guilty of a third degree felony and subject to forfeiture of license to practice medicine or authority to provide medical services and treatment section section b which is renumbered from section is renumbered and amended to read b contracts for provision of medical services federal provisions modifying department rules compliance with social security act the department may contract with other public or private agencies to purchase or provide medical services in connection with the programs of the division where these programs are used by other government entities contracts shall provide that other government entities in compliance with state and federal law regarding intergovernmental transfers transfer the state matching funds to the department in amounts sufficient to satisfy needs of the specified program contract terms shall include provisions for maintenance administration and service costs if a federal legislative or executive provision requires modifications or revisions in an eligibility factor established under this chapter as a condition for participation in medical assistance the department may modify or change its rules as necessary to qualify for participation the provisions of this section do not apply to department rules governing abortion the department shall comply with all pertinent requirements of the social security act and all orders rules and regulations adopted thereunder when required as a condition of participation in benefits under the social security act section section b which is renumbered from section is renumbered and amended to read b liability insurance required the medicaid program may not reimburse a home health agency as defined in section b for home health services provided to an enrollee unless the home health agency has liability coverage of at least per incident or an amount established by department rule made in accordance with title g chapter utah administrative rulemaking act section section b which is renumbered from section is renumbered and amended to read b federal aid authority of executive director the executive director with the approval of the governor may bind the state to any executive or legislative provisions promulgated or enacted by the federal government which invite the state to participate in the distribution disbursement or administration of any fund or service advanced offered or contributed in whole or in part by the federal government for purposes consistent with the powers and duties of the department such funds shall be used as provided in this chapter and be administered by the department for purposes related to medical assistance programs section section b which is renumbered from section is renumbered and amended to read b medical vendor rates medical vendor payments made to providers of services for and in behalf of recipient households shall be based upon predetermined rates from standards developed by the division in cooperation with providers of services for each type of service purchased by the division as far as possible the rates paid for services shall be established in advance of the fiscal year for which funds are to be requested section section b which is renumbered from section is renumbered and amended to read b enforcement of public assistance statutes the department shall enforce or contract for the enforcement of sections a a a a a and a to the extent that these sections pertain to benefits conferred or administered by the division under this chapter to the extent allowed under federal law or regulation the department may contract for services covered in section a insofar as that section pertains to benefits conferred or administered by the division under this chapter section section b which is renumbered from section is renumbered and amended to read b prohibited acts of state or local employees of medicaid program violation a misdemeanor each state or local employee responsible for the expenditure of funds under the state medicaid program each individual who formerly was such an officer or employee and each partner of such an officer or employee is prohibited for a period of one year after termination of such responsibility from committing any act the commission of which by an officer or employee of the united states government an individual who was such an officer or employee or a partner of such an officer or employee is prohibited by section or section of title united states code violation of this section is a class a misdemeanor section section b which is renumbered from section is renumbered and amended to read b rural hospitals for purposes of as used in this section rural hospital means a hospital located outside of a standard metropolitan statistical area as designated by the united states bureau of the census for purposes of the medicaid program the division of medicaid and health financing division may not discriminate among rural hospitals on the basis of size section section b which is renumbered from section is renumbered and amended to read b telemedicine reimbursement rulemaking a as used in this section communication by telemedicine is considered face to face contact between a health care provider and a patient under the state s medical assistance program if i the communication by telemedicine meets the requirements of administrative rules adopted in accordance with subsection and ii the health care services are eligible for reimbursement under the state s medical assistance program b this subsection applies to any managed care organization that contracts with the state s medical assistance program the reimbursement rate for telemedicine services approved under this section a shall be subject to reimbursement policies set by the state plan and b may be based on i a monthly reimbursement rate ii a daily reimbursement rate or iii an encounter rate the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act which establish a the particular telemedicine services that are considered face to face encounters for reimbursement purposes under the state s medical assistance program and b the reimbursement methodology for the telemedicine services designated under subsection a section section b which is renumbered from section is renumbered and amended to read b reimbursement of telemedicine services and telepsychiatric consultations as used in this section a telehealth services means the same as that term is defined in section b b telemedicine services means the same as that term is defined in section b c telepsychiatric consultation means a consultation between a physician and a board certified psychiatrist both of whom are licensed to engage in the practice of medicine in the state that utilizes i the health records of the patient provided from the patient or the referring physician ii a written evidence based patient questionnaire and iii telehealth services that meet industry security and privacy standards including compliance with the a health insurance portability and accountability act and b health information technology for economic and clinical health act pub l no stat as amended this section applies to a a managed care organization that contracts with the medicaid program and b a provider who is reimbursed for health care services under the medicaid program the medicaid program shall reimburse for telemedicine services at the same rate that the medicaid program reimburses for other health care services the medicaid program shall reimburse for telepsychiatric consultations at a rate set by the medicaid program section section b which is renumbered from section is renumbered and amended to read b process to promote health insurance coverage for children the department in collaboration with the department of workforce services and the state board of education shall develop a process to promote health insurance coverage for a child in school when a the child applies for free or reduced price school lunch b a child enrolls in or registers in school and c other appropriate school related opportunities the department in collaboration with the department of workforce services shall promote and facilitate the enrollment of children identified under subsection without health insurance in the utah children s health insurance program the medicaid program or the utah premium partnership for health insurance program section section b which is renumbered from section is renumbered and amended to read b medicaid continuous eligibility promoting payment and delivery reform in accordance with subsection and within appropriations from the legislature the department may amend the state medicaid plan to a create continuous eligibility for up to months for an individual who has qualified for the state medicaid program b provide incentives in managed care contracts for an individual to obtain appropriate care in appropriate settings and c require the managed care system to accept the risk of managing the medicaid population assigned to the plan amendment in return for receiving the benefits of providing quality and cost effective care if the department amends the state medicaid plan under subsection a or b the department a shall ensure that the plan amendment i is cost effective for the state medicaid program ii increases the quality and continuity of care for recipients and iii calculates and transfers administrative savings from continuous enrollment from the department of workforce services to the department of health department and b may limit the plan amendment under subsection a or b to select geographic areas or specific medicaid populations the department may seek approval for a state plan amendment waiver or a demonstration project from the secretary of the united states department of health and human services if necessary to implement a plan amendment under subsection a or b section section b which is renumbered from section is renumbered and amended to read b patient notice of health care provider privacy practices a for purposes of this section i health care provider means a health care provider as defined in section b who a receives payment for medical services from the medicaid program established in this chapter or the children s health insurance program established in chapter utah children s health insurance act section b and b submits a patient s personally identifiable information to the medicaid eligibility database or the children s health insurance program eligibility database ii hipaa means c f r parts and health insurance portability and accountability act of as amended b beginning july this section applies to the medicaid program the children s health insurance program created in chapter utah children s health insurance act section b and a health care provider a health care provider shall as part of the notice of privacy practices required by hipaa provide notice to the patient or the patient s personal representative that the health care provider either has or may submit personally identifiable information about the patient to the medicaid eligibility database and the children s health insurance program eligibility database the medicaid program and the children s health insurance program may not give a health care provider access to the medicaid eligibility database or the children s health insurance program eligibility database unless the health care provider s notice of privacy practices complies with subsection the department may adopt an administrative rule to establish uniform language for the state requirement regarding notice of privacy practices to patients required under subsection section section b which is renumbered from section is renumbered and amended to read b optional medicaid expansion the department and the governor may not expand the state s medicaid program under ppaca unless a the department expands medicaid in accordance with section b or b i the governor or the governor s designee has reported the intention to expand the state medicaid program under ppaca to the legislature in compliance with the legislative review process in section b and ii the governor submits the request for expansion of the medicaid program for optional populations to the legislature under the high impact federal funds request process required by section j a the department shall request approval from cms for waivers from federal statutory and regulatory law necessary to implement the health coverage improvement program under section b b the health coverage improvement program under section b is not subject to the requirements in subsection section section b which is renumbered from section is renumbered and amended to read b medicaid vision services request for proposals the department may select one or more contractors in accordance with title g chapter a utah procurement code to provide vision services to the medicaid populations that are eligible for vision services as described in department rules without restricting provider participation and within existing appropriations from the legislature section section b which is renumbered from section is renumbered and amended to read b review of claims audit and investigation procedures a the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act and in consultation with providers and health care professionals subject to audit and investigation under the state medicaid program to establish procedures for audits and investigations that are fair and consistent with the duties of the department as the single state agency responsible for the administration of the medicaid program under section b and title xix of the social security act b if the providers and health care professionals do not agree with the rules proposed or adopted by the department under subsection a the providers or health care professionals may i request a hearing for the proposed administrative rule or seek any other remedies under the provisions of title g chapter utah administrative rulemaking act and ii request a review of the rule by the legislature s administrative rules review and general oversight committee created in section g the department shall a notify and educate providers and health care professionals subject to audit and investigation under the medicaid program of the providers and health care professionals responsibilities and rights under the administrative rules adopted by the department under the provisions of this section b ensure that the department or any entity that contracts with the department to conduct audits i has on staff or contracts with a medical or dental professional who is experienced in the treatment billing and coding procedures used by the type of provider being audited and ii uses the services of the appropriate professional described in subsection b i if the provider who is the subject of the audit disputes the findings of the audit c ensure that a finding of overpayment or underpayment to a provider is not based on extrapolation as defined in section a unless i there is a determination that the level of payment error involving the provider exceeds a error rate a for a sample of claims for a particular service code and b over a three year period of time ii documented education intervention has failed to correct the level of payment error and iii the value of the claims for the provider in aggregate exceeds in reimbursement for a particular service code on an annual basis and d require that any entity with which the office contracts for the purpose of conducting an audit of a service provider shall be paid on a flat fee basis for identifying both overpayments and underpayments a if the department or a contractor on behalf of the department i intends to implement the use of extrapolation as a method of auditing claims the department shall prior to adopting the extrapolation method of auditing report its intent to use extrapolation to the social services appropriations subcommittee and ii determines subsections c i through iii are applicable to a provider the department or the contractor may use extrapolation only for the service code associated with the findings under subsections c i through iii b i if extrapolation is used under this section a provider may at the provider s option appeal the results of the audit based on a each individual claim or b the extrapolation sample ii nothing in this section limits a provider s right to appeal the audit under title g general government title g chapter administrative procedures act the medicaid program and its manual or rules or other laws or rules that may provide remedies to providers section section b which is renumbered from section is renumbered and amended to read b medicaid intergovernmental transfer report approval requirements as used in this section a i intergovernmental transfer means the transfer of public funds from a a local government entity to another nonfederal governmental entity or b from a nonfederal government owned health care facility regulated under chapter health care facility licensing and inspection act chapter part health care facility licensing and inspection to another nonfederal governmental entity ii intergovernmental transfer does not include a the transfer of public funds from one state agency to another state agency or b a transfer of funds from the university of utah hospitals and clinics b i intergovernmental transfer program means a federally approved reimbursement program or category that is authorized by the medicaid state plan or waiver authority for intergovernmental transfers ii intergovernmental transfer program does not include the addition of a provider to an existing intergovernmental transfer program c local government entity means a county city town special service district local district or local education agency as that term is defined in section j d non state government entity means a hospital authority hospital district health care district special service district county or city a an entity that receives federal medicaid dollars from the department as a result of an intergovernmental transfer shall on or before august and on or before august each year thereafter provide the department with i information regarding the payments funded with the intergovernmental transfer as authorized by and consistent with state and federal law ii information regarding the entity s ability to repay federal funds to the extent required by the department in the contract for the intergovernmental transfer and iii other information reasonably related to the intergovernmental transfer that may be required by the department in the contract for the intergovernmental transfer b on or before october and on or before october each subsequent year the department shall prepare a report for the executive appropriations committee that includes i the amount of each intergovernmental transfer under subsection a ii a summary of changes to cms regulations and practices that are known by the department regarding federal funds related to an intergovernmental transfer program and iii other information the department gathers about the intergovernmental transfer under subsection a the department shall not create a new intergovernmental transfer program after july unless the department reports to the executive appropriations committee in accordance with section j before submitting the new intergovernmental transfer program for federal approval the report shall include information required by subsection j d and the analysis required in subsections a and b a the department shall enter into new nursing care facility non state government owned upper payment limit program contracts and contract amendments adding new nursing care facilities and new non state government entity operators in accordance with this subsection b i if the nursing care facility expects to receive less than in federal funds each year from the nursing care facility non state government owned upper payment limit program excluding seed funding and administrative fees paid by the non state government entity the department shall enter into a nursing care facility non state government owned upper payment limit program contract with the non state government entity operator of the nursing care facility ii if the nursing care facility expects to receive between and in federal funds each year from the nursing care facility non state government owned upper payment limit program excluding seed funding and administrative fees paid by the non state government entity the department shall enter into a nursing care facility non state government owned upper payment limit program contract with the non state government entity operator of the nursing care facility after receiving the approval of the executive appropriations committee iii if the nursing care facility expects to receive more than in federal funds each year from the nursing care facility non state government owned upper payment limit program excluding seed funding and administrative fees paid by the non state government entity the department may not approve the application without obtaining approval from the legislature and the governor c a non state government entity may not participate in the nursing care facility non state government owned upper payment limit program unless the non state government entity is a special service district county or city that operates a hospital or holds a license under chapter health care facility licensing and inspection act chapter part health care facility licensing and inspection d each non state government entity that participates in the nursing care facility non state government owned upper payment limit program shall certify to the department that i the non state government entity is a local government entity that is able to make an intergovernmental transfer under applicable state and federal law ii the non state government entity has sufficient public funds or other permissible sources of seed funding that comply with the requirements in c f r part subpart b iii the funds received from the nursing care facility non state government owned upper payment limit program are a for each nursing care facility available for patient care until the end of the non state government entity s fiscal year and b used exclusively for operating expenses for nursing care facility operations patient care capital expenses rent royalties and other operating expenses and iv the non state government entity has completed all licensing enrollment and other forms and documents required by federal and state law to register a change of ownership with the department and with cms the department shall add a nursing care facility to an existing nursing care facility non state government owned upper payment limit program contract if a the nursing care facility is managed by or affiliated with the same non state government entity that also manages one or more nursing care facilities that are included in an existing nursing care facility non state government owned upper payment limit program contract and b the non state government entity makes the certification described in subsection d ii the department may not increase the percentage of the administrative fee paid by a non state government entity to the department under the nursing care facility non state government owned upper payment limit program the department may not condition participation in the nursing care facility non state government owned upper payment limit program on a a requirement that the department be allowed to direct or determine the types of patients that a non state government entity will treat or the course of treatment for a patient in a non state government nursing care facility or b a requirement that a non state government entity or nursing care facility post a bond purchase insurance or create a reserve account of any kind the non state government entity shall have the primary responsibility for ensuring compliance with subsection d ii a the department may not enter into a new nursing care facility non state government owned upper payment limit program contract before january b subsection a does not apply to i a new nursing care facility non state government owned upper payment limit program contract that was included in the federal funds request summary under section j for fiscal year or ii a nursing care facility that is operated or managed by the same company as a nursing care facility that was included in the federal funds request summary under section j for fiscal year section section b which is renumbered from section is renumbered and amended to read b screening brief intervention and referral to treatment medicaid reimbursement as used in this section a controlled substance prescriber means a controlled substance prescriber as that term is defined in section who i has a record of having completed sbirt training in accordance with subsection before providing the sbirt services and ii is a medicaid enrolled health care provider b sbirt means the same as that term is defined in section the department shall reimburse a controlled substance prescriber who provides sbirt services to a medicaid enrollee who is years of age old or older for the sbirt services section section b which is renumbered from section is renumbered and amended to read b prescribing policies for opioid prescriptions the department may implement a prescribing policy for certain opioid prescriptions that is substantially similar to the prescribing policies required in section a the department may amend the state program and apply for waivers for the state program if necessary to implement subsection section section b which is renumbered from section is renumbered and amended to read b reimbursement for long acting reversible contraception immediately following childbirth as used in this section long acting reversible contraception means a contraception method that requires administration less than once per month including a an intrauterine device and b a contraceptive implant the division shall separately identify and reimburse from other labor and delivery services within the medicaid program the provision and insertion of long acting reversible contraception immediately after childbirth section section b which is renumbered from section is renumbered and amended to read b coverage of exome sequence testing as used in this section exome sequence testing means a genomic technique for sequencing the genome of an individual for diagnostic purposes the medicaid program shall reimburse for exome sequence testing a for an enrollee who i is younger than years of age old and ii who remains undiagnosed after exhausting all other appropriate diagnostic related tests b performed by a nationally recognized provider with significant experience in exome sequence testing c that is medically necessary and d at a rate set by the medicaid program section section b which is renumbered from section is renumbered and amended to read b reimbursement for nonemergency secured behavioral health transport providers the department may not reimburse a nonemergency secured behavioral health transport provider that is designated under section a b section section b which is renumbered from section is renumbered and amended to read b children s health care coverage program as used in this section a chip means the children s health insurance program created in section b b program means the children s health care coverage program created in subsection a there is created the children s health care coverage program within the department b the purpose of the program is to i promote health insurance coverage for children in accordance with section b ii conduct research regarding families who are eligible for medicaid and chip to determine awareness and understanding of available coverage iii analyze trends in disenrollment and identify reasons that families may not be renewing enrollment including any barriers in the process of renewing enrollment iv administer surveys to recently enrolled chip and children s medicaid enrollees to identify a how the enrollees learned about coverage and b any barriers during the application process v develop promotional material regarding chip and children s medicaid eligibility including outreach through social media video production and other media platforms vi identify ways that the eligibility website for enrollment in chip and children s medicaid can be redesigned to increase accessibility and enhance the user experience vii identify outreach opportunities including partnerships with community organizations including a schools b small businesses c unemployment centers d parent teacher associations and e youth athlete clubs and associations and viii develop messaging to increase awareness of coverage options that are available through the department a the department may not delegate implementation of the program to a private entity b notwithstanding subsection a the department may contract with a media agency to conduct the activities described in subsection b iv and vii section section b which is renumbered from section is renumbered and amended to read b reimbursement for diabetes prevention program as used in this section dpp means the national diabetes prevention program developed by the united states centers for disease control and prevention beginning july the medicaid program shall reimburse a provider for an enrollee s participation in the dpp if the enrollee a meets the dpp s eligibility requirements and b has not previously participated in the dpp after july while enrolled in the medicaid program subject to appropriation the medicaid program may set the rate for reimbursement the department may apply for a state plan amendment if necessary to implement this section a on or after july but before october the department shall provide a written report regarding the efficacy of the dpp and reimbursement under this section to the health and human services interim committee b the report described in subsection a shall include i the total number of enrollees with a prediabetic condition as of july ii the total number of enrollees as of july with a diagnosis of type diabetes iii the total number of enrollees who participated in the dpp iv the total cost incurred by the state to implement this section and v any conclusions that can be drawn regarding the impact of the dpp on the rate of type diabetes for enrollees section section b which is renumbered from section is renumbered and amended to read b behavioral health delivery working group as used in this section targeted adult medicaid program means the same as that term is defined in section b on or before may the department shall convene a working group to collaborate with the department on a establishing specific and measurable metrics regarding i compliance of managed care organizations in the state with federal medicaid managed care requirements ii timeliness and accuracy of authorization and claims processing in accordance with medicaid policy and contract requirements iii reimbursement by managed care organizations in the state to providers to maintain adequacy of access to care iv availability of care management services to meet the needs of medicaid eligible individuals enrolled in the plans of managed care organizations in the state and v timeliness of resolution for disputes between a managed care organization and the managed care organization s providers and enrollees b improving the delivery of behavioral health services in the medicaid program c proposals to implement the delivery system adjustments authorized under subsection b and d issues that are identified by managed care organizations behavioral health service providers and the department the working group convened under subsection shall a meet quarterly and b consist of at least the following individuals i the executive director or the executive director s designee ii for each medicaid accountable care organization with which the department contracts an individual selected by the accountable care organization iii five individuals selected by the department to represent various types of behavioral health services providers including at a minimum individuals who represent providers who provide the following types of services a acute inpatient behavioral health treatment b residential treatment c intensive outpatient or partial hospitalization treatment and d general outpatient treatment iv a representative of an association that represents behavioral health treatment providers in the state designated by the utah behavioral healthcare council convened by the utah association of counties v a representative of an organization representing behavioral health organizations vi the chair of the utah substance use and mental health advisory council created in section m vii a representative of an association that represents local authorities who provide public behavioral health care designated by the department viii one member of the senate appointed by the president of the senate and ix one member of the house of representatives appointed by the speaker of the house of representatives the working group convened under this section shall recommend to the department a specific and measurable metrics under subsection a b how physical and behavioral health services may be integrated for the targeted adult medicaid program including ways the department may address issues regarding i filing of claims ii authorization and reauthorization for treatment services iii reimbursement rates and iv other issues identified by the department behavioral health services providers or medicaid managed care organizations c ways to improve delivery of behavioral health services to enrollees including changes to statute or administrative rule and d wraparound service coverage for enrollees who need specific nonclinical services to ensure a path to success section section b which is renumbered from section is renumbered and amended to read b adjudicative proceedings related to medicaid funds if a proceeding of the department under title g chapter administrative procedures act relates in any way to recovery of medicaid funds a the presiding officer shall be designated by the executive director of the department and report directly to the executive director or in the discretion of the executive director report directly to the director of the office of internal audit and b the decision of the presiding officer is the recommended decision to the executive director of the department or a designee of the executive director who is not in the division subsection does not apply to hearings conducted by the department of workforce services relating to medical assistance eligibility determinations if a proceeding of the department under title g chapter administrative procedures act relates in any way to medicaid or medicaid funds the following may attend and present evidence or testimony at the proceeding a the director of the office of internal audit or the director s designee and b the inspector general of medicaid services or the inspector general s designee in relation to a proceeding of the department under title g chapter administrative procedures act a person may not outside of the actual proceeding attempt to influence the decision of the presiding officer section section b which is renumbered from section is renumbered and amended to read b medical assistance accountability division duties reporting as used in this section a abuse means i an action or practice that a is inconsistent with sound fiscal business or medical practices and b results or may result in unnecessary medicaid related costs or other medical or hospital assistance costs or ii reckless or negligent upcoding b fraud means intentional or knowing i deception misrepresentation or upcoding in relation to medicaid funds costs claims reimbursement or practice or ii deception or misrepresentation in relation to medical or hospital assistance funds costs claims reimbursement or practice c upcoding means assigning an inaccurate billing code for a service that is payable or reimbursable by medicaid funds if the correct billing code for the service taking into account reasonable opinions derived from official published coding definitions would result in a lower medicaid payment or reimbursement d waste means overutilization of resources or inappropriate payment the division shall a develop and implement procedures relating to medicaid funds and medical or hospital assistance funds to ensure that providers do not receive a i duplicate payments for the same goods or services b ii payment for goods or services by resubmitting a claim for which i a payment has been disallowed on the grounds that payment would be a violation of federal or state law administrative rule or the state plan and ii b the decision to disallow the payment has become final c iii payment for goods or services provided after a recipient s death including payment for pharmaceuticals or long term care or d iv payment for transporting an unborn infant b consult with the centers for medicaid and medicare services cms other states and the office of inspector general of medicaid services to determine and implement best practices for discovering and eliminating fraud waste and abuse of medicaid funds and medical or hospital assistance funds c actively seek repayment from providers for improperly used or paid a i medicaid funds and b ii medical or hospital assistance funds d coordinate track and keep records of all division efforts to obtain repayment of the funds described in subsection c and the results of those efforts e keep medicaid pharmaceutical costs as low as possible by actively seeking to obtain pharmaceuticals at the lowest price possible including on a quarterly basis for the pharmaceuticals that represent the highest of state medicaid expenditures for pharmaceuticals and on an annual basis for the remaining pharmaceuticals a i tracking changes in the price of pharmaceuticals b ii checking the availability and price of generic drugs c iii reviewing and updating the state s maximum allowable cost list and d iv comparing pharmaceutical costs of the state medicaid program to available pharmacy price lists and f provide training on an annual basis to the employees of the division who make decisions on billing codes or who are in the best position to observe and identify upcoding in order to avoid and detect upcoding section section b which is renumbered from section is renumbered and amended to read b medical assistance from division or department of workforce services and compliance under adoption assistance interstate compact penalty for fraudulent claim as used in this section a adoption assistance means the same as that term is defined in section b adoption assistance agreement means the same as that term is defined in section c adoption assistance interstate compact means an agreement executed by the division of child and family services with any other state in accordance with section a a child who is a resident of this state and is the subject of an adoption assistance interstate compact is entitled to receive medical assistance from the division and the department of workforce services by filing a certified copy of the child s adoption assistance agreement with the division or the department of workforce services b the adoptive parent of the child described in subsection a shall annually provide the division or the department of workforce services with evidence verifying that the adoption assistance agreement is still effective the department of workforce services shall consider the recipient of medical assistance under this section as the department of workforce services does any other recipient of medical assistance under an adoption assistance agreement executed by the division of child and family services a a person may not submit a claim for payment or reimbursement under this section that the person knows is false misleading or fraudulent b a violation of subsection a is a third degree felony the division and the department of workforce services shall a cooperate with the division of child and family services in regard to an adoption assistance interstate compact and b comply with an adoption assistance interstate compact section section b which is renumbered from section is renumbered and amended to read part medicaid waivers b medicaid waiver for independent foster care adolescents for purposes of as used in this section an independent foster care adolescent includes any individual who reached years of age old while in the custody of the division of child and family services or the department of human services department if the division of child and family services department was the primary case manager or a federally recognized indian tribe an independent foster care adolescent is eligible when funds are available for medicaid coverage until the individual reaches years of age old before july the division shall submit a state medicaid plan amendment to the center for medicaid services cms to provide medical coverage for independent foster care adolescents effective fiscal year section section b which is renumbered from section is renumbered and amended to read b waivers to maximize replacement of fee for service delivery model cost of mandated program changes the department shall develop a waiver program in the medicaid program to replace the fee for service delivery model with one or more risk based delivery models the waiver program shall a restructure the program s provider payment provisions to reward health care providers for delivering the most appropriate services at the lowest cost and in ways that compared to services delivered before implementation of the waiver program maintain or improve recipient health status b restructure the program s cost sharing provisions and other incentives to reward recipients for personal efforts to i maintain or improve their health status and ii use providers that deliver the most appropriate services at the lowest cost c identify the evidence based practices and measures risk adjustment methodologies payment systems funding sources and other mechanisms necessary to reward providers for delivering the most appropriate services at the lowest cost including mechanisms that i pay providers for packages of services delivered over entire episodes of illness rather than for individual services delivered during each patient encounter and ii reward providers for delivering services that make the most positive contribution to a recipient s health status d limit total annual per patient per month expenditures for services delivered through fee for service arrangements to total annual per patient per month expenditures for services delivered through risk based arrangements covering similar recipient populations and services and e except as provided in subsection limit the rate of growth in per patient per month general fund expenditures for the program to the rate of growth in general fund expenditures for all other programs when the rate of growth in the general fund expenditures for all other programs is greater than zero to the extent possible the department shall operate the waiver program with the input of stakeholder groups representing those who will be affected by the waiver program a for purposes of this subsection mandated program change shall be determined by the department in consultation with the medicaid accountable care organizations and may include a change to the state medicaid program that is required by state or federal law state or federal guidance policy or the state medicaid plan b a mandated program change shall be included in the base budget for the medicaid program for the fiscal year in which the medicaid program adopted the mandated program change c the mandated program change is not subject to the limit on the rate of growth in per patient per month general fund expenditures for the program established in subsection e until the fiscal year following the fiscal year in which the medicaid program adopted the mandated program change a managed care organization or a pharmacy benefit manager that provides a pharmacy benefit to an enrollee shall establish a unique group number payment classification number or bank identification number for each medicaid managed care organization plan for which the managed care organization or pharmacy benefit manager provides a pharmacy benefit section section b which is renumbered from section is renumbered and amended to read b base budget appropriations for medicaid accountable care organizations and behavioral health plans forecast of behavioral health services cost as used in this section a aco means an accountable care organization that contracts with the state s medicaid program for i physical health services or ii integrated physical and behavioral health services b base budget means the same as that term is defined in legislative rule c behavioral health plan means a managed care or fee for service delivery system that contracts with or is operated by the department to provide behavioral health services to medicaid eligible individuals d behavioral health services means mental health or substance use treatment or services e general fund growth factor means the amount determined by dividing the next fiscal year ongoing general fund revenue estimate by current fiscal year ongoing appropriations from the general fund f next fiscal year ongoing general fund revenue estimate means the next fiscal year ongoing general fund revenue estimate identified by the executive appropriations committee in accordance with legislative rule for use by the office of the legislative fiscal analyst in preparing budget recommendations g pmpm means per member per month funding if the general fund growth factor is less than the next fiscal year base budget shall subject to subsection include an appropriation to the department in an amount necessary to ensure that the next fiscal year pmpm for acos and behavioral health plans equals the current fiscal year pmpm for the acos and behavioral health plans multiplied by if the general fund growth factor is greater than or equal to but less than the next fiscal year base budget shall subject to subsection include an appropriation to the department in an amount necessary to ensure that the next fiscal year pmpm for acos and behavioral health plans equals the current fiscal year pmpm for the acos and behavioral health plans multiplied by the general fund growth factor if the general fund growth factor is greater than or equal to the next fiscal year base budget shall subject to subsection include an appropriation to the department in an amount necessary to ensure that the next fiscal year pmpm for acos and behavioral health plans is greater than or equal to the current fiscal year pmpm for the acos and behavioral health plans multiplied by and less than or equal to the current fiscal year pmpm for the acos and behavioral health plans multiplied by the general fund growth factor the appropriations provided to the department for behavioral health plans under this section shall be reduced by the amount contributed by counties in the current fiscal year for behavioral health plans in accordance with subsections k and a x in order for the department to estimate the impact of subsections through before identification of the next fiscal year ongoing general fund revenue estimate the governor s office of planning and budget shall in cooperation with the office of the legislative fiscal analyst develop an estimate of ongoing general fund revenue for the next fiscal year and provide the estimate to the department no later than november of each year the office of the legislative fiscal analyst shall include an estimate of the cost of behavioral health services in any state medicaid funding or savings forecast that is completed in coordination with the department and the governor s office of planning and budget section section b which is renumbered from section is renumbered and amended to read b incentives to appropriately use emergency department services a this section applies to the medicaid program and to the utah children s health insurance program created in chapter utah children s health insurance act section b b as used in this section i managed care organization means a comprehensive full risk managed care delivery system that contracts with the medicaid program or the children s health insurance program to deliver health care through a managed care plan ii managed care plan means a risk based delivery service model authorized by section b and administered by a managed care organization iii non emergent care a means use of the emergency department to receive health care that is non emergent as defined by the department by administrative rule adopted in accordance with title g chapter utah administrative rulemaking act and the emergency medical treatment and active labor act and b does not mean the medical services provided to an individual required by the emergency medical treatment and active labor act including services to conduct a medical screening examination to determine if the recipient has an emergent or non emergent condition iv professional compensation means payment made for services rendered to a medicaid recipient by an individual licensed to provide health care services v super utilizer means a medicaid recipient who has been identified by the recipient s managed care organization as a person who uses the emergency department excessively as defined by the managed care organization a a managed care organization may in accordance with subsections b and c i audit emergency department services provided to a recipient enrolled in the managed care plan to determine if non emergent care was provided to the recipient and ii establish differential payment for emergent and non emergent care provided in an emergency department b i the differential payments under subsection a ii do not apply to professional compensation for services rendered in an emergency department ii except in cases of suspected fraud waste and abuse a managed care organization s audit of payment under subsection a i is limited to the month period of time after the date on which the medical services were provided to the recipient if fraud waste or abuse is alleged the managed care organization s audit of payment under subsection a i is limited to three years after the date on which the medical services were provided to the recipient c the audits and differential payments under subsections a and b apply to services provided to a recipient on or after july a managed care organization shall a use the savings under subsection to maintain and improve access to primary care and urgent care services for all medicaid or chip recipients enrolled in the managed care plan b provide viable alternatives for increasing primary care provider reimbursement rates to incentivize after hours primary care access for recipients and c report to the department on how the managed care organization complied with this subsection the department may a through administrative rule adopted by the department develop quality measurements that evaluate a managed care organization s delivery of i appropriate emergency department services to recipients enrolled in the managed care plan ii expanded primary care and urgent care for recipients enrolled in the managed care plan with consideration of the managed care organization s a delivery of primary care urgent care and after hours care through means other than the emergency department b recipient access to primary care providers and community health centers including evening and weekend access and c other innovations for expanding access to primary care and iii quality of care for the managed care plan members b compare the quality measures developed under subsection a for each managed care organization and c develop by administrative rule an algorithm to determine assignment of new unassigned recipients to specific managed care plans based on the plan s performance in relation to the quality measures developed pursuant to subsection a section section b which is renumbered from section is renumbered and amended to read b long term care insurance partnership as used in this section a qualified long term care insurance contract is as defined in u s c sec b b b qualified long term care insurance partnership is as defined in u s c sec p b c iii c state plan amendment means an amendment to the state medicaid plan drafted by the department in compliance with this section no later than july the department shall seek federal approval of a state plan amendment that creates a qualified long term care insurance partnership the department may make rules to comply with federal laws and regulations relating to qualified long term care insurance partnerships and qualified long term care insurance contracts section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for children with disabilities and complex medical needs as used in this section a additional eligibility criteria means the additional eligibility criteria set by the department under subsection e b complex medical condition means a physical condition of an individual that i results in severe functional limitations for the individual and ii is likely to a last at least months or b result in death c program means the program for children with complex medical conditions created in subsection d qualified child means a child who i is less than years old ii is diagnosed with a complex medical condition iii has a condition that meets the definition of disability in u s c sec and iv meets the additional eligibility criteria the department shall apply for a medicaid home and community based waiver with cms to implement within the state medicaid program the program described in subsection if the waiver described in subsection is approved the department shall offer a program that a as funding permits provides treatment for qualified children b if approved by cms and as funding permits beginning in fiscal year provides on an ongoing basis treatment for more qualified children than the program provided treatment for during fiscal year and c accepts applications for the program on an ongoing basis i d requires periodic reevaluations of an enrolled child s eligibility and other applicants or eligible children waiting for services in the program based on the additional eligibility criteria and ii e at the time of reevaluation allows the department to disenroll a child based on the prioritization described in subsection a and additional eligibility criteria the department shall a establish by rule made in accordance with title g chapter utah administrative rulemaking act criteria to prioritize qualified children s participation in the program based on the following factors in the following priority order i the complexity of a qualified child s medical condition and ii the financial needs of the qualified child and the qualified child s family b convene a public process to determine the benefits and services to offer a qualified child under the program c evaluate on an ongoing basis the cost and effectiveness of the program d if funding for the program is reduced develop an evaluation process to reduce the number of children served based on the participation criteria established under subsection a and e establish by rule made in accordance with title g chapter utah administrative rulemaking act additional eligibility criteria based on the factors described in subsections a i and ii section section b which is renumbered from section is renumbered and amended to read b health coverage improvement program eligibility annual report expansion of eligibility for adults with dependent children as used in this section a adult in the expansion population means an individual who i is described in u s c sec a a a i viii and ii is not otherwise eligible for medicaid as a mandatory categorically needy individual b enhancement waiver program means the primary care network enhancement waiver program described in section b c federal poverty level means the poverty guidelines established by the secretary of the united states department of health and human services under u s c sec d health coverage improvement program means the health coverage improvement program described in subsections through e homeless i means an individual who is chronically homeless as determined by the department and ii includes someone who was chronically homeless and is currently living in supported housing for the chronically homeless f income eligibility ceiling means the percent of federal poverty level i established by the state in an appropriations act adopted pursuant to title j chapter budgetary procedures act and ii under which an individual may qualify for medicaid coverage in accordance with this section g targeted adult medicaid program means the program implemented by the department under subsections through beginning july the department shall amend the state medicaid plan to allow temporary residential treatment for substance abuse use for the traditional medicaid population in a short term non institutional hour facility without a bed capacity limit that provides rehabilitation services that are medically necessary and in accordance with an individualized treatment plan as approved by cms and as long as the county makes the required match under section beginning july the department shall amend the state medicaid plan to increase the income eligibility ceiling to a percentage of the federal poverty level designated by the department based on appropriations for the program for an individual with a dependent child before july the division shall submit to cms a request for waivers or an amendment of existing waivers from federal statutory and regulatory law necessary for the state to implement the health coverage improvement program in the medicaid program in accordance with this section a an adult in the expansion population is eligible for medicaid if the adult meets the income eligibility and other criteria established under subsection b an adult who qualifies under subsection shall receive medicaid coverage i through the traditional fee for service medicaid model in counties without medicaid accountable care organizations or the state s medicaid accountable care organization delivery system where implemented and subject to section b ii except as provided in subsection b iii for behavioral health through the counties in accordance with sections and iii that subject to section b integrates behavioral health services and physical health services with medicaid accountable care organizations in select geographic areas of the state that choose an integrated model and iv that permits temporary residential treatment for substance abuse use in a short term non institutional hour facility without a bed capacity limit as approved by cms that provides rehabilitation services that are medically necessary and in accordance with an individualized treatment plan a an individual is eligible for the health coverage improvement program under subsection if i at the time of enrollment the individual s annual income is below the income eligibility ceiling established by the state under subsection f and ii the individual meets the eligibility criteria established by the department under subsection b b based on available funding and approval from cms the department shall select the criteria for an individual to qualify for the medicaid program under subsection a ii based on the following priority i a chronically homeless individual ii if funding is available an individual a involved in the justice system through probation parole or court ordered treatment and b in need of substance abuse use treatment or mental health treatment as determined by the department or iii if funding is available an individual in need of substance abuse use treatment or mental health treatment as determined by the department c an individual who qualifies for medicaid coverage under subsections a and b may remain on the medicaid program for a month certification period as defined by the department eligibility changes made by the department under subsection f or b shall not apply to an individual during the month certification period the state may request a modification of the income eligibility ceiling and other eligibility criteria under subsection each fiscal year based on projected enrollment costs to the state and the state budget the current medicaid program and the health coverage improvement program when implemented shall coordinate with a state prison or county jail to expedite medicaid enrollment for an individual who is released from custody and was eligible for or enrolled in medicaid before incarceration notwithstanding sections and a county does not have to provide matching funds to the state for the cost of providing medicaid services to newly enrolled individuals who qualify for medicaid coverage under the health coverage improvement program under subsection if the enhancement waiver program is implemented the department a may not accept any new enrollees into the health coverage improvement program after the day on which the enhancement waiver program is implemented b shall transition all individuals who are enrolled in the health coverage improvement program into the enhancement waiver program c shall suspend the health coverage improvement program within one year after the day on which the enhancement waiver program is implemented d shall within one year after the day on which the enhancement waiver program is implemented use all appropriations for the health coverage improvement program to implement the enhancement waiver program and e shall work with cms to maintain any waiver for the health coverage improvement program while the health coverage improvement program is suspended under subsection c if after the enhancement waiver program takes effect the enhancement waiver program is repealed or suspended by either the state or federal government the department shall reinstate the health coverage improvement program and continue to accept new enrollees into the health coverage improvement program in accordance with the provisions of this section section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for delivery of adult dental services a before june the department shall ask cms to grant waivers from federal statutory and regulatory law necessary for the medicaid program to provide dental services in the manner described in subsection a b before june the department shall submit to cms a request for waivers or an amendment of existing waivers from federal law necessary for the state to provide dental services in accordance with subsections b i and d through g to an individual described in subsection b i c before june the department shall submit to the centers for medicare and medicaid services a request for waivers or an amendment to existing waivers from federal law necessary for the state to i provide dental services in accordance with subsections b ii and d through g to an individual described in subsection b ii and ii provide the services described in subsection h a to the extent funded the department shall provide services to only blind or disabled individuals as defined in u s c sec c a who are years old or older and eligible for the program b notwithstanding subsection a i if a waiver is approved under subsection b the department shall provide dental services to an individual who a qualifies for the health coverage improvement program described in section b and b is receiving treatment in a substance abuse treatment program as defined in section a b licensed under title a chapter licensure of programs and facilities chapter part human services programs and facilities and ii if a waiver is approved under subsection c i the department shall provide dental services to an individual who is an aged individual as defined in u s c sec c a c to the extent possible services to individuals described in subsection a shall be provided through the university of utah school of dentistry and the university of utah school of dentistry s associated statewide network d the department shall provide the services to individuals described in subsection b i by contracting with an entity that a has demonstrated experience working with individuals who are being treated for both a substance use disorder and a major oral health disease b operates a program targeted at the individuals described in subsection b that has demonstrated through a peer reviewed evaluation the effectiveness of providing dental treatment to those individuals described in subsection b c is willing to pay for an amount equal to the program s non federal share of the cost of providing dental services to the population described in subsection b and d is willing to pay all state costs associated with applying for the waiver described in subsection b and administering the program described in subsection b and ii through a fee for service payment model e the entity that receives the contract under subsection d i shall cover all state costs of the program described in subsection b f each fiscal year the university of utah school of dentistry shall in compliance with state and federal regulations regarding intergovernmental transfers transfer funds to the program in an amount equal to the program s non federal share of the cost of providing services under this section through the school during the fiscal year g if a waiver is approved under subsection c ii the department shall provide coverage for porcelain and porcelain to metal crowns if the services are provided i to an individual who qualifies for dental services under subsection b and ii by an entity that covers all state costs of a providing the coverage described in this subsection h g and b applying for the waiver described in subsection c h where possible the department shall ensure that services described in subsection a that are not provided by the university of utah school of dentistry or the university of utah school of dentistry s associated network are provided i through fee for service reimbursement until july and ii after july through the method of reimbursement used by the division for medicaid dental benefits i subject to appropriations by the legislature and as determined by the department the scope amount duration and frequency of services may be limited a if the waivers requested under subsection a are granted the medicaid program shall begin providing dental services in the manner described in subsection no later than july b if the waivers requested under subsection b are granted the medicaid program shall begin providing dental services to the population described in subsection b within days from the day on which the waivers are granted c if the waivers requested under subsection c i are granted the medicaid program shall begin providing dental services to the population described in subsection b ii within days after the day on which the waivers are granted if the federal share of the cost of providing dental services under this section will be less than during any portion of the next fiscal year the medicaid program shall cease providing dental services under this section no later than the end of the current fiscal year section section b which is renumbered from section is renumbered and amended to read b medicaid long term support services housing coordinator there is created within the medicaid program a full time equivalent position of medicaid long term support services housing coordinator the coordinator shall help medicaid recipients receive long term support services in a home or other community based setting rather than in a nursing home or other institutional setting by a working with municipalities counties the housing and community development division within the department of workforce services and others to identify community based settings available to recipients b working with the same entities to promote the development construction and availability of additional community based settings c training medicaid case managers and support coordinators on how to help medicaid recipients move from an institutional setting to a community based setting and d performing other related duties section section b which is renumbered from section is renumbered and amended to read b medicaid waiver expansion as used in this section a federal poverty level means the same as that term is defined in section b b medicaid waiver expansion means an expansion of the medicaid program in accordance with this section a before january the department shall apply to cms for approval of a waiver or state plan amendment to implement the medicaid waiver expansion b the medicaid waiver expansion shall i expand medicaid coverage to eligible individuals whose income is below of the federal poverty level ii obtain maximum federal financial participation under u s c sec d y for enrolling an individual in the medicaid program iii provide medicaid benefits through the state s medicaid accountable care organizations in areas where a medicaid accountable care organization is implemented iv integrate the delivery of behavioral health services and physical health services with medicaid accountable care organizations in select geographic areas of the state that choose an integrated model v include a path to self sufficiency including work activities as defined in u s c sec d for qualified adults vi require an individual who is offered a private health benefit plan by an employer to enroll in the employer s health plan vii sunset in accordance with subsection a and viii permit the state to close enrollment in the medicaid waiver expansion if the department has insufficient funding to provide services to additional eligible individuals if the medicaid waiver described in subsection a is approved the department may only pay the state portion of costs for the medicaid waiver expansion with appropriations from a the medicaid expansion fund created in section b b b county contributions to the non federal share of medicaid expenditures and c any other contributions funds or transfers from a non state agency for medicaid expenditures a in consultation with the department medicaid accountable care organizations and counties that elect to integrate care under subsection b iv shall collaborate on enrollment engagement of patients and coordination of services b as part of the provision described in subsection b iv the department shall apply for a waiver to permit the creation of an integrated delivery system i for any geographic area that expresses interest in integrating the delivery of services under subsection b iv and ii in which the department a may permit a local mental health authority to integrate the delivery of behavioral health services and physical health services b may permit a county local mental health authority or medicaid accountable care organization to integrate the delivery of behavioral health services and physical health services to select groups within the population that are newly eligible under the medicaid waiver expansion and c may make rules in accordance with title g chapter utah administrative rulemaking act to integrate payments for behavioral health services and physical health services to plans or providers a if federal financial participation for the medicaid waiver expansion is reduced below the authority of the department to implement the medicaid waiver expansion shall sunset no later than the next july after the date on which the federal financial participation is reduced b the department shall close the program to new enrollment if the cost of the medicaid waiver expansion is projected to exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act if the medicaid waiver expansion is approved by cms the department shall report to the social services appropriations subcommittee on or before november of each year that the medicaid waiver expansion is operational a the number of individuals who enrolled in the medicaid waiver program b costs to the state for the medicaid waiver program c estimated costs for the current and following state fiscal year and d recommendations to control costs of the medicaid waiver expansion section section b which is renumbered from section is renumbered and amended to read b primary care network enhancement waiver program as used in this section a enhancement waiver program means the primary care network enhancement waiver program described in this section b federal poverty level means the poverty guidelines established by the secretary of the united states department of health and human services under u s c sec c health coverage improvement program means the same as that term is defined in section b d income eligibility ceiling means the percentage of federal poverty level i established by the legislature in an appropriations act adopted pursuant to title j chapter budgetary procedures act and ii under which an individual may qualify for coverage in the enhancement waiver program in accordance with this section e optional population means the optional expansion population under ppaca if the expansion provides coverage for individuals at or above of the federal poverty level f primary care network means the state primary care network program created by the medicaid primary care network demonstration waiver obtained under section b the department shall continue to implement the primary care network program for qualified individuals under the primary care network program a the division shall apply for a medicaid waiver or a state plan amendment with cms to implement within the state medicaid program the enhancement waiver program described in this section within six months after the day on which i the division receives a notice from cms that the waiver for the medicaid waiver expansion submitted under section b medicaid waiver expansion will not be approved or ii the division withdraws the waiver for the medicaid waiver expansion submitted under section b medicaid waiver expansion b the division may not apply for a waiver under subsection a while a waiver request under section b medicaid waiver expansion is pending with cms an individual who is eligible for the enhancement waiver program may receive the following benefits under the enhancement waiver program a the benefits offered under the primary care network program b diagnostic testing and procedures c medical specialty care d inpatient hospital services e outpatient hospital services f outpatient behavioral health care including outpatient substance abuse use care and g for an individual who qualifies for the health coverage improvement program as approved by cms temporary residential treatment for substance abuse use in a short term non institutional hour facility without a bed capacity limit that provides rehabilitation services that are medically necessary and in accordance with an individualized treatment plan an individual is eligible for the enhancement waiver program if at the time of enrollment a the individual is qualified to enroll in the primary care network or the health coverage improvement program b the individual s annual income is below the income eligibility ceiling established by the legislature under subsection d and c the individual meets the eligibility criteria established by the department under subsection a based on available funding and approval from cms the department shall determine the criteria for an individual to qualify for the enhancement waiver program based on the following priority i adults in the expansion population as defined in section b who qualify for the health coverage improvement program ii adults with dependent children who qualify for the health coverage improvement program under subsection b iii adults with dependent children who do not qualify for the health coverage improvement program and iv if funding is available adults without dependent children b the number of individuals enrolled in the enhancement waiver program may not exceed of the number of individuals who were enrolled in the primary care network on december c the department may only use appropriations from the medicaid expansion fund created in section b b to fund the state portion of the enhancement waiver program the department may request a modification of the income eligibility ceiling and the eligibility criteria under subsection from cms each fiscal year based on enrollment in the enhancement waiver program projected enrollment in the enhancement waiver program costs to the state and the state budget the department may implement the enhancement waiver program by contracting with medicaid accountable care organizations to administer the enhancement waiver program in accordance with subsections and b and the department may use funds that have been appropriated for the health coverage improvement program to implement the enhancement waiver program if the department expands the state medicaid program to the optional population the department a except as provided in subsection may not accept any new enrollees into the enhancement waiver program after the day on which the expansion to the optional population is effective b shall suspend the enhancement waiver program within one year after the day on which the expansion to the optional population is effective and c shall work with cms to maintain the waiver for the enhancement waiver program submitted under subsection while the enhancement waiver program is suspended under subsection b if after the expansion to the optional population described in subsection takes effect the expansion to the optional population is repealed by either the state or the federal government the department shall reinstate the enhancement waiver program and continue to accept new enrollees into the enhancement waiver program in accordance with the provisions of this section section section b which is renumbered from section is renumbered and amended to read b limited family planning services for low income individuals as used in this section a i family planning services means family planning services that are provided under the state medicaid program including a sexual health education and family planning counseling and b other medical diagnosis treatment or preventative care routinely provided as part of a family planning service visit ii family planning services do not include an abortion as that term is defined in section b low income individual means an individual who i has an income level that is equal to or below of the federal poverty level and ii does not qualify for full coverage under the medicaid program before july the division shall apply for a medicaid waiver or a state plan amendment with cms to a offer a program that provides family planning services to low income individuals and b receive a federal match rate of of state expenditures for family planning services provided under the waiver or state plan amendment section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for mental health crisis lines and mobile crisis outreach teams as used in this section a local mental health crisis line means the same as that term is defined in section a b b mental health crisis means i a mental health condition that manifests itself in an individual by symptoms of sufficient severity that a prudent layperson who possesses an average knowledge of mental health issues could reasonably expect the absence of immediate attention or intervention to result in a serious danger to the individual s health or well being or b a danger to the health or well being of others or ii a mental health condition that in the opinion of a mental health therapist or the therapist s designee requires direct professional observation or the intervention of a mental health therapist c i mental health crisis services means direct mental health services and on site intervention that a mobile crisis outreach team provides to an individual suffering from a mental health crisis including the provision of safety and care plans prolonged mental health services for up to days and referrals to other community resources ii mental health crisis services includes a local mental health crisis lines and b the statewide mental health crisis line d mental health therapist means the same as that term is defined in section e mobile crisis outreach team or mcot means a mobile team of medical and mental health professionals that in coordination with local law enforcement and emergency medical service personnel provides mental health crisis services f statewide mental health crisis line means the same as that term is defined in section a b in consultation with the department of human services and the behavioral health crisis response commission created in section c the department shall develop a proposal to amend the state medicaid plan to include mental health crisis services including the statewide mental health crisis line local mental health crisis lines and mobile crisis outreach teams by january the department shall apply for a medicaid waiver with cms if necessary to implement within the state medicaid program the mental health crisis services described in subsection section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for coverage of mental health services in schools as used in this section local education agency means a a school district b a charter school or c the utah schools for the deaf and the blind in consultation with the department of human services and the state board of education the department shall develop a proposal to allow the state medicaid program to reimburse a local education agency a local mental health authority or a private provider for covered mental health services provided a in accordance with section e and b i at a local education agency building or facility or ii by an employee or contractor of a local education agency before january the department shall apply to cms for a state plan amendment to implement the coverage described in subsection section section b which is renumbered from section is renumbered and amended to read b coverage for in vitro fertilization and genetic testing as used in this section a qualified condition means i cystic fibrosis ii spinal muscular atrophy iii morquio syndrome iv myotonic dystrophy or v sickle cell anemia b qualified enrollee means an individual who i is enrolled in the medicaid program ii has been diagnosed by a physician as having a genetic trait associated with a qualified condition and iii intends to get pregnant with a partner who is diagnosed by a physician as having a genetic trait associated with the same qualified condition as the individual before january the department shall apply for a medicaid waiver or a state plan amendment with the centers for medicare and medicaid services within the united states department of health and human services to implement the coverage described in subsection if the waiver described in subsection is approved the medicaid program shall provide coverage to a qualified enrollee for a in vitro fertilization services and b genetic testing of a qualified enrollee who receives in vitro fertilization services under subsection a the medicaid program may not provide the coverage described in subsection before the later of a the day on which the waiver described in subsection is approved and b january before november and before november of every third year thereafter the department shall a calculate the change in state spending attributable to the coverage under this section and b report the amount described in subsection a a to the health and human services interim committee and the social services appropriations subcommittee section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for fertility preservation services as used in this section a iatrogenic infertility means an impairment of fertility or reproductive functioning caused by surgery chemotherapy radiation or other medical treatment b physician means an individual licensed to practice under title chapter utah medical practice act or title chapter utah osteopathic medical practice act c qualified enrollee means an individual who i is enrolled in the medicaid program ii has been diagnosed with a form of cancer by a physician and iii needs treatment for that cancer that may cause a substantial risk of sterility or iatrogenic infertility including surgery radiation or chemotherapy d standard fertility preservation service means a fertility preservation procedure and service that i is not considered experimental or investigational by the american society for reproductive medicine or the american society of clinical oncology and ii is consistent with established medical practices or professional guidelines published by the american society for reproductive medicine or the american society of clinical oncology including a sperm banking b oocyte banking c embryo banking d banking of reproductive tissues and e storage of reproductive cells and tissues before january the department shall apply for a medicaid waiver or a state plan amendment with cms to implement the coverage described in subsection if the waiver or state plan amendment described in subsection is approved the medicaid program shall provide coverage to a qualified enrollee for standard fertility preservation services the medicaid program may not provide the coverage described in subsection before the later of a the day on which the waiver described in subsection is approved and b january before november and before november of each third year after the department shall a calculate the change in state spending attributable to the coverage described in this section and b report the amount described in subsection a to the health and human services interim committee and the social services appropriations subcommittee section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for coverage of qualified inmates leaving prison or jail as used in this section a correctional facility means i a county jail ii the department of corrections created in section or iii a prison penitentiary or other institution operated by or under contract with the department of corrections for the confinement of an offender as defined in section b qualified inmate means an individual who i is incarcerated in a correctional facility and ii has a a chronic physical or behavioral health condition b a mental illness as defined in section a b or c an opioid use disorder before july the division shall apply for a medicaid waiver or a state plan amendment with cms to offer a program to provide medicaid coverage to a qualified inmate for up to days immediately before the day on which the qualified inmate is released from a correctional facility if the waiver or state plan amendment described in subsection is approved the department shall report to the health and human services interim committee each year before november while the waiver or state plan amendment is in effect regarding a the number of qualified inmates served under the program b the cost of the program and c the effectiveness of the program including i any reduction in the number of emergency room visits or hospitalizations by inmates after release from a correctional facility ii any reduction in the number of inmates undergoing inpatient treatment after release from a correctional facility iii any reduction in overdose rates and deaths of inmates after release from a correctional facility and iv any other costs or benefits as a result of the program if the waiver or state plan amendment described in subsection is approved a county that is responsible for the cost of a qualified inmate s medical care shall provide the required matching funds to the state for a any costs to enroll the qualified inmate for the medicaid coverage described in subsection b any administrative fees for the medicaid coverage described in subsection and c the medicaid coverage that is provided to the qualified inmate under subsection section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for inpatient care in an institution for mental diseases as used in this section institution for mental diseases means the same as that term is defined in c f r sec before august the division shall apply for a medicaid waiver or a state plan amendment with cms to offer a program that provides reimbursement for mental health services that are provided a in an institution for mental diseases that includes more than beds and b to an individual who receives mental health services in an institution for mental diseases for a period of more than days in a calendar month if the waiver or state plan amendment described in subsection is approved the department shall a coordinate with the department of human services to develop and offer the program described in subsection and b submit to the health and human services interim committee and the social services appropriations subcommittee any report that the department submits to cms that relates to the budget neutrality independent waiver evaluation or performance metrics of the program described in subsection within days after the day on which the report is submitted to cms notwithstanding sections and if the waiver or state plan amendment described in subsection is approved a county does not have to provide matching funds to the state for the mental health services described in subsection that are provided to an individual who qualifies for medicaid coverage under section or section b or b section section b which is renumbered from section is renumbered and amended to read b reimbursement for crisis management services provided in a behavioral health receiving center integration of payment for physical health services as used in this section a accountable care organization means the same as that term is defined in section b b behavioral health receiving center means the same as that term is defined in section a b c crisis management services means behavioral health services provided to an individual who is experiencing a mental health crisis d managed care organization means the same as that term is defined in c f r sec before july the division shall apply for a medicaid waiver or state plan amendment with cms to offer a program that provides reimbursement through a bundled daily rate for crisis management services that are delivered to an individual during the individual s stay at a behavioral health receiving center if the waiver or state plan amendment described in subsection is approved the department shall a implement the program described in subsection and b require a managed care organization that contracts with the state s medicaid program for behavioral health services or integrated health services to provide coverage for crisis management services that are delivered to an individual during the individual s stay at a behavioral health receiving center a the department may elect to integrate payment for physical health services provided in a behavioral health receiving center b in determining whether to integrate payment under subsection a the department shall consult with accountable care organizations and counties in the state section section b which is renumbered from section is renumbered and amended to read b crisis services reimbursement the department department shall submit a waiver or state plan amendment to allow for reimbursement for services provided to an individual who is eligible and enrolled in medicaid at the time this service is provided section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for respite care facility that provides services to homeless individuals as used in this section a adult in the expansion population means an adult i described in u s c sec a a a i viii and ii not otherwise eligible for medicaid as a mandatory categorically needy individual b homeless means the same as that term is defined in section b c medical respite care means short term housing with supportive medical services d medical respite facility means a residential facility that provides medical respite care to homeless individuals before january the department shall apply for a medicaid waiver or state plan amendment with cms to choose a single medical respite facility to reimburse for services provided to an individual who is a homeless and b an adult in the expansion population the department shall choose a medical respite facility best able to serve homeless individuals who are adults in the expansion population if the waiver or state plan amendment described in subsection is approved while the waiver or state plan amendment is in effect the department shall submit a report to the health and human services interim committee each year before november detailing a the number of homeless individuals served at the facility b the cost of the program and c the reduction of health care costs due to the program s implementation through administrative rule made in accordance with title g chapter utah administrative rulemaking act the department shall further define and limit the services described in this section provided to a homeless individual section section b which is renumbered from section is renumbered and amended to read b medicaid waiver expansion for extraordinary care reimbursement as used in this section a existing home and community based services waiver means an existing home and community based services waiver in the state that serves an individual i with an acquired brain injury ii with an intellectual or physical disability or iii who is years old or older b personal care services means a service that i is furnished to an individual who is not an inpatient nor a resident of a hospital nursing facility intermediate care facility or institution for mental diseases ii is authorized for an individual described in subsection b i in accordance with a plan of treatment iii is provided by an individual who is qualified to provide the services and iv is furnished in a home or another community based setting c waiver enrollee means an individual who is enrolled in an existing home and community based services waiver before july the department shall apply with cms for an amendment to an existing home and community based services waiver to implement a program to offer reimbursement to an individual who provides personal care services that constitute extraordinary care to a waiver enrollee who is the individual s spouse if cms approves the amendment described in subsection the department shall implement the program described in subsection the department shall by rule made in accordance with title g chapter utah administrative rulemaking act define extraordinary care for purposes of subsection section section b which is renumbered from section is renumbered and amended to read b delivery system adjustments for the targeted adult medicaid program as used in this section targeted adult medicaid program means the same as that term is defined in section b the department may implement the delivery system adjustments authorized under subsection only on the later of a july and b the department determining that the medicaid program including providers and managed care organizations are satisfying the metrics established in collaboration with the working group convened under subsection b the department may for individuals who are enrolled in the targeted adult medicaid program a integrate the delivery of behavioral and physical health in certain counties and b deliver behavioral health services through an accountable care organization where implemented before implementing the delivery system adjustments described in subsection in a county the department shall at a minimum seek input from a individuals who qualify for the targeted adult medicaid program who reside in the county b the county s executive officer legislative body and other county officials who are involved in the delivery of behavioral health services c the local mental health authority and local substance use abuse authority that serves the county d medicaid managed care organizations operating in the state including medicaid accountable care organizations e providers of physical or behavioral health services in the county who provide services to enrollees in the targeted adult medicaid program in the county and f other individuals that the department deems necessary if the department provides medicaid coverage through a managed care delivery system under this section the department shall include language in the department s managed care contracts that require the managed care plan to a be in compliance with federal medicaid managed care requirements b timely and accurately process authorizations and claims in accordance with medicaid policy and contract requirements c adequately reimburse providers to maintain adequacy of access to care d provide care management services sufficient to meet the needs of medicaid eligible individuals enrolled in the managed care plan s plan and e timely resolve any disputes between a provider or enrollee with the managed care plan the department may take corrective action if the managed care organization fails to comply with the terms of the managed care organization s contract section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for increased integrated health care reimbursement as used in this section a integrated health care setting means a health care or behavioral health care setting that provides integrated physical and behavioral health care services b local mental health authority means a local mental health authority described in section the department shall develop a proposal to allow the state medicaid program to reimburse a local mental health authority for covered physical health care services provided in an integrated health care setting to medicaid eligible individuals before december the department shall apply for a medicaid waiver or a state plan amendment with cms to implement the proposal described in subsection if the waiver or state plan amendment described in subsection is approved the department shall a implement the proposal described in subsection and b while the waiver or state plan amendment is in effect submit a report to the health and human services interim committee each year before november detailing i the number of patients served under the waiver or state plan amendment ii the cost of the waiver or state plan amendment and iii any benefits of the waiver or state plan amendment section section b which is renumbered from section is renumbered and amended to read part administration of medicaid programs drug utilization review and long term care facility certification b definitions as used in this part appropriate and medically necessary means regarding drug prescribing dispensing and patient usage that it is in conformity with the criteria and standards developed in accordance with this part board means the drug utilization review board created in section b certified program means a nursing care facility program with medicaid certification compendia means resources widely accepted by the medical profession in the efficacious use of drugs including american hospital formulary services service drug information u s pharmacopeia drug information a m a drug evaluations peer reviewed medical literature and information provided by manufacturers of drug products counseling means the activities conducted by a pharmacist to inform medicaid recipients about the proper use of drugs as required by the board under this part criteria means those predetermined and explicitly accepted elements used to measure drug use on an ongoing basis in order to determine if the use is appropriate medically necessary and not likely to result in adverse medical outcomes drug disease contraindications means that the therapeutic effect of a drug is adversely altered by the presence of another disease condition drug interactions means that two or more drugs taken by a recipient lead to clinically significant toxicity that is characteristic of one or any of the drugs present or that leads to interference with the effectiveness of one or any of the drugs drug utilization review or dur means the program designed to measure and assess on a retrospective and prospective basis the proper use of outpatient drugs in the medicaid program intervention means a form of communication utilized by the board with a prescriber or pharmacist to inform about or influence prescribing or dispensing practices medicaid certification means the right of a nursing care facility as a provider of a nursing care facility program to receive medicaid reimbursement for a specified number of beds within the facility a nursing care facility means the following facilities licensed by the department under chapter part health care facility licensing and inspection i skilled nursing facilities ii intermediate care facilities and iii an intermediate care facility for people with an intellectual disability b nursing care facility does not mean a critical access hospital that meets the criteria of u s c sec i c nursing care facility program means the personnel licenses services contracts and all other requirements that shall be met for a nursing care facility to be eligible for medicaid certification under this part and division rule overutilization or underutilization means the use of a drug in such quantities that the desired therapeutic goal is not achieved pharmacist means a person licensed in this state to engage in the practice of pharmacy under title chapter b pharmacy practice act physical facility means the buildings or other physical structures where a nursing care facility program is operated physician means a person licensed in this state to practice medicine and surgery under section or osteopathic medicine under section prospective dur means that part of the drug utilization review program that occurs before a drug is dispensed and that is designed to screen for potential drug therapy problems based on explicit and predetermined criteria and standards retrospective dur means that part of the drug utilization review program that assesses or measures drug use based on an historical review of drug use data against predetermined and explicit criteria and standards on an ongoing basis with professional input rural county means a county with a population of less than as determined by a the most recent official census or census estimate of the united states bureau of the census or b the most recent population estimate for the county from the utah population committee if a population figure for the county is not available under subsection a service area means the boundaries of the distinct geographic area served by a certified program as determined by the division in accordance with this part and division rule standards means the acceptable range of deviation from the criteria that reflects local medical practice and that is tested on the medicaid recipient database surs means the surveillance utilization review system of the medicaid program therapeutic appropriateness means drug prescribing and dispensing based on rational drug therapy that is consistent with criteria and standards therapeutic duplication means prescribing and dispensing the same drug or two or more drugs from the same therapeutic class where periods of drug administration overlap and where that practice is not medically indicated urban county means a county that is not a rural county section section b which is renumbered from section is renumbered and amended to read b dur board creation and membership expenses there is created a member drug utilization review board responsible for implementation of a retrospective and prospective dur program a except as required by subsection b as terms of current board members expire the executive director shall appoint each new member or reappointed member to a four year term b notwithstanding the requirements of subsection a the executive director shall at the time of appointment or reappointment adjust the length of terms to ensure that the terms of board members are staggered so that approximately half of the board is appointed every two years c persons appointed to the board may be reappointed upon completion of their terms but may not serve more than two consecutive terms d the executive director shall provide for geographic balance in representation on the board when a vacancy occurs in the membership for any reason the replacement shall be appointed for the unexpired term the membership shall be comprised of the following a four physicians who are actively engaged in the practice of medicine or osteopathic medicine in this state to be selected from a list of nominees provided by the utah medical association b one physician in this state who is actively engaged in academic medicine c three pharmacists who are actively practicing in retail pharmacy in this state to be selected from a list of nominees provided by the utah pharmaceutical association d one pharmacist who is actively engaged in academic pharmacy e one person who shall represent consumers f one person who shall represent pharmaceutical manufacturers to be recommended by the pharmaceutical manufacturers association and g one dentist licensed to practice in this state under title chapter dentist and dental hygienist practice act who is actively engaged in the practice of dentistry nominated by the utah dental association physician and pharmacist members of the board shall have expertise in clinically appropriate prescribing and dispensing of outpatient drugs the board shall elect a chair from among its members who shall serve a one year term and may serve consecutive terms a member may not receive compensation or benefits for the member s service but may receive per diem and travel expenses in accordance with a section a b section a and c rules made by the division of finance pursuant to sections a and a section section b which is renumbered from section is renumbered and amended to read b dur board responsibilities the board shall develop rules necessary to carry out its responsibilities as defined in this part oversee the implementation of a medicaid retrospective and prospective dur program in accordance with this part including responsibility for approving provisions of contractual agreements between the medicaid program and any other entity that will process and review medicaid drug claims and profiles for the dur program in accordance with this part develop and apply predetermined criteria and standards to be used in retrospective and prospective dur ensuring that the criteria and standards are based on the compendia and that they are developed with professional input in a consensus fashion with provisions for timely revision and assessment as necessary the dur standards developed by the board shall reflect the local practices of physicians in order to monitor a therapeutic appropriateness b overutilization or underutilization c therapeutic duplication d drug disease contraindications e drug drug interactions f incorrect drug dosage or duration of drug treatment and g clinical abuse and misuse develop select apply and assess interventions and remedial strategies for physicians pharmacists and recipients that are educational and not punitive in nature in order to improve the quality of care disseminate information to physicians and pharmacists to ensure that they are aware of the board s duties and powers provide written oral or electronic reminders of patient specific or drug specific information designed to ensure recipient physician and pharmacist confidentiality and suggest changes in prescribing or dispensing practices designed to improve the quality of care utilize face to face discussions between experts in drug therapy and the prescriber or pharmacist who has been targeted for educational intervention conduct intensified reviews or monitoring of selected prescribers or pharmacists create an educational program using data provided through dur to provide active and ongoing educational outreach programs to improve prescribing and dispensing practices either directly or by contract with other governmental or private entities provide a timely evaluation of intervention to determine if those interventions have improved the quality of care publish the annual drug utilization review report required under c f r sec develop a working agreement with related boards or agencies including the state board of pharmacy physicians licensing board and surs staff within the division in order to clarify areas of responsibility for each where those areas may overlap establish a grievance process for physicians and pharmacists under this part in accordance with title g chapter administrative procedures act publish and disseminate educational information to physicians and pharmacists concerning the board and the dur program including information regarding a identification and reduction of the frequency of patterns of fraud abuse gross overuse inappropriate or medically unnecessary care among physicians pharmacists and recipients b potential or actual severe or adverse reactions to drugs c therapeutic appropriateness d overutilization or underutilization e appropriate use of generics f therapeutic duplication g drug disease contraindications h drug drug interactions i incorrect drug dosage and duration of drug treatment j drug allergy interactions and k clinical abuse and misuse develop and publish with the input of the state board of pharmacy guidelines and standards to be used by pharmacists in counseling medicaid recipients in accordance with this part the guidelines shall ensure that the recipient may refuse counseling and that the refusal is to be documented by the pharmacist items to be discussed as part of that counseling include a the name and description of the medication b administration form and duration of therapy c special directions and precautions for use d common severe side effects or interactions and therapeutic interactions and how to avoid those occurrences e techniques for self monitoring drug therapy f proper storage g prescription refill information and h action to be taken in the event of a missed dose and establish procedures in cooperation with the state board of pharmacy for pharmacists to record information to be collected under this part the recorded information shall include a the name address age and gender of the recipient b individual history of the recipient where significant including disease state known allergies and drug reactions and a comprehensive list of medications and relevant devices c the pharmacist s comments on the individual s drug therapy d name of prescriber and e name of drug dose duration of therapy and directions for use section section b which is renumbered from section is renumbered and amended to read b confidentiality of records information obtained under this part shall be treated as confidential or controlled information under title g chapter government records access and management act the board shall establish procedures insuring ensuring that the information described in subsection b is held confidential by the pharmacist being provided to the physician only upon request the board shall adopt and implement procedures designed to ensure the confidentiality of all information collected stored retrieved assessed or analyzed by the board staff to the board or contractors to the dur program that identifies individual physicians pharmacists or recipients the board may have access to identifying information for purposes of carrying out intervention activities but that identifying information may not be released to anyone other than a member of the board the board may release cumulative nonidentifying information for research purposes section section b which is renumbered from section is renumbered and amended to read b drug prior approval program a drug prior approval program approved or implemented by the board shall meet the following conditions a except as provided in subsection a drug may not be placed on prior approval for other than medical reasons b the board shall hold a public hearing at least days prior to placing a drug on prior approval c notwithstanding the provisions of section the board shall provide not less than days notice to the public before holding a public hearing under subsection b d the board shall consider written and oral comments submitted by interested parties prior to or during the hearing held in accordance with subsection b e the board shall provide evidence that placing a drug class on prior approval i will not impede quality of recipient care and ii that the drug class is subject to clinical abuse or misuse f the board shall reconsider its decision to place a drug on prior approval i no later than nine months after any drug class is placed on prior approval and ii at a public hearing with notice as provided in subsection b g the program shall provide an approval or denial of a request for prior approval i by either a fax b telephone or c electronic transmission ii at least monday through friday except for state holidays and iii within hours after receipt of the prior approval request h the program shall provide for the dispensing of at least a hour supply of the drug on the prior approval program i in an emergency situation or ii on weekends or state holidays i the program may be applied to allow acceptable medical use of a drug on prior approval for appropriate off label indications and j before placing a drug class on the prior approval program the board shall i determine that the requirements of subsections a through i have been met and ii by majority vote place the drug class on prior approval the board may only after complying with subsections b through j consider the cost a of a drug when placing a drug on the prior approval program and b associated with including or excluding a drug from the prior approval process including i potential side effects associated with a drug or ii potential hospitalizations or other complications that may occur as a result of a drug s inclusion on the prior approval process section section b which is renumbered from section is renumbered and amended to read b advisory committees the board may establish advisory committees to assist it in carrying out its duties under this part sections b through b section section b which is renumbered from section is renumbered and amended to read b retrospective and prospective dur the board in cooperation with the division shall include in its state plan the creation and implementation of a retrospective and prospective dur program for medicaid outpatient drugs to ensure that prescriptions are appropriate medically necessary and not likely to result in adverse medical outcomes the retrospective and prospective dur program shall be operated under guidelines established by the board under subsections and the retrospective dur program shall be based on guidelines established by the board using the mechanized drug claims processing and information retrieval system to analyze claims data in order to a identify patterns of fraud abuse gross overuse and inappropriate or medically unnecessary care and b assess data on drug use against explicit predetermined standards that are based on the compendia and other sources for the purpose of monitoring i therapeutic appropriateness ii overutilization or underutilization iii therapeutic duplication iv drug disease contraindications v drug drug interactions vi incorrect drug dosage or duration of drug treatment and vii clinical abuse and misuse the prospective dur program shall be based on guidelines established by the board and shall provide that before a prescription is filled or delivered a review will be conducted by the pharmacist at the point of sale to screen for potential drug therapy problems resulting from a therapeutic duplication b drug drug interactions c incorrect dosage or duration of treatment d drug allergy interactions and e clinical abuse or misuse in conducting the prospective dur a pharmacist may not alter the prescribed outpatient drug therapy without the consent of the prescribing physician or physician assistant this section does not effect the ability of a pharmacist to substitute a generic equivalent section section b which is renumbered from section is renumbered and amended to read b penalties any person who violates the confidentiality provisions of this part sections b through b is guilty of a class b misdemeanor section section b which is renumbered from section is renumbered and amended to read b immunity there is no liability on the part of and no cause of action of any nature arises against any member of the board its agents or employees for any action or omission by them in effecting the provisions of this part sections b through b section section b which is renumbered from section is renumbered and amended to read b purpose medicaid certification of nursing care facilities the legislature finds a that an oversupply of nursing care facilities in the state adversely affects the state medicaid program and the health of the people in the state b it is in the best interest of the state to prohibit nursing care facilities from receiving medicaid certification except as provided by this part sections b through b and c it is in the best interest of the state to encourage aging nursing care facilities with medicaid certification to renovate the nursing care facilities physical facilities so that the quality of life and clinical services for medicaid residents are preserved medicaid reimbursement of nursing care facility programs is limited to a the number of nursing care facility programs with medicaid certification as of may and b additional nursing care facility programs approved for medicaid certification under the provisions of subsections b and the division may not a except as authorized by section b i process initial applications for medicaid certification or execute provider agreements with nursing care facility programs or ii reinstate medicaid certification for a nursing care facility whose certification expired or was terminated by action of the federal or state government or b execute a medicaid provider agreement with a certified program that moves to a different physical facility except as authorized by subsection b notwithstanding section b beginning may the division may not approve a new or additional bed in an intermediate care facility for individuals with an intellectual disability for medicaid certification unless certification of the bed by the division does not increase the total number in the state of medicaid certified beds in intermediate care facilities for individuals with an intellectual disability section section b which is renumbered from section is renumbered and amended to read b authorization to renew transfer or increase medicaid certified programs reimbursement methodology a the division may renew medicaid certification of a certified program if the program without lapse in service to medicaid recipients has its nursing care facility program certified by the division at the same physical facility as long as the licensed and certified bed capacity at the facility has not been expanded unless the director has approved additional beds in accordance with subsection b the division may renew medicaid certification of a nursing care facility program that is not currently certified if i since the day on which the program last operated with medicaid certification a the physical facility where the program operated has functioned solely and continuously as a nursing care facility and b the owner of the program has not under this section or section b transferred to another nursing care facility program the license for any of the medicaid beds in the program and ii except as provided in subsection b the number of beds granted renewed medicaid certification does not exceed the number of beds certified at the time the program last operated with medicaid certification excluding a period of time where the program operated with temporary certification under subsection b a the division may issue a medicaid certification for a new nursing care facility program if a current owner of the medicaid certified program transfers its ownership of the medicaid certification to the new nursing care facility program and the new nursing care facility program meets all of the following conditions i the new nursing care facility program operates at the same physical facility as the previous medicaid certified program ii the new nursing care facility program gives a written assurance to the director in accordance with subsection iii the new nursing care facility program receives the medicaid certification within one year of the date the previously certified program ceased to provide medical assistance to a medicaid recipient and iv the licensed and certified bed capacity at the facility has not been expanded unless the director has approved additional beds in accordance with subsection b a nursing care facility program that receives medicaid certification under the provisions of subsection a does not assume the medicaid liabilities of the previous nursing care facility program if the new nursing care facility program i is not owned in whole or in part by the previous nursing care facility program or ii is not a successor in interest of the previous nursing care facility program the division may issue a medicaid certification to a nursing care facility program that was previously a certified program but now resides in a new or renovated physical facility if the nursing care facility program meets all of the following a the nursing care facility program met all applicable requirements for medicaid certification at the time of closure b the new or renovated physical facility is in the same county or within a five mile radius of the original physical facility c the time between which the certified program ceased to operate in the original facility and will begin to operate in the new physical facility is not more than three years unless i an emergency is declared by the president of the united states or the governor affecting the building or renovation of the physical facility ii the director approves an exception to the three year requirement for any nursing care facility program within the three year requirement iii the provider submits documentation supporting a request for an extension to the director that demonstrates a need for an extension and iv the exception does not extend for more than two years beyond the three year requirement d if subsection c applies the certified program notifies the department within days after ceasing operations in its original facility of its intent to retain its medicaid certification e the provider gives written assurance to the director in accordance with subsection that no third party has a legitimate claim to operate a certified program at the previous physical facility and f the bed capacity in the physical facility has not been expanded unless the director has approved additional beds in accordance with subsection a the entity requesting medicaid certification under subsections and shall give written assurances satisfactory to the director or the director s designee that i no third party has a legitimate claim to operate the certified program ii the requesting entity agrees to defend and indemnify the department against any claims by a third party who may assert a right to operate the certified program and iii if a third party is found by final agency action of the department after exhaustion of all administrative and judicial appeal rights to be entitled to operate a certified program at the physical facility the certified program shall voluntarily comply with subsection b b if a finding is made under the provisions of subsection a iii i the certified program shall immediately surrender its medicaid certification and comply with division rules regarding billing for medicaid and the provision of services to medicaid patients and ii the department shall transfer the surrendered medicaid certification to the third party who prevailed under subsection a iii a the director may approve additional nursing care facility programs for medicaid certification or additional beds for medicaid certification within an existing nursing care facility program if a nursing care facility or other interested party requests medicaid certification for a nursing care facility program or additional beds within an existing nursing care facility program and the nursing care facility program or other interested party complies with this section b the nursing care facility or other interested party requesting medicaid certification for a nursing care facility program or additional beds within an existing nursing care facility program under subsection a shall submit to the director i proof of the following as reasonable evidence that bed capacity provided by medicaid certified programs within the county or group of counties impacted by the requested additional medicaid certification is insufficient a nursing care facility occupancy levels for all existing and proposed facilities will be at least for the next three years b current nursing care facility occupancy is or more or c there is no other nursing care facility within a mile radius of the nursing care facility requesting the additional certification and ii an independent analysis demonstrating that at projected occupancy rates the nursing care facility s after tax net income is sufficient for the facility to be financially viable c any request for additional beds as part of a renovation project are limited to the maximum number of beds allowed in subsection d the director shall determine whether to issue additional medicaid certification by considering i whether bed capacity provided by certified programs within the county or group of counties impacted by the requested additional medicaid certification is insufficient based on the information submitted to the director under subsection b ii whether the county or group of counties impacted by the requested additional medicaid certification is underserved by specialized or unique services that would be provided by the nursing care facility iii whether any medicaid certified beds are subject to a claim by a previous certified program that may reopen under the provisions of subsections and iv how additional bed capacity should be added to the long term care delivery system to best meet the needs of medicaid recipients and v a whether the existing certified programs within the county or group of counties have provided services of sufficient quality to merit at least a two star rating in the medicare five star quality rating system over the previous three year period and b information obtained under subsection the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act to adjust the medicaid nursing care facility property reimbursement methodology to a only pay that portion of the property component of rates representing actual bed usage by medicaid clients as a percentage of the greater of i actual occupancy or ii a for a nursing care facility other than a facility described in subsection a ii b of total bed capacity or b for a rural nursing care facility of total bed capacity and b not allow for increases in reimbursement for property values without major renovation or replacement projects as defined by the department by rule a except as provided in subsection b if a nursing care facility does not seek medicaid certification for a bed under subsections through the department shall notwithstanding subsections b a and b grant medicaid certification for additional beds in an existing medicaid certified nursing care facility that has or fewer licensed beds including medicaid certified beds in the facility if i the nursing care facility program was previously a certified program for all beds but now resides in a new facility or in a facility that underwent major renovations involving major structural changes with or greater facility square footage design changes requiring review and approval by the department ii the nursing care facility meets the quality of care regulations issued by cms and iii the total number of additional beds in the facility granted medicaid certification under this section does not exceed of the number of licensed beds in the facility b the department may not revoke the medicaid certification of a bed under this subsection as long as the provisions of subsection a ii are met a if a nursing care facility or other interested party indicates in its request for additional medicaid certification under subsection a that the facility will offer specialized or unique services but the facility does not offer those services after receiving additional medicaid certification the director shall revoke the additional medicaid certification b the nursing care facility program shall obtain medicaid certification for any additional medicaid beds approved under subsection or within three years of the date of the director s approval or the approval is void a if the director makes an initial determination that quality standards under subsection d v have not been met in a rural county or group of rural counties over the previous three year period the director shall before approving certification of additional medicaid beds in the rural county or group of counties i notify the certified program that has not met the quality standards in subsection d v that the director intends to certify additional medicaid beds under the provisions of subsection d v and ii consider additional information submitted to the director by the certified program in a rural county that has not met the quality standards under subsection d v b the notice under subsection a does not give the certified program that has not met the quality standards under subsection d v the right to legally challenge or appeal the director s decision to certify additional medicaid beds under subsection d v section section b which is renumbered from section is renumbered and amended to read b appeals of division decision rulemaking authority application of act a decision by the director under this part to deny medicaid certification for a nursing care facility program or to deny additional bed capacity for an existing certified program is subject to review under the procedures and requirements of title g chapter administrative procedures act the department shall make rules to administer and enforce this part sections b through b in accordance with title g chapter utah administrative rulemaking act a in the event the department is at risk for a federal disallowance with regard to a medicaid recipient being served in a nursing care facility program that is not medicaid certified the department may grant temporary medicaid certification to that facility for up to months b i the department may extend a temporary medicaid certification granted to a facility under subsection a a for the number of beds in the nursing care facility occupied by a medicaid recipient and b for the period of time during which the medicaid recipient resides at the facility ii a temporary medicaid certification granted under this subsection is revoked upon a the discharge of the patient from the facility or b the patient no longer residing at the facility for any reason c the department may place conditions on the temporary certification granted under subsections a and b such as i not allowing additional admissions of medicaid recipients to the program and ii not paying for the care of the patient after october with state only dollars section section b which is renumbered from section is renumbered and amended to read b authorization to sell or transfer licensed medicaid beds duties of transferor duties of transferee duties of division this section provides a method to transfer or sell the license for a medicaid bed from a nursing care facility program to another entity that is in addition to the authorization to transfer under section b a a nursing care facility program may transfer or sell one or more of its licenses for medicaid beds in accordance with subsection b if i at the time of the transfer and with respect to the license for the medicaid bed that will be transferred the nursing care facility program that will transfer the medicaid license meets all applicable regulations for medicaid certification ii the nursing care facility program gives a written assurance which is postmarked or has proof of delivery days before the transfer to the director and to the transferee in accordance with subsection b iii the nursing care facility program that will transfer the license for a medicaid bed notifies the division in writing which is postmarked or has proof of delivery days before the transfer of a the number of bed licenses that will be transferred b the date of the transfer and c the identity and location of the entity receiving the transferred licenses and iv if the nursing care facility program for which the license will be transferred or purchased is located in an urban county with a nursing care facility average annual occupancy rate over the previous two years less than or equal to the nursing care facility program transferring or selling the license demonstrates to the satisfaction of the director that the sale or transfer a will not result in an excessive number of medicaid certified beds within the county or group of counties that would be impacted by the transfer or sale and b best meets the needs of medicaid recipients b except as provided in subsection c a nursing care facility program may transfer or sell one or more of its licenses for medicaid beds to i a nursing care facility program that has the same owner or successor in interest of the same owner ii a nursing care facility program that has a different owner or iii a related party nonnursing care facility entity that wants to hold one or more of the licenses for a nursing care facility program not yet identified as long as a the licenses are subsequently transferred or sold to a nursing care facility program within three years and b the nursing care facility program notifies the director of the transfer or sale in accordance with subsection a iii c a nursing care facility program may not transfer or sell one or more of its licenses for medicaid beds to an entity under subsection b i ii or iii that is located in a rural county unless the entity requests and the director issues medicaid certification for the beds under subsection b a nursing care facility program or entity under subsection b i ii or iii that receives or purchases a license for a medicaid bed under subsection b a may receive a license for a medicaid bed from more than one nursing care facility program b shall give the division notice which is postmarked or has proof of delivery within days of the nursing care facility program or entity seeking medicaid certification of beds in the nursing care facility program or entity of the total number of licenses for medicaid beds that the entity received and who it received the licenses from c may only seek medicaid certification for the number of licensed beds in the nursing care facility program equal to the total number of licenses for medicaid beds received by the entity d does not have to demonstrate need or seek approval for the medicaid licensed bed under subsection b except as provided in subsections a iv and c e shall meet the standards for medicaid certification other than those in subsection b including personnel services contracts and licensing of facilities under chapter health care facility licensing and inspection act chapter part health care facility licensing and inspection and f shall obtain medicaid certification for the licensed medicaid beds within three years of the date of transfer as documented under subsection a iii b a when the division receives notice of a transfer of a license for a medicaid bed under subsection a iii a the department shall reduce the number of licenses for medicaid beds at the transferring nursing care facility i equal to the number of licenses transferred and ii effective on the date of the transfer as reported under subsection a iii b b for purposes of section b the division shall approve medicaid certification for the receiving nursing care facility program or entity i in accordance with the formula established in subsection c and ii if a the nursing care facility seeks medicaid certification for the transferred licenses within the time limit required by subsection f and b the nursing care facility program meets other requirements for medicaid certification under subsection e c a license for a medicaid bed may not be approved for medicaid certification without meeting the requirements of sections and b and b if i the license for a medicaid bed is transferred under this section but the receiving entity does not obtain medicaid certification for the licensed bed within the time required by subsection f or ii the license for a medicaid bed is transferred under this section but the license is no longer eligible for medicaid certification section section b which is renumbered from section a is renumbered and amended to read part nursing care facility assessment a b definitions as used in this chapter part a nursing care facility means i a nursing care facility described in subsection as defined in section b ii beginning january a designated swing bed in a a general acute hospital as defined in subsection section b and b a critical access hospital which meets the criteria of u s c sec i c and iii an intermediate care facility for people with an intellectual disability that is licensed under section b b nursing care facility does not include i the utah state developmental center ii the utah state hospital iii a general acute hospital specialty hospital or small health care facility as those terms are defined in section b or iv a utah state veterans home patient day means each calendar day in which an individual patient is admitted to the nursing care facility during a calendar month even if on a temporary leave of absence from the facility section section b which is renumbered from section a is renumbered and amended to read a b legislative findings the legislature finds that there is an important state purpose to improve the quality of care given to persons who are elderly and to people who have a disability in long term care nursing facilities the legislature finds that in order to improve the quality of care to those persons described in subsection the rates paid to the nursing care facilities by the medicaid program must be adequate to encourage and support quality care the legislature finds that in order to meet the objectives in subsections and adequate funding must be provided to increase the rates paid to nursing care facilities providing services pursuant to the medicaid program section section b which is renumbered from section a is renumbered and amended to read a b collection remittance and payment of nursing care facilities assessment a beginning july an assessment is imposed upon each nursing care facility in the amount designated in subsection c b i the department shall establish by rule a uniform rate per non medicare patient day that may not exceed of the total gross revenue for services provided to patients of all nursing care facilities licensed in this state ii for purposes of subsection b i total revenue does not include charitable contribution received by a nursing care facility c the department shall calculate the assessment imposed under subsection a by multiplying the total number of patient days of care provided to non medicare patients by the nursing care facility as provided to the department pursuant to subsection a by the uniform rate established by the department pursuant to subsection b a the assessment imposed by this chapter part is due and payable on a monthly basis on or before the last day of the month next succeeding each monthly period b the collecting agent for this assessment shall be the department which is vested with the administration and enforcement of this chapter part including the right to audit records of a nursing care facility related to patient days of care for the facility c the department shall forward proceeds from the assessment imposed by this chapter part to the state treasurer for deposit in the expendable special revenue fund as specified in section a b each nursing care facility shall on or before the end of the month next succeeding each calendar monthly period file with the department a a report which includes i the total number of patient days of care the facility provided to non medicare patients during the preceding month ii the total gross revenue the facility earned as compensation for services provided to patients during the preceding month and iii any other information required by the department and b a return for the monthly period and shall remit with the return the assessment required by this chapter part to be paid for the period covered by the return each return shall contain information and be in the form the department prescribes by rule the assessment as computed in the return is an allowable cost for medicaid reimbursement purposes the department may by rule extend the time for making returns and paying the assessment each nursing care facility that fails to pay any assessment required to be paid to the state within the time required by this chapter part or that fails to file a return as required by this chapter part shall pay in addition to the assessment penalties and interest as provided in section a b section section b which is renumbered from section a is renumbered and amended to read a b penalties and interest the penalty for failure to file a return or pay the assessment due within the time prescribed by this chapter part is the greater of or of the assessment due on the return for failure to pay within days of a notice of deficiency of assessment required to be paid the penalty is the greater of or of the assessment due the penalty for underpayment of the assessment is as follows a if any underpayment of assessment is due to negligence the penalty is of the underpayment b if the underpayment of the assessment is due to intentional disregard of law or rule the penalty is of the underpayment for intent to evade the assessment the penalty is of the underpayment the rate of interest applicable to an underpayment of an assessment under this chapter part or an unpaid penalty under this chapter part is annually the department may waive the imposition of a penalty for good cause section section b which is renumbered from section a is renumbered and amended to read a b adjustment to nursing care facility medicaid reimbursement rates if federal law or regulation prohibits the money in the nursing care facilities provider assessment fund from being used in the manner set forth in subsection a b b the rates paid to nursing care facilities for providing services pursuant to the medicaid program shall be changed except as otherwise provided in subsection to the rates paid to nursing care facilities on june or if the legislature or the department has on or after july changed the rates paid to facilities through a manner other than the use of expenditures from the nursing care facilities provider assessment fund to the rates provided for by the legislature or the department section section b which is renumbered from section a is renumbered and amended to read a b intermediate care facility for people with an intellectual disability uniform rate an intermediate care facility for people with an intellectual disability is subject to all the provisions of this chapter part except that the department shall establish a uniform rate for an intermediate care facility for people with an intellectual disability that is based on the same formula specified for nursing care facilities under the provisions of subsection a b b and may be different than the uniform rate established for other nursing care facilities section section b which is renumbered from section b is renumbered and amended to read part inpatient hospital assessment b b definitions as used in this chapter part assessment means the inpatient hospital assessment established by this chapter part cms means the centers for medicare and medicaid services within the united states department of health and human services discharges means the number of total hospital discharges reported on a worksheet s part i column lines and of the medicare cost report for the applicable assessment year or b a similar report adopted by the department by administrative rule if the report under subsection a is no longer available division means the division of health care financing integrated healthcare within the department enhancement waiver program means the program established by the primary care network enhancement waiver program described in section b health coverage improvement program means the health coverage improvement program described in section b hospital share means the hospital share described in section b b medicaid accountable care organization means a managed care organization as defined in c f r sec that contracts with the department under the provisions of section b medicaid waiver expansion means a medicaid expansion in accordance with section or b or b medicare cost report means cms the cost report for electronic filing of hospitals a non state government hospital means a hospital owned by a non state government entity b non state government hospital does not include i the utah state hospital or ii a hospital owned by the federal government including the veterans administration hospital a private hospital means i a general acute hospital as defined in section b that is privately owned and operating in the state and ii a privately owned specialty hospital operating in the state including a privately owned hospital whose inpatient admissions are predominantly for a rehabilitation b psychiatric care c chemical dependency services or d long term acute care services b private hospital does not include a facility for residential treatment as defined in section a b state teaching hospital means a state owned teaching hospital that is part of an institution of higher education upper payment limit gap means the difference between the private hospital outpatient upper payment limit and the private hospital medicaid outpatient payments as determined in accordance with c f r sec section section b which is renumbered from section b is renumbered and amended to read b b application other than for the imposition of the assessment described in this chapter part nothing in this chapter part shall affect the nonprofit or tax exempt status of any nonprofit charitable religious or educational health care provider under any a state law b ad valorem property taxes c sales or use taxes or d other taxes fees or assessments whether imposed or sought to be imposed by the state or any political subdivision of the state all assessments paid under this chapter part may be included as an allowable cost of a hospital for purposes of any applicable medicaid reimbursement formula this chapter part does not authorize a political subdivision of the state to a license a hospital for revenue b impose a tax or assessment upon a hospital or c impose a tax or assessment measured by the income or earnings of a hospital section section b which is renumbered from section b is renumbered and amended to read b b assessment an assessment is imposed on each private hospital a beginning upon the later of cms approval of i the health coverage improvement program waiver under section b and ii the assessment under this chapter part b in the amount designated in sections b and b b and b and c in accordance with section b b subject to section b b the assessment imposed by this chapter part is due and payable on a quarterly basis after payment of the outpatient upper payment limit supplemental payments under section b b have been paid the first quarterly payment is not due until at least three months after the earlier of the effective dates of the coverage provided through a the health coverage improvement program b the enhancement waiver program or c the medicaid waiver expansion section section b which is renumbered from section b is renumbered and amended to read b b collection of assessment deposit of revenue rulemaking the collecting agent for the assessment imposed under section b b is the department the department is vested with the administration and enforcement of this chapter part and may make rules in accordance with title g chapter utah administrative
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+n this bill recodifies portions of the utah health code and utah human services code highlighted provisions this bill recodifies provisions regarding health care administration and assistance and vital statistics health data and the utah medical examiner and makes technical and corresponding changes money appropriated in this bill none other special clauses this bill provides a coordination clause this bill provides revisor instructions utah code sections affected amends b as enacted by laws of utah chapter b as enacted by laws of utah chapter renumbers and amends b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah sixth special session chapter b renumbered from as last amended by laws of utah fifth special session chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah fifth special session chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from c as last amended by laws of utah chapter b renumbered from c as enacted by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as enacted by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as repealed and reenacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as repealed and reenacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter utah code sections affected by coordination clause as last amended by laws of utah chapter as last amended by laws of utah chapter b as enacted by laws of utah chapter b utah code annotated be it enacted by the legislature of the state of utah section section b is amended to read chapter health care administration and assistance part health care assistance b definitions reserved as used in this chapter applicant means any person who requests assistance under the medical programs of the state cms means the centers for medicare and medicaid services within the united states department of health and human services division means the division of integrated healthcare within the department established under section b enrollee or member means an individual whom the department has determined to be eligible for assistance under the medicaid program medicaid program means the state program for medical assistance for persons who are eligible under the state plan adopted pursuant to title xix of the federal social security act medical assistance means services furnished or payments made to or on behalf of a member a passenger vehicle means a self propelled two axle vehicle intended primarily for operation on highways and used by an applicant or recipient to meet basic transportation needs and has a fair market value below of the applicable amount of the federal luxury passenger automobile tax established in u s c sec and adjusted annually for inflation b passenger vehicle does not include i a commercial vehicle as defined in section a ii an off highway vehicle as defined in section a or iii a motor home as defined in section ppaca means the same as that term is defined in section a recipient means a person who has received medical assistance under the medicaid program section section b which is renumbered from section is renumbered and amended to read b division creation there is created within the department the division of medicaid and health financing integrated healthcare which shall be responsible for implementing organizing and maintaining the medicaid program and the children s health insurance program established in section b in accordance with the provisions of this chapter and applicable federal law section section b which is renumbered from section is renumbered and amended to read b state medicaid director appointment responsibilities the state medicaid director shall be appointed by the governor after consultation with the executive director with the advice and consent of the senate the state medicaid director may employ other employees as necessary to implement the provisions of this chapter and shall a administer the responsibilities of the division as set forth in this chapter b administer the division s budget and c establish and maintain a state plan for the medicaid program in compliance with federal law and regulations section section b which is renumbered from section is renumbered and amended to read b division responsibilities emphasis periodic assessment in accordance with the requirements of title xix of the social security act and applicable federal regulations the division is responsible for the effective and impartial administration of this chapter in an efficient economical manner the division shall a establish on a statewide basis a program to safeguard against unnecessary or inappropriate use of medicaid services excessive payments and unnecessary or inappropriate hospital admissions or lengths of stay b deny any provider claim for services that fail to meet criteria established by the division concerning medical necessity or appropriateness and c place its emphasis on high quality care to recipients in the most economical and cost effective manner possible with regard to both publicly and privately provided services the division shall implement and utilize cost containment methods where possible which may include a prepayment and postpayment review systems to determine if utilization is reasonable and necessary b preadmission certification of nonemergency admissions c mandatory outpatient rather than inpatient surgery in appropriate cases d second surgical opinions e procedures for encouraging the use of outpatient services f consistent with sections b and b a medicaid drug program g coordination of benefits and h review and exclusion of providers who are not cost effective or who have abused the medicaid program in accordance with the procedures and provisions of federal law and regulation the state medicaid director shall periodically assess the cost effectiveness and health implications of the existing medicaid program and consider alternative approaches to the provision of covered health and medical services through the medicaid program in order to reduce unnecessary or unreasonable utilization a the department shall ensure medicaid program integrity by conducting internal audits of the medicaid program for efficiencies best practices and cost avoidance b the department shall coordinate with the office of the inspector general for medicaid services created in section a to implement subsection and to address medicaid fraud waste or abuse as described in section a section section b which is renumbered from section is renumbered and amended to read b medicaid drug program preferred drug list a medicaid drug program developed by the department under subsection b f a shall notwithstanding subsection b b be based on clinical and cost related factors which include medical necessity as determined by a provider in accordance with administrative rules established by the drug utilization review board b may include therapeutic categories of drugs that may be exempted from the drug program c may include placing some drugs except the drugs described in subsection on a preferred drug list i to the extent determined appropriate by the department and ii in the manner described in subsection for psychotropic drugs d notwithstanding the requirements of part sections b through b regarding the drug utilization review board and except as provided in subsection shall immediately implement the prior authorization requirements for a nonpreferred drug that is in the same therapeutic class as a drug that is i on the preferred drug list on the date that this act takes effect or ii added to the preferred drug list after this act takes effect and e except as prohibited by subsections b and shall establish the prior authorization requirements established under subsections c and d which shall permit a health care provider or the health care provider s agent to obtain a prior authorization override of the preferred drug list through the department s pharmacy prior authorization review process and which shall i provide either telephone or fax approval or denial of the request within hours of the receipt of a request that is submitted during normal business hours of monday through friday from a m to p m ii provide for the dispensing of a limited supply of a requested drug as determined appropriate by the department in an emergency situation if the request for an override is received outside of the department s normal business hours and iii require the health care provider to provide the department with documentation of the medical need for the preferred drug list override in accordance with criteria established by the department in consultation with the pharmacy and therapeutics committee a for purposes of as used in this subsection i immunosuppressive drug a means a drug that is used in immunosuppressive therapy to inhibit or prevent activity of the immune system to aid the body in preventing the rejection of transplanted organs and tissue and b does not include drugs used for the treatment of autoimmune disease or diseases that are most likely of autoimmune origin ii stabilized means a health care provider has documented in the patient s medical chart that a patient has achieved a stable or steadfast medical state within the past days using a particular psychotropic drug b a preferred drug list developed under the provisions of this section may not include an immunosuppressive drug c i the state medicaid program shall reimburse for a prescription for an immunosuppressive drug as written by the health care provider for a patient who has undergone an organ transplant ii for purposes of subsection b and with respect to patients who have undergone an organ transplant the prescription for a particular immunosuppressive drug as written by a health care provider meets the criteria of demonstrating to the department a medical necessity for dispensing the prescribed immunosuppressive drug d notwithstanding the requirements of part sections b through b regarding the drug utilization review board the state medicaid drug program may not require the use of step therapy for immunosuppressive drugs without the written or oral consent of the health care provider and the patient e the department may include a sedative hypnotic on a preferred drug list in accordance with subsection f f the department shall grant a prior authorization for a sedative hypnotic that is not on the preferred drug list under subsection e if the health care provider has documentation related to one of the following conditions for the medicaid client i a trial and failure of at least one preferred agent in the drug class including the name of the preferred drug that was tried the length of therapy and the reason for the discontinuation ii detailed evidence of a potential drug interaction between current medication and the preferred drug iii detailed evidence of a condition or contraindication that prevents the use of the preferred drug iv objective clinical evidence that a patient is at high risk of adverse events due to a therapeutic interchange with a preferred drug v the patient is a new or previous medicaid client with an existing diagnosis previously stabilized with a nonpreferred drug or vi other valid reasons as determined by the department g a prior authorization granted under subsection f is valid for one year from the date the department grants the prior authorization and shall be renewed in accordance with subsection f a for purposes of as used in this subsection psychotropic drug means the following classes of drugs i atypical anti psychotic ii anti depressant iii anti convulsant mood stabilizer iv anti anxiety and v attention deficit hyperactivity disorder stimulant b i the department shall develop a preferred drug list for psychotropic drugs ii except as provided in subsection d a preferred drug list for psychotropic drugs developed under this section shall allow a health care provider to override the preferred drug list by writing dispense as written on the prescription for the psychotropic drug iii a health care provider may not override section b by writing dispense as written on a prescription c the department and a medicaid accountable care organization that is responsible for providing behavioral health shall i establish a system to a track health care provider prescribing patterns for psychotropic drugs b educate health care providers who are not complying with the preferred drug list and c implement peer to peer education for health care providers whose prescribing practices continue to not comply with the preferred drug list and ii determine whether health care provider compliance with the preferred drug list is at least a of prescriptions by july b of prescriptions by july and c of prescriptions by july d beginning october the department shall eliminate the dispense as written override for the preferred drug list and shall implement a prior authorization system for psychotropic drugs in accordance with subsection f if by july the department has not realized annual savings from implementing the preferred drug list for psychotropic drugs of at least general fund savings section section b which is renumbered from section is renumbered and amended to read b simplified enrollment and renewal process for medicaid and other state medical programs financial institutions the department may apply for grants and accept donations to make technology system improvements necessary to implement a simplified enrollment and renewal process for the medicaid program utah premium partnership and primary care network demonstration project programs a the department may enter into an agreement with a financial institution doing business in the state to develop and operate a data match system to identify an applicant s or enrollee s assets that i uses automated data exchanges to the maximum extent feasible and ii requires a financial institution each month to provide the name record address social security number other taxpayer identification number or other identifying information for each applicant or enrollee who maintains an account at the financial institution b the department may pay a reasonable fee to a financial institution for compliance with this subsection as provided in section c a financial institution may not be liable under any federal or state law to any person for any disclosure of information or action taken in good faith under this subsection d the department may disclose a financial record obtained from a financial institution under this section only for the purpose of and to the extent necessary in verifying eligibility as provided in this section and section b section section b which is renumbered from section is renumbered and amended to read b dental benefits a except as provided in subsection the division may establish a competitive bid process to bid out medicaid dental benefits under this chapter b the division may bid out the medicaid dental benefits separately from other program benefits the division shall use the following criteria to evaluate dental bids a ability to manage dental expenses b proven ability to handle dental insurance c efficiency of claim paying procedures d provider contracting discounts and adequacy of network and e other criteria established by the department the division shall request bids for the program s benefits at least once every five years the division s contract with dental plans for the program s benefits shall include risk sharing provisions in which the dental plan must accept of the risk for any difference between the division s premium payments per client and actual dental expenditures the division may not award contracts to a more than three responsive bidders under this section or b an insurer that does not have a current license in the state a the division may cancel the request for proposals if i there are no responsive bidders or ii the division determines that accepting the bids would increase the program s costs b if the division cancels a request for proposal or a contract that results from a request for proposal described in subsection a the division shall report to the health and human services interim committee regarding the reasons for the decision title g chapter a utah procurement code shall apply to this section a the division may i establish a dental health care delivery system and payment reform pilot program for medicaid dental benefits to increase access to cost effective and quality dental health care by increasing the number of dentists available for medicaid dental services and ii target specific medicaid populations or geographic areas in the state b the pilot program shall establish compensation models for dentists and dental hygienists that i increase access to quality cost effective dental care and ii use funds from the division of family health and preparedness that are available to reimburse dentists for educational loans in exchange for the dentist agreeing to serve medicaid and under served populations c the division may amend the state plan and apply to the secretary of the united states department of health and human services for waivers or pilot programs if necessary to establish the new dental care delivery and payment reform model d the division shall evaluate the pilot program s effect on the cost of dental care and access to dental care for the targeted medicaid populations a as used in this subsection dental hygienist means an individual who is licensed as a dental hygienist under section b the department shall reimburse a dental hygienist for dental services performed in a public health setting and in accordance with subsection c beginning on the earlier of i january or ii days after the date on which the replacement of the department s medicaid management information system software is complete c the department shall reimburse a dental hygienist directly for a service provided through the medicaid program if i the dental hygienist requests to be reimbursed directly and ii the dental hygienist provides the service within the scope of practice described in section d before november of each year in which the department reimburses dental hygienists in accordance with subsection c the department shall report to the health and human services interim committee for the previous fiscal year i the number and geographic distribution of dental hygienists who requested to be reimbursed directly ii the total number of medicaid enrollees who were served by a dental hygienist who were reimbursed under this subsection iii the total amount reimbursed directly to dental hygienists under this subsection iv the specific services and billing codes that are reimbursed under this subsection and v the aggregate amount reimbursed for each service and billing code described in subsection d iv e i except as provided in this subsection nothing in this subsection shall be interpreted as expanding or otherwise altering the limitations and scope of practice for a dental hygienist ii a dental hygienist may only directly bill and receive compensation for billing codes that fall within the scope of practice of a dental hygienist section section b which is renumbered from section is renumbered and amended to read b administration of medicaid program by department reporting to the legislature disciplinary measures and sanctions funds collected eligibility standards internal audits health opportunity accounts the department shall be the single state agency responsible for the administration of the medicaid program in connection with the united states department of health and human services pursuant to title xix of the social security act a the department shall implement the medicaid program through administrative rules in conformity with this chapter title g chapter utah administrative rulemaking act the requirements of title xix and applicable federal regulations b the rules adopted under subsection a shall include in addition to other rules necessary to implement the program i the standards used by the department for determining eligibility for medicaid services ii the services and benefits to be covered by the medicaid program iii reimbursement methodologies for providers under the medicaid program and iv a requirement that a a person receiving medicaid services shall participate in the electronic exchange of clinical health records established in accordance with section b unless the individual opts out of participation b prior to enrollment in the electronic exchange of clinical health records the enrollee shall receive notice of enrollment in the electronic exchange of clinical health records and the right to opt out of participation at any time and c beginning july when the program sends enrollment or renewal information to the enrollee and when the enrollee logs onto the program s website the enrollee shall receive notice of the right to opt out of the electronic exchange of clinical health records a the department shall in accordance with subsection b report to the social services appropriations subcommittee when the department i implements a change in the medicaid state plan ii initiates a new medicaid waiver iii initiates an amendment to an existing medicaid waiver iv applies for an extension of an application for a waiver or an existing medicaid waiver v applies for or receives approval for a change in any capitation rate within the medicaid program or vi initiates a rate change that requires public notice under state or federal law b the report required by subsection a shall i be submitted to the social services appropriations subcommittee prior to the department implementing the proposed change and ii include a a description of the department s current practice or policy that the department is proposing to change b an explanation of why the department is proposing the change c the proposed change in services or reimbursement including a description of the effect of the change d the effect of an increase or decrease in services or benefits on individuals and families e the degree to which any proposed cut may result in cost shifting to more expensive services in health or human service programs and f the fiscal impact of the proposed change including i the effect of the proposed change on current or future appropriations from the legislature to the department ii the effect the proposed change may have on federal matching dollars received by the state medicaid program iii any cost shifting or cost savings within the department s budget that may result from the proposed change and iv identification of the funds that will be used for the proposed change including any transfer of funds within the department s budget any rules adopted by the department under subsection are subject to review and reauthorization by the legislature in accordance with section g the department may in its discretion contract with the department of human services or other qualified agencies for services in connection with the administration of the medicaid program including a the determination of the eligibility of individuals for the program b recovery of overpayments and c consistent with section b and to the extent permitted by law and quality control services enforcement of fraud and abuse laws the department shall provide by rule disciplinary measures and sanctions for medicaid providers who fail to comply with the rules and procedures of the program provided that sanctions imposed administratively may not extend beyond a termination from the program b recovery of claim reimbursements incorrectly paid and c those specified in section of title xix of the federal social security act a funds collected as a result of a sanction imposed under section of title xix of the federal social security act shall be deposited in the general fund as dedicated credits to be used by the division in accordance with the requirements of section of title xix of the federal social security act b in accordance with section j sanctions collected under this subsection are nonlapsing a in determining whether an applicant or recipient is eligible for a service or benefit under this part or chapter part utah children s health insurance act program the department shall if subsection b is satisfied exclude from consideration one passenger vehicle designated by the applicant or recipient b before subsection a may be applied i the federal government shall a determine that subsection a may be implemented within the state s existing public assistance related waivers as of january b extend a waiver to the state permitting the implementation of subsection a or c determine that the state s waivers that permit dual eligibility determinations for cash assistance and medicaid are no longer valid and ii the department shall determine that subsection a can be implemented within existing funding a for purposes of as used in this subsection i aged blind or has a disability means an aged blind or disabled individual as defined in u s c sec c a and ii spend down means an amount of income in excess of the allowable income standard that shall be paid in cash to the department or incurred through the medical services not paid by medicaid b in determining whether an applicant or recipient who is aged blind or has a disability is eligible for a service or benefit under this chapter the department shall use of the federal poverty level as i the allowable income standard for eligibility for services or benefits and ii the allowable income standard for eligibility as a result of spend down the department shall conduct internal audits of the medicaid program a the department may apply for and if approved implement a demonstration program for health opportunity accounts as provided for in u s c sec u b a health opportunity account established under subsection a shall be an alternative to the existing benefits received by an individual eligible to receive medicaid under this chapter c subsection a is not intended to expand the coverage of the medicaid program a i the department shall apply for and if approved implement an amendment to the state plan under this subsection for benefits for a medically needy pregnant women b medically needy children and c medically needy parents and caretaker relatives ii the department may implement the eligibility standards of subsection b for eligibility determinations made on or after the date of the approval of the amendment to the state plan b in determining whether an applicant is eligible for benefits described in subsection a i the department shall i disregard resources held in an account in the savings plan created under title b chapter a utah educational savings plan if the beneficiary of the account is a under the age of and b living with the account owner as that term is defined in section b a or temporarily absent from the residence of the account owner and ii include the withdrawals from an account in the utah educational savings plan as resources for a benefit determination if the withdrawal was not used for qualified higher education costs as that term is defined in section b a a the department may not deny or terminate eligibility for medicaid solely because an individual is i incarcerated and ii not an inmate as defined in section b subsection a does not require the medicaid program to provide coverage for any services for an individual while the individual is incarcerated the department is a party to and may intervene at any time in any judicial or administrative action a to which the department of workforce services is a party and b that involves medical assistance under this chapter i title chapter medical assistance act or ii title chapter utah children s health insurance act section section b which is renumbered from section is renumbered and amended to read b medicaid expansion the purpose of this section is to expand the coverage of the medicaid program to persons who are in categories traditionally not served by that program within appropriations from the legislature the department may amend the state plan for medical assistance to provide for eligibility for medicaid a on or after july for children to years old who live in households below the federal poverty income guideline and b on or after july for persons who have incomes below the federal poverty income guideline and who are aged blind or have a disability a within appropriations from the legislature on or after july the medicaid program may provide for eligibility for persons who have incomes below the federal poverty income guideline b in order to meet the provisions of this subsection the department may seek approval for a demonstration project under u s c sec from the secretary of the united states department of health and human services the medicaid program shall provide for eligibility for persons as required by subsection b services available for persons described in this section shall include required medicaid services and may include one or more optional medicaid services if those services are funded by the legislature the department may also require persons described in subsections through to meet an asset test section section b which is renumbered from section is renumbered and amended to read b copayments by recipients employer sponsored plans the department shall selectively provide for enrollment fees premiums deductions cost sharing or other similar charges to be paid by recipients their spouses and parents within the limitations of federal law and regulation beginning may within appropriations by the legislature and as a means to increase health care coverage among the uninsured the department shall take steps to promote increased participation in employer sponsored health insurance including a maximizing the health insurance premium subsidy provided under the state s demonstration waiver by i ensuring that state funds are matched by federal funds to the greatest extent allowable and ii as the department determines appropriate seeking federal approval to do one or more of the following a eliminate or otherwise modify the annual enrollment fee b eliminate or otherwise modify the schedule used to determine the level of subsidy provided to an enrollee each year c reduce the maximum number of participants allowable under the subsidy program or d otherwise modify the program in a manner that promotes enrollment in employer sponsored health insurance and b exploring the use of other options including the development of a waiver under the medicaid health insurance flexibility demonstration initiative or other federal authority section section b which is renumbered from section is renumbered and amended to read b income and resources from institutionalized spouses as used in this section a community spouse means the spouse of an institutionalized spouse b i community spouse monthly income allowance means an amount by which the minimum monthly maintenance needs allowance for the spouse exceeds the amount of monthly income otherwise available to the community spouse determined without regard to the allowance except as provided in subsection b ii ii if a court has entered an order against an institutionalized spouse for monthly income for the support of the community spouse the community spouse monthly income allowance for the spouse may not be less than the amount of the monthly income so ordered c community spouse resource allowance is the amount of combined resources that are protected for a community spouse living in the community which the division shall establish by rule made in accordance with title g chapter utah administrative rulemaking act based on the amounts established by the united states department of health and human services d excess shelter allowance for a community spouse means the amount by which the sum of the spouse s expense for rent or mortgage payment taxes and insurance and in the case of condominium or cooperative required maintenance charge for the community spouse s principal residence and the spouse s actual expenses for electricity natural gas and water utilities or at the discretion of the department the federal standard utility allowance under snap as defined in section a exceeds of the amount described in subsection e family member means a minor dependent child dependent parents or dependent sibling of the institutionalized spouse or community spouse who are residing with the community spouse f i institutionalized spouse means a person who is residing in a nursing facility and is married to a spouse who is not in a nursing facility ii an institutionalized spouse does not include a person who is not likely to reside in a nursing facility for at least consecutive days g nursing care facility means the same as that term is defined in section b the division shall comply with this section when determining eligibility for medical assistance for an institutionalized spouse for services furnished during a calendar year beginning on or after january the community spouse resource allowance shall be increased by the division by an amount as determined annually by cms the division shall compute as of the beginning of the first continuous period of institutionalization of the institutionalized spouse a the total value of the resources to the extent either the institutionalized spouse or the community spouse has an ownership interest and b a spousal share which is of the resources described in subsection a at the request of an institutionalized spouse or a community spouse at the beginning of the first continuous period of institutionalization of the institutionalized spouse and upon the receipt of relevant documentation of resources the division shall promptly assess and document the total value described in subsection a and shall provide a copy of that assessment and documentation to each spouse and shall retain a copy of the assessment when the division provides a copy of the assessment it shall include a notice stating that the spouse may request a hearing under subsection when determining eligibility for medical assistance under this chapter a except as provided in subsection b all resources held by either the institutionalized spouse community spouse or both are considered to be available to the institutionalized spouse b resources are considered to be available to the institutionalized spouse only to the extent that the amount of those resources exceeds the community spouse resource allowance at the time of application for medical assistance under this chapter a the division may not find an institutionalized spouse to be ineligible for medical assistance by reason of resources determined under subsection to be available for the cost of care when i the institutionalized spouse has assigned to the state any rights to support from the community spouse ii except as provided in subsection b the institutionalized spouse lacks the ability to execute an assignment due to physical or mental impairment or iii the division determines that denial of medical assistance would cause an undue burden b subsection a ii does not prevent the division from seeking a court order for an assignment of support during the continuous period in which an institutionalized spouse is in an institution and after the month in which an institutionalized spouse is eligible for medical assistance the resources of the community spouse may not be considered to be available to the institutionalized spouse when an institutionalized spouse is determined to be eligible for medical assistance in determining the amount of the spouse s income that is to be applied monthly for the cost of care in the nursing care facility the division shall deduct from the spouse s monthly income the following amounts in the following order a a personal needs allowance the amount of which is determined by the division b a community spouse monthly income allowance but only to the extent that the income of the institutionalized spouse is made available to or for the benefit of the community spouse c a family allowance for each family member equal to at least of the amount that the amount described in subsection a exceeds the amount of the family member s monthly income and d amounts for incurred expenses for the medical or remedial care for the institutionalized spouse the division shall establish a minimum monthly maintenance needs allowance for each community spouse that includes a an amount established by the division by rule made in accordance with title g chapter utah administrative rulemaking act based on the amounts established by the united states department of health and human services and b an excess shelter allowance a an institutionalized spouse or a community spouse may request a hearing with respect to the determinations described in subsections e i through v if an application for medical assistance has been made on behalf of the institutionalized spouse b a hearing under this subsection regarding the community spouse resource allowance shall be held by the division within days from the date of the request for the hearing c if either spouse establishes that the community spouse needs income above the level otherwise provided by the minimum monthly maintenance needs allowance due to exceptional circumstances resulting in significant financial duress there shall be substituted for the minimum monthly maintenance needs allowance provided under subsection an amount adequate to provide additional income as is necessary d if either spouse establishes that the community spouse resource allowance in relation to the amount of income generated by the allowance is inadequate to raise the community spouse s income to the minimum monthly maintenance needs allowance there shall be substituted for the community spouse resource allowance an amount adequate to provide a minimum monthly maintenance needs allowance e a hearing may be held under this subsection if either the institutionalized spouse or community spouse is dissatisfied with a determination of i the community spouse monthly income allowance ii the amount of monthly income otherwise available to the community spouse iii the computation of the spousal share of resources under subsection iv the attribution of resources under subsection or v the determination of the community spouse resource allocation a an institutionalized spouse may transfer an amount equal to the community spouse resource allowance but only to the extent the resources of the institutionalized spouse are transferred to or for the sole benefit of the community spouse b the transfer under subsection a shall be made as soon as practicable after the date of the initial determination of eligibility taking into account the time necessary to obtain a court order under subsection c c chapter medical benefits recovery act part medical benefits recovery does not apply if a court has entered an order against an institutionalized spouse for the support of the community spouse section section b which is renumbered from section is renumbered and amended to read b maximizing use of premium assistance programs utah s premium partnership for health insurance a the department shall seek to maximize the use of medicaid and children s health insurance program funds for assistance in the purchase of private health insurance coverage for medicaid eligible and non medicaid eligible individuals b the department s efforts to expand the use of premium assistance shall i include as necessary seeking federal approval under all medicaid and children s health insurance program premium assistance provisions of federal law including provisions of the patient protection and affordable care act public law ppaca ii give priority to but not be limited to expanding the state s utah premium partnership for health insurance program including as required under subsection and iii encourage the enrollment of all individuals within a household in the same plan where possible including enrollment in a plan that allows individuals within the household transitioning out of medicaid to retain the same network and benefits they had while enrolled in medicaid the department shall seek federal approval of an amendment to the state s utah premium partnership for health insurance program to adjust the eligibility determination for single adults and parents who have an offer of employer sponsored insurance the amendment shall a be within existing appropriations for the utah premium partnership for health insurance program and b provide that adults who are up to of the federal poverty level are eligible for premium subsidies in the utah premium partnership for health insurance program for the fiscal year the department shall seek authority to increase the maximum premium subsidy per month for adults under the utah premium partnership for health insurance program to beginning with the fiscal year and in each subsequent fiscal year the department may increase premium subsidies for single adults and parents who have an offer of employer sponsored insurance to keep pace with the increase in insurance premium costs subject to appropriation of additional funding section section b which is renumbered from section is renumbered and amended to read b expanding the medicaid program as used in this section a cms means the centers for medicare and medicaid services in the united states department of health and human services b a federal poverty level means the same as that term is defined in section b c b medicaid expansion means an expansion of the medicaid program in accordance with this section d c medicaid expansion fund means the medicaid expansion fund created in section b b a as set forth in subsections through eligibility criteria for the medicaid program shall be expanded to cover additional low income individuals b the department shall continue to seek approval from cms to implement the medicaid waiver expansion as defined in section b c the department may implement any provision described in subsections b b iii through viii in a medicaid expansion if the department receives approval from cms to implement that provision the department shall expand the medicaid program in accordance with this subsection if the department a receives approval from cms to i expand medicaid coverage to eligible individuals whose income is below of the federal poverty level ii obtain maximum federal financial participation under u s c sec d b for enrolling an individual in the medicaid expansion under this subsection and iii permit the state to close enrollment in the medicaid expansion under this subsection if the department has insufficient funds to provide services to new enrollment under the medicaid expansion under this subsection b pays the state portion of costs for the medicaid expansion under this subsection with funds from i the medicaid expansion fund ii county contributions to the nonfederal share of medicaid expenditures or iii any other contributions funds or transfers from a nonstate agency for medicaid expenditures and c closes the medicaid program to new enrollment under the medicaid expansion under this subsection if the department projects that the cost of the medicaid expansion under this subsection will exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act a the department shall expand the medicaid program in accordance with this subsection if the department i receives approval from cms to a expand medicaid coverage to eligible individuals whose income is below of the federal poverty level b obtain maximum federal financial participation under u s c sec d y for enrolling an individual in the medicaid expansion under this subsection and c permit the state to close enrollment in the medicaid expansion under this subsection if the department has insufficient funds to provide services to new enrollment under the medicaid expansion under this subsection ii pays the state portion of costs for the medicaid expansion under this subsection with funds from a the medicaid expansion fund b county contributions to the nonfederal share of medicaid expenditures or c any other contributions funds or transfers from a nonstate agency for medicaid expenditures and iii closes the medicaid program to new enrollment under the medicaid expansion under this subsection if the department projects that the cost of the medicaid expansion under this subsection will exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act b the department shall submit a waiver an amendment to an existing waiver or a state plan amendment to cms to i administer federal funds for the medicaid expansion under this subsection according to a per capita cap developed by the department that includes an annual inflationary adjustment accounts for differences in cost among categories of medicaid expansion enrollees and provides greater flexibility to the state than the current medicaid payment model ii limit in certain circumstances as defined by the department the ability of a qualified entity to determine presumptive eligibility for medicaid coverage for an individual enrolled in a medicaid expansion under this subsection iii impose a lock out period if an individual enrolled in a medicaid expansion under this subsection violates certain program requirements as defined by the department iv allow an individual enrolled in a medicaid expansion under this subsection to remain in the medicaid program for up to a month certification period as defined by the department and v allow federal medicaid funds to be used for housing support for eligible enrollees in the medicaid expansion under this subsection a i if cms does not approve a waiver to expand the medicaid program in accordance with subsection a on or before january the department shall develop proposals to implement additional flexibilities and cost controls including cost sharing tools within a medicaid expansion under this subsection through a request to cms for a waiver or state plan amendment ii the request for a waiver or state plan amendment described in subsection a i shall include a a path to self sufficiency for qualified adults in the medicaid expansion that includes employment and training as defined in u s c sec d and b a requirement that an individual who is offered a private health benefit plan by an employer to enroll in the employer s health plan iii the department shall submit the request for a waiver or state plan amendment developed under subsection a i on or before march b notwithstanding sections b and j and in accordance with this subsection eligibility for the medicaid program shall be expanded to include all persons in the optional medicaid expansion population under the patient protection and affordable care act pub l no ppaca and the health care education reconciliation act of pub l no and related federal regulations and guidance on the earlier of i the day on which cms approves a waiver to implement the provisions described in subsections a ii a and b or ii july c the department shall seek a waiver or an amendment to an existing waiver from federal law to i implement each provision described in subsections b b iii through viii in a medicaid expansion under this subsection ii limit in certain circumstances as defined by the department the ability of a qualified entity to determine presumptive eligibility for medicaid coverage for an individual enrolled in a medicaid expansion under this subsection and iii impose a lock out period if an individual enrolled in a medicaid expansion under this subsection violates certain program requirements as defined by the department d the eligibility criteria in this subsection shall be construed to include all individuals eligible for the health coverage improvement program under section b e the department shall pay the state portion of costs for a medicaid expansion under this subsection entirely from i the medicaid expansion fund ii county contributions to the nonfederal share of medicaid expenditures or iii any other contributions funds or transfers from a nonstate agency for medicaid expenditures f if the costs of the medicaid expansion under this subsection exceed the funds available under subsection e i the department may reduce or eliminate optional medicaid services under this chapter and ii savings as determined by the department from the reduction or elimination of optional medicaid services under subsection f i shall be deposited into the medicaid expansion fund and iii the department may submit to cms a request for waivers or an amendment of existing waivers from federal law necessary to implement budget controls within the medicaid program to address the deficiency g if the costs of the medicaid expansion under this subsection are projected by the department to exceed the funds available in the current fiscal year under subsection e including savings resulting from any action taken under subsection f i the governor shall direct the department of health department of human services department and department of workforce services to reduce commitments and expenditures by an amount sufficient to offset the deficiency a proportionate to the share of total current fiscal year general fund appropriations for each of those agencies and b up to of each agency s total current fiscal year general fund appropriations ii the division of finance shall reduce allotments to the department of health department of human services department and department of workforce services by a percentage a proportionate to the amount of the deficiency and b up to of each agency s total current fiscal year general fund appropriations and iii the division of finance shall deposit the total amount from the reduced allotments described in subsection g ii into the medicaid expansion fund the department shall maximize federal financial participation in implementing this section including by seeking to obtain any necessary federal approvals or waivers notwithstanding sections and a county does not have to provide matching funds to the state for the cost of providing medicaid services to newly enrolled individuals who qualify for medicaid coverage under a medicaid expansion the department shall report to the social services appropriations subcommittee on or before november of each year that a medicaid expansion is operational a the number of individuals who enrolled in the medicaid expansion b costs to the state for the medicaid expansion c estimated costs to the state for the medicaid expansion for the current and following fiscal years d recommendations to control costs of the medicaid expansion and e as calculated in accordance with subsections b b and c b the state s net cost of the qualified medicaid expansion section section b which is renumbered from section is renumbered and amended to read b department standards for eligibility under medicaid funds for abortions a the department may develop standards and administer policies relating to eligibility under the medicaid program as long as they are consistent with subsection b b an applicant receiving medicaid assistance may be limited to particular types of care or services or to payment of part or all costs of care determined to be medically necessary the department may not provide any funds for medical hospital or other medical expenditures or medical services to otherwise eligible persons where the purpose of the assistance is to perform an abortion unless the life of the mother would be endangered if an abortion were not performed any employee of the department who authorizes payment for an abortion contrary to the provisions of this section is guilty of a class b misdemeanor and subject to forfeiture of office any person or organization that under the guise of other medical treatment provides an abortion under auspices of the medicaid program is guilty of a third degree felony and subject to forfeiture of license to practice medicine or authority to provide medical services and treatment section section b which is renumbered from section is renumbered and amended to read b contracts for provision of medical services federal provisions modifying department rules compliance with social security act the department may contract with other public or private agencies to purchase or provide medical services in connection with the programs of the division where these programs are used by other government entities contracts shall provide that other government entities in compliance with state and federal law regarding intergovernmental transfers transfer the state matching funds to the department in amounts sufficient to satisfy needs of the specified program contract terms shall include provisions for maintenance administration and service costs if a federal legislative or executive provision requires modifications or revisions in an eligibility factor established under this chapter as a condition for participation in medical assistance the department may modify or change its rules as necessary to qualify for participation the provisions of this section do not apply to department rules governing abortion the department shall comply with all pertinent requirements of the social security act and all orders rules and regulations adopted thereunder when required as a condition of participation in benefits under the social security act section section b which is renumbered from section is renumbered and amended to read b liability insurance required the medicaid program may not reimburse a home health agency as defined in section b for home health services provided to an enrollee unless the home health agency has liability coverage of at least per incident or an amount established by department rule made in accordance with title g chapter utah administrative rulemaking act section section b which is renumbered from section is renumbered and amended to read b federal aid authority of executive director the executive director with the approval of the governor may bind the state to any executive or legislative provisions promulgated or enacted by the federal government which invite the state to participate in the distribution disbursement or administration of any fund or service advanced offered or contributed in whole or in part by the federal government for purposes consistent with the powers and duties of the department such funds shall be used as provided in this chapter and be administered by the department for purposes related to medical assistance programs section section b which is renumbered from section is renumbered and amended to read b medical vendor rates medical vendor payments made to providers of services for and in behalf of recipient households shall be based upon predetermined rates from standards developed by the division in cooperation with providers of services for each type of service purchased by the division as far as possible the rates paid for services shall be established in advance of the fiscal year for which funds are to be requested section section b which is renumbered from section is renumbered and amended to read b enforcement of public assistance statutes the department shall enforce or contract for the enforcement of sections a a a a a and a to the extent that these sections pertain to benefits conferred or administered by the division under this chapter to the extent allowed under federal law or regulation the department may contract for services covered in section a insofar as that section pertains to benefits conferred or administered by the division under this chapter section section b which is renumbered from section is renumbered and amended to read b prohibited acts of state or local employees of medicaid program violation a misdemeanor each state or local employee responsible for the expenditure of funds under the state medicaid program each individual who formerly was such an officer or employee and each partner of such an officer or employee is prohibited for a period of one year after termination of such responsibility from committing any act the commission of which by an officer or employee of the united states government an individual who was such an officer or employee or a partner of such an officer or employee is prohibited by section or section of title united states code violation of this section is a class a misdemeanor section section b which is renumbered from section is renumbered and amended to read b rural hospitals for purposes of as used in this section rural hospital means a hospital located outside of a standard metropolitan statistical area as designated by the united states bureau of the census for purposes of the medicaid program the division of medicaid and health financing division may not discriminate among rural hospitals on the basis of size section section b which is renumbered from section is renumbered and amended to read b telemedicine reimbursement rulemaking a as used in this section communication by telemedicine is considered face to face contact between a health care provider and a patient under the state s medical assistance program if i the communication by telemedicine meets the requirements of administrative rules adopted in accordance with subsection and ii the health care services are eligible for reimbursement under the state s medical assistance program b this subsection applies to any managed care organization that contracts with the state s medical assistance program the reimbursement rate for telemedicine services approved under this section a shall be subject to reimbursement policies set by the state plan and b may be based on i a monthly reimbursement rate ii a daily reimbursement rate or iii an encounter rate the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act which establish a the particular telemedicine services that are considered face to face encounters for reimbursement purposes under the state s medical assistance program and b the reimbursement methodology for the telemedicine services designated under subsection a section section b which is renumbered from section is renumbered and amended to read b reimbursement of telemedicine services and telepsychiatric consultations as used in this section a telehealth services means the same as that term is defined in section b b telemedicine services means the same as that term is defined in section b c telepsychiatric consultation means a consultation between a physician and a board certified psychiatrist both of whom are licensed to engage in the practice of medicine in the state that utilizes i the health records of the patient provided from the patient or the referring physician ii a written evidence based patient questionnaire and iii telehealth services that meet industry security and privacy standards including compliance with the a health insurance portability and accountability act and b health information technology for economic and clinical health act pub l no stat as amended this section applies to a a managed care organization that contracts with the medicaid program and b a provider who is reimbursed for health care services under the medicaid program the medicaid program shall reimburse for telemedicine services at the same rate that the medicaid program reimburses for other health care services the medicaid program shall reimburse for telepsychiatric consultations at a rate set by the medicaid program section section b which is renumbered from section is renumbered and amended to read b process to promote health insurance coverage for children the department in collaboration with the department of workforce services and the state board of education shall develop a process to promote health insurance coverage for a child in school when a the child applies for free or reduced price school lunch b a child enrolls in or registers in school and c other appropriate school related opportunities the department in collaboration with the department of workforce services shall promote and facilitate the enrollment of children identified under subsection without health insurance in the utah children s health insurance program the medicaid program or the utah premium partnership for health insurance program section section b which is renumbered from section is renumbered and amended to read b medicaid continuous eligibility promoting payment and delivery reform in accordance with subsection and within appropriations from the legislature the department may amend the state medicaid plan to a create continuous eligibility for up to months for an individual who has qualified for the state medicaid program b provide incentives in managed care contracts for an individual to obtain appropriate care in appropriate settings and c require the managed care system to accept the risk of managing the medicaid population assigned to the plan amendment in return for receiving the benefits of providing quality and cost effective care if the department amends the state medicaid plan under subsection a or b the department a shall ensure that the plan amendment i is cost effective for the state medicaid program ii increases the quality and continuity of care for recipients and iii calculates and transfers administrative savings from continuous enrollment from the department of workforce services to the department of health department and b may limit the plan amendment under subsection a or b to select geographic areas or specific medicaid populations the department may seek approval for a state plan amendment waiver or a demonstration project from the secretary of the united states department of health and human services if necessary to implement a plan amendment under subsection a or b section section b which is renumbered from section is renumbered and amended to read b patient notice of health care provider privacy practices a for purposes of this section i health care provider means a health care provider as defined in section b who a receives payment for medical services from the medicaid program established in this chapter or the children s health insurance program established in chapter utah children s health insurance act section b and b submits a patient s personally identifiable information to the medicaid eligibility database or the children s health insurance program eligibility database ii hipaa means c f r parts and health insurance portability and accountability act of as amended b beginning july this section applies to the medicaid program the children s health insurance program created in chapter utah children s health insurance act section b and a health care provider a health care provider shall as part of the notice of privacy practices required by hipaa provide notice to the patient or the patient s personal representative that the health care provider either has or may submit personally identifiable information about the patient to the medicaid eligibility database and the children s health insurance program eligibility database the medicaid program and the children s health insurance program may not give a health care provider access to the medicaid eligibility database or the children s health insurance program eligibility database unless the health care provider s notice of privacy practices complies with subsection the department may adopt an administrative rule to establish uniform language for the state requirement regarding notice of privacy practices to patients required under subsection section section b which is renumbered from section is renumbered and amended to read b optional medicaid expansion the department and the governor may not expand the state s medicaid program under ppaca unless a the department expands medicaid in accordance with section b or b i the governor or the governor s designee has reported the intention to expand the state medicaid program under ppaca to the legislature in compliance with the legislative review process in section b and ii the governor submits the request for expansion of the medicaid program for optional populations to the legislature under the high impact federal funds request process required by section j a the department shall request approval from cms for waivers from federal statutory and regulatory law necessary to implement the health coverage improvement program under section b b the health coverage improvement program under section b is not subject to the requirements in subsection section section b which is renumbered from section is renumbered and amended to read b medicaid vision services request for proposals the department may select one or more contractors in accordance with title g chapter a utah procurement code to provide vision services to the medicaid populations that are eligible for vision services as described in department rules without restricting provider participation and within existing appropriations from the legislature section section b which is renumbered from section is renumbered and amended to read b review of claims audit and investigation procedures a the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act and in consultation with providers and health care professionals subject to audit and investigation under the state medicaid program to establish procedures for audits and investigations that are fair and consistent with the duties of the department as the single state agency responsible for the administration of the medicaid program under section b and title xix of the social security act b if the providers and health care professionals do not agree with the rules proposed or adopted by the department under subsection a the providers or health care professionals may i request a hearing for the proposed administrative rule or seek any other remedies under the provisions of title g chapter utah administrative rulemaking act and ii request a review of the rule by the legislature s administrative rules review and general oversight committee created in section g the department shall a notify and educate providers and health care professionals subject to audit and investigation under the medicaid program of the providers and health care professionals responsibilities and rights under the administrative rules adopted by the department under the provisions of this section b ensure that the department or any entity that contracts with the department to conduct audits i has on staff or contracts with a medical or dental professional who is experienced in the treatment billing and coding procedures used by the type of provider being audited and ii uses the services of the appropriate professional described in subsection b i if the provider who is the subject of the audit disputes the findings of the audit c ensure that a finding of overpayment or underpayment to a provider is not based on extrapolation as defined in section a unless i there is a determination that the level of payment error involving the provider exceeds a error rate a for a sample of claims for a particular service code and b over a three year period of time ii documented education intervention has failed to correct the level of payment error and iii the value of the claims for the provider in aggregate exceeds in reimbursement for a particular service code on an annual basis and d require that any entity with which the office contracts for the purpose of conducting an audit of a service provider shall be paid on a flat fee basis for identifying both overpayments and underpayments a if the department or a contractor on behalf of the department i intends to implement the use of extrapolation as a method of auditing claims the department shall prior to adopting the extrapolation method of auditing report its intent to use extrapolation to the social services appropriations subcommittee and ii determines subsections c i through iii are applicable to a provider the department or the contractor may use extrapolation only for the service code associated with the findings under subsections c i through iii b i if extrapolation is used under this section a provider may at the provider s option appeal the results of the audit based on a each individual claim or b the extrapolation sample ii nothing in this section limits a provider s right to appeal the audit under title g general government title g chapter administrative procedures act the medicaid program and its manual or rules or other laws or rules that may provide remedies to providers section section b which is renumbered from section is renumbered and amended to read b medicaid intergovernmental transfer report approval requirements as used in this section a i intergovernmental transfer means the transfer of public funds from a a local government entity to another nonfederal governmental entity or b from a nonfederal government owned health care facility regulated under chapter health care facility licensing and inspection act chapter part health care facility licensing and inspection to another nonfederal governmental entity ii intergovernmental transfer does not include a the transfer of public funds from one state agency to another state agency or b a transfer of funds from the university of utah hospitals and clinics b i intergovernmental transfer program means a federally approved reimbursement program or category that is authorized by the medicaid state plan or waiver authority for intergovernmental transfers ii intergovernmental transfer program does not include the addition of a provider to an existing intergovernmental transfer program c local government entity means a county city town special service district local district or local education agency as that term is defined in section j d non state government entity means a hospital authority hospital district health care district special service district county or city a an entity that receives federal medicaid dollars from the department as a result of an intergovernmental transfer shall on or before august and on or before august each year thereafter provide the department with i information regarding the payments funded with the intergovernmental transfer as authorized by and consistent with state and federal law ii information regarding the entity s ability to repay federal funds to the extent required by the department in the contract for the intergovernmental transfer and iii other information reasonably related to the intergovernmental transfer that may be required by the department in the contract for the intergovernmental transfer b on or before october and on or before october each subsequent year the department shall prepare a report for the executive appropriations committee that includes i the amount of each intergovernmental transfer under subsection a ii a summary of changes to cms regulations and practices that are known by the department regarding federal funds related to an intergovernmental transfer program and iii other information the department gathers about the intergovernmental transfer under subsection a the department shall not create a new intergovernmental transfer program after july unless the department reports to the executive appropriations committee in accordance with section j before submitting the new intergovernmental transfer program for federal approval the report shall include information required by subsection j d and the analysis required in subsections a and b a the department shall enter into new nursing care facility non state government owned upper payment limit program contracts and contract amendments adding new nursing care facilities and new non state government entity operators in accordance with this subsection b i if the nursing care facility expects to receive less than in federal funds each year from the nursing care facility non state government owned upper payment limit program excluding seed funding and administrative fees paid by the non state government entity the department shall enter into a nursing care facility non state government owned upper payment limit program contract with the non state government entity operator of the nursing care facility ii if the nursing care facility expects to receive between and in federal funds each year from the nursing care facility non state government owned upper payment limit program excluding seed funding and administrative fees paid by the non state government entity the department shall enter into a nursing care facility non state government owned upper payment limit program contract with the non state government entity operator of the nursing care facility after receiving the approval of the executive appropriations committee iii if the nursing care facility expects to receive more than in federal funds each year from the nursing care facility non state government owned upper payment limit program excluding seed funding and administrative fees paid by the non state government entity the department may not approve the application without obtaining approval from the legislature and the governor c a non state government entity may not participate in the nursing care facility non state government owned upper payment limit program unless the non state government entity is a special service district county or city that operates a hospital or holds a license under chapter health care facility licensing and inspection act chapter part health care facility licensing and inspection d each non state government entity that participates in the nursing care facility non state government owned upper payment limit program shall certify to the department that i the non state government entity is a local government entity that is able to make an intergovernmental transfer under applicable state and federal law ii the non state government entity has sufficient public funds or other permissible sources of seed funding that comply with the requirements in c f r part subpart b iii the funds received from the nursing care facility non state government owned upper payment limit program are a for each nursing care facility available for patient care until the end of the non state government entity s fiscal year and b used exclusively for operating expenses for nursing care facility operations patient care capital expenses rent royalties and other operating expenses and iv the non state government entity has completed all licensing enrollment and other forms and documents required by federal and state law to register a change of ownership with the department and with cms the department shall add a nursing care facility to an existing nursing care facility non state government owned upper payment limit program contract if a the nursing care facility is managed by or affiliated with the same non state government entity that also manages one or more nursing care facilities that are included in an existing nursing care facility non state government owned upper payment limit program contract and b the non state government entity makes the certification described in subsection d ii the department may not increase the percentage of the administrative fee paid by a non state government entity to the department under the nursing care facility non state government owned upper payment limit program the department may not condition participation in the nursing care facility non state government owned upper payment limit program on a a requirement that the department be allowed to direct or determine the types of patients that a non state government entity will treat or the course of treatment for a patient in a non state government nursing care facility or b a requirement that a non state government entity or nursing care facility post a bond purchase insurance or create a reserve account of any kind the non state government entity shall have the primary responsibility for ensuring compliance with subsection d ii a the department may not enter into a new nursing care facility non state government owned upper payment limit program contract before january b subsection a does not apply to i a new nursing care facility non state government owned upper payment limit program contract that was included in the federal funds request summary under section j for fiscal year or ii a nursing care facility that is operated or managed by the same company as a nursing care facility that was included in the federal funds request summary under section j for fiscal year section section b which is renumbered from section is renumbered and amended to read b screening brief intervention and referral to treatment medicaid reimbursement as used in this section a controlled substance prescriber means a controlled substance prescriber as that term is defined in section who i has a record of having completed sbirt training in accordance with subsection before providing the sbirt services and ii is a medicaid enrolled health care provider b sbirt means the same as that term is defined in section the department shall reimburse a controlled substance prescriber who provides sbirt services to a medicaid enrollee who is years of age old or older for the sbirt services section section b which is renumbered from section is renumbered and amended to read b prescribing policies for opioid prescriptions the department may implement a prescribing policy for certain opioid prescriptions that is substantially similar to the prescribing policies required in section a the department may amend the state program and apply for waivers for the state program if necessary to implement subsection section section b which is renumbered from section is renumbered and amended to read b reimbursement for long acting reversible contraception immediately following childbirth as used in this section long acting reversible contraception means a contraception method that requires administration less than once per month including a an intrauterine device and b a contraceptive implant the division shall separately identify and reimburse from other labor and delivery services within the medicaid program the provision and insertion of long acting reversible contraception immediately after childbirth section section b which is renumbered from section is renumbered and amended to read b coverage of exome sequence testing as used in this section exome sequence testing means a genomic technique for sequencing the genome of an individual for diagnostic purposes the medicaid program shall reimburse for exome sequence testing a for an enrollee who i is younger than years of age old and ii who remains undiagnosed after exhausting all other appropriate diagnostic related tests b performed by a nationally recognized provider with significant experience in exome sequence testing c that is medically necessary and d at a rate set by the medicaid program section section b which is renumbered from section is renumbered and amended to read b reimbursement for nonemergency secured behavioral health transport providers the department may not reimburse a nonemergency secured behavioral health transport provider that is designated under section a b section section b which is renumbered from section is renumbered and amended to read b children s health care coverage program as used in this section a chip means the children s health insurance program created in section b b program means the children s health care coverage program created in subsection a there is created the children s health care coverage program within the department b the purpose of the program is to i promote health insurance coverage for children in accordance with section b ii conduct research regarding families who are eligible for medicaid and chip to determine awareness and understanding of available coverage iii analyze trends in disenrollment and identify reasons that families may not be renewing enrollment including any barriers in the process of renewing enrollment iv administer surveys to recently enrolled chip and children s medicaid enrollees to identify a how the enrollees learned about coverage and b any barriers during the application process v develop promotional material regarding chip and children s medicaid eligibility including outreach through social media video production and other media platforms vi identify ways that the eligibility website for enrollment in chip and children s medicaid can be redesigned to increase accessibility and enhance the user experience vii identify outreach opportunities including partnerships with community organizations including a schools b small businesses c unemployment centers d parent teacher associations and e youth athlete clubs and associations and viii develop messaging to increase awareness of coverage options that are available through the department a the department may not delegate implementation of the program to a private entity b notwithstanding subsection a the department may contract with a media agency to conduct the activities described in subsection b iv and vii section section b which is renumbered from section is renumbered and amended to read b reimbursement for diabetes prevention program as used in this section dpp means the national diabetes prevention program developed by the united states centers for disease control and prevention beginning july the medicaid program shall reimburse a provider for an enrollee s participation in the dpp if the enrollee a meets the dpp s eligibility requirements and b has not previously participated in the dpp after july while enrolled in the medicaid program subject to appropriation the medicaid program may set the rate for reimbursement the department may apply for a state plan amendment if necessary to implement this section a on or after july but before october the department shall provide a written report regarding the efficacy of the dpp and reimbursement under this section to the health and human services interim committee b the report described in subsection a shall include i the total number of enrollees with a prediabetic condition as of july ii the total number of enrollees as of july with a diagnosis of type diabetes iii the total number of enrollees who participated in the dpp iv the total cost incurred by the state to implement this section and v any conclusions that can be drawn regarding the impact of the dpp on the rate of type diabetes for enrollees section section b which is renumbered from section is renumbered and amended to read b behavioral health delivery working group as used in this section targeted adult medicaid program means the same as that term is defined in section b on or before may the department shall convene a working group to collaborate with the department on a establishing specific and measurable metrics regarding i compliance of managed care organizations in the state with federal medicaid managed care requirements ii timeliness and accuracy of authorization and claims processing in accordance with medicaid policy and contract requirements iii reimbursement by managed care organizations in the state to providers to maintain adequacy of access to care iv availability of care management services to meet the needs of medicaid eligible individuals enrolled in the plans of managed care organizations in the state and v timeliness of resolution for disputes between a managed care organization and the managed care organization s providers and enrollees b improving the delivery of behavioral health services in the medicaid program c proposals to implement the delivery system adjustments authorized under subsection b and d issues that are identified by managed care organizations behavioral health service providers and the department the working group convened under subsection shall a meet quarterly and b consist of at least the following individuals i the executive director or the executive director s designee ii for each medicaid accountable care organization with which the department contracts an individual selected by the accountable care organization iii five individuals selected by the department to represent various types of behavioral health services providers including at a minimum individuals who represent providers who provide the following types of services a acute inpatient behavioral health treatment b residential treatment c intensive outpatient or partial hospitalization treatment and d general outpatient treatment iv a representative of an association that represents behavioral health treatment providers in the state designated by the utah behavioral healthcare council convened by the utah association of counties v a representative of an organization representing behavioral health organizations vi the chair of the utah substance use and mental health advisory council created in section m vii a representative of an association that represents local authorities who provide public behavioral health care designated by the department viii one member of the senate appointed by the president of the senate and ix one member of the house of representatives appointed by the speaker of the house of representatives the working group convened under this section shall recommend to the department a specific and measurable metrics under subsection a b how physical and behavioral health services may be integrated for the targeted adult medicaid program including ways the department may address issues regarding i filing of claims ii authorization and reauthorization for treatment services iii reimbursement rates and iv other issues identified by the department behavioral health services providers or medicaid managed care organizations c ways to improve delivery of behavioral health services to enrollees including changes to statute or administrative rule and d wraparound service coverage for enrollees who need specific nonclinical services to ensure a path to success section section b which is renumbered from section is renumbered and amended to read b adjudicative proceedings related to medicaid funds if a proceeding of the department under title g chapter administrative procedures act relates in any way to recovery of medicaid funds a the presiding officer shall be designated by the executive director of the department and report directly to the executive director or in the discretion of the executive director report directly to the director of the office of internal audit and b the decision of the presiding officer is the recommended decision to the executive director of the department or a designee of the executive director who is not in the division subsection does not apply to hearings conducted by the department of workforce services relating to medical assistance eligibility determinations if a proceeding of the department under title g chapter administrative procedures act relates in any way to medicaid or medicaid funds the following may attend and present evidence or testimony at the proceeding a the director of the office of internal audit or the director s designee and b the inspector general of medicaid services or the inspector general s designee in relation to a proceeding of the department under title g chapter administrative procedures act a person may not outside of the actual proceeding attempt to influence the decision of the presiding officer section section b which is renumbered from section is renumbered and amended to read b medical assistance accountability division duties reporting as used in this section a abuse means i an action or practice that a is inconsistent with sound fiscal business or medical practices and b results or may result in unnecessary medicaid related costs or other medical or hospital assistance costs or ii reckless or negligent upcoding b fraud means intentional or knowing i deception misrepresentation or upcoding in relation to medicaid funds costs claims reimbursement or practice or ii deception or misrepresentation in relation to medical or hospital assistance funds costs claims reimbursement or practice c upcoding means assigning an inaccurate billing code for a service that is payable or reimbursable by medicaid funds if the correct billing code for the service taking into account reasonable opinions derived from official published coding definitions would result in a lower medicaid payment or reimbursement d waste means overutilization of resources or inappropriate payment the division shall a develop and implement procedures relating to medicaid funds and medical or hospital assistance funds to ensure that providers do not receive a i duplicate payments for the same goods or services b ii payment for goods or services by resubmitting a claim for which i a payment has been disallowed on the grounds that payment would be a violation of federal or state law administrative rule or the state plan and ii b the decision to disallow the payment has become final c iii payment for goods or services provided after a recipient s death including payment for pharmaceuticals or long term care or d iv payment for transporting an unborn infant b consult with the centers for medicaid and medicare services cms other states and the office of inspector general of medicaid services to determine and implement best practices for discovering and eliminating fraud waste and abuse of medicaid funds and medical or hospital assistance funds c actively seek repayment from providers for improperly used or paid a i medicaid funds and b ii medical or hospital assistance funds d coordinate track and keep records of all division efforts to obtain repayment of the funds described in subsection c and the results of those efforts e keep medicaid pharmaceutical costs as low as possible by actively seeking to obtain pharmaceuticals at the lowest price possible including on a quarterly basis for the pharmaceuticals that represent the highest of state medicaid expenditures for pharmaceuticals and on an annual basis for the remaining pharmaceuticals a i tracking changes in the price of pharmaceuticals b ii checking the availability and price of generic drugs c iii reviewing and updating the state s maximum allowable cost list and d iv comparing pharmaceutical costs of the state medicaid program to available pharmacy price lists and f provide training on an annual basis to the employees of the division who make decisions on billing codes or who are in the best position to observe and identify upcoding in order to avoid and detect upcoding section section b which is renumbered from section is renumbered and amended to read b medical assistance from division or department of workforce services and compliance under adoption assistance interstate compact penalty for fraudulent claim as used in this section a adoption assistance means the same as that term is defined in section b adoption assistance agreement means the same as that term is defined in section c adoption assistance interstate compact means an agreement executed by the division of child and family services with any other state in accordance with section a a child who is a resident of this state and is the subject of an adoption assistance interstate compact is entitled to receive medical assistance from the division and the department of workforce services by filing a certified copy of the child s adoption assistance agreement with the division or the department of workforce services b the adoptive parent of the child described in subsection a shall annually provide the division or the department of workforce services with evidence verifying that the adoption assistance agreement is still effective the department of workforce services shall consider the recipient of medical assistance under this section as the department of workforce services does any other recipient of medical assistance under an adoption assistance agreement executed by the division of child and family services a a person may not submit a claim for payment or reimbursement under this section that the person knows is false misleading or fraudulent b a violation of subsection a is a third degree felony the division and the department of workforce services shall a cooperate with the division of child and family services in regard to an adoption assistance interstate compact and b comply with an adoption assistance interstate compact section section b which is renumbered from section is renumbered and amended to read part medicaid waivers b medicaid waiver for independent foster care adolescents for purposes of as used in this section an independent foster care adolescent includes any individual who reached years of age old while in the custody of the division of child and family services or the department of human services department if the division of child and family services department was the primary case manager or a federally recognized indian tribe an independent foster care adolescent is eligible when funds are available for medicaid coverage until the individual reaches years of age old before july the division shall submit a state medicaid plan amendment to the center for medicaid services cms to provide medical coverage for independent foster care adolescents effective fiscal year section section b which is renumbered from section is renumbered and amended to read b waivers to maximize replacement of fee for service delivery model cost of mandated program changes the department shall develop a waiver program in the medicaid program to replace the fee for service delivery model with one or more risk based delivery models the waiver program shall a restructure the program s provider payment provisions to reward health care providers for delivering the most appropriate services at the lowest cost and in ways that compared to services delivered before implementation of the waiver program maintain or improve recipient health status b restructure the program s cost sharing provisions and other incentives to reward recipients for personal efforts to i maintain or improve their health status and ii use providers that deliver the most appropriate services at the lowest cost c identify the evidence based practices and measures risk adjustment methodologies payment systems funding sources and other mechanisms necessary to reward providers for delivering the most appropriate services at the lowest cost including mechanisms that i pay providers for packages of services delivered over entire episodes of illness rather than for individual services delivered during each patient encounter and ii reward providers for delivering services that make the most positive contribution to a recipient s health status d limit total annual per patient per month expenditures for services delivered through fee for service arrangements to total annual per patient per month expenditures for services delivered through risk based arrangements covering similar recipient populations and services and e except as provided in subsection limit the rate of growth in per patient per month general fund expenditures for the program to the rate of growth in general fund expenditures for all other programs when the rate of growth in the general fund expenditures for all other programs is greater than zero to the extent possible the department shall operate the waiver program with the input of stakeholder groups representing those who will be affected by the waiver program a for purposes of this subsection mandated program change shall be determined by the department in consultation with the medicaid accountable care organizations and may include a change to the state medicaid program that is required by state or federal law state or federal guidance policy or the state medicaid plan b a mandated program change shall be included in the base budget for the medicaid program for the fiscal year in which the medicaid program adopted the mandated program change c the mandated program change is not subject to the limit on the rate of growth in per patient per month general fund expenditures for the program established in subsection e until the fiscal year following the fiscal year in which the medicaid program adopted the mandated program change a managed care organization or a pharmacy benefit manager that provides a pharmacy benefit to an enrollee shall establish a unique group number payment classification number or bank identification number for each medicaid managed care organization plan for which the managed care organization or pharmacy benefit manager provides a pharmacy benefit section section b which is renumbered from section is renumbered and amended to read b base budget appropriations for medicaid accountable care organizations and behavioral health plans forecast of behavioral health services cost as used in this section a aco means an accountable care organization that contracts with the state s medicaid program for i physical health services or ii integrated physical and behavioral health services b base budget means the same as that term is defined in legislative rule c behavioral health plan means a managed care or fee for service delivery system that contracts with or is operated by the department to provide behavioral health services to medicaid eligible individuals d behavioral health services means mental health or substance use treatment or services e general fund growth factor means the amount determined by dividing the next fiscal year ongoing general fund revenue estimate by current fiscal year ongoing appropriations from the general fund f next fiscal year ongoing general fund revenue estimate means the next fiscal year ongoing general fund revenue estimate identified by the executive appropriations committee in accordance with legislative rule for use by the office of the legislative fiscal analyst in preparing budget recommendations g pmpm means per member per month funding if the general fund growth factor is less than the next fiscal year base budget shall subject to subsection include an appropriation to the department in an amount necessary to ensure that the next fiscal year pmpm for acos and behavioral health plans equals the current fiscal year pmpm for the acos and behavioral health plans multiplied by if the general fund growth factor is greater than or equal to but less than the next fiscal year base budget shall subject to subsection include an appropriation to the department in an amount necessary to ensure that the next fiscal year pmpm for acos and behavioral health plans equals the current fiscal year pmpm for the acos and behavioral health plans multiplied by the general fund growth factor if the general fund growth factor is greater than or equal to the next fiscal year base budget shall subject to subsection include an appropriation to the department in an amount necessary to ensure that the next fiscal year pmpm for acos and behavioral health plans is greater than or equal to the current fiscal year pmpm for the acos and behavioral health plans multiplied by and less than or equal to the current fiscal year pmpm for the acos and behavioral health plans multiplied by the general fund growth factor the appropriations provided to the department for behavioral health plans under this section shall be reduced by the amount contributed by counties in the current fiscal year for behavioral health plans in accordance with subsections k and a x in order for the department to estimate the impact of subsections through before identification of the next fiscal year ongoing general fund revenue estimate the governor s office of planning and budget shall in cooperation with the office of the legislative fiscal analyst develop an estimate of ongoing general fund revenue for the next fiscal year and provide the estimate to the department no later than november of each year the office of the legislative fiscal analyst shall include an estimate of the cost of behavioral health services in any state medicaid funding or savings forecast that is completed in coordination with the department and the governor s office of planning and budget section section b which is renumbered from section is renumbered and amended to read b incentives to appropriately use emergency department services a this section applies to the medicaid program and to the utah children s health insurance program created in chapter utah children s health insurance act section b b as used in this section i managed care organization means a comprehensive full risk managed care delivery system that contracts with the medicaid program or the children s health insurance program to deliver health care through a managed care plan ii managed care plan means a risk based delivery service model authorized by section b and administered by a managed care organization iii non emergent care a means use of the emergency department to receive health care that is non emergent as defined by the department by administrative rule adopted in accordance with title g chapter utah administrative rulemaking act and the emergency medical treatment and active labor act and b does not mean the medical services provided to an individual required by the emergency medical treatment and active labor act including services to conduct a medical screening examination to determine if the recipient has an emergent or non emergent condition iv professional compensation means payment made for services rendered to a medicaid recipient by an individual licensed to provide health care services v super utilizer means a medicaid recipient who has been identified by the recipient s managed care organization as a person who uses the emergency department excessively as defined by the managed care organization a a managed care organization may in accordance with subsections b and c i audit emergency department services provided to a recipient enrolled in the managed care plan to determine if non emergent care was provided to the recipient and ii establish differential payment for emergent and non emergent care provided in an emergency department b i the differential payments under subsection a ii do not apply to professional compensation for services rendered in an emergency department ii except in cases of suspected fraud waste and abuse a managed care organization s audit of payment under subsection a i is limited to the month period of time after the date on which the medical services were provided to the recipient if fraud waste or abuse is alleged the managed care organization s audit of payment under subsection a i is limited to three years after the date on which the medical services were provided to the recipient c the audits and differential payments under subsections a and b apply to services provided to a recipient on or after july a managed care organization shall a use the savings under subsection to maintain and improve access to primary care and urgent care services for all medicaid or chip recipients enrolled in the managed care plan b provide viable alternatives for increasing primary care provider reimbursement rates to incentivize after hours primary care access for recipients and c report to the department on how the managed care organization complied with this subsection the department may a through administrative rule adopted by the department develop quality measurements that evaluate a managed care organization s delivery of i appropriate emergency department services to recipients enrolled in the managed care plan ii expanded primary care and urgent care for recipients enrolled in the managed care plan with consideration of the managed care organization s a delivery of primary care urgent care and after hours care through means other than the emergency department b recipient access to primary care providers and community health centers including evening and weekend access and c other innovations for expanding access to primary care and iii quality of care for the managed care plan members b compare the quality measures developed under subsection a for each managed care organization and c develop by administrative rule an algorithm to determine assignment of new unassigned recipients to specific managed care plans based on the plan s performance in relation to the quality measures developed pursuant to subsection a section section b which is renumbered from section is renumbered and amended to read b long term care insurance partnership as used in this section a qualified long term care insurance contract is as defined in u s c sec b b b qualified long term care insurance partnership is as defined in u s c sec p b c iii c state plan amendment means an amendment to the state medicaid plan drafted by the department in compliance with this section no later than july the department shall seek federal approval of a state plan amendment that creates a qualified long term care insurance partnership the department may make rules to comply with federal laws and regulations relating to qualified long term care insurance partnerships and qualified long term care insurance contracts section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for children with disabilities and complex medical needs as used in this section a additional eligibility criteria means the additional eligibility criteria set by the department under subsection e b complex medical condition means a physical condition of an individual that i results in severe functional limitations for the individual and ii is likely to a last at least months or b result in death c program means the program for children with complex medical conditions created in subsection d qualified child means a child who i is less than years old ii is diagnosed with a complex medical condition iii has a condition that meets the definition of disability in u s c sec and iv meets the additional eligibility criteria the department shall apply for a medicaid home and community based waiver with cms to implement within the state medicaid program the program described in subsection if the waiver described in subsection is approved the department shall offer a program that a as funding permits provides treatment for qualified children b if approved by cms and as funding permits beginning in fiscal year provides on an ongoing basis treatment for more qualified children than the program provided treatment for during fiscal year and c accepts applications for the program on an ongoing basis i d requires periodic reevaluations of an enrolled child s eligibility and other applicants or eligible children waiting for services in the program based on the additional eligibility criteria and ii e at the time of reevaluation allows the department to disenroll a child based on the prioritization described in subsection a and additional eligibility criteria the department shall a establish by rule made in accordance with title g chapter utah administrative rulemaking act criteria to prioritize qualified children s participation in the program based on the following factors in the following priority order i the complexity of a qualified child s medical condition and ii the financial needs of the qualified child and the qualified child s family b convene a public process to determine the benefits and services to offer a qualified child under the program c evaluate on an ongoing basis the cost and effectiveness of the program d if funding for the program is reduced develop an evaluation process to reduce the number of children served based on the participation criteria established under subsection a and e establish by rule made in accordance with title g chapter utah administrative rulemaking act additional eligibility criteria based on the factors described in subsections a i and ii section section b which is renumbered from section is renumbered and amended to read b health coverage improvement program eligibility annual report expansion of eligibility for adults with dependent children as used in this section a adult in the expansion population means an individual who i is described in u s c sec a a a i viii and ii is not otherwise eligible for medicaid as a mandatory categorically needy individual b enhancement waiver program means the primary care network enhancement waiver program described in section b c federal poverty level means the poverty guidelines established by the secretary of the united states department of health and human services under u s c sec d health coverage improvement program means the health coverage improvement program described in subsections through e homeless i means an individual who is chronically homeless as determined by the department and ii includes someone who was chronically homeless and is currently living in supported housing for the chronically homeless f income eligibility ceiling means the percent of federal poverty level i established by the state in an appropriations act adopted pursuant to title j chapter budgetary procedures act and ii under which an individual may qualify for medicaid coverage in accordance with this section g targeted adult medicaid program means the program implemented by the department under subsections through beginning july the department shall amend the state medicaid plan to allow temporary residential treatment for substance abuse use for the traditional medicaid population in a short term non institutional hour facility without a bed capacity limit that provides rehabilitation services that are medically necessary and in accordance with an individualized treatment plan as approved by cms and as long as the county makes the required match under section beginning july the department shall amend the state medicaid plan to increase the income eligibility ceiling to a percentage of the federal poverty level designated by the department based on appropriations for the program for an individual with a dependent child before july the division shall submit to cms a request for waivers or an amendment of existing waivers from federal statutory and regulatory law necessary for the state to implement the health coverage improvement program in the medicaid program in accordance with this section a an adult in the expansion population is eligible for medicaid if the adult meets the income eligibility and other criteria established under subsection b an adult who qualifies under subsection shall receive medicaid coverage i through the traditional fee for service medicaid model in counties without medicaid accountable care organizations or the state s medicaid accountable care organization delivery system where implemented and subject to section b ii except as provided in subsection b iii for behavioral health through the counties in accordance with sections and iii that subject to section b integrates behavioral health services and physical health services with medicaid accountable care organizations in select geographic areas of the state that choose an integrated model and iv that permits temporary residential treatment for substance abuse use in a short term non institutional hour facility without a bed capacity limit as approved by cms that provides rehabilitation services that are medically necessary and in accordance with an individualized treatment plan a an individual is eligible for the health coverage improvement program under subsection if i at the time of enrollment the individual s annual income is below the income eligibility ceiling established by the state under subsection f and ii the individual meets the eligibility criteria established by the department under subsection b b based on available funding and approval from cms the department shall select the criteria for an individual to qualify for the medicaid program under subsection a ii based on the following priority i a chronically homeless individual ii if funding is available an individual a involved in the justice system through probation parole or court ordered treatment and b in need of substance abuse use treatment or mental health treatment as determined by the department or iii if funding is available an individual in need of substance abuse use treatment or mental health treatment as determined by the department c an individual who qualifies for medicaid coverage under subsections a and b may remain on the medicaid program for a month certification period as defined by the department eligibility changes made by the department under subsection f or b shall not apply to an individual during the month certification period the state may request a modification of the income eligibility ceiling and other eligibility criteria under subsection each fiscal year based on projected enrollment costs to the state and the state budget the current medicaid program and the health coverage improvement program when implemented shall coordinate with a state prison or county jail to expedite medicaid enrollment for an individual who is released from custody and was eligible for or enrolled in medicaid before incarceration notwithstanding sections and a county does not have to provide matching funds to the state for the cost of providing medicaid services to newly enrolled individuals who qualify for medicaid coverage under the health coverage improvement program under subsection if the enhancement waiver program is implemented the department a may not accept any new enrollees into the health coverage improvement program after the day on which the enhancement waiver program is implemented b shall transition all individuals who are enrolled in the health coverage improvement program into the enhancement waiver program c shall suspend the health coverage improvement program within one year after the day on which the enhancement waiver program is implemented d shall within one year after the day on which the enhancement waiver program is implemented use all appropriations for the health coverage improvement program to implement the enhancement waiver program and e shall work with cms to maintain any waiver for the health coverage improvement program while the health coverage improvement program is suspended under subsection c if after the enhancement waiver program takes effect the enhancement waiver program is repealed or suspended by either the state or federal government the department shall reinstate the health coverage improvement program and continue to accept new enrollees into the health coverage improvement program in accordance with the provisions of this section section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for delivery of adult dental services a before june the department shall ask cms to grant waivers from federal statutory and regulatory law necessary for the medicaid program to provide dental services in the manner described in subsection a b before june the department shall submit to cms a request for waivers or an amendment of existing waivers from federal law necessary for the state to provide dental services in accordance with subsections b i and d through g to an individual described in subsection b i c before june the department shall submit to the centers for medicare and medicaid services a request for waivers or an amendment to existing waivers from federal law necessary for the state to i provide dental services in accordance with subsections b ii and d through g to an individual described in subsection b ii and ii provide the services described in subsection h a to the extent funded the department shall provide services to only blind or disabled individuals as defined in u s c sec c a who are years old or older and eligible for the program b notwithstanding subsection a i if a waiver is approved under subsection b the department shall provide dental services to an individual who a qualifies for the health coverage improvement program described in section b and b is receiving treatment in a substance abuse treatment program as defined in section a b licensed under title a chapter licensure of programs and facilities chapter part human services programs and facilities and ii if a waiver is approved under subsection c i the department shall provide dental services to an individual who is an aged individual as defined in u s c sec c a c to the extent possible services to individuals described in subsection a shall be provided through the university of utah school of dentistry and the university of utah school of dentistry s associated statewide network d the department shall provide the services to individuals described in subsection b i by contracting with an entity that a has demonstrated experience working with individuals who are being treated for both a substance use disorder and a major oral health disease b operates a program targeted at the individuals described in subsection b that has demonstrated through a peer reviewed evaluation the effectiveness of providing dental treatment to those individuals described in subsection b c is willing to pay for an amount equal to the program s non federal share of the cost of providing dental services to the population described in subsection b and d is willing to pay all state costs associated with applying for the waiver described in subsection b and administering the program described in subsection b and ii through a fee for service payment model e the entity that receives the contract under subsection d i shall cover all state costs of the program described in subsection b f each fiscal year the university of utah school of dentistry shall in compliance with state and federal regulations regarding intergovernmental transfers transfer funds to the program in an amount equal to the program s non federal share of the cost of providing services under this section through the school during the fiscal year g if a waiver is approved under subsection c ii the department shall provide coverage for porcelain and porcelain to metal crowns if the services are provided i to an individual who qualifies for dental services under subsection b and ii by an entity that covers all state costs of a providing the coverage described in this subsection h g and b applying for the waiver described in subsection c h where possible the department shall ensure that services described in subsection a that are not provided by the university of utah school of dentistry or the university of utah school of dentistry s associated network are provided i through fee for service reimbursement until july and ii after july through the method of reimbursement used by the division for medicaid dental benefits i subject to appropriations by the legislature and as determined by the department the scope amount duration and frequency of services may be limited a if the waivers requested under subsection a are granted the medicaid program shall begin providing dental services in the manner described in subsection no later than july b if the waivers requested under subsection b are granted the medicaid program shall begin providing dental services to the population described in subsection b within days from the day on which the waivers are granted c if the waivers requested under subsection c i are granted the medicaid program shall begin providing dental services to the population described in subsection b ii within days after the day on which the waivers are granted if the federal share of the cost of providing dental services under this section will be less than during any portion of the next fiscal year the medicaid program shall cease providing dental services under this section no later than the end of the current fiscal year section section b which is renumbered from section is renumbered and amended to read b medicaid long term support services housing coordinator there is created within the medicaid program a full time equivalent position of medicaid long term support services housing coordinator the coordinator shall help medicaid recipients receive long term support services in a home or other community based setting rather than in a nursing home or other institutional setting by a working with municipalities counties the housing and community development division within the department of workforce services and others to identify community based settings available to recipients b working with the same entities to promote the development construction and availability of additional community based settings c training medicaid case managers and support coordinators on how to help medicaid recipients move from an institutional setting to a community based setting and d performing other related duties section section b which is renumbered from section is renumbered and amended to read b medicaid waiver expansion as used in this section a federal poverty level means the same as that term is defined in section b b medicaid waiver expansion means an expansion of the medicaid program in accordance with this section a before january the department shall apply to cms for approval of a waiver or state plan amendment to implement the medicaid waiver expansion b the medicaid waiver expansion shall i expand medicaid coverage to eligible individuals whose income is below of the federal poverty level ii obtain maximum federal financial participation under u s c sec d y for enrolling an individual in the medicaid program iii provide medicaid benefits through the state s medicaid accountable care organizations in areas where a medicaid accountable care organization is implemented iv integrate the delivery of behavioral health services and physical health services with medicaid accountable care organizations in select geographic areas of the state that choose an integrated model v include a path to self sufficiency including work activities as defined in u s c sec d for qualified adults vi require an individual who is offered a private health benefit plan by an employer to enroll in the employer s health plan vii sunset in accordance with subsection a and viii permit the state to close enrollment in the medicaid waiver expansion if the department has insufficient funding to provide services to additional eligible individuals if the medicaid waiver described in subsection a is approved the department may only pay the state portion of costs for the medicaid waiver expansion with appropriations from a the medicaid expansion fund created in section b b b county contributions to the non federal share of medicaid expenditures and c any other contributions funds or transfers from a non state agency for medicaid expenditures a in consultation with the department medicaid accountable care organizations and counties that elect to integrate care under subsection b iv shall collaborate on enrollment engagement of patients and coordination of services b as part of the provision described in subsection b iv the department shall apply for a waiver to permit the creation of an integrated delivery system i for any geographic area that expresses interest in integrating the delivery of services under subsection b iv and ii in which the department a may permit a local mental health authority to integrate the delivery of behavioral health services and physical health services b may permit a county local mental health authority or medicaid accountable care organization to integrate the delivery of behavioral health services and physical health services to select groups within the population that are newly eligible under the medicaid waiver expansion and c may make rules in accordance with title g chapter utah administrative rulemaking act to integrate payments for behavioral health services and physical health services to plans or providers a if federal financial participation for the medicaid waiver expansion is reduced below the authority of the department to implement the medicaid waiver expansion shall sunset no later than the next july after the date on which the federal financial participation is reduced b the department shall close the program to new enrollment if the cost of the medicaid waiver expansion is projected to exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act if the medicaid waiver expansion is approved by cms the department shall report to the social services appropriations subcommittee on or before november of each year that the medicaid waiver expansion is operational a the number of individuals who enrolled in the medicaid waiver program b costs to the state for the medicaid waiver program c estimated costs for the current and following state fiscal year and d recommendations to control costs of the medicaid waiver expansion section section b which is renumbered from section is renumbered and amended to read b primary care network enhancement waiver program as used in this section a enhancement waiver program means the primary care network enhancement waiver program described in this section b federal poverty level means the poverty guidelines established by the secretary of the united states department of health and human services under u s c sec c health coverage improvement program means the same as that term is defined in section b d income eligibility ceiling means the percentage of federal poverty level i established by the legislature in an appropriations act adopted pursuant to title j chapter budgetary procedures act and ii under which an individual may qualify for coverage in the enhancement waiver program in accordance with this section e optional population means the optional expansion population under ppaca if the expansion provides coverage for individuals at or above of the federal poverty level f primary care network means the state primary care network program created by the medicaid primary care network demonstration waiver obtained under section b the department shall continue to implement the primary care network program for qualified individuals under the primary care network program a the division shall apply for a medicaid waiver or a state plan amendment with cms to implement within the state medicaid program the enhancement waiver program described in this section within six months after the day on which i the division receives a notice from cms that the waiver for the medicaid waiver expansion submitted under section b medicaid waiver expansion will not be approved or ii the division withdraws the waiver for the medicaid waiver expansion submitted under section b medicaid waiver expansion b the division may not apply for a waiver under subsection a while a waiver request under section b medicaid waiver expansion is pending with cms an individual who is eligible for the enhancement waiver program may receive the following benefits under the enhancement waiver program a the benefits offered under the primary care network program b diagnostic testing and procedures c medical specialty care d inpatient hospital services e outpatient hospital services f outpatient behavioral health care including outpatient substance abuse use care and g for an individual who qualifies for the health coverage improvement program as approved by cms temporary residential treatment for substance abuse use in a short term non institutional hour facility without a bed capacity limit that provides rehabilitation services that are medically necessary and in accordance with an individualized treatment plan an individual is eligible for the enhancement waiver program if at the time of enrollment a the individual is qualified to enroll in the primary care network or the health coverage improvement program b the individual s annual income is below the income eligibility ceiling established by the legislature under subsection d and c the individual meets the eligibility criteria established by the department under subsection a based on available funding and approval from cms the department shall determine the criteria for an individual to qualify for the enhancement waiver program based on the following priority i adults in the expansion population as defined in section b who qualify for the health coverage improvement program ii adults with dependent children who qualify for the health coverage improvement program under subsection b iii adults with dependent children who do not qualify for the health coverage improvement program and iv if funding is available adults without dependent children b the number of individuals enrolled in the enhancement waiver program may not exceed of the number of individuals who were enrolled in the primary care network on december c the department may only use appropriations from the medicaid expansion fund created in section b b to fund the state portion of the enhancement waiver program the department may request a modification of the income eligibility ceiling and the eligibility criteria under subsection from cms each fiscal year based on enrollment in the enhancement waiver program projected enrollment in the enhancement waiver program costs to the state and the state budget the department may implement the enhancement waiver program by contracting with medicaid accountable care organizations to administer the enhancement waiver program in accordance with subsections and b and the department may use funds that have been appropriated for the health coverage improvement program to implement the enhancement waiver program if the department expands the state medicaid program to the optional population the department a except as provided in subsection may not accept any new enrollees into the enhancement waiver program after the day on which the expansion to the optional population is effective b shall suspend the enhancement waiver program within one year after the day on which the expansion to the optional population is effective and c shall work with cms to maintain the waiver for the enhancement waiver program submitted under subsection while the enhancement waiver program is suspended under subsection b if after the expansion to the optional population described in subsection takes effect the expansion to the optional population is repealed by either the state or the federal government the department shall reinstate the enhancement waiver program and continue to accept new enrollees into the enhancement waiver program in accordance with the provisions of this section section section b which is renumbered from section is renumbered and amended to read b limited family planning services for low income individuals as used in this section a i family planning services means family planning services that are provided under the state medicaid program including a sexual health education and family planning counseling and b other medical diagnosis treatment or preventative care routinely provided as part of a family planning service visit ii family planning services do not include an abortion as that term is defined in section b low income individual means an individual who i has an income level that is equal to or below of the federal poverty level and ii does not qualify for full coverage under the medicaid program before july the division shall apply for a medicaid waiver or a state plan amendment with cms to a offer a program that provides family planning services to low income individuals and b receive a federal match rate of of state expenditures for family planning services provided under the waiver or state plan amendment section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for mental health crisis lines and mobile crisis outreach teams as used in this section a local mental health crisis line means the same as that term is defined in section a b b mental health crisis means i a mental health condition that manifests itself in an individual by symptoms of sufficient severity that a prudent layperson who possesses an average knowledge of mental health issues could reasonably expect the absence of immediate attention or intervention to result in a serious danger to the individual s health or well being or b a danger to the health or well being of others or ii a mental health condition that in the opinion of a mental health therapist or the therapist s designee requires direct professional observation or the intervention of a mental health therapist c i mental health crisis services means direct mental health services and on site intervention that a mobile crisis outreach team provides to an individual suffering from a mental health crisis including the provision of safety and care plans prolonged mental health services for up to days and referrals to other community resources ii mental health crisis services includes a local mental health crisis lines and b the statewide mental health crisis line d mental health therapist means the same as that term is defined in section e mobile crisis outreach team or mcot means a mobile team of medical and mental health professionals that in coordination with local law enforcement and emergency medical service personnel provides mental health crisis services f statewide mental health crisis line means the same as that term is defined in section a b in consultation with the department of human services and the behavioral health crisis response commission created in section c the department shall develop a proposal to amend the state medicaid plan to include mental health crisis services including the statewide mental health crisis line local mental health crisis lines and mobile crisis outreach teams by january the department shall apply for a medicaid waiver with cms if necessary to implement within the state medicaid program the mental health crisis services described in subsection section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for coverage of mental health services in schools as used in this section local education agency means a a school district b a charter school or c the utah schools for the deaf and the blind in consultation with the department of human services and the state board of education the department shall develop a proposal to allow the state medicaid program to reimburse a local education agency a local mental health authority or a private provider for covered mental health services provided a in accordance with section e and b i at a local education agency building or facility or ii by an employee or contractor of a local education agency before january the department shall apply to cms for a state plan amendment to implement the coverage described in subsection section section b which is renumbered from section is renumbered and amended to read b coverage for in vitro fertilization and genetic testing as used in this section a qualified condition means i cystic fibrosis ii spinal muscular atrophy iii morquio syndrome iv myotonic dystrophy or v sickle cell anemia b qualified enrollee means an individual who i is enrolled in the medicaid program ii has been diagnosed by a physician as having a genetic trait associated with a qualified condition and iii intends to get pregnant with a partner who is diagnosed by a physician as having a genetic trait associated with the same qualified condition as the individual before january the department shall apply for a medicaid waiver or a state plan amendment with the centers for medicare and medicaid services within the united states department of health and human services to implement the coverage described in subsection if the waiver described in subsection is approved the medicaid program shall provide coverage to a qualified enrollee for a in vitro fertilization services and b genetic testing of a qualified enrollee who receives in vitro fertilization services under subsection a the medicaid program may not provide the coverage described in subsection before the later of a the day on which the waiver described in subsection is approved and b january before november and before november of every third year thereafter the department shall a calculate the change in state spending attributable to the coverage under this section and b report the amount described in subsection a a to the health and human services interim committee and the social services appropriations subcommittee section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for fertility preservation services as used in this section a iatrogenic infertility means an impairment of fertility or reproductive functioning caused by surgery chemotherapy radiation or other medical treatment b physician means an individual licensed to practice under title chapter utah medical practice act or title chapter utah osteopathic medical practice act c qualified enrollee means an individual who i is enrolled in the medicaid program ii has been diagnosed with a form of cancer by a physician and iii needs treatment for that cancer that may cause a substantial risk of sterility or iatrogenic infertility including surgery radiation or chemotherapy d standard fertility preservation service means a fertility preservation procedure and service that i is not considered experimental or investigational by the american society for reproductive medicine or the american society of clinical oncology and ii is consistent with established medical practices or professional guidelines published by the american society for reproductive medicine or the american society of clinical oncology including a sperm banking b oocyte banking c embryo banking d banking of reproductive tissues and e storage of reproductive cells and tissues before january the department shall apply for a medicaid waiver or a state plan amendment with cms to implement the coverage described in subsection if the waiver or state plan amendment described in subsection is approved the medicaid program shall provide coverage to a qualified enrollee for standard fertility preservation services the medicaid program may not provide the coverage described in subsection before the later of a the day on which the waiver described in subsection is approved and b january before november and before november of each third year after the department shall a calculate the change in state spending attributable to the coverage described in this section and b report the amount described in subsection a to the health and human services interim committee and the social services appropriations subcommittee section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for coverage of qualified inmates leaving prison or jail as used in this section a correctional facility means i a county jail ii the department of corrections created in section or iii a prison penitentiary or other institution operated by or under contract with the department of corrections for the confinement of an offender as defined in section b qualified inmate means an individual who i is incarcerated in a correctional facility and ii has a a chronic physical or behavioral health condition b a mental illness as defined in section a b or c an opioid use disorder before july the division shall apply for a medicaid waiver or a state plan amendment with cms to offer a program to provide medicaid coverage to a qualified inmate for up to days immediately before the day on which the qualified inmate is released from a correctional facility if the waiver or state plan amendment described in subsection is approved the department shall report to the health and human services interim committee each year before november while the waiver or state plan amendment is in effect regarding a the number of qualified inmates served under the program b the cost of the program and c the effectiveness of the program including i any reduction in the number of emergency room visits or hospitalizations by inmates after release from a correctional facility ii any reduction in the number of inmates undergoing inpatient treatment after release from a correctional facility iii any reduction in overdose rates and deaths of inmates after release from a correctional facility and iv any other costs or benefits as a result of the program if the waiver or state plan amendment described in subsection is approved a county that is responsible for the cost of a qualified inmate s medical care shall provide the required matching funds to the state for a any costs to enroll the qualified inmate for the medicaid coverage described in subsection b any administrative fees for the medicaid coverage described in subsection and c the medicaid coverage that is provided to the qualified inmate under subsection section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for inpatient care in an institution for mental diseases as used in this section institution for mental diseases means the same as that term is defined in c f r sec before august the division shall apply for a medicaid waiver or a state plan amendment with cms to offer a program that provides reimbursement for mental health services that are provided a in an institution for mental diseases that includes more than beds and b to an individual who receives mental health services in an institution for mental diseases for a period of more than days in a calendar month if the waiver or state plan amendment described in subsection is approved the department shall a coordinate with the department of human services to develop and offer the program described in subsection and b submit to the health and human services interim committee and the social services appropriations subcommittee any report that the department submits to cms that relates to the budget neutrality independent waiver evaluation or performance metrics of the program described in subsection within days after the day on which the report is submitted to cms notwithstanding sections and if the waiver or state plan amendment described in subsection is approved a county does not have to provide matching funds to the state for the mental health services described in subsection that are provided to an individual who qualifies for medicaid coverage under section or section b or b section section b which is renumbered from section is renumbered and amended to read b reimbursement for crisis management services provided in a behavioral health receiving center integration of payment for physical health services as used in this section a accountable care organization means the same as that term is defined in section b b behavioral health receiving center means the same as that term is defined in section a b c crisis management services means behavioral health services provided to an individual who is experiencing a mental health crisis d managed care organization means the same as that term is defined in c f r sec before july the division shall apply for a medicaid waiver or state plan amendment with cms to offer a program that provides reimbursement through a bundled daily rate for crisis management services that are delivered to an individual during the individual s stay at a behavioral health receiving center if the waiver or state plan amendment described in subsection is approved the department shall a implement the program described in subsection and b require a managed care organization that contracts with the state s medicaid program for behavioral health services or integrated health services to provide coverage for crisis management services that are delivered to an individual during the individual s stay at a behavioral health receiving center a the department may elect to integrate payment for physical health services provided in a behavioral health receiving center b in determining whether to integrate payment under subsection a the department shall consult with accountable care organizations and counties in the state section section b which is renumbered from section is renumbered and amended to read b crisis services reimbursement the department department shall submit a waiver or state plan amendment to allow for reimbursement for services provided to an individual who is eligible and enrolled in medicaid at the time this service is provided section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for respite care facility that provides services to homeless individuals as used in this section a adult in the expansion population means an adult i described in u s c sec a a a i viii and ii not otherwise eligible for medicaid as a mandatory categorically needy individual b homeless means the same as that term is defined in section b c medical respite care means short term housing with supportive medical services d medical respite facility means a residential facility that provides medical respite care to homeless individuals before january the department shall apply for a medicaid waiver or state plan amendment with cms to choose a single medical respite facility to reimburse for services provided to an individual who is a homeless and b an adult in the expansion population the department shall choose a medical respite facility best able to serve homeless individuals who are adults in the expansion population if the waiver or state plan amendment described in subsection is approved while the waiver or state plan amendment is in effect the department shall submit a report to the health and human services interim committee each year before november detailing a the number of homeless individuals served at the facility b the cost of the program and c the reduction of health care costs due to the program s implementation through administrative rule made in accordance with title g chapter utah administrative rulemaking act the department shall further define and limit the services described in this section provided to a homeless individual section section b which is renumbered from section is renumbered and amended to read b medicaid waiver expansion for extraordinary care reimbursement as used in this section a existing home and community based services waiver means an existing home and community based services waiver in the state that serves an individual i with an acquired brain injury ii with an intellectual or physical disability or iii who is years old or older b personal care services means a service that i is furnished to an individual who is not an inpatient nor a resident of a hospital nursing facility intermediate care facility or institution for mental diseases ii is authorized for an individual described in subsection b i in accordance with a plan of treatment iii is provided by an individual who is qualified to provide the services and iv is furnished in a home or another community based setting c waiver enrollee means an individual who is enrolled in an existing home and community based services waiver before july the department shall apply with cms for an amendment to an existing home and community based services waiver to implement a program to offer reimbursement to an individual who provides personal care services that constitute extraordinary care to a waiver enrollee who is the individual s spouse if cms approves the amendment described in subsection the department shall implement the program described in subsection the department shall by rule made in accordance with title g chapter utah administrative rulemaking act define extraordinary care for purposes of subsection section section b which is renumbered from section is renumbered and amended to read b delivery system adjustments for the targeted adult medicaid program as used in this section targeted adult medicaid program means the same as that term is defined in section b the department may implement the delivery system adjustments authorized under subsection only on the later of a july and b the department determining that the medicaid program including providers and managed care organizations are satisfying the metrics established in collaboration with the working group convened under subsection b the department may for individuals who are enrolled in the targeted adult medicaid program a integrate the delivery of behavioral and physical health in certain counties and b deliver behavioral health services through an accountable care organization where implemented before implementing the delivery system adjustments described in subsection in a county the department shall at a minimum seek input from a individuals who qualify for the targeted adult medicaid program who reside in the county b the county s executive officer legislative body and other county officials who are involved in the delivery of behavioral health services c the local mental health authority and local substance use abuse authority that serves the county d medicaid managed care organizations operating in the state including medicaid accountable care organizations e providers of physical or behavioral health services in the county who provide services to enrollees in the targeted adult medicaid program in the county and f other individuals that the department deems necessary if the department provides medicaid coverage through a managed care delivery system under this section the department shall include language in the department s managed care contracts that require the managed care plan to a be in compliance with federal medicaid managed care requirements b timely and accurately process authorizations and claims in accordance with medicaid policy and contract requirements c adequately reimburse providers to maintain adequacy of access to care d provide care management services sufficient to meet the needs of medicaid eligible individuals enrolled in the managed care plan s plan and e timely resolve any disputes between a provider or enrollee with the managed care plan the department may take corrective action if the managed care organization fails to comply with the terms of the managed care organization s contract section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for increased integrated health care reimbursement as used in this section a integrated health care setting means a health care or behavioral health care setting that provides integrated physical and behavioral health care services b local mental health authority means a local mental health authority described in section the department shall develop a proposal to allow the state medicaid program to reimburse a local mental health authority for covered physical health care services provided in an integrated health care setting to medicaid eligible individuals before december the department shall apply for a medicaid waiver or a state plan amendment with cms to implement the proposal described in subsection if the waiver or state plan amendment described in subsection is approved the department shall a implement the proposal described in subsection and b while the waiver or state plan amendment is in effect submit a report to the health and human services interim committee each year before november detailing i the number of patients served under the waiver or state plan amendment ii the cost of the waiver or state plan amendment and iii any benefits of the waiver or state plan amendment section section b which is renumbered from section is renumbered and amended to read part administration of medicaid programs drug utilization review and long term care facility certification b definitions as used in this part appropriate and medically necessary means regarding drug prescribing dispensing and patient usage that it is in conformity with the criteria and standards developed in accordance with this part board means the drug utilization review board created in section b certified program means a nursing care facility program with medicaid certification compendia means resources widely accepted by the medical profession in the efficacious use of drugs including american hospital formulary services service drug information u s pharmacopeia drug information a m a drug evaluations peer reviewed medical literature and information provided by manufacturers of drug products counseling means the activities conducted by a pharmacist to inform medicaid recipients about the proper use of drugs as required by the board under this part criteria means those predetermined and explicitly accepted elements used to measure drug use on an ongoing basis in order to determine if the use is appropriate medically necessary and not likely to result in adverse medical outcomes drug disease contraindications means that the therapeutic effect of a drug is adversely altered by the presence of another disease condition drug interactions means that two or more drugs taken by a recipient lead to clinically significant toxicity that is characteristic of one or any of the drugs present or that leads to interference with the effectiveness of one or any of the drugs drug utilization review or dur means the program designed to measure and assess on a retrospective and prospective basis the proper use of outpatient drugs in the medicaid program intervention means a form of communication utilized by the board with a prescriber or pharmacist to inform about or influence prescribing or dispensing practices medicaid certification means the right of a nursing care facility as a provider of a nursing care facility program to receive medicaid reimbursement for a specified number of beds within the facility a nursing care facility means the following facilities licensed by the department under chapter part health care facility licensing and inspection i skilled nursing facilities ii intermediate care facilities and iii an intermediate care facility for people with an intellectual disability b nursing care facility does not mean a critical access hospital that meets the criteria of u s c sec i c nursing care facility program means the personnel licenses services contracts and all other requirements that shall be met for a nursing care facility to be eligible for medicaid certification under this part and division rule overutilization or underutilization means the use of a drug in such quantities that the desired therapeutic goal is not achieved pharmacist means a person licensed in this state to engage in the practice of pharmacy under title chapter b pharmacy practice act physical facility means the buildings or other physical structures where a nursing care facility program is operated physician means a person licensed in this state to practice medicine and surgery under section or osteopathic medicine under section prospective dur means that part of the drug utilization review program that occurs before a drug is dispensed and that is designed to screen for potential drug therapy problems based on explicit and predetermined criteria and standards retrospective dur means that part of the drug utilization review program that assesses or measures drug use based on an historical review of drug use data against predetermined and explicit criteria and standards on an ongoing basis with professional input rural county means a county with a population of less than as determined by a the most recent official census or census estimate of the united states bureau of the census or b the most recent population estimate for the county from the utah population committee if a population figure for the county is not available under subsection a service area means the boundaries of the distinct geographic area served by a certified program as determined by the division in accordance with this part and division rule standards means the acceptable range of deviation from the criteria that reflects local medical practice and that is tested on the medicaid recipient database surs means the surveillance utilization review system of the medicaid program therapeutic appropriateness means drug prescribing and dispensing based on rational drug therapy that is consistent with criteria and standards therapeutic duplication means prescribing and dispensing the same drug or two or more drugs from the same therapeutic class where periods of drug administration overlap and where that practice is not medically indicated urban county means a county that is not a rural county section section b which is renumbered from section is renumbered and amended to read b dur board creation and membership expenses there is created a member drug utilization review board responsible for implementation of a retrospective and prospective dur program a except as required by subsection b as terms of current board members expire the executive director shall appoint each new member or reappointed member to a four year term b notwithstanding the requirements of subsection a the executive director shall at the time of appointment or reappointment adjust the length of terms to ensure that the terms of board members are staggered so that approximately half of the board is appointed every two years c persons appointed to the board may be reappointed upon completion of their terms but may not serve more than two consecutive terms d the executive director shall provide for geographic balance in representation on the board when a vacancy occurs in the membership for any reason the replacement shall be appointed for the unexpired term the membership shall be comprised of the following a four physicians who are actively engaged in the practice of medicine or osteopathic medicine in this state to be selected from a list of nominees provided by the utah medical association b one physician in this state who is actively engaged in academic medicine c three pharmacists who are actively practicing in retail pharmacy in this state to be selected from a list of nominees provided by the utah pharmaceutical association d one pharmacist who is actively engaged in academic pharmacy e one person who shall represent consumers f one person who shall represent pharmaceutical manufacturers to be recommended by the pharmaceutical manufacturers association and g one dentist licensed to practice in this state under title chapter dentist and dental hygienist practice act who is actively engaged in the practice of dentistry nominated by the utah dental association physician and pharmacist members of the board shall have expertise in clinically appropriate prescribing and dispensing of outpatient drugs the board shall elect a chair from among its members who shall serve a one year term and may serve consecutive terms a member may not receive compensation or benefits for the member s service but may receive per diem and travel expenses in accordance with a section a b section a and c rules made by the division of finance pursuant to sections a and a section section b which is renumbered from section is renumbered and amended to read b dur board responsibilities the board shall develop rules necessary to carry out its responsibilities as defined in this part oversee the implementation of a medicaid retrospective and prospective dur program in accordance with this part including responsibility for approving provisions of contractual agreements between the medicaid program and any other entity that will process and review medicaid drug claims and profiles for the dur program in accordance with this part develop and apply predetermined criteria and standards to be used in retrospective and prospective dur ensuring that the criteria and standards are based on the compendia and that they are developed with professional input in a consensus fashion with provisions for timely revision and assessment as necessary the dur standards developed by the board shall reflect the local practices of physicians in order to monitor a therapeutic appropriateness b overutilization or underutilization c therapeutic duplication d drug disease contraindications e drug drug interactions f incorrect drug dosage or duration of drug treatment and g clinical abuse and misuse develop select apply and assess interventions and remedial strategies for physicians pharmacists and recipients that are educational and not punitive in nature in order to improve the quality of care disseminate information to physicians and pharmacists to ensure that they are aware of the board s duties and powers provide written oral or electronic reminders of patient specific or drug specific information designed to ensure recipient physician and pharmacist confidentiality and suggest changes in prescribing or dispensing practices designed to improve the quality of care utilize face to face discussions between experts in drug therapy and the prescriber or pharmacist who has been targeted for educational intervention conduct intensified reviews or monitoring of selected prescribers or pharmacists create an educational program using data provided through dur to provide active and ongoing educational outreach programs to improve prescribing and dispensing practices either directly or by contract with other governmental or private entities provide a timely evaluation of intervention to determine if those interventions have improved the quality of care publish the annual drug utilization review report required under c f r sec develop a working agreement with related boards or agencies including the state board of pharmacy physicians licensing board and surs staff within the division in order to clarify areas of responsibility for each where those areas may overlap establish a grievance process for physicians and pharmacists under this part in accordance with title g chapter administrative procedures act publish and disseminate educational information to physicians and pharmacists concerning the board and the dur program including information regarding a identification and reduction of the frequency of patterns of fraud abuse gross overuse inappropriate or medically unnecessary care among physicians pharmacists and recipients b potential or actual severe or adverse reactions to drugs c therapeutic appropriateness d overutilization or underutilization e appropriate use of generics f therapeutic duplication g drug disease contraindications h drug drug interactions i incorrect drug dosage and duration of drug treatment j drug allergy interactions and k clinical abuse and misuse develop and publish with the input of the state board of pharmacy guidelines and standards to be used by pharmacists in counseling medicaid recipients in accordance with this part the guidelines shall ensure that the recipient may refuse counseling and that the refusal is to be documented by the pharmacist items to be discussed as part of that counseling include a the name and description of the medication b administration form and duration of therapy c special directions and precautions for use d common severe side effects or interactions and therapeutic interactions and how to avoid those occurrences e techniques for self monitoring drug therapy f proper storage g prescription refill information and h action to be taken in the event of a missed dose and establish procedures in cooperation with the state board of pharmacy for pharmacists to record information to be collected under this part the recorded information shall include a the name address age and gender of the recipient b individual history of the recipient where significant including disease state known allergies and drug reactions and a comprehensive list of medications and relevant devices c the pharmacist s comments on the individual s drug therapy d name of prescriber and e name of drug dose duration of therapy and directions for use section section b which is renumbered from section is renumbered and amended to read b confidentiality of records information obtained under this part shall be treated as confidential or controlled information under title g chapter government records access and management act the board shall establish procedures insuring ensuring that the information described in subsection b is held confidential by the pharmacist being provided to the physician only upon request the board shall adopt and implement procedures designed to ensure the confidentiality of all information collected stored retrieved assessed or analyzed by the board staff to the board or contractors to the dur program that identifies individual physicians pharmacists or recipients the board may have access to identifying information for purposes of carrying out intervention activities but that identifying information may not be released to anyone other than a member of the board the board may release cumulative nonidentifying information for research purposes section section b which is renumbered from section is renumbered and amended to read b drug prior approval program a drug prior approval program approved or implemented by the board shall meet the following conditions a except as provided in subsection a drug may not be placed on prior approval for other than medical reasons b the board shall hold a public hearing at least days prior to placing a drug on prior approval c notwithstanding the provisions of section the board shall provide not less than days notice to the public before holding a public hearing under subsection b d the board shall consider written and oral comments submitted by interested parties prior to or during the hearing held in accordance with subsection b e the board shall provide evidence that placing a drug class on prior approval i will not impede quality of recipient care and ii that the drug class is subject to clinical abuse or misuse f the board shall reconsider its decision to place a drug on prior approval i no later than nine months after any drug class is placed on prior approval and ii at a public hearing with notice as provided in subsection b g the program shall provide an approval or denial of a request for prior approval i by either a fax b telephone or c electronic transmission ii at least monday through friday except for state holidays and iii within hours after receipt of the prior approval request h the program shall provide for the dispensing of at least a hour supply of the drug on the prior approval program i in an emergency situation or ii on weekends or state holidays i the program may be applied to allow acceptable medical use of a drug on prior approval for appropriate off label indications and j before placing a drug class on the prior approval program the board shall i determine that the requirements of subsections a through i have been met and ii by majority vote place the drug class on prior approval the board may only after complying with subsections b through j consider the cost a of a drug when placing a drug on the prior approval program and b associated with including or excluding a drug from the prior approval process including i potential side effects associated with a drug or ii potential hospitalizations or other complications that may occur as a result of a drug s inclusion on the prior approval process section section b which is renumbered from section is renumbered and amended to read b advisory committees the board may establish advisory committees to assist it in carrying out its duties under this part sections b through b section section b which is renumbered from section is renumbered and amended to read b retrospective and prospective dur the board in cooperation with the division shall include in its state plan the creation and implementation of a retrospective and prospective dur program for medicaid outpatient drugs to ensure that prescriptions are appropriate medically necessary and not likely to result in adverse medical outcomes the retrospective and prospective dur program shall be operated under guidelines established by the board under subsections and the retrospective dur program shall be based on guidelines established by the board using the mechanized drug claims processing and information retrieval system to analyze claims data in order to a identify patterns of fraud abuse gross overuse and inappropriate or medically unnecessary care and b assess data on drug use against explicit predetermined standards that are based on the compendia and other sources for the purpose of monitoring i therapeutic appropriateness ii overutilization or underutilization iii therapeutic duplication iv drug disease contraindications v drug drug interactions vi incorrect drug dosage or duration of drug treatment and vii clinical abuse and misuse the prospective dur program shall be based on guidelines established by the board and shall provide that before a prescription is filled or delivered a review will be conducted by the pharmacist at the point of sale to screen for potential drug therapy problems resulting from a therapeutic duplication b drug drug interactions c incorrect dosage or duration of treatment d drug allergy interactions and e clinical abuse or misuse in conducting the prospective dur a pharmacist may not alter the prescribed outpatient drug therapy without the consent of the prescribing physician or physician assistant this section does not effect the ability of a pharmacist to substitute a generic equivalent section section b which is renumbered from section is renumbered and amended to read b penalties any person who violates the confidentiality provisions of this part sections b through b is guilty of a class b misdemeanor section section b which is renumbered from section is renumbered and amended to read b immunity there is no liability on the part of and no cause of action of any nature arises against any member of the board its agents or employees for any action or omission by them in effecting the provisions of this part sections b through b section section b which is renumbered from section is renumbered and amended to read b purpose medicaid certification of nursing care facilities the legislature finds a that an oversupply of nursing care facilities in the state adversely affects the state medicaid program and the health of the people in the state b it is in the best interest of the state to prohibit nursing care facilities from receiving medicaid certification except as provided by this part sections b through b and c it is in the best interest of the state to encourage aging nursing care facilities with medicaid certification to renovate the nursing care facilities physical facilities so that the quality of life and clinical services for medicaid residents are preserved medicaid reimbursement of nursing care facility programs is limited to a the number of nursing care facility programs with medicaid certification as of may and b additional nursing care facility programs approved for medicaid certification under the provisions of subsections b and the division may not a except as authorized by section b i process initial applications for medicaid certification or execute provider agreements with nursing care facility programs or ii reinstate medicaid certification for a nursing care facility whose certification expired or was terminated by action of the federal or state government or b execute a medicaid provider agreement with a certified program that moves to a different physical facility except as authorized by subsection b notwithstanding section b beginning may the division may not approve a new or additional bed in an intermediate care facility for individuals with an intellectual disability for medicaid certification unless certification of the bed by the division does not increase the total number in the state of medicaid certified beds in intermediate care facilities for individuals with an intellectual disability section section b which is renumbered from section is renumbered and amended to read b authorization to renew transfer or increase medicaid certified programs reimbursement methodology a the division may renew medicaid certification of a certified program if the program without lapse in service to medicaid recipients has its nursing care facility program certified by the division at the same physical facility as long as the licensed and certified bed capacity at the facility has not been expanded unless the director has approved additional beds in accordance with subsection b the division may renew medicaid certification of a nursing care facility program that is not currently certified if i since the day on which the program last operated with medicaid certification a the physical facility where the program operated has functioned solely and continuously as a nursing care facility and b the owner of the program has not under this section or section b transferred to another nursing care facility program the license for any of the medicaid beds in the program and ii except as provided in subsection b the number of beds granted renewed medicaid certification does not exceed the number of beds certified at the time the program last operated with medicaid certification excluding a period of time where the program operated with temporary certification under subsection b a the division may issue a medicaid certification for a new nursing care facility program if a current owner of the medicaid certified program transfers its ownership of the medicaid certification to the new nursing care facility program and the new nursing care facility program meets all of the following conditions i the new nursing care facility program operates at the same physical facility as the previous medicaid certified program ii the new nursing care facility program gives a written assurance to the director in accordance with subsection iii the new nursing care facility program receives the medicaid certification within one year of the date the previously certified program ceased to provide medical assistance to a medicaid recipient and iv the licensed and certified bed capacity at the facility has not been expanded unless the director has approved additional beds in accordance with subsection b a nursing care facility program that receives medicaid certification under the provisions of subsection a does not assume the medicaid liabilities of the previous nursing care facility program if the new nursing care facility program i is not owned in whole or in part by the previous nursing care facility program or ii is not a successor in interest of the previous nursing care facility program the division may issue a medicaid certification to a nursing care facility program that was previously a certified program but now resides in a new or renovated physical facility if the nursing care facility program meets all of the following a the nursing care facility program met all applicable requirements for medicaid certification at the time of closure b the new or renovated physical facility is in the same county or within a five mile radius of the original physical facility c the time between which the certified program ceased to operate in the original facility and will begin to operate in the new physical facility is not more than three years unless i an emergency is declared by the president of the united states or the governor affecting the building or renovation of the physical facility ii the director approves an exception to the three year requirement for any nursing care facility program within the three year requirement iii the provider submits documentation supporting a request for an extension to the director that demonstrates a need for an extension and iv the exception does not extend for more than two years beyond the three year requirement d if subsection c applies the certified program notifies the department within days after ceasing operations in its original facility of its intent to retain its medicaid certification e the provider gives written assurance to the director in accordance with subsection that no third party has a legitimate claim to operate a certified program at the previous physical facility and f the bed capacity in the physical facility has not been expanded unless the director has approved additional beds in accordance with subsection a the entity requesting medicaid certification under subsections and shall give written assurances satisfactory to the director or the director s designee that i no third party has a legitimate claim to operate the certified program ii the requesting entity agrees to defend and indemnify the department against any claims by a third party who may assert a right to operate the certified program and iii if a third party is found by final agency action of the department after exhaustion of all administrative and judicial appeal rights to be entitled to operate a certified program at the physical facility the certified program shall voluntarily comply with subsection b b if a finding is made under the provisions of subsection a iii i the certified program shall immediately surrender its medicaid certification and comply with division rules regarding billing for medicaid and the provision of services to medicaid patients and ii the department shall transfer the surrendered medicaid certification to the third party who prevailed under subsection a iii a the director may approve additional nursing care facility programs for medicaid certification or additional beds for medicaid certification within an existing nursing care facility program if a nursing care facility or other interested party requests medicaid certification for a nursing care facility program or additional beds within an existing nursing care facility program and the nursing care facility program or other interested party complies with this section b the nursing care facility or other interested party requesting medicaid certification for a nursing care facility program or additional beds within an existing nursing care facility program under subsection a shall submit to the director i proof of the following as reasonable evidence that bed capacity provided by medicaid certified programs within the county or group of counties impacted by the requested additional medicaid certification is insufficient a nursing care facility occupancy levels for all existing and proposed facilities will be at least for the next three years b current nursing care facility occupancy is or more or c there is no other nursing care facility within a mile radius of the nursing care facility requesting the additional certification and ii an independent analysis demonstrating that at projected occupancy rates the nursing care facility s after tax net income is sufficient for the facility to be financially viable c any request for additional beds as part of a renovation project are limited to the maximum number of beds allowed in subsection d the director shall determine whether to issue additional medicaid certification by considering i whether bed capacity provided by certified programs within the county or group of counties impacted by the requested additional medicaid certification is insufficient based on the information submitted to the director under subsection b ii whether the county or group of counties impacted by the requested additional medicaid certification is underserved by specialized or unique services that would be provided by the nursing care facility iii whether any medicaid certified beds are subject to a claim by a previous certified program that may reopen under the provisions of subsections and iv how additional bed capacity should be added to the long term care delivery system to best meet the needs of medicaid recipients and v a whether the existing certified programs within the county or group of counties have provided services of sufficient quality to merit at least a two star rating in the medicare five star quality rating system over the previous three year period and b information obtained under subsection the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act to adjust the medicaid nursing care facility property reimbursement methodology to a only pay that portion of the property component of rates representing actual bed usage by medicaid clients as a percentage of the greater of i actual occupancy or ii a for a nursing care facility other than a facility described in subsection a ii b of total bed capacity or b for a rural nursing care facility of total bed capacity and b not allow for increases in reimbursement for property values without major renovation or replacement projects as defined by the department by rule a except as provided in subsection b if a nursing care facility does not seek medicaid certification for a bed under subsections through the department shall notwithstanding subsections b a and b grant medicaid certification for additional beds in an existing medicaid certified nursing care facility that has or fewer licensed beds including medicaid certified beds in the facility if i the nursing care facility program was previously a certified program for all beds but now resides in a new facility or in a facility that underwent major renovations involving major structural changes with or greater facility square footage design changes requiring review and approval by the department ii the nursing care facility meets the quality of care regulations issued by cms and iii the total number of additional beds in the facility granted medicaid certification under this section does not exceed of the number of licensed beds in the facility b the department may not revoke the medicaid certification of a bed under this subsection as long as the provisions of subsection a ii are met a if a nursing care facility or other interested party indicates in its request for additional medicaid certification under subsection a that the facility will offer specialized or unique services but the facility does not offer those services after receiving additional medicaid certification the director shall revoke the additional medicaid certification b the nursing care facility program shall obtain medicaid certification for any additional medicaid beds approved under subsection or within three years of the date of the director s approval or the approval is void a if the director makes an initial determination that quality standards under subsection d v have not been met in a rural county or group of rural counties over the previous three year period the director shall before approving certification of additional medicaid beds in the rural county or group of counties i notify the certified program that has not met the quality standards in subsection d v that the director intends to certify additional medicaid beds under the provisions of subsection d v and ii consider additional information submitted to the director by the certified program in a rural county that has not met the quality standards under subsection d v b the notice under subsection a does not give the certified program that has not met the quality standards under subsection d v the right to legally challenge or appeal the director s decision to certify additional medicaid beds under subsection d v section section b which is renumbered from section is renumbered and amended to read b appeals of division decision rulemaking authority application of act a decision by the director under this part to deny medicaid certification for a nursing care facility program or to deny additional bed capacity for an existing certified program is subject to review under the procedures and requirements of title g chapter administrative procedures act the department shall make rules to administer and enforce this part sections b through b in accordance with title g chapter utah administrative rulemaking act a in the event the department is at risk for a federal disallowance with regard to a medicaid recipient being served in a nursing care facility program that is not medicaid certified the department may grant temporary medicaid certification to that facility for up to months b i the department may extend a temporary medicaid certification granted to a facility under subsection a a for the number of beds in the nursing care facility occupied by a medicaid recipient and b for the period of time during which the medicaid recipient resides at the facility ii a temporary medicaid certification granted under this subsection is revoked upon a the discharge of the patient from the facility or b the patient no longer residing at the facility for any reason c the department may place conditions on the temporary certification granted under subsections a and b such as i not allowing additional admissions of medicaid recipients to the program and ii not paying for the care of the patient after october with state only dollars section section b which is renumbered from section is renumbered and amended to read b authorization to sell or transfer licensed medicaid beds duties of transferor duties of transferee duties of division this section provides a method to transfer or sell the license for a medicaid bed from a nursing care facility program to another entity that is in addition to the authorization to transfer under section b a a nursing care facility program may transfer or sell one or more of its licenses for medicaid beds in accordance with subsection b if i at the time of the transfer and with respect to the license for the medicaid bed that will be transferred the nursing care facility program that will transfer the medicaid license meets all applicable regulations for medicaid certification ii the nursing care facility program gives a written assurance which is postmarked or has proof of delivery days before the transfer to the director and to the transferee in accordance with subsection b iii the nursing care facility program that will transfer the license for a medicaid bed notifies the division in writing which is postmarked or has proof of delivery days before the transfer of a the number of bed licenses that will be transferred b the date of the transfer and c the identity and location of the entity receiving the transferred licenses and iv if the nursing care facility program for which the license will be transferred or purchased is located in an urban county with a nursing care facility average annual occupancy rate over the previous two years less than or equal to the nursing care facility program transferring or selling the license demonstrates to the satisfaction of the director that the sale or transfer a will not result in an excessive number of medicaid certified beds within the county or group of counties that would be impacted by the transfer or sale and b best meets the needs of medicaid recipients b except as provided in subsection c a nursing care facility program may transfer or sell one or more of its licenses for medicaid beds to i a nursing care facility program that has the same owner or successor in interest of the same owner ii a nursing care facility program that has a different owner or iii a related party nonnursing care facility entity that wants to hold one or more of the licenses for a nursing care facility program not yet identified as long as a the licenses are subsequently transferred or sold to a nursing care facility program within three years and b the nursing care facility program notifies the director of the transfer or sale in accordance with subsection a iii c a nursing care facility program may not transfer or sell one or more of its licenses for medicaid beds to an entity under subsection b i ii or iii that is located in a rural county unless the entity requests and the director issues medicaid certification for the beds under subsection b a nursing care facility program or entity under subsection b i ii or iii that receives or purchases a license for a medicaid bed under subsection b a may receive a license for a medicaid bed from more than one nursing care facility program b shall give the division notice which is postmarked or has proof of delivery within days of the nursing care facility program or entity seeking medicaid certification of beds in the nursing care facility program or entity of the total number of licenses for medicaid beds that the entity received and who it received the licenses from c may only seek medicaid certification for the number of licensed beds in the nursing care facility program equal to the total number of licenses for medicaid beds received by the entity d does not have to demonstrate need or seek approval for the medicaid licensed bed under subsection b except as provided in subsections a iv and c e shall meet the standards for medicaid certification other than those in subsection b including personnel services contracts and licensing of facilities under chapter health care facility licensing and inspection act chapter part health care facility licensing and inspection and f shall obtain medicaid certification for the licensed medicaid beds within three years of the date of transfer as documented under subsection a iii b a when the division receives notice of a transfer of a license for a medicaid bed under subsection a iii a the department shall reduce the number of licenses for medicaid beds at the transferring nursing care facility i equal to the number of licenses transferred and ii effective on the date of the transfer as reported under subsection a iii b b for purposes of section b the division shall approve medicaid certification for the receiving nursing care facility program or entity i in accordance with the formula established in subsection c and ii if a the nursing care facility seeks medicaid certification for the transferred licenses within the time limit required by subsection f and b the nursing care facility program meets other requirements for medicaid certification under subsection e c a license for a medicaid bed may not be approved for medicaid certification without meeting the requirements of sections and b and b if i the license for a medicaid bed is transferred under this section but the receiving entity does not obtain medicaid certification for the licensed bed within the time required by subsection f or ii the license for a medicaid bed is transferred under this section but the license is no longer eligible for medicaid certification section section b which is renumbered from section a is renumbered and amended to read part nursing care facility assessment a b definitions as used in this chapter part a nursing care facility means i a nursing care facility described in subsection as defined in section b ii beginning january a designated swing bed in a a general acute hospital as defined in subsection section b and b a critical access hospital which meets the criteria of u s c sec i c and iii an intermediate care facility for people with an intellectual disability that is licensed under section b b nursing care facility does not include i the utah state developmental center ii the utah state hospital iii a general acute hospital specialty hospital or small health care facility as those terms are defined in section b or iv a utah state veterans home patient day means each calendar day in which an individual patient is admitted to the nursing care facility during a calendar month even if on a temporary leave of absence from the facility section section b which is renumbered from section a is renumbered and amended to read a b legislative findings the legislature finds that there is an important state purpose to improve the quality of care given to persons who are elderly and to people who have a disability in long term care nursing facilities the legislature finds that in order to improve the quality of care to those persons described in subsection the rates paid to the nursing care facilities by the medicaid program must be adequate to encourage and support quality care the legislature finds that in order to meet the objectives in subsections and adequate funding must be provided to increase the rates paid to nursing care facilities providing services pursuant to the medicaid program section section b which is renumbered from section a is renumbered and amended to read a b collection remittance and payment of nursing care facilities assessment a beginning july an assessment is imposed upon each nursing care facility in the amount designated in subsection c b i the department shall establish by rule a uniform rate per non medicare patient day that may not exceed of the total gross revenue for services provided to patients of all nursing care facilities licensed in this state ii for purposes of subsection b i total revenue does not include charitable contribution received by a nursing care facility c the department shall calculate the assessment imposed under subsection a by multiplying the total number of patient days of care provided to non medicare patients by the nursing care facility as provided to the department pursuant to subsection a by the uniform rate established by the department pursuant to subsection b a the assessment imposed by this chapter part is due and payable on a monthly basis on or before the last day of the month next succeeding each monthly period b the collecting agent for this assessment shall be the department which is vested with the administration and enforcement of this chapter part including the right to audit records of a nursing care facility related to patient days of care for the facility c the department shall forward proceeds from the assessment imposed by this chapter part to the state treasurer for deposit in the expendable special revenue fund as specified in section a b each nursing care facility shall on or before the end of the month next succeeding each calendar monthly period file with the department a a report which includes i the total number of patient days of care the facility provided to non medicare patients during the preceding month ii the total gross revenue the facility earned as compensation for services provided to patients during the preceding month and iii any other information required by the department and b a return for the monthly period and shall remit with the return the assessment required by this chapter part to be paid for the period covered by the return each return shall contain information and be in the form the department prescribes by rule the assessment as computed in the return is an allowable cost for medicaid reimbursement purposes the department may by rule extend the time for making returns and paying the assessment each nursing care facility that fails to pay any assessment required to be paid to the state within the time required by this chapter part or that fails to file a return as required by this chapter part shall pay in addition to the assessment penalties and interest as provided in section a b section section b which is renumbered from section a is renumbered and amended to read a b penalties and interest the penalty for failure to file a return or pay the assessment due within the time prescribed by this chapter part is the greater of or of the assessment due on the return for failure to pay within days of a notice of deficiency of assessment required to be paid the penalty is the greater of or of the assessment due the penalty for underpayment of the assessment is as follows a if any underpayment of assessment is due to negligence the penalty is of the underpayment b if the underpayment of the assessment is due to intentional disregard of law or rule the penalty is of the underpayment for intent to evade the assessment the penalty is of the underpayment the rate of interest applicable to an underpayment of an assessment under this chapter part or an unpaid penalty under this chapter part is annually the department may waive the imposition of a penalty for good cause section section b which is renumbered from section a is renumbered and amended to read a b adjustment to nursing care facility medicaid reimbursement rates if federal law or regulation prohibits the money in the nursing care facilities provider assessment fund from being used in the manner set forth in subsection a b b the rates paid to nursing care facilities for providing services pursuant to the medicaid program shall be changed except as otherwise provided in subsection to the rates paid to nursing care facilities on june or if the legislature or the department has on or after july changed the rates paid to facilities through a manner other than the use of expenditures from the nursing care facilities provider assessment fund to the rates provided for by the legislature or the department section section b which is renumbered from section a is renumbered and amended to read a b intermediate care facility for people with an intellectual disability uniform rate an intermediate care facility for people with an intellectual disability is subject to all the provisions of this chapter part except that the department shall establish a uniform rate for an intermediate care facility for people with an intellectual disability that is based on the same formula specified for nursing care facilities under the provisions of subsection a b b and may be different than the uniform rate established for other nursing care facilities section section b which is renumbered from section b is renumbered and amended to read part inpatient hospital assessment b b definitions as used in this chapter part assessment means the inpatient hospital assessment established by this chapter part cms means the centers for medicare and medicaid services within the united states department of health and human services discharges means the number of total hospital discharges reported on a worksheet s part i column lines and of the medicare cost report for the applicable assessment year or b a similar report adopted by the department by administrative rule if the report under subsection a is no longer available division means the division of health care financing integrated healthcare within the department enhancement waiver program means the program established by the primary care network enhancement waiver program described in section b health coverage improvement program means the health coverage improvement program described in section b hospital share means the hospital share described in section b b medicaid accountable care organization means a managed care organization as defined in c f r sec that contracts with the department under the provisions of section b medicaid waiver expansion means a medicaid expansion in accordance with section or b or b medicare cost report means cms the cost report for electronic filing of hospitals a non state government hospital means a hospital owned by a non state government entity b non state government hospital does not include i the utah state hospital or ii a hospital owned by the federal government including the veterans administration hospital a private hospital means i a general acute hospital as defined in section b that is privately owned and operating in the state and ii a privately owned specialty hospital operating in the state including a privately owned hospital whose inpatient admissions are predominantly for a rehabilitation b psychiatric care c chemical dependency services or d long term acute care services b private hospital does not include a facility for residential treatment as defined in section a b state teaching hospital means a state owned teaching hospital that is part of an institution of higher education upper payment limit gap means the difference between the private hospital outpatient upper payment limit and the private hospital medicaid outpatient payments as determined in accordance with c f r sec section section b which is renumbered from section b is renumbered and amended to read b b application other than for the imposition of the assessment described in this chapter part nothing in this chapter part shall affect the nonprofit or tax exempt status of any nonprofit charitable religious or educational health care provider under any a state law b ad valorem property taxes c sales or use taxes or d other taxes fees or assessments whether imposed or sought to be imposed by the state or any political subdivision of the state all assessments paid under this chapter part may be included as an allowable cost of a hospital for purposes of any applicable medicaid reimbursement formula this chapter part does not authorize a political subdivision of the state to a license a hospital for revenue b impose a tax or assessment upon a hospital or c impose a tax or assessment measured by the income or earnings of a hospital section section b which is renumbered from section b is renumbered and amended to read b b assessment an assessment is imposed on each private hospital a beginning upon the later of cms approval of i the health coverage improvement program waiver under section b and ii the assessment under this chapter part b in the amount designated in sections b and b b and b and c in accordance with section b b subject to section b b the assessment imposed by this chapter part is due and payable on a quarterly basis after payment of the outpatient upper payment limit supplemental payments under section b b have been paid the first quarterly payment is not due until at least three months after the earlier of the effective dates of the coverage provided through a the health coverage improvement program b the enhancement waiver program or c the medicaid waiver expansion section section b which is renumbered from section b is renumbered and amended to read b b collection of assessment deposit of revenue rulemaking the collecting agent for the assessment imposed under section b b is the department the department is vested with the administration and enforcement of this chapter part and may make rules in accordance with title g chapter utah administrative rulemaking act necessary to a collect the assessment intergovernmental transfers and penalties imposed under this chapter part b audit records of a facility that i is subject to the assessment imposed by this chapter part and ii does not file a medicare cost report and c select a report similar to the medicare cost report if medicare no longer uses a medicare cost report the department shall a administer the assessment in this chapter part separately from the assessment in chapter d part hospital provider assessment act and b deposit assessments collected under this chapter part into the medicaid expansion fund created by section b b section section b which is renumbered from section b is renumbered and amended to read b b quarterly notice quarterly assessments imposed by this chapter part shall be paid to the division within business days after the original invoice date that appears on the invoice issued by the division the department may by rule extend the time for paying the assessment section section b which is renumbered from section b is renumbered and amended to read b b hospital financing of health coverage improvement program medicaid waiver expansion hospital share the hospital share is a of the state s net cost of the health coverage improvement program including medicaid coverage for individuals with dependent children up to the federal poverty level designated under section b b of the state s net cost of the enhancement waiver program c if the waiver for the medicaid waiver expansion is approved and d of the state s net cost of the upper payment limit gap a the hospital share is capped at no more than annually consisting of i an cap for the programs specified in subsections a through c and ii a cap for the program specified in subsection d b the department shall prorate the cap described in subsection a in any year in which the programs specified in subsections a and d are not in effect for the full fiscal year private hospitals shall be assessed under this chapter part for a of the portion of the hospital share for the programs specified in subsections a through c and b of the portion of the hospital share specified in subsection d a in the report described in subsection b the department shall calculate the state s net cost of each of the programs described in subsections a through c that are in effect for that year b if the assessment collected in the previous fiscal year is above or below the hospital share for private hospitals for the previous fiscal year the underpayment or overpayment of the assessment by the private hospitals shall be applied to the fiscal year in which the report is issued a medicaid accountable care organization shall on or before october of each year report to the department the following data from the prior state fiscal year for each private hospital state teaching hospital and non state government hospital provider that the medicaid accountable care organization contracts with a for the traditional medicaid population i hospital inpatient payments ii hospital inpatient discharges iii hospital inpatient days and iv hospital outpatient payments and b if the medicaid accountable care organization enrolls any individuals in the health coverage improvement program the enhancement waiver program or the medicaid waiver expansion for the population newly eligible for any of those programs i hospital inpatient payments ii hospital inpatient discharges iii hospital inpatient days and iv hospital outpatient payments the department shall by rule made in accordance with title g chapter utah administrative rulemaking act provide details surrounding specific content and format for the reporting by the medicaid accountable care organization section section b which is renumbered from section b is renumbered and amended to read b b calculation of assessment a except as provided in subsection b an annual assessment is payable on a quarterly basis for each private hospital in an amount calculated by the division at a uniform assessment rate for each hospital discharge in accordance with this section b a private teaching hospital with more than beds and residents shall pay an assessment rate times the uniform rate established under subsection c c the division shall calculate the uniform assessment rate described in subsection a by dividing the hospital share for assessed private hospitals described in subsections b and b b and by the sum of i the total number of discharges for assessed private hospitals that are not a private teaching hospital and ii times the number of discharges for a private teaching hospital described in subsection b d the division may by rule made in accordance with title g chapter utah administrative rulemaking act adjust the formula described in subsection c to address unforeseen circumstances in the administration of the assessment under this chapter part e any quarterly changes to the uniform assessment rate shall be applied uniformly to all assessed private hospitals except as provided in subsection for each state fiscal year the division shall determine a hospital s discharges as follows a for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june and b for each subsequent state fiscal year the hospital s cost report data for the hospital s fiscal year that ended in the state fiscal year two years before the assessment fiscal year a if a hospital s fiscal year medicare cost report is not contained in the cms healthcare cost report information system file i the hospital shall submit to the division a copy of the hospital s medicare cost report applicable to the assessment year and ii the division shall determine the hospital s discharges b if a hospital is not certified by the medicare program and is not required to file a medicare cost report i the hospital shall submit to the division the hospital s applicable fiscal year discharges with supporting documentation ii the division shall determine the hospital s discharges from the information submitted under subsection b i and iii failure to submit discharge information shall result in an audit of the hospital s records and a penalty equal to of the calculated assessment except as provided in subsection if a hospital is owned by an organization that owns more than one hospital in the state a the assessment for each hospital shall be separately calculated by the department and b each separate hospital shall pay the assessment imposed by this chapter part if multiple hospitals use the same medicaid provider number a the department shall calculate the assessment in the aggregate for the hospitals using the same medicaid provider number and b the hospitals may pay the assessment in the aggregate section section b which is renumbered from section b is renumbered and amended to read b b state teaching hospital and non state government hospital mandatory intergovernmental transfer the state teaching hospital and a non state government hospital shall make an intergovernmental transfer to the medicaid expansion fund created in section b b in accordance with this section the hospitals described in subsection shall pay the intergovernmental transfer beginning on the later of cms approval of a the health improvement program waiver under section b or b the assessment for private hospitals in this chapter part the intergovernmental transfer is apportioned as follows a the state teaching hospital is responsible for i of the portion of the hospital share specified in subsections b b a through c and ii of the hospital share specified in subsection b b d and b non state government hospitals are responsible for i of the portion of the hospital share specified in subsections b b a through c and ii of the hospital share specified in subsection b b d the department shall by rule made in accordance with title g chapter utah administrative rulemaking act designate a the method of calculating the amounts designated in subsection and b the schedule for the intergovernmental transfers section section b which is renumbered from section b is renumbered and amended to read b b penalties and interest a hospital that fails to pay a quarterly assessment make the mandated intergovernmental transfer or file a return as required under this chapter part within the time required by this chapter part shall pay penalties described in this section in addition to the assessment or intergovernmental transfer if a hospital fails to timely pay the full amount of a quarterly assessment or the mandated intergovernmental transfer the department shall add to the assessment or intergovernmental transfer a a penalty equal to of the quarterly amount not paid on or before the due date and b on the last day of each quarter after the due date until the assessed amount and the penalty imposed under subsection a are paid in full an additional penalty on i any unpaid quarterly assessment or intergovernmental transfer and ii any unpaid penalty assessment upon making a record of the division s actions and upon reasonable cause shown the division may waive reduce or compromise any of the penalties imposed under this chapter part section section b which is renumbered from section b is renumbered and amended to read b b hospital reimbursement if the health coverage improvement program the enhancement waiver program or the medicaid waiver expansion is implemented by contracting with a medicaid accountable care organization the department shall to the extent allowed by law include in a contract to provide benefits under the health coverage improvement program the enhancement waiver program or the medicaid waiver expansion a requirement that the medicaid accountable care organization reimburse hospitals in the accountable care organization s provider network at no less than the medicaid fee for service rate if the health coverage improvement program the enhancement waiver program or the medicaid waiver expansion is implemented by the department as a fee for service program the department shall reimburse hospitals at no less than the medicaid fee for service rate nothing in this section prohibits a medicaid accountable care organization from paying a rate that exceeds the medicaid fee for service rate section section b which is renumbered from section b is renumbered and amended to read b b outpatient upper payment limit supplemental payments beginning on the effective date of the assessment imposed under this chapter part and for each subsequent fiscal year the department shall implement an outpatient upper payment limit program for private hospitals that shall supplement the reimbursement to private hospitals in accordance with subsection the division shall ensure that supplemental payment to utah private hospitals under subsection a does not exceed the positive upper payment limit gap and b is allocated based on the medicaid state plan the department shall use the same outpatient data to allocate the payments under subsection and to calculate the upper payment limit gap the supplemental payments to private hospitals under subsection are payable for outpatient hospital services provided on or after the later of a july b the effective date of the medicaid state plan amendment necessary to implement the payments under this section or c the effective date of the coverage provided through the health coverage improvement program waiver section section b which is renumbered from section b is renumbered and amended to read b b repeal of assessment the assessment imposed by this chapter part shall be repealed when a the executive director certifies that i action by congress is in effect that disqualifies the assessment imposed by this chapter part from counting toward state medicaid funds available to be used to determine the amount of federal financial participation ii a decision enactment or other determination by the legislature or by any court officer department or agency of the state or of the federal government is in effect that a disqualifies the assessment from counting toward state medicaid funds available to be used to determine federal financial participation for medicaid matching funds or b creates for any reason a failure of the state to use the assessments for at least one of the medicaid programs described in this chapter part or iii a change is in effect that reduces the aggregate hospital inpatient and outpatient payment rate below the aggregate hospital inpatient and outpatient payment rate for july or b this chapter part is repealed in accordance with section i if the assessment is repealed under subsection a the division may not collect any assessment or intergovernmental transfer under this chapter part b the department shall disburse money in the special medicaid expansion fund in accordance with the requirements in subsection b b to the extent federal matching is not reduced by cms due to the repeal of the assessment c any money remaining in the medicaid expansion fund after the disbursement described in subsection b that was derived from assessments imposed by this chapter part shall be refunded to the hospitals in proportion to the amount paid by each hospital for the last three fiscal years and d any money remaining in the medicaid expansion fund after the disbursements described in subsections b and c shall be deposited into the general fund by the end of the fiscal year that the assessment is suspended section section b which is renumbered from section c is renumbered and amended to read part medicaid expansion hospital assessment c b definitions as used in this chapter part assessment means the medicaid expansion hospital assessment established by this chapter part cms means the centers for medicare and medicaid services within the united states department of health and human services discharges means the number of total hospital discharges reported on a worksheet s part i column lines and of the medicare cost report for the applicable assessment year or b a similar report adopted by the department by administrative rule if the report under subsection a is no longer available division means the division of health care financing integrated healthcare within the department hospital share means the hospital share described in section c b medicaid accountable care organization means a managed care organization as defined in c f r sec that contracts with the department under the provisions of section b medicaid expansion fund means the medicaid expansion fund created in section b b medicaid waiver expansion means the same as that term is defined in section b medicare cost report means cms the cost report for electronic filing of hospitals a non state government hospital means a hospital owned by a non state government entity b non state government hospital does not include i the utah state hospital or ii a hospital owned by the federal government including the veterans administration hospital a private hospital means i a privately owned general acute hospital operating in the state as defined in section b or ii a privately owned specialty hospital operating in the state including a privately owned hospital for which inpatient admissions are predominantly a rehabilitation b psychiatric c chemical dependency or d long term acute care services b private hospital does not include a facility for residential treatment as defined in section a b qualified medicaid expansion means an expansion of the medicaid program in accordance with subsection b state teaching hospital means a state owned teaching hospital that is part of an institution of higher education section section b which is renumbered from section c is renumbered and amended to read c b application other than for the imposition of the assessment described in this chapter part nothing in this chapter part shall affect the nonprofit or tax exempt status of any nonprofit charitable religious or educational health care provider under any a state law b ad valorem property tax requirement c sales or use tax requirement or d other requirements imposed by taxes fees or assessments whether imposed or sought to be imposed by the state or any political subdivision of the state a hospital paying an assessment under this chapter part may include the assessment as an allowable cost of a hospital for purposes of any applicable medicaid reimbursement formula this chapter part does not authorize a political subdivision of the state to a license a hospital for revenue b impose a tax or assessment upon a hospital or c impose a tax or assessment measured by the income or earnings of a hospital section section b which is renumbered from section c is renumbered and amended to read c b assessment an assessment is imposed on each private hospital a beginning upon the later of i april and ii cms approval of the assessment under this chapter part b in the amount designated in sections c and c b and b and c in accordance with section c b the assessment imposed by this chapter part is due and payable in accordance with subsection c b section section b which is renumbered from section c is renumbered and amended to read c b collection of assessment deposit of revenue rulemaking the department shall act as the collecting agent for the assessment imposed under section c b the department shall administer and enforce the provisions of this chapter part and may make rules in accordance with title g chapter utah administrative rulemaking act necessary to a collect the assessment intergovernmental transfers and penalties imposed under this chapter part b audit records of a facility that i is subject to the assessment imposed under this chapter part and ii does not file a medicare cost report and c select a report similar to the medicare cost report if medicare no longer uses a medicare cost report the department shall a administer the assessment in this part separately from the assessments in chapter d part hospital provider assessment act and chapter b and part inpatient hospital assessment act and b deposit assessments collected under this chapter part into the medicaid expansion fund a hospitals shall pay the quarterly assessments imposed by this chapter part to the division within business days after the original invoice date that appears on the invoice issued by the division b the department may make rules creating requirements to allow the time for paying the assessment to be extended section section b which is renumbered from section c is renumbered and amended to read c b hospital share the hospital share is a for the period from april through june and b beginning july of the state s net cost of the qualified medicaid expansion after deducting appropriate offsets and savings expected as a result of implementing the qualified medicaid expansion including i savings from a the primary care network program b the health coverage improvement program as defined in section b c the state portion of inpatient prison medical coverage d behavioral health coverage and e county contributions to the non federal share of medicaid expenditures and ii any funds appropriated to the medicaid expansion fund a beginning july the hospital share is capped at no more than annually b beginning july the division shall prorate the cap specified in subsection a in any year in which the qualified medicaid expansion is not in effect for the full fiscal year section section b which is renumbered from section c is renumbered and amended to read c b hospital financing private hospitals shall be assessed under this chapter part for the portion of the hospital share described in section c b in the report described in subsection b the department shall calculate the state s net cost of the qualified medicaid expansion if the assessment collected in the previous fiscal year is above or below the hospital share for private hospitals for the previous fiscal year the division shall apply the underpayment or overpayment of the assessment by the private hospitals to the fiscal year in which the report is issued section section b which is renumbered from section c is renumbered and amended to read c b calculation of assessment a except as provided in subsection b each private hospital shall pay an annual assessment due on the last day of each quarter in an amount calculated by the division at a uniform assessment rate for each hospital discharge in accordance with this section b a private teaching hospital with more than beds and more than residents shall pay an assessment rate times the uniform rate established under subsection c c the division shall calculate the uniform assessment rate described in subsection a by dividing the hospital share for assessed private hospitals as described in subsection c b by the sum of i the total number of discharges for assessed private hospitals that are not a private teaching hospital and ii times the number of discharges for a private teaching hospital described in subsection b d the division may make rules in accordance with title g chapter utah administrative rulemaking act to adjust the formula described in subsection c to address unforeseen circumstances in the administration of the assessment under this chapter part e the division shall apply any quarterly changes to the uniform assessment rate uniformly to all assessed private hospitals except as provided in subsection for each state fiscal year the division shall determine a hospital s discharges as follows a for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june and b for each subsequent state fiscal year the hospital s cost report data for the hospital s fiscal year that ended in the state fiscal year two years before the assessment fiscal year a if a hospital s fiscal year medicare cost report is not contained in the centers for medicare and medicaid services healthcare cost report information system file i the hospital shall submit to the division a copy of the hospital s medicare cost report applicable to the assessment year and ii the division shall determine the hospital s discharges b if a hospital is not certified by the medicare program and is not required to file a medicare cost report i the hospital shall submit to the division the hospital s applicable fiscal year discharges with supporting documentation ii the division shall determine the hospital s discharges from the information submitted under subsection b i and iii if the hospital fails to submit discharge information the division shall audit the hospital s records and may impose a penalty equal to of the calculated assessment except as provided in subsection if a hospital is owned by an organization that owns more than one hospital in the state a the division shall calculate the assessment for each hospital separately and b each separate hospital shall pay the assessment imposed by this chapter part if multiple hospitals use the same medicaid provider number a the department shall calculate the assessment in the aggregate for the hospitals using the same medicaid provider number and b the hospitals may pay the assessment in the aggregate section section b which is renumbered from section c is renumbered and amended to read c b state teaching hospital and non state government hospital mandatory intergovernmental transfer a state teaching hospital and a non state government hospital shall make an intergovernmental transfer to the medicaid expansion fund in accordance with this section the hospitals described in subsection shall pay the intergovernmental transfer beginning on the later of a april or b cms approval of the assessment for private hospitals in this chapter part the intergovernmental transfer is apportioned between the non state government hospitals as follows a the state teaching hospital shall pay for the portion of the hospital share described in section c b and b non state government hospitals shall pay for the portion of the hospital share described in section c b the department shall by rule made in accordance with title g chapter utah administrative rulemaking act designate a the method of calculating the amounts designated in subsection and b the schedule for the intergovernmental transfers section section b which is renumbered from section c is renumbered and amended to read c b penalties a hospital that fails to pay a quarterly assessment make the mandated intergovernmental transfer or file a return as required under this chapter part within the time required by this chapter part shall pay penalties described in this section in addition to the assessment or intergovernmental transfer if a hospital fails to timely pay the full amount of a quarterly assessment or the mandated intergovernmental transfer the department shall add to the assessment or intergovernmental transfer a a penalty equal to of the quarterly amount not paid on or before the due date and b on the last day of each quarter after the due date until the assessed amount and the penalty imposed under subsection a are paid in full an additional penalty on i any unpaid quarterly assessment or intergovernmental transfer and ii any unpaid penalty assessment upon making a record of the division s actions and upon reasonable cause shown the division may waive or reduce any of the penalties imposed under this chapter part section section b which is renumbered from section c is renumbered and amended to read c b hospital reimbursement if the qualified medicaid expansion is implemented by contracting with a medicaid accountable care organization the department shall to the extent allowed by law include in a contract to provide benefits under the qualified medicaid expansion a requirement that the accountable care organization reimburse hospitals in the accountable care organization s provider network at no less than the medicaid fee for service rate if the qualified medicaid expansion is implemented by the department as a fee for service program the department shall reimburse hospitals at no less than the medicaid fee for service rate nothing in this section prohibits the department or a medicaid accountable care organization from paying a rate that exceeds the medicaid fee for service rate section section b which is renumbered from section c is renumbered and amended to read c b hospital financing of the hospital share for the first two full fiscal years that the assessment is in effect the department shall a assess private hospitals under this chapter part for of the hospital share b require the state teaching hospital to make an intergovernmental transfer under this chapter part for of the hospital share and c require non state government hospitals to make an intergovernmental transfer under this chapter part for of the hospital share a at the beginning of the third full fiscal year that the assessment is in effect and at the beginning of each subsequent fiscal year the department may set a different percentage share for private hospitals the state teaching hospital and non state government hospitals by rule made in accordance with title g chapter utah administrative rulemaking act with input from private hospitals and private teaching hospitals b if the department does not set a different percentage share under subsection a the percentage shares in subsection shall apply section section b which is renumbered from section c is renumbered and amended to read c b suspension of assessment the department shall suspend the assessment imposed by this chapter part when the executive director certifies that a action by congress is in effect that disqualifies the assessment imposed by this chapter part from counting toward state medicaid funds available to be used to determine the amount of federal financial participation b a decision enactment or other determination by the legislature or by any court officer department or agency of the state or of the federal government is in effect that i disqualifies the assessment from counting toward state medicaid funds available to be used to determine federal financial participation for medicaid matching funds or ii creates for any reason a failure of the state to use the assessments for at least one of the medicaid programs described in this chapter part or c a change is in effect that reduces the aggregate hospital inpatient and outpatient payment rate below the aggregate hospital inpatient and outpatient payment rate for july if the assessment is suspended under subsection a the division may not collect any assessment or intergovernmental transfer under this chapter part b the division shall disburse money in the medicaid expansion fund that was derived from assessments imposed by this chapter part in accordance with the requirements in subsection b b to the extent federal matching is not reduced by cms due to the repeal of the assessment and c the division shall refund any money remaining in the medicaid expansion fund after the disbursement described in subsection b that was derived from assessments imposed by this chapter part to the hospitals in proportion to the amount paid by each hospital for the last three fiscal years section section b which is renumbered from section d is renumbered and amended to read part hospital provider assessment d b definitions as used in this chapter part accountable care organization means a managed care organization as defined in c f r sec that contracts with the department under the provisions of section b assessment means the medicaid hospital provider assessment established by this chapter part discharges means the number of total hospital discharges reported on worksheet s part i column lines and of the medicare cost report or on worksheet s part i column lines and of the medicare cost report for the applicable assessment year division means the division of health care financing integrated healthcare of the department hospital a means a privately owned i general acute hospital operating in the state as defined in section b and ii specialty hospital operating in the state which shall include a privately owned hospital whose inpatient admissions are predominantly a rehabilitation b psychiatric c chemical dependency or d long term acute care services and b does not include i a human services program as defined in section a b ii a hospital owned by the federal government including the veterans administration hospital or iii a hospital that is owned by the state government a state agency or a political subdivision of the state including a a state owned teaching hospital and b the utah state hospital medicare cost report means cms or cms the cost report for electronic filing of hospitals state plan amendment means a change or update to the state medicaid plan section section b which is renumbered from section d is renumbered and amended to read d b legislative findings the legislature finds that there is an important state purpose to improve the access of medicaid patients to quality care in utah hospitals because of continuous decreases in state revenues and increases in enrollment under the utah medicaid program the legislature finds that in order to improve this access to those persons described in subsection a the rates paid to utah hospitals shall be adequate to encourage and support improved access and b adequate funding shall be provided to increase the rates paid to utah hospitals providing services pursuant to the utah medicaid program section section b which is renumbered from section d is renumbered and amended to read d b application of part other than for the imposition of the assessment described in this chapter part nothing in this chapter part shall affect the nonprofit or tax exempt status of any nonprofit charitable religious or educational health care provider under a section c as amended of the internal revenue code b other applicable federal law c any state law d any ad valorem property taxes e any sales or use taxes or f any other taxes fees or assessments whether imposed or sought to be imposed by the state or any political subdivision county municipality district authority or any agency or department thereof all assessments paid under this chapter part may be included as an allowable cost of a hospital for purposes of any applicable medicaid reimbursement formula this chapter part does not authorize a political subdivision of the state to a license a hospital for revenue b impose a tax or assessment upon hospitals or c impose a tax or assessment measured by the income or earnings of a hospital section section b which is renumbered from section d is renumbered and amended to read d b assessment collection and payment of hospital provider assessment a uniform broad based assessment is imposed on each hospital as defined in subsection d b a a in the amount designated in section d b and b in accordance with section d b a the assessment imposed by this chapter part is due and payable on a quarterly basis in accordance with section d b b the collecting agent for this assessment is the department which is vested with the administration and enforcement of this chapter part including the right to adopt administrative rules in accordance with title g chapter utah administrative rulemaking act necessary to i implement and enforce the provisions of this act and ii audit records of a facility a that is subject to the assessment imposed by this chapter part and b does not file a medicare cost report c the department shall forward proceeds from the assessment imposed by this chapter part to the state treasurer for deposit in the expendable special revenue fund as specified in section d b the department may by rule extend the time for paying the assessment section section b which is renumbered from section d is renumbered and amended to read d b calculation of assessment a an annual assessment is payable on a quarterly basis for each hospital in an amount calculated at a uniform assessment rate for each hospital discharge in accordance with this section b the uniform assessment rate shall be determined using the total number of hospital discharges for assessed hospitals divided into the total non federal portion in an amount consistent with section d b that is needed to support capitated rates for accountable care organizations for purposes of hospital services provided to medicaid enrollees c any quarterly changes to the uniform assessment rate shall be applied uniformly to all assessed hospitals d the annual uniform assessment rate may not generate more than i to offset medicaid mandatory expenditures and ii the non federal share to seed amounts needed to support capitated rates for accountable care organizations as provided for in subsection b a for each state fiscal year discharges shall be determined using the data from each hospital s medicare cost report contained in the centers for medicare and medicaid services healthcare cost report information system file the hospital s discharge data will be derived as follows i for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june ii for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june iii for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june iv for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june and v for each subsequent state fiscal year the hospital s cost report data for the hospital s fiscal year that ended in the state fiscal year two years prior to the assessment fiscal year b if a hospital s fiscal year medicare cost report is not contained in the centers for medicare and medicaid services healthcare cost report information system file i the hospital shall submit to the division a copy of the hospital s medicare cost report applicable to the assessment year and ii the division shall determine the hospital s discharges c if a hospital is not certified by the medicare program and is not required to file a medicare cost report i the hospital shall submit to the division its applicable fiscal year discharges with supporting documentation ii the division shall determine the hospital s discharges from the information submitted under subsection c i and iii the failure to submit discharge information shall result in an audit of the hospital s records and a penalty equal to of the calculated assessment except as provided in subsection if a hospital is owned by an organization that owns more than one hospital in the state a the assessment for each hospital shall be separately calculated by the department and b each separate hospital shall pay the assessment imposed by this chapter part notwithstanding the requirement of subsection if multiple hospitals use the same medicaid provider number a the department shall calculate the assessment in the aggregate for the hospitals using the same medicaid provider number and b the hospitals may pay the assessment in the aggregate section section b which is renumbered from section d is renumbered and amended to read d b quarterly notice collection quarterly assessments imposed by this chapter part shall be paid to the division within business days after the original invoice date that appears on the invoice issued by the division section section b which is renumbered from section d is renumbered and amended to read d b medicaid hospital adjustment under accountable care organization rates to preserve and improve access to hospital services the division shall for accountable care organization rates effective on or after april incorporate into the accountable care organization rate structure calculation consistent with the certified actuarial rate range to be allocated toward the hospital inpatient directed payments for the medicaid eligibility categories covered in utah before january and an amount equal to the difference between payments made to hospitals by accountable care organizations for the medicaid eligibility categories covered in utah before january based on submitted encounter data and the maximum amount that could be paid for those services using medicare payment principles to be used for directed payments to hospitals for outpatient services section section b which is renumbered from section d is renumbered and amended to read d b penalties and interest a facility that fails to pay any assessment or file a return as required under this chapter part within the time required by this chapter part shall pay in addition to the assessment penalties and interest established by the department a consistent with subsection b the department shall adopt rules in accordance with title g chapter utah administrative rulemaking act which establish reasonable penalties and interest for the violations described in subsection b if a hospital fails to timely pay the full amount of a quarterly assessment the department shall add to the assessment i a penalty equal to of the quarterly amount not paid on or before the due date and ii on the last day of each quarter after the due date until the assessed amount and the penalty imposed under subsection b i are paid in full an additional penalty on a any unpaid quarterly assessment and b any unpaid penalty assessment c upon making a record of its actions and upon reasonable cause shown the division may waive reduce or compromise any of the penalties imposed under this part section section b which is renumbered from section d is renumbered and amended to read d b repeal of assessment the repeal of the assessment imposed by this chapter part shall occur upon the certification by the executive director of the department that the sooner of the following has occurred a the effective date of any action by congress that would disqualify the assessment imposed by this chapter part from counting toward state medicaid funds available to be used to determine the federal financial participation b the effective date of any decision enactment or other determination by the legislature or by any court officer department or agency of the state or of the federal government that has the effect of i disqualifying the assessment from counting towards state medicaid funds available to be used to determine federal financial participation for medicaid matching funds or ii creating for any reason a failure of the state to use the assessments for the medicaid program as described in this chapter part c the effective date of i an appropriation for any state fiscal year from the general fund for hospital payments under the state medicaid program that is less than the amount appropriated for state fiscal year ii the annual revenues of the state general fund budget return to the level that was appropriated for fiscal year iii a division change in rules that reduces any of the following below july payments a aggregate hospital inpatient payments b adjustment payment rates or c any cost settlement protocol or iv a division change in rules that reduces the aggregate outpatient payments below july payments and d the sunset of this chapter part in accordance with section i if the assessment is repealed under subsection money in the fund that was derived from assessments imposed by this chapter part before the determination made under subsection shall be disbursed under section d b to the extent federal matching is not reduced due to the impermissibility of the assessments any funds remaining in the special revenue fund shall be refunded to the hospitals in proportion to the amount paid by each hospital section section b which is renumbered from section a is renumbered and amended to read part ambulance service provider assessment a b definitions as used in this chapter part ambulance service provider means a an ambulance provider as defined in section a b or b a non service provider as defined in section a b assessment means the medicaid ambulance service provider assessment established by this chapter part division means the division of health care financing integrated healthcare within the department non federal portion means the non federal share the division needs to seed amounts that will support fee for service ambulance service provider rates as described in section a b total transports means the number of total ambulance transports applicable to a given fiscal year as determined under subsection a b section section b which is renumbered from section a is renumbered and amended to read a b assessment collection and payment of ambulance service provider assessment an ambulance service provider shall pay an assessment to the division a in the amount designated in section a b b in accordance with this chapter part c quarterly on a day determined by the division by rule made under subsection b and d no more than business days after the day on which the division issues the ambulance service provider notice of the assessment the division shall a collect the assessment described in subsection b determine by rule made in accordance with title g chapter utah administrative rulemaking act standards and procedures for implementing and enforcing the provisions of this chapter part and c transfer assessment proceeds to the state treasurer for deposit into the ambulance service provider assessment expendable revenue fund created in section a b section section b which is renumbered from section a is renumbered and amended to read a b calculation of assessment the division shall calculate a uniform assessment per transport as described in this section the assessment due from a given ambulance service provider equals the non federal portion divided by total transports multiplied by the number of transports for the ambulance service provider
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+enrolled copy s b health and human services recodification health care assistance and data general session state of utah chief sponsor jacob l anderegg house sponsor raymond p ward long title general description this bill recodifies portions of the utah health code and utah human services code highlighted provisions this bill recodifies provisions regarding health care administration and assistance and vital statistics health data and the utah medical examiner and makes technical and corresponding changes money appropriated in this bill none other special clauses this bill provides a coordination clause this bill provides revisor instructions utah code sections affected amends b as enacted by laws of utah chapter b as enacted by laws of utah chapter renumbers and amends b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah sixth special session chapter b renumbered from as last amended by laws of utah fifth special session chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah fifth special session chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from c as last amended by laws of utah chapter b renumbered from c as enacted by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as enacted by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as repealed and reenacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as repealed and reenacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter utah code sections affected by coordination clause as last amended by laws of utah chapter as last amended by laws of utah chapter b as enacted by laws of utah chapter b utah code annotated be it enacted by the legislature of the state of utah section section b is amended to read chapter health care administration and assistance part health care assistance b definitions reserved as used in this chapter applicant means any person who requests assistance under the medical programs of the state cms means the centers for medicare and medicaid services within the united states department of health and human services division means the division of integrated healthcare within the department established under section b enrollee or member means an individual whom the department has determined to be eligible for assistance under the medicaid program medicaid program means the state program for medical assistance for persons who are eligible under the state plan adopted pursuant to title xix of the federal social security act medical assistance means services furnished or payments made to or on behalf of a member a passenger vehicle means a self propelled two axle vehicle intended primarily for operation on highways and used by an applicant or recipient to meet basic transportation needs and has a fair market value below of the applicable amount of the federal luxury passenger automobile tax established in u s c sec and adjusted annually for inflation b passenger vehicle does not include i a commercial vehicle as defined in section a ii an off highway vehicle as defined in section a or iii a motor home as defined in section ppaca means the same as that term is defined in section a recipient means a person who has received medical assistance under the medicaid program section section b which is renumbered from section is renumbered and amended to read b division creation there is created within the department the division of medicaid and health financing integrated healthcare which shall be responsible for implementing organizing and maintaining the medicaid program and the children s health insurance program established in section b in accordance with the provisions of this chapter and applicable federal law section section b which is renumbered from section is renumbered and amended to read b state medicaid director appointment responsibilities the state medicaid director shall be appointed by the governor after consultation with the executive director with the advice and consent of the senate the state medicaid director may employ other employees as necessary to implement the provisions of this chapter and shall a administer the responsibilities of the division as set forth in this chapter b administer the division s budget and c establish and maintain a state plan for the medicaid program in compliance with federal law and regulations section section b which is renumbered from section is renumbered and amended to read b division responsibilities emphasis periodic assessment in accordance with the requirements of title xix of the social security act and applicable federal regulations the division is responsible for the effective and impartial administration of this chapter in an efficient economical manner the division shall a establish on a statewide basis a program to safeguard against unnecessary or inappropriate use of medicaid services excessive payments and unnecessary or inappropriate hospital admissions or lengths of stay b deny any provider claim for services that fail to meet criteria established by the division concerning medical necessity or appropriateness and c place its emphasis on high quality care to recipients in the most economical and cost effective manner possible with regard to both publicly and privately provided services the division shall implement and utilize cost containment methods where possible which may include a prepayment and postpayment review systems to determine if utilization is reasonable and necessary b preadmission certification of nonemergency admissions c mandatory outpatient rather than inpatient surgery in appropriate cases d second surgical opinions e procedures for encouraging the use of outpatient services f consistent with sections b and b a medicaid drug program g coordination of benefits and h review and exclusion of providers who are not cost effective or who have abused the medicaid program in accordance with the procedures and provisions of federal law and regulation the state medicaid director shall periodically assess the cost effectiveness and health implications of the existing medicaid program and consider alternative approaches to the provision of covered health and medical services through the medicaid program in order to reduce unnecessary or unreasonable utilization a the department shall ensure medicaid program integrity by conducting internal audits of the medicaid program for efficiencies best practices and cost avoidance b the department shall coordinate with the office of the inspector general for medicaid services created in section a to implement subsection and to address medicaid fraud waste or abuse as described in section a section section b which is renumbered from section is renumbered and amended to read b medicaid drug program preferred drug list a medicaid drug program developed by the department under subsection b f a shall notwithstanding subsection b b be based on clinical and cost related factors which include medical necessity as determined by a provider in accordance with administrative rules established by the drug utilization review board b may include therapeutic categories of drugs that may be exempted from the drug program c may include placing some drugs except the drugs described in subsection on a preferred drug list i to the extent determined appropriate by the department and ii in the manner described in subsection for psychotropic drugs d notwithstanding the requirements of part sections b through b regarding the drug utilization review board and except as provided in subsection shall immediately implement the prior authorization requirements for a nonpreferred drug that is in the same therapeutic class as a drug that is i on the preferred drug list on the date that this act takes effect or ii added to the preferred drug list after this act takes effect and e except as prohibited by subsections b and shall establish the prior authorization requirements established under subsections c and d which shall permit a health care provider or the health care provider s agent to obtain a prior authorization override of the preferred drug list through the department s pharmacy prior authorization review process and which shall i provide either telephone or fax approval or denial of the request within hours of the receipt of a request that is submitted during normal business hours of monday through friday from a m to p m ii provide for the dispensing of a limited supply of a requested drug as determined appropriate by the department in an emergency situation if the request for an override is received outside of the department s normal business hours and iii require the health care provider to provide the department with documentation of the medical need for the preferred drug list override in accordance with criteria established by the department in consultation with the pharmacy and therapeutics committee a for purposes of as used in this subsection i immunosuppressive drug a means a drug that is used in immunosuppressive therapy to inhibit or prevent activity of the immune system to aid the body in preventing the rejection of transplanted organs and tissue and b does not include drugs used for the treatment of autoimmune disease or diseases that are most likely of autoimmune origin ii stabilized means a health care provider has documented in the patient s medical chart that a patient has achieved a stable or steadfast medical state within the past days using a particular psychotropic drug b a preferred drug list developed under the provisions of this section may not include an immunosuppressive drug c i the state medicaid program shall reimburse for a prescription for an immunosuppressive drug as written by the health care provider for a patient who has undergone an organ transplant ii for purposes of subsection b and with respect to patients who have undergone an organ transplant the prescription for a particular immunosuppressive drug as written by a health care provider meets the criteria of demonstrating to the department a medical necessity for dispensing the prescribed immunosuppressive drug d notwithstanding the requirements of part sections b through b regarding the drug utilization review board the state medicaid drug program may not require the use of step therapy for immunosuppressive drugs without the written or oral consent of the health care provider and the patient e the department may include a sedative hypnotic on a preferred drug list in accordance with subsection f f the department shall grant a prior authorization for a sedative hypnotic that is not on the preferred drug list under subsection e if the health care provider has documentation related to one of the following conditions for the medicaid client i a trial and failure of at least one preferred agent in the drug class including the name of the preferred drug that was tried the length of therapy and the reason for the discontinuation ii detailed evidence of a potential drug interaction between current medication and the preferred drug iii detailed evidence of a condition or contraindication that prevents the use of the preferred drug iv objective clinical evidence that a patient is at high risk of adverse events due to a therapeutic interchange with a preferred drug v the patient is a new or previous medicaid client with an existing diagnosis previously stabilized with a nonpreferred drug or vi other valid reasons as determined by the department g a prior authorization granted under subsection f is valid for one year from the date the department grants the prior authorization and shall be renewed in accordance with subsection f a for purposes of as used in this subsection psychotropic drug means the following classes of drugs i atypical anti psychotic ii anti depressant iii anti convulsant mood stabilizer iv anti anxiety and v attention deficit hyperactivity disorder stimulant b i the department shall develop a preferred drug list for psychotropic drugs ii except as provided in subsection d a preferred drug list for psychotropic drugs developed under this section shall allow a health care provider to override the preferred drug list by writing dispense as written on the prescription for the psychotropic drug iii a health care provider may not override section b by writing dispense as written on a prescription c the department and a medicaid accountable care organization that is responsible for providing behavioral health shall i establish a system to a track health care provider prescribing patterns for psychotropic drugs b educate health care providers who are not complying with the preferred drug list and c implement peer to peer education for health care providers whose prescribing practices continue to not comply with the preferred drug list and ii determine whether health care provider compliance with the preferred drug list is at least a of prescriptions by july b of prescriptions by july and c of prescriptions by july d beginning october the department shall eliminate the dispense as written override for the preferred drug list and shall implement a prior authorization system for psychotropic drugs in accordance with subsection f if by july the department has not realized annual savings from implementing the preferred drug list for psychotropic drugs of at least general fund savings section section b which is renumbered from section is renumbered and amended to read b simplified enrollment and renewal process for medicaid and other state medical programs financial institutions the department may apply for grants and accept donations to make technology system improvements necessary to implement a simplified enrollment and renewal process for the medicaid program utah premium partnership and primary care network demonstration project programs a the department may enter into an agreement with a financial institution doing business in the state to develop and operate a data match system to identify an applicant s or enrollee s assets that i uses automated data exchanges to the maximum extent feasible and ii requires a financial institution each month to provide the name record address social security number other taxpayer identification number or other identifying information for each applicant or enrollee who maintains an account at the financial institution b the department may pay a reasonable fee to a financial institution for compliance with this subsection as provided in section c a financial institution may not be liable under any federal or state law to any person for any disclosure of information or action taken in good faith under this subsection d the department may disclose a financial record obtained from a financial institution under this section only for the purpose of and to the extent necessary in verifying eligibility as provided in this section and section b section section b which is renumbered from section is renumbered and amended to read b dental benefits a except as provided in subsection the division may establish a competitive bid process to bid out medicaid dental benefits under this chapter b the division may bid out the medicaid dental benefits separately from other program benefits the division shall use the following criteria to evaluate dental bids a ability to manage dental expenses b proven ability to handle dental insurance c efficiency of claim paying procedures d provider contracting discounts and adequacy of network and e other criteria established by the department the division shall request bids for the program s benefits at least once every five years the division s contract with dental plans for the program s benefits shall include risk sharing provisions in which the dental plan must accept of the risk for any difference between the division s premium payments per client and actual dental expenditures the division may not award contracts to a more than three responsive bidders under this section or b an insurer that does not have a current license in the state a the division may cancel the request for proposals if i there are no responsive bidders or ii the division determines that accepting the bids would increase the program s costs b if the division cancels a request for proposal or a contract that results from a request for proposal described in subsection a the division shall report to the health and human services interim committee regarding the reasons for the decision title g chapter a utah procurement code shall apply to this section a the division may i establish a dental health care delivery system and payment reform pilot program for medicaid dental benefits to increase access to cost effective and quality dental health care by increasing the number of dentists available for medicaid dental services and ii target specific medicaid populations or geographic areas in the state b the pilot program shall establish compensation models for dentists and dental hygienists that i increase access to quality cost effective dental care and ii use funds from the division of family health and preparedness that are available to reimburse dentists for educational loans in exchange for the dentist agreeing to serve medicaid and under served populations c the division may amend the state plan and apply to the secretary of the united states department of health and human services for waivers or pilot programs if necessary to establish the new dental care delivery and payment reform model d the division shall evaluate the pilot program s effect on the cost of dental care and access to dental care for the targeted medicaid populations a as used in this subsection dental hygienist means an individual who is licensed as a dental hygienist under section b the department shall reimburse a dental hygienist for dental services performed in a public health setting and in accordance with subsection c beginning on the earlier of i january or ii days after the date on which the replacement of the department s medicaid management information system software is complete c the department shall reimburse a dental hygienist directly for a service provided through the medicaid program if i the dental hygienist requests to be reimbursed directly and ii the dental hygienist provides the service within the scope of practice described in section d before november of each year in which the department reimburses dental hygienists in accordance with subsection c the department shall report to the health and human services interim committee for the previous fiscal year i the number and geographic distribution of dental hygienists who requested to be reimbursed directly ii the total number of medicaid enrollees who were served by a dental hygienist who were reimbursed under this subsection iii the total amount reimbursed directly to dental hygienists under this subsection iv the specific services and billing codes that are reimbursed under this subsection and v the aggregate amount reimbursed for each service and billing code described in subsection d iv e i except as provided in this subsection nothing in this subsection shall be interpreted as expanding or otherwise altering the limitations and scope of practice for a dental hygienist ii a dental hygienist may only directly bill and receive compensation for billing codes that fall within the scope of practice of a dental hygienist section section b which is renumbered from section is renumbered and amended to read b administration of medicaid program by department reporting to the legislature disciplinary measures and sanctions funds collected eligibility standards internal audits health opportunity accounts the department shall be the single state agency responsible for the administration of the medicaid program in connection with the united states department of health and human services pursuant to title xix of the social security act a the department shall implement the medicaid program through administrative rules in conformity with this chapter title g chapter utah administrative rulemaking act the requirements of title xix and applicable federal regulations b the rules adopted under subsection a shall include in addition to other rules necessary to implement the program i the standards used by the department for determining eligibility for medicaid services ii the services and benefits to be covered by the medicaid program iii reimbursement methodologies for providers under the medicaid program and iv a requirement that a a person receiving medicaid services shall participate in the electronic exchange of clinical health records established in accordance with section b unless the individual opts out of participation b prior to enrollment in the electronic exchange of clinical health records the enrollee shall receive notice of enrollment in the electronic exchange of clinical health records and the right to opt out of participation at any time and c beginning july when the program sends enrollment or renewal information to the enrollee and when the enrollee logs onto the program s website the enrollee shall receive notice of the right to opt out of the electronic exchange of clinical health records a the department shall in accordance with subsection b report to the social services appropriations subcommittee when the department i implements a change in the medicaid state plan ii initiates a new medicaid waiver iii initiates an amendment to an existing medicaid waiver iv applies for an extension of an application for a waiver or an existing medicaid waiver v applies for or receives approval for a change in any capitation rate within the medicaid program or vi initiates a rate change that requires public notice under state or federal law b the report required by subsection a shall i be submitted to the social services appropriations subcommittee prior to the department implementing the proposed change and ii include a a description of the department s current practice or policy that the department is proposing to change b an explanation of why the department is proposing the change c the proposed change in services or reimbursement including a description of the effect of the change d the effect of an increase or decrease in services or benefits on individuals and families e the degree to which any proposed cut may result in cost shifting to more expensive services in health or human service programs and f the fiscal impact of the proposed change including i the effect of the proposed change on current or future appropriations from the legislature to the department ii the effect the proposed change may have on federal matching dollars received by the state medicaid program iii any cost shifting or cost savings within the department s budget that may result from the proposed change and iv identification of the funds that will be used for the proposed change including any transfer of funds within the department s budget any rules adopted by the department under subsection are subject to review and reauthorization by the legislature in accordance with section g the department may in its discretion contract with the department of human services or other qualified agencies for services in connection with the administration of the medicaid program including a the determination of the eligibility of individuals for the program b recovery of overpayments and c consistent with section b and to the extent permitted by law and quality control services enforcement of fraud and abuse laws the department shall provide by rule disciplinary measures and sanctions for medicaid providers who fail to comply with the rules and procedures of the program provided that sanctions imposed administratively may not extend beyond a termination from the program b recovery of claim reimbursements incorrectly paid and c those specified in section of title xix of the federal social security act a funds collected as a result of a sanction imposed under section of title xix of the federal social security act shall be deposited in the general fund as dedicated credits to be used by the division in accordance with the requirements of section of title xix of the federal social security act b in accordance with section j sanctions collected under this subsection are nonlapsing a in determining whether an applicant or recipient is eligible for a service or benefit under this part or chapter part utah children s health insurance act program the department shall if subsection b is satisfied exclude from consideration one passenger vehicle designated by the applicant or recipient b before subsection a may be applied i the federal government shall a determine that subsection a may be implemented within the state s existing public assistance related waivers as of january b extend a waiver to the state permitting the implementation of subsection a or c determine that the state s waivers that permit dual eligibility determinations for cash assistance and medicaid are no longer valid and ii the department shall determine that subsection a can be implemented within existing funding a for purposes of as used in this subsection i aged blind or has a disability means an aged blind or disabled individual as defined in u s c sec c a and ii spend down means an amount of income in excess of the allowable income standard that shall be paid in cash to the department or incurred through the medical services not paid by medicaid b in determining whether an applicant or recipient who is aged blind or has a disability is eligible for a service or benefit under this chapter the department shall use of the federal poverty level as i the allowable income standard for eligibility for services or benefits and ii the allowable income standard for eligibility as a result of spend down the department shall conduct internal audits of the medicaid program a the department may apply for and if approved implement a demonstration program for health opportunity accounts as provided for in u s c sec u b a health opportunity account established under subsection a shall be an alternative to the existing benefits received by an individual eligible to receive medicaid under this chapter c subsection a is not intended to expand the coverage of the medicaid program a i the department shall apply for and if approved implement an amendment to the state plan under this subsection for benefits for a medically needy pregnant women b medically needy children and c medically needy parents and caretaker relatives ii the department may implement the eligibility standards of subsection b for eligibility determinations made on or after the date of the approval of the amendment to the state plan b in determining whether an applicant is eligible for benefits described in subsection a i the department shall i disregard resources held in an account in the savings plan created under title b chapter a utah educational savings plan if the beneficiary of the account is a under the age of and b living with the account owner as that term is defined in section b a or temporarily absent from the residence of the account owner and ii include the withdrawals from an account in the utah educational savings plan as resources for a benefit determination if the withdrawal was not used for qualified higher education costs as that term is defined in section b a a the department may not deny or terminate eligibility for medicaid solely because an individual is i incarcerated and ii not an inmate as defined in section b subsection a does not require the medicaid program to provide coverage for any services for an individual while the individual is incarcerated the department is a party to and may intervene at any time in any judicial or administrative action a to which the department of workforce services is a party and b that involves medical assistance under this chapter i title chapter medical assistance act or ii title chapter utah children s health insurance act section section b which is renumbered from section is renumbered and amended to read b medicaid expansion the purpose of this section is to expand the coverage of the medicaid program to persons who are in categories traditionally not served by that program within appropriations from the legislature the department may amend the state plan for medical assistance to provide for eligibility for medicaid a on or after july for children to years old who live in households below the federal poverty income guideline and b on or after july for persons who have incomes below the federal poverty income guideline and who are aged blind or have a disability a within appropriations from the legislature on or after july the medicaid program may provide for eligibility for persons who have incomes below the federal poverty income guideline b in order to meet the provisions of this subsection the department may seek approval for a demonstration project under u s c sec from the secretary of the united states department of health and human services the medicaid program shall provide for eligibility for persons as required by subsection b services available for persons described in this section shall include required medicaid services and may include one or more optional medicaid services if those services are funded by the legislature the department may also require persons described in subsections through to meet an asset test section section b which is renumbered from section is renumbered and amended to read b copayments by recipients employer sponsored plans the department shall selectively provide for enrollment fees premiums deductions cost sharing or other similar charges to be paid by recipients their spouses and parents within the limitations of federal law and regulation beginning may within appropriations by the legislature and as a means to increase health care coverage among the uninsured the department shall take steps to promote increased participation in employer sponsored health insurance including a maximizing the health insurance premium subsidy provided under the state s demonstration waiver by i ensuring that state funds are matched by federal funds to the greatest extent allowable and ii as the department determines appropriate seeking federal approval to do one or more of the following a eliminate or otherwise modify the annual enrollment fee b eliminate or otherwise modify the schedule used to determine the level of subsidy provided to an enrollee each year c reduce the maximum number of participants allowable under the subsidy program or d otherwise modify the program in a manner that promotes enrollment in employer sponsored health insurance and b exploring the use of other options including the development of a waiver under the medicaid health insurance flexibility demonstration initiative or other federal authority section section b which is renumbered from section is renumbered and amended to read b income and resources from institutionalized spouses as used in this section a community spouse means the spouse of an institutionalized spouse b i community spouse monthly income allowance means an amount by which the minimum monthly maintenance needs allowance for the spouse exceeds the amount of monthly income otherwise available to the community spouse determined without regard to the allowance except as provided in subsection b ii ii if a court has entered an order against an institutionalized spouse for monthly income for the support of the community spouse the community spouse monthly income allowance for the spouse may not be less than the amount of the monthly income so ordered c community spouse resource allowance is the amount of combined resources that are protected for a community spouse living in the community which the division shall establish by rule made in accordance with title g chapter utah administrative rulemaking act based on the amounts established by the united states department of health and human services d excess shelter allowance for a community spouse means the amount by which the sum of the spouse s expense for rent or mortgage payment taxes and insurance and in the case of condominium or cooperative required maintenance charge for the community spouse s principal residence and the spouse s actual expenses for electricity natural gas and water utilities or at the discretion of the department the federal standard utility allowance under snap as defined in section a exceeds of the amount described in subsection e family member means a minor dependent child dependent parents or dependent sibling of the institutionalized spouse or community spouse who are residing with the community spouse f i institutionalized spouse means a person who is residing in a nursing facility and is married to a spouse who is not in a nursing facility ii an institutionalized spouse does not include a person who is not likely to reside in a nursing facility for at least consecutive days g nursing care facility means the same as that term is defined in section b the division shall comply with this section when determining eligibility for medical assistance for an institutionalized spouse for services furnished during a calendar year beginning on or after january the community spouse resource allowance shall be increased by the division by an amount as determined annually by cms the division shall compute as of the beginning of the first continuous period of institutionalization of the institutionalized spouse a the total value of the resources to the extent either the institutionalized spouse or the community spouse has an ownership interest and b a spousal share which is of the resources described in subsection a at the request of an institutionalized spouse or a community spouse at the beginning of the first continuous period of institutionalization of the institutionalized spouse and upon the receipt of relevant documentation of resources the division shall promptly assess and document the total value described in subsection a and shall provide a copy of that assessment and documentation to each spouse and shall retain a copy of the assessment when the division provides a copy of the assessment it shall include a notice stating that the spouse may request a hearing under subsection when determining eligibility for medical assistance under this chapter a except as provided in subsection b all resources held by either the institutionalized spouse community spouse or both are considered to be available to the institutionalized spouse b resources are considered to be available to the institutionalized spouse only to the extent that the amount of those resources exceeds the community spouse resource allowance at the time of application for medical assistance under this chapter a the division may not find an institutionalized spouse to be ineligible for medical assistance by reason of resources determined under subsection to be available for the cost of care when i the institutionalized spouse has assigned to the state any rights to support from the community spouse ii except as provided in subsection b the institutionalized spouse lacks the ability to execute an assignment due to physical or mental impairment or iii the division determines that denial of medical assistance would cause an undue burden b subsection a ii does not prevent the division from seeking a court order for an assignment of support during the continuous period in which an institutionalized spouse is in an institution and after the month in which an institutionalized spouse is eligible for medical assistance the resources of the community spouse may not be considered to be available to the institutionalized spouse when an institutionalized spouse is determined to be eligible for medical assistance in determining the amount of the spouse s income that is to be applied monthly for the cost of care in the nursing care facility the division shall deduct from the spouse s monthly income the following amounts in the following order a a personal needs allowance the amount of which is determined by the division b a community spouse monthly income allowance but only to the extent that the income of the institutionalized spouse is made available to or for the benefit of the community spouse c a family allowance for each family member equal to at least of the amount that the amount described in subsection a exceeds the amount of the family member s monthly income and d amounts for incurred expenses for the medical or remedial care for the institutionalized spouse the division shall establish a minimum monthly maintenance needs allowance for each community spouse that includes a an amount established by the division by rule made in accordance with title g chapter utah administrative rulemaking act based on the amounts established by the united states department of health and human services and b an excess shelter allowance a an institutionalized spouse or a community spouse may request a hearing with respect to the determinations described in subsections e i through v if an application for medical assistance has been made on behalf of the institutionalized spouse b a hearing under this subsection regarding the community spouse resource allowance shall be held by the division within days from the date of the request for the hearing c if either spouse establishes that the community spouse needs income above the level otherwise provided by the minimum monthly maintenance needs allowance due to exceptional circumstances resulting in significant financial duress there shall be substituted for the minimum monthly maintenance needs allowance provided under subsection an amount adequate to provide additional income as is necessary d if either spouse establishes that the community spouse resource allowance in relation to the amount of income generated by the allowance is inadequate to raise the community spouse s income to the minimum monthly maintenance needs allowance there shall be substituted for the community spouse resource allowance an amount adequate to provide a minimum monthly maintenance needs allowance e a hearing may be held under this subsection if either the institutionalized spouse or community spouse is dissatisfied with a determination of i the community spouse monthly income allowance ii the amount of monthly income otherwise available to the community spouse iii the computation of the spousal share of resources under subsection iv the attribution of resources under subsection or v the determination of the community spouse resource allocation a an institutionalized spouse may transfer an amount equal to the community spouse resource allowance but only to the extent the resources of the institutionalized spouse are transferred to or for the sole benefit of the community spouse b the transfer under subsection a shall be made as soon as practicable after the date of the initial determination of eligibility taking into account the time necessary to obtain a court order under subsection c c chapter medical benefits recovery act part medical benefits recovery does not apply if a court has entered an order against an institutionalized spouse for the support of the community spouse section section b which is renumbered from section is renumbered and amended to read b maximizing use of premium assistance programs utah s premium partnership for health insurance a the department shall seek to maximize the use of medicaid and children s health insurance program funds for assistance in the purchase of private health insurance coverage for medicaid eligible and non medicaid eligible individuals b the department s efforts to expand the use of premium assistance shall i include as necessary seeking federal approval under all medicaid and children s health insurance program premium assistance provisions of federal law including provisions of the patient protection and affordable care act public law ppaca ii give priority to but not be limited to expanding the state s utah premium partnership for health insurance program including as required under subsection and iii encourage the enrollment of all individuals within a household in the same plan where possible including enrollment in a plan that allows individuals within the household transitioning out of medicaid to retain the same network and benefits they had while enrolled in medicaid the department shall seek federal approval of an amendment to the state s utah premium partnership for health insurance program to adjust the eligibility determination for single adults and parents who have an offer of employer sponsored insurance the amendment shall a be within existing appropriations for the utah premium partnership for health insurance program and b provide that adults who are up to of the federal poverty level are eligible for premium subsidies in the utah premium partnership for health insurance program for the fiscal year the department shall seek authority to increase the maximum premium subsidy per month for adults under the utah premium partnership for health insurance program to beginning with the fiscal year and in each subsequent fiscal year the department may increase premium subsidies for single adults and parents who have an offer of employer sponsored insurance to keep pace with the increase in insurance premium costs subject to appropriation of additional funding section section b which is renumbered from section is renumbered and amended to read b expanding the medicaid program as used in this section a cms means the centers for medicare and medicaid services in the united states department of health and human services b a federal poverty level means the same as that term is defined in section b c b medicaid expansion means an expansion of the medicaid program in accordance with this section d c medicaid expansion fund means the medicaid expansion fund created in section b b a as set forth in subsections through eligibility criteria for the medicaid program shall be expanded to cover additional low income individuals b the department shall continue to seek approval from cms to implement the medicaid waiver expansion as defined in section b c the department may implement any provision described in subsections b b iii through viii in a medicaid expansion if the department receives approval from cms to implement that provision the department shall expand the medicaid program in accordance with this subsection if the department a receives approval from cms to i expand medicaid coverage to eligible individuals whose income is below of the federal poverty level ii obtain maximum federal financial participation under u s c sec d b for enrolling an individual in the medicaid expansion under this subsection and iii permit the state to close enrollment in the medicaid expansion under this subsection if the department has insufficient funds to provide services to new enrollment under the medicaid expansion under this subsection b pays the state portion of costs for the medicaid expansion under this subsection with funds from i the medicaid expansion fund ii county contributions to the nonfederal share of medicaid expenditures or iii any other contributions funds or transfers from a nonstate agency for medicaid expenditures and c closes the medicaid program to new enrollment under the medicaid expansion under this subsection if the department projects that the cost of the medicaid expansion under this subsection will exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act a the department shall expand the medicaid program in accordance with this subsection if the department i receives approval from cms to a expand medicaid coverage to eligible individuals whose income is below of the federal poverty level b obtain maximum federal financial participation under u s c sec d y for enrolling an individual in the medicaid expansion under this subsection and c permit the state to close enrollment in the medicaid expansion under this subsection if the department has insufficient funds to provide services to new enrollment under the medicaid expansion under this subsection ii pays the state portion of costs for the medicaid expansion under this subsection with funds from a the medicaid expansion fund b county contributions to the nonfederal share of medicaid expenditures or c any other contributions funds or transfers from a nonstate agency for medicaid expenditures and iii closes the medicaid program to new enrollment under the medicaid expansion under this subsection if the department projects that the cost of the medicaid expansion under this subsection will exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act b the department shall submit a waiver an amendment to an existing waiver or a state plan amendment to cms to i administer federal funds for the medicaid expansion under this subsection according to a per capita cap developed by the department that includes an annual inflationary adjustment accounts for differences in cost among categories of medicaid expansion enrollees and provides greater flexibility to the state than the current medicaid payment model ii limit in certain circumstances as defined by the department the ability of a qualified entity to determine presumptive eligibility for medicaid coverage for an individual enrolled in a medicaid expansion under this subsection iii impose a lock out period if an individual enrolled in a medicaid expansion under this subsection violates certain program requirements as defined by the department iv allow an individual enrolled in a medicaid expansion under this subsection to remain in the medicaid program for up to a month certification period as defined by the department and v allow federal medicaid funds to be used for housing support for eligible enrollees in the medicaid expansion under this subsection a i if cms does not approve a waiver to expand the medicaid program in accordance with subsection a on or before january the department shall develop proposals to implement additional flexibilities and cost controls including cost sharing tools within a medicaid expansion under this subsection through a request to cms for a waiver or state plan amendment ii the request for a waiver or state plan amendment described in subsection a i shall include a a path to self sufficiency for qualified adults in the medicaid expansion that includes employment and training as defined in u s c sec d and b a requirement that an individual who is offered a private health benefit plan by an employer to enroll in the employer s health plan iii the department shall submit the request for a waiver or state plan amendment developed under subsection a i on or before march b notwithstanding sections b and j and in accordance with this subsection eligibility for the medicaid program shall be expanded to include all persons in the optional medicaid expansion population under the patient protection and affordable care act pub l no ppaca and the health care education reconciliation act of pub l no and related federal regulations and guidance on the earlier of i the day on which cms approves a waiver to implement the provisions described in subsections a ii a and b or ii july c the department shall seek a waiver or an amendment to an existing waiver from federal law to i implement each provision described in subsections b b iii through viii in a medicaid expansion under this subsection ii limit in certain circumstances as defined by the department the ability of a qualified entity to determine presumptive eligibility for medicaid coverage for an individual enrolled in a medicaid expansion under this subsection and iii impose a lock out period if an individual enrolled in a medicaid expansion under this subsection violates certain program requirements as defined by the department d the eligibility criteria in this subsection shall be construed to include all individuals eligible for the health coverage improvement program under section b e the department shall pay the state portion of costs for a medicaid expansion under this subsection entirely from i the medicaid expansion fund ii county contributions to the nonfederal share of medicaid expenditures or iii any other contributions funds or transfers from a nonstate agency for medicaid expenditures f if the costs of the medicaid expansion under this subsection exceed the funds available under subsection e i the department may reduce or eliminate optional medicaid services under this chapter and ii savings as determined by the department from the reduction or elimination of optional medicaid services under subsection f i shall be deposited into the medicaid expansion fund and iii the department may submit to cms a request for waivers or an amendment of existing waivers from federal law necessary to implement budget controls within the medicaid program to address the deficiency g if the costs of the medicaid expansion under this subsection are projected by the department to exceed the funds available in the current fiscal year under subsection e including savings resulting from any action taken under subsection f i the governor shall direct the department of health department of human services department and department of workforce services to reduce commitments and expenditures by an amount sufficient to offset the deficiency a proportionate to the share of total current fiscal year general fund appropriations for each of those agencies and b up to of each agency s total current fiscal year general fund appropriations ii the division of finance shall reduce allotments to the department of health department of human services department and department of workforce services by a percentage a proportionate to the amount of the deficiency and b up to of each agency s total current fiscal year general fund appropriations and iii the division of finance shall deposit the total amount from the reduced allotments described in subsection g ii into the medicaid expansion fund the department shall maximize federal financial participation in implementing this section including by seeking to obtain any necessary federal approvals or waivers notwithstanding sections and a county does not have to provide matching funds to the state for the cost of providing medicaid services to newly enrolled individuals who qualify for medicaid coverage under a medicaid expansion the department shall report to the social services appropriations subcommittee on or before november of each year that a medicaid expansion is operational a the number of individuals who enrolled in the medicaid expansion b costs to the state for the medicaid expansion c estimated costs to the state for the medicaid expansion for the current and following fiscal years d recommendations to control costs of the medicaid expansion and e as calculated in accordance with subsections b b and c b the state s net cost of the qualified medicaid expansion section section b which is renumbered from section is renumbered and amended to read b department standards for eligibility under medicaid funds for abortions a the department may develop standards and administer policies relating to eligibility under the medicaid program as long as they are consistent with subsection b b an applicant receiving medicaid assistance may be limited to particular types of care or services or to payment of part or all costs of care determined to be medically necessary the department may not provide any funds for medical hospital or other medical expenditures or medical services to otherwise eligible persons where the purpose of the assistance is to perform an abortion unless the life of the mother would be endangered if an abortion were not performed any employee of the department who authorizes payment for an abortion contrary to the provisions of this section is guilty of a class b misdemeanor and subject to forfeiture of office any person or organization that under the guise of other medical treatment provides an abortion under auspices of the medicaid program is guilty of a third degree felony and subject to forfeiture of license to practice medicine or authority to provide medical services and treatment section section b which is renumbered from section is renumbered and amended to read b contracts for provision of medical services federal provisions modifying department rules compliance with social security act the department may contract with other public or private agencies to purchase or provide medical services in connection with the programs of the division where these programs are used by other government entities contracts shall provide that other government entities in compliance with state and federal law regarding intergovernmental transfers transfer the state matching funds to the department in amounts sufficient to satisfy needs of the specified program contract terms shall include provisions for maintenance administration and service costs if a federal legislative or executive provision requires modifications or revisions in an eligibility factor established under this chapter as a condition for participation in medical assistance the department may modify or change its rules as necessary to qualify for participation the provisions of this section do not apply to department rules governing abortion the department shall comply with all pertinent requirements of the social security act and all orders rules and regulations adopted thereunder when required as a condition of participation in benefits under the social security act section section b which is renumbered from section is renumbered and amended to read b liability insurance required the medicaid program may not reimburse a home health agency as defined in section b for home health services provided to an enrollee unless the home health agency has liability coverage of at least per incident or an amount established by department rule made in accordance with title g chapter utah administrative rulemaking act section section b which is renumbered from section is renumbered and amended to read b federal aid authority of executive director the executive director with the approval of the governor may bind the state to any executive or legislative provisions promulgated or enacted by the federal government which invite the state to participate in the distribution disbursement or administration of any fund or service advanced offered or contributed in whole or in part by the federal government for purposes consistent with the powers and duties of the department such funds shall be used as provided in this chapter and be administered by the department for purposes related to medical assistance programs section section b which is renumbered from section is renumbered and amended to read b medical vendor rates medical vendor payments made to providers of services for and in behalf of recipient households shall be based upon predetermined rates from standards developed by the division in cooperation with providers of services for each type of service purchased by the division as far as possible the rates paid for services shall be established in advance of the fiscal year for which funds are to be requested section section b which is renumbered from section is renumbered and amended to read b enforcement of public assistance statutes the department shall enforce or contract for the enforcement of sections a a a a a and a to the extent that these sections pertain to benefits conferred or administered by the division under this chapter to the extent allowed under federal law or regulation the department may contract for services covered in section a insofar as that section pertains to benefits conferred or administered by the division under this chapter section section b which is renumbered from section is renumbered and amended to read b prohibited acts of state or local employees of medicaid program violation a misdemeanor each state or local employee responsible for the expenditure of funds under the state medicaid program each individual who formerly was such an officer or employee and each partner of such an officer or employee is prohibited for a period of one year after termination of such responsibility from committing any act the commission of which by an officer or employee of the united states government an individual who was such an officer or employee or a partner of such an officer or employee is prohibited by section or section of title united states code violation of this section is a class a misdemeanor section section b which is renumbered from section is renumbered and amended to read b rural hospitals for purposes of as used in this section rural hospital means a hospital located outside of a standard metropolitan statistical area as designated by the united states bureau of the census for purposes of the medicaid program the division of medicaid and health financing division may not discriminate among rural hospitals on the basis of size section section b which is renumbered from section is renumbered and amended to read b telemedicine reimbursement rulemaking a as used in this section communication by telemedicine is considered face to face contact between a health care provider and a patient under the state s medical assistance program if i the communication by telemedicine meets the requirements of administrative rules adopted in accordance with subsection and ii the health care services are eligible for reimbursement under the state s medical assistance program b this subsection applies to any managed care organization that contracts with the state s medical assistance program the reimbursement rate for telemedicine services approved under this section a shall be subject to reimbursement policies set by the state plan and b may be based on i a monthly reimbursement rate ii a daily reimbursement rate or iii an encounter rate the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act which establish a the particular telemedicine services that are considered face to face encounters for reimbursement purposes under the state s medical assistance program and b the reimbursement methodology for the telemedicine services designated under subsection a section section b which is renumbered from section is renumbered and amended to read b reimbursement of telemedicine services and telepsychiatric consultations as used in this section a telehealth services means the same as that term is defined in section b b telemedicine services means the same as that term is defined in section b c telepsychiatric consultation means a consultation between a physician and a board certified psychiatrist both of whom are licensed to engage in the practice of medicine in the state that utilizes i the health records of the patient provided from the patient or the referring physician ii a written evidence based patient questionnaire and iii telehealth services that meet industry security and privacy standards including compliance with the a health insurance portability and accountability act and b health information technology for economic and clinical health act pub l no stat as amended this section applies to a a managed care organization that contracts with the medicaid program and b a provider who is reimbursed for health care services under the medicaid program the medicaid program shall reimburse for telemedicine services at the same rate that the medicaid program reimburses for other health care services the medicaid program shall reimburse for telepsychiatric consultations at a rate set by the medicaid program section section b which is renumbered from section is renumbered and amended to read b process to promote health insurance coverage for children the department in collaboration with the department of workforce services and the state board of education shall develop a process to promote health insurance coverage for a child in school when a the child applies for free or reduced price school lunch b a child enrolls in or registers in school and c other appropriate school related opportunities the department in collaboration with the department of workforce services shall promote and facilitate the enrollment of children identified under subsection without health insurance in the utah children s health insurance program the medicaid program or the utah premium partnership for health insurance program section section b which is renumbered from section is renumbered and amended to read b medicaid continuous eligibility promoting payment and delivery reform in accordance with subsection and within appropriations from the legislature the department may amend the state medicaid plan to a create continuous eligibility for up to months for an individual who has qualified for the state medicaid program b provide incentives in managed care contracts for an individual to obtain appropriate care in appropriate settings and c require the managed care system to accept the risk of managing the medicaid population assigned to the plan amendment in return for receiving the benefits of providing quality and cost effective care if the department amends the state medicaid plan under subsection a or b the department a shall ensure that the plan amendment i is cost effective for the state medicaid program ii increases the quality and continuity of care for recipients and iii calculates and transfers administrative savings from continuous enrollment from the department of workforce services to the department of health department and b may limit the plan amendment under subsection a or b to select geographic areas or specific medicaid populations the department may seek approval for a state plan amendment waiver or a demonstration project from the secretary of the united states department of health and human services if necessary to implement a plan amendment under subsection a or b section section b which is renumbered from section is renumbered and amended to read b patient notice of health care provider privacy practices a for purposes of this section i health care provider means a health care provider as defined in section b who a receives payment for medical services from the medicaid program established in this chapter or the children s health insurance program established in chapter utah children s health insurance act section b and b submits a patient s personally identifiable information to the medicaid eligibility database or the children s health insurance program eligibility database ii hipaa means c f r parts and health insurance portability and accountability act of as amended b beginning july this section applies to the medicaid program the children s health insurance program created in chapter utah children s health insurance act section b and a health care provider a health care provider shall as part of the notice of privacy practices required by hipaa provide notice to the patient or the patient s personal representative that the health care provider either has or may submit personally identifiable information about the patient to the medicaid eligibility database and the children s health insurance program eligibility database the medicaid program and the children s health insurance program may not give a health care provider access to the medicaid eligibility database or the children s health insurance program eligibility database unless the health care provider s notice of privacy practices complies with subsection the department may adopt an administrative rule to establish uniform language for the state requirement regarding notice of privacy practices to patients required under subsection section section b which is renumbered from section is renumbered and amended to read b optional medicaid expansion the department and the governor may not expand the state s medicaid program under ppaca unless a the department expands medicaid in accordance with section b or b i the governor or the governor s designee has reported the intention to expand the state medicaid program under ppaca to the legislature in compliance with the legislative review process in section b and ii the governor submits the request for expansion of the medicaid program for optional populations to the legislature under the high impact federal funds request process required by section j a the department shall request approval from cms for waivers from federal statutory and regulatory law necessary to implement the health coverage improvement program under section b b the health coverage improvement program under section b is not subject to the requirements in subsection section section b which is renumbered from section is renumbered and amended to read b medicaid vision services request for proposals the department may select one or more contractors in accordance with title g chapter a utah procurement code to provide vision services to the medicaid populations that are eligible for vision services as described in department rules without restricting provider participation and within existing appropriations from the legislature section section b which is renumbered from section is renumbered and amended to read b review of claims audit and investigation procedures a the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act and in consultation with providers and health care professionals subject to audit and investigation under the state medicaid program to establish procedures for audits and investigations that are fair and consistent with the duties of the department as the single state agency responsible for the administration of the medicaid program under section b and title xix of the social security act b if the providers and health care professionals do not agree with the rules proposed or adopted by the department under subsection a the providers or health care professionals may i request a hearing for the proposed administrative rule or seek any other remedies under the provisions of title g chapter utah administrative rulemaking act and ii request a review of the rule by the legislature s administrative rules review and general oversight committee created in section g the department shall a notify and educate providers and health care professionals subject to audit and investigation under the medicaid program of the providers and health care professionals responsibilities and rights under the administrative rules adopted by the department under the provisions of this section b ensure that the department or any entity that contracts with the department to conduct audits i has on staff or contracts with a medical or dental professional who is experienced in the treatment billing and coding procedures used by the type of provider being audited and ii uses the services of the appropriate professional described in subsection b i if the provider who is the subject of the audit disputes the findings of the audit c ensure that a finding of overpayment or underpayment to a provider is not based on extrapolation as defined in section a unless i there is a determination that the level of payment error involving the provider exceeds a error rate a for a sample of claims for a particular service code and b over a three year period of time ii documented education intervention has failed to correct the level of payment error and iii the value of the claims for the provider in aggregate exceeds in reimbursement for a particular service code on an annual basis and d require that any entity with which the office contracts for the purpose of conducting an audit of a service provider shall be paid on a flat fee basis for identifying both overpayments and underpayments a if the department or a contractor on behalf of the department i intends to implement the use of extrapolation as a method of auditing claims the department shall prior to adopting the extrapolation method of auditing report its intent to use extrapolation to the social services appropriations subcommittee and ii determines subsections c i through iii are applicable to a provider the department or the contractor may use extrapolation only for the service code associated with the findings under subsections c i through iii b i if extrapolation is used under this section a provider may at the provider s option appeal the results of the audit based on a each individual claim or b the extrapolation sample ii nothing in this section limits a provider s right to appeal the audit under title g general government title g chapter administrative procedures act the medicaid program and its manual or rules or other laws or rules that may provide remedies to providers section section b which is renumbered from section is renumbered and amended to read b medicaid intergovernmental transfer report approval requirements as used in this section a i intergovernmental transfer means the transfer of public funds from a a local government entity to another nonfederal governmental entity or b from a nonfederal government owned health care facility regulated under chapter health care facility licensing and inspection act chapter part health care facility licensing and inspection to another nonfederal governmental entity ii intergovernmental transfer does not include a the transfer of public funds from one state agency to another state agency or b a transfer of funds from the university of utah hospitals and clinics b i intergovernmental transfer program means a federally approved reimbursement program or category that is authorized by the medicaid state plan or waiver authority for intergovernmental transfers ii intergovernmental transfer program does not include the addition of a provider to an existing intergovernmental transfer program c local government entity means a county city town special service district local district or local education agency as that term is defined in section j d non state government entity means a hospital authority hospital district health care district special service district county or city a an entity that receives federal medicaid dollars from the department as a result of an intergovernmental transfer shall on or before august and on or before august each year thereafter provide the department with i information regarding the payments funded with the intergovernmental transfer as authorized by and consistent with state and federal law ii information regarding the entity s ability to repay federal funds to the extent required by the department in the contract for the intergovernmental transfer and iii other information reasonably related to the intergovernmental transfer that may be required by the department in the contract for the intergovernmental transfer b on or before october and on or before october each subsequent year the department shall prepare a report for the executive appropriations committee that includes i the amount of each intergovernmental transfer under subsection a ii a summary of changes to cms regulations and practices that are known by the department regarding federal funds related to an intergovernmental transfer program and iii other information the department gathers about the intergovernmental transfer under subsection a the department shall not create a new intergovernmental transfer program after july unless the department reports to the executive appropriations committee in accordance with section j before submitting the new intergovernmental transfer program for federal approval the report shall include information required by subsection j d and the analysis required in subsections a and b a the department shall enter into new nursing care facility non state government owned upper payment limit program contracts and contract amendments adding new nursing care facilities and new non state government entity operators in accordance with this subsection b i if the nursing care facility expects to receive less than in federal funds each year from the nursing care facility non state government owned upper payment limit program excluding seed funding and administrative fees paid by the non state government entity the department shall enter into a nursing care facility non state government owned upper payment limit program contract with the non state government entity operator of the nursing care facility ii if the nursing care facility expects to receive between and in federal funds each year from the nursing care facility non state government owned upper payment limit program excluding seed funding and administrative fees paid by the non state government entity the department shall enter into a nursing care facility non state government owned upper payment limit program contract with the non state government entity operator of the nursing care facility after receiving the approval of the executive appropriations committee iii if the nursing care facility expects to receive more than in federal funds each year from the nursing care facility non state government owned upper payment limit program excluding seed funding and administrative fees paid by the non state government entity the department may not approve the application without obtaining approval from the legislature and the governor c a non state government entity may not participate in the nursing care facility non state government owned upper payment limit program unless the non state government entity is a special service district county or city that operates a hospital or holds a license under chapter health care facility licensing and inspection act chapter part health care facility licensing and inspection d each non state government entity that participates in the nursing care facility non state government owned upper payment limit program shall certify to the department that i the non state government entity is a local government entity that is able to make an intergovernmental transfer under applicable state and federal law ii the non state government entity has sufficient public funds or other permissible sources of seed funding that comply with the requirements in c f r part subpart b iii the funds received from the nursing care facility non state government owned upper payment limit program are a for each nursing care facility available for patient care until the end of the non state government entity s fiscal year and b used exclusively for operating expenses for nursing care facility operations patient care capital expenses rent royalties and other operating expenses and iv the non state government entity has completed all licensing enrollment and other forms and documents required by federal and state law to register a change of ownership with the department and with cms the department shall add a nursing care facility to an existing nursing care facility non state government owned upper payment limit program contract if a the nursing care facility is managed by or affiliated with the same non state government entity that also manages one or more nursing care facilities that are included in an existing nursing care facility non state government owned upper payment limit program contract and b the non state government entity makes the certification described in subsection d ii the department may not increase the percentage of the administrative fee paid by a non state government entity to the department under the nursing care facility non state government owned upper payment limit program the department may not condition participation in the nursing care facility non state government owned upper payment limit program on a a requirement that the department be allowed to direct or determine the types of patients that a non state government entity will treat or the course of treatment for a patient in a non state government nursing care facility or b a requirement that a non state government entity or nursing care facility post a bond purchase insurance or create a reserve account of any kind the non state government entity shall have the primary responsibility for ensuring compliance with subsection d ii a the department may not enter into a new nursing care facility non state government owned upper payment limit program contract before january b subsection a does not apply to i a new nursing care facility non state government owned upper payment limit program contract that was included in the federal funds request summary under section j for fiscal year or ii a nursing care facility that is operated or managed by the same company as a nursing care facility that was included in the federal funds request summary under section j for fiscal year section section b which is renumbered from section is renumbered and amended to read b screening brief intervention and referral to treatment medicaid reimbursement as used in this section a controlled substance prescriber means a controlled substance prescriber as that term is defined in section who i has a record of having completed sbirt training in accordance with subsection before providing the sbirt services and ii is a medicaid enrolled health care provider b sbirt means the same as that term is defined in section the department shall reimburse a controlled substance prescriber who provides sbirt services to a medicaid enrollee who is years of age old or older for the sbirt services section section b which is renumbered from section is renumbered and amended to read b prescribing policies for opioid prescriptions the department may implement a prescribing policy for certain opioid prescriptions that is substantially similar to the prescribing policies required in section a the department may amend the state program and apply for waivers for the state program if necessary to implement subsection section section b which is renumbered from section is renumbered and amended to read b reimbursement for long acting reversible contraception immediately following childbirth as used in this section long acting reversible contraception means a contraception method that requires administration less than once per month including a an intrauterine device and b a contraceptive implant the division shall separately identify and reimburse from other labor and delivery services within the medicaid program the provision and insertion of long acting reversible contraception immediately after childbirth section section b which is renumbered from section is renumbered and amended to read b coverage of exome sequence testing as used in this section exome sequence testing means a genomic technique for sequencing the genome of an individual for diagnostic purposes the medicaid program shall reimburse for exome sequence testing a for an enrollee who i is younger than years of age old and ii who remains undiagnosed after exhausting all other appropriate diagnostic related tests b performed by a nationally recognized provider with significant experience in exome sequence testing c that is medically necessary and d at a rate set by the medicaid program section section b which is renumbered from section is renumbered and amended to read b reimbursement for nonemergency secured behavioral health transport providers the department may not reimburse a nonemergency secured behavioral health transport provider that is designated under section a b section section b which is renumbered from section is renumbered and amended to read b children s health care coverage program as used in this section a chip means the children s health insurance program created in section b b program means the children s health care coverage program created in subsection a there is created the children s health care coverage program within the department b the purpose of the program is to i promote health insurance coverage for children in accordance with section b ii conduct research regarding families who are eligible for medicaid and chip to determine awareness and understanding of available coverage iii analyze trends in disenrollment and identify reasons that families may not be renewing enrollment including any barriers in the process of renewing enrollment iv administer surveys to recently enrolled chip and children s medicaid enrollees to identify a how the enrollees learned about coverage and b any barriers during the application process v develop promotional material regarding chip and children s medicaid eligibility including outreach through social media video production and other media platforms vi identify ways that the eligibility website for enrollment in chip and children s medicaid can be redesigned to increase accessibility and enhance the user experience vii identify outreach opportunities including partnerships with community organizations including a schools b small businesses c unemployment centers d parent teacher associations and e youth athlete clubs and associations and viii develop messaging to increase awareness of coverage options that are available through the department a the department may not delegate implementation of the program to a private entity b notwithstanding subsection a the department may contract with a media agency to conduct the activities described in subsection b iv and vii section section b which is renumbered from section is renumbered and amended to read b reimbursement for diabetes prevention program as used in this section dpp means the national diabetes prevention program developed by the united states centers for disease control and prevention beginning july the medicaid program shall reimburse a provider for an enrollee s participation in the dpp if the enrollee a meets the dpp s eligibility requirements and b has not previously participated in the dpp after july while enrolled in the medicaid program subject to appropriation the medicaid program may set the rate for reimbursement the department may apply for a state plan amendment if necessary to implement this section a on or after july but before october the department shall provide a written report regarding the efficacy of the dpp and reimbursement under this section to the health and human services interim committee b the report described in subsection a shall include i the total number of enrollees with a prediabetic condition as of july ii the total number of enrollees as of july with a diagnosis of type diabetes iii the total number of enrollees who participated in the dpp iv the total cost incurred by the state to implement this section and v any conclusions that can be drawn regarding the impact of the dpp on the rate of type diabetes for enrollees section section b which is renumbered from section is renumbered and amended to read b behavioral health delivery working group as used in this section targeted adult medicaid program means the same as that term is defined in section b on or before may the department shall convene a working group to collaborate with the department on a establishing specific and measurable metrics regarding i compliance of managed care organizations in the state with federal medicaid managed care requirements ii timeliness and accuracy of authorization and claims processing in accordance with medicaid policy and contract requirements iii reimbursement by managed care organizations in the state to providers to maintain adequacy of access to care iv availability of care management services to meet the needs of medicaid eligible individuals enrolled in the plans of managed care organizations in the state and v timeliness of resolution for disputes between a managed care organization and the managed care organization s providers and enrollees b improving the delivery of behavioral health services in the medicaid program c proposals to implement the delivery system adjustments authorized under subsection b and d issues that are identified by managed care organizations behavioral health service providers and the department the working group convened under subsection shall a meet quarterly and b consist of at least the following individuals i the executive director or the executive director s designee ii for each medicaid accountable care organization with which the department contracts an individual selected by the accountable care organization iii five individuals selected by the department to represent various types of behavioral health services providers including at a minimum individuals who represent providers who provide the following types of services a acute inpatient behavioral health treatment b residential treatment c intensive outpatient or partial hospitalization treatment and d general outpatient treatment iv a representative of an association that represents behavioral health treatment providers in the state designated by the utah behavioral healthcare council convened by the utah association of counties v a representative of an organization representing behavioral health organizations vi the chair of the utah substance use and mental health advisory council created in section m vii a representative of an association that represents local authorities who provide public behavioral health care designated by the department viii one member of the senate appointed by the president of the senate and ix one member of the house of representatives appointed by the speaker of the house of representatives the working group convened under this section shall recommend to the department a specific and measurable metrics under subsection a b how physical and behavioral health services may be integrated for the targeted adult medicaid program including ways the department may address issues regarding i filing of claims ii authorization and reauthorization for treatment services iii reimbursement rates and iv other issues identified by the department behavioral health services providers or medicaid managed care organizations c ways to improve delivery of behavioral health services to enrollees including changes to statute or administrative rule and d wraparound service coverage for enrollees who need specific nonclinical services to ensure a path to success section section b which is renumbered from section is renumbered and amended to read b adjudicative proceedings related to medicaid funds if a proceeding of the department under title g chapter administrative procedures act relates in any way to recovery of medicaid funds a the presiding officer shall be designated by the executive director of the department and report directly to the executive director or in the discretion of the executive director report directly to the director of the office of internal audit and b the decision of the presiding officer is the recommended decision to the executive director of the department or a designee of the executive director who is not in the division subsection does not apply to hearings conducted by the department of workforce services relating to medical assistance eligibility determinations if a proceeding of the department under title g chapter administrative procedures act relates in any way to medicaid or medicaid funds the following may attend and present evidence or testimony at the proceeding a the director of the office of internal audit or the director s designee and b the inspector general of medicaid services or the inspector general s designee in relation to a proceeding of the department under title g chapter administrative procedures act a person may not outside of the actual proceeding attempt to influence the decision of the presiding officer section section b which is renumbered from section is renumbered and amended to read b medical assistance accountability division duties reporting as used in this section a abuse means i an action or practice that a is inconsistent with sound fiscal business or medical practices and b results or may result in unnecessary medicaid related costs or other medical or hospital assistance costs or ii reckless or negligent upcoding b fraud means intentional or knowing i deception misrepresentation or upcoding in relation to medicaid funds costs claims reimbursement or practice or ii deception or misrepresentation in relation to medical or hospital assistance funds costs claims reimbursement or practice c upcoding means assigning an inaccurate billing code for a service that is payable or reimbursable by medicaid funds if the correct billing code for the service taking into account reasonable opinions derived from official published coding definitions would result in a lower medicaid payment or reimbursement d waste means overutilization of resources or inappropriate payment the division shall a develop and implement procedures relating to medicaid funds and medical or hospital assistance funds to ensure that providers do not receive a i duplicate payments for the same goods or services b ii payment for goods or services by resubmitting a claim for which i a payment has been disallowed on the grounds that payment would be a violation of federal or state law administrative rule or the state plan and ii b the decision to disallow the payment has become final c iii payment for goods or services provided after a recipient s death including payment for pharmaceuticals or long term care or d iv payment for transporting an unborn infant b consult with the centers for medicaid and medicare services cms other states and the office of inspector general of medicaid services to determine and implement best practices for discovering and eliminating fraud waste and abuse of medicaid funds and medical or hospital assistance funds c actively seek repayment from providers for improperly used or paid a i medicaid funds and b ii medical or hospital assistance funds d coordinate track and keep records of all division efforts to obtain repayment of the funds described in subsection c and the results of those efforts e keep medicaid pharmaceutical costs as low as possible by actively seeking to obtain pharmaceuticals at the lowest price possible including on a quarterly basis for the pharmaceuticals that represent the highest of state medicaid expenditures for pharmaceuticals and on an annual basis for the remaining pharmaceuticals a i tracking changes in the price of pharmaceuticals b ii checking the availability and price of generic drugs c iii reviewing and updating the state s maximum allowable cost list and d iv comparing pharmaceutical costs of the state medicaid program to available pharmacy price lists and f provide training on an annual basis to the employees of the division who make decisions on billing codes or who are in the best position to observe and identify upcoding in order to avoid and detect upcoding section section b which is renumbered from section is renumbered and amended to read b medical assistance from division or department of workforce services and compliance under adoption assistance interstate compact penalty for fraudulent claim as used in this section a adoption assistance means the same as that term is defined in section b adoption assistance agreement means the same as that term is defined in section c adoption assistance interstate compact means an agreement executed by the division of child and family services with any other state in accordance with section a a child who is a resident of this state and is the subject of an adoption assistance interstate compact is entitled to receive medical assistance from the division and the department of workforce services by filing a certified copy of the child s adoption assistance agreement with the division or the department of workforce services b the adoptive parent of the child described in subsection a shall annually provide the division or the department of workforce services with evidence verifying that the adoption assistance agreement is still effective the department of workforce services shall consider the recipient of medical assistance under this section as the department of workforce services does any other recipient of medical assistance under an adoption assistance agreement executed by the division of child and family services a a person may not submit a claim for payment or reimbursement under this section that the person knows is false misleading or fraudulent b a violation of subsection a is a third degree felony the division and the department of workforce services shall a cooperate with the division of child and family services in regard to an adoption assistance interstate compact and b comply with an adoption assistance interstate compact section section b which is renumbered from section is renumbered and amended to read part medicaid waivers b medicaid waiver for independent foster care adolescents for purposes of as used in this section an independent foster care adolescent includes any individual who reached years of age old while in the custody of the division of child and family services or the department of human services department if the division of child and family services department was the primary case manager or a federally recognized indian tribe an independent foster care adolescent is eligible when funds are available for medicaid coverage until the individual reaches years of age old before july the division shall submit a state medicaid plan amendment to the center for medicaid services cms to provide medical coverage for independent foster care adolescents effective fiscal year section section b which is renumbered from section is renumbered and amended to read b waivers to maximize replacement of fee for service delivery model cost of mandated program changes the department shall develop a waiver program in the medicaid program to replace the fee for service delivery model with one or more risk based delivery models the waiver program shall a restructure the program s provider payment provisions to reward health care providers for delivering the most appropriate services at the lowest cost and in ways that compared to services delivered before implementation of the waiver program maintain or improve recipient health status b restructure the program s cost sharing provisions and other incentives to reward recipients for personal efforts to i maintain or improve their health status and ii use providers that deliver the most appropriate services at the lowest cost c identify the evidence based practices and measures risk adjustment methodologies payment systems funding sources and other mechanisms necessary to reward providers for delivering the most appropriate services at the lowest cost including mechanisms that i pay providers for packages of services delivered over entire episodes of illness rather than for individual services delivered during each patient encounter and ii reward providers for delivering services that make the most positive contribution to a recipient s health status d limit total annual per patient per month expenditures for services delivered through fee for service arrangements to total annual per patient per month expenditures for services delivered through risk based arrangements covering similar recipient populations and services and e except as provided in subsection limit the rate of growth in per patient per month general fund expenditures for the program to the rate of growth in general fund expenditures for all other programs when the rate of growth in the general fund expenditures for all other programs is greater than zero to the extent possible the department shall operate the waiver program with the input of stakeholder groups representing those who will be affected by the waiver program a for purposes of this subsection mandated program change shall be determined by the department in consultation with the medicaid accountable care organizations and may include a change to the state medicaid program that is required by state or federal law state or federal guidance policy or the state medicaid plan b a mandated program change shall be included in the base budget for the medicaid program for the fiscal year in which the medicaid program adopted the mandated program change c the mandated program change is not subject to the limit on the rate of growth in per patient per month general fund expenditures for the program established in subsection e until the fiscal year following the fiscal year in which the medicaid program adopted the mandated program change a managed care organization or a pharmacy benefit manager that provides a pharmacy benefit to an enrollee shall establish a unique group number payment classification number or bank identification number for each medicaid managed care organization plan for which the managed care organization or pharmacy benefit manager provides a pharmacy benefit section section b which is renumbered from section is renumbered and amended to read b base budget appropriations for medicaid accountable care organizations and behavioral health plans forecast of behavioral health services cost as used in this section a aco means an accountable care organization that contracts with the state s medicaid program for i physical health services or ii integrated physical and behavioral health services b base budget means the same as that term is defined in legislative rule c behavioral health plan means a managed care or fee for service delivery system that contracts with or is operated by the department to provide behavioral health services to medicaid eligible individuals d behavioral health services means mental health or substance use treatment or services e general fund growth factor means the amount determined by dividing the next fiscal year ongoing general fund revenue estimate by current fiscal year ongoing appropriations from the general fund f next fiscal year ongoing general fund revenue estimate means the next fiscal year ongoing general fund revenue estimate identified by the executive appropriations committee in accordance with legislative rule for use by the office of the legislative fiscal analyst in preparing budget recommendations g pmpm means per member per month funding if the general fund growth factor is less than the next fiscal year base budget shall subject to subsection include an appropriation to the department in an amount necessary to ensure that the next fiscal year pmpm for acos and behavioral health plans equals the current fiscal year pmpm for the acos and behavioral health plans multiplied by if the general fund growth factor is greater than or equal to but less than the next fiscal year base budget shall subject to subsection include an appropriation to the department in an amount necessary to ensure that the next fiscal year pmpm for acos and behavioral health plans equals the current fiscal year pmpm for the acos and behavioral health plans multiplied by the general fund growth factor if the general fund growth factor is greater than or equal to the next fiscal year base budget shall subject to subsection include an appropriation to the department in an amount necessary to ensure that the next fiscal year pmpm for acos and behavioral health plans is greater than or equal to the current fiscal year pmpm for the acos and behavioral health plans multiplied by and less than or equal to the current fiscal year pmpm for the acos and behavioral health plans multiplied by the general fund growth factor the appropriations provided to the department for behavioral health plans under this section shall be reduced by the amount contributed by counties in the current fiscal year for behavioral health plans in accordance with subsections k and a x in order for the department to estimate the impact of subsections through before identification of the next fiscal year ongoing general fund revenue estimate the governor s office of planning and budget shall in cooperation with the office of the legislative fiscal analyst develop an estimate of ongoing general fund revenue for the next fiscal year and provide the estimate to the department no later than november of each year the office of the legislative fiscal analyst shall include an estimate of the cost of behavioral health services in any state medicaid funding or savings forecast that is completed in coordination with the department and the governor s office of planning and budget section section b which is renumbered from section is renumbered and amended to read b incentives to appropriately use emergency department services a this section applies to the medicaid program and to the utah children s health insurance program created in chapter utah children s health insurance act section b b as used in this section i managed care organization means a comprehensive full risk managed care delivery system that contracts with the medicaid program or the children s health insurance program to deliver health care through a managed care plan ii managed care plan means a risk based delivery service model authorized by section b and administered by a managed care organization iii non emergent care a means use of the emergency department to receive health care that is non emergent as defined by the department by administrative rule adopted in accordance with title g chapter utah administrative rulemaking act and the emergency medical treatment and active labor act and b does not mean the medical services provided to an individual required by the emergency medical treatment and active labor act including services to conduct a medical screening examination to determine if the recipient has an emergent or non emergent condition iv professional compensation means payment made for services rendered to a medicaid recipient by an individual licensed to provide health care services v super utilizer means a medicaid recipient who has been identified by the recipient s managed care organization as a person who uses the emergency department excessively as defined by the managed care organization a a managed care organization may in accordance with subsections b and c i audit emergency department services provided to a recipient enrolled in the managed care plan to determine if non emergent care was provided to the recipient and ii establish differential payment for emergent and non emergent care provided in an emergency department b i the differential payments under subsection a ii do not apply to professional compensation for services rendered in an emergency department ii except in cases of suspected fraud waste and abuse a managed care organization s audit of payment under subsection a i is limited to the month period of time after the date on which the medical services were provided to the recipient if fraud waste or abuse is alleged the managed care organization s audit of payment under subsection a i is limited to three years after the date on which the medical services were provided to the recipient c the audits and differential payments under subsections a and b apply to services provided to a recipient on or after july a managed care organization shall a use the savings under subsection to maintain and improve access to primary care and urgent care services for all medicaid or chip recipients enrolled in the managed care plan b provide viable alternatives for increasing primary care provider reimbursement rates to incentivize after hours primary care access for recipients and c report to the department on how the managed care organization complied with this subsection the department may a through administrative rule adopted by the department develop quality measurements that evaluate a managed care organization s delivery of i appropriate emergency department services to recipients enrolled in the managed care plan ii expanded primary care and urgent care for recipients enrolled in the managed care plan with consideration of the managed care organization s a delivery of primary care urgent care and after hours care through means other than the emergency department b recipient access to primary care providers and community health centers including evening and weekend access and c other innovations for expanding access to primary care and iii quality of care for the managed care plan members b compare the quality measures developed under subsection a for each managed care organization and c develop by administrative rule an algorithm to determine assignment of new unassigned recipients to specific managed care plans based on the plan s performance in relation to the quality measures developed pursuant to subsection a section section b which is renumbered from section is renumbered and amended to read b long term care insurance partnership as used in this section a qualified long term care insurance contract is as defined in u s c sec b b b qualified long term care insurance partnership is as defined in u s c sec p b c iii c state plan amendment means an amendment to the state medicaid plan drafted by the department in compliance with this section no later than july the department shall seek federal approval of a state plan amendment that creates a qualified long term care insurance partnership the department may make rules to comply with federal laws and regulations relating to qualified long term care insurance partnerships and qualified long term care insurance contracts section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for children with disabilities and complex medical needs as used in this section a additional eligibility criteria means the additional eligibility criteria set by the department under subsection e b complex medical condition means a physical condition of an individual that i results in severe functional limitations for the individual and ii is likely to a last at least months or b result in death c program means the program for children with complex medical conditions created in subsection d qualified child means a child who i is less than years old ii is diagnosed with a complex medical condition iii has a condition that meets the definition of disability in u s c sec and iv meets the additional eligibility criteria the department shall apply for a medicaid home and community based waiver with cms to implement within the state medicaid program the program described in subsection if the waiver described in subsection is approved the department shall offer a program that a as funding permits provides treatment for qualified children b if approved by cms and as funding permits beginning in fiscal year provides on an ongoing basis treatment for more qualified children than the program provided treatment for during fiscal year and c accepts applications for the program on an ongoing basis i d requires periodic reevaluations of an enrolled child s eligibility and other applicants or eligible children waiting for services in the program based on the additional eligibility criteria and ii e at the time of reevaluation allows the department to disenroll a child based on the prioritization described in subsection a and additional eligibility criteria the department shall a establish by rule made in accordance with title g chapter utah administrative rulemaking act criteria to prioritize qualified children s participation in the program based on the following factors in the following priority order i the complexity of a qualified child s medical condition and ii the financial needs of the qualified child and the qualified child s family b convene a public process to determine the benefits and services to offer a qualified child under the program c evaluate on an ongoing basis the cost and effectiveness of the program d if funding for the program is reduced develop an evaluation process to reduce the number of children served based on the participation criteria established under subsection a and e establish by rule made in accordance with title g chapter utah administrative rulemaking act additional eligibility criteria based on the factors described in subsections a i and ii section section b which is renumbered from section is renumbered and amended to read b health coverage improvement program eligibility annual report expansion of eligibility for adults with dependent children as used in this section a adult in the expansion population means an individual who i is described in u s c sec a a a i viii and ii is not otherwise eligible for medicaid as a mandatory categorically needy individual b enhancement waiver program means the primary care network enhancement waiver program described in section b c federal poverty level means the poverty guidelines established by the secretary of the united states department of health and human services under u s c sec d health coverage improvement program means the health coverage improvement program described in subsections through e homeless i means an individual who is chronically homeless as determined by the department and ii includes someone who was chronically homeless and is currently living in supported housing for the chronically homeless f income eligibility ceiling means the percent of federal poverty level i established by the state in an appropriations act adopted pursuant to title j chapter budgetary procedures act and ii under which an individual may qualify for medicaid coverage in accordance with this section g targeted adult medicaid program means the program implemented by the department under subsections through beginning july the department shall amend the state medicaid plan to allow temporary residential treatment for substance abuse use for the traditional medicaid population in a short term non institutional hour facility without a bed capacity limit that provides rehabilitation services that are medically necessary and in accordance with an individualized treatment plan as approved by cms and as long as the county makes the required match under section beginning july the department shall amend the state medicaid plan to increase the income eligibility ceiling to a percentage of the federal poverty level designated by the department based on appropriations for the program for an individual with a dependent child before july the division shall submit to cms a request for waivers or an amendment of existing waivers from federal statutory and regulatory law necessary for the state to implement the health coverage improvement program in the medicaid program in accordance with this section a an adult in the expansion population is eligible for medicaid if the adult meets the income eligibility and other criteria established under subsection b an adult who qualifies under subsection shall receive medicaid coverage i through the traditional fee for service medicaid model in counties without medicaid accountable care organizations or the state s medicaid accountable care organization delivery system where implemented and subject to section b ii except as provided in subsection b iii for behavioral health through the counties in accordance with sections and iii that subject to section b integrates behavioral health services and physical health services with medicaid accountable care organizations in select geographic areas of the state that choose an integrated model and iv that permits temporary residential treatment for substance abuse use in a short term non institutional hour facility without a bed capacity limit as approved by cms that provides rehabilitation services that are medically necessary and in accordance with an individualized treatment plan a an individual is eligible for the health coverage improvement program under subsection if i at the time of enrollment the individual s annual income is below the income eligibility ceiling established by the state under subsection f and ii the individual meets the eligibility criteria established by the department under subsection b b based on available funding and approval from cms the department shall select the criteria for an individual to qualify for the medicaid program under subsection a ii based on the following priority i a chronically homeless individual ii if funding is available an individual a involved in the justice system through probation parole or court ordered treatment and b in need of substance abuse use treatment or mental health treatment as determined by the department or iii if funding is available an individual in need of substance abuse use treatment or mental health treatment as determined by the department c an individual who qualifies for medicaid coverage under subsections a and b may remain on the medicaid program for a month certification period as defined by the department eligibility changes made by the department under subsection f or b shall not apply to an individual during the month certification period the state may request a modification of the income eligibility ceiling and other eligibility criteria under subsection each fiscal year based on projected enrollment costs to the state and the state budget the current medicaid program and the health coverage improvement program when implemented shall coordinate with a state prison or county jail to expedite medicaid enrollment for an individual who is released from custody and was eligible for or enrolled in medicaid before incarceration notwithstanding sections and a county does not have to provide matching funds to the state for the cost of providing medicaid services to newly enrolled individuals who qualify for medicaid coverage under the health coverage improvement program under subsection if the enhancement waiver program is implemented the department a may not accept any new enrollees into the health coverage improvement program after the day on which the enhancement waiver program is implemented b shall transition all individuals who are enrolled in the health coverage improvement program into the enhancement waiver program c shall suspend the health coverage improvement program within one year after the day on which the enhancement waiver program is implemented d shall within one year after the day on which the enhancement waiver program is implemented use all appropriations for the health coverage improvement program to implement the enhancement waiver program and e shall work with cms to maintain any waiver for the health coverage improvement program while the health coverage improvement program is suspended under subsection c if after the enhancement waiver program takes effect the enhancement waiver program is repealed or suspended by either the state or federal government the department shall reinstate the health coverage improvement program and continue to accept new enrollees into the health coverage improvement program in accordance with the provisions of this section section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for delivery of adult dental services a before june the department shall ask cms to grant waivers from federal statutory and regulatory law necessary for the medicaid program to provide dental services in the manner described in subsection a b before june the department shall submit to cms a request for waivers or an amendment of existing waivers from federal law necessary for the state to provide dental services in accordance with subsections b i and d through g to an individual described in subsection b i c before june the department shall submit to the centers for medicare and medicaid services a request for waivers or an amendment to existing waivers from federal law necessary for the state to i provide dental services in accordance with subsections b ii and d through g to an individual described in subsection b ii and ii provide the services described in subsection h a to the extent funded the department shall provide services to only blind or disabled individuals as defined in u s c sec c a who are years old or older and eligible for the program b notwithstanding subsection a i if a waiver is approved under subsection b the department shall provide dental services to an individual who a qualifies for the health coverage improvement program described in section b and b is receiving treatment in a substance abuse treatment program as defined in section a b licensed under title a chapter licensure of programs and facilities chapter part human services programs and facilities and ii if a waiver is approved under subsection c i the department shall provide dental services to an individual who is an aged individual as defined in u s c sec c a c to the extent possible services to individuals described in subsection a shall be provided through the university of utah school of dentistry and the university of utah school of dentistry s associated statewide network d the department shall provide the services to individuals described in subsection b i by contracting with an entity that a has demonstrated experience working with individuals who are being treated for both a substance use disorder and a major oral health disease b operates a program targeted at the individuals described in subsection b that has demonstrated through a peer reviewed evaluation the effectiveness of providing dental treatment to those individuals described in subsection b c is willing to pay for an amount equal to the program s non federal share of the cost of providing dental services to the population described in subsection b and d is willing to pay all state costs associated with applying for the waiver described in subsection b and administering the program described in subsection b and ii through a fee for service payment model e the entity that receives the contract under subsection d i shall cover all state costs of the program described in subsection b f each fiscal year the university of utah school of dentistry shall in compliance with state and federal regulations regarding intergovernmental transfers transfer funds to the program in an amount equal to the program s non federal share of the cost of providing services under this section through the school during the fiscal year g if a waiver is approved under subsection c ii the department shall provide coverage for porcelain and porcelain to metal crowns if the services are provided i to an individual who qualifies for dental services under subsection b and ii by an entity that covers all state costs of a providing the coverage described in this subsection h g and b applying for the waiver described in subsection c h where possible the department shall ensure that services described in subsection a that are not provided by the university of utah school of dentistry or the university of utah school of dentistry s associated network are provided i through fee for service reimbursement until july and ii after july through the method of reimbursement used by the division for medicaid dental benefits i subject to appropriations by the legislature and as determined by the department the scope amount duration and frequency of services may be limited a if the waivers requested under subsection a are granted the medicaid program shall begin providing dental services in the manner described in subsection no later than july b if the waivers requested under subsection b are granted the medicaid program shall begin providing dental services to the population described in subsection b within days from the day on which the waivers are granted c if the waivers requested under subsection c i are granted the medicaid program shall begin providing dental services to the population described in subsection b ii within days after the day on which the waivers are granted if the federal share of the cost of providing dental services under this section will be less than during any portion of the next fiscal year the medicaid program shall cease providing dental services under this section no later than the end of the current fiscal year section section b which is renumbered from section is renumbered and amended to read b medicaid long term support services housing coordinator there is created within the medicaid program a full time equivalent position of medicaid long term support services housing coordinator the coordinator shall help medicaid recipients receive long term support services in a home or other community based setting rather than in a nursing home or other institutional setting by a working with municipalities counties the housing and community development division within the department of workforce services and others to identify community based settings available to recipients b working with the same entities to promote the development construction and availability of additional community based settings c training medicaid case managers and support coordinators on how to help medicaid recipients move from an institutional setting to a community based setting and d performing other related duties section section b which is renumbered from section is renumbered and amended to read b medicaid waiver expansion as used in this section a federal poverty level means the same as that term is defined in section b b medicaid waiver expansion means an expansion of the medicaid program in accordance with this section a before january the department shall apply to cms for approval of a waiver or state plan amendment to implement the medicaid waiver expansion b the medicaid waiver expansion shall i expand medicaid coverage to eligible individuals whose income is below of the federal poverty level ii obtain maximum federal financial participation under u s c sec d y for enrolling an individual in the medicaid program iii provide medicaid benefits through the state s medicaid accountable care organizations in areas where a medicaid accountable care organization is implemented iv integrate the delivery of behavioral health services and physical health services with medicaid accountable care organizations in select geographic areas of the state that choose an integrated model v include a path to self sufficiency including work activities as defined in u s c sec d for qualified adults vi require an individual who is offered a private health benefit plan by an employer to enroll in the employer s health plan vii sunset in accordance with subsection a and viii permit the state to close enrollment in the medicaid waiver expansion if the department has insufficient funding to provide services to additional eligible individuals if the medicaid waiver described in subsection a is approved the department may only pay the state portion of costs for the medicaid waiver expansion with appropriations from a the medicaid expansion fund created in section b b b county contributions to the non federal share of medicaid expenditures and c any other contributions funds or transfers from a non state agency for medicaid expenditures a in consultation with the department medicaid accountable care organizations and counties that elect to integrate care under subsection b iv shall collaborate on enrollment engagement of patients and coordination of services b as part of the provision described in subsection b iv the department shall apply for a waiver to permit the creation of an integrated delivery system i for any geographic area that expresses interest in integrating the delivery of services under subsection b iv and ii in which the department a may permit a local mental health authority to integrate the delivery of behavioral health services and physical health services b may permit a county local mental health authority or medicaid accountable care organization to integrate the delivery of behavioral health services and physical health services to select groups within the population that are newly eligible under the medicaid waiver expansion and c may make rules in accordance with title g chapter utah administrative rulemaking act to integrate payments for behavioral health services and physical health services to plans or providers a if federal financial participation for the medicaid waiver expansion is reduced below the authority of the department to implement the medicaid waiver expansion shall sunset no later than the next july after the date on which the federal financial participation is reduced b the department shall close the program to new enrollment if the cost of the medicaid waiver expansion is projected to exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act if the medicaid waiver expansion is approved by cms the department shall report to the social services appropriations subcommittee on or before november of each year that the medicaid waiver expansion is operational a the number of individuals who enrolled in the medicaid waiver program b costs to the state for the medicaid waiver program c estimated costs for the current and following state fiscal year and d recommendations to control costs of the medicaid waiver expansion section section b which is renumbered from section is renumbered and amended to read b primary care network enhancement waiver program as used in this section a enhancement waiver program means the primary care network enhancement waiver program described in this section b federal poverty level means the poverty guidelines established by the secretary of the united states department of health and human services under u s c sec c health coverage improvement program means the same as that term is defined in section b d income eligibility ceiling means the percentage of federal poverty level i established by the legislature in an appropriations act adopted pursuant to title j chapter budgetary procedures act and ii under which an individual may qualify for coverage in the enhancement waiver program in accordance with this section e optional population means the optional expansion population under ppaca if the expansion provides coverage for individuals at or above of the federal poverty level f primary care network means the state primary care network program created by the medicaid primary care network demonstration waiver obtained under section b the department shall continue to implement the primary care network program for qualified individuals under the primary care network program a the division shall apply for a medicaid waiver or a state plan amendment with cms to implement within the state medicaid program the enhancement waiver program described in this section within six months after the day on which i the division receives a notice from cms that the waiver for the medicaid waiver expansion submitted under section b medicaid waiver expansion will not be approved or ii the division withdraws the waiver for the medicaid waiver expansion submitted under section b medicaid waiver expansion b the division may not apply for a waiver under subsection a while a waiver request under section b medicaid waiver expansion is pending with cms an individual who is eligible for the enhancement waiver program may receive the following benefits under the enhancement waiver program a the benefits offered under the primary care network program b diagnostic testing and procedures c medical specialty care d inpatient hospital services e outpatient hospital services f outpatient behavioral health care including outpatient substance abuse use care and g for an individual who qualifies for the health coverage improvement program as approved by cms temporary residential treatment for substance abuse use in a short term non institutional hour facility without a bed capacity limit that provides rehabilitation services that are medically necessary and in accordance with an individualized treatment plan an individual is eligible for the enhancement waiver program if at the time of enrollment a the individual is qualified to enroll in the primary care network or the health coverage improvement program b the individual s annual income is below the income eligibility ceiling established by the legislature under subsection d and c the individual meets the eligibility criteria established by the department under subsection a based on available funding and approval from cms the department shall determine the criteria for an individual to qualify for the enhancement waiver program based on the following priority i adults in the expansion population as defined in section b who qualify for the health coverage improvement program ii adults with dependent children who qualify for the health coverage improvement program under subsection b iii adults with dependent children who do not qualify for the health coverage improvement program and iv if funding is available adults without dependent children b the number of individuals enrolled in the enhancement waiver program may not exceed of the number of individuals who were enrolled in the primary care network on december c the department may only use appropriations from the medicaid expansion fund created in section b b to fund the state portion of the enhancement waiver program the department may request a modification of the income eligibility ceiling and the eligibility criteria under subsection from cms each fiscal year based on enrollment in the enhancement waiver program projected enrollment in the enhancement waiver program costs to the state and the state budget the department may implement the enhancement waiver program by contracting with medicaid accountable care organizations to administer the enhancement waiver program in accordance with subsections and b and the department may use funds that have been appropriated for the health coverage improvement program to implement the enhancement waiver program if the department expands the state medicaid program to the optional population the department a except as provided in subsection may not accept any new enrollees into the enhancement waiver program after the day on which the expansion to the optional population is effective b shall suspend the enhancement waiver program within one year after the day on which the expansion to the optional population is effective and c shall work with cms to maintain the waiver for the enhancement waiver program submitted under subsection while the enhancement waiver program is suspended under subsection b if after the expansion to the optional population described in subsection takes effect the expansion to the optional population is repealed by either the state or the federal government the department shall reinstate the enhancement waiver program and continue to accept new enrollees into the enhancement waiver program in accordance with the provisions of this section section section b which is renumbered from section is renumbered and amended to read b limited family planning services for low income individuals as used in this section a i family planning services means family planning services that are provided under the state medicaid program including a sexual health education and family planning counseling and b other medical diagnosis treatment or preventative care routinely provided as part of a family planning service visit ii family planning services do not include an abortion as that term is defined in section b low income individual means an individual who i has an income level that is equal to or below of the federal poverty level and ii does not qualify for full coverage under the medicaid program before july the division shall apply for a medicaid waiver or a state plan amendment with cms to a offer a program that provides family planning services to low income individuals and b receive a federal match rate of of state expenditures for family planning services provided under the waiver or state plan amendment section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for mental health crisis lines and mobile crisis outreach teams as used in this section a local mental health crisis line means the same as that term is defined in section a b b mental health crisis means i a mental health condition that manifests itself in an individual by symptoms of sufficient severity that a prudent layperson who possesses an average knowledge of mental health issues could reasonably expect the absence of immediate attention or intervention to result in a serious danger to the individual s health or well being or b a danger to the health or well being of others or ii a mental health condition that in the opinion of a mental health therapist or the therapist s designee requires direct professional observation or the intervention of a mental health therapist c i mental health crisis services means direct mental health services and on site intervention that a mobile crisis outreach team provides to an individual suffering from a mental health crisis including the provision of safety and care plans prolonged mental health services for up to days and referrals to other community resources ii mental health crisis services includes a local mental health crisis lines and b the statewide mental health crisis line d mental health therapist means the same as that term is defined in section e mobile crisis outreach team or mcot means a mobile team of medical and mental health professionals that in coordination with local law enforcement and emergency medical service personnel provides mental health crisis services f statewide mental health crisis line means the same as that term is defined in section a b in consultation with the department of human services and the behavioral health crisis response commission created in section c the department shall develop a proposal to amend the state medicaid plan to include mental health crisis services including the statewide mental health crisis line local mental health crisis lines and mobile crisis outreach teams by january the department shall apply for a medicaid waiver with cms if necessary to implement within the state medicaid program the mental health crisis services described in subsection section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for coverage of mental health services in schools as used in this section local education agency means a a school district b a charter school or c the utah schools for the deaf and the blind in consultation with the department of human services and the state board of education the department shall develop a proposal to allow the state medicaid program to reimburse a local education agency a local mental health authority or a private provider for covered mental health services provided a in accordance with section e and b i at a local education agency building or facility or ii by an employee or contractor of a local education agency before january the department shall apply to cms for a state plan amendment to implement the coverage described in subsection section section b which is renumbered from section is renumbered and amended to read b coverage for in vitro fertilization and genetic testing as used in this section a qualified condition means i cystic fibrosis ii spinal muscular atrophy iii morquio syndrome iv myotonic dystrophy or v sickle cell anemia b qualified enrollee means an individual who i is enrolled in the medicaid program ii has been diagnosed by a physician as having a genetic trait associated with a qualified condition and iii intends to get pregnant with a partner who is diagnosed by a physician as having a genetic trait associated with the same qualified condition as the individual before january the department shall apply for a medicaid waiver or a state plan amendment with the centers for medicare and medicaid services within the united states department of health and human services to implement the coverage described in subsection if the waiver described in subsection is approved the medicaid program shall provide coverage to a qualified enrollee for a in vitro fertilization services and b genetic testing of a qualified enrollee who receives in vitro fertilization services under subsection a the medicaid program may not provide the coverage described in subsection before the later of a the day on which the waiver described in subsection is approved and b january before november and before november of every third year thereafter the department shall a calculate the change in state spending attributable to the coverage under this section and b report the amount described in subsection a a to the health and human services interim committee and the social services appropriations subcommittee section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for fertility preservation services as used in this section a iatrogenic infertility means an impairment of fertility or reproductive functioning caused by surgery chemotherapy radiation or other medical treatment b physician means an individual licensed to practice under title chapter utah medical practice act or title chapter utah osteopathic medical practice act c qualified enrollee means an individual who i is enrolled in the medicaid program ii has been diagnosed with a form of cancer by a physician and iii needs treatment for that cancer that may cause a substantial risk of sterility or iatrogenic infertility including surgery radiation or chemotherapy d standard fertility preservation service means a fertility preservation procedure and service that i is not considered experimental or investigational by the american society for reproductive medicine or the american society of clinical oncology and ii is consistent with established medical practices or professional guidelines published by the american society for reproductive medicine or the american society of clinical oncology including a sperm banking b oocyte banking c embryo banking d banking of reproductive tissues and e storage of reproductive cells and tissues before january the department shall apply for a medicaid waiver or a state plan amendment with cms to implement the coverage described in subsection if the waiver or state plan amendment described in subsection is approved the medicaid program shall provide coverage to a qualified enrollee for standard fertility preservation services the medicaid program may not provide the coverage described in subsection before the later of a the day on which the waiver described in subsection is approved and b january before november and before november of each third year after the department shall a calculate the change in state spending attributable to the coverage described in this section and b report the amount described in subsection a to the health and human services interim committee and the social services appropriations subcommittee section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for coverage of qualified inmates leaving prison or jail as used in this section a correctional facility means i a county jail ii the department of corrections created in section or iii a prison penitentiary or other institution operated by or under contract with the department of corrections for the confinement of an offender as defined in section b qualified inmate means an individual who i is incarcerated in a correctional facility and ii has a a chronic physical or behavioral health condition b a mental illness as defined in section a b or c an opioid use disorder before july the division shall apply for a medicaid waiver or a state plan amendment with cms to offer a program to provide medicaid coverage to a qualified inmate for up to days immediately before the day on which the qualified inmate is released from a correctional facility if the waiver or state plan amendment described in subsection is approved the department shall report to the health and human services interim committee each year before november while the waiver or state plan amendment is in effect regarding a the number of qualified inmates served under the program b the cost of the program and c the effectiveness of the program including i any reduction in the number of emergency room visits or hospitalizations by inmates after release from a correctional facility ii any reduction in the number of inmates undergoing inpatient treatment after release from a correctional facility iii any reduction in overdose rates and deaths of inmates after release from a correctional facility and iv any other costs or benefits as a result of the program if the waiver or state plan amendment described in subsection is approved a county that is responsible for the cost of a qualified inmate s medical care shall provide the required matching funds to the state for a any costs to enroll the qualified inmate for the medicaid coverage described in subsection b any administrative fees for the medicaid coverage described in subsection and c the medicaid coverage that is provided to the qualified inmate under subsection section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for inpatient care in an institution for mental diseases as used in this section institution for mental diseases means the same as that term is defined in c f r sec before august the division shall apply for a medicaid waiver or a state plan amendment with cms to offer a program that provides reimbursement for mental health services that are provided a in an institution for mental diseases that includes more than beds and b to an individual who receives mental health services in an institution for mental diseases for a period of more than days in a calendar month if the waiver or state plan amendment described in subsection is approved the department shall a coordinate with the department of human services to develop and offer the program described in subsection and b submit to the health and human services interim committee and the social services appropriations subcommittee any report that the department submits to cms that relates to the budget neutrality independent waiver evaluation or performance metrics of the program described in subsection within days after the day on which the report is submitted to cms notwithstanding sections and if the waiver or state plan amendment described in subsection is approved a county does not have to provide matching funds to the state for the mental health services described in subsection that are provided to an individual who qualifies for medicaid coverage under section or section b or b section section b which is renumbered from section is renumbered and amended to read b reimbursement for crisis management services provided in a behavioral health receiving center integration of payment for physical health services as used in this section a accountable care organization means the same as that term is defined in section b b behavioral health receiving center means the same as that term is defined in section a b c crisis management services means behavioral health services provided to an individual who is experiencing a mental health crisis d managed care organization means the same as that term is defined in c f r sec before july the division shall apply for a medicaid waiver or state plan amendment with cms to offer a program that provides reimbursement through a bundled daily rate for crisis management services that are delivered to an individual during the individual s stay at a behavioral health receiving center if the waiver or state plan amendment described in subsection is approved the department shall a implement the program described in subsection and b require a managed care organization that contracts with the state s medicaid program for behavioral health services or integrated health services to provide coverage for crisis management services that are delivered to an individual during the individual s stay at a behavioral health receiving center a the department may elect to integrate payment for physical health services provided in a behavioral health receiving center b in determining whether to integrate payment under subsection a the department shall consult with accountable care organizations and counties in the state section section b which is renumbered from section is renumbered and amended to read b crisis services reimbursement the department department shall submit a waiver or state plan amendment to allow for reimbursement for services provided to an individual who is eligible and enrolled in medicaid at the time this service is provided section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for respite care facility that provides services to homeless individuals as used in this section a adult in the expansion population means an adult i described in u s c sec a a a i viii and ii not otherwise eligible for medicaid as a mandatory categorically needy individual b homeless means the same as that term is defined in section b c medical respite care means short term housing with supportive medical services d medical respite facility means a residential facility that provides medical respite care to homeless individuals before january the department shall apply for a medicaid waiver or state plan amendment with cms to choose a single medical respite facility to reimburse for services provided to an individual who is a homeless and b an adult in the expansion population the department shall choose a medical respite facility best able to serve homeless individuals who are adults in the expansion population if the waiver or state plan amendment described in subsection is approved while the waiver or state plan amendment is in effect the department shall submit a report to the health and human services interim committee each year before november detailing a the number of homeless individuals served at the facility b the cost of the program and c the reduction of health care costs due to the program s implementation through administrative rule made in accordance with title g chapter utah administrative rulemaking act the department shall further define and limit the services described in this section provided to a homeless individual section section b which is renumbered from section is renumbered and amended to read b medicaid waiver expansion for extraordinary care reimbursement as used in this section a existing home and community based services waiver means an existing home and community based services waiver in the state that serves an individual i with an acquired brain injury ii with an intellectual or physical disability or iii who is years old or older b personal care services means a service that i is furnished to an individual who is not an inpatient nor a resident of a hospital nursing facility intermediate care facility or institution for mental diseases ii is authorized for an individual described in subsection b i in accordance with a plan of treatment iii is provided by an individual who is qualified to provide the services and iv is furnished in a home or another community based setting c waiver enrollee means an individual who is enrolled in an existing home and community based services waiver before july the department shall apply with cms for an amendment to an existing home and community based services waiver to implement a program to offer reimbursement to an individual who provides personal care services that constitute extraordinary care to a waiver enrollee who is the individual s spouse if cms approves the amendment described in subsection the department shall implement the program described in subsection the department shall by rule made in accordance with title g chapter utah administrative rulemaking act define extraordinary care for purposes of subsection section section b which is renumbered from section is renumbered and amended to read b delivery system adjustments for the targeted adult medicaid program as used in this section targeted adult medicaid program means the same as that term is defined in section b the department may implement the delivery system adjustments authorized under subsection only on the later of a july and b the department determining that the medicaid program including providers and managed care organizations are satisfying the metrics established in collaboration with the working group convened under subsection b the department may for individuals who are enrolled in the targeted adult medicaid program a integrate the delivery of behavioral and physical health in certain counties and b deliver behavioral health services through an accountable care organization where implemented before implementing the delivery system adjustments described in subsection in a county the department shall at a minimum seek input from a individuals who qualify for the targeted adult medicaid program who reside in the county b the county s executive officer legislative body and other county officials who are involved in the delivery of behavioral health services c the local mental health authority and local substance use abuse authority that serves the county d medicaid managed care organizations operating in the state including medicaid accountable care organizations e providers of physical or behavioral health services in the county who provide services to enrollees in the targeted adult medicaid program in the county and f other individuals that the department deems necessary if the department provides medicaid coverage through a managed care delivery system under this section the department shall include language in the department s managed care contracts that require the managed care plan to a be in compliance with federal medicaid managed care requirements b timely and accurately process authorizations and claims in accordance with medicaid policy and contract requirements c adequately reimburse providers to maintain adequacy of access to care d provide care management services sufficient to meet the needs of medicaid eligible individuals enrolled in the managed care plan s plan and e timely resolve any disputes between a provider or enrollee with the managed care plan the department may take corrective action if the managed care organization fails to comply with the terms of the managed care organization s contract section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for increased integrated health care reimbursement as used in this section a integrated health care setting means a health care or behavioral health care setting that provides integrated physical and behavioral health care services b local mental health authority means a local mental health authority described in section the department shall develop a proposal to allow the state medicaid program to reimburse a local mental health authority for covered physical health care services provided in an integrated health care setting to medicaid eligible individuals before december the department shall apply for a medicaid waiver or a state plan amendment with cms to implement the proposal described in subsection if the waiver or state plan amendment described in subsection is approved the department shall a implement the proposal described in subsection and b while the waiver or state plan amendment is in effect submit a report to the health and human services interim committee each year before november detailing i the number of patients served under the waiver or state plan amendment ii the cost of the waiver or state plan amendment and iii any benefits of the waiver or state plan amendment section section b which is renumbered from section is renumbered and amended to read part administration of medicaid programs drug utilization review and long term care facility certification b definitions as used in this part appropriate and medically necessary means regarding drug prescribing dispensing and patient usage that it is in conformity with the criteria and standards developed in accordance with this part board means the drug utilization review board created in section b certified program means a nursing care facility program with medicaid certification compendia means resources widely accepted by the medical profession in the efficacious use of drugs including american hospital formulary services service drug information u s pharmacopeia drug information a m a drug evaluations peer reviewed medical literature and information provided by manufacturers of drug products counseling means the activities conducted by a pharmacist to inform medicaid recipients about the proper use of drugs as required by the board under this part criteria means those predetermined and explicitly accepted elements used to measure drug use on an ongoing basis in order to determine if the use is appropriate medically necessary and not likely to result in adverse medical outcomes drug disease contraindications means that the therapeutic effect of a drug is adversely altered by the presence of another disease condition drug interactions means that two or more drugs taken by a recipient lead to clinically significant toxicity that is characteristic of one or any of the drugs present or that leads to interference with the effectiveness of one or any of the drugs drug utilization review or dur means the program designed to measure and assess on a retrospective and prospective basis the proper use of outpatient drugs in the medicaid program intervention means a form of communication utilized by the board with a prescriber or pharmacist to inform about or influence prescribing or dispensing practices medicaid certification means the right of a nursing care facility as a provider of a nursing care facility program to receive medicaid reimbursement for a specified number of beds within the facility a nursing care facility means the following facilities licensed by the department under chapter part health care facility licensing and inspection i skilled nursing facilities ii intermediate care facilities and iii an intermediate care facility for people with an intellectual disability b nursing care facility does not mean a critical access hospital that meets the criteria of u s c sec i c nursing care facility program means the personnel licenses services contracts and all other requirements that shall be met for a nursing care facility to be eligible for medicaid certification under this part and division rule overutilization or underutilization means the use of a drug in such quantities that the desired therapeutic goal is not achieved pharmacist means a person licensed in this state to engage in the practice of pharmacy under title chapter b pharmacy practice act physical facility means the buildings or other physical structures where a nursing care facility program is operated physician means a person licensed in this state to practice medicine and surgery under section or osteopathic medicine under section prospective dur means that part of the drug utilization review program that occurs before a drug is dispensed and that is designed to screen for potential drug therapy problems based on explicit and predetermined criteria and standards retrospective dur means that part of the drug utilization review program that assesses or measures drug use based on an historical review of drug use data against predetermined and explicit criteria and standards on an ongoing basis with professional input rural county means a county with a population of less than as determined by a the most recent official census or census estimate of the united states bureau of the census or b the most recent population estimate for the county from the utah population committee if a population figure for the county is not available under subsection a service area means the boundaries of the distinct geographic area served by a certified program as determined by the division in accordance with this part and division rule standards means the acceptable range of deviation from the criteria that reflects local medical practice and that is tested on the medicaid recipient database surs means the surveillance utilization review system of the medicaid program therapeutic appropriateness means drug prescribing and dispensing based on rational drug therapy that is consistent with criteria and standards therapeutic duplication means prescribing and dispensing the same drug or two or more drugs from the same therapeutic class where periods of drug administration overlap and where that practice is not medically indicated urban county means a county that is not a rural county section section b which is renumbered from section is renumbered and amended to read b dur board creation and membership expenses there is created a member drug utilization review board responsible for implementation of a retrospective and prospective dur program a except as required by subsection b as terms of current board members expire the executive director shall appoint each new member or reappointed member to a four year term b notwithstanding the requirements of subsection a the executive director shall at the time of appointment or reappointment adjust the length of terms to ensure that the terms of board members are staggered so that approximately half of the board is appointed every two years c persons appointed to the board may be reappointed upon completion of their terms but may not serve more than two consecutive terms d the executive director shall provide for geographic balance in representation on the board when a vacancy occurs in the membership for any reason the replacement shall be appointed for the unexpired term the membership shall be comprised of the following a four physicians who are actively engaged in the practice of medicine or osteopathic medicine in this state to be selected from a list of nominees provided by the utah medical association b one physician in this state who is actively engaged in academic medicine c three pharmacists who are actively practicing in retail pharmacy in this state to be selected from a list of nominees provided by the utah pharmaceutical association d one pharmacist who is actively engaged in academic pharmacy e one person who shall represent consumers f one person who shall represent pharmaceutical manufacturers to be recommended by the pharmaceutical manufacturers association and g one dentist licensed to practice in this state under title chapter dentist and dental hygienist practice act who is actively engaged in the practice of dentistry nominated by the utah dental association physician and pharmacist members of the board shall have expertise in clinically appropriate prescribing and dispensing of outpatient drugs the board shall elect a chair from among its members who shall serve a one year term and may serve consecutive terms a member may not receive compensation or benefits for the member s service but may receive per diem and travel expenses in accordance with a section a b section a and c rules made by the division of finance pursuant to sections a and a section section b which is renumbered from section is renumbered and amended to read b dur board responsibilities the board shall develop rules necessary to carry out its responsibilities as defined in this part oversee the implementation of a medicaid retrospective and prospective dur program in accordance with this part including responsibility for approving provisions of contractual agreements between the medicaid program and any other entity that will process and review medicaid drug claims and profiles for the dur program in accordance with this part develop and apply predetermined criteria and standards to be used in retrospective and prospective dur ensuring that the criteria and standards are based on the compendia and that they are developed with professional input in a consensus fashion with provisions for timely revision and assessment as necessary the dur standards developed by the board shall reflect the local practices of physicians in order to monitor a therapeutic appropriateness b overutilization or underutilization c therapeutic duplication d drug disease contraindications e drug drug interactions f incorrect drug dosage or duration of drug treatment and g clinical abuse and misuse develop select apply and assess interventions and remedial strategies for physicians pharmacists and recipients that are educational and not punitive in nature in order to improve the quality of care disseminate information to physicians and pharmacists to ensure that they are aware of the board s duties and powers provide written oral or electronic reminders of patient specific or drug specific information designed to ensure recipient physician and pharmacist confidentiality and suggest changes in prescribing or dispensing practices designed to improve the quality of care utilize face to face discussions between experts in drug therapy and the prescriber or pharmacist who has been targeted for educational intervention conduct intensified reviews or monitoring of selected prescribers or pharmacists create an educational program using data provided through dur to provide active and ongoing educational outreach programs to improve prescribing and dispensing practices either directly or by contract with other governmental or private entities provide a timely evaluation of intervention to determine if those interventions have improved the quality of care publish the annual drug utilization review report required under c f r sec develop a working agreement with related boards or agencies including the state board of pharmacy physicians licensing board and surs staff within the division in order to clarify areas of responsibility for each where those areas may overlap establish a grievance process for physicians and pharmacists under this part in accordance with title g chapter administrative procedures act publish and disseminate educational information to physicians and pharmacists concerning the board and the dur program including information regarding a identification and reduction of the frequency of patterns of fraud abuse gross overuse inappropriate or medically unnecessary care among physicians pharmacists and recipients b potential or actual severe or adverse reactions to drugs c therapeutic appropriateness d overutilization or underutilization e appropriate use of generics f therapeutic duplication g drug disease contraindications h drug drug interactions i incorrect drug dosage and duration of drug treatment j drug allergy interactions and k clinical abuse and misuse develop and publish with the input of the state board of pharmacy guidelines and standards to be used by pharmacists in counseling medicaid recipients in accordance with this part the guidelines shall ensure that the recipient may refuse counseling and that the refusal is to be documented by the pharmacist items to be discussed as part of that counseling include a the name and description of the medication b administration form and duration of therapy c special directions and precautions for use d common severe side effects or interactions and therapeutic interactions and how to avoid those occurrences e techniques for self monitoring drug therapy f proper storage g prescription refill information and h action to be taken in the event of a missed dose and establish procedures in cooperation with the state board of pharmacy for pharmacists to record information to be collected under this part the recorded information shall include a the name address age and gender of the recipient b individual history of the recipient where significant including disease state known allergies and drug reactions and a comprehensive list of medications and relevant devices c the pharmacist s comments on the individual s drug therapy d name of prescriber and e name of drug dose duration of therapy and directions for use section section b which is renumbered from section is renumbered and amended to read b confidentiality of records information obtained under this part shall be treated as confidential or controlled information under title g chapter government records access and management act the board shall establish procedures insuring ensuring that the information described in subsection b is held confidential by the pharmacist being provided to the physician only upon request the board shall adopt and implement procedures designed to ensure the confidentiality of all information collected stored retrieved assessed or analyzed by the board staff to the board or contractors to the dur program that identifies individual physicians pharmacists or recipients the board may have access to identifying information for purposes of carrying out intervention activities but that identifying information may not be released to anyone other than a member of the board the board may release cumulative nonidentifying information for research purposes section section b which is renumbered from section is renumbered and amended to read b drug prior approval program a drug prior approval program approved or implemented by the board shall meet the following conditions a except as provided in subsection a drug may not be placed on prior approval for other than medical reasons b the board shall hold a public hearing at least days prior to placing a drug on prior approval c notwithstanding the provisions of section the board shall provide not less than days notice to the public before holding a public hearing under subsection b d the board shall consider written and oral comments submitted by interested parties prior to or during the hearing held in accordance with subsection b e the board shall provide evidence that placing a drug class on prior approval i will not impede quality of recipient care and ii that the drug class is subject to clinical abuse or misuse f the board shall reconsider its decision to place a drug on prior approval i no later than nine months after any drug class is placed on prior approval and ii at a public hearing with notice as provided in subsection b g the program shall provide an approval or denial of a request for prior approval i by either a fax b telephone or c electronic transmission ii at least monday through friday except for state holidays and iii within hours after receipt of the prior approval request h the program shall provide for the dispensing of at least a hour supply of the drug on the prior approval program i in an emergency situation or ii on weekends or state holidays i the program may be applied to allow acceptable medical use of a drug on prior approval for appropriate off label indications and j before placing a drug class on the prior approval program the board shall i determine that the requirements of subsections a through i have been met and ii by majority vote place the drug class on prior approval the board may only after complying with subsections b through j consider the cost a of a drug when placing a drug on the prior approval program and b associated with including or excluding a drug from the prior approval process including i potential side effects associated with a drug or ii potential hospitalizations or other complications that may occur as a result of a drug s inclusion on the prior approval process section section b which is renumbered from section is renumbered and amended to read b advisory committees the board may establish advisory committees to assist it in carrying out its duties under this part sections b through b section section b which is renumbered from section is renumbered and amended to read b retrospective and prospective dur the board in cooperation with the division shall include in its state plan the creation and implementation of a retrospective and prospective dur program for medicaid outpatient drugs to ensure that prescriptions are appropriate medically necessary and not likely to result in adverse medical outcomes the retrospective and prospective dur program shall be operated under guidelines established by the board under subsections and the retrospective dur program shall be based on guidelines established by the board using the mechanized drug claims processing and information retrieval system to analyze claims data in order to a identify patterns of fraud abuse gross overuse and inappropriate or medically unnecessary care and b assess data on drug use against explicit predetermined standards that are based on the compendia and other sources for the purpose of monitoring i therapeutic appropriateness ii overutilization or underutilization iii therapeutic duplication iv drug disease contraindications v drug drug interactions vi incorrect drug dosage or duration of drug treatment and vii clinical abuse and misuse the prospective dur program shall be based on guidelines established by the board and shall provide that before a prescription is filled or delivered a review will be conducted by the pharmacist at the point of sale to screen for potential drug therapy problems resulting from a therapeutic duplication b drug drug interactions c incorrect dosage or duration of treatment d drug allergy interactions and e clinical abuse or misuse in conducting the prospective dur a pharmacist may not alter the prescribed outpatient drug therapy without the consent of the prescribing physician or physician assistant this section does not effect the ability of a pharmacist to substitute a generic equivalent section section b which is renumbered from section is renumbered and amended to read b penalties any person who violates the confidentiality provisions of this part sections b through b is guilty of a class b misdemeanor section section b which is renumbered from section is renumbered and amended to read b immunity there is no liability on the part of and no cause of action of any nature arises against any member of the board its agents or employees for any action or omission by them in effecting the provisions of this part sections b through b section section b which is renumbered from section is renumbered and amended to read b purpose medicaid certification of nursing care facilities the legislature finds a that an oversupply of nursing care facilities in the state adversely affects the state medicaid program and the health of the people in the state b it is in the best interest of the state to prohibit nursing care facilities from receiving medicaid certification except as provided by this part sections b through b and c it is in the best interest of the state to encourage aging nursing care facilities with medicaid certification to renovate the nursing care facilities physical facilities so that the quality of life and clinical services for medicaid residents are preserved medicaid reimbursement of nursing care facility programs is limited to a the number of nursing care facility programs with medicaid certification as of may and b additional nursing care facility programs approved for medicaid certification under the provisions of subsections b and the division may not a except as authorized by section b i process initial applications for medicaid certification or execute provider agreements with nursing care facility programs or ii reinstate medicaid certification for a nursing care facility whose certification expired or was terminated by action of the federal or state government or b execute a medicaid provider agreement with a certified program that moves to a different physical facility except as authorized by subsection b notwithstanding section b beginning may the division may not approve a new or additional bed in an intermediate care facility for individuals with an intellectual disability for medicaid certification unless certification of the bed by the division does not increase the total number in the state of medicaid certified beds in intermediate care facilities for individuals with an intellectual disability section section b which is renumbered from section is renumbered and amended to read b authorization to renew transfer or increase medicaid certified programs reimbursement methodology a the division may renew medicaid certification of a certified program if the program without lapse in service to medicaid recipients has its nursing care facility program certified by the division at the same physical facility as long as the licensed and certified bed capacity at the facility has not been expanded unless the director has approved additional beds in accordance with subsection b the division may renew medicaid certification of a nursing care facility program that is not currently certified if i since the day on which the program last operated with medicaid certification a the physical facility where the program operated has functioned solely and continuously as a nursing care facility and b the owner of the program has not under this section or section b transferred to another nursing care facility program the license for any of the medicaid beds in the program and ii except as provided in subsection b the number of beds granted renewed medicaid certification does not exceed the number of beds certified at the time the program last operated with medicaid certification excluding a period of time where the program operated with temporary certification under subsection b a the division may issue a medicaid certification for a new nursing care facility program if a current owner of the medicaid certified program transfers its ownership of the medicaid certification to the new nursing care facility program and the new nursing care facility program meets all of the following conditions i the new nursing care facility program operates at the same physical facility as the previous medicaid certified program ii the new nursing care facility program gives a written assurance to the director in accordance with subsection iii the new nursing care facility program receives the medicaid certification within one year of the date the previously certified program ceased to provide medical assistance to a medicaid recipient and iv the licensed and certified bed capacity at the facility has not been expanded unless the director has approved additional beds in accordance with subsection b a nursing care facility program that receives medicaid certification under the provisions of subsection a does not assume the medicaid liabilities of the previous nursing care facility program if the new nursing care facility program i is not owned in whole or in part by the previous nursing care facility program or ii is not a successor in interest of the previous nursing care facility program the division may issue a medicaid certification to a nursing care facility program that was previously a certified program but now resides in a new or renovated physical facility if the nursing care facility program meets all of the following a the nursing care facility program met all applicable requirements for medicaid certification at the time of closure b the new or renovated physical facility is in the same county or within a five mile radius of the original physical facility c the time between which the certified program ceased to operate in the original facility and will begin to operate in the new physical facility is not more than three years unless i an emergency is declared by the president of the united states or the governor affecting the building or renovation of the physical facility ii the director approves an exception to the three year requirement for any nursing care facility program within the three year requirement iii the provider submits documentation supporting a request for an extension to the director that demonstrates a need for an extension and iv the exception does not extend for more than two years beyond the three year requirement d if subsection c applies the certified program notifies the department within days after ceasing operations in its original facility of its intent to retain its medicaid certification e the provider gives written assurance to the director in accordance with subsection that no third party has a legitimate claim to operate a certified program at the previous physical facility and f the bed capacity in the physical facility has not been expanded unless the director has approved additional beds in accordance with subsection a the entity requesting medicaid certification under subsections and shall give written assurances satisfactory to the director or the director s designee that i no third party has a legitimate claim to operate the certified program ii the requesting entity agrees to defend and indemnify the department against any claims by a third party who may assert a right to operate the certified program and iii if a third party is found by final agency action of the department after exhaustion of all administrative and judicial appeal rights to be entitled to operate a certified program at the physical facility the certified program shall voluntarily comply with subsection b b if a finding is made under the provisions of subsection a iii i the certified program shall immediately surrender its medicaid certification and comply with division rules regarding billing for medicaid and the provision of services to medicaid patients and ii the department shall transfer the surrendered medicaid certification to the third party who prevailed under subsection a iii a the director may approve additional nursing care facility programs for medicaid certification or additional beds for medicaid certification within an existing nursing care facility program if a nursing care facility or other interested party requests medicaid certification for a nursing care facility program or additional beds within an existing nursing care facility program and the nursing care facility program or other interested party complies with this section b the nursing care facility or other interested party requesting medicaid certification for a nursing care facility program or additional beds within an existing nursing care facility program under subsection a shall submit to the director i proof of the following as reasonable evidence that bed capacity provided by medicaid certified programs within the county or group of counties impacted by the requested additional medicaid certification is insufficient a nursing care facility occupancy levels for all existing and proposed facilities will be at least for the next three years b current nursing care facility occupancy is or more or c there is no other nursing care facility within a mile radius of the nursing care facility requesting the additional certification and ii an independent analysis demonstrating that at projected occupancy rates the nursing care facility s after tax net income is sufficient for the facility to be financially viable c any request for additional beds as part of a renovation project are limited to the maximum number of beds allowed in subsection d the director shall determine whether to issue additional medicaid certification by considering i whether bed capacity provided by certified programs within the county or group of counties impacted by the requested additional medicaid certification is insufficient based on the information submitted to the director under subsection b ii whether the county or group of counties impacted by the requested additional medicaid certification is underserved by specialized or unique services that would be provided by the nursing care facility iii whether any medicaid certified beds are subject to a claim by a previous certified program that may reopen under the provisions of subsections and iv how additional bed capacity should be added to the long term care delivery system to best meet the needs of medicaid recipients and v a whether the existing certified programs within the county or group of counties have provided services of sufficient quality to merit at least a two star rating in the medicare five star quality rating system over the previous three year period and b information obtained under subsection the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act to adjust the medicaid nursing care facility property reimbursement methodology to a only pay that portion of the property component of rates representing actual bed usage by medicaid clients as a percentage of the greater of i actual occupancy or ii a for a nursing care facility other than a facility described in subsection a ii b of total bed capacity or b for a rural nursing care facility of total bed capacity and b not allow for increases in reimbursement for property values without major renovation or replacement projects as defined by the department by rule a except as provided in subsection b if a nursing care facility does not seek medicaid certification for a bed under subsections through the department shall notwithstanding subsections b a and b grant medicaid certification for additional beds in an existing medicaid certified nursing care facility that has or fewer licensed beds including medicaid certified beds in the facility if i the nursing care facility program was previously a certified program for all beds but now resides in a new facility or in a facility that underwent major renovations involving major structural changes with or greater facility square footage design changes requiring review and approval by the department ii the nursing care facility meets the quality of care regulations issued by cms and iii the total number of additional beds in the facility granted medicaid certification under this section does not exceed of the number of licensed beds in the facility b the department may not revoke the medicaid certification of a bed under this subsection as long as the provisions of subsection a ii are met a if a nursing care facility or other interested party indicates in its request for additional medicaid certification under subsection a that the facility will offer specialized or unique services but the facility does not offer those services after receiving additional medicaid certification the director shall revoke the additional medicaid certification b the nursing care facility program shall obtain medicaid certification for any additional medicaid beds approved under subsection or within three years of the date of the director s approval or the approval is void a if the director makes an initial determination that quality standards under subsection d v have not been met in a rural county or group of rural counties over the previous three year period the director shall before approving certification of additional medicaid beds in the rural county or group of counties i notify the certified program that has not met the quality standards in subsection d v that the director intends to certify additional medicaid beds under the provisions of subsection d v and ii consider additional information submitted to the director by the certified program in a rural county that has not met the quality standards under subsection d v b the notice under subsection a does not give the certified program that has not met the quality standards under subsection d v the right to legally challenge or appeal the director s decision to certify additional medicaid beds under subsection d v section section b which is renumbered from section is renumbered and amended to read b appeals of division decision rulemaking authority application of act a decision by the director under this part to deny medicaid certification for a nursing care facility program or to deny additional bed capacity for an existing certified program is subject to review under the procedures and requirements of title g chapter administrative procedures act the department shall make rules to administer and enforce this part sections b through b in accordance with title g chapter utah administrative rulemaking act a in the event the department is at risk for a federal disallowance with regard to a medicaid recipient being served in a nursing care facility program that is not medicaid certified the department may grant temporary medicaid certification to that facility for up to months b i the department may extend a temporary medicaid certification granted to a facility under subsection a a for the number of beds in the nursing care facility occupied by a medicaid recipient and b for the period of time during which the medicaid recipient resides at the facility ii a temporary medicaid certification granted under this subsection is revoked upon a the discharge of the patient from the facility or b the patient no longer residing at the facility for any reason c the department may place conditions on the temporary certification granted under subsections a and b such as i not allowing additional admissions of medicaid recipients to the program and ii not paying for the care of the patient after october with state only dollars section section b which is renumbered from section is renumbered and amended to read b authorization to sell or transfer licensed medicaid beds duties of transferor duties of transferee duties of division this section provides a method to transfer or sell the license for a medicaid bed from a nursing care facility program to another entity that is in addition to the authorization to transfer under section b a a nursing care facility program may transfer or sell one or more of its licenses for medicaid beds in accordance with subsection b if i at the time of the transfer and with respect to the license for the medicaid bed that will be transferred the nursing care facility program that will transfer the medicaid license meets all applicable regulations for medicaid certification ii the nursing care facility program gives a written assurance which is postmarked or has proof of delivery days before the transfer to the director and to the transferee in accordance with subsection b iii the nursing care facility program that will transfer the license for a medicaid bed notifies the division in writing which is postmarked or has proof of delivery days before the transfer of a the number of bed licenses that will be transferred b the date of the transfer and c the identity and location of the entity receiving the transferred licenses and iv if the nursing care facility program for which the license will be transferred or purchased is located in an urban county with a nursing care facility average annual occupancy rate over the previous two years less than or equal to the nursing care facility program transferring or selling the license demonstrates to the satisfaction of the director that the sale or transfer a will not result in an excessive number of medicaid certified beds within the county or group of counties that would be impacted by the transfer or sale and b best meets the needs of medicaid recipients b except as provided in subsection c a nursing care facility program may transfer or sell one or more of its licenses for medicaid beds to i a nursing care facility program that has the same owner or successor in interest of the same owner ii a nursing care facility program that has a different owner or iii a related party nonnursing care facility entity that wants to hold one or more of the licenses for a nursing care facility program not yet identified as long as a the licenses are subsequently transferred or sold to a nursing care facility program within three years and b the nursing care facility program notifies the director of the transfer or sale in accordance with subsection a iii c a nursing care facility program may not transfer or sell one or more of its licenses for medicaid beds to an entity under subsection b i ii or iii that is located in a rural county unless the entity requests and the director issues medicaid certification for the beds under subsection b a nursing care facility program or entity under subsection b i ii or iii that receives or purchases a license for a medicaid bed under subsection b a may receive a license for a medicaid bed from more than one nursing care facility program b shall give the division notice which is postmarked or has proof of delivery within days of the nursing care facility program or entity seeking medicaid certification of beds in the nursing care facility program or entity of the total number of licenses for medicaid beds that the entity received and who it received the licenses from c may only seek medicaid certification for the number of licensed beds in the nursing care facility program equal to the total number of licenses for medicaid beds received by the entity d does not have to demonstrate need or seek approval for the medicaid licensed bed under subsection b except as provided in subsections a iv and c e shall meet the standards for medicaid certification other than those in subsection b including personnel services contracts and licensing of facilities under chapter health care facility licensing and inspection act chapter part health care facility licensing and inspection and f shall obtain medicaid certification for the licensed medicaid beds within three years of the date of transfer as documented under subsection a iii b a when the division receives notice of a transfer of a license for a medicaid bed under subsection a iii a the department shall reduce the number of licenses for medicaid beds at the transferring nursing care facility i equal to the number of licenses transferred and ii effective on the date of the transfer as reported under subsection a iii b b for purposes of section b the division shall approve medicaid certification for the receiving nursing care facility program or entity i in accordance with the formula established in subsection c and ii if a the nursing care facility seeks medicaid certification for the transferred licenses within the time limit required by subsection f and b the nursing care facility program meets other requirements for medicaid certification under subsection e c a license for a medicaid bed may not be approved for medicaid certification without meeting the requirements of sections and b and b if i the license for a medicaid bed is transferred under this section but the receiving entity does not obtain medicaid certification for the licensed bed within the time required by subsection f or ii the license for a medicaid bed is transferred under this section but the license is no longer eligible for medicaid certification section section b which is renumbered from section a is renumbered and amended to read part nursing care facility assessment a b definitions as used in this chapter part a nursing care facility means i a nursing care facility described in subsection as defined in section b ii beginning january a designated swing bed in a a general acute hospital as defined in subsection section b and b a critical access hospital which meets the criteria of u s c sec i c and iii an intermediate care facility for people with an intellectual disability that is licensed under section b b nursing care facility does not include i the utah state developmental center ii the utah state hospital iii a general acute hospital specialty hospital or small health care facility as those terms are defined in section b or iv a utah state veterans home patient day means each calendar day in which an individual patient is admitted to the nursing care facility during a calendar month even if on a temporary leave of absence from the facility section section b which is renumbered from section a is renumbered and amended to read a b legislative findings the legislature finds that there is an important state purpose to improve the quality of care given to persons who are elderly and to people who have a disability in long term care nursing facilities the legislature finds that in order to improve the quality of care to those persons described in subsection the rates paid to the nursing care facilities by the medicaid program must be adequate to encourage and support quality care the legislature finds that in order to meet the objectives in subsections and adequate funding must be provided to increase the rates paid to nursing care facilities providing services pursuant to the medicaid program section section b which is renumbered from section a is renumbered and amended to read a b collection remittance and payment of nursing care facilities assessment a beginning july an assessment is imposed upon each nursing care facility in the amount designated in subsection c b i the department shall establish by rule a uniform rate per non medicare patient day that may not exceed of the total gross revenue for services provided to patients of all nursing care facilities licensed in this state ii for purposes of subsection b i total revenue does not include charitable contribution received by a nursing care facility c the department shall calculate the assessment imposed under subsection a by multiplying the total number of patient days of care provided to non medicare patients by the nursing care facility as provided to the department pursuant to subsection a by the uniform rate established by the department pursuant to subsection b a the assessment imposed by this chapter part is due and payable on a monthly basis on or before the last day of the month next succeeding each monthly period b the collecting agent for this assessment shall be the department which is vested with the administration and enforcement of this chapter part including the right to audit records of a nursing care facility related to patient days of care for the facility c the department shall forward proceeds from the assessment imposed by this chapter part to the state treasurer for deposit in the expendable special revenue fund as specified in section a b each nursing care facility shall on or before the end of the month next succeeding each calendar monthly period file with the department a a report which includes i the total number of patient days of care the facility provided to non medicare patients during the preceding month ii the total gross revenue the facility earned as compensation for services provided to patients during the preceding month and iii any other information required by the department and b a return for the monthly period and shall remit with the return the assessment required by this chapter part to be paid for the period covered by the return each return shall contain information and be in the form the department prescribes by rule the assessment as computed in the return is an allowable cost for medicaid reimbursement purposes the department may by rule extend the time for making returns and paying the assessment each nursing care facility that fails to pay any assessment required to be paid to the state within the time required by this chapter part or that fails to file a return as required by this chapter part shall pay in addition to the assessment penalties and interest as provided in section a b section section b which is renumbered from section a is renumbered and amended to read a b penalties and interest the penalty for failure to file a return or pay the assessment due within the time prescribed by this chapter part is the greater of or of the assessment due on the return for failure to pay within days of a notice of deficiency of assessment required to be paid the penalty is the greater of or of the assessment due the penalty for underpayment of the assessment is as follows a if any underpayment of assessment is due to negligence the penalty is of the underpayment b if the underpayment of the assessment is due to intentional disregard of law or rule the penalty is of the underpayment for intent to evade the assessment the penalty is of the underpayment the rate of interest applicable to an underpayment of an assessment under this chapter part or an unpaid penalty under this chapter part is annually the department may waive the imposition of a penalty for good cause section section b which is renumbered from section a is renumbered and amended to read a b adjustment to nursing care facility medicaid reimbursement rates if federal law or regulation prohibits the money in the nursing care facilities provider assessment fund from being used in the manner set forth in subsection a b b the rates paid to nursing care facilities for providing services pursuant to the medicaid program shall be changed except as otherwise provided in subsection to the rates paid to nursing care facilities on june or if the legislature or the department has on or after july changed the rates paid to facilities through a manner other than the use of expenditures from the nursing care facilities provider assessment fund to the rates provided for by the legislature or the department section section b which is renumbered from section a is renumbered and amended to read a b intermediate care facility for people with an intellectual disability uniform rate an intermediate care facility for people with an intellectual disability is subject to all the provisions of this chapter part except that the department shall establish a uniform rate for an intermediate care facility for people with an intellectual disability that is based on the same formula specified for nursing care facilities under the provisions of subsection a b b and may be different than the uniform rate established for other nursing care facilities section section b which is renumbered from section b is renumbered and amended to read part inpatient hospital assessment b b definitions as used in this chapter part assessment means the inpatient hospital assessment established by this chapter part cms means the centers for medicare and medicaid services within the united states department of health and human services discharges means the number of total hospital discharges reported on a worksheet s part i column lines and of the medicare cost report for the applicable assessment year or b a similar report adopted by the department by administrative rule if the report under subsection a is no longer available division means the division of health care financing integrated healthcare within the department enhancement waiver program means the program established by the primary care network enhancement waiver program described in section b health coverage improvement program means the health coverage improvement program described in section b hospital share means the hospital share described in section b b medicaid accountable care organization means a managed care organization as defined in c f r sec that contracts with the department under the provisions of section b medicaid waiver expansion means a medicaid expansion in accordance with section or b or b medicare cost report means cms the cost report for electronic filing of hospitals a non state government hospital means a hospital owned by a non state government entity b non state government hospital does not include i the utah state hospital or ii a hospital owned by the federal government including the veterans administration hospital a private hospital means i a general acute hospital as defined in section b that is privately owned and operating in the state and ii a privately owned specialty hospital operating in the state including a privately owned hospital whose inpatient admissions are predominantly for a rehabilitation b psychiatric care c chemical dependency services or d long term acute care services b private hospital does not include a facility for residential treatment as defined in section a b state teaching hospital means a state owned teaching hospital that is part of an institution of higher education upper payment limit gap means the difference between the private hospital outpatient upper payment limit and the private hospital medicaid outpatient payments as determined in accordance with c f r sec section section b which is renumbered from section b is renumbered and amended to read b b application other than for the imposition of the assessment described in this chapter part nothing in this chapter part shall affect the nonprofit or tax exempt status of any nonprofit charitable religious or educational health care provider under any a state law b ad valorem property taxes c sales or use taxes or d other taxes fees or assessments whether imposed or sought to be imposed by the state or any political subdivision of the state all assessments paid under this chapter part may be included as an allowable cost of a hospital for purposes of any applicable medicaid reimbursement formula this chapter part does not authorize a political subdivision of the state to a license a hospital for revenue b impose a tax or assessment upon a hospital or c impose a tax or assessment measured by the income or earnings of a hospital section section b which is renumbered from section b is renumbered and amended to read b b assessment an assessment is imposed on each private hospital a beginning upon the later of cms approval of i the health coverage improvement program waiver under section b and ii the assessment under this chapter part b in the amount designated in sections b and b b and b and c in accordance with section b b subject to section b b the assessment imposed by this chapter part is due and payable on a quarterly basis after payment of the outpatient upper payment limit supplemental payments under section b b have been paid the first quarterly payment is not due until at least three months after the earlier of the effective dates of the coverage provided through a the health coverage improvement program b the enhancement waiver program or c the medicaid waiver expansion section section b which is renumbered from section b is renumbered and amended to read b b collection of assessment deposit of revenue rulemaking the collecting agent for the assessment imposed under section b b is the department the department is vested with the administration and enforcement of this chapter part and may make rules in accordance with title g chapter utah administrative rulemaking act necessary to a collect the assessment intergovernmental transfers and penalties imposed under this chapter part b audit records of a facility that i is subject to the assessment imposed by this chapter part and ii does not file a medicare cost report and c select a report similar to the medicare cost report if medicare no longer uses a medicare cost report the department shall a administer the assessment in this chapter part separately from the assessment in chapter d part hospital provider assessment act and b deposit assessments collected under this chapter part into the medicaid expansion fund created by section b b section section b which is renumbered from section b is renumbered and amended to read b b quarterly notice quarterly assessments imposed by this chapter part shall be paid to the division within business days after the original invoice date that appears on the invoice issued by the division the department may by rule extend the time for paying the assessment section section b which is renumbered from section b is renumbered and amended to read b b hospital financing of health coverage improvement program medicaid waiver expansion hospital share the hospital share is a of the state s net cost of the health coverage improvement program including medicaid coverage for individuals with dependent children up to the federal poverty level designated under section b b of the state s net cost of the enhancement waiver program c if the waiver for the medicaid waiver expansion is approved and d of the state s net cost of the upper payment limit gap a the hospital share is capped at no more than annually consisting of i an cap for the programs specified in subsections a through c and ii a cap for the program specified in subsection d b the department shall prorate the cap described in subsection a in any year in which the programs specified in subsections a and d are not in effect for the full fiscal year private hospitals shall be assessed under this chapter part for a of the portion of the hospital share for the programs specified in subsections a through c and b of the portion of the hospital share specified in subsection d a in the report described in subsection b the department shall calculate the state s net cost of each of the programs described in subsections a through c that are in effect for that year b if the assessment collected in the previous fiscal year is above or below the hospital share for private hospitals for the previous fiscal year the underpayment or overpayment of the assessment by the private hospitals shall be applied to the fiscal year in which the report is issued a medicaid accountable care organization shall on or before october of each year report to the department the following data from the prior state fiscal year for each private hospital state teaching hospital and non state government hospital provider that the medicaid accountable care organization contracts with a for the traditional medicaid population i hospital inpatient payments ii hospital inpatient discharges iii hospital inpatient days and iv hospital outpatient payments and b if the medicaid accountable care organization enrolls any individuals in the health coverage improvement program the enhancement waiver program or the medicaid waiver expansion for the population newly eligible for any of those programs i hospital inpatient payments ii hospital inpatient discharges iii hospital inpatient days and iv hospital outpatient payments the department shall by rule made in accordance with title g chapter utah administrative rulemaking act provide details surrounding specific content and format for the reporting by the medicaid accountable care organization section section b which is renumbered from section b is renumbered and amended to read b b calculation of assessment a except as provided in subsection b an annual assessment is payable on a quarterly basis for each private hospital in an amount calculated by the division at a uniform assessment rate for each hospital discharge in accordance with this section b a private teaching hospital with more than beds and residents shall pay an assessment rate times the uniform rate established under subsection c c the division shall calculate the uniform assessment rate described in subsection a by dividing the hospital share for assessed private hospitals described in subsections b and b b and by the sum of i the total number of discharges for assessed private hospitals that are not a private teaching hospital and ii times the number of discharges for a private teaching hospital described in subsection b d the division may by rule made in accordance with title g chapter utah administrative rulemaking act adjust the formula described in subsection c to address unforeseen circumstances in the administration of the assessment under this chapter part e any quarterly changes to the uniform assessment rate shall be applied uniformly to all assessed private hospitals except as provided in subsection for each state fiscal year the division shall determine a hospital s discharges as follows a for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june and b for each subsequent state fiscal year the hospital s cost report data for the hospital s fiscal year that ended in the state fiscal year two years before the assessment fiscal year a if a hospital s fiscal year medicare cost report is not contained in the cms healthcare cost report information system file i the hospital shall submit to the division a copy of the hospital s medicare cost report applicable to the assessment year and ii the division shall determine the hospital s discharges b if a hospital is not certified by the medicare program and is not required to file a medicare cost report i the hospital shall submit to the division the hospital s applicable fiscal year discharges with supporting documentation ii the division shall determine the hospital s discharges from the information submitted under subsection b i and iii failure to submit discharge information shall result in an audit of the hospital s records and a penalty equal to of the calculated assessment except as provided in subsection if a hospital is owned by an organization that owns more than one hospital in the state a the assessment for each hospital shall be separately calculated by the department and b each separate hospital shall pay the assessment imposed by this chapter part if multiple hospitals use the same medicaid provider number a the department shall calculate the assessment in the aggregate for the hospitals using the same medicaid provider number and b the hospitals may pay the assessment in the aggregate section section b which is renumbered from section b is renumbered and amended to read b b state teaching hospital and non state government hospital mandatory intergovernmental transfer the state teaching hospital and a non state government hospital shall make an intergovernmental transfer to the medicaid expansion fund created in section b b in accordance with this section the hospitals described in subsection shall pay the intergovernmental transfer beginning on the later of cms approval of a the health improvement program waiver under section b or b the assessment for private hospitals in this chapter part the intergovernmental transfer is apportioned as follows a the state teaching hospital is responsible for i of the portion of the hospital share specified in subsections b b a through c and ii of the hospital share specified in subsection b b d and b non state government hospitals are responsible for i of the portion of the hospital share specified in subsections b b a through c and ii of the hospital share specified in subsection b b d the department shall by rule made in accordance with title g chapter utah administrative rulemaking act designate a the method of calculating the amounts designated in subsection and b the schedule for the intergovernmental transfers section section b which is renumbered from section b is renumbered and amended to read b b penalties and interest a hospital that fails to pay a quarterly assessment make the mandated intergovernmental transfer or file a return as required under this chapter part within the time required by this chapter part shall pay penalties described in this section in addition to the assessment or intergovernmental transfer if a hospital fails to timely pay the full amount of a quarterly assessment or the mandated intergovernmental transfer the department shall add to the assessment or intergovernmental transfer a a penalty equal to of the quarterly amount not paid on or before the due date and b on the last day of each quarter after the due date until the assessed amount and the penalty imposed under subsection a are paid in full an additional penalty on i any unpaid quarterly assessment or intergovernmental transfer and ii any unpaid penalty assessment upon making a record of the division s actions and upon reasonable cause shown the division may waive reduce or compromise any of the penalties imposed under this chapter part section section b which is renumbered from section b is renumbered and amended to read b b hospital reimbursement if the health coverage improvement program the enhancement waiver program or the medicaid waiver expansion is implemented by contracting with a medicaid accountable care organization the department shall to the extent allowed by law include in a contract to provide benefits under the health coverage improvement program the enhancement waiver program or the medicaid waiver expansion a requirement that the medicaid accountable care organization reimburse hospitals in the accountable care organization s provider network at no less than the medicaid fee for service rate if the health coverage improvement program the enhancement waiver program or the medicaid waiver expansion is implemented by the department as a fee for service program the department shall reimburse hospitals at no less than the medicaid fee for service rate nothing in this section prohibits a medicaid accountable care organization from paying a rate that exceeds the medicaid fee for service rate section section b which is renumbered from section b is renumbered and amended to read b b outpatient upper payment limit supplemental payments beginning on the effective date of the assessment imposed under this chapter part and for each subsequent fiscal year the department shall implement an outpatient upper payment limit program for private hospitals that shall supplement the reimbursement to private hospitals in accordance with subsection the division shall ensure that supplemental payment to utah private hospitals under subsection a does not exceed the positive upper payment limit gap and b is allocated based on the medicaid state plan the department shall use the same outpatient data to allocate the payments under subsection and to calculate the upper payment limit gap the supplemental payments to private hospitals under subsection are payable for outpatient hospital services provided on or after the later of a july b the effective date of the medicaid state plan amendment necessary to implement the payments under this section or c the effective date of the coverage provided through the health coverage improvement program waiver section section b which is renumbered from section b is renumbered and amended to read b b repeal of assessment the assessment imposed by this chapter part shall be repealed when a the executive director certifies that i action by congress is in effect that disqualifies the assessment imposed by this chapter part from counting toward state medicaid funds available to be used to determine the amount of federal financial participation ii a decision enactment or other determination by the legislature or by any court officer department or agency of the state or of the federal government is in effect that a disqualifies the assessment from counting toward state medicaid funds available to be used to determine federal financial participation for medicaid matching funds or b creates for any reason a failure of the state to use the assessments for at least one of the medicaid programs described in this chapter part or iii a change is in effect that reduces the aggregate hospital inpatient and outpatient payment rate below the aggregate hospital inpatient and outpatient payment rate for july or b this chapter part is repealed in accordance with section i if the assessment is repealed under subsection a the division may not collect any assessment or intergovernmental transfer under this chapter part b the department shall disburse money in the special medicaid expansion fund in accordance with the requirements in subsection b b to the extent federal matching is not reduced by cms due to the repeal of the assessment c any money remaining in the medicaid expansion fund after the disbursement described in subsection b that was derived from assessments imposed by this chapter part shall be refunded to the hospitals in proportion to the amount paid by each hospital for the last three fiscal years and d any money remaining in the medicaid expansion fund after the disbursements described in subsections b and c shall be deposited into the general fund by the end of the fiscal year that the assessment is suspended section section b which is renumbered from section c is renumbered and amended to read part medicaid expansion hospital assessment c b definitions as used in this chapter part assessment means the medicaid expansion hospital assessment established by this chapter part cms means the centers for medicare and medicaid services within the united states department of health and human services discharges means the number of total hospital discharges reported on a worksheet s part i column lines and of the medicare cost report for the applicable assessment year or b a similar report adopted by the department by administrative rule if the report under subsection a is no longer available division means the division of health care financing integrated healthcare within the department hospital share means the hospital share described in section c b medicaid accountable care organization means a managed care organization as defined in c f r sec that contracts with the department under the provisions of section b medicaid expansion fund means the medicaid expansion fund created in section b b medicaid waiver expansion means the same as that term is defined in section b medicare cost report means cms the cost report for electronic filing of hospitals a non state government hospital means a hospital owned by a non state government entity b non state government hospital does not include i the utah state hospital or ii a hospital owned by the federal government including the veterans administration hospital a private hospital means i a privately owned general acute hospital operating in the state as defined in section b or ii a privately owned specialty hospital operating in the state including a privately owned hospital for which inpatient admissions are predominantly a rehabilitation b psychiatric c chemical dependency or d long term acute care services b private hospital does not include a facility for residential treatment as defined in section a b qualified medicaid expansion means an expansion of the medicaid program in accordance with subsection b state teaching hospital means a state owned teaching hospital that is part of an institution of higher education section section b which is renumbered from section c is renumbered and amended to read c b application other than for the imposition of the assessment described in this chapter part nothing in this chapter part shall affect the nonprofit or tax exempt status of any nonprofit charitable religious or educational health care provider under any a state law b ad valorem property tax requirement c sales or use tax requirement or d other requirements imposed by taxes fees or assessments whether imposed or sought to be imposed by the state or any political subdivision of the state a hospital paying an assessment under this chapter part may include the assessment as an allowable cost of a hospital for purposes of any applicable medicaid reimbursement formula this chapter part does not authorize a political subdivision of the state to a license a hospital for revenue b impose a tax or assessment upon a hospital or c impose a tax or assessment measured by the income or earnings of a hospital section section b which is renumbered from section c is renumbered and amended to read c b assessment an assessment is imposed on each private hospital a beginning upon the later of i april and ii cms approval of the assessment under this chapter part b in the amount designated in sections c and c b and b and c in accordance with section c b the assessment imposed by this chapter part is due and payable in accordance with subsection c b section section b which is renumbered from section c is renumbered and amended to read c b collection of assessment deposit of revenue rulemaking the department shall act as the collecting agent for the assessment imposed under section c b the department shall administer and enforce the provisions of this chapter part and may make rules in accordance with title g chapter utah administrative rulemaking act necessary to a collect the assessment intergovernmental transfers and penalties imposed under this chapter part b audit records of a facility that i is subject to the assessment imposed under this chapter part and ii does not file a medicare cost report and c select a report similar to the medicare cost report if medicare no longer uses a medicare cost report the department shall a administer the assessment in this part separately from the assessments in chapter d part hospital provider assessment act and chapter b and part inpatient hospital assessment act and b deposit assessments collected under this chapter part into the medicaid expansion fund a hospitals shall pay the quarterly assessments imposed by this chapter part to the division within business days after the original invoice date that appears on the invoice issued by the division b the department may make rules creating requirements to allow the time for paying the assessment to be extended section section b which is renumbered from section c is renumbered and amended to read c b hospital share the hospital share is a for the period from april through june and b beginning july of the state s net cost of the qualified medicaid expansion after deducting appropriate offsets and savings expected as a result of implementing the qualified medicaid expansion including i savings from a the primary care network program b the health coverage improvement program as defined in section b c the state portion of inpatient prison medical coverage d behavioral health coverage and e county contributions to the non federal share of medicaid expenditures and ii any funds appropriated to the medicaid expansion fund a beginning july the hospital share is capped at no more than annually b beginning july the division shall prorate the cap specified in subsection a in any year in which the qualified medicaid expansion is not in effect for the full fiscal year section section b which is renumbered from section c is renumbered and amended to read c b hospital financing private hospitals shall be assessed under this chapter part for the portion of the hospital share described in section c b in the report described in subsection b the department shall calculate the state s net cost of the qualified medicaid expansion if the assessment collected in the previous fiscal year is above or below the hospital share for private hospitals for the previous fiscal year the division shall apply the underpayment or overpayment of the assessment by the private hospitals to the fiscal year in which the report is issued section section b which is renumbered from section c is renumbered and amended to read c b calculation of assessment a except as provided in subsection b each private hospital shall pay an annual assessment due on the last day of each quarter in an amount calculated by the division at a uniform assessment rate for each hospital discharge in accordance with this section b a private teaching hospital with more than beds and more than residents shall pay an assessment rate times the uniform rate established under subsection c c the division shall calculate the uniform assessment rate described in subsection a by dividing the hospital share for assessed private hospitals as described in subsection c b by the sum of i the total number of discharges for assessed private hospitals that are not a private teaching hospital and ii times the number of discharges for a private teaching hospital described in subsection b d the division may make rules in accordance with title g chapter utah administrative rulemaking act to adjust the formula described in subsection c to address unforeseen circumstances in the administration of the assessment under this chapter part e the division shall apply any quarterly changes to the uniform assessment rate uniformly to all assessed private hospitals except as provided in subsection for each state fiscal year the division shall determine a hospital s discharges as follows a for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june and b for each subsequent state fiscal year the hospital s cost report data for the hospital s fiscal year that ended in the state fiscal year two years before the assessment fiscal year a if a hospital s fiscal year medicare cost report is not contained in the centers for medicare and medicaid services healthcare cost report information system file i the hospital shall submit to the division a copy of the hospital s medicare cost report applicable to the assessment year and ii the division shall determine the hospital s discharges b if a hospital is not certified by the medicare program and is not required to file a medicare cost report i the hospital shall submit to the division the hospital s applicable fiscal year discharges with supporting documentation ii the division shall determine the hospital s discharges from the information submitted under subsection b i and iii if the hospital fails to submit discharge information the division shall audit the hospital s records and may impose a penalty equal to of the calculated assessment except as provided in subsection if a hospital is owned by an organization that owns more than one hospital in the state a the division shall calculate the assessment for each hospital separately and b each separate hospital shall pay the assessment imposed by this chapter part if multiple hospitals use the same medicaid provider number a the department shall calculate the assessment in the aggregate for the hospitals using the same medicaid provider number and b the hospitals may pay the assessment in the aggregate section section b which is renumbered from section c is renumbered and amended to read c b state teaching hospital and non state government hospital mandatory intergovernmental transfer a state teaching hospital and a non state government hospital shall make an intergovernmental transfer to the medicaid expansion fund in accordance with this section the hospitals described in subsection shall pay the intergovernmental transfer beginning on the later of a april or b cms approval of the assessment for private hospitals in this chapter part the intergovernmental transfer is apportioned between the non state government hospitals as follows a the state teaching hospital shall pay for the portion of the hospital share described in section c b and b non state government hospitals shall pay for the portion of the hospital share described in section c b the department shall by rule made in accordance with title g chapter utah administrative rulemaking act designate a the method of calculating the amounts designated in subsection and b the schedule for the intergovernmental transfers section section b which is renumbered from section c is renumbered and amended to read c b penalties a hospital that fails to pay a quarterly assessment make the mandated intergovernmental transfer or file a return as required under this chapter part within the time required by this chapter part shall pay penalties described in this section in addition to the assessment or intergovernmental transfer if a hospital fails to timely pay the full amount of a quarterly assessment or the mandated intergovernmental transfer the department shall add to the assessment or intergovernmental transfer a a penalty equal to of the quarterly amount not paid on or before the due date and b on the last day of each quarter after the due date until the assessed amount and the penalty imposed under subsection a are paid in full an additional penalty on i any unpaid quarterly assessment or intergovernmental transfer and ii any unpaid penalty assessment upon making a record of the division s actions and upon reasonable cause shown the division may waive or reduce any of the penalties imposed under this chapter part section section b which is renumbered from section c is renumbered and amended to read c b hospital reimbursement if the qualified medicaid expansion is implemented by contracting with a medicaid accountable care organization the department shall to the extent allowed by law include in a contract to provide benefits under the qualified medicaid expansion a requirement that the accountable care organization reimburse hospitals in the accountable care organization s provider network at no less than the medicaid fee for service rate if the qualified medicaid expansion is implemented by the department as a fee for service program the department shall reimburse hospitals at no less than the medicaid fee for service rate nothing in this section prohibits the department or a medicaid accountable care organization from paying a rate that exceeds the medicaid fee for service rate section section b which is renumbered from section c is renumbered and amended to read c b hospital financing of the hospital share for the first two full fiscal years that the assessment is in effect the department shall a assess private hospitals under this chapter part for of the hospital share b require the state teaching hospital to make an intergovernmental transfer under this chapter part for of the hospital share and c require non state government hospitals to make an intergovernmental transfer under this chapter part for of the hospital share a at the beginning of the third full fiscal year that the assessment is in effect and at the beginning of each subsequent fiscal year the department may set a different percentage share for private hospitals the state teaching hospital and non state government hospitals by rule made in accordance with title g chapter utah administrative rulemaking act with input from private hospitals and private teaching hospitals b if the department does not set a different percentage share under subsection a the percentage shares in subsection shall apply section section b which is renumbered from section c is renumbered and amended to read c b suspension of assessment the department shall suspend the assessment imposed by this chapter part when the executive director certifies that a action by congress is in effect that disqualifies the assessment imposed by this chapter part from counting toward state medicaid funds available to be used to determine the amount of federal financial participation b a decision enactment or other determination by the legislature or by any court officer department or agency of the state or of the federal government is in effect that i disqualifies the assessment from counting toward state medicaid funds available to be used to determine federal financial participation for medicaid matching funds or ii creates for any reason a failure of the state to use the assessments for at least one of the medicaid programs described in this chapter part or c a change is in effect that reduces the aggregate hospital inpatient and outpatient payment rate below the aggregate hospital inpatient and outpatient payment rate for july if the assessment is suspended under subsection a the division may not collect any assessment or intergovernmental transfer under this chapter part b the division shall disburse money in the medicaid expansion fund that was derived from assessments imposed by this chapter part in accordance with the requirements in subsection b b to the extent federal matching is not reduced by cms due to the repeal of the assessment and c the division shall refund any money remaining in the medicaid expansion fund after the disbursement described in subsection b that was derived from assessments imposed by this chapter part to the hospitals in proportion to the amount paid by each hospital for the last three fiscal years section section b which is renumbered from section d is renumbered and amended to read part hospital provider assessment d b definitions as used in this chapter part accountable care organization means a managed care organization as defined in c f r sec that contracts with the department under the provisions of section b assessment means the medicaid hospital provider assessment established by this chapter part discharges means the number of total hospital discharges reported on worksheet s part i column lines and of the medicare cost report or on worksheet s part i column lines and of the medicare cost report for the applicable assessment year division means the division of health care financing integrated healthcare of the department hospital a means a privately owned i general acute hospital operating in the state as defined in section b and ii specialty hospital operating in the state which shall include a privately owned hospital whose inpatient admissions are predominantly a rehabilitation b psychiatric c chemical dependency or d long term acute care services and b does not include i a human services program as defined in section a b ii a hospital owned by the federal government including the veterans administration hospital or iii a hospital that is owned by the state government a state agency or a political subdivision of the state including a a state owned teaching hospital and b the utah state hospital medicare cost report means cms or cms the cost report for electronic filing of hospitals state plan amendment means a change or update to the state medicaid plan section section b which is renumbered from section d is renumbered and amended to read d b legislative findings the legislature finds that there is an important state purpose to improve the access of medicaid patients to quality care in utah hospitals because of continuous decreases in state revenues and increases in enrollment under the utah medicaid program the legislature finds that in order to improve this access to those persons described in subsection a the rates paid to utah hospitals shall be adequate to encourage and support improved access and b adequate funding shall be provided to increase the rates paid to utah hospitals providing services pursuant to the utah medicaid program section section b which is renumbered from section d is renumbered and amended to read d b application of part other than for the imposition of the assessment described in this chapter part nothing in this chapter part shall affect the nonprofit or tax exempt status of any nonprofit charitable religious or educational health care provider under a section c as amended of the internal revenue code b other applicable federal law c any state law d any ad valorem property taxes e any sales or use taxes or f any other taxes fees or assessments whether imposed or sought to be imposed by the state or any political subdivision county municipality district authority or any agency or department thereof all assessments paid under this chapter part may be included as an allowable cost of a hospital for purposes of any applicable medicaid reimbursement formula this chapter part does not authorize a political subdivision of the state to a license a hospital for revenue b impose a tax or assessment upon hospitals or c impose a tax or assessment measured by the income or earnings of a hospital section section b which is renumbered from section d is renumbered and amended to read d b assessment collection and payment of hospital provider assessment a uniform broad based assessment is imposed on each hospital as defined in subsection d b a a in the amount designated in section d b and b in accordance with section d b a the assessment imposed by this chapter part is due and payable on a quarterly basis in accordance with section d b b the collecting agent for this assessment is the department which is vested with the administration and enforcement of this chapter part including the right to adopt administrative rules in accordance with title g chapter utah administrative rulemaking act necessary to i implement and enforce the provisions of this act and ii audit records of a facility a that is subject to the assessment imposed by this chapter part and b does not file a medicare cost report c the department shall forward proceeds from the assessment imposed by this chapter part to the state treasurer for deposit in the expendable special revenue fund as specified in section d b the department may by rule extend the time for paying the assessment section section b which is renumbered from section d is renumbered and amended to read d b calculation of assessment a an annual assessment is payable on a quarterly basis for each hospital in an amount calculated at a uniform assessment rate for each hospital discharge in accordance with this section b the uniform assessment rate shall be determined using the total number of hospital discharges for assessed hospitals divided into the total non federal portion in an amount consistent with section d b that is needed to support capitated rates for accountable care organizations for purposes of hospital services provided to medicaid enrollees c any quarterly changes to the uniform assessment rate shall be applied uniformly to all assessed hospitals d the annual uniform assessment rate may not generate more than i to offset medicaid mandatory expenditures and ii the non federal share to seed amounts needed to support capitated rates for accountable care organizations as provided for in subsection b a for each state fiscal year discharges shall be determined using the data from each hospital s medicare cost report contained in the centers for medicare and medicaid services healthcare cost report information system file the hospital s discharge data will be derived as follows i for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june ii for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june iii for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june iv for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june and v for each subsequent state fiscal year the hospital s cost report data for the hospital s fiscal year that ended in the state fiscal year two years prior to the assessment fiscal year b if a hospital s fiscal year medicare cost report is not contained in the centers for medicare and medicaid services healthcare cost report information system file i the hospital shall submit to the division a copy of the hospital s medicare cost report applicable to the assessment year and ii the division shall determine the hospital s discharges c if a hospital is not certified by the medicare program and is not required to file a medicare cost report i the hospital shall submit to the division its applicable fiscal year discharges with supporting documentation ii the division shall determine the hospital s discharges from the information submitted under subsection c i and iii the failure to submit discharge information shall result in an audit of the hospital s records and a penalty equal to of the calculated assessment except as provided in subsection if a hospital is owned by an organization that owns more than one hospital in the state a the assessment for each hospital shall be separately calculated by the department and b each separate hospital shall pay the assessment imposed by this chapter part notwithstanding the requirement of subsection if multiple hospitals use the same medicaid provider number a the department shall calculate the assessment in the aggregate for the hospitals using the same medicaid provider number and b the hospitals may pay the assessment in the aggregate section section b which is renumbered from section d is renumbered and amended to read d b quarterly notice collection quarterly assessments imposed by this chapter part shall be paid to the division within business days after the original invoice date that appears on the invoice issued by the division section section b which is renumbered from section d is renumbered and amended to read d b medicaid hospital adjustment under accountable care organization rates to preserve and improve access to hospital services the division shall for accountable care organization rates effective on or after april incorporate into the accountable care organization rate structure calculation consistent with the certified actuarial rate range to be allocated toward the hospital inpatient directed payments for the medicaid eligibility categories covered in utah before january and an amount equal to the difference between payments made to hospitals by accountable care organizations for the medicaid eligibility categories covered in utah before january based on submitted encounter data and the maximum amount that could be paid for those services using medicare payment principles to be used for directed payments to hospitals for outpatient services section section b which is renumbered from section d is renumbered and amended to read d b penalties and interest a facility that fails to pay any assessment or file a return as required under this chapter part within the time required by this chapter part shall pay in addition to the assessment penalties and interest established by the department a consistent with subsection b the department shall adopt rules in accordance with title g chapter utah administrative rulemaking act which establish reasonable penalties and interest for the violations described in subsection b if a hospital fails to timely pay the full amount of a quarterly assessment the department shall add to the assessment i a penalty equal to of the quarterly amount not paid on or before the due date and ii on the last day of each quarter after the due date until the assessed amount and the penalty imposed under subsection b i are paid in full an additional penalty on a any unpaid quarterly assessment and b any unpaid penalty assessment c upon making a record of its actions and upon reasonable cause shown the division may waive reduce or compromise any of the penalties imposed under this part section section b which is renumbered from section d is renumbered and amended to read d b repeal of assessment the repeal of the assessment imposed by this chapter part shall occur upon the certification by the executive director of the department that the sooner of the following has occurred a the effective date of any action by congress that would disqualify the assessment imposed by this chapter part from counting toward state medicaid funds available to be used to determine the federal financial participation b the effective date of any decision enactment or other determination by the legislature or by any court officer department or agency of the state or of the federal government that has the effect of i disqualifying the assessment from counting towards state medicaid funds available to be used to determine federal financial participation for medicaid matching funds or ii creating for any reason a failure of the state to use the assessments for the medicaid program as described in this chapter part c the effective date of i an appropriation for any state fiscal year from the general fund for hospital payments under the state medicaid program that is less than the amount appropriated for state fiscal year ii the annual revenues of the state general fund budget return to the level that was appropriated for fiscal year iii a division change in rules that reduces any of the following below july payments a aggregate hospital inpatient payments b adjustment payment rates or c any cost settlement protocol or iv a division change in rules that reduces the aggregate outpatient payments below july payments and d the sunset of this chapter part in accordance with section i if the assessment is repealed under subsection money in the fund that was derived from assessments imposed by this chapter part before the determination made under subsection shall be disbursed under section d b to the extent federal matching is not reduced due to the impermissibility of the assessments any funds remaining in the special revenue fund shall be refunded to the hospitals in proportion to the amount paid by each hospital section section b which is renumbered from section a is renumbered and amended to read part ambulance service provider assessment a b definitions as used in this chapter part ambulance service provider means a an ambulance provider as defined in section a b or b a non service provider as defined in section a b assessment means the medicaid ambulance service provider assessment established by this chapter part division means the division of health care financing integrated healthcare within the department non federal portion means the non federal share the division needs to seed amounts that will support fee for service ambulance service provider rates as described in section a b total transports means the number of total ambulance transports applicable to a given fiscal year as determined under subsection a b section section b which is renumbered from section a is renumbered and amended to read a b assessment collection and payment of ambulance service provider assessment an ambulance service provider shall pay an assessment to the division a in the amount designated in section a b b in accordance with this chapter part c quarterly on a day determined by the division by rule made under subsection b and d no more than business days after the day on which the division issues the ambulance service provider notice of the assessment the division shall a collect the assessment described in subsection b determine by rule made in accordance with title g chapter utah administrative rulemaking act standards and procedures for implementing and enforcing the provisions of this chapter part and c transfer assessment proceeds to the state treasurer for deposit into the ambulance service provider assessment expendable revenue fund created in section a b section section b which is renumbered from section a is renumbered and amended to read a b calculation of assessment the division shall calculate a uniform assessment per transport as described in this section the assessment due from a given ambulance service provider equals the non federal portion divided by total transports multiplied by the number of transports for the ambulance service provider the division shall apply any quarterly changes to the assessment rate calculated as described in subsection uniformly to all assessed ambulance service providers the assessment may not generate more than the total of a an annual amount of to offset medicaid administration expenses and b the non federal portion a for each state fiscal year the division shall calculate total transports using data from the emergency medical system as follows i for state fiscal year the division shall use ambulance service provider transports during the calendar year and ii for a fiscal year after the division shall use ambulance service provider transports during the calendar year ending months before the end of the fiscal year b if an ambulance service provider fails to submit transport information to the emergency medical system the division may audit the ambulance service provider to determine the ambulance service provider s transports for a given fiscal year section section b which is renumbered from section a is renumbered and amended to read a b medicaid ambulance service provider adjustment under fee for service rates the division shall if the assessment imposed by this chapter part is approved by the centers for medicare and medicaid services for fee for service rates effective on or after july reimburse an ambulance service provider in an amount up to the emergency medical services ambulance rates adopted annually by the department section section b which is renumbered from section a is renumbered and amended to read a b penalties the division shall require an ambulance service provider that fails to pay an assessment due under this chapter part to pay the division in addition to the assessment a penalty determined by the division by rule made in accordance with title g chapter utah administrative rulemaking act section section b which is renumbered from section a is renumbered and amended to read a b repeal of assessment this chapter part is repealed when as certified by the executive director of the department any of the following occurs a an action by congress that disqualifies the assessment imposed by this chapter part from state medicaid funds available to be used to determine the federal financial participation takes legal effect or b an action decision enactment or other determination by the legislature or by any court officer department or agency of the state or federal government takes effect that i disqualifies the assessment from counting toward state medicaid funds available to be used to determine federal financial participation for medicaid matching funds or ii creates for any reason a failure of the state to use the assessments for the medicaid program as described in this chapter part if this chapter part is repealed under subsection a money in the ambulance service provider assessment expendable revenue fund that was derived from assessments imposed by this chapter part deposited before the determination made under subsection shall be disbursed under section a b to the extent federal matching is not reduced due to the impermissibility of the assessments and b any funds remaining in the special revenue fund shall be refunded to each ambulance service provider in proportion to the amount paid by the ambulance service provider section section b which is renumbered from section is renumbered and amended to read part utah children s health insurance program b definitions as used in this chapter part child means a person who is under years of age an individual who is younger than years old eligible child means a child who qualifies for enrollment in the program as provided in section b member means a child enrolled in the program plan means the department s plan submitted to the united states department of health and human services pursuant to u s c sec ff program means the utah children s health insurance program created by this chapter part section section b which is renumbered from section is renumbered and amended to read b creation and administration of the utah children s health insurance program there is created the utah children s health insurance program to be administered by the department in accordance with the provisions of a this chapter part and b the state children s health insurance program u s c sec aa et seq the department shall a prepare and submit the state s children s health insurance plan before may and any amendments to the federal united states department of health and human services in accordance with u s c sec ff and b make rules in accordance with title g chapter utah administrative rulemaking act regarding i eligibility requirements consistent with section b ii program benefits iii the level of coverage for each program benefit iv cost sharing requirements for members which may not a exceed the guidelines set forth in u s c sec ee or b impose deductible copayment or coinsurance requirements on a member for well child well baby and immunizations v the administration of the program and vi a requirement that a members in the program shall participate in the electronic exchange of clinical health records established in accordance with section b unless the member opts out of participation b prior to enrollment in the electronic exchange of clinical health records the member shall receive notice of the enrollment in the electronic exchange of clinical health records and the right to opt out of participation at any time and c beginning july when the program sends enrollment or renewal information to the member and when the member logs onto the program s website the member shall receive notice of the right to opt out of the electronic exchange of clinical health records section section b which is renumbered from section is renumbered and amended to read b eligibility a child is eligible to enroll in the program if the child a is a bona fide utah resident b is a citizen or legal resident of the united states c is under years of age d does not have access to or coverage under other health insurance including any coverage available through a parent or legal guardian s employer e is ineligible for medicaid benefits f resides in a household whose gross family income as defined by rule is at or below of the federal poverty level and g is not an inmate of a public institution or a patient in an institution for mental diseases a child who qualifies for enrollment in the program under subsection may not be denied enrollment due to a diagnosis or pre existing condition a the department shall determine eligibility and send notification of the eligibility decision within days after receiving the application for coverage b if the department cannot reach a decision because the applicant fails to take a required action or because there is an administrative or other emergency beyond the department s control the department shall i document the reason for the delay in the applicant s case record and ii inform the applicant of the status of the application and time frame for completion the department may not close enrollment in the program for a child who is eligible to enroll in the program under the provisions of subsection the program shall a apply for grants to make technology system improvements necessary to implement a simplified enrollment and renewal process in accordance with subsection b and b if funding is available implement a simplified enrollment and renewal process section section b which is renumbered from section is renumbered and amended to read b program benefits except as provided in subsection medical and dental program benefits shall be benchmarked in accordance with u s c sec cc as follows a medical program benefits including behavioral health care benefits shall be benchmarked effective july and on july every third year thereafter to i be substantially equal to a health benefit plan with the largest insured commercial enrollment offered by a health maintenance organization in the state and ii comply with the mental health parity and addiction equity act pub l no and b dental program benefits shall be benchmarked effective july and on july every third year thereafter in accordance with the children s health insurance program reauthorization act of to be substantially equal to a dental benefit plan that has the largest insured commercial non medicaid enrollment of covered lives that is offered in the state except that the utilization review mechanism for orthodontia shall be based on medical necessity on or before july of each year the department shall publish the benchmark for dental program benefits established under subsection b the program benefits a for enrollees who are at or below of the federal poverty level are exempt from the benchmark requirements of subsections and and b shall include treatment for autism spectrum disorder as defined in section a which i shall include coverage for applied behavioral analysis and ii if the benchmark described in subsection a does not include the coverage described in this subsection b the department shall exclude from the benchmark described in subsection a for any purpose other than providing benefits under the program section section b which is renumbered from section is renumbered and amended to read b limitation of benefits abortion is not a covered benefit except as provided in u s c sec ee section section b which is renumbered from section is renumbered and amended to read b funding the program shall be funded by federal matching funds received under together with state matching funds required by u s c sec ee program expenditures in the following categories may not exceed in the aggregate of all federal payments pursuant to u s c sec ee a other forms of child health assistance for children with gross family incomes below of the federal poverty level b other health services initiatives to improve low income children s health c outreach program expenditures and d administrative costs section section b which is renumbered from section is renumbered and amended to read b evaluation the department shall develop performance measures and annually evaluate the program s performance section section b which is renumbered from section is renumbered and amended to read b managed care contracting for services program benefits provided to a member under the program as described in section b shall be delivered by a managed care organization if the department determines that adequate services are available where the member lives or resides the department may contract with a managed care organization to provide program benefits the department shall evaluate a potential contract with a managed care organization based on a the managed care organization s i ability to manage medical expenses including mental health costs ii proven ability to handle accident and health insurance iii efficiency of claim paying procedures iv proven ability for managed care and quality assurance v provider contracting and discounts vi pharmacy benefit management vii estimated total charges for administering the pool viii ability to administer the pool in a cost efficient manner ix ability to provide adequate providers and services in the state and x ability to meet quality measures for emergency room use and access to primary care established by the department under subsection b and b other factors established by the department the department may enter into separate managed care organization contracts to provide dental benefits required by section b the department s contract with a managed care organization for the program s benefits shall include risk sharing provisions in which the plan shall accept at least of the risk for any difference between the department s premium payments per member and actual medical expenditures a the department may contract with the group insurance division within the utah state retirement office to provide services under subsection if no managed care organization is willing to contract with the department or the department determines no managed care organization meets the criteria established under subsection b in accordance with section a contract awarded under subsection a is not subject to the risk sharing required by subsection section section b which is renumbered from section is renumbered and amended to read b state contractor employee and dependent health benefit plan coverage for purposes of sections b a a b c and qualified health coverage means at the time the contract is entered into or renewed a a health benefit plan and employer contribution level with a combined actuarial value at least actuarially equivalent to the combined actuarial value of i the benchmark plan determined by the program under subsection b a and ii a contribution level at which the employer pays at least of the premium or contribution amounts for the employee and the dependents of the employee who reside or work in the state or b a federally qualified high deductible health plan that at a minimum i has a deductible that is a the lowest deductible permitted for a federally qualified high deductible health plan or b a deductible that is higher than the lowest deductible permitted for a federally qualified high deductible health plan but includes an employer contribution to a health savings account in a dollar amount at least equal to the dollar amount difference between the lowest deductible permitted for a federally qualified high deductible plan and the deductible for the employer offered federally qualified high deductible plan ii has an out of pocket maximum that does not exceed three times the amount of the annual deductible and iii provides that the employer pays of the premium or contribution amounts for the employee and the dependents of the employee who work or reside in the state the department shall a on or before july i determine the commercial equivalent of the benchmark plan described in subsection a and ii post the commercially equivalent benchmark plan described in subsection a i on the department s website noting the date posted and b update the posted commercially equivalent benchmark plan annually and at the time of any change in the benchmark section section b which is renumbered from section is renumbered and amended to read part medical benefits recovery b definitions as used in this chapter part annuity shall have the same meaning as provided in section a care facility means a a nursing facility b an intermediate care facility for an individual with an intellectual disability or c any other medical institution claim means a a request or demand for payment or b a cause of action for money or damages arising under any law employee welfare benefit plan means a medical insurance plan developed by an employer under u s c section sec et seq the employee retirement income security act of as amended health insurance entity means a an insurer b a person who administers manages provides offers sells carries or underwrites health insurance as defined in section a c a self insured plan d a group health plan as defined in subsection of the federal employee retirement income security act of e a service benefit plan f a managed care organization g a pharmacy benefit manager h an employee welfare benefit plan or i a person who is by statute contract or agreement legally responsible for payment of a claim for a health care item or service inpatient means an individual who is a patient and a resident of a care facility insurer includes a a group health plan as defined in subsection of the federal employee retirement income security act of b a health maintenance organization and c any entity offering a health service benefit plan medical assistance means a all funds expended for the benefit of a recipient under title chapter medical assistance act or under this chapter or titles xviii and xix federal social security act and b any other services provided for the benefit of a recipient by a prepaid health care delivery system under contract with the department office of recovery services means the office of recovery services within the department of human services department provider means a person or entity who provides services to a recipient recipient means a an individual who has applied for or received medical assistance from the state b the guardian conservator or other personal representative of an individual under subsection a if the individual is a minor or an incapacitated person or c the estate and survivors of an individual under subsection a if the individual is deceased recovery estate means regarding a deceased recipient a all real and personal property or other assets included within a decedent s estate as defined in section b the decedent s augmented estate as defined in section and c that part of other real or personal property in which the decedent had a legal interest at the time of death including assets conveyed to a survivor heir or assign of the decedent through joint tenancy tenancy in common survivorship life estate living trust or other arrangement state plan means the state medicaid program as enacted in accordance with title xix federal social security act tefra lien means a lien authorized under the tax equity and fiscal responsibility act of against the real property of an individual prior to the individual s death as described in u s c sec p third party includes a an individual institution corporation public or private agency trust estate insurance carrier employee welfare benefit plan health maintenance organization health service organization preferred provider organization governmental program such as medicare champus and workers compensation which may be obligated to pay all or part of the medical costs of injury disease or disability of a recipient unless any of these are excluded by department rule and b a spouse or a parent who i may be obligated to pay all or part of the medical costs of a recipient under law or by court or administrative order or ii has been ordered to maintain health dental or accident and health insurance to cover medical expenses of a spouse or dependent child by court or administrative order trust shall have the same meaning as provided in section section section b which is renumbered from section is renumbered and amended to read b program established by department promulgation of rules the department shall establish and maintain a program for the recoupment of medical assistance the department may promulgate rules to implement the purposes of this chapter part section section b which is renumbered from section is renumbered and amended to read b assignment of rights to benefits a except as provided in subsection b to the extent that medical assistance is actually provided to a recipient all benefits for medical services or payments from a third party otherwise payable to or on behalf of a recipient are assigned by operation of law to the department if the department provides or becomes obligated to provide medical assistance regardless of who made application for the benefits on behalf of the recipient b the assignment i authorizes the department to submit its claim to the third party and authorizes payment of benefits directly to the department and ii is effective for all medical assistance the department may recover the assigned benefits or payments in accordance with section b and as otherwise provided by law a the assignment of benefits includes medical support and third party payments ordered decreed or adjudged by any court of this state or any other state or territory of the united states b the assignment is not in lieu of and does not supersede or alter any other court order decree or judgment when an assignment takes effect the recipient is entitled to receive medical assistance and the benefits paid to the department are a reimbursement to the department section section b which is renumbered from section is renumbered and amended to read b health insurance entity duties related to state claims for medicaid payment or recovery as a condition of doing business in the state a health insurance entity shall with respect to an individual who is eligible for or is provided medical assistance under the state plan upon the request of the department of health department provide information to determine a during what period the individual or the spouse or dependent of the individual may be or may have been covered by the health insurance entity and b the nature of the coverage that is or was provided by the health insurance entity described in subsection a including the name address and identifying number of the plan accept the state s right of recovery and the assignment to the state of any right of an individual to payment from a party for an item or service for which payment has been made under the state plan respond to any inquiry by the department of health department regarding a claim for payment for any health care item or service that is submitted no later than three years after the day on which the health care item or service is provided and not deny a claim submitted by the department of health department solely on the basis of the date of submission of the claim the type or format of the claim form or failure to present proper documentation at the point of sale that is the basis for the claim if a the claim is submitted no later than three years after the day on which the item or service is furnished and b any action by the department of health department to enforce the rights of the state with respect to the claim is commenced no later than six years after the day on which the claim is submitted section section b which is renumbered from section is renumbered and amended to read b insurance policies not to deny or reduce benefits of individuals eligible for state medical assistance exemptions a policy of accident or sickness insurance may not contain any provision denying or reducing benefits because services are rendered to an insured or dependent who is eligible for or receiving medical assistance from the state an association corporation or organization may not deliver issue for delivery or renew any subscriber s contract which contains any provisions denying or reducing benefits because services are rendered to a subscriber or dependent who is eligible for or receiving medical assistance from the state an association corporation business or organization authorized to do business in this state and which provides or pays for any health care benefits may not deny or reduce benefits because services are rendered to a beneficiary who is eligible for or receiving medical assistance from the state notwithstanding subsection or the utah state public employees health program administered by the utah state retirement board is not required to reimburse any agency of state government for custodial care which the agency provides through its staff or facilities to members of the utah state public employees health program section section b which is renumbered from section is renumbered and amended to read b availability of insurance policy if the third party does not pay the department s claim or lien within days from the date the claim or lien is received the third party shall provide a written explanation if the claim is denied specifically describe and request any additional information from the department that is necessary to process the claim and provide the department or its agent a copy of any relevant or applicable insurance or benefit policy section section b which is renumbered from section is renumbered and amended to read b employee benefit plans as allowed pursuant to u s c section sec an employee benefit plan may not include any provision that has the effect of limiting or excluding coverage or payment for any health care for an individual who would otherwise be covered or entitled to benefits or services under the terms of the employee benefit plan based on the fact that the individual is eligible for or is provided services under the state plan section section b which is renumbered from section is renumbered and amended to read b statute of limitations survival of right of action insurance policy not to limit time allowed for recovery a subject to subsection action commenced by the department under this chapter part against a health insurance entity shall be commenced within i subject to subsection six years after the day on which the department submits the claim for recovery or payment for the health care item or service upon which the action is based or ii six months after the date of the last payment for medical assistance whichever is later b an action against any other third party the recipient or anyone to whom the proceeds are payable shall be commenced within i four years after the date of the injury or onset of the illness or ii six months after the date of the last payment for medical assistance whichever is later the death of the recipient does not abate any right of action established by this chapter part a no insurance policy issued or renewed after june may contain any provision that limits the time in which the department may submit its claim to recover medical assistance benefits to a period of less than months from the date the provider furnishes services or goods to the recipient b no insurance policy issued or renewed after april may contain any provision that limits the time in which the department may submit its claim to recover medical assistance benefits to a period of less than that described in subsection a the provisions of this section do not apply to section or part tefra liens b or sections b through b the provisions of this section supercede supersede any other sections regarding the time limit in which an action shall be commenced including section a subsection a extends the statute of limitations on a cause of action described in subsection a that was not time barred on or before april b subsection a does not revive a cause of action that was time barred on or before april an action described in subsection a may not be commenced if the claim for recovery or payment described in subsection a i is submitted later than three years after the day on which the health care item or service upon which the claim is based was provided section section b which is renumbered from section is renumbered and amended to read b recovery of medical assistance from third party lien notice action compromise or waiver recipient s right to action protected a except as provided in subsection c if the department provides or becomes obligated to provide medical assistance to a recipient that a third party is obligated to pay for the department may recover the medical assistance directly from the third party b i a claim under subsection a or section b to recover medical assistance provided to a recipient is a lien against any proceeds payable to or on behalf of the recipient by the third party ii the lien described in subsection b i has priority over all other claims to the proceeds except claims for attorney fees and costs authorized under subsection b c ii c i the department may not recover medical assistance under subsection a if a the third party is obligated to pay the recipient for an injury to the recipient s child that occurred while the child was in the physical custody of the child s foster parent b the child s injury is a physical or mental impairment that requires ongoing medical attention or limits activities of daily living for at least one year c the third party s payment to the recipient is placed in a trust annuity financial account or other financial instrument for the benefit of the child and d the recipient makes reasonable efforts to mitigate any other medical assistance costs for the recipient to the state ii the department is responsible for any repayment to the federal government related to the medical assistance the department is prohibited from recovering under subsection c i a the department shall mail or deliver written notice of the department s claim or lien to the third party at the third party s principal place of business or last known address b the notice shall include i the recipient s name ii the approximate date of illness or injury iii a general description of the type of illness or injury and iv if applicable the general location where the injury is alleged to have occurred the department may commence an action on the department s claim or lien in the department s name but the claim or lien is not enforceable as to a third party unless a the third party receives written notice of the department s claim or lien before the third party settles with the recipient or b the department has evidence that the third party had knowledge that the department provided or was obligated to provide medical assistance the department may a waive a claim or lien against a third party in whole or in part or b compromise settle or release a claim or lien an action commenced under this section does not bar an action by a recipient or a dependent of a recipient for loss or damage not included in the department s action except as provided in subsection c the department s claim or lien on proceeds under this section is not affected by the transfer of the proceeds to a trust annuity financial account or other financial instrument section section b which is renumbered from section is renumbered and amended to read b action by department notice to recipient a within days after commencing an action under subsection b the department shall give the recipient the recipient s guardian personal representative trustee estate or survivor whichever is appropriate written notice of the action by i personal service or certified mail to the last known address of the person receiving the notice or ii if no last known address is available by publishing a notice a once a week for three successive weeks in a newspaper of general circulation in the county where the recipient resides and b in accordance with section for three weeks b proof of service shall be filed in the action c the recipient may intervene in the department s action at any time before trial the notice required by subsection shall name the court in which the action is commenced and advise the recipient of a the right to intervene in the proceeding b the right to obtain a private attorney and c the department s right to recover medical assistance directly from the third party section section b which is renumbered from section is renumbered and amended to read b notice of claim by recipient department response conditions for proceeding collection agreements a a recipient may not file a claim commence an action or settle compromise release or waive a claim against a third party for recovery of medical costs for an injury disease or disability for which the department has provided or has become obligated to provide medical assistance without the department s written consent as provided in subsection b or b for purposes of subsection a consent may be obtained if i a recipient who files a claim or commences an action against a third party notifies the department in accordance with subsection d within days of the recipient making the claim or commencing an action or ii an attorney who has been retained by the recipient to file a claim or commence an action against a third party notifies the department in accordance with subsection d of the recipient s claim a within days after being retained by the recipient for that purpose or b within days from the date the attorney either knew or should have known that the recipient received medical assistance from the department c service of the notice of claim to the department shall be made by certified mail personal service or by e mail in accordance with rule of the utah rules of civil procedure to the director of the office of recovery services d the notice of claim shall include the following information i the name of the recipient ii the recipient s social security number iii the recipient s date of birth iv the name of the recipient s attorney if applicable v the name or names of individuals or entities against whom the recipient is making the claim if known vi the name of the third party s insurance carrier if known vii the date of the incident giving rise to the claim and viii a short statement identifying the nature of the recipient s claim a within days of receipt of the notice of the claim required in subsection the department shall acknowledge receipt of the notice of the claim to the recipient or the recipient s attorney and shall notify the recipient or the recipient s attorney in writing of the following i if the department has a claim or lien pursuant to section b or has become obligated to provide medical assistance and ii whether the department is denying or granting written consent in accordance with subsection a b the department shall provide the recipient s attorney the opportunity to enter into a collection agreement with the department with the recipient s consent unless i the department prior to the receipt of the notice of the recipient s claim pursuant to subsection filed a written claim with the third party the third party agreed to make payment to the department before the date the department received notice of the recipient s claim and the agreement is documented in the department s record or ii there has been a failure by the recipient s attorney to comply with any provision of this section by a failing to comply with the notice provisions of this section b failing or refusing to enter into a collection agreement c failing to comply with the terms of a collection agreement with the department or d failing to disburse funds owed to the state in accordance with this section c i the collection agreement shall be a consistent with this section and the attorney s obligation to represent the recipient and represent the state s claim and b state the terms under which the interests of the department may be represented in an action commenced by the recipient ii if the recipient s attorney enters into a written collection agreement with the department or includes the department s claim in the recipient s claim or action pursuant to subsection the department shall pay attorney fees at the rate of of the department s total recovery and shall pay a proportionate share of the litigation expenses directly related to the action d the department is not required to enter into a collection agreement with the recipient s attorney for collection of personal injury protection under subsection a a if the department receives notice pursuant to subsection and notifies the recipient and the recipient s attorney that the department will not enter into a collection agreement with the recipient s attorney the recipient may proceed with the recipient s claim or action against the third party if the recipient excludes from the claim i any medical expenses paid by the department or ii any medical costs for which the department is obligated to provide medical assistance b when a recipient proceeds with a claim under subsection a the recipient shall provide written notice to the third party of the exclusion of the department s claim for expenses under subsection a i or ii if the department receives notice pursuant to subsection and does not respond within days to the recipient or the recipient s attorney the recipient or the recipient s attorney a may proceed with the recipient s claim or action against the third party b may include the state s claim in the recipient s claim or action and c may not negotiate compromise settle or waive the department s claim without the department s consent section section b which is renumbered from section is renumbered and amended to read b department s right to intervene department s interests protected remitting funds disbursements liability and penalty for noncompliance the department has an unconditional right to intervene in an action commenced by a recipient against a third party for the purpose of recovering medical costs for which the department has provided or has become obligated to provide medical assistance a if the recipient proceeds without complying with the provisions of section b the department is not bound by any decision judgment agreement settlement or compromise rendered or made on the claim or in the action b the department i may recover in full from the recipient or any party to which the proceeds were made payable all medical assistance that the department has provided and ii retains its right to commence an independent action against the third party subject to subsection b any amounts assigned to and recoverable by the department pursuant to sections and b and b collected directly by the recipient shall be remitted to the bureau of medical collections within the office of recovery services no later than five business days after receipt a any amounts assigned to and recoverable by the department pursuant to sections and b and b collected directly by the recipient s attorney shall be remitted to the bureau of medical collections within the office of recovery services no later than days after the funds are placed in the attorney s trust account b the date by which the funds shall be remitted to the department may be modified based on agreement between the department and the recipient s attorney c the department s consent to another date for remittance may not be unreasonably withheld d if the funds are received by the recipient s attorney no disbursements shall be made to the recipient or the recipient s attorney until the department s claim has been paid a recipient or recipient s attorney who knowingly and intentionally fails to comply with this section is liable to the department for a the amount of the department s claim or lien pursuant to subsection b a penalty equal to of the amount of the department s claim and c attorney fees and litigation expenses related to recovering the department s claim section section b which is renumbered from section is renumbered and amended to read b estate and trust recovery a except as provided in subsection b upon a recipient s death the department may recover from the recipient s recovery estate and any trust in which the recipient is the grantor and a beneficiary medical assistance correctly provided for the benefit of the recipient when the recipient was years of age old or older b the department may not make an adjustment or a recovery under subsection a i while the deceased recipient s spouse is still living or ii if the deceased recipient has a surviving child who is a under age years old or b blind or disabled as defined in the state plan a the amount of medical assistance correctly provided for the benefit of a recipient and recoverable under this section is a lien against the deceased recipient s recovery estate or any trust when the recipient is the grantor and a beneficiary b the lien holds the same priority as reasonable and necessary medical expenses of the last illness as provided in section a for a lien described in subsection the department shall provide notice in accordance with section b before final distribution the department shall perfect the lien as follows i for an estate by presenting the lien to the estate s personal representative in accordance with section and ii for a trust by presenting the lien to the trustee in accordance with section c the department may file an amended lien before the entry of the final order to close the estate or trust claims against a deceased recipient s inter vivos trust shall be presented in accordance with sections and any trust provision that denies recovery for medical assistance is void at the time of its making nothing in this section affects the right of the department to recover medicaid assistance before a recipient s death under section or section b or b a lien imposed under this section is of indefinite duration section section b which is renumbered from section is renumbered and amended to read b recovery from recipient of incorrectly provided medical assistance the department may recover medical assistance incorrectly provided whether due to administrative or factual error or fraud from the recipient or the recipient s recovery estate and pursuant to a judgment impose a lien against real property of the recipient section section b which is renumbered from section is renumbered and amended to read b tefra liens authorized grounds for tefra liens exemptions except as provided in subsections and the department may impose a tefra lien on the real property of an individual for the amount of medical assistance provided for or to the individual while the individual is an inpatient in a care facility if a the individual is an inpatient in a care facility b the individual is required as a condition of receiving services under the state plan to spend for costs of medical care all but a minimal amount of the individual s income required for personal needs and c the department determines that the individual cannot reasonably be expected to i be discharged from the care facility and ii return to the individual s home the department may not impose a lien on the home of an individual described in subsection if any of the following individuals are lawfully residing in the home a the spouse of the individual b a child of the individual if the child is i under years of age old or ii blind or permanently and totally disabled as defined in title u s c sec c a f or c a sibling of the individual if the sibling i has an equity interest in the home and ii resided in the home for at least one year immediately preceding the day on which the individual was admitted to the care facility the department may not impose a tefra lien on the real property of an individual unless a the individual has been an inpatient in a care facility for the day period immediately preceding the day on which the lien is imposed b the department serves i a preliminary notice of intent to impose a tefra lien relating to the real property in accordance with section b and ii a final notice of intent to impose a tefra lien relating to the real property in accordance with section b and c i the individual does not file a timely request for review of the department s decision under title g chapter administrative procedures act or ii the department s decision is upheld upon final review or appeal under title g chapter administrative procedures act section section b which is renumbered from section is renumbered and amended to read b presumption of permanency there is a rebuttable presumption that an individual who is an inpatient in a care facility cannot reasonably be expected to be discharged from a care facility and return to the individual s home if the individual has been an inpatient in a care facility for a period of at least consecutive days section section b which is renumbered from section is renumbered and amended to read b preliminary notice of intent to impose a tefra lien prior to imposing a tefra lien on real property the department shall serve a preliminary notice of intent to impose a tefra lien on the individual described in subsection b who owns the property the preliminary notice of intent shall a be served in person or by certified mail on the individual described in subsection b and if the department is aware that the individual has a legally authorized representative on the representative b include a statement indicating that according to the department s records the individual i meets the criteria described in subsections b a and b ii has been an inpatient in a care facility for a period of at least days immediately preceding the day on which the department provides the notice to the individual and iii is legally presumed to be in a condition where it cannot reasonably be expected that the individual will be discharged from the care facility and return to the individual s home c indicate that the department intends to impose a tefra lien on real property belonging to the individual d describe the real property that the tefra lien will apply to e describe the current amount of and purpose of the tefra lien f indicate that the amount of the lien may continue to increase as the individual continues to receive medical assistance g indicate that the individual may seek to prevent the tefra lien from being imposed on the real property by providing documentation to the department that
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+enrolled copy s b health and human services recodification health care assistance and data general session state of utah chief sponsor jacob l anderegg house sponsor raymond p ward long title general description this bill recodifies portions of the utah health code and utah human services code highlighted provisions this bill recodifies provisions regarding health care administration and assistance and vital statistics health data and the utah medical examiner and makes technical and corresponding changes money appropriated in this bill none other special clauses this bill provides a coordination clause this bill provides revisor instructions utah code sections affected amends b as enacted by laws of utah chapter b as enacted by laws of utah chapter renumbers and amends b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah sixth special session chapter b renumbered from as last amended by laws of utah fifth special session chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah fifth special session chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from c as last amended by laws of utah chapter b renumbered from c as enacted by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as enacted by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as repealed and reenacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as repealed and reenacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter utah code sections affected by coordination clause as last amended by laws of utah chapter as last amended by laws of utah chapter b as enacted by laws of utah chapter b utah code annotated be it enacted by the legislature of the state of utah section section b is amended to read chapter health care administration and assistance part health care assistance b definitions reserved as used in this chapter applicant means any person who requests assistance under the medical programs of the state cms means the centers for medicare and medicaid services within the united states department of health and human services division means the division of integrated healthcare within the department established under section b enrollee or member means an individual whom the department has determined to be eligible for assistance under the medicaid program medicaid program means the state program for medical assistance for persons who are eligible under the state plan adopted pursuant to title xix of the federal social security act medical assistance means services furnished or payments made to or on behalf of a member a passenger vehicle means a self propelled two axle vehicle intended primarily for operation on highways and used by an applicant or recipient to meet basic transportation needs and has a fair market value below of the applicable amount of the federal luxury passenger automobile tax established in u s c sec and adjusted annually for inflation b passenger vehicle does not include i a commercial vehicle as defined in section a ii an off highway vehicle as defined in section a or iii a motor home as defined in section ppaca means the same as that term is defined in section a recipient means a person who has received medical assistance under the medicaid program section section b which is renumbered from section is renumbered and amended to read b division creation there is created within the department the division of medicaid and health financing integrated healthcare which shall be responsible for implementing organizing and maintaining the medicaid program and the children s health insurance program established in section b in accordance with the provisions of this chapter and applicable federal law section section b which is renumbered from section is renumbered and amended to read b state medicaid director appointment responsibilities the state medicaid director shall be appointed by the governor after consultation with the executive director with the advice and consent of the senate the state medicaid director may employ other employees as necessary to implement the provisions of this chapter and shall a administer the responsibilities of the division as set forth in this chapter b administer the division s budget and c establish and maintain a state plan for the medicaid program in compliance with federal law and regulations section section b which is renumbered from section is renumbered and amended to read b division responsibilities emphasis periodic assessment in accordance with the requirements of title xix of the social security act and applicable federal regulations the division is responsible for the effective and impartial administration of this chapter in an efficient economical manner the division shall a establish on a statewide basis a program to safeguard against unnecessary or inappropriate use of medicaid services excessive payments and unnecessary or inappropriate hospital admissions or lengths of stay b deny any provider claim for services that fail to meet criteria established by the division concerning medical necessity or appropriateness and c place its emphasis on high quality care to recipients in the most economical and cost effective manner possible with regard to both publicly and privately provided services the division shall implement and utilize cost containment methods where possible which may include a prepayment and postpayment review systems to determine if utilization is reasonable and necessary b preadmission certification of nonemergency admissions c mandatory outpatient rather than inpatient surgery in appropriate cases d second surgical opinions e procedures for encouraging the use of outpatient services f consistent with sections b and b a medicaid drug program g coordination of benefits and h review and exclusion of providers who are not cost effective or who have abused the medicaid program in accordance with the procedures and provisions of federal law and regulation the state medicaid director shall periodically assess the cost effectiveness and health implications of the existing medicaid program and consider alternative approaches to the provision of covered health and medical services through the medicaid program in order to reduce unnecessary or unreasonable utilization a the department shall ensure medicaid program integrity by conducting internal audits of the medicaid program for efficiencies best practices and cost avoidance b the department shall coordinate with the office of the inspector general for medicaid services created in section a to implement subsection and to address medicaid fraud waste or abuse as described in section a section section b which is renumbered from section is renumbered and amended to read b medicaid drug program preferred drug list a medicaid drug program developed by the department under subsection b f a shall notwithstanding subsection b b be based on clinical and cost related factors which include medical necessity as determined by a provider in accordance with administrative rules established by the drug utilization review board b may include therapeutic categories of drugs that may be exempted from the drug program c may include placing some drugs except the drugs described in subsection on a preferred drug list i to the extent determined appropriate by the department and ii in the manner described in subsection for psychotropic drugs d notwithstanding the requirements of part sections b through b regarding the drug utilization review board and except as provided in subsection shall immediately implement the prior authorization requirements for a nonpreferred drug that is in the same therapeutic class as a drug that is i on the preferred drug list on the date that this act takes effect or ii added to the preferred drug list after this act takes effect and e except as prohibited by subsections b and shall establish the prior authorization requirements established under subsections c and d which shall permit a health care provider or the health care provider s agent to obtain a prior authorization override of the preferred drug list through the department s pharmacy prior authorization review process and which shall i provide either telephone or fax approval or denial of the request within hours of the receipt of a request that is submitted during normal business hours of monday through friday from a m to p m ii provide for the dispensing of a limited supply of a requested drug as determined appropriate by the department in an emergency situation if the request for an override is received outside of the department s normal business hours and iii require the health care provider to provide the department with documentation of the medical need for the preferred drug list override in accordance with criteria established by the department in consultation with the pharmacy and therapeutics committee a for purposes of as used in this subsection i immunosuppressive drug a means a drug that is used in immunosuppressive therapy to inhibit or prevent activity of the immune system to aid the body in preventing the rejection of transplanted organs and tissue and b does not include drugs used for the treatment of autoimmune disease or diseases that are most likely of autoimmune origin ii stabilized means a health care provider has documented in the patient s medical chart that a patient has achieved a stable or steadfast medical state within the past days using a particular psychotropic drug b a preferred drug list developed under the provisions of this section may not include an immunosuppressive drug c i the state medicaid program shall reimburse for a prescription for an immunosuppressive drug as written by the health care provider for a patient who has undergone an organ transplant ii for purposes of subsection b and with respect to patients who have undergone an organ transplant the prescription for a particular immunosuppressive drug as written by a health care provider meets the criteria of demonstrating to the department a medical necessity for dispensing the prescribed immunosuppressive drug d notwithstanding the requirements of part sections b through b regarding the drug utilization review board the state medicaid drug program may not require the use of step therapy for immunosuppressive drugs without the written or oral consent of the health care provider and the patient e the department may include a sedative hypnotic on a preferred drug list in accordance with subsection f f the department shall grant a prior authorization for a sedative hypnotic that is not on the preferred drug list under subsection e if the health care provider has documentation related to one of the following conditions for the medicaid client i a trial and failure of at least one preferred agent in the drug class including the name of the preferred drug that was tried the length of therapy and the reason for the discontinuation ii detailed evidence of a potential drug interaction between current medication and the preferred drug iii detailed evidence of a condition or contraindication that prevents the use of the preferred drug iv objective clinical evidence that a patient is at high risk of adverse events due to a therapeutic interchange with a preferred drug v the patient is a new or previous medicaid client with an existing diagnosis previously stabilized with a nonpreferred drug or vi other valid reasons as determined by the department g a prior authorization granted under subsection f is valid for one year from the date the department grants the prior authorization and shall be renewed in accordance with subsection f a for purposes of as used in this subsection psychotropic drug means the following classes of drugs i atypical anti psychotic ii anti depressant iii anti convulsant mood stabilizer iv anti anxiety and v attention deficit hyperactivity disorder stimulant b i the department shall develop a preferred drug list for psychotropic drugs ii except as provided in subsection d a preferred drug list for psychotropic drugs developed under this section shall allow a health care provider to override the preferred drug list by writing dispense as written on the prescription for the psychotropic drug iii a health care provider may not override section b by writing dispense as written on a prescription c the department and a medicaid accountable care organization that is responsible for providing behavioral health shall i establish a system to a track health care provider prescribing patterns for psychotropic drugs b educate health care providers who are not complying with the preferred drug list and c implement peer to peer education for health care providers whose prescribing practices continue to not comply with the preferred drug list and ii determine whether health care provider compliance with the preferred drug list is at least a of prescriptions by july b of prescriptions by july and c of prescriptions by july d beginning october the department shall eliminate the dispense as written override for the preferred drug list and shall implement a prior authorization system for psychotropic drugs in accordance with subsection f if by july the department has not realized annual savings from implementing the preferred drug list for psychotropic drugs of at least general fund savings section section b which is renumbered from section is renumbered and amended to read b simplified enrollment and renewal process for medicaid and other state medical programs financial institutions the department may apply for grants and accept donations to make technology system improvements necessary to implement a simplified enrollment and renewal process for the medicaid program utah premium partnership and primary care network demonstration project programs a the department may enter into an agreement with a financial institution doing business in the state to develop and operate a data match system to identify an applicant s or enrollee s assets that i uses automated data exchanges to the maximum extent feasible and ii requires a financial institution each month to provide the name record address social security number other taxpayer identification number or other identifying information for each applicant or enrollee who maintains an account at the financial institution b the department may pay a reasonable fee to a financial institution for compliance with this subsection as provided in section c a financial institution may not be liable under any federal or state law to any person for any disclosure of information or action taken in good faith under this subsection d the department may disclose a financial record obtained from a financial institution under this section only for the purpose of and to the extent necessary in verifying eligibility as provided in this section and section b section section b which is renumbered from section is renumbered and amended to read b dental benefits a except as provided in subsection the division may establish a competitive bid process to bid out medicaid dental benefits under this chapter b the division may bid out the medicaid dental benefits separately from other program benefits the division shall use the following criteria to evaluate dental bids a ability to manage dental expenses b proven ability to handle dental insurance c efficiency of claim paying procedures d provider contracting discounts and adequacy of network and e other criteria established by the department the division shall request bids for the program s benefits at least once every five years the division s contract with dental plans for the program s benefits shall include risk sharing provisions in which the dental plan must accept of the risk for any difference between the division s premium payments per client and actual dental expenditures the division may not award contracts to a more than three responsive bidders under this section or b an insurer that does not have a current license in the state a the division may cancel the request for proposals if i there are no responsive bidders or ii the division determines that accepting the bids would increase the program s costs b if the division cancels a request for proposal or a contract that results from a request for proposal described in subsection a the division shall report to the health and human services interim committee regarding the reasons for the decision title g chapter a utah procurement code shall apply to this section a the division may i establish a dental health care delivery system and payment reform pilot program for medicaid dental benefits to increase access to cost effective and quality dental health care by increasing the number of dentists available for medicaid dental services and ii target specific medicaid populations or geographic areas in the state b the pilot program shall establish compensation models for dentists and dental hygienists that i increase access to quality cost effective dental care and ii use funds from the division of family health and preparedness that are available to reimburse dentists for educational loans in exchange for the dentist agreeing to serve medicaid and under served populations c the division may amend the state plan and apply to the secretary of the united states department of health and human services for waivers or pilot programs if necessary to establish the new dental care delivery and payment reform model d the division shall evaluate the pilot program s effect on the cost of dental care and access to dental care for the targeted medicaid populations a as used in this subsection dental hygienist means an individual who is licensed as a dental hygienist under section b the department shall reimburse a dental hygienist for dental services performed in a public health setting and in accordance with subsection c beginning on the earlier of i january or ii days after the date on which the replacement of the department s medicaid management information system software is complete c the department shall reimburse a dental hygienist directly for a service provided through the medicaid program if i the dental hygienist requests to be reimbursed directly and ii the dental hygienist provides the service within the scope of practice described in section d before november of each year in which the department reimburses dental hygienists in accordance with subsection c the department shall report to the health and human services interim committee for the previous fiscal year i the number and geographic distribution of dental hygienists who requested to be reimbursed directly ii the total number of medicaid enrollees who were served by a dental hygienist who were reimbursed under this subsection iii the total amount reimbursed directly to dental hygienists under this subsection iv the specific services and billing codes that are reimbursed under this subsection and v the aggregate amount reimbursed for each service and billing code described in subsection d iv e i except as provided in this subsection nothing in this subsection shall be interpreted as expanding or otherwise altering the limitations and scope of practice for a dental hygienist ii a dental hygienist may only directly bill and receive compensation for billing codes that fall within the scope of practice of a dental hygienist section section b which is renumbered from section is renumbered and amended to read b administration of medicaid program by department reporting to the legislature disciplinary measures and sanctions funds collected eligibility standards internal audits health opportunity accounts the department shall be the single state agency responsible for the administration of the medicaid program in connection with the united states department of health and human services pursuant to title xix of the social security act a the department shall implement the medicaid program through administrative rules in conformity with this chapter title g chapter utah administrative rulemaking act the requirements of title xix and applicable federal regulations b the rules adopted under subsection a shall include in addition to other rules necessary to implement the program i the standards used by the department for determining eligibility for medicaid services ii the services and benefits to be covered by the medicaid program iii reimbursement methodologies for providers under the medicaid program and iv a requirement that a a person receiving medicaid services shall participate in the electronic exchange of clinical health records established in accordance with section b unless the individual opts out of participation b prior to enrollment in the electronic exchange of clinical health records the enrollee shall receive notice of enrollment in the electronic exchange of clinical health records and the right to opt out of participation at any time and c beginning july when the program sends enrollment or renewal information to the enrollee and when the enrollee logs onto the program s website the enrollee shall receive notice of the right to opt out of the electronic exchange of clinical health records a the department shall in accordance with subsection b report to the social services appropriations subcommittee when the department i implements a change in the medicaid state plan ii initiates a new medicaid waiver iii initiates an amendment to an existing medicaid waiver iv applies for an extension of an application for a waiver or an existing medicaid waiver v applies for or receives approval for a change in any capitation rate within the medicaid program or vi initiates a rate change that requires public notice under state or federal law b the report required by subsection a shall i be submitted to the social services appropriations subcommittee prior to the department implementing the proposed change and ii include a a description of the department s current practice or policy that the department is proposing to change b an explanation of why the department is proposing the change c the proposed change in services or reimbursement including a description of the effect of the change d the effect of an increase or decrease in services or benefits on individuals and families e the degree to which any proposed cut may result in cost shifting to more expensive services in health or human service programs and f the fiscal impact of the proposed change including i the effect of the proposed change on current or future appropriations from the legislature to the department ii the effect the proposed change may have on federal matching dollars received by the state medicaid program iii any cost shifting or cost savings within the department s budget that may result from the proposed change and iv identification of the funds that will be used for the proposed change including any transfer of funds within the department s budget any rules adopted by the department under subsection are subject to review and reauthorization by the legislature in accordance with section g the department may in its discretion contract with the department of human services or other qualified agencies for services in connection with the administration of the medicaid program including a the determination of the eligibility of individuals for the program b recovery of overpayments and c consistent with section b and to the extent permitted by law and quality control services enforcement of fraud and abuse laws the department shall provide by rule disciplinary measures and sanctions for medicaid providers who fail to comply with the rules and procedures of the program provided that sanctions imposed administratively may not extend beyond a termination from the program b recovery of claim reimbursements incorrectly paid and c those specified in section of title xix of the federal social security act a funds collected as a result of a sanction imposed under section of title xix of the federal social security act shall be deposited in the general fund as dedicated credits to be used by the division in accordance with the requirements of section of title xix of the federal social security act b in accordance with section j sanctions collected under this subsection are nonlapsing a in determining whether an applicant or recipient is eligible for a service or benefit under this part or chapter part utah children s health insurance act program the department shall if subsection b is satisfied exclude from consideration one passenger vehicle designated by the applicant or recipient b before subsection a may be applied i the federal government shall a determine that subsection a may be implemented within the state s existing public assistance related waivers as of january b extend a waiver to the state permitting the implementation of subsection a or c determine that the state s waivers that permit dual eligibility determinations for cash assistance and medicaid are no longer valid and ii the department shall determine that subsection a can be implemented within existing funding a for purposes of as used in this subsection i aged blind or has a disability means an aged blind or disabled individual as defined in u s c sec c a and ii spend down means an amount of income in excess of the allowable income standard that shall be paid in cash to the department or incurred through the medical services not paid by medicaid b in determining whether an applicant or recipient who is aged blind or has a disability is eligible for a service or benefit under this chapter the department shall use of the federal poverty level as i the allowable income standard for eligibility for services or benefits and ii the allowable income standard for eligibility as a result of spend down the department shall conduct internal audits of the medicaid program a the department may apply for and if approved implement a demonstration program for health opportunity accounts as provided for in u s c sec u b a health opportunity account established under subsection a shall be an alternative to the existing benefits received by an individual eligible to receive medicaid under this chapter c subsection a is not intended to expand the coverage of the medicaid program a i the department shall apply for and if approved implement an amendment to the state plan under this subsection for benefits for a medically needy pregnant women b medically needy children and c medically needy parents and caretaker relatives ii the department may implement the eligibility standards of subsection b for eligibility determinations made on or after the date of the approval of the amendment to the state plan b in determining whether an applicant is eligible for benefits described in subsection a i the department shall i disregard resources held in an account in the savings plan created under title b chapter a utah educational savings plan if the beneficiary of the account is a under the age of and b living with the account owner as that term is defined in section b a or temporarily absent from the residence of the account owner and ii include the withdrawals from an account in the utah educational savings plan as resources for a benefit determination if the withdrawal was not used for qualified higher education costs as that term is defined in section b a a the department may not deny or terminate eligibility for medicaid solely because an individual is i incarcerated and ii not an inmate as defined in section b subsection a does not require the medicaid program to provide coverage for any services for an individual while the individual is incarcerated the department is a party to and may intervene at any time in any judicial or administrative action a to which the department of workforce services is a party and b that involves medical assistance under this chapter i title chapter medical assistance act or ii title chapter utah children s health insurance act section section b which is renumbered from section is renumbered and amended to read b medicaid expansion the purpose of this section is to expand the coverage of the medicaid program to persons who are in categories traditionally not served by that program within appropriations from the legislature the department may amend the state plan for medical assistance to provide for eligibility for medicaid a on or after july for children to years old who live in households below the federal poverty income guideline and b on or after july for persons who have incomes below the federal poverty income guideline and who are aged blind or have a disability a within appropriations from the legislature on or after july the medicaid program may provide for eligibility for persons who have incomes below the federal poverty income guideline b in order to meet the provisions of this subsection the department may seek approval for a demonstration project under u s c sec from the secretary of the united states department of health and human services the medicaid program shall provide for eligibility for persons as required by subsection b services available for persons described in this section shall include required medicaid services and may include one or more optional medicaid services if those services are funded by the legislature the department may also require persons described in subsections through to meet an asset test section section b which is renumbered from section is renumbered and amended to read b copayments by recipients employer sponsored plans the department shall selectively provide for enrollment fees premiums deductions cost sharing or other similar charges to be paid by recipients their spouses and parents within the limitations of federal law and regulation beginning may within appropriations by the legislature and as a means to increase health care coverage among the uninsured the department shall take steps to promote increased participation in employer sponsored health insurance including a maximizing the health insurance premium subsidy provided under the state s demonstration waiver by i ensuring that state funds are matched by federal funds to the greatest extent allowable and ii as the department determines appropriate seeking federal approval to do one or more of the following a eliminate or otherwise modify the annual enrollment fee b eliminate or otherwise modify the schedule used to determine the level of subsidy provided to an enrollee each year c reduce the maximum number of participants allowable under the subsidy program or d otherwise modify the program in a manner that promotes enrollment in employer sponsored health insurance and b exploring the use of other options including the development of a waiver under the medicaid health insurance flexibility demonstration initiative or other federal authority section section b which is renumbered from section is renumbered and amended to read b income and resources from institutionalized spouses as used in this section a community spouse means the spouse of an institutionalized spouse b i community spouse monthly income allowance means an amount by which the minimum monthly maintenance needs allowance for the spouse exceeds the amount of monthly income otherwise available to the community spouse determined without regard to the allowance except as provided in subsection b ii ii if a court has entered an order against an institutionalized spouse for monthly income for the support of the community spouse the community spouse monthly income allowance for the spouse may not be less than the amount of the monthly income so ordered c community spouse resource allowance is the amount of combined resources that are protected for a community spouse living in the community which the division shall establish by rule made in accordance with title g chapter utah administrative rulemaking act based on the amounts established by the united states department of health and human services d excess shelter allowance for a community spouse means the amount by which the sum of the spouse s expense for rent or mortgage payment taxes and insurance and in the case of condominium or cooperative required maintenance charge for the community spouse s principal residence and the spouse s actual expenses for electricity natural gas and water utilities or at the discretion of the department the federal standard utility allowance under snap as defined in section a exceeds of the amount described in subsection e family member means a minor dependent child dependent parents or dependent sibling of the institutionalized spouse or community spouse who are residing with the community spouse f i institutionalized spouse means a person who is residing in a nursing facility and is married to a spouse who is not in a nursing facility ii an institutionalized spouse does not include a person who is not likely to reside in a nursing facility for at least consecutive days g nursing care facility means the same as that term is defined in section b the division shall comply with this section when determining eligibility for medical assistance for an institutionalized spouse for services furnished during a calendar year beginning on or after january the community spouse resource allowance shall be increased by the division by an amount as determined annually by cms the division shall compute as of the beginning of the first continuous period of institutionalization of the institutionalized spouse a the total value of the resources to the extent either the institutionalized spouse or the community spouse has an ownership interest and b a spousal share which is of the resources described in subsection a at the request of an institutionalized spouse or a community spouse at the beginning of the first continuous period of institutionalization of the institutionalized spouse and upon the receipt of relevant documentation of resources the division shall promptly assess and document the total value described in subsection a and shall provide a copy of that assessment and documentation to each spouse and shall retain a copy of the assessment when the division provides a copy of the assessment it shall include a notice stating that the spouse may request a hearing under subsection when determining eligibility for medical assistance under this chapter a except as provided in subsection b all resources held by either the institutionalized spouse community spouse or both are considered to be available to the institutionalized spouse b resources are considered to be available to the institutionalized spouse only to the extent that the amount of those resources exceeds the community spouse resource allowance at the time of application for medical assistance under this chapter a the division may not find an institutionalized spouse to be ineligible for medical assistance by reason of resources determined under subsection to be available for the cost of care when i the institutionalized spouse has assigned to the state any rights to support from the community spouse ii except as provided in subsection b the institutionalized spouse lacks the ability to execute an assignment due to physical or mental impairment or iii the division determines that denial of medical assistance would cause an undue burden b subsection a ii does not prevent the division from seeking a court order for an assignment of support during the continuous period in which an institutionalized spouse is in an institution and after the month in which an institutionalized spouse is eligible for medical assistance the resources of the community spouse may not be considered to be available to the institutionalized spouse when an institutionalized spouse is determined to be eligible for medical assistance in determining the amount of the spouse s income that is to be applied monthly for the cost of care in the nursing care facility the division shall deduct from the spouse s monthly income the following amounts in the following order a a personal needs allowance the amount of which is determined by the division b a community spouse monthly income allowance but only to the extent that the income of the institutionalized spouse is made available to or for the benefit of the community spouse c a family allowance for each family member equal to at least of the amount that the amount described in subsection a exceeds the amount of the family member s monthly income and d amounts for incurred expenses for the medical or remedial care for the institutionalized spouse the division shall establish a minimum monthly maintenance needs allowance for each community spouse that includes a an amount established by the division by rule made in accordance with title g chapter utah administrative rulemaking act based on the amounts established by the united states department of health and human services and b an excess shelter allowance a an institutionalized spouse or a community spouse may request a hearing with respect to the determinations described in subsections e i through v if an application for medical assistance has been made on behalf of the institutionalized spouse b a hearing under this subsection regarding the community spouse resource allowance shall be held by the division within days from the date of the request for the hearing c if either spouse establishes that the community spouse needs income above the level otherwise provided by the minimum monthly maintenance needs allowance due to exceptional circumstances resulting in significant financial duress there shall be substituted for the minimum monthly maintenance needs allowance provided under subsection an amount adequate to provide additional income as is necessary d if either spouse establishes that the community spouse resource allowance in relation to the amount of income generated by the allowance is inadequate to raise the community spouse s income to the minimum monthly maintenance needs allowance there shall be substituted for the community spouse resource allowance an amount adequate to provide a minimum monthly maintenance needs allowance e a hearing may be held under this subsection if either the institutionalized spouse or community spouse is dissatisfied with a determination of i the community spouse monthly income allowance ii the amount of monthly income otherwise available to the community spouse iii the computation of the spousal share of resources under subsection iv the attribution of resources under subsection or v the determination of the community spouse resource allocation a an institutionalized spouse may transfer an amount equal to the community spouse resource allowance but only to the extent the resources of the institutionalized spouse are transferred to or for the sole benefit of the community spouse b the transfer under subsection a shall be made as soon as practicable after the date of the initial determination of eligibility taking into account the time necessary to obtain a court order under subsection c c chapter medical benefits recovery act part medical benefits recovery does not apply if a court has entered an order against an institutionalized spouse for the support of the community spouse section section b which is renumbered from section is renumbered and amended to read b maximizing use of premium assistance programs utah s premium partnership for health insurance a the department shall seek to maximize the use of medicaid and children s health insurance program funds for assistance in the purchase of private health insurance coverage for medicaid eligible and non medicaid eligible individuals b the department s efforts to expand the use of premium assistance shall i include as necessary seeking federal approval under all medicaid and children s health insurance program premium assistance provisions of federal law including provisions of the patient protection and affordable care act public law ppaca ii give priority to but not be limited to expanding the state s utah premium partnership for health insurance program including as required under subsection and iii encourage the enrollment of all individuals within a household in the same plan where possible including enrollment in a plan that allows individuals within the household transitioning out of medicaid to retain the same network and benefits they had while enrolled in medicaid the department shall seek federal approval of an amendment to the state s utah premium partnership for health insurance program to adjust the eligibility determination for single adults and parents who have an offer of employer sponsored insurance the amendment shall a be within existing appropriations for the utah premium partnership for health insurance program and b provide that adults who are up to of the federal poverty level are eligible for premium subsidies in the utah premium partnership for health insurance program for the fiscal year the department shall seek authority to increase the maximum premium subsidy per month for adults under the utah premium partnership for health insurance program to beginning with the fiscal year and in each subsequent fiscal year the department may increase premium subsidies for single adults and parents who have an offer of employer sponsored insurance to keep pace with the increase in insurance premium costs subject to appropriation of additional funding section section b which is renumbered from section is renumbered and amended to read b expanding the medicaid program as used in this section a cms means the centers for medicare and medicaid services in the united states department of health and human services b a federal poverty level means the same as that term is defined in section b c b medicaid expansion means an expansion of the medicaid program in accordance with this section d c medicaid expansion fund means the medicaid expansion fund created in section b b a as set forth in subsections through eligibility criteria for the medicaid program shall be expanded to cover additional low income individuals b the department shall continue to seek approval from cms to implement the medicaid waiver expansion as defined in section b c the department may implement any provision described in subsections b b iii through viii in a medicaid expansion if the department receives approval from cms to implement that provision the department shall expand the medicaid program in accordance with this subsection if the department a receives approval from cms to i expand medicaid coverage to eligible individuals whose income is below of the federal poverty level ii obtain maximum federal financial participation under u s c sec d b for enrolling an individual in the medicaid expansion under this subsection and iii permit the state to close enrollment in the medicaid expansion under this subsection if the department has insufficient funds to provide services to new enrollment under the medicaid expansion under this subsection b pays the state portion of costs for the medicaid expansion under this subsection with funds from i the medicaid expansion fund ii county contributions to the nonfederal share of medicaid expenditures or iii any other contributions funds or transfers from a nonstate agency for medicaid expenditures and c closes the medicaid program to new enrollment under the medicaid expansion under this subsection if the department projects that the cost of the medicaid expansion under this subsection will exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act a the department shall expand the medicaid program in accordance with this subsection if the department i receives approval from cms to a expand medicaid coverage to eligible individuals whose income is below of the federal poverty level b obtain maximum federal financial participation under u s c sec d y for enrolling an individual in the medicaid expansion under this subsection and c permit the state to close enrollment in the medicaid expansion under this subsection if the department has insufficient funds to provide services to new enrollment under the medicaid expansion under this subsection ii pays the state portion of costs for the medicaid expansion under this subsection with funds from a the medicaid expansion fund b county contributions to the nonfederal share of medicaid expenditures or c any other contributions funds or transfers from a nonstate agency for medicaid expenditures and iii closes the medicaid program to new enrollment under the medicaid expansion under this subsection if the department projects that the cost of the medicaid expansion under this subsection will exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act b the department shall submit a waiver an amendment to an existing waiver or a state plan amendment to cms to i administer federal funds for the medicaid expansion under this subsection according to a per capita cap developed by the department that includes an annual inflationary adjustment accounts for differences in cost among categories of medicaid expansion enrollees and provides greater flexibility to the state than the current medicaid payment model ii limit in certain circumstances as defined by the department the ability of a qualified entity to determine presumptive eligibility for medicaid coverage for an individual enrolled in a medicaid expansion under this subsection iii impose a lock out period if an individual enrolled in a medicaid expansion under this subsection violates certain program requirements as defined by the department iv allow an individual enrolled in a medicaid expansion under this subsection to remain in the medicaid program for up to a month certification period as defined by the department and v allow federal medicaid funds to be used for housing support for eligible enrollees in the medicaid expansion under this subsection a i if cms does not approve a waiver to expand the medicaid program in accordance with subsection a on or before january the department shall develop proposals to implement additional flexibilities and cost controls including cost sharing tools within a medicaid expansion under this subsection through a request to cms for a waiver or state plan amendment ii the request for a waiver or state plan amendment described in subsection a i shall include a a path to self sufficiency for qualified adults in the medicaid expansion that includes employment and training as defined in u s c sec d and b a requirement that an individual who is offered a private health benefit plan by an employer to enroll in the employer s health plan iii the department shall submit the request for a waiver or state plan amendment developed under subsection a i on or before march b notwithstanding sections b and j and in accordance with this subsection eligibility for the medicaid program shall be expanded to include all persons in the optional medicaid expansion population under the patient protection and affordable care act pub l no ppaca and the health care education reconciliation act of pub l no and related federal regulations and guidance on the earlier of i the day on which cms approves a waiver to implement the provisions described in subsections a ii a and b or ii july c the department shall seek a waiver or an amendment to an existing waiver from federal law to i implement each provision described in subsections b b iii through viii in a medicaid expansion under this subsection ii limit in certain circumstances as defined by the department the ability of a qualified entity to determine presumptive eligibility for medicaid coverage for an individual enrolled in a medicaid expansion under this subsection and iii impose a lock out period if an individual enrolled in a medicaid expansion under this subsection violates certain program requirements as defined by the department d the eligibility criteria in this subsection shall be construed to include all individuals eligible for the health coverage improvement program under section b e the department shall pay the state portion of costs for a medicaid expansion under this subsection entirely from i the medicaid expansion fund ii county contributions to the nonfederal share of medicaid expenditures or iii any other contributions funds or transfers from a nonstate agency for medicaid expenditures f if the costs of the medicaid expansion under this subsection exceed the funds available under subsection e i the department may reduce or eliminate optional medicaid services under this chapter and ii savings as determined by the department from the reduction or elimination of optional medicaid services under subsection f i shall be deposited into the medicaid expansion fund and iii the department may submit to cms a request for waivers or an amendment of existing waivers from federal law necessary to implement budget controls within the medicaid program to address the deficiency g if the costs of the medicaid expansion under this subsection are projected by the department to exceed the funds available in the current fiscal year under subsection e including savings resulting from any action taken under subsection f i the governor shall direct the department of health department of human services department and department of workforce services to reduce commitments and expenditures by an amount sufficient to offset the deficiency a proportionate to the share of total current fiscal year general fund appropriations for each of those agencies and b up to of each agency s total current fiscal year general fund appropriations ii the division of finance shall reduce allotments to the department of health department of human services department and department of workforce services by a percentage a proportionate to the amount of the deficiency and b up to of each agency s total current fiscal year general fund appropriations and iii the division of finance shall deposit the total amount from the reduced allotments described in subsection g ii into the medicaid expansion fund the department shall maximize federal financial participation in implementing this section including by seeking to obtain any necessary federal approvals or waivers notwithstanding sections and a county does not have to provide matching funds to the state for the cost of providing medicaid services to newly enrolled individuals who qualify for medicaid coverage under a medicaid expansion the department shall report to the social services appropriations subcommittee on or before november of each year that a medicaid expansion is operational a the number of individuals who enrolled in the medicaid expansion b costs to the state for the medicaid expansion c estimated costs to the state for the medicaid expansion for the current and following fiscal years d recommendations to control costs of the medicaid expansion and e as calculated in accordance with subsections b b and c b the state s net cost of the qualified medicaid expansion section section b which is renumbered from section is renumbered and amended to read b department standards for eligibility under medicaid funds for abortions a the department may develop standards and administer policies relating to eligibility under the medicaid program as long as they are consistent with subsection b b an applicant receiving medicaid assistance may be limited to particular types of care or services or to payment of part or all costs of care determined to be medically necessary the department may not provide any funds for medical hospital or other medical expenditures or medical services to otherwise eligible persons where the purpose of the assistance is to perform an abortion unless the life of the mother would be endangered if an abortion were not performed any employee of the department who authorizes payment for an abortion contrary to the provisions of this section is guilty of a class b misdemeanor and subject to forfeiture of office any person or organization that under the guise of other medical treatment provides an abortion under auspices of the medicaid program is guilty of a third degree felony and subject to forfeiture of license to practice medicine or authority to provide medical services and treatment section section b which is renumbered from section is renumbered and amended to read b contracts for provision of medical services federal provisions modifying department rules compliance with social security act the department may contract with other public or private agencies to purchase or provide medical services in connection with the programs of the division where these programs are used by other government entities contracts shall provide that other government entities in compliance with state and federal law regarding intergovernmental transfers transfer the state matching funds to the department in amounts sufficient to satisfy needs of the specified program contract terms shall include provisions for maintenance administration and service costs if a federal legislative or executive provision requires modifications or revisions in an eligibility factor established under this chapter as a condition for participation in medical assistance the department may modify or change its rules as necessary to qualify for participation the provisions of this section do not apply to department rules governing abortion the department shall comply with all pertinent requirements of the social security act and all orders rules and regulations adopted thereunder when required as a condition of participation in benefits under the social security act section section b which is renumbered from section is renumbered and amended to read b liability insurance required the medicaid program may not reimburse a home health agency as defined in section b for home health services provided to an enrollee unless the home health agency has liability coverage of at least per incident or an amount established by department rule made in accordance with title g chapter utah administrative rulemaking act section section b which is renumbered from section is renumbered and amended to read b federal aid authority of executive director the executive director with the approval of the governor may bind the state to any executive or legislative provisions promulgated or enacted by the federal government which invite the state to participate in the distribution disbursement or administration of any fund or service advanced offered or contributed in whole or in part by the federal government for purposes consistent with the powers and duties of the department such funds shall be used as provided in this chapter and be administered by the department for purposes related to medical assistance programs section section b which is renumbered from section is renumbered and amended to read b medical vendor rates medical vendor payments made to providers of services for and in behalf of recipient households shall be based upon predetermined rates from standards developed by the division in cooperation with providers of services for each type of service purchased by the division as far as possible the rates paid for services shall be established in advance of the fiscal year for which funds are to be requested section section b which is renumbered from section is renumbered and amended to read b enforcement of public assistance statutes the department shall enforce or contract for the enforcement of sections a a a a a and a to the extent that these sections pertain to benefits conferred or administered by the division under this chapter to the extent allowed under federal law or regulation the department may contract for services covered in section a insofar as that section pertains to benefits conferred or administered by the division under this chapter section section b which is renumbered from section is renumbered and amended to read b prohibited acts of state or local employees of medicaid program violation a misdemeanor each state or local employee responsible for the expenditure of funds under the state medicaid program each individual who formerly was such an officer or employee and each partner of such an officer or employee is prohibited for a period of one year after termination of such responsibility from committing any act the commission of which by an officer or employee of the united states government an individual who was such an officer or employee or a partner of such an officer or employee is prohibited by section or section of title united states code violation of this section is a class a misdemeanor section section b which is renumbered from section is renumbered and amended to read b rural hospitals for purposes of as used in this section rural hospital means a hospital located outside of a standard metropolitan statistical area as designated by the united states bureau of the census for purposes of the medicaid program the division of medicaid and health financing division may not discriminate among rural hospitals on the basis of size section section b which is renumbered from section is renumbered and amended to read b telemedicine reimbursement rulemaking a as used in this section communication by telemedicine is considered face to face contact between a health care provider and a patient under the state s medical assistance program if i the communication by telemedicine meets the requirements of administrative rules adopted in accordance with subsection and ii the health care services are eligible for reimbursement under the state s medical assistance program b this subsection applies to any managed care organization that contracts with the state s medical assistance program the reimbursement rate for telemedicine services approved under this section a shall be subject to reimbursement policies set by the state plan and b may be based on i a monthly reimbursement rate ii a daily reimbursement rate or iii an encounter rate the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act which establish a the particular telemedicine services that are considered face to face encounters for reimbursement purposes under the state s medical assistance program and b the reimbursement methodology for the telemedicine services designated under subsection a section section b which is renumbered from section is renumbered and amended to read b reimbursement of telemedicine services and telepsychiatric consultations as used in this section a telehealth services means the same as that term is defined in section b b telemedicine services means the same as that term is defined in section b c telepsychiatric consultation means a consultation between a physician and a board certified psychiatrist both of whom are licensed to engage in the practice of medicine in the state that utilizes i the health records of the patient provided from the patient or the referring physician ii a written evidence based patient questionnaire and iii telehealth services that meet industry security and privacy standards including compliance with the a health insurance portability and accountability act and b health information technology for economic and clinical health act pub l no stat as amended this section applies to a a managed care organization that contracts with the medicaid program and b a provider who is reimbursed for health care services under the medicaid program the medicaid program shall reimburse for telemedicine services at the same rate that the medicaid program reimburses for other health care services the medicaid program shall reimburse for telepsychiatric consultations at a rate set by the medicaid program section section b which is renumbered from section is renumbered and amended to read b process to promote health insurance coverage for children the department in collaboration with the department of workforce services and the state board of education shall develop a process to promote health insurance coverage for a child in school when a the child applies for free or reduced price school lunch b a child enrolls in or registers in school and c other appropriate school related opportunities the department in collaboration with the department of workforce services shall promote and facilitate the enrollment of children identified under subsection without health insurance in the utah children s health insurance program the medicaid program or the utah premium partnership for health insurance program section section b which is renumbered from section is renumbered and amended to read b medicaid continuous eligibility promoting payment and delivery reform in accordance with subsection and within appropriations from the legislature the department may amend the state medicaid plan to a create continuous eligibility for up to months for an individual who has qualified for the state medicaid program b provide incentives in managed care contracts for an individual to obtain appropriate care in appropriate settings and c require the managed care system to accept the risk of managing the medicaid population assigned to the plan amendment in return for receiving the benefits of providing quality and cost effective care if the department amends the state medicaid plan under subsection a or b the department a shall ensure that the plan amendment i is cost effective for the state medicaid program ii increases the quality and continuity of care for recipients and iii calculates and transfers administrative savings from continuous enrollment from the department of workforce services to the department of health department and b may limit the plan amendment under subsection a or b to select geographic areas or specific medicaid populations the department may seek approval for a state plan amendment waiver or a demonstration project from the secretary of the united states department of health and human services if necessary to implement a plan amendment under subsection a or b section section b which is renumbered from section is renumbered and amended to read b patient notice of health care provider privacy practices a for purposes of this section i health care provider means a health care provider as defined in section b who a receives payment for medical services from the medicaid program established in this chapter or the children s health insurance program established in chapter utah children s health insurance act section b and b submits a patient s personally identifiable information to the medicaid eligibility database or the children s health insurance program eligibility database ii hipaa means c f r parts and health insurance portability and accountability act of as amended b beginning july this section applies to the medicaid program the children s health insurance program created in chapter utah children s health insurance act section b and a health care provider a health care provider shall as part of the notice of privacy practices required by hipaa provide notice to the patient or the patient s personal representative that the health care provider either has or may submit personally identifiable information about the patient to the medicaid eligibility database and the children s health insurance program eligibility database the medicaid program and the children s health insurance program may not give a health care provider access to the medicaid eligibility database or the children s health insurance program eligibility database unless the health care provider s notice of privacy practices complies with subsection the department may adopt an administrative rule to establish uniform language for the state requirement regarding notice of privacy practices to patients required under subsection section section b which is renumbered from section is renumbered and amended to read b optional medicaid expansion the department and the governor may not expand the state s medicaid program under ppaca unless a the department expands medicaid in accordance with section b or b i the governor or the governor s designee has reported the intention to expand the state medicaid program under ppaca to the legislature in compliance with the legislative review process in section b and ii the governor submits the request for expansion of the medicaid program for optional populations to the legislature under the high impact federal funds request process required by section j a the department shall request approval from cms for waivers from federal statutory and regulatory law necessary to implement the health coverage improvement program under section b b the health coverage improvement program under section b is not subject to the requirements in subsection section section b which is renumbered from section is renumbered and amended to read b medicaid vision services request for proposals the department may select one or more contractors in accordance with title g chapter a utah procurement code to provide vision services to the medicaid populations that are eligible for vision services as described in department rules without restricting provider participation and within existing appropriations from the legislature section section b which is renumbered from section is renumbered and amended to read b review of claims audit and investigation procedures a the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act and in consultation with providers and health care professionals subject to audit and investigation under the state medicaid program to establish procedures for audits and investigations that are fair and consistent with the duties of the department as the single state agency responsible for the administration of the medicaid program under section b and title xix of the social security act b if the providers and health care professionals do not agree with the rules proposed or adopted by the department under subsection a the providers or health care professionals may i request a hearing for the proposed administrative rule or seek any other remedies under the provisions of title g chapter utah administrative rulemaking act and ii request a review of the rule by the legislature s administrative rules review and general oversight committee created in section g the department shall a notify and educate providers and health care professionals subject to audit and investigation under the medicaid program of the providers and health care professionals responsibilities and rights under the administrative rules adopted by the department under the provisions of this section b ensure that the department or any entity that contracts with the department to conduct audits i has on staff or contracts with a medical or dental professional who is experienced in the treatment billing and coding procedures used by the type of provider being audited and ii uses the services of the appropriate professional described in subsection b i if the provider who is the subject of the audit disputes the findings of the audit c ensure that a finding of overpayment or underpayment to a provider is not based on extrapolation as defined in section a unless i there is a determination that the level of payment error involving the provider exceeds a error rate a for a sample of claims for a particular service code and b over a three year period of time ii documented education intervention has failed to correct the level of payment error and iii the value of the claims for the provider in aggregate exceeds in reimbursement for a particular service code on an annual basis and d require that any entity with which the office contracts for the purpose of conducting an audit of a service provider shall be paid on a flat fee basis for identifying both overpayments and underpayments a if the department or a contractor on behalf of the department i intends to implement the use of extrapolation as a method of auditing claims the department shall prior to adopting the extrapolation method of auditing report its intent to use extrapolation to the social services appropriations subcommittee and ii determines subsections c i through iii are applicable to a provider the department or the contractor may use extrapolation only for the service code associated with the findings under subsections c i through iii b i if extrapolation is used under this section a provider may at the provider s option appeal the results of the audit based on a each individual claim or b the extrapolation sample ii nothing in this section limits a provider s right to appeal the audit under title g general government title g chapter administrative procedures act the medicaid program and its manual or rules or other laws or rules that may provide remedies to providers section section b which is renumbered from section is renumbered and amended to read b medicaid intergovernmental transfer report approval requirements as used in this section a i intergovernmental transfer means the transfer of public funds from a a local government entity to another nonfederal governmental entity or b from a nonfederal government owned health care facility regulated under chapter health care facility licensing and inspection act chapter part health care facility licensing and inspection to another nonfederal governmental entity ii intergovernmental transfer does not include a the transfer of public funds from one state agency to another state agency or b a transfer of funds from the university of utah hospitals and clinics b i intergovernmental transfer program means a federally approved reimbursement program or category that is authorized by the medicaid state plan or waiver authority for intergovernmental transfers ii intergovernmental transfer program does not include the addition of a provider to an existing intergovernmental transfer program c local government entity means a county city town special service district local district or local education agency as that term is defined in section j d non state government entity means a hospital authority hospital district health care district special service district county or city a an entity that receives federal medicaid dollars from the department as a result of an intergovernmental transfer shall on or before august and on or before august each year thereafter provide the department with i information regarding the payments funded with the intergovernmental transfer as authorized by and consistent with state and federal law ii information regarding the entity s ability to repay federal funds to the extent required by the department in the contract for the intergovernmental transfer and iii other information reasonably related to the intergovernmental transfer that may be required by the department in the contract for the intergovernmental transfer b on or before october and on or before october each subsequent year the department shall prepare a report for the executive appropriations committee that includes i the amount of each intergovernmental transfer under subsection a ii a summary of changes to cms regulations and practices that are known by the department regarding federal funds related to an intergovernmental transfer program and iii other information the department gathers about the intergovernmental transfer under subsection a the department shall not create a new intergovernmental transfer program after july unless the department reports to the executive appropriations committee in accordance with section j before submitting the new intergovernmental transfer program for federal approval the report shall include information required by subsection j d and the analysis required in subsections a and b a the department shall enter into new nursing care facility non state government owned upper payment limit program contracts and contract amendments adding new nursing care facilities and new non state government entity operators in accordance with this subsection b i if the nursing care facility expects to receive less than in federal funds each year from the nursing care facility non state government owned upper payment limit program excluding seed funding and administrative fees paid by the non state government entity the department shall enter into a nursing care facility non state government owned upper payment limit program contract with the non state government entity operator of the nursing care facility ii if the nursing care facility expects to receive between and in federal funds each year from the nursing care facility non state government owned upper payment limit program excluding seed funding and administrative fees paid by the non state government entity the department shall enter into a nursing care facility non state government owned upper payment limit program contract with the non state government entity operator of the nursing care facility after receiving the approval of the executive appropriations committee iii if the nursing care facility expects to receive more than in federal funds each year from the nursing care facility non state government owned upper payment limit program excluding seed funding and administrative fees paid by the non state government entity the department may not approve the application without obtaining approval from the legislature and the governor c a non state government entity may not participate in the nursing care facility non state government owned upper payment limit program unless the non state government entity is a special service district county or city that operates a hospital or holds a license under chapter health care facility licensing and inspection act chapter part health care facility licensing and inspection d each non state government entity that participates in the nursing care facility non state government owned upper payment limit program shall certify to the department that i the non state government entity is a local government entity that is able to make an intergovernmental transfer under applicable state and federal law ii the non state government entity has sufficient public funds or other permissible sources of seed funding that comply with the requirements in c f r part subpart b iii the funds received from the nursing care facility non state government owned upper payment limit program are a for each nursing care facility available for patient care until the end of the non state government entity s fiscal year and b used exclusively for operating expenses for nursing care facility operations patient care capital expenses rent royalties and other operating expenses and iv the non state government entity has completed all licensing enrollment and other forms and documents required by federal and state law to register a change of ownership with the department and with cms the department shall add a nursing care facility to an existing nursing care facility non state government owned upper payment limit program contract if a the nursing care facility is managed by or affiliated with the same non state government entity that also manages one or more nursing care facilities that are included in an existing nursing care facility non state government owned upper payment limit program contract and b the non state government entity makes the certification described in subsection d ii the department may not increase the percentage of the administrative fee paid by a non state government entity to the department under the nursing care facility non state government owned upper payment limit program the department may not condition participation in the nursing care facility non state government owned upper payment limit program on a a requirement that the department be allowed to direct or determine the types of patients that a non state government entity will treat or the course of treatment for a patient in a non state government nursing care facility or b a requirement that a non state government entity or nursing care facility post a bond purchase insurance or create a reserve account of any kind the non state government entity shall have the primary responsibility for ensuring compliance with subsection d ii a the department may not enter into a new nursing care facility non state government owned upper payment limit program contract before january b subsection a does not apply to i a new nursing care facility non state government owned upper payment limit program contract that was included in the federal funds request summary under section j for fiscal year or ii a nursing care facility that is operated or managed by the same company as a nursing care facility that was included in the federal funds request summary under section j for fiscal year section section b which is renumbered from section is renumbered and amended to read b screening brief intervention and referral to treatment medicaid reimbursement as used in this section a controlled substance prescriber means a controlled substance prescriber as that term is defined in section who i has a record of having completed sbirt training in accordance with subsection before providing the sbirt services and ii is a medicaid enrolled health care provider b sbirt means the same as that term is defined in section the department shall reimburse a controlled substance prescriber who provides sbirt services to a medicaid enrollee who is years of age old or older for the sbirt services section section b which is renumbered from section is renumbered and amended to read b prescribing policies for opioid prescriptions the department may implement a prescribing policy for certain opioid prescriptions that is substantially similar to the prescribing policies required in section a the department may amend the state program and apply for waivers for the state program if necessary to implement subsection section section b which is renumbered from section is renumbered and amended to read b reimbursement for long acting reversible contraception immediately following childbirth as used in this section long acting reversible contraception means a contraception method that requires administration less than once per month including a an intrauterine device and b a contraceptive implant the division shall separately identify and reimburse from other labor and delivery services within the medicaid program the provision and insertion of long acting reversible contraception immediately after childbirth section section b which is renumbered from section is renumbered and amended to read b coverage of exome sequence testing as used in this section exome sequence testing means a genomic technique for sequencing the genome of an individual for diagnostic purposes the medicaid program shall reimburse for exome sequence testing a for an enrollee who i is younger than years of age old and ii who remains undiagnosed after exhausting all other appropriate diagnostic related tests b performed by a nationally recognized provider with significant experience in exome sequence testing c that is medically necessary and d at a rate set by the medicaid program section section b which is renumbered from section is renumbered and amended to read b reimbursement for nonemergency secured behavioral health transport providers the department may not reimburse a nonemergency secured behavioral health transport provider that is designated under section a b section section b which is renumbered from section is renumbered and amended to read b children s health care coverage program as used in this section a chip means the children s health insurance program created in section b b program means the children s health care coverage program created in subsection a there is created the children s health care coverage program within the department b the purpose of the program is to i promote health insurance coverage for children in accordance with section b ii conduct research regarding families who are eligible for medicaid and chip to determine awareness and understanding of available coverage iii analyze trends in disenrollment and identify reasons that families may not be renewing enrollment including any barriers in the process of renewing enrollment iv administer surveys to recently enrolled chip and children s medicaid enrollees to identify a how the enrollees learned about coverage and b any barriers during the application process v develop promotional material regarding chip and children s medicaid eligibility including outreach through social media video production and other media platforms vi identify ways that the eligibility website for enrollment in chip and children s medicaid can be redesigned to increase accessibility and enhance the user experience vii identify outreach opportunities including partnerships with community organizations including a schools b small businesses c unemployment centers d parent teacher associations and e youth athlete clubs and associations and viii develop messaging to increase awareness of coverage options that are available through the department a the department may not delegate implementation of the program to a private entity b notwithstanding subsection a the department may contract with a media agency to conduct the activities described in subsection b iv and vii section section b which is renumbered from section is renumbered and amended to read b reimbursement for diabetes prevention program as used in this section dpp means the national diabetes prevention program developed by the united states centers for disease control and prevention beginning july the medicaid program shall reimburse a provider for an enrollee s participation in the dpp if the enrollee a meets the dpp s eligibility requirements and b has not previously participated in the dpp after july while enrolled in the medicaid program subject to appropriation the medicaid program may set the rate for reimbursement the department may apply for a state plan amendment if necessary to implement this section a on or after july but before october the department shall provide a written report regarding the efficacy of the dpp and reimbursement under this section to the health and human services interim committee b the report described in subsection a shall include i the total number of enrollees with a prediabetic condition as of july ii the total number of enrollees as of july with a diagnosis of type diabetes iii the total number of enrollees who participated in the dpp iv the total cost incurred by the state to implement this section and v any conclusions that can be drawn regarding the impact of the dpp on the rate of type diabetes for enrollees section section b which is renumbered from section is renumbered and amended to read b behavioral health delivery working group as used in this section targeted adult medicaid program means the same as that term is defined in section b on or before may the department shall convene a working group to collaborate with the department on a establishing specific and measurable metrics regarding i compliance of managed care organizations in the state with federal medicaid managed care requirements ii timeliness and accuracy of authorization and claims processing in accordance with medicaid policy and contract requirements iii reimbursement by managed care organizations in the state to providers to maintain adequacy of access to care iv availability of care management services to meet the needs of medicaid eligible individuals enrolled in the plans of managed care organizations in the state and v timeliness of resolution for disputes between a managed care organization and the managed care organization s providers and enrollees b improving the delivery of behavioral health services in the medicaid program c proposals to implement the delivery system adjustments authorized under subsection b and d issues that are identified by managed care organizations behavioral health service providers and the department the working group convened under subsection shall a meet quarterly and b consist of at least the following individuals i the executive director or the executive director s designee ii for each medicaid accountable care organization with which the department contracts an individual selected by the accountable care organization iii five individuals selected by the department to represent various types of behavioral health services providers including at a minimum individuals who represent providers who provide the following types of services a acute inpatient behavioral health treatment b residential treatment c intensive outpatient or partial hospitalization treatment and d general outpatient treatment iv a representative of an association that represents behavioral health treatment providers in the state designated by the utah behavioral healthcare council convened by the utah association of counties v a representative of an organization representing behavioral health organizations vi the chair of the utah substance use and mental health advisory council created in section m vii a representative of an association that represents local authorities who provide public behavioral health care designated by the department viii one member of the senate appointed by the president of the senate and ix one member of the house of representatives appointed by the speaker of the house of representatives the working group convened under this section shall recommend to the department a specific and measurable metrics under subsection a b how physical and behavioral health services may be integrated for the targeted adult medicaid program including ways the department may address issues regarding i filing of claims ii authorization and reauthorization for treatment services iii reimbursement rates and iv other issues identified by the department behavioral health services providers or medicaid managed care organizations c ways to improve delivery of behavioral health services to enrollees including changes to statute or administrative rule and d wraparound service coverage for enrollees who need specific nonclinical services to ensure a path to success section section b which is renumbered from section is renumbered and amended to read b adjudicative proceedings related to medicaid funds if a proceeding of the department under title g chapter administrative procedures act relates in any way to recovery of medicaid funds a the presiding officer shall be designated by the executive director of the department and report directly to the executive director or in the discretion of the executive director report directly to the director of the office of internal audit and b the decision of the presiding officer is the recommended decision to the executive director of the department or a designee of the executive director who is not in the division subsection does not apply to hearings conducted by the department of workforce services relating to medical assistance eligibility determinations if a proceeding of the department under title g chapter administrative procedures act relates in any way to medicaid or medicaid funds the following may attend and present evidence or testimony at the proceeding a the director of the office of internal audit or the director s designee and b the inspector general of medicaid services or the inspector general s designee in relation to a proceeding of the department under title g chapter administrative procedures act a person may not outside of the actual proceeding attempt to influence the decision of the presiding officer section section b which is renumbered from section is renumbered and amended to read b medical assistance accountability division duties reporting as used in this section a abuse means i an action or practice that a is inconsistent with sound fiscal business or medical practices and b results or may result in unnecessary medicaid related costs or other medical or hospital assistance costs or ii reckless or negligent upcoding b fraud means intentional or knowing i deception misrepresentation or upcoding in relation to medicaid funds costs claims reimbursement or practice or ii deception or misrepresentation in relation to medical or hospital assistance funds costs claims reimbursement or practice c upcoding means assigning an inaccurate billing code for a service that is payable or reimbursable by medicaid funds if the correct billing code for the service taking into account reasonable opinions derived from official published coding definitions would result in a lower medicaid payment or reimbursement d waste means overutilization of resources or inappropriate payment the division shall a develop and implement procedures relating to medicaid funds and medical or hospital assistance funds to ensure that providers do not receive a i duplicate payments for the same goods or services b ii payment for goods or services by resubmitting a claim for which i a payment has been disallowed on the grounds that payment would be a violation of federal or state law administrative rule or the state plan and ii b the decision to disallow the payment has become final c iii payment for goods or services provided after a recipient s death including payment for pharmaceuticals or long term care or d iv payment for transporting an unborn infant b consult with the centers for medicaid and medicare services cms other states and the office of inspector general of medicaid services to determine and implement best practices for discovering and eliminating fraud waste and abuse of medicaid funds and medical or hospital assistance funds c actively seek repayment from providers for improperly used or paid a i medicaid funds and b ii medical or hospital assistance funds d coordinate track and keep records of all division efforts to obtain repayment of the funds described in subsection c and the results of those efforts e keep medicaid pharmaceutical costs as low as possible by actively seeking to obtain pharmaceuticals at the lowest price possible including on a quarterly basis for the pharmaceuticals that represent the highest of state medicaid expenditures for pharmaceuticals and on an annual basis for the remaining pharmaceuticals a i tracking changes in the price of pharmaceuticals b ii checking the availability and price of generic drugs c iii reviewing and updating the state s maximum allowable cost list and d iv comparing pharmaceutical costs of the state medicaid program to available pharmacy price lists and f provide training on an annual basis to the employees of the division who make decisions on billing codes or who are in the best position to observe and identify upcoding in order to avoid and detect upcoding section section b which is renumbered from section is renumbered and amended to read b medical assistance from division or department of workforce services and compliance under adoption assistance interstate compact penalty for fraudulent claim as used in this section a adoption assistance means the same as that term is defined in section b adoption assistance agreement means the same as that term is defined in section c adoption assistance interstate compact means an agreement executed by the division of child and family services with any other state in accordance with section a a child who is a resident of this state and is the subject of an adoption assistance interstate compact is entitled to receive medical assistance from the division and the department of workforce services by filing a certified copy of the child s adoption assistance agreement with the division or the department of workforce services b the adoptive parent of the child described in subsection a shall annually provide the division or the department of workforce services with evidence verifying that the adoption assistance agreement is still effective the department of workforce services shall consider the recipient of medical assistance under this section as the department of workforce services does any other recipient of medical assistance under an adoption assistance agreement executed by the division of child and family services a a person may not submit a claim for payment or reimbursement under this section that the person knows is false misleading or fraudulent b a violation of subsection a is a third degree felony the division and the department of workforce services shall a cooperate with the division of child and family services in regard to an adoption assistance interstate compact and b comply with an adoption assistance interstate compact section section b which is renumbered from section is renumbered and amended to read part medicaid waivers b medicaid waiver for independent foster care adolescents for purposes of as used in this section an independent foster care adolescent includes any individual who reached years of age old while in the custody of the division of child and family services or the department of human services department if the division of child and family services department was the primary case manager or a federally recognized indian tribe an independent foster care adolescent is eligible when funds are available for medicaid coverage until the individual reaches years of age old before july the division shall submit a state medicaid plan amendment to the center for medicaid services cms to provide medical coverage for independent foster care adolescents effective fiscal year section section b which is renumbered from section is renumbered and amended to read b waivers to maximize replacement of fee for service delivery model cost of mandated program changes the department shall develop a waiver program in the medicaid program to replace the fee for service delivery model with one or more risk based delivery models the waiver program shall a restructure the program s provider payment provisions to reward health care providers for delivering the most appropriate services at the lowest cost and in ways that compared to services delivered before implementation of the waiver program maintain or improve recipient health status b restructure the program s cost sharing provisions and other incentives to reward recipients for personal efforts to i maintain or improve their health status and ii use providers that deliver the most appropriate services at the lowest cost c identify the evidence based practices and measures risk adjustment methodologies payment systems funding sources and other mechanisms necessary to reward providers for delivering the most appropriate services at the lowest cost including mechanisms that i pay providers for packages of services delivered over entire episodes of illness rather than for individual services delivered during each patient encounter and ii reward providers for delivering services that make the most positive contribution to a recipient s health status d limit total annual per patient per month expenditures for services delivered through fee for service arrangements to total annual per patient per month expenditures for services delivered through risk based arrangements covering similar recipient populations and services and e except as provided in subsection limit the rate of growth in per patient per month general fund expenditures for the program to the rate of growth in general fund expenditures for all other programs when the rate of growth in the general fund expenditures for all other programs is greater than zero to the extent possible the department shall operate the waiver program with the input of stakeholder groups representing those who will be affected by the waiver program a for purposes of this subsection mandated program change shall be determined by the department in consultation with the medicaid accountable care organizations and may include a change to the state medicaid program that is required by state or federal law state or federal guidance policy or the state medicaid plan b a mandated program change shall be included in the base budget for the medicaid program for the fiscal year in which the medicaid program adopted the mandated program change c the mandated program change is not subject to the limit on the rate of growth in per patient per month general fund expenditures for the program established in subsection e until the fiscal year following the fiscal year in which the medicaid program adopted the mandated program change a managed care organization or a pharmacy benefit manager that provides a pharmacy benefit to an enrollee shall establish a unique group number payment classification number or bank identification number for each medicaid managed care organization plan for which the managed care organization or pharmacy benefit manager provides a pharmacy benefit section section b which is renumbered from section is renumbered and amended to read b base budget appropriations for medicaid accountable care organizations and behavioral health plans forecast of behavioral health services cost as used in this section a aco means an accountable care organization that contracts with the state s medicaid program for i physical health services or ii integrated physical and behavioral health services b base budget means the same as that term is defined in legislative rule c behavioral health plan means a managed care or fee for service delivery system that contracts with or is operated by the department to provide behavioral health services to medicaid eligible individuals d behavioral health services means mental health or substance use treatment or services e general fund growth factor means the amount determined by dividing the next fiscal year ongoing general fund revenue estimate by current fiscal year ongoing appropriations from the general fund f next fiscal year ongoing general fund revenue estimate means the next fiscal year ongoing general fund revenue estimate identified by the executive appropriations committee in accordance with legislative rule for use by the office of the legislative fiscal analyst in preparing budget recommendations g pmpm means per member per month funding if the general fund growth factor is less than the next fiscal year base budget shall subject to subsection include an appropriation to the department in an amount necessary to ensure that the next fiscal year pmpm for acos and behavioral health plans equals the current fiscal year pmpm for the acos and behavioral health plans multiplied by if the general fund growth factor is greater than or equal to but less than the next fiscal year base budget shall subject to subsection include an appropriation to the department in an amount necessary to ensure that the next fiscal year pmpm for acos and behavioral health plans equals the current fiscal year pmpm for the acos and behavioral health plans multiplied by the general fund growth factor if the general fund growth factor is greater than or equal to the next fiscal year base budget shall subject to subsection include an appropriation to the department in an amount necessary to ensure that the next fiscal year pmpm for acos and behavioral health plans is greater than or equal to the current fiscal year pmpm for the acos and behavioral health plans multiplied by and less than or equal to the current fiscal year pmpm for the acos and behavioral health plans multiplied by the general fund growth factor the appropriations provided to the department for behavioral health plans under this section shall be reduced by the amount contributed by counties in the current fiscal year for behavioral health plans in accordance with subsections k and a x in order for the department to estimate the impact of subsections through before identification of the next fiscal year ongoing general fund revenue estimate the governor s office of planning and budget shall in cooperation with the office of the legislative fiscal analyst develop an estimate of ongoing general fund revenue for the next fiscal year and provide the estimate to the department no later than november of each year the office of the legislative fiscal analyst shall include an estimate of the cost of behavioral health services in any state medicaid funding or savings forecast that is completed in coordination with the department and the governor s office of planning and budget section section b which is renumbered from section is renumbered and amended to read b incentives to appropriately use emergency department services a this section applies to the medicaid program and to the utah children s health insurance program created in chapter utah children s health insurance act section b b as used in this section i managed care organization means a comprehensive full risk managed care delivery system that contracts with the medicaid program or the children s health insurance program to deliver health care through a managed care plan ii managed care plan means a risk based delivery service model authorized by section b and administered by a managed care organization iii non emergent care a means use of the emergency department to receive health care that is non emergent as defined by the department by administrative rule adopted in accordance with title g chapter utah administrative rulemaking act and the emergency medical treatment and active labor act and b does not mean the medical services provided to an individual required by the emergency medical treatment and active labor act including services to conduct a medical screening examination to determine if the recipient has an emergent or non emergent condition iv professional compensation means payment made for services rendered to a medicaid recipient by an individual licensed to provide health care services v super utilizer means a medicaid recipient who has been identified by the recipient s managed care organization as a person who uses the emergency department excessively as defined by the managed care organization a a managed care organization may in accordance with subsections b and c i audit emergency department services provided to a recipient enrolled in the managed care plan to determine if non emergent care was provided to the recipient and ii establish differential payment for emergent and non emergent care provided in an emergency department b i the differential payments under subsection a ii do not apply to professional compensation for services rendered in an emergency department ii except in cases of suspected fraud waste and abuse a managed care organization s audit of payment under subsection a i is limited to the month period of time after the date on which the medical services were provided to the recipient if fraud waste or abuse is alleged the managed care organization s audit of payment under subsection a i is limited to three years after the date on which the medical services were provided to the recipient c the audits and differential payments under subsections a and b apply to services provided to a recipient on or after july a managed care organization shall a use the savings under subsection to maintain and improve access to primary care and urgent care services for all medicaid or chip recipients enrolled in the managed care plan b provide viable alternatives for increasing primary care provider reimbursement rates to incentivize after hours primary care access for recipients and c report to the department on how the managed care organization complied with this subsection the department may a through administrative rule adopted by the department develop quality measurements that evaluate a managed care organization s delivery of i appropriate emergency department services to recipients enrolled in the managed care plan ii expanded primary care and urgent care for recipients enrolled in the managed care plan with consideration of the managed care organization s a delivery of primary care urgent care and after hours care through means other than the emergency department b recipient access to primary care providers and community health centers including evening and weekend access and c other innovations for expanding access to primary care and iii quality of care for the managed care plan members b compare the quality measures developed under subsection a for each managed care organization and c develop by administrative rule an algorithm to determine assignment of new unassigned recipients to specific managed care plans based on the plan s performance in relation to the quality measures developed pursuant to subsection a section section b which is renumbered from section is renumbered and amended to read b long term care insurance partnership as used in this section a qualified long term care insurance contract is as defined in u s c sec b b b qualified long term care insurance partnership is as defined in u s c sec p b c iii c state plan amendment means an amendment to the state medicaid plan drafted by the department in compliance with this section no later than july the department shall seek federal approval of a state plan amendment that creates a qualified long term care insurance partnership the department may make rules to comply with federal laws and regulations relating to qualified long term care insurance partnerships and qualified long term care insurance contracts section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for children with disabilities and complex medical needs as used in this section a additional eligibility criteria means the additional eligibility criteria set by the department under subsection e b complex medical condition means a physical condition of an individual that i results in severe functional limitations for the individual and ii is likely to a last at least months or b result in death c program means the program for children with complex medical conditions created in subsection d qualified child means a child who i is less than years old ii is diagnosed with a complex medical condition iii has a condition that meets the definition of disability in u s c sec and iv meets the additional eligibility criteria the department shall apply for a medicaid home and community based waiver with cms to implement within the state medicaid program the program described in subsection if the waiver described in subsection is approved the department shall offer a program that a as funding permits provides treatment for qualified children b if approved by cms and as funding permits beginning in fiscal year provides on an ongoing basis treatment for more qualified children than the program provided treatment for during fiscal year and c accepts applications for the program on an ongoing basis i d requires periodic reevaluations of an enrolled child s eligibility and other applicants or eligible children waiting for services in the program based on the additional eligibility criteria and ii e at the time of reevaluation allows the department to disenroll a child based on the prioritization described in subsection a and additional eligibility criteria the department shall a establish by rule made in accordance with title g chapter utah administrative rulemaking act criteria to prioritize qualified children s participation in the program based on the following factors in the following priority order i the complexity of a qualified child s medical condition and ii the financial needs of the qualified child and the qualified child s family b convene a public process to determine the benefits and services to offer a qualified child under the program c evaluate on an ongoing basis the cost and effectiveness of the program d if funding for the program is reduced develop an evaluation process to reduce the number of children served based on the participation criteria established under subsection a and e establish by rule made in accordance with title g chapter utah administrative rulemaking act additional eligibility criteria based on the factors described in subsections a i and ii section section b which is renumbered from section is renumbered and amended to read b health coverage improvement program eligibility annual report expansion of eligibility for adults with dependent children as used in this section a adult in the expansion population means an individual who i is described in u s c sec a a a i viii and ii is not otherwise eligible for medicaid as a mandatory categorically needy individual b enhancement waiver program means the primary care network enhancement waiver program described in section b c federal poverty level means the poverty guidelines established by the secretary of the united states department of health and human services under u s c sec d health coverage improvement program means the health coverage improvement program described in subsections through e homeless i means an individual who is chronically homeless as determined by the department and ii includes someone who was chronically homeless and is currently living in supported housing for the chronically homeless f income eligibility ceiling means the percent of federal poverty level i established by the state in an appropriations act adopted pursuant to title j chapter budgetary procedures act and ii under which an individual may qualify for medicaid coverage in accordance with this section g targeted adult medicaid program means the program implemented by the department under subsections through beginning july the department shall amend the state medicaid plan to allow temporary residential treatment for substance abuse use for the traditional medicaid population in a short term non institutional hour facility without a bed capacity limit that provides rehabilitation services that are medically necessary and in accordance with an individualized treatment plan as approved by cms and as long as the county makes the required match under section beginning july the department shall amend the state medicaid plan to increase the income eligibility ceiling to a percentage of the federal poverty level designated by the department based on appropriations for the program for an individual with a dependent child before july the division shall submit to cms a request for waivers or an amendment of existing waivers from federal statutory and regulatory law necessary for the state to implement the health coverage improvement program in the medicaid program in accordance with this section a an adult in the expansion population is eligible for medicaid if the adult meets the income eligibility and other criteria established under subsection b an adult who qualifies under subsection shall receive medicaid coverage i through the traditional fee for service medicaid model in counties without medicaid accountable care organizations or the state s medicaid accountable care organization delivery system where implemented and subject to section b ii except as provided in subsection b iii for behavioral health through the counties in accordance with sections and iii that subject to section b integrates behavioral health services and physical health services with medicaid accountable care organizations in select geographic areas of the state that choose an integrated model and iv that permits temporary residential treatment for substance abuse use in a short term non institutional hour facility without a bed capacity limit as approved by cms that provides rehabilitation services that are medically necessary and in accordance with an individualized treatment plan a an individual is eligible for the health coverage improvement program under subsection if i at the time of enrollment the individual s annual income is below the income eligibility ceiling established by the state under subsection f and ii the individual meets the eligibility criteria established by the department under subsection b b based on available funding and approval from cms the department shall select the criteria for an individual to qualify for the medicaid program under subsection a ii based on the following priority i a chronically homeless individual ii if funding is available an individual a involved in the justice system through probation parole or court ordered treatment and b in need of substance abuse use treatment or mental health treatment as determined by the department or iii if funding is available an individual in need of substance abuse use treatment or mental health treatment as determined by the department c an individual who qualifies for medicaid coverage under subsections a and b may remain on the medicaid program for a month certification period as defined by the department eligibility changes made by the department under subsection f or b shall not apply to an individual during the month certification period the state may request a modification of the income eligibility ceiling and other eligibility criteria under subsection each fiscal year based on projected enrollment costs to the state and the state budget the current medicaid program and the health coverage improvement program when implemented shall coordinate with a state prison or county jail to expedite medicaid enrollment for an individual who is released from custody and was eligible for or enrolled in medicaid before incarceration notwithstanding sections and a county does not have to provide matching funds to the state for the cost of providing medicaid services to newly enrolled individuals who qualify for medicaid coverage under the health coverage improvement program under subsection if the enhancement waiver program is implemented the department a may not accept any new enrollees into the health coverage improvement program after the day on which the enhancement waiver program is implemented b shall transition all individuals who are enrolled in the health coverage improvement program into the enhancement waiver program c shall suspend the health coverage improvement program within one year after the day on which the enhancement waiver program is implemented d shall within one year after the day on which the enhancement waiver program is implemented use all appropriations for the health coverage improvement program to implement the enhancement waiver program and e shall work with cms to maintain any waiver for the health coverage improvement program while the health coverage improvement program is suspended under subsection c if after the enhancement waiver program takes effect the enhancement waiver program is repealed or suspended by either the state or federal government the department shall reinstate the health coverage improvement program and continue to accept new enrollees into the health coverage improvement program in accordance with the provisions of this section section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for delivery of adult dental services a before june the department shall ask cms to grant waivers from federal statutory and regulatory law necessary for the medicaid program to provide dental services in the manner described in subsection a b before june the department shall submit to cms a request for waivers or an amendment of existing waivers from federal law necessary for the state to provide dental services in accordance with subsections b i and d through g to an individual described in subsection b i c before june the department shall submit to the centers for medicare and medicaid services a request for waivers or an amendment to existing waivers from federal law necessary for the state to i provide dental services in accordance with subsections b ii and d through g to an individual described in subsection b ii and ii provide the services described in subsection h a to the extent funded the department shall provide services to only blind or disabled individuals as defined in u s c sec c a who are years old or older and eligible for the program b notwithstanding subsection a i if a waiver is approved under subsection b the department shall provide dental services to an individual who a qualifies for the health coverage improvement program described in section b and b is receiving treatment in a substance abuse treatment program as defined in section a b licensed under title a chapter licensure of programs and facilities chapter part human services programs and facilities and ii if a waiver is approved under subsection c i the department shall provide dental services to an individual who is an aged individual as defined in u s c sec c a c to the extent possible services to individuals described in subsection a shall be provided through the university of utah school of dentistry and the university of utah school of dentistry s associated statewide network d the department shall provide the services to individuals described in subsection b i by contracting with an entity that a has demonstrated experience working with individuals who are being treated for both a substance use disorder and a major oral health disease b operates a program targeted at the individuals described in subsection b that has demonstrated through a peer reviewed evaluation the effectiveness of providing dental treatment to those individuals described in subsection b c is willing to pay for an amount equal to the program s non federal share of the cost of providing dental services to the population described in subsection b and d is willing to pay all state costs associated with applying for the waiver described in subsection b and administering the program described in subsection b and ii through a fee for service payment model e the entity that receives the contract under subsection d i shall cover all state costs of the program described in subsection b f each fiscal year the university of utah school of dentistry shall in compliance with state and federal regulations regarding intergovernmental transfers transfer funds to the program in an amount equal to the program s non federal share of the cost of providing services under this section through the school during the fiscal year g if a waiver is approved under subsection c ii the department shall provide coverage for porcelain and porcelain to metal crowns if the services are provided i to an individual who qualifies for dental services under subsection b and ii by an entity that covers all state costs of a providing the coverage described in this subsection h g and b applying for the waiver described in subsection c h where possible the department shall ensure that services described in subsection a that are not provided by the university of utah school of dentistry or the university of utah school of dentistry s associated network are provided i through fee for service reimbursement until july and ii after july through the method of reimbursement used by the division for medicaid dental benefits i subject to appropriations by the legislature and as determined by the department the scope amount duration and frequency of services may be limited a if the waivers requested under subsection a are granted the medicaid program shall begin providing dental services in the manner described in subsection no later than july b if the waivers requested under subsection b are granted the medicaid program shall begin providing dental services to the population described in subsection b within days from the day on which the waivers are granted c if the waivers requested under subsection c i are granted the medicaid program shall begin providing dental services to the population described in subsection b ii within days after the day on which the waivers are granted if the federal share of the cost of providing dental services under this section will be less than during any portion of the next fiscal year the medicaid program shall cease providing dental services under this section no later than the end of the current fiscal year section section b which is renumbered from section is renumbered and amended to read b medicaid long term support services housing coordinator there is created within the medicaid program a full time equivalent position of medicaid long term support services housing coordinator the coordinator shall help medicaid recipients receive long term support services in a home or other community based setting rather than in a nursing home or other institutional setting by a working with municipalities counties the housing and community development division within the department of workforce services and others to identify community based settings available to recipients b working with the same entities to promote the development construction and availability of additional community based settings c training medicaid case managers and support coordinators on how to help medicaid recipients move from an institutional setting to a community based setting and d performing other related duties section section b which is renumbered from section is renumbered and amended to read b medicaid waiver expansion as used in this section a federal poverty level means the same as that term is defined in section b b medicaid waiver expansion means an expansion of the medicaid program in accordance with this section a before january the department shall apply to cms for approval of a waiver or state plan amendment to implement the medicaid waiver expansion b the medicaid waiver expansion shall i expand medicaid coverage to eligible individuals whose income is below of the federal poverty level ii obtain maximum federal financial participation under u s c sec d y for enrolling an individual in the medicaid program iii provide medicaid benefits through the state s medicaid accountable care organizations in areas where a medicaid accountable care organization is implemented iv integrate the delivery of behavioral health services and physical health services with medicaid accountable care organizations in select geographic areas of the state that choose an integrated model v include a path to self sufficiency including work activities as defined in u s c sec d for qualified adults vi require an individual who is offered a private health benefit plan by an employer to enroll in the employer s health plan vii sunset in accordance with subsection a and viii permit the state to close enrollment in the medicaid waiver expansion if the department has insufficient funding to provide services to additional eligible individuals if the medicaid waiver described in subsection a is approved the department may only pay the state portion of costs for the medicaid waiver expansion with appropriations from a the medicaid expansion fund created in section b b b county contributions to the non federal share of medicaid expenditures and c any other contributions funds or transfers from a non state agency for medicaid expenditures a in consultation with the department medicaid accountable care organizations and counties that elect to integrate care under subsection b iv shall collaborate on enrollment engagement of patients and coordination of services b as part of the provision described in subsection b iv the department shall apply for a waiver to permit the creation of an integrated delivery system i for any geographic area that expresses interest in integrating the delivery of services under subsection b iv and ii in which the department a may permit a local mental health authority to integrate the delivery of behavioral health services and physical health services b may permit a county local mental health authority or medicaid accountable care organization to integrate the delivery of behavioral health services and physical health services to select groups within the population that are newly eligible under the medicaid waiver expansion and c may make rules in accordance with title g chapter utah administrative rulemaking act to integrate payments for behavioral health services and physical health services to plans or providers a if federal financial participation for the medicaid waiver expansion is reduced below the authority of the department to implement the medicaid waiver expansion shall sunset no later than the next july after the date on which the federal financial participation is reduced b the department shall close the program to new enrollment if the cost of the medicaid waiver expansion is projected to exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act if the medicaid waiver expansion is approved by cms the department shall report to the social services appropriations subcommittee on or before november of each year that the medicaid waiver expansion is operational a the number of individuals who enrolled in the medicaid waiver program b costs to the state for the medicaid waiver program c estimated costs for the current and following state fiscal year and d recommendations to control costs of the medicaid waiver expansion section section b which is renumbered from section is renumbered and amended to read b primary care network enhancement waiver program as used in this section a enhancement waiver program means the primary care network enhancement waiver program described in this section b federal poverty level means the poverty guidelines established by the secretary of the united states department of health and human services under u s c sec c health coverage improvement program means the same as that term is defined in section b d income eligibility ceiling means the percentage of federal poverty level i established by the legislature in an appropriations act adopted pursuant to title j chapter budgetary procedures act and ii under which an individual may qualify for coverage in the enhancement waiver program in accordance with this section e optional population means the optional expansion population under ppaca if the expansion provides coverage for individuals at or above of the federal poverty level f primary care network means the state primary care network program created by the medicaid primary care network demonstration waiver obtained under section b the department shall continue to implement the primary care network program for qualified individuals under the primary care network program a the division shall apply for a medicaid waiver or a state plan amendment with cms to implement within the state medicaid program the enhancement waiver program described in this section within six months after the day on which i the division receives a notice from cms that the waiver for the medicaid waiver expansion submitted under section b medicaid waiver expansion will not be approved or ii the division withdraws the waiver for the medicaid waiver expansion submitted under section b medicaid waiver expansion b the division may not apply for a waiver under subsection a while a waiver request under section b medicaid waiver expansion is pending with cms an individual who is eligible for the enhancement waiver program may receive the following benefits under the enhancement waiver program a the benefits offered under the primary care network program b diagnostic testing and procedures c medical specialty care d inpatient hospital services e outpatient hospital services f outpatient behavioral health care including outpatient substance abuse use care and g for an individual who qualifies for the health coverage improvement program as approved by cms temporary residential treatment for substance abuse use in a short term non institutional hour facility without a bed capacity limit that provides rehabilitation services that are medically necessary and in accordance with an individualized treatment plan an individual is eligible for the enhancement waiver program if at the time of enrollment a the individual is qualified to enroll in the primary care network or the health coverage improvement program b the individual s annual income is below the income eligibility ceiling established by the legislature under subsection d and c the individual meets the eligibility criteria established by the department under subsection a based on available funding and approval from cms the department shall determine the criteria for an individual to qualify for the enhancement waiver program based on the following priority i adults in the expansion population as defined in section b who qualify for the health coverage improvement program ii adults with dependent children who qualify for the health coverage improvement program under subsection b iii adults with dependent children who do not qualify for the health coverage improvement program and iv if funding is available adults without dependent children b the number of individuals enrolled in the enhancement waiver program may not exceed of the number of individuals who were enrolled in the primary care network on december c the department may only use appropriations from the medicaid expansion fund created in section b b to fund the state portion of the enhancement waiver program the department may request a modification of the income eligibility ceiling and the eligibility criteria under subsection from cms each fiscal year based on enrollment in the enhancement waiver program projected enrollment in the enhancement waiver program costs to the state and the state budget the department may implement the enhancement waiver program by contracting with medicaid accountable care organizations to administer the enhancement waiver program in accordance with subsections and b and the department may use funds that have been appropriated for the health coverage improvement program to implement the enhancement waiver program if the department expands the state medicaid program to the optional population the department a except as provided in subsection may not accept any new enrollees into the enhancement waiver program after the day on which the expansion to the optional population is effective b shall suspend the enhancement waiver program within one year after the day on which the expansion to the optional population is effective and c shall work with cms to maintain the waiver for the enhancement waiver program submitted under subsection while the enhancement waiver program is suspended under subsection b if after the expansion to the optional population described in subsection takes effect the expansion to the optional population is repealed by either the state or the federal government the department shall reinstate the enhancement waiver program and continue to accept new enrollees into the enhancement waiver program in accordance with the provisions of this section section section b which is renumbered from section is renumbered and amended to read b limited family planning services for low income individuals as used in this section a i family planning services means family planning services that are provided under the state medicaid program including a sexual health education and family planning counseling and b other medical diagnosis treatment or preventative care routinely provided as part of a family planning service visit ii family planning services do not include an abortion as that term is defined in section b low income individual means an individual who i has an income level that is equal to or below of the federal poverty level and ii does not qualify for full coverage under the medicaid program before july the division shall apply for a medicaid waiver or a state plan amendment with cms to a offer a program that provides family planning services to low income individuals and b receive a federal match rate of of state expenditures for family planning services provided under the waiver or state plan amendment section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for mental health crisis lines and mobile crisis outreach teams as used in this section a local mental health crisis line means the same as that term is defined in section a b b mental health crisis means i a mental health condition that manifests itself in an individual by symptoms of sufficient severity that a prudent layperson who possesses an average knowledge of mental health issues could reasonably expect the absence of immediate attention or intervention to result in a serious danger to the individual s health or well being or b a danger to the health or well being of others or ii a mental health condition that in the opinion of a mental health therapist or the therapist s designee requires direct professional observation or the intervention of a mental health therapist c i mental health crisis services means direct mental health services and on site intervention that a mobile crisis outreach team provides to an individual suffering from a mental health crisis including the provision of safety and care plans prolonged mental health services for up to days and referrals to other community resources ii mental health crisis services includes a local mental health crisis lines and b the statewide mental health crisis line d mental health therapist means the same as that term is defined in section e mobile crisis outreach team or mcot means a mobile team of medical and mental health professionals that in coordination with local law enforcement and emergency medical service personnel provides mental health crisis services f statewide mental health crisis line means the same as that term is defined in section a b in consultation with the department of human services and the behavioral health crisis response commission created in section c the department shall develop a proposal to amend the state medicaid plan to include mental health crisis services including the statewide mental health crisis line local mental health crisis lines and mobile crisis outreach teams by january the department shall apply for a medicaid waiver with cms if necessary to implement within the state medicaid program the mental health crisis services described in subsection section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for coverage of mental health services in schools as used in this section local education agency means a a school district b a charter school or c the utah schools for the deaf and the blind in consultation with the department of human services and the state board of education the department shall develop a proposal to allow the state medicaid program to reimburse a local education agency a local mental health authority or a private provider for covered mental health services provided a in accordance with section e and b i at a local education agency building or facility or ii by an employee or contractor of a local education agency before january the department shall apply to cms for a state plan amendment to implement the coverage described in subsection section section b which is renumbered from section is renumbered and amended to read b coverage for in vitro fertilization and genetic testing as used in this section a qualified condition means i cystic fibrosis ii spinal muscular atrophy iii morquio syndrome iv myotonic dystrophy or v sickle cell anemia b qualified enrollee means an individual who i is enrolled in the medicaid program ii has been diagnosed by a physician as having a genetic trait associated with a qualified condition and iii intends to get pregnant with a partner who is diagnosed by a physician as having a genetic trait associated with the same qualified condition as the individual before january the department shall apply for a medicaid waiver or a state plan amendment with the centers for medicare and medicaid services within the united states department of health and human services to implement the coverage described in subsection if the waiver described in subsection is approved the medicaid program shall provide coverage to a qualified enrollee for a in vitro fertilization services and b genetic testing of a qualified enrollee who receives in vitro fertilization services under subsection a the medicaid program may not provide the coverage described in subsection before the later of a the day on which the waiver described in subsection is approved and b january before november and before november of every third year thereafter the department shall a calculate the change in state spending attributable to the coverage under this section and b report the amount described in subsection a a to the health and human services interim committee and the social services appropriations subcommittee section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for fertility preservation services as used in this section a iatrogenic infertility means an impairment of fertility or reproductive functioning caused by surgery chemotherapy radiation or other medical treatment b physician means an individual licensed to practice under title chapter utah medical practice act or title chapter utah osteopathic medical practice act c qualified enrollee means an individual who i is enrolled in the medicaid program ii has been diagnosed with a form of cancer by a physician and iii needs treatment for that cancer that may cause a substantial risk of sterility or iatrogenic infertility including surgery radiation or chemotherapy d standard fertility preservation service means a fertility preservation procedure and service that i is not considered experimental or investigational by the american society for reproductive medicine or the american society of clinical oncology and ii is consistent with established medical practices or professional guidelines published by the american society for reproductive medicine or the american society of clinical oncology including a sperm banking b oocyte banking c embryo banking d banking of reproductive tissues and e storage of reproductive cells and tissues before january the department shall apply for a medicaid waiver or a state plan amendment with cms to implement the coverage described in subsection if the waiver or state plan amendment described in subsection is approved the medicaid program shall provide coverage to a qualified enrollee for standard fertility preservation services the medicaid program may not provide the coverage described in subsection before the later of a the day on which the waiver described in subsection is approved and b january before november and before november of each third year after the department shall a calculate the change in state spending attributable to the coverage described in this section and b report the amount described in subsection a to the health and human services interim committee and the social services appropriations subcommittee section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for coverage of qualified inmates leaving prison or jail as used in this section a correctional facility means i a county jail ii the department of corrections created in section or iii a prison penitentiary or other institution operated by or under contract with the department of corrections for the confinement of an offender as defined in section b qualified inmate means an individual who i is incarcerated in a correctional facility and ii has a a chronic physical or behavioral health condition b a mental illness as defined in section a b or c an opioid use disorder before july the division shall apply for a medicaid waiver or a state plan amendment with cms to offer a program to provide medicaid coverage to a qualified inmate for up to days immediately before the day on which the qualified inmate is released from a correctional facility if the waiver or state plan amendment described in subsection is approved the department shall report to the health and human services interim committee each year before november while the waiver or state plan amendment is in effect regarding a the number of qualified inmates served under the program b the cost of the program and c the effectiveness of the program including i any reduction in the number of emergency room visits or hospitalizations by inmates after release from a correctional facility ii any reduction in the number of inmates undergoing inpatient treatment after release from a correctional facility iii any reduction in overdose rates and deaths of inmates after release from a correctional facility and iv any other costs or benefits as a result of the program if the waiver or state plan amendment described in subsection is approved a county that is responsible for the cost of a qualified inmate s medical care shall provide the required matching funds to the state for a any costs to enroll the qualified inmate for the medicaid coverage described in subsection b any administrative fees for the medicaid coverage described in subsection and c the medicaid coverage that is provided to the qualified inmate under subsection section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for inpatient care in an institution for mental diseases as used in this section institution for mental diseases means the same as that term is defined in c f r sec before august the division shall apply for a medicaid waiver or a state plan amendment with cms to offer a program that provides reimbursement for mental health services that are provided a in an institution for mental diseases that includes more than beds and b to an individual who receives mental health services in an institution for mental diseases for a period of more than days in a calendar month if the waiver or state plan amendment described in subsection is approved the department shall a coordinate with the department of human services to develop and offer the program described in subsection and b submit to the health and human services interim committee and the social services appropriations subcommittee any report that the department submits to cms that relates to the budget neutrality independent waiver evaluation or performance metrics of the program described in subsection within days after the day on which the report is submitted to cms notwithstanding sections and if the waiver or state plan amendment described in subsection is approved a county does not have to provide matching funds to the state for the mental health services described in subsection that are provided to an individual who qualifies for medicaid coverage under section or section b or b section section b which is renumbered from section is renumbered and amended to read b reimbursement for crisis management services provided in a behavioral health receiving center integration of payment for physical health services as used in this section a accountable care organization means the same as that term is defined in section b b behavioral health receiving center means the same as that term is defined in section a b c crisis management services means behavioral health services provided to an individual who is experiencing a mental health crisis d managed care organization means the same as that term is defined in c f r sec before july the division shall apply for a medicaid waiver or state plan amendment with cms to offer a program that provides reimbursement through a bundled daily rate for crisis management services that are delivered to an individual during the individual s stay at a behavioral health receiving center if the waiver or state plan amendment described in subsection is approved the department shall a implement the program described in subsection and b require a managed care organization that contracts with the state s medicaid program for behavioral health services or integrated health services to provide coverage for crisis management services that are delivered to an individual during the individual s stay at a behavioral health receiving center a the department may elect to integrate payment for physical health services provided in a behavioral health receiving center b in determining whether to integrate payment under subsection a the department shall consult with accountable care organizations and counties in the state section section b which is renumbered from section is renumbered and amended to read b crisis services reimbursement the department department shall submit a waiver or state plan amendment to allow for reimbursement for services provided to an individual who is eligible and enrolled in medicaid at the time this service is provided section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for respite care facility that provides services to homeless individuals as used in this section a adult in the expansion population means an adult i described in u s c sec a a a i viii and ii not otherwise eligible for medicaid as a mandatory categorically needy individual b homeless means the same as that term is defined in section b c medical respite care means short term housing with supportive medical services d medical respite facility means a residential facility that provides medical respite care to homeless individuals before january the department shall apply for a medicaid waiver or state plan amendment with cms to choose a single medical respite facility to reimburse for services provided to an individual who is a homeless and b an adult in the expansion population the department shall choose a medical respite facility best able to serve homeless individuals who are adults in the expansion population if the waiver or state plan amendment described in subsection is approved while the waiver or state plan amendment is in effect the department shall submit a report to the health and human services interim committee each year before november detailing a the number of homeless individuals served at the facility b the cost of the program and c the reduction of health care costs due to the program s implementation through administrative rule made in accordance with title g chapter utah administrative rulemaking act the department shall further define and limit the services described in this section provided to a homeless individual section section b which is renumbered from section is renumbered and amended to read b medicaid waiver expansion for extraordinary care reimbursement as used in this section a existing home and community based services waiver means an existing home and community based services waiver in the state that serves an individual i with an acquired brain injury ii with an intellectual or physical disability or iii who is years old or older b personal care services means a service that i is furnished to an individual who is not an inpatient nor a resident of a hospital nursing facility intermediate care facility or institution for mental diseases ii is authorized for an individual described in subsection b i in accordance with a plan of treatment iii is provided by an individual who is qualified to provide the services and iv is furnished in a home or another community based setting c waiver enrollee means an individual who is enrolled in an existing home and community based services waiver before july the department shall apply with cms for an amendment to an existing home and community based services waiver to implement a program to offer reimbursement to an individual who provides personal care services that constitute extraordinary care to a waiver enrollee who is the individual s spouse if cms approves the amendment described in subsection the department shall implement the program described in subsection the department shall by rule made in accordance with title g chapter utah administrative rulemaking act define extraordinary care for purposes of subsection section section b which is renumbered from section is renumbered and amended to read b delivery system adjustments for the targeted adult medicaid program as used in this section targeted adult medicaid program means the same as that term is defined in section b the department may implement the delivery system adjustments authorized under subsection only on the later of a july and b the department determining that the medicaid program including providers and managed care organizations are satisfying the metrics established in collaboration with the working group convened under subsection b the department may for individuals who are enrolled in the targeted adult medicaid program a integrate the delivery of behavioral and physical health in certain counties and b deliver behavioral health services through an accountable care organization where implemented before implementing the delivery system adjustments described in subsection in a county the department shall at a minimum seek input from a individuals who qualify for the targeted adult medicaid program who reside in the county b the county s executive officer legislative body and other county officials who are involved in the delivery of behavioral health services c the local mental health authority and local substance use abuse authority that serves the county d medicaid managed care organizations operating in the state including medicaid accountable care organizations e providers of physical or behavioral health services in the county who provide services to enrollees in the targeted adult medicaid program in the county and f other individuals that the department deems necessary if the department provides medicaid coverage through a managed care delivery system under this section the department shall include language in the department s managed care contracts that require the managed care plan to a be in compliance with federal medicaid managed care requirements b timely and accurately process authorizations and claims in accordance with medicaid policy and contract requirements c adequately reimburse providers to maintain adequacy of access to care d provide care management services sufficient to meet the needs of medicaid eligible individuals enrolled in the managed care plan s plan and e timely resolve any disputes between a provider or enrollee with the managed care plan the department may take corrective action if the managed care organization fails to comply with the terms of the managed care organization s contract section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for increased integrated health care reimbursement as used in this section a integrated health care setting means a health care or behavioral health care setting that provides integrated physical and behavioral health care services b local mental health authority means a local mental health authority described in section the department shall develop a proposal to allow the state medicaid program to reimburse a local mental health authority for covered physical health care services provided in an integrated health care setting to medicaid eligible individuals before december the department shall apply for a medicaid waiver or a state plan amendment with cms to implement the proposal described in subsection if the waiver or state plan amendment described in subsection is approved the department shall a implement the proposal described in subsection and b while the waiver or state plan amendment is in effect submit a report to the health and human services interim committee each year before november detailing i the number of patients served under the waiver or state plan amendment ii the cost of the waiver or state plan amendment and iii any benefits of the waiver or state plan amendment section section b which is renumbered from section is renumbered and amended to read part administration of medicaid programs drug utilization review and long term care facility certification b definitions as used in this part appropriate and medically necessary means regarding drug prescribing dispensing and patient usage that it is in conformity with the criteria and standards developed in accordance with this part board means the drug utilization review board created in section b certified program means a nursing care facility program with medicaid certification compendia means resources widely accepted by the medical profession in the efficacious use of drugs including american hospital formulary services service drug information u s pharmacopeia drug information a m a drug evaluations peer reviewed medical literature and information provided by manufacturers of drug products counseling means the activities conducted by a pharmacist to inform medicaid recipients about the proper use of drugs as required by the board under this part criteria means those predetermined and explicitly accepted elements used to measure drug use on an ongoing basis in order to determine if the use is appropriate medically necessary and not likely to result in adverse medical outcomes drug disease contraindications means that the therapeutic effect of a drug is adversely altered by the presence of another disease condition drug interactions means that two or more drugs taken by a recipient lead to clinically significant toxicity that is characteristic of one or any of the drugs present or that leads to interference with the effectiveness of one or any of the drugs drug utilization review or dur means the program designed to measure and assess on a retrospective and prospective basis the proper use of outpatient drugs in the medicaid program intervention means a form of communication utilized by the board with a prescriber or pharmacist to inform about or influence prescribing or dispensing practices medicaid certification means the right of a nursing care facility as a provider of a nursing care facility program to receive medicaid reimbursement for a specified number of beds within the facility a nursing care facility means the following facilities licensed by the department under chapter part health care facility licensing and inspection i skilled nursing facilities ii intermediate care facilities and iii an intermediate care facility for people with an intellectual disability b nursing care facility does not mean a critical access hospital that meets the criteria of u s c sec i c nursing care facility program means the personnel licenses services contracts and all other requirements that shall be met for a nursing care facility to be eligible for medicaid certification under this part and division rule overutilization or underutilization means the use of a drug in such quantities that the desired therapeutic goal is not achieved pharmacist means a person licensed in this state to engage in the practice of pharmacy under title chapter b pharmacy practice act physical facility means the buildings or other physical structures where a nursing care facility program is operated physician means a person licensed in this state to practice medicine and surgery under section or osteopathic medicine under section prospective dur means that part of the drug utilization review program that occurs before a drug is dispensed and that is designed to screen for potential drug therapy problems based on explicit and predetermined criteria and standards retrospective dur means that part of the drug utilization review program that assesses or measures drug use based on an historical review of drug use data against predetermined and explicit criteria and standards on an ongoing basis with professional input rural county means a county with a population of less than as determined by a the most recent official census or census estimate of the united states bureau of the census or b the most recent population estimate for the county from the utah population committee if a population figure for the county is not available under subsection a service area means the boundaries of the distinct geographic area served by a certified program as determined by the division in accordance with this part and division rule standards means the acceptable range of deviation from the criteria that reflects local medical practice and that is tested on the medicaid recipient database surs means the surveillance utilization review system of the medicaid program therapeutic appropriateness means drug prescribing and dispensing based on rational drug therapy that is consistent with criteria and standards therapeutic duplication means prescribing and dispensing the same drug or two or more drugs from the same therapeutic class where periods of drug administration overlap and where that practice is not medically indicated urban county means a county that is not a rural county section section b which is renumbered from section is renumbered and amended to read b dur board creation and membership expenses there is created a member drug utilization review board responsible for implementation of a retrospective and prospective dur program a except as required by subsection b as terms of current board members expire the executive director shall appoint each new member or reappointed member to a four year term b notwithstanding the requirements of subsection a the executive director shall at the time of appointment or reappointment adjust the length of terms to ensure that the terms of board members are staggered so that approximately half of the board is appointed every two years c persons appointed to the board may be reappointed upon completion of their terms but may not serve more than two consecutive terms d the executive director shall provide for geographic balance in representation on the board when a vacancy occurs in the membership for any reason the replacement shall be appointed for the unexpired term the membership shall be comprised of the following a four physicians who are actively engaged in the practice of medicine or osteopathic medicine in this state to be selected from a list of nominees provided by the utah medical association b one physician in this state who is actively engaged in academic medicine c three pharmacists who are actively practicing in retail pharmacy in this state to be selected from a list of nominees provided by the utah pharmaceutical association d one pharmacist who is actively engaged in academic pharmacy e one person who shall represent consumers f one person who shall represent pharmaceutical manufacturers to be recommended by the pharmaceutical manufacturers association and g one dentist licensed to practice in this state under title chapter dentist and dental hygienist practice act who is actively engaged in the practice of dentistry nominated by the utah dental association physician and pharmacist members of the board shall have expertise in clinically appropriate prescribing and dispensing of outpatient drugs the board shall elect a chair from among its members who shall serve a one year term and may serve consecutive terms a member may not receive compensation or benefits for the member s service but may receive per diem and travel expenses in accordance with a section a b section a and c rules made by the division of finance pursuant to sections a and a section section b which is renumbered from section is renumbered and amended to read b dur board responsibilities the board shall develop rules necessary to carry out its responsibilities as defined in this part oversee the implementation of a medicaid retrospective and prospective dur program in accordance with this part including responsibility for approving provisions of contractual agreements between the medicaid program and any other entity that will process and review medicaid drug claims and profiles for the dur program in accordance with this part develop and apply predetermined criteria and standards to be used in retrospective and prospective dur ensuring that the criteria and standards are based on the compendia and that they are developed with professional input in a consensus fashion with provisions for timely revision and assessment as necessary the dur standards developed by the board shall reflect the local practices of physicians in order to monitor a therapeutic appropriateness b overutilization or underutilization c therapeutic duplication d drug disease contraindications e drug drug interactions f incorrect drug dosage or duration of drug treatment and g clinical abuse and misuse develop select apply and assess interventions and remedial strategies for physicians pharmacists and recipients that are educational and not punitive in nature in order to improve the quality of care disseminate information to physicians and pharmacists to ensure that they are aware of the board s duties and powers provide written oral or electronic reminders of patient specific or drug specific information designed to ensure recipient physician and pharmacist confidentiality and suggest changes in prescribing or dispensing practices designed to improve the quality of care utilize face to face discussions between experts in drug therapy and the prescriber or pharmacist who has been targeted for educational intervention conduct intensified reviews or monitoring of selected prescribers or pharmacists create an educational program using data provided through dur to provide active and ongoing educational outreach programs to improve prescribing and dispensing practices either directly or by contract with other governmental or private entities provide a timely evaluation of intervention to determine if those interventions have improved the quality of care publish the annual drug utilization review report required under c f r sec develop a working agreement with related boards or agencies including the state board of pharmacy physicians licensing board and surs staff within the division in order to clarify areas of responsibility for each where those areas may overlap establish a grievance process for physicians and pharmacists under this part in accordance with title g chapter administrative procedures act publish and disseminate educational information to physicians and pharmacists concerning the board and the dur program including information regarding a identification and reduction of the frequency of patterns of fraud abuse gross overuse inappropriate or medically unnecessary care among physicians pharmacists and recipients b potential or actual severe or adverse reactions to drugs c therapeutic appropriateness d overutilization or underutilization e appropriate use of generics f therapeutic duplication g drug disease contraindications h drug drug interactions i incorrect drug dosage and duration of drug treatment j drug allergy interactions and k clinical abuse and misuse develop and publish with the input of the state board of pharmacy guidelines and standards to be used by pharmacists in counseling medicaid recipients in accordance with this part the guidelines shall ensure that the recipient may refuse counseling and that the refusal is to be documented by the pharmacist items to be discussed as part of that counseling include a the name and description of the medication b administration form and duration of therapy c special directions and precautions for use d common severe side effects or interactions and therapeutic interactions and how to avoid those occurrences e techniques for self monitoring drug therapy f proper storage g prescription refill information and h action to be taken in the event of a missed dose and establish procedures in cooperation with the state board of pharmacy for pharmacists to record information to be collected under this part the recorded information shall include a the name address age and gender of the recipient b individual history of the recipient where significant including disease state known allergies and drug reactions and a comprehensive list of medications and relevant devices c the pharmacist s comments on the individual s drug therapy d name of prescriber and e name of drug dose duration of therapy and directions for use section section b which is renumbered from section is renumbered and amended to read b confidentiality of records information obtained under this part shall be treated as confidential or controlled information under title g chapter government records access and management act the board shall establish procedures insuring ensuring that the information described in subsection b is held confidential by the pharmacist being provided to the physician only upon request the board shall adopt and implement procedures designed to ensure the confidentiality of all information collected stored retrieved assessed or analyzed by the board staff to the board or contractors to the dur program that identifies individual physicians pharmacists or recipients the board may have access to identifying information for purposes of carrying out intervention activities but that identifying information may not be released to anyone other than a member of the board the board may release cumulative nonidentifying information for research purposes section section b which is renumbered from section is renumbered and amended to read b drug prior approval program a drug prior approval program approved or implemented by the board shall meet the following conditions a except as provided in subsection a drug may not be placed on prior approval for other than medical reasons b the board shall hold a public hearing at least days prior to placing a drug on prior approval c notwithstanding the provisions of section the board shall provide not less than days notice to the public before holding a public hearing under subsection b d the board shall consider written and oral comments submitted by interested parties prior to or during the hearing held in accordance with subsection b e the board shall provide evidence that placing a drug class on prior approval i will not impede quality of recipient care and ii that the drug class is subject to clinical abuse or misuse f the board shall reconsider its decision to place a drug on prior approval i no later than nine months after any drug class is placed on prior approval and ii at a public hearing with notice as provided in subsection b g the program shall provide an approval or denial of a request for prior approval i by either a fax b telephone or c electronic transmission ii at least monday through friday except for state holidays and iii within hours after receipt of the prior approval request h the program shall provide for the dispensing of at least a hour supply of the drug on the prior approval program i in an emergency situation or ii on weekends or state holidays i the program may be applied to allow acceptable medical use of a drug on prior approval for appropriate off label indications and j before placing a drug class on the prior approval program the board shall i determine that the requirements of subsections a through i have been met and ii by majority vote place the drug class on prior approval the board may only after complying with subsections b through j consider the cost a of a drug when placing a drug on the prior approval program and b associated with including or excluding a drug from the prior approval process including i potential side effects associated with a drug or ii potential hospitalizations or other complications that may occur as a result of a drug s inclusion on the prior approval process section section b which is renumbered from section is renumbered and amended to read b advisory committees the board may establish advisory committees to assist it in carrying out its duties under this part sections b through b section section b which is renumbered from section is renumbered and amended to read b retrospective and prospective dur the board in cooperation with the division shall include in its state plan the creation and implementation of a retrospective and prospective dur program for medicaid outpatient drugs to ensure that prescriptions are appropriate medically necessary and not likely to result in adverse medical outcomes the retrospective and prospective dur program shall be operated under guidelines established by the board under subsections and the retrospective dur program shall be based on guidelines established by the board using the mechanized drug claims processing and information retrieval system to analyze claims data in order to a identify patterns of fraud abuse gross overuse and inappropriate or medically unnecessary care and b assess data on drug use against explicit predetermined standards that are based on the compendia and other sources for the purpose of monitoring i therapeutic appropriateness ii overutilization or underutilization iii therapeutic duplication iv drug disease contraindications v drug drug interactions vi incorrect drug dosage or duration of drug treatment and vii clinical abuse and misuse the prospective dur program shall be based on guidelines established by the board and shall provide that before a prescription is filled or delivered a review will be conducted by the pharmacist at the point of sale to screen for potential drug therapy problems resulting from a therapeutic duplication b drug drug interactions c incorrect dosage or duration of treatment d drug allergy interactions and e clinical abuse or misuse in conducting the prospective dur a pharmacist may not alter the prescribed outpatient drug therapy without the consent of the prescribing physician or physician assistant this section does not effect the ability of a pharmacist to substitute a generic equivalent section section b which is renumbered from section is renumbered and amended to read b penalties any person who violates the confidentiality provisions of this part sections b through b is guilty of a class b misdemeanor section section b which is renumbered from section is renumbered and amended to read b immunity there is no liability on the part of and no cause of action of any nature arises against any member of the board its agents or employees for any action or omission by them in effecting the provisions of this part sections b through b section section b which is renumbered from section is renumbered and amended to read b purpose medicaid certification of nursing care facilities the legislature finds a that an oversupply of nursing care facilities in the state adversely affects the state medicaid program and the health of the people in the state b it is in the best interest of the state to prohibit nursing care facilities from receiving medicaid certification except as provided by this part sections b through b and c it is in the best interest of the state to encourage aging nursing care facilities with medicaid certification to renovate the nursing care facilities physical facilities so that the quality of life and clinical services for medicaid residents are preserved medicaid reimbursement of nursing care facility programs is limited to a the number of nursing care facility programs with medicaid certification as of may and b additional nursing care facility programs approved for medicaid certification under the provisions of subsections b and the division may not a except as authorized by section b i process initial applications for medicaid certification or execute provider agreements with nursing care facility programs or ii reinstate medicaid certification for a nursing care facility whose certification expired or was terminated by action of the federal or state government or b execute a medicaid provider agreement with a certified program that moves to a different physical facility except as authorized by subsection b notwithstanding section b beginning may the division may not approve a new or additional bed in an intermediate care facility for individuals with an intellectual disability for medicaid certification unless certification of the bed by the division does not increase the total number in the state of medicaid certified beds in intermediate care facilities for individuals with an intellectual disability section section b which is renumbered from section is renumbered and amended to read b authorization to renew transfer or increase medicaid certified programs reimbursement methodology a the division may renew medicaid certification of a certified program if the program without lapse in service to medicaid recipients has its nursing care facility program certified by the division at the same physical facility as long as the licensed and certified bed capacity at the facility has not been expanded unless the director has approved additional beds in accordance with subsection b the division may renew medicaid certification of a nursing care facility program that is not currently certified if i since the day on which the program last operated with medicaid certification a the physical facility where the program operated has functioned solely and continuously as a nursing care facility and b the owner of the program has not under this section or section b transferred to another nursing care facility program the license for any of the medicaid beds in the program and ii except as provided in subsection b the number of beds granted renewed medicaid certification does not exceed the number of beds certified at the time the program last operated with medicaid certification excluding a period of time where the program operated with temporary certification under subsection b a the division may issue a medicaid certification for a new nursing care facility program if a current owner of the medicaid certified program transfers its ownership of the medicaid certification to the new nursing care facility program and the new nursing care facility program meets all of the following conditions i the new nursing care facility program operates at the same physical facility as the previous medicaid certified program ii the new nursing care facility program gives a written assurance to the director in accordance with subsection iii the new nursing care facility program receives the medicaid certification within one year of the date the previously certified program ceased to provide medical assistance to a medicaid recipient and iv the licensed and certified bed capacity at the facility has not been expanded unless the director has approved additional beds in accordance with subsection b a nursing care facility program that receives medicaid certification under the provisions of subsection a does not assume the medicaid liabilities of the previous nursing care facility program if the new nursing care facility program i is not owned in whole or in part by the previous nursing care facility program or ii is not a successor in interest of the previous nursing care facility program the division may issue a medicaid certification to a nursing care facility program that was previously a certified program but now resides in a new or renovated physical facility if the nursing care facility program meets all of the following a the nursing care facility program met all applicable requirements for medicaid certification at the time of closure b the new or renovated physical facility is in the same county or within a five mile radius of the original physical facility c the time between which the certified program ceased to operate in the original facility and will begin to operate in the new physical facility is not more than three years unless i an emergency is declared by the president of the united states or the governor affecting the building or renovation of the physical facility ii the director approves an exception to the three year requirement for any nursing care facility program within the three year requirement iii the provider submits documentation supporting a request for an extension to the director that demonstrates a need for an extension and iv the exception does not extend for more than two years beyond the three year requirement d if subsection c applies the certified program notifies the department within days after ceasing operations in its original facility of its intent to retain its medicaid certification e the provider gives written assurance to the director in accordance with subsection that no third party has a legitimate claim to operate a certified program at the previous physical facility and f the bed capacity in the physical facility has not been expanded unless the director has approved additional beds in accordance with subsection a the entity requesting medicaid certification under subsections and shall give written assurances satisfactory to the director or the director s designee that i no third party has a legitimate claim to operate the certified program ii the requesting entity agrees to defend and indemnify the department against any claims by a third party who may assert a right to operate the certified program and iii if a third party is found by final agency action of the department after exhaustion of all administrative and judicial appeal rights to be entitled to operate a certified program at the physical facility the certified program shall voluntarily comply with subsection b b if a finding is made under the provisions of subsection a iii i the certified program shall immediately surrender its medicaid certification and comply with division rules regarding billing for medicaid and the provision of services to medicaid patients and ii the department shall transfer the surrendered medicaid certification to the third party who prevailed under subsection a iii a the director may approve additional nursing care facility programs for medicaid certification or additional beds for medicaid certification within an existing nursing care facility program if a nursing care facility or other interested party requests medicaid certification for a nursing care facility program or additional beds within an existing nursing care facility program and the nursing care facility program or other interested party complies with this section b the nursing care facility or other interested party requesting medicaid certification for a nursing care facility program or additional beds within an existing nursing care facility program under subsection a shall submit to the director i proof of the following as reasonable evidence that bed capacity provided by medicaid certified programs within the county or group of counties impacted by the requested additional medicaid certification is insufficient a nursing care facility occupancy levels for all existing and proposed facilities will be at least for the next three years b current nursing care facility occupancy is or more or c there is no other nursing care facility within a mile radius of the nursing care facility requesting the additional certification and ii an independent analysis demonstrating that at projected occupancy rates the nursing care facility s after tax net income is sufficient for the facility to be financially viable c any request for additional beds as part of a renovation project are limited to the maximum number of beds allowed in subsection d the director shall determine whether to issue additional medicaid certification by considering i whether bed capacity provided by certified programs within the county or group of counties impacted by the requested additional medicaid certification is insufficient based on the information submitted to the director under subsection b ii whether the county or group of counties impacted by the requested additional medicaid certification is underserved by specialized or unique services that would be provided by the nursing care facility iii whether any medicaid certified beds are subject to a claim by a previous certified program that may reopen under the provisions of subsections and iv how additional bed capacity should be added to the long term care delivery system to best meet the needs of medicaid recipients and v a whether the existing certified programs within the county or group of counties have provided services of sufficient quality to merit at least a two star rating in the medicare five star quality rating system over the previous three year period and b information obtained under subsection the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act to adjust the medicaid nursing care facility property reimbursement methodology to a only pay that portion of the property component of rates representing actual bed usage by medicaid clients as a percentage of the greater of i actual occupancy or ii a for a nursing care facility other than a facility described in subsection a ii b of total bed capacity or b for a rural nursing care facility of total bed capacity and b not allow for increases in reimbursement for property values without major renovation or replacement projects as defined by the department by rule a except as provided in subsection b if a nursing care facility does not seek medicaid certification for a bed under subsections through the department shall notwithstanding subsections b a and b grant medicaid certification for additional beds in an existing medicaid certified nursing care facility that has or fewer licensed beds including medicaid certified beds in the facility if i the nursing care facility program was previously a certified program for all beds but now resides in a new facility or in a facility that underwent major renovations involving major structural changes with or greater facility square footage design changes requiring review and approval by the department ii the nursing care facility meets the quality of care regulations issued by cms and iii the total number of additional beds in the facility granted medicaid certification under this section does not exceed of the number of licensed beds in the facility b the department may not revoke the medicaid certification of a bed under this subsection as long as the provisions of subsection a ii are met a if a nursing care facility or other interested party indicates in its request for additional medicaid certification under subsection a that the facility will offer specialized or unique services but the facility does not offer those services after receiving additional medicaid certification the director shall revoke the additional medicaid certification b the nursing care facility program shall obtain medicaid certification for any additional medicaid beds approved under subsection or within three years of the date of the director s approval or the approval is void a if the director makes an initial determination that quality standards under subsection d v have not been met in a rural county or group of rural counties over the previous three year period the director shall before approving certification of additional medicaid beds in the rural county or group of counties i notify the certified program that has not met the quality standards in subsection d v that the director intends to certify additional medicaid beds under the provisions of subsection d v and ii consider additional information submitted to the director by the certified program in a rural county that has not met the quality standards under subsection d v b the notice under subsection a does not give the certified program that has not met the quality standards under subsection d v the right to legally challenge or appeal the director s decision to certify additional medicaid beds under subsection d v section section b which is renumbered from section is renumbered and amended to read b appeals of division decision rulemaking authority application of act a decision by the director under this part to deny medicaid certification for a nursing care facility program or to deny additional bed capacity for an existing certified program is subject to review under the procedures and requirements of title g chapter administrative procedures act the department shall make rules to administer and enforce this part sections b through b in accordance with title g chapter utah administrative rulemaking act a in the event the department is at risk for a federal disallowance with regard to a medicaid recipient being served in a nursing care facility program that is not medicaid certified the department may grant temporary medicaid certification to that facility for up to months b i the department may extend a temporary medicaid certification granted to a facility under subsection a a for the number of beds in the nursing care facility occupied by a medicaid recipient and b for the period of time during which the medicaid recipient resides at the facility ii a temporary medicaid certification granted under this subsection is revoked upon a the discharge of the patient from the facility or b the patient no longer residing at the facility for any reason c the department may place conditions on the temporary certification granted under subsections a and b such as i not allowing additional admissions of medicaid recipients to the program and ii not paying for the care of the patient after october with state only dollars section section b which is renumbered from section is renumbered and amended to read b authorization to sell or transfer licensed medicaid beds duties of transferor duties of transferee duties of division this section provides a method to transfer or sell the license for a medicaid bed from a nursing care facility program to another entity that is in addition to the authorization to transfer under section b a a nursing care facility program may transfer or sell one or more of its licenses for medicaid beds in accordance with subsection b if i at the time of the transfer and with respect to the license for the medicaid bed that will be transferred the nursing care facility program that will transfer the medicaid license meets all applicable regulations for medicaid certification ii the nursing care facility program gives a written assurance which is postmarked or has proof of delivery days before the transfer to the director and to the transferee in accordance with subsection b iii the nursing care facility program that will transfer the license for a medicaid bed notifies the division in writing which is postmarked or has proof of delivery days before the transfer of a the number of bed licenses that will be transferred b the date of the transfer and c the identity and location of the entity receiving the transferred licenses and iv if the nursing care facility program for which the license will be transferred or purchased is located in an urban county with a nursing care facility average annual occupancy rate over the previous two years less than or equal to the nursing care facility program transferring or selling the license demonstrates to the satisfaction of the director that the sale or transfer a will not result in an excessive number of medicaid certified beds within the county or group of counties that would be impacted by the transfer or sale and b best meets the needs of medicaid recipients b except as provided in subsection c a nursing care facility program may transfer or sell one or more of its licenses for medicaid beds to i a nursing care facility program that has the same owner or successor in interest of the same owner ii a nursing care facility program that has a different owner or iii a related party nonnursing care facility entity that wants to hold one or more of the licenses for a nursing care facility program not yet identified as long as a the licenses are subsequently transferred or sold to a nursing care facility program within three years and b the nursing care facility program notifies the director of the transfer or sale in accordance with subsection a iii c a nursing care facility program may not transfer or sell one or more of its licenses for medicaid beds to an entity under subsection b i ii or iii that is located in a rural county unless the entity requests and the director issues medicaid certification for the beds under subsection b a nursing care facility program or entity under subsection b i ii or iii that receives or purchases a license for a medicaid bed under subsection b a may receive a license for a medicaid bed from more than one nursing care facility program b shall give the division notice which is postmarked or has proof of delivery within days of the nursing care facility program or entity seeking medicaid certification of beds in the nursing care facility program or entity of the total number of licenses for medicaid beds that the entity received and who it received the licenses from c may only seek medicaid certification for the number of licensed beds in the nursing care facility program equal to the total number of licenses for medicaid beds received by the entity d does not have to demonstrate need or seek approval for the medicaid licensed bed under subsection b except as provided in subsections a iv and c e shall meet the standards for medicaid certification other than those in subsection b including personnel services contracts and licensing of facilities under chapter health care facility licensing and inspection act chapter part health care facility licensing and inspection and f shall obtain medicaid certification for the licensed medicaid beds within three years of the date of transfer as documented under subsection a iii b a when the division receives notice of a transfer of a license for a medicaid bed under subsection a iii a the department shall reduce the number of licenses for medicaid beds at the transferring nursing care facility i equal to the number of licenses transferred and ii effective on the date of the transfer as reported under subsection a iii b b for purposes of section b the division shall approve medicaid certification for the receiving nursing care facility program or entity i in accordance with the formula established in subsection c and ii if a the nursing care facility seeks medicaid certification for the transferred licenses within the time limit required by subsection f and b the nursing care facility program meets other requirements for medicaid certification under subsection e c a license for a medicaid bed may not be approved for medicaid certification without meeting the requirements of sections and b and b if i the license for a medicaid bed is transferred under this section but the receiving entity does not obtain medicaid certification for the licensed bed within the time required by subsection f or ii the license for a medicaid bed is transferred under this section but the license is no longer eligible for medicaid certification section section b which is renumbered from section a is renumbered and amended to read part nursing care facility assessment a b definitions as used in this chapter part a nursing care facility means i a nursing care facility described in subsection as defined in section b ii beginning january a designated swing bed in a a general acute hospital as defined in subsection section b and b a critical access hospital which meets the criteria of u s c sec i c and iii an intermediate care facility for people with an intellectual disability that is licensed under section b b nursing care facility does not include i the utah state developmental center ii the utah state hospital iii a general acute hospital specialty hospital or small health care facility as those terms are defined in section b or iv a utah state veterans home patient day means each calendar day in which an individual patient is admitted to the nursing care facility during a calendar month even if on a temporary leave of absence from the facility section section b which is renumbered from section a is renumbered and amended to read a b legislative findings the legislature finds that there is an important state purpose to improve the quality of care given to persons who are elderly and to people who have a disability in long term care nursing facilities the legislature finds that in order to improve the quality of care to those persons described in subsection the rates paid to the nursing care facilities by the medicaid program must be adequate to encourage and support quality care the legislature finds that in order to meet the objectives in subsections and adequate funding must be provided to increase the rates paid to nursing care facilities providing services pursuant to the medicaid program section section b which is renumbered from section a is renumbered and amended to read a b collection remittance and payment of nursing care facilities assessment a beginning july an assessment is imposed upon each nursing care facility in the amount designated in subsection c b i the department shall establish by rule a uniform rate per non medicare patient day that may not exceed of the total gross revenue for services provided to patients of all nursing care facilities licensed in this state ii for purposes of subsection b i total revenue does not include charitable contribution received by a nursing care facility c the department shall calculate the assessment imposed under subsection a by multiplying the total number of patient days of care provided to non medicare patients by the nursing care facility as provided to the department pursuant to subsection a by the uniform rate established by the department pursuant to subsection b a the assessment imposed by this chapter part is due and payable on a monthly basis on or before the last day of the month next succeeding each monthly period b the collecting agent for this assessment shall be the department which is vested with the administration and enforcement of this chapter part including the right to audit records of a nursing care facility related to patient days of care for the facility c the department shall forward proceeds from the assessment imposed by this chapter part to the state treasurer for deposit in the expendable special revenue fund as specified in section a b each nursing care facility shall on or before the end of the month next succeeding each calendar monthly period file with the department a a report which includes i the total number of patient days of care the facility provided to non medicare patients during the preceding month ii the total gross revenue the facility earned as compensation for services provided to patients during the preceding month and iii any other information required by the department and b a return for the monthly period and shall remit with the return the assessment required by this chapter part to be paid for the period covered by the return each return shall contain information and be in the form the department prescribes by rule the assessment as computed in the return is an allowable cost for medicaid reimbursement purposes the department may by rule extend the time for making returns and paying the assessment each nursing care facility that fails to pay any assessment required to be paid to the state within the time required by this chapter part or that fails to file a return as required by this chapter part shall pay in addition to the assessment penalties and interest as provided in section a b section section b which is renumbered from section a is renumbered and amended to read a b penalties and interest the penalty for failure to file a return or pay the assessment due within the time prescribed by this chapter part is the greater of or of the assessment due on the return for failure to pay within days of a notice of deficiency of assessment required to be paid the penalty is the greater of or of the assessment due the penalty for underpayment of the assessment is as follows a if any underpayment of assessment is due to negligence the penalty is of the underpayment b if the underpayment of the assessment is due to intentional disregard of law or rule the penalty is of the underpayment for intent to evade the assessment the penalty is of the underpayment the rate of interest applicable to an underpayment of an assessment under this chapter part or an unpaid penalty under this chapter part is annually the department may waive the imposition of a penalty for good cause section section b which is renumbered from section a is renumbered and amended to read a b adjustment to nursing care facility medicaid reimbursement rates if federal law or regulation prohibits the money in the nursing care facilities provider assessment fund from being used in the manner set forth in subsection a b b the rates paid to nursing care facilities for providing services pursuant to the medicaid program shall be changed except as otherwise provided in subsection to the rates paid to nursing care facilities on june or if the legislature or the department has on or after july changed the rates paid to facilities through a manner other than the use of expenditures from the nursing care facilities provider assessment fund to the rates provided for by the legislature or the department section section b which is renumbered from section a is renumbered and amended to read a b intermediate care facility for people with an intellectual disability uniform rate an intermediate care facility for people with an intellectual disability is subject to all the provisions of this chapter part except that the department shall establish a uniform rate for an intermediate care facility for people with an intellectual disability that is based on the same formula specified for nursing care facilities under the provisions of subsection a b b and may be different than the uniform rate established for other nursing care facilities section section b which is renumbered from section b is renumbered and amended to read part inpatient hospital assessment b b definitions as used in this chapter part assessment means the inpatient hospital assessment established by this chapter part cms means the centers for medicare and medicaid services within the united states department of health and human services discharges means the number of total hospital discharges reported on a worksheet s part i column lines and of the medicare cost report for the applicable assessment year or b a similar report adopted by the department by administrative rule if the report under subsection a is no longer available division means the division of health care financing integrated healthcare within the department enhancement waiver program means the program established by the primary care network enhancement waiver program described in section b health coverage improvement program means the health coverage improvement program described in section b hospital share means the hospital share described in section b b medicaid accountable care organization means a managed care organization as defined in c f r sec that contracts with the department under the provisions of section b medicaid waiver expansion means a medicaid expansion in accordance with section or b or b medicare cost report means cms the cost report for electronic filing of hospitals a non state government hospital means a hospital owned by a non state government entity b non state government hospital does not include i the utah state hospital or ii a hospital owned by the federal government including the veterans administration hospital a private hospital means i a general acute hospital as defined in section b that is privately owned and operating in the state and ii a privately owned specialty hospital operating in the state including a privately owned hospital whose inpatient admissions are predominantly for a rehabilitation b psychiatric care c chemical dependency services or d long term acute care services b private hospital does not include a facility for residential treatment as defined in section a b state teaching hospital means a state owned teaching hospital that is part of an institution of higher education upper payment limit gap means the difference between the private hospital outpatient upper payment limit and the private hospital medicaid outpatient payments as determined in accordance with c f r sec section section b which is renumbered from section b is renumbered and amended to read b b application other than for the imposition of the assessment described in this chapter part nothing in this chapter part shall affect the nonprofit or tax exempt status of any nonprofit charitable religious or educational health care provider under any a state law b ad valorem property taxes c sales or use taxes or d other taxes fees or assessments whether imposed or sought to be imposed by the state or any political subdivision of the state all assessments paid under this chapter part may be included as an allowable cost of a hospital for purposes of any applicable medicaid reimbursement formula this chapter part does not authorize a political subdivision of the state to a license a hospital for revenue b impose a tax or assessment upon a hospital or c impose a tax or assessment measured by the income or earnings of a hospital section section b which is renumbered from section b is renumbered and amended to read b b assessment an assessment is imposed on each private hospital a beginning upon the later of cms approval of i the health coverage improvement program waiver under section b and ii the assessment under this chapter part b in the amount designated in sections b and b b and b and c in accordance with section b b subject to section b b the assessment imposed by this chapter part is due and payable on a quarterly basis after payment of the outpatient upper payment limit supplemental payments under section b b have been paid the first quarterly payment is not due until at least three months after the earlier of the effective dates of the coverage provided through a the health coverage improvement program b the enhancement waiver program or c the medicaid waiver expansion section section b which is renumbered from section b is renumbered and amended to read b b collection of assessment deposit of revenue rulemaking the collecting agent for the assessment imposed under section b b is the department the department is vested with the administration and enforcement of this chapter part and may make rules in accordance with title g chapter utah administrative rulemaking act necessary to a collect the assessment intergovernmental transfers and penalties imposed under this chapter part b audit records of a facility that i is subject to the assessment imposed by this chapter part and ii does not file a medicare cost report and c select a report similar to the medicare cost report if medicare no longer uses a medicare cost report the department shall a administer the assessment in this chapter part separately from the assessment in chapter d part hospital provider assessment act and b deposit assessments collected under this chapter part into the medicaid expansion fund created by section b b section section b which is renumbered from section b is renumbered and amended to read b b quarterly notice quarterly assessments imposed by this chapter part shall be paid to the division within business days after the original invoice date that appears on the invoice issued by the division the department may by rule extend the time for paying the assessment section section b which is renumbered from section b is renumbered and amended to read b b hospital financing of health coverage improvement program medicaid waiver expansion hospital share the hospital share is a of the state s net cost of the health coverage improvement program including medicaid coverage for individuals with dependent children up to the federal poverty level designated under section b b of the state s net cost of the enhancement waiver program c if the waiver for the medicaid waiver expansion is approved and d of the state s net cost of the upper payment limit gap a the hospital share is capped at no more than annually consisting of i an cap for the programs specified in subsections a through c and ii a cap for the program specified in subsection d b the department shall prorate the cap described in subsection a in any year in which the programs specified in subsections a and d are not in effect for the full fiscal year private hospitals shall be assessed under this chapter part for a of the portion of the hospital share for the programs specified in subsections a through c and b of the portion of the hospital share specified in subsection d a in the report described in subsection b the department shall calculate the state s net cost of each of the programs described in subsections a through c that are in effect for that year b if the assessment collected in the previous fiscal year is above or below the hospital share for private hospitals for the previous fiscal year the underpayment or overpayment of the assessment by the private hospitals shall be applied to the fiscal year in which the report is issued a medicaid accountable care organization shall on or before october of each year report to the department the following data from the prior state fiscal year for each private hospital state teaching hospital and non state government hospital provider that the medicaid accountable care organization contracts with a for the traditional medicaid population i hospital inpatient payments ii hospital inpatient discharges iii hospital inpatient days and iv hospital outpatient payments and b if the medicaid accountable care organization enrolls any individuals in the health coverage improvement program the enhancement waiver program or the medicaid waiver expansion for the population newly eligible for any of those programs i hospital inpatient payments ii hospital inpatient discharges iii hospital inpatient days and iv hospital outpatient payments the department shall by rule made in accordance with title g chapter utah administrative rulemaking act provide details surrounding specific content and format for the reporting by the medicaid accountable care organization section section b which is renumbered from section b is renumbered and amended to read b b calculation of assessment a except as provided in subsection b an annual assessment is payable on a quarterly basis for each private hospital in an amount calculated by the division at a uniform assessment rate for each hospital discharge in accordance with this section b a private teaching hospital with more than beds and residents shall pay an assessment rate times the uniform rate established under subsection c c the division shall calculate the uniform assessment rate described in subsection a by dividing the hospital share for assessed private hospitals described in subsections b and b b and by the sum of i the total number of discharges for assessed private hospitals that are not a private teaching hospital and ii times the number of discharges for a private teaching hospital described in subsection b d the division may by rule made in accordance with title g chapter utah administrative rulemaking act adjust the formula described in subsection c to address unforeseen circumstances in the administration of the assessment under this chapter part e any quarterly changes to the uniform assessment rate shall be applied uniformly to all assessed private hospitals except as provided in subsection for each state fiscal year the division shall determine a hospital s discharges as follows a for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june and b for each subsequent state fiscal year the hospital s cost report data for the hospital s fiscal year that ended in the state fiscal year two years before the assessment fiscal year a if a hospital s fiscal year medicare cost report is not contained in the cms healthcare cost report information system file i the hospital shall submit to the division a copy of the hospital s medicare cost report applicable to the assessment year and ii the division shall determine the hospital s discharges b if a hospital is not certified by the medicare program and is not required to file a medicare cost report i the hospital shall submit to the division the hospital s applicable fiscal year discharges with supporting documentation ii the division shall determine the hospital s discharges from the information submitted under subsection b i and iii failure to submit discharge information shall result in an audit of the hospital s records and a penalty equal to of the calculated assessment except as provided in subsection if a hospital is owned by an organization that owns more than one hospital in the state a the assessment for each hospital shall be separately calculated by the department and b each separate hospital shall pay the assessment imposed by this chapter part if multiple hospitals use the same medicaid provider number a the department shall calculate the assessment in the aggregate for the hospitals using the same medicaid provider number and b the hospitals may pay the assessment in the aggregate section section b which is renumbered from section b is renumbered and amended to read b b state teaching hospital and non state government hospital mandatory intergovernmental transfer the state teaching hospital and a non state government hospital shall make an intergovernmental transfer to the medicaid expansion fund created in section b b in accordance with this section the hospitals described in subsection shall pay the intergovernmental transfer beginning on the later of cms approval of a the health improvement program waiver under section b or b the assessment for private hospitals in this chapter part the intergovernmental transfer is apportioned as follows a the state teaching hospital is responsible for i of the portion of the hospital share specified in subsections b b a through c and ii of the hospital share specified in subsection b b d and b non state government hospitals are responsible for i of the portion of the hospital share specified in subsections b b a through c and ii of the hospital share specified in subsection b b d the department shall by rule made in accordance with title g chapter utah administrative rulemaking act designate a the method of calculating the amounts designated in subsection and b the schedule for the intergovernmental transfers section section b which is renumbered from section b is renumbered and amended to read b b penalties and interest a hospital that fails to pay a quarterly assessment make the mandated intergovernmental transfer or file a return as required under this chapter part within the time required by this chapter part shall pay penalties described in this section in addition to the assessment or intergovernmental transfer if a hospital fails to timely pay the full amount of a quarterly assessment or the mandated intergovernmental transfer the department shall add to the assessment or intergovernmental transfer a a penalty equal to of the quarterly amount not paid on or before the due date and b on the last day of each quarter after the due date until the assessed amount and the penalty imposed under subsection a are paid in full an additional penalty on i any unpaid quarterly assessment or intergovernmental transfer and ii any unpaid penalty assessment upon making a record of the division s actions and upon reasonable cause shown the division may waive reduce or compromise any of the penalties imposed under this chapter part section section b which is renumbered from section b is renumbered and amended to read b b hospital reimbursement if the health coverage improvement program the enhancement waiver program or the medicaid waiver expansion is implemented by contracting with a medicaid accountable care organization the department shall to the extent allowed by law include in a contract to provide benefits under the health coverage improvement program the enhancement waiver program or the medicaid waiver expansion a requirement that the medicaid accountable care organization reimburse hospitals in the accountable care organization s provider network at no less than the medicaid fee for service rate if the health coverage improvement program the enhancement waiver program or the medicaid waiver expansion is implemented by the department as a fee for service program the department shall reimburse hospitals at no less than the medicaid fee for service rate nothing in this section prohibits a medicaid accountable care organization from paying a rate that exceeds the medicaid fee for service rate section section b which is renumbered from section b is renumbered and amended to read b b outpatient upper payment limit supplemental payments beginning on the effective date of the assessment imposed under this chapter part and for each subsequent fiscal year the department shall implement an outpatient upper payment limit program for private hospitals that shall supplement the reimbursement to private hospitals in accordance with subsection the division shall ensure that supplemental payment to utah private hospitals under subsection a does not exceed the positive upper payment limit gap and b is allocated based on the medicaid state plan the department shall use the same outpatient data to allocate the payments under subsection and to calculate the upper payment limit gap the supplemental payments to private hospitals under subsection are payable for outpatient hospital services provided on or after the later of a july b the effective date of the medicaid state plan amendment necessary to implement the payments under this section or c the effective date of the coverage provided through the health coverage improvement program waiver section section b which is renumbered from section b is renumbered and amended to read b b repeal of assessment the assessment imposed by this chapter part shall be repealed when a the executive director certifies that i action by congress is in effect that disqualifies the assessment imposed by this chapter part from counting toward state medicaid funds available to be used to determine the amount of federal financial participation ii a decision enactment or other determination by the legislature or by any court officer department or agency of the state or of the federal government is in effect that a disqualifies the assessment from counting toward state medicaid funds available to be used to determine federal financial participation for medicaid matching funds or b creates for any reason a failure of the state to use the assessments for at least one of the medicaid programs described in this chapter part or iii a change is in effect that reduces the aggregate hospital inpatient and outpatient payment rate below the aggregate hospital inpatient and outpatient payment rate for july or b this chapter part is repealed in accordance with section i if the assessment is repealed under subsection a the division may not collect any assessment or intergovernmental transfer under this chapter part b the department shall disburse money in the special medicaid expansion fund in accordance with the requirements in subsection b b to the extent federal matching is not reduced by cms due to the repeal of the assessment c any money remaining in the medicaid expansion fund after the disbursement described in subsection b that was derived from assessments imposed by this chapter part shall be refunded to the hospitals in proportion to the amount paid by each hospital for the last three fiscal years and d any money remaining in the medicaid expansion fund after the disbursements described in subsections b and c shall be deposited into the general fund by the end of the fiscal year that the assessment is suspended section section b which is renumbered from section c is renumbered and amended to read part medicaid expansion hospital assessment c b definitions as used in this chapter part assessment means the medicaid expansion hospital assessment established by this chapter part cms means the centers for medicare and medicaid services within the united states department of health and human services discharges means the number of total hospital discharges reported on a worksheet s part i column lines and of the medicare cost report for the applicable assessment year or b a similar report adopted by the department by administrative rule if the report under subsection a is no longer available division means the division of health care financing integrated healthcare within the department hospital share means the hospital share described in section c b medicaid accountable care organization means a managed care organization as defined in c f r sec that contracts with the department under the provisions of section b medicaid expansion fund means the medicaid expansion fund created in section b b medicaid waiver expansion means the same as that term is defined in section b medicare cost report means cms the cost report for electronic filing of hospitals a non state government hospital means a hospital owned by a non state government entity b non state government hospital does not include i the utah state hospital or ii a hospital owned by the federal government including the veterans administration hospital a private hospital means i a privately owned general acute hospital operating in the state as defined in section b or ii a privately owned specialty hospital operating in the state including a privately owned hospital for which inpatient admissions are predominantly a rehabilitation b psychiatric c chemical dependency or d long term acute care services b private hospital does not include a facility for residential treatment as defined in section a b qualified medicaid expansion means an expansion of the medicaid program in accordance with subsection b state teaching hospital means a state owned teaching hospital that is part of an institution of higher education section section b which is renumbered from section c is renumbered and amended to read c b application other than for the imposition of the assessment described in this chapter part nothing in this chapter part shall affect the nonprofit or tax exempt status of any nonprofit charitable religious or educational health care provider under any a state law b ad valorem property tax requirement c sales or use tax requirement or d other requirements imposed by taxes fees or assessments whether imposed or sought to be imposed by the state or any political subdivision of the state a hospital paying an assessment under this chapter part may include the assessment as an allowable cost of a hospital for purposes of any applicable medicaid reimbursement formula this chapter part does not authorize a political subdivision of the state to a license a hospital for revenue b impose a tax or assessment upon a hospital or c impose a tax or assessment measured by the income or earnings of a hospital section section b which is renumbered from section c is renumbered and amended to read c b assessment an assessment is imposed on each private hospital a beginning upon the later of i april and ii cms approval of the assessment under this chapter part b in the amount designated in sections c and c b and b and c in accordance with section c b the assessment imposed by this chapter part is due and payable in accordance with subsection c b section section b which is renumbered from section c is renumbered and amended to read c b collection of assessment deposit of revenue rulemaking the department shall act as the collecting agent for the assessment imposed under section c b the department shall administer and enforce the provisions of this chapter part and may make rules in accordance with title g chapter utah administrative rulemaking act necessary to a collect the assessment intergovernmental transfers and penalties imposed under this chapter part b audit records of a facility that i is subject to the assessment imposed under this chapter part and ii does not file a medicare cost report and c select a report similar to the medicare cost report if medicare no longer uses a medicare cost report the department shall a administer the assessment in this part separately from the assessments in chapter d part hospital provider assessment act and chapter b and part inpatient hospital assessment act and b deposit assessments collected under this chapter part into the medicaid expansion fund a hospitals shall pay the quarterly assessments imposed by this chapter part to the division within business days after the original invoice date that appears on the invoice issued by the division b the department may make rules creating requirements to allow the time for paying the assessment to be extended section section b which is renumbered from section c is renumbered and amended to read c b hospital share the hospital share is a for the period from april through june and b beginning july of the state s net cost of the qualified medicaid expansion after deducting appropriate offsets and savings expected as a result of implementing the qualified medicaid expansion including i savings from a the primary care network program b the health coverage improvement program as defined in section b c the state portion of inpatient prison medical coverage d behavioral health coverage and e county contributions to the non federal share of medicaid expenditures and ii any funds appropriated to the medicaid expansion fund a beginning july the hospital share is capped at no more than annually b beginning july the division shall prorate the cap specified in subsection a in any year in which the qualified medicaid expansion is not in effect for the full fiscal year section section b which is renumbered from section c is renumbered and amended to read c b hospital financing private hospitals shall be assessed under this chapter part for the portion of the hospital share described in section c b in the report described in subsection b the department shall calculate the state s net cost of the qualified medicaid expansion if the assessment collected in the previous fiscal year is above or below the hospital share for private hospitals for the previous fiscal year the division shall apply the underpayment or overpayment of the assessment by the private hospitals to the fiscal year in which the report is issued section section b which is renumbered from section c is renumbered and amended to read c b calculation of assessment a except as provided in subsection b each private hospital shall pay an annual assessment due on the last day of each quarter in an amount calculated by the division at a uniform assessment rate for each hospital discharge in accordance with this section b a private teaching hospital with more than beds and more than residents shall pay an assessment rate times the uniform rate established under subsection c c the division shall calculate the uniform assessment rate described in subsection a by dividing the hospital share for assessed private hospitals as described in subsection c b by the sum of i the total number of discharges for assessed private hospitals that are not a private teaching hospital and ii times the number of discharges for a private teaching hospital described in subsection b d the division may make rules in accordance with title g chapter utah administrative rulemaking act to adjust the formula described in subsection c to address unforeseen circumstances in the administration of the assessment under this chapter part e the division shall apply any quarterly changes to the uniform assessment rate uniformly to all assessed private hospitals except as provided in subsection for each state fiscal year the division shall determine a hospital s discharges as follows a for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june and b for each subsequent state fiscal year the hospital s cost report data for the hospital s fiscal year that ended in the state fiscal year two years before the assessment fiscal year a if a hospital s fiscal year medicare cost report is not contained in the centers for medicare and medicaid services healthcare cost report information system file i the hospital shall submit to the division a copy of the hospital s medicare cost report applicable to the assessment year and ii the division shall determine the hospital s discharges b if a hospital is not certified by the medicare program and is not required to file a medicare cost report i the hospital shall submit to the division the hospital s applicable fiscal year discharges with supporting documentation ii the division shall determine the hospital s discharges from the information submitted under subsection b i and iii if the hospital fails to submit discharge information the division shall audit the hospital s records and may impose a penalty equal to of the calculated assessment except as provided in subsection if a hospital is owned by an organization that owns more than one hospital in the state a the division shall calculate the assessment for each hospital separately and b each separate hospital shall pay the assessment imposed by this chapter part if multiple hospitals use the same medicaid provider number a the department shall calculate the assessment in the aggregate for the hospitals using the same medicaid provider number and b the hospitals may pay the assessment in the aggregate section section b which is renumbered from section c is renumbered and amended to read c b state teaching hospital and non state government hospital mandatory intergovernmental transfer a state teaching hospital and a non state government hospital shall make an intergovernmental transfer to the medicaid expansion fund in accordance with this section the hospitals described in subsection shall pay the intergovernmental transfer beginning on the later of a april or b cms approval of the assessment for private hospitals in this chapter part the intergovernmental transfer is apportioned between the non state government hospitals as follows a the state teaching hospital shall pay for the portion of the hospital share described in section c b and b non state government hospitals shall pay for the portion of the hospital share described in section c b the department shall by rule made in accordance with title g chapter utah administrative rulemaking act designate a the method of calculating the amounts designated in subsection and b the schedule for the intergovernmental transfers section section b which is renumbered from section c is renumbered and amended to read c b penalties a hospital that fails to pay a quarterly assessment make the mandated intergovernmental transfer or file a return as required under this chapter part within the time required by this chapter part shall pay penalties described in this section in addition to the assessment or intergovernmental transfer if a hospital fails to timely pay the full amount of a quarterly assessment or the mandated intergovernmental transfer the department shall add to the assessment or intergovernmental transfer a a penalty equal to of the quarterly amount not paid on or before the due date and b on the last day of each quarter after the due date until the assessed amount and the penalty imposed under subsection a are paid in full an additional penalty on i any unpaid quarterly assessment or intergovernmental transfer and ii any unpaid penalty assessment upon making a record of the division s actions and upon reasonable cause shown the division may waive or reduce any of the penalties imposed under this chapter part section section b which is renumbered from section c is renumbered and amended to read c b hospital reimbursement if the qualified medicaid expansion is implemented by contracting with a medicaid accountable care organization the department shall to the extent allowed by law include in a contract to provide benefits under the qualified medicaid expansion a requirement that the accountable care organization reimburse hospitals in the accountable care organization s provider network at no less than the medicaid fee for service rate if the qualified medicaid expansion is implemented by the department as a fee for service program the department shall reimburse hospitals at no less than the medicaid fee for service rate nothing in this section prohibits the department or a medicaid accountable care organization from paying a rate that exceeds the medicaid fee for service rate section section b which is renumbered from section c is renumbered and amended to read c b hospital financing of the hospital share for the first two full fiscal years that the assessment is in effect the department shall a assess private hospitals under this chapter part for of the hospital share b require the state teaching hospital to make an intergovernmental transfer under this chapter part for of the hospital share and c require non state government hospitals to make an intergovernmental transfer under this chapter part for of the hospital share a at the beginning of the third full fiscal year that the assessment is in effect and at the beginning of each subsequent fiscal year the department may set a different percentage share for private hospitals the state teaching hospital and non state government hospitals by rule made in accordance with title g chapter utah administrative rulemaking act with input from private hospitals and private teaching hospitals b if the department does not set a different percentage share under subsection a the percentage shares in subsection shall apply section section b which is renumbered from section c is renumbered and amended to read c b suspension of assessment the department shall suspend the assessment imposed by this chapter part when the executive director certifies that a action by congress is in effect that disqualifies the assessment imposed by this chapter part from counting toward state medicaid funds available to be used to determine the amount of federal financial participation b a decision enactment or other determination by the legislature or by any court officer department or agency of the state or of the federal government is in effect that i disqualifies the assessment from counting toward state medicaid funds available to be used to determine federal financial participation for medicaid matching funds or ii creates for any reason a failure of the state to use the assessments for at least one of the medicaid programs described in this chapter part or c a change is in effect that reduces the aggregate hospital inpatient and outpatient payment rate below the aggregate hospital inpatient and outpatient payment rate for july if the assessment is suspended under subsection a the division may not collect any assessment or intergovernmental transfer under this chapter part b the division shall disburse money in the medicaid expansion fund that was derived from assessments imposed by this chapter part in accordance with the requirements in subsection b b to the extent federal matching is not reduced by cms due to the repeal of the assessment and c the division shall refund any money remaining in the medicaid expansion fund after the disbursement described in subsection b that was derived from assessments imposed by this chapter part to the hospitals in proportion to the amount paid by each hospital for the last three fiscal years section section b which is renumbered from section d is renumbered and amended to read part hospital provider assessment d b definitions as used in this chapter part accountable care organization means a managed care organization as defined in c f r sec that contracts with the department under the provisions of section b assessment means the medicaid hospital provider assessment established by this chapter part discharges means the number of total hospital discharges reported on worksheet s part i column lines and of the medicare cost report or on worksheet s part i column lines and of the medicare cost report for the applicable assessment year division means the division of health care financing integrated healthcare of the department hospital a means a privately owned i general acute hospital operating in the state as defined in section b and ii specialty hospital operating in the state which shall include a privately owned hospital whose inpatient admissions are predominantly a rehabilitation b psychiatric c chemical dependency or d long term acute care services and b does not include i a human services program as defined in section a b ii a hospital owned by the federal government including the veterans administration hospital or iii a hospital that is owned by the state government a state agency or a political subdivision of the state including a a state owned teaching hospital and b the utah state hospital medicare cost report means cms or cms the cost report for electronic filing of hospitals state plan amendment means a change or update to the state medicaid plan section section b which is renumbered from section d is renumbered and amended to read d b legislative findings the legislature finds that there is an important state purpose to improve the access of medicaid patients to quality care in utah hospitals because of continuous decreases in state revenues and increases in enrollment under the utah medicaid program the legislature finds that in order to improve this access to those persons described in subsection a the rates paid to utah hospitals shall be adequate to encourage and support improved access and b adequate funding shall be provided to increase the rates paid to utah hospitals providing services pursuant to the utah medicaid program section section b which is renumbered from section d is renumbered and amended to read d b application of part other than for the imposition of the assessment described in this chapter part nothing in this chapter part shall affect the nonprofit or tax exempt status of any nonprofit charitable religious or educational health care provider under a section c as amended of the internal revenue code b other applicable federal law c any state law d any ad valorem property taxes e any sales or use taxes or f any other taxes fees or assessments whether imposed or sought to be imposed by the state or any political subdivision county municipality district authority or any agency or department thereof all assessments paid under this chapter part may be included as an allowable cost of a hospital for purposes of any applicable medicaid reimbursement formula this chapter part does not authorize a political subdivision of the state to a license a hospital for revenue b impose a tax or assessment upon hospitals or c impose a tax or assessment measured by the income or earnings of a hospital section section b which is renumbered from section d is renumbered and amended to read d b assessment collection and payment of hospital provider assessment a uniform broad based assessment is imposed on each hospital as defined in subsection d b a a in the amount designated in section d b and b in accordance with section d b a the assessment imposed by this chapter part is due and payable on a quarterly basis in accordance with section d b b the collecting agent for this assessment is the department which is vested with the administration and enforcement of this chapter part including the right to adopt administrative rules in accordance with title g chapter utah administrative rulemaking act necessary to i implement and enforce the provisions of this act and ii audit records of a facility a that is subject to the assessment imposed by this chapter part and b does not file a medicare cost report c the department shall forward proceeds from the assessment imposed by this chapter part to the state treasurer for deposit in the expendable special revenue fund as specified in section d b the department may by rule extend the time for paying the assessment section section b which is renumbered from section d is renumbered and amended to read d b calculation of assessment a an annual assessment is payable on a quarterly basis for each hospital in an amount calculated at a uniform assessment rate for each hospital discharge in accordance with this section b the uniform assessment rate shall be determined using the total number of hospital discharges for assessed hospitals divided into the total non federal portion in an amount consistent with section d b that is needed to support capitated rates for accountable care organizations for purposes of hospital services provided to medicaid enrollees c any quarterly changes to the uniform assessment rate shall be applied uniformly to all assessed hospitals d the annual uniform assessment rate may not generate more than i to offset medicaid mandatory expenditures and ii the non federal share to seed amounts needed to support capitated rates for accountable care organizations as provided for in subsection b a for each state fiscal year discharges shall be determined using the data from each hospital s medicare cost report contained in the centers for medicare and medicaid services healthcare cost report information system file the hospital s discharge data will be derived as follows i for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june ii for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june iii for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june iv for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june and v for each subsequent state fiscal year the hospital s cost report data for the hospital s fiscal year that ended in the state fiscal year two years prior to the assessment fiscal year b if a hospital s fiscal year medicare cost report is not contained in the centers for medicare and medicaid services healthcare cost report information system file i the hospital shall submit to the division a copy of the hospital s medicare cost report applicable to the assessment year and ii the division shall determine the hospital s discharges c if a hospital is not certified by the medicare program and is not required to file a medicare cost report i the hospital shall submit to the division its applicable fiscal year discharges with supporting documentation ii the division shall determine the hospital s discharges from the information submitted under subsection c i and iii the failure to submit discharge information shall result in an audit of the hospital s records and a penalty equal to of the calculated assessment except as provided in subsection if a hospital is owned by an organization that owns more than one hospital in the state a the assessment for each hospital shall be separately calculated by the department and b each separate hospital shall pay the assessment imposed by this chapter part notwithstanding the requirement of subsection if multiple hospitals use the same medicaid provider number a the department shall calculate the assessment in the aggregate for the hospitals using the same medicaid provider number and b the hospitals may pay the assessment in the aggregate section section b which is renumbered from section d is renumbered and amended to read d b quarterly notice collection quarterly assessments imposed by this chapter part shall be paid to the division within business days after the original invoice date that appears on the invoice issued by the division section section b which is renumbered from section d is renumbered and amended to read d b medicaid hospital adjustment under accountable care organization rates to preserve and improve access to hospital services the division shall for accountable care organization rates effective on or after april incorporate into the accountable care organization rate structure calculation consistent with the certified actuarial rate range to be allocated toward the hospital inpatient directed payments for the medicaid eligibility categories covered in utah before january and an amount equal to the difference between payments made to hospitals by accountable care organizations for the medicaid eligibility categories covered in utah before january based on submitted encounter data and the maximum amount that could be paid for those services using medicare payment principles to be used for directed payments to hospitals for outpatient services section section b which is renumbered from section d is renumbered and amended to read d b penalties and interest a facility that fails to pay any assessment or file a return as required under this chapter part within the time required by this chapter part shall pay in addition to the assessment penalties and interest established by the department a consistent with subsection b the department shall adopt rules in accordance with title g chapter utah administrative rulemaking act which establish reasonable penalties and interest for the violations described in subsection b if a hospital fails to timely pay the full amount of a quarterly assessment the department shall add to the assessment i a penalty equal to of the quarterly amount not paid on or before the due date and ii on the last day of each quarter after the due date until the assessed amount and the penalty imposed under subsection b i are paid in full an additional penalty on a any unpaid quarterly assessment and b any unpaid penalty assessment c upon making a record of its actions and upon reasonable cause shown the division may waive reduce or compromise any of the penalties imposed under this part section section b which is renumbered from section d is renumbered and amended to read d b repeal of assessment the repeal of the assessment imposed by this chapter part shall occur upon the certification by the executive director of the department that the sooner of the following has occurred a the effective date of any action by congress that would disqualify the assessment imposed by this chapter part from counting toward state medicaid funds available to be used to determine the federal financial participation b the effective date of any decision enactment or other determination by the legislature or by any court officer department or agency of the state or of the federal government that has the effect of i disqualifying the assessment from counting towards state medicaid funds available to be used to determine federal financial participation for medicaid matching funds or ii creating for any reason a failure of the state to use the assessments for the medicaid program as described in this chapter part c the effective date of i an appropriation for any state fiscal year from the general fund for hospital payments under the state medicaid program that is less than the amount appropriated for state fiscal year ii the annual revenues of the state general fund budget return to the level that was appropriated for fiscal year iii a division change in rules that reduces any of the following below july payments a aggregate hospital inpatient payments b adjustment payment rates or c any cost settlement protocol or iv a division change in rules that reduces the aggregate outpatient payments below july payments and d the sunset of this chapter part in accordance with section i if the assessment is repealed under subsection money in the fund that was derived from assessments imposed by this chapter part before the determination made under subsection shall be disbursed under section d b to the extent federal matching is not reduced due to the impermissibility of the assessments any funds remaining in the special revenue fund shall be refunded to the hospitals in proportion to the amount paid by each hospital section section b which is renumbered from section a is renumbered and amended to read part ambulance service provider assessment a b definitions as used in this chapter part ambulance service provider means a an ambulance provider as defined in section a b or b a non service provider as defined in section a b assessment means the medicaid ambulance service provider assessment established by this chapter part division means the division of health care financing integrated healthcare within the department non federal portion means the non federal share the division needs to seed amounts that will support fee for service ambulance service provider rates as described in section a b total transports means the number of total ambulance transports applicable to a given fiscal year as determined under subsection a b section section b which is renumbered from section a is renumbered and amended to read a b assessment collection and payment of ambulance service provider assessment an ambulance service provider shall pay an assessment to the division a in the amount designated in section a b b in accordance with this chapter part c quarterly on a day determined by the division by rule made under subsection b and d no more than business days after the day on which the division issues the ambulance service provider notice of the assessment the division shall a collect the assessment described in subsection b determine by rule made in accordance with title g chapter utah administrative rulemaking act standards and procedures for implementing and enforcing the provisions of this chapter part and c transfer assessment proceeds to the state treasurer for deposit into the ambulance service provider assessment expendable revenue fund created in section a b section section b which is renumbered from section a is renumbered and amended to read a b calculation of assessment the division shall calculate a uniform assessment per transport as described in this section the assessment due from a given ambulance service provider equals the non federal portion divided by total transports multiplied by the number of transports for the ambulance service provider the division shall apply any quarterly changes to the assessment rate calculated as described in subsection uniformly to all assessed ambulance service providers the assessment may not generate more than the total of a an annual amount of to offset medicaid administration expenses and b the non federal portion a for each state fiscal year the division shall calculate total transports using data from the emergency medical system as follows i for state fiscal year the division shall use ambulance service provider transports during the calendar year and ii for a fiscal year after the division shall use ambulance service provider transports during the calendar year ending months before the end of the fiscal year b if an ambulance service provider fails to submit transport information to the emergency medical system the division may audit the ambulance service provider to determine the ambulance service provider s transports for a given fiscal year section section b which is renumbered from section a is renumbered and amended to read a b medicaid ambulance service provider adjustment under fee for service rates the division shall if the assessment imposed by this chapter part is approved by the centers for medicare and medicaid services for fee for service rates effective on or after july reimburse an ambulance service provider in an amount up to the emergency medical services ambulance rates adopted annually by the department section section b which is renumbered from section a is renumbered and amended to read a b penalties the division shall require an ambulance service provider that fails to pay an assessment due under this chapter part to pay the division in addition to the assessment a penalty determined by the division by rule made in accordance with title g chapter utah administrative rulemaking act section section b which is renumbered from section a is renumbered and amended to read a b repeal of assessment this chapter part is repealed when as certified by the executive director of the department any of the following occurs a an action by congress that disqualifies the assessment imposed by this chapter part from state medicaid funds available to be used to determine the federal financial participation takes legal effect or b an action decision enactment or other determination by the legislature or by any court officer department or agency of the state or federal government takes effect that i disqualifies the assessment from counting toward state medicaid funds available to be used to determine federal financial participation for medicaid matching funds or ii creates for any reason a failure of the state to use the assessments for the medicaid program as described in this chapter part if this chapter part is repealed under subsection a money in the ambulance service provider assessment expendable revenue fund that was derived from assessments imposed by this chapter part deposited before the determination made under subsection shall be disbursed under section a b to the extent federal matching is not reduced due to the impermissibility of the assessments and b any funds remaining in the special revenue fund shall be refunded to each ambulance service provider in proportion to the amount paid by the ambulance service provider section section b which is renumbered from section is renumbered and amended to read part utah children s health insurance program b definitions as used in this chapter part child means a person who is under years of age an individual who is younger than years old eligible child means a child who qualifies for enrollment in the program as provided in section b member means a child enrolled in the program plan means the department s plan submitted to the united states department of health and human services pursuant to u s c sec ff program means the utah children s health insurance program created by this chapter part section section b which is renumbered from section is renumbered and amended to read b creation and administration of the utah children s health insurance program there is created the utah children s health insurance program to be administered by the department in accordance with the provisions of a this chapter part and b the state children s health insurance program u s c sec aa et seq the department shall a prepare and submit the state s children s health insurance plan before may and any amendments to the federal united states department of health and human services in accordance with u s c sec ff and b make rules in accordance with title g chapter utah administrative rulemaking act regarding i eligibility requirements consistent with section b ii program benefits iii the level of coverage for each program benefit iv cost sharing requirements for members which may not a exceed the guidelines set forth in u s c sec ee or b impose deductible copayment or coinsurance requirements on a member for well child well baby and immunizations v the administration of the program and vi a requirement that a members in the program shall participate in the electronic exchange of clinical health records established in accordance with section b unless the member opts out of participation b prior to enrollment in the electronic exchange of clinical health records the member shall receive notice of the enrollment in the electronic exchange of clinical health records and the right to opt out of participation at any time and c beginning july when the program sends enrollment or renewal information to the member and when the member logs onto the program s website the member shall receive notice of the right to opt out of the electronic exchange of clinical health records section section b which is renumbered from section is renumbered and amended to read b eligibility a child is eligible to enroll in the program if the child a is a bona fide utah resident b is a citizen or legal resident of the united states c is under years of age d does not have access to or coverage under other health insurance including any coverage available through a parent or legal guardian s employer e is ineligible for medicaid benefits f resides in a household whose gross family income as defined by rule is at or below of the federal poverty level and g is not an inmate of a public institution or a patient in an institution for mental diseases a child who qualifies for enrollment in the program under subsection may not be denied enrollment due to a diagnosis or pre existing condition a the department shall determine eligibility and send notification of the eligibility decision within days after receiving the application for coverage b if the department cannot reach a decision because the applicant fails to take a required action or because there is an administrative or other emergency beyond the department s control the department shall i document the reason for the delay in the applicant s case record and ii inform the applicant of the status of the application and time frame for completion the department may not close enrollment in the program for a child who is eligible to enroll in the program under the provisions of subsection the program shall a apply for grants to make technology system improvements necessary to implement a simplified enrollment and renewal process in accordance with subsection b and b if funding is available implement a simplified enrollment and renewal process section section b which is renumbered from section is renumbered and amended to read b program benefits except as provided in subsection medical and dental program benefits shall be benchmarked in accordance with u s c sec cc as follows a medical program benefits including behavioral health care benefits shall be benchmarked effective july and on july every third year thereafter to i be substantially equal to a health benefit plan with the largest insured commercial enrollment offered by a health maintenance organization in the state and ii comply with the mental health parity and addiction equity act pub l no and b dental program benefits shall be benchmarked effective july and on july every third year thereafter in accordance with the children s health insurance program reauthorization act of to be substantially equal to a dental benefit plan that has the largest insured commercial non medicaid enrollment of covered lives that is offered in the state except that the utilization review mechanism for orthodontia shall be based on medical necessity on or before july of each year the department shall publish the benchmark for dental program benefits established under subsection b the program benefits a for enrollees who are at or below of the federal poverty level are exempt from the benchmark requirements of subsections and and b shall include treatment for autism spectrum disorder as defined in section a which i shall include coverage for applied behavioral analysis and ii if the benchmark described in subsection a does not include the coverage described in this subsection b the department shall exclude from the benchmark described in subsection a for any purpose other than providing benefits under the program section section b which is renumbered from section is renumbered and amended to read b limitation of benefits abortion is not a covered benefit except as provided in u s c sec ee section section b which is renumbered from section is renumbered and amended to read b funding the program shall be funded by federal matching funds received under together with state matching funds required by u s c sec ee program expenditures in the following categories may not exceed in the aggregate of all federal payments pursuant to u s c sec ee a other forms of child health assistance for children with gross family incomes below of the federal poverty level b other health services initiatives to improve low income children s health c outreach program expenditures and d administrative costs section section b which is renumbered from section is renumbered and amended to read b evaluation the department shall develop performance measures and annually evaluate the program s performance section section b which is renumbered from section is renumbered and amended to read b managed care contracting for services program benefits provided to a member under the program as described in section b shall be delivered by a managed care organization if the department determines that adequate services are available where the member lives or resides the department may contract with a managed care organization to provide program benefits the department shall evaluate a potential contract with a managed care organization based on a the managed care organization s i ability to manage medical expenses including mental health costs ii proven ability to handle accident and health insurance iii efficiency of claim paying procedures iv proven ability for managed care and quality assurance v provider contracting and discounts vi pharmacy benefit management vii estimated total charges for administering the pool viii ability to administer the pool in a cost efficient manner ix ability to provide adequate providers and services in the state and x ability to meet quality measures for emergency room use and access to primary care established by the department under subsection b and b other factors established by the department the department may enter into separate managed care organization contracts to provide dental benefits required by section b the department s contract with a managed care organization for the program s benefits shall include risk sharing provisions in which the plan shall accept at least of the risk for any difference between the department s premium payments per member and actual medical expenditures a the department may contract with the group insurance division within the utah state retirement office to provide services under subsection if no managed care organization is willing to contract with the department or the department determines no managed care organization meets the criteria established under subsection b in accordance with section a contract awarded under subsection a is not subject to the risk sharing required by subsection section section b which is renumbered from section is renumbered and amended to read b state contractor employee and dependent health benefit plan coverage for purposes of sections b a a b c and qualified health coverage means at the time the contract is entered into or renewed a a health benefit plan and employer contribution level with a combined actuarial value at least actuarially equivalent to the combined actuarial value of i the benchmark plan determined by the program under subsection b a and ii a contribution level at which the employer pays at least of the premium or contribution amounts for the employee and the dependents of the employee who reside or work in the state or b a federally qualified high deductible health plan that at a minimum i has a deductible that is a the lowest deductible permitted for a federally qualified high deductible health plan or b a deductible that is higher than the lowest deductible permitted for a federally qualified high deductible health plan but includes an employer contribution to a health savings account in a dollar amount at least equal to the dollar amount difference between the lowest deductible permitted for a federally qualified high deductible plan and the deductible for the employer offered federally qualified high deductible plan ii has an out of pocket maximum that does not exceed three times the amount of the annual deductible and iii provides that the employer pays of the premium or contribution amounts for the employee and the dependents of the employee who work or reside in the state the department shall a on or before july i determine the commercial equivalent of the benchmark plan described in subsection a and ii post the commercially equivalent benchmark plan described in subsection a i on the department s website noting the date posted and b update the posted commercially equivalent benchmark plan annually and at the time of any change in the benchmark section section b which is renumbered from section is renumbered and amended to read part medical benefits recovery b definitions as used in this chapter part annuity shall have the same meaning as provided in section a care facility means a a nursing facility b an intermediate care facility for an individual with an intellectual disability or c any other medical institution claim means a a request or demand for payment or b a cause of action for money or damages arising under any law employee welfare benefit plan means a medical insurance plan developed by an employer under u s c section sec et seq the employee retirement income security act of as amended health insurance entity means a an insurer b a person who administers manages provides offers sells carries or underwrites health insurance as defined in section a c a self insured plan d a group health plan as defined in subsection of the federal employee retirement income security act of e a service benefit plan f a managed care organization g a pharmacy benefit manager h an employee welfare benefit plan or i a person who is by statute contract or agreement legally responsible for payment of a claim for a health care item or service inpatient means an individual who is a patient and a resident of a care facility insurer includes a a group health plan as defined in subsection of the federal employee retirement income security act of b a health maintenance organization and c any entity offering a health service benefit plan medical assistance means a all funds expended for the benefit of a recipient under title chapter medical assistance act or under this chapter or titles xviii and xix federal social security act and b any other services provided for the benefit of a recipient by a prepaid health care delivery system under contract with the department office of recovery services means the office of recovery services within the department of human services department provider means a person or entity who provides services to a recipient recipient means a an individual who has applied for or received medical assistance from the state b the guardian conservator or other personal representative of an individual under subsection a if the individual is a minor or an incapacitated person or c the estate and survivors of an individual under subsection a if the individual is deceased recovery estate means regarding a deceased recipient a all real and personal property or other assets included within a decedent s estate as defined in section b the decedent s augmented estate as defined in section and c that part of other real or personal property in which the decedent had a legal interest at the time of death including assets conveyed to a survivor heir or assign of the decedent through joint tenancy tenancy in common survivorship life estate living trust or other arrangement state plan means the state medicaid program as enacted in accordance with title xix federal social security act tefra lien means a lien authorized under the tax equity and fiscal responsibility act of against the real property of an individual prior to the individual s death as described in u s c sec p third party includes a an individual institution corporation public or private agency trust estate insurance carrier employee welfare benefit plan health maintenance organization health service organization preferred provider organization governmental program such as medicare champus and workers compensation which may be obligated to pay all or part of the medical costs of injury disease or disability of a recipient unless any of these are excluded by department rule and b a spouse or a parent who i may be obligated to pay all or part of the medical costs of a recipient under law or by court or administrative order or ii has been ordered to maintain health dental or accident and health insurance to cover medical expenses of a spouse or dependent child by court or administrative order trust shall have the same meaning as provided in section section section b which is renumbered from section is renumbered and amended to read b program established by department promulgation of rules the department shall establish and maintain a program for the recoupment of medical assistance the department may promulgate rules to implement the purposes of this chapter part section section b which is renumbered from section is renumbered and amended to read b assignment of rights to benefits a except as provided in subsection b to the extent that medical assistance is actually provided to a recipient all benefits for medical services or payments from a third party otherwise payable to or on behalf of a recipient are assigned by operation of law to the department if the department provides or becomes obligated to provide medical assistance regardless of who made application for the benefits on behalf of the recipient b the assignment i authorizes the department to submit its claim to the third party and authorizes payment of benefits directly to the department and ii is effective for all medical assistance the department may recover the assigned benefits or payments in accordance with section b and as otherwise provided by law a the assignment of benefits includes medical support and third party payments ordered decreed or adjudged by any court of this state or any other state or territory of the united states b the assignment is not in lieu of and does not supersede or alter any other court order decree or judgment when an assignment takes effect the recipient is entitled to receive medical assistance and the benefits paid to the department are a reimbursement to the department section section b which is renumbered from section is renumbered and amended to read b health insurance entity duties related to state claims for medicaid payment or recovery as a condition of doing business in the state a health insurance entity shall with respect to an individual who is eligible for or is provided medical assistance under the state plan upon the request of the department of health department provide information to determine a during what period the individual or the spouse or dependent of the individual may be or may have been covered by the health insurance entity and b the nature of the coverage that is or was provided by the health insurance entity described in subsection a including the name address and identifying number of the plan accept the state s right of recovery and the assignment to the state of any right of an individual to payment from a party for an item or service for which payment has been made under the state plan respond to any inquiry by the department of health department regarding a claim for payment for any health care item or service that is submitted no later than three years after the day on which the health care item or service is provided and not deny a claim submitted by the department of health department solely on the basis of the date of submission of the claim the type or format of the claim form or failure to present proper documentation at the point of sale that is the basis for the claim if a the claim is submitted no later than three years after the day on which the item or service is furnished and b any action by the department of health department to enforce the rights of the state with respect to the claim is commenced no later than six years after the day on which the claim is submitted section section b which is renumbered from section is renumbered and amended to read b insurance policies not to deny or reduce benefits of individuals eligible for state medical assistance exemptions a policy of accident or sickness insurance may not contain any provision denying or reducing benefits because services are rendered to an insured or dependent who is eligible for or receiving medical assistance from the state an association corporation or organization may not deliver issue for delivery or renew any subscriber s contract which contains any provisions denying or reducing benefits because services are rendered to a subscriber or dependent who is eligible for or receiving medical assistance from the state an association corporation business or organization authorized to do business in this state and which provides or pays for any health care benefits may not deny or reduce benefits because services are rendered to a beneficiary who is eligible for or receiving medical assistance from the state notwithstanding subsection or the utah state public employees health program administered by the utah state retirement board is not required to reimburse any agency of state government for custodial care which the agency provides through its staff or facilities to members of the utah state public employees health program section section b which is renumbered from section is renumbered and amended to read b availability of insurance policy if the third party does not pay the department s claim or lien within days from the date the claim or lien is received the third party shall provide a written explanation if the claim is denied specifically describe and request any additional information from the department that is necessary to process the claim and provide the department or its agent a copy of any relevant or applicable insurance or benefit policy section section b which is renumbered from section is renumbered and amended to read b employee benefit plans as allowed pursuant to u s c section sec an employee benefit plan may not include any provision that has the effect of limiting or excluding coverage or payment for any health care for an individual who would otherwise be covered or entitled to benefits or services under the terms of the employee benefit plan based on the fact that the individual is eligible for or is provided services under the state plan section section b which is renumbered from section is renumbered and amended to read b statute of limitations survival of right of action insurance policy not to limit time allowed for recovery a subject to subsection action commenced by the department under this chapter part against a health insurance entity shall be commenced within i subject to subsection six years after the day on which the department submits the claim for recovery or payment for the health care item or service upon which the action is based or ii six months after the date of the last payment for medical assistance whichever is later b an action against any other third party the recipient or anyone to whom the proceeds are payable shall be commenced within i four years after the date of the injury or onset of the illness or ii six months after the date of the last payment for medical assistance whichever is later the death of the recipient does not abate any right of action established by this chapter part a no insurance policy issued or renewed after june may contain any provision that limits the time in which the department may submit its claim to recover medical assistance benefits to a period of less than months from the date the provider furnishes services or goods to the recipient b no insurance policy issued or renewed after april may contain any provision that limits the time in which the department may submit its claim to recover medical assistance benefits to a period of less than that described in subsection a the provisions of this section do not apply to section or part tefra liens b or sections b through b the provisions of this section supercede supersede any other sections regarding the time limit in which an action shall be commenced including section a subsection a extends the statute of limitations on a cause of action described in subsection a that was not time barred on or before april b subsection a does not revive a cause of action that was time barred on or before april an action described in subsection a may not be commenced if the claim for recovery or payment described in subsection a i is submitted later than three years after the day on which the health care item or service upon which the claim is based was provided section section b which is renumbered from section is renumbered and amended to read b recovery of medical assistance from third party lien notice action compromise or waiver recipient s right to action protected a except as provided in subsection c if the department provides or becomes obligated to provide medical assistance to a recipient that a third party is obligated to pay for the department may recover the medical assistance directly from the third party b i a claim under subsection a or section b to recover medical assistance provided to a recipient is a lien against any proceeds payable to or on behalf of the recipient by the third party ii the lien described in subsection b i has priority over all other claims to the proceeds except claims for attorney fees and costs authorized under subsection b c ii c i the department may not recover medical assistance under subsection a if a the third party is obligated to pay the recipient for an injury to the recipient s child that occurred while the child was in the physical custody of the child s foster parent b the child s injury is a physical or mental impairment that requires ongoing medical attention or limits activities of daily living for at least one year c the third party s payment to the recipient is placed in a trust annuity financial account or other financial instrument for the benefit of the child and d the recipient makes reasonable efforts to mitigate any other medical assistance costs for the recipient to the state ii the department is responsible for any repayment to the federal government related to the medical assistance the department is prohibited from recovering under subsection c i a the department shall mail or deliver written notice of the department s claim or lien to the third party at the third party s principal place of business or last known address b the notice shall include i the recipient s name ii the approximate date of illness or injury iii a general description of the type of illness or injury and iv if applicable the general location where the injury is alleged to have occurred the department may commence an action on the department s claim or lien in the department s name but the claim or lien is not enforceable as to a third party unless a the third party receives written notice of the department s claim or lien before the third party settles with the recipient or b the department has evidence that the third party had knowledge that the department provided or was obligated to provide medical assistance the department may a waive a claim or lien against a third party in whole or in part or b compromise settle or release a claim or lien an action commenced under this section does not bar an action by a recipient or a dependent of a recipient for loss or damage not included in the department s action except as provided in subsection c the department s claim or lien on proceeds under this section is not affected by the transfer of the proceeds to a trust annuity financial account or other financial instrument section section b which is renumbered from section is renumbered and amended to read b action by department notice to recipient a within days after commencing an action under subsection b the department shall give the recipient the recipient s guardian personal representative trustee estate or survivor whichever is appropriate written notice of the action by i personal service or certified mail to the last known address of the person receiving the notice or ii if no last known address is available by publishing a notice a once a week for three successive weeks in a newspaper of general circulation in the county where the recipient resides and b in accordance with section for three weeks b proof of service shall be filed in the action c the recipient may intervene in the department s action at any time before trial the notice required by subsection shall name the court in which the action is commenced and advise the recipient of a the right to intervene in the proceeding b the right to obtain a private attorney and c the department s right to recover medical assistance directly from the third party section section b which is renumbered from section is renumbered and amended to read b notice of claim by recipient department response conditions for proceeding collection agreements a a recipient may not file a claim commence an action or settle compromise release or waive a claim against a third party for recovery of medical costs for an injury disease or disability for which the department has provided or has become obligated to provide medical assistance without the department s written consent as provided in subsection b or b for purposes of subsection a consent may be obtained if i a recipient who files a claim or commences an action against a third party notifies the department in accordance with subsection d within days of the recipient making the claim or commencing an action or ii an attorney who has been retained by the recipient to file a claim or commence an action against a third party notifies the department in accordance with subsection d of the recipient s claim a within days after being retained by the recipient for that purpose or b within days from the date the attorney either knew or should have known that the recipient received medical assistance from the department c service of the notice of claim to the department shall be made by certified mail personal service or by e mail in accordance with rule of the utah rules of civil procedure to the director of the office of recovery services d the notice of claim shall include the following information i the name of the recipient ii the recipient s social security number iii the recipient s date of birth iv the name of the recipient s attorney if applicable v the name or names of individuals or entities against whom the recipient is making the claim if known vi the name of the third party s insurance carrier if known vii the date of the incident giving rise to the claim and viii a short statement identifying the nature of the recipient s claim a within days of receipt of the notice of the claim required in subsection the department shall acknowledge receipt of the notice of the claim to the recipient or the recipient s attorney and shall notify the recipient or the recipient s attorney in writing of the following i if the department has a claim or lien pursuant to section b or has become obligated to provide medical assistance and ii whether the department is denying or granting written consent in accordance with subsection a b the department shall provide the recipient s attorney the opportunity to enter into a collection agreement with the department with the recipient s consent unless i the department prior to the receipt of the notice of the recipient s claim pursuant to subsection filed a written claim with the third party the third party agreed to make payment to the department before the date the department received notice of the recipient s claim and the agreement is documented in the department s record or ii there has been a failure by the recipient s attorney to comply with any provision of this section by a failing to comply with the notice provisions of this section b failing or refusing to enter into a collection agreement c failing to comply with the terms of a collection agreement with the department or d failing to disburse funds owed to the state in accordance with this section c i the collection agreement shall be a consistent with this section and the attorney s obligation to represent the recipient and represent the state s claim and b state the terms under which the interests of the department may be represented in an action commenced by the recipient ii if the recipient s attorney enters into a written collection agreement with the department or includes the department s claim in the recipient s claim or action pursuant to subsection the department shall pay attorney fees at the rate of of the department s total recovery and shall pay a proportionate share of the litigation expenses directly related to the action d the department is not required to enter into a collection agreement with the recipient s attorney for collection of personal injury protection under subsection a a if the department receives notice pursuant to subsection and notifies the recipient and the recipient s attorney that the department will not enter into a collection agreement with the recipient s attorney the recipient may proceed with the recipient s claim or action against the third party if the recipient excludes from the claim i any medical expenses paid by the department or ii any medical costs for which the department is obligated to provide medical assistance b when a recipient proceeds with a claim under subsection a the recipient shall provide written notice to the third party of the exclusion of the department s claim for expenses under subsection a i or ii if the department receives notice pursuant to subsection and does not respond within days to the recipient or the recipient s attorney the recipient or the recipient s attorney a may proceed with the recipient s claim or action against the third party b may include the state s claim in the recipient s claim or action and c may not negotiate compromise settle or waive the department s claim without the department s consent section section b which is renumbered from section is renumbered and amended to read b department s right to intervene department s interests protected remitting funds disbursements liability and penalty for noncompliance the department has an unconditional right to intervene in an action commenced by a recipient against a third party for the purpose of recovering medical costs for which the department has provided or has become obligated to provide medical assistance a if the recipient proceeds without complying with the provisions of section b the department is not bound by any decision judgment agreement settlement or compromise rendered or made on the claim or in the action b the department i may recover in full from the recipient or any party to which the proceeds were made payable all medical assistance that the department has provided and ii retains its right to commence an independent action against the third party subject to subsection b any amounts assigned to and recoverable by the department pursuant to sections and b and b collected directly by the recipient shall be remitted to the bureau of medical collections within the office of recovery services no later than five business days after receipt a any amounts assigned to and recoverable by the department pursuant to sections and b and b collected directly by the recipient s attorney shall be remitted to the bureau of medical collections within the office of recovery services no later than days after the funds are placed in the attorney s trust account b the date by which the funds shall be remitted to the department may be modified based on agreement between the department and the recipient s attorney c the department s consent to another date for remittance may not be unreasonably withheld d if the funds are received by the recipient s attorney no disbursements shall be made to the recipient or the recipient s attorney until the department s claim has been paid a recipient or recipient s attorney who knowingly and intentionally fails to comply with this section is liable to the department for a the amount of the department s claim or lien pursuant to subsection b a penalty equal to of the amount of the department s claim and c attorney fees and litigation expenses related to recovering the department s claim section section b which is renumbered from section is renumbered and amended to read b estate and trust recovery a except as provided in subsection b upon a recipient s death the department may recover from the recipient s recovery estate and any trust in which the recipient is the grantor and a beneficiary medical assistance correctly provided for the benefit of the recipient when the recipient was years of age old or older b the department may not make an adjustment or a recovery under subsection a i while the deceased recipient s spouse is still living or ii if the deceased recipient has a surviving child who is a under age years old or b blind or disabled as defined in the state plan a the amount of medical assistance correctly provided for the benefit of a recipient and recoverable under this section is a lien against the deceased recipient s recovery estate or any trust when the recipient is the grantor and a beneficiary b the lien holds the same priority as reasonable and necessary medical expenses of the last illness as provided in section a for a lien described in subsection the department shall provide notice in accordance with section b before final distribution the department shall perfect the lien as follows i for an estate by presenting the lien to the estate s personal representative in accordance with section and ii for a trust by presenting the lien to the trustee in accordance with section c the department may file an amended lien before the entry of the final order to close the estate or trust claims against a deceased recipient s inter vivos trust shall be presented in accordance with sections and any trust provision that denies recovery for medical assistance is void at the time of its making nothing in this section affects the right of the department to recover medicaid assistance before a recipient s death under section or section b or b a lien imposed under this section is of indefinite duration section section b which is renumbered from section is renumbered and amended to read b recovery from recipient of incorrectly provided medical assistance the department may recover medical assistance incorrectly provided whether due to administrative or factual error or fraud from the recipient or the recipient s recovery estate and pursuant to a judgment impose a lien against real property of the recipient section section b which is renumbered from section is renumbered and amended to read b tefra liens authorized grounds for tefra liens exemptions except as provided in subsections and the department may impose a tefra lien on the real property of an individual for the amount of medical assistance provided for or to the individual while the individual is an inpatient in a care facility if a the individual is an inpatient in a care facility b the individual is required as a condition of receiving services under the state plan to spend for costs of medical care all but a minimal amount of the individual s income required for personal needs and c the department determines that the individual cannot reasonably be expected to i be discharged from the care facility and ii return to the individual s home the department may not impose a lien on the home of an individual described in subsection if any of the following individuals are lawfully residing in the home a the spouse of the individual b a child of the individual if the child is i under years of age old or ii blind or permanently and totally disabled as defined in title u s c sec c a f or c a sibling of the individual if the sibling i has an equity interest in the home and ii resided in the home for at least one year immediately preceding the day on which the individual was admitted to the care facility the department may not impose a tefra lien on the real property of an individual unless a the individual has been an inpatient in a care facility for the day period immediately preceding the day on which the lien is imposed b the department serves i a preliminary notice of intent to impose a tefra lien relating to the real property in accordance with section b and ii a final notice of intent to impose a tefra lien relating to the real property in accordance with section b and c i the individual does not file a timely request for review of the department s decision under title g chapter administrative procedures act or ii the department s decision is upheld upon final review or appeal under title g chapter administrative procedures act section section b which is renumbered from section is renumbered and amended to read b presumption of permanency there is a rebuttable presumption that an individual who is an inpatient in a care facility cannot reasonably be expected to be discharged from a care facility and return to the individual s home if the individual has been an inpatient in a care facility for a period of at least consecutive days section section b which is renumbered from section is renumbered and amended to read b preliminary notice of intent to impose a tefra lien prior to imposing a tefra lien on real property the department shall serve a preliminary notice of intent to impose a tefra lien on the individual described in subsection b who owns the property the preliminary notice of intent shall a be served in person or by certified mail on the individual described in subsection b and if the department is aware that the individual has a legally authorized representative on the representative b include a statement indicating that according to the department s records the individual i meets the criteria described in subsections b a and b ii has been an inpatient in a care facility for a period of at least days immediately preceding the day on which the department provides the notice to the individual and iii is legally presumed to be in a condition where it cannot reasonably be expected that the individual will be discharged from the care facility and return to the individual s home c indicate that the department intends to impose a tefra lien on real property belonging to the individual d describe the real property that the tefra lien will apply to e describe the current amount of and purpose of the tefra lien f indicate that the amount of the lien may continue to increase as the individual continues to receive medical assistance g indicate that the individual may seek to prevent the tefra lien from being imposed on the real property by providing documentation to the department that i establishes that the individual does not meet the criteria described in subsection b a or b ii establishes that the individual has not been an inpatient in a care facility for a period of at least days iii rebuts the presumption described in section b or iv establishes that the real property is exempt from imposition of a tefra lien under subsection b h indicate that if the owner fails to provide the documentation described in subsection g within days after the day on which the preliminary notice of intent is served the department will issue a final notice of intent to impose a tefra lien on the real property and will proceed to impose the lien i identify the type of documentation that the owner may provide to comply with subsection g j describe the circumstances under which a tefra lien is required to be released and k describe the circumstances under which the department may seek to recover the lien section section b which is renumbered from section is renumbered and amended to read b final notice of intent to impose a tefra lien the department may issue a final notice of intent to impose a tefra lien on real property if a a preliminary notice of intent relating to the property is served in accordance with section b b it is at least days after the day on which the preliminary notice of intent was served and c the department has not received documentation or other evidence that adequately establishes that a tefra lien may not be imposed on the real property the final notice of intent to impose a tefra lien on real property shall a be served in person or by certified mail on the individual described in subsection b who owns the property and if the department is aware that the individual has a legally authorized representative on the representative b indicate that the department has complied with the requirements for filing the final notice of intent under subsection c include a statement indicating that according to the department s records the individual i meets the criteria described in subsections b a and b ii has been an inpatient in a care facility for a period of at least days immediately preceding the day on which the department provides the notice to the individual and iii is legally presumed to be in a condition where it cannot reasonably be expected that the individual will be discharged from the care facility and return to the individual s home d indicate that the department intends to impose a tefra lien on real property belonging to the individual e describe the real property that the tefra lien will apply to f describe the current amount of and purpose of the tefra lien g indicate that the amount of the lien may continue to increase as the individual continues to receive medical assistance h describe the circumstances under which a tefra lien is required to be released i describe the circumstances under which the department may seek to recover the lien j describe the right of the individual to challenge the decision of the department in an adjudicative proceeding and k indicate that failure by the individual to successfully challenge the decision of the department will result in the tefra lien being imposed section section b which is renumbered from section is renumbered and amended to read b review of department decision an individual who has been served with a final notice of intent to impose a tefra lien under section b may seek agency or judicial review of that decision under title g chapter administrative procedures act section section b which is renumbered from section is renumbered and amended to read b dissolution and removal of tefra lien a tefra lien shall dissolve and be removed by the department if the individual described in subsection b a i is discharged from the care facility and ii returns to the individual s home or b provides sufficient documentation to the department that i rebuts the presumption described in section b or ii any of the following individuals are lawfully residing in the individual s home a the spouse of the individual b a child of the individual if the child is under years of age old or blind or permanently and totally disabled as defined in title u s c sec c a f or c a sibling of the individual if the sibling has an equity interest in the home and resided in the home for at least one year immediately preceding the day on which the individual was admitted to the care facility an individual described in subsection b a may at any time after the department has imposed a lien under this part sections b through b file a request for the department to remove the lien a request filed under subsection shall be considered and reviewed pursuant to title g chapter administrative procedures act section section b which is renumbered from section is renumbered and amended to read b expenditures included in lien other proceedings a tefra lien imposed on real property under this part sections b through b includes all expenses relating to medical assistance provided or paid for under the state plan from the first day that the individual is placed in a care facility regardless of when the lien is imposed or filed on the property nothing in this part affects or prevents sections b through b affect or prevent the department from bringing or pursuing any other legally authorized action to recover medical assistance or to set aside a fraudulent or improper conveyance section section b which is renumbered from section is renumbered and amended to read b contract with another government agency if the department contracts with another government agency to recover funds paid for medical assistance under this chapter part that government agency shall be the sole agency that determines whether to impose or remove a tefra lien under this part sections b through b section section b which is renumbered from section is renumbered and amended to read b precedence of the tax equity and fiscal responsibility act of if any provision of this part conflicts sections b through b conflict with the requirements of the tax equity and fiscal responsibility act of for imposing a lien against the property of an individual prior to the individual s death under u s c sec p the provisions of the tax equity and fiscal responsibility act of take precedence and shall be complied with by the department section section b which is renumbered from section is renumbered and amended to read b legal recognition of electronic claims records pursuant to title chapter uniform electronic transactions act a claim submitted to the department for payment may not be denied legal effect enforceability or admissibility as evidence in any court in any civil action because it is in electronic form and a third party shall accept an electronic record of payments by the department for medical services on behalf of a recipient as evidence in support of the department s claim section section b which is renumbered from section is renumbered and amended to read b direct payment to the department by third party any third party required to make payment to the department pursuant to this chapter part shall make the payment directly to the department or its designee the department may negotiate a payment or payment instrument it receives in connection with subsection without the cosignature or other participation of the recipient or any other party section section b which is renumbered from section is renumbered and amended to read b attorney general or county attorney to represent department the attorney general or a county attorney shall represent the department in any action commenced under this chapter part section section b which is renumbered from section is renumbered and amended to read b department s right to attorney fees and costs in any action brought by the department under this chapter part in which it prevails the department shall recover along with the principal sum and interest a reasonable attorney fee and costs incurred section section b which is renumbered from section is renumbered and amended to read b application of provisions contrary to federal law prohibited in no event shall any provision contained in this chapter part be applied contrary to existing federal law section section b which is renumbered from section is renumbered and amended to read part utah false claims act b definitions as used in this chapter part benefit means the receipt of money goods or any other thing of pecuniary value claim means any request or demand for money or property a made to any i employee officer or agent of the state ii contractor with the state or iii grantee or other recipient whether or not under contract with the state and b if i any portion of the money or property requested or demanded was issued from or provided by the state or ii the state will reimburse the contractor grantee or other recipient for any portion of the money or property false statement or false representation means a wholly or partially untrue statement or representation which is a knowingly made and b a material fact with respect to the claim knowing and knowingly a for purposes of criminal prosecutions for violations of this chapter part is one of the culpable mental states described in subsection b and b for purposes of civil prosecutions for violations of this chapter part is the required culpable mental state as defined in subsection b medical benefit means a benefit paid or payable to a recipient or a provider under a program administered by the state under a titles v and xix of the federal social security act b title x of the federal public health services act c the federal child nutrition act of as amended by p l pub l no and d any programs for medical assistance of the state person means an individual corporation unincorporated association professional corporation partnership or other form of business association section section b which is renumbered from section is renumbered and amended to read b false statement or representation relating to medical benefits a person may not make or cause to be made a false statement or false representation of a material fact in an application for medical benefits a person may not make or cause to be made a false statement or false representation of a material fact for use in determining rights to a medical benefit a person who having knowledge of the occurrence of an event affecting the person s initial or continued right to receive a medical benefit or the initial or continued right of any other person on whose behalf the person has applied for or is receiving a medical benefit may not conceal or fail to disclose that event with intent to obtain a medical benefit to which the person or any other person is not entitled or in an amount greater than that to which the person or any other person is entitled section section b which is renumbered from section is renumbered and amended to read b kickbacks or bribes prohibited for purposes of this section kickback or bribe a includes rebates compensation or any other form of remuneration which is i direct or indirect ii overt or covert or iii in cash or in kind and b does not include a rebate paid to the state under u s c sec r or any state supplemental rebates a person may not solicit offer pay or receive a kickback or bribe in return for or to induce a the purchasing leasing or ordering of any goods or services for which payment is or may be made in whole or in part pursuant to a medical benefit program or b the referral of an individual to another person for the furnishing of any goods or services for which payment is or may be made in whole or in part pursuant to a medical benefit program section section b which is renumbered from section is renumbered and amended to read b false statements or false representations relating to qualification of health institution or facility prohibited felony a person may not knowingly intentionally or recklessly make induce or seek to induce the making of a false statement or false representation of a material fact with respect to the conditions or operation of an institution or facility in order that the institution or facility may qualify upon initial certification or upon recertification as a hospital skilled nursing facility intermediate care facility or home health agency a person who violates this section is guilty of a second degree felony section section b which is renumbered from section is renumbered and amended to read b conspiracy to defraud prohibited a person may not enter into an agreement combination or conspiracy to defraud the state by obtaining or aiding another to obtain the payment or allowance of a false fictitious or fraudulent claim for a medical benefit section section b which is renumbered from section is renumbered and amended to read b false claims for medical benefits prohibited a person may not make or present or cause to be made or presented to an employee or officer of the state a claim for a medical benefit a which is wholly or partially false fictitious or fraudulent b for services which were not rendered or for items or materials which were not delivered c which misrepresents the type quality or quantity of items or services rendered d representing charges at a higher rate than those charged by the provider to the general public e for items or services which the person or the provider knew were not medically necessary in accordance with professionally recognized standards f which has previously been paid g for services also covered by one or more private sources when the person or provider knew of the private sources without disclosing those sources on the claim or h where a provider i unbundles a product procedure or group of procedures usually and customarily provided or performed as a single billable product or procedure into artificial components or separate procedures and ii bills for each component of the product procedure or group of procedures a as if they had been provided or performed independently and at separate times and b the aggregate billing for the components exceeds the amount otherwise billable for the usual and customary single product or procedure in addition to the prohibitions in subsection a person may not a fail to credit the state for payments received from other sources b recover or attempt to recover payment in violation of the provider agreement from i a recipient under a medical benefit program or ii the recipient s family c falsify or alter with intent to deceive any report or document required by state or federal law rule or medicaid provider agreement d retain any unauthorized payment as a result of acts described by this section or e aid or abet the commission of any act prohibited by this section section section b which is renumbered from section is renumbered and amended to read b knowledge of past acts not necessary to establish fact that false statement or representation knowingly made in prosecution under this chapter part it is not necessary to show that the person had knowledge of similar acts having been performed in the past on the part of persons acting on his behalf nor to show that the person had actual notice that the acts by the persons acting on his behalf occurred to establish the fact that a false statement or representation was knowingly made section section b which is renumbered from section is renumbered and amended to read b criminal penalties a except as provided in subsection b the culpable mental state required for a criminal violation of this chapter part is knowingly intentionally or recklessly as defined in section b the culpable mental state required for a criminal violation of this chapter part for kickbacks and bribes under section b is knowingly and intentionally as defined in section the punishment for a criminal violation of any provision of this chapter part except as provided under section b is determined by the cumulative value of the funds or other benefits received or claimed in the commission of all violations of a similar nature and not by each separate violation punishment for criminal violation of this chapter part except as provided under section b is a felony of the second degree felony of the third degree class a misdemeanor or class b misdemeanor based on the dollar amounts as prescribed by subsection for theft of property and services section section b which is renumbered from section is renumbered and amended to read b civil penalties the culpable mental state required for a civil violation of this chapter part is knowing or knowingly which a means that person with respect to information i has actual knowledge of the information ii acts in deliberate ignorance of the truth or falsity of the information or iii acts in reckless disregard of the truth or falsity of the information and b does not require a specific intent to defraud any person who violates this chapter part shall in all cases in addition to other penalties provided by law be required to a make full and complete restitution to the state of all damages that the state sustains because of the person s violation of this chapter part b pay to the state its costs of enforcement of this chapter part in that case including the cost of investigators attorneys and other public employees as determined by the state and c pay to the state a civil penalty equal to i three times the amount of damages that the state sustains because of the person s violation of this chapter part and ii not less than or more than for each claim filed or act done in violation of this chapter part any civil penalties assessed under subsection shall be awarded by the court as part of its judgment in both criminal and civil actions a criminal action need not be brought against a person in order for that person to be civilly liable under this section section section b which is renumbered from section is renumbered and amended to read b revocation of license of assisted living facility appointment of receiver if the license of an assisted living facility is revoked for violation of this chapter part the county attorney may file a petition with the district court for the county in which the facility is located for the appointment of a receiver the district court shall issue an order to show cause why a receiver should not be appointed returnable within five days after the filing of the petition a if the court finds that the facts warrant the granting of the petition the court shall appoint a receiver to take charge of the facility b the court may determine fair compensation for the receiver a receiver appointed pursuant to this section shall have the powers and duties prescribed by the court section section b which is renumbered from section is renumbered and amended to read b presumption based on paid state warrant value of medical benefits repayment of benefits in any civil or criminal action brought under this chapter part a paid state warrant made payable to the order of a party creates a presumption that the party received funds from the state in any civil or criminal action brought under this chapter part the value of the benefits received shall be the ordinary or usual charge for similar benefits in the private sector in any criminal action under this chapter part the repayment of funds or other benefits obtained in violation of the provisions of this chapter part does not constitute a defense to or grounds for dismissal of that action section section b which is renumbered from section is renumbered and amended to read b violation of other laws the provisions of this chapter part are a not exclusive and the remedies provided for in this chapter part are in addition to any other remedies provided for under i any other applicable law or ii common law and b to be liberally construed and applied to i effectuate the chapter s remedial and deterrent purposes and ii serve the public interest if any provision of this chapter part or the application of this chapter part to any person or circumstance is held unconstitutional a the remaining provisions of this chapter part are not affected and b the application of this chapter part to other persons or circumstances are not affected section section b which is renumbered from section is renumbered and amended to read b medicaid fraud enforcement this chapter part shall be enforced in accordance with this section the department is responsible for a i investigating and prosecuting suspected civil violations of this chapter part or ii referring suspected civil violations of this chapter part to the attorney general for investigation and prosecution and b promptly referring suspected criminal violations of this chapter part to the attorney general for criminal investigation and prosecution the attorney general has a concurrent jurisdiction with the department for investigating and prosecuting suspected civil violations of this chapter part and b exclusive jurisdiction to investigate and prosecute all suspected criminal violations of this chapter part the department and the attorney general share concurrent civil enforcement authority under this chapter part and may enter into an interagency agreement regarding the investigation and prosecution of violations of this chapter part in accordance with this section the requirements of title xix of the federal social security act and applicable federal regulations a any violation of this chapter part which comes to the attention of any state government officer or agency shall be reported to the attorney general or the department b all state government officers and agencies shall cooperate with and assist in any prosecution for violation of this chapter part section section b which is renumbered from section is renumbered and amended to read b investigations civil investigative demands the attorney general may take investigative action under subsection if the attorney general has reason to believe that a a person has information or custody or control of documentary material relevant to the subject matter of an investigation of an alleged violation of this chapter part b a person is committing has committed or is about to commit a violation of this chapter part or c it is in the public interest to conduct an investigation to ascertain whether or not a person is committing has committed or is about to commit a violation of this chapter part in taking investigative action the attorney general may a require the person to file on a prescribed form a statement in writing under oath or affirmation describing i the facts and circumstances concerning the alleged violation of this chapter part and ii other information considered necessary by the attorney general b examine under oath a person in connection with the alleged violation of this chapter part and c in accordance with subsections through execute in writing and serve on the person a civil investigative demand requiring the person to produce the documentary material and permit inspection and copying of the material the attorney general may not release or disclose information that is obtained under subsection a or b or any documentary material or other record derived from the information obtained under subsection a or b except a by court order for good cause shown b with the consent of the person who provided the information c to an employee of the attorney general or the department d to an agency of this state the united states or another state e to a special assistant attorney general representing the state in a civil action f to a political subdivision of this state or g to a person authorized by the attorney general to receive the information the attorney general may use documentary material derived from information obtained under subsection a or b or copies of that material as the attorney general determines necessary in the enforcement of this chapter part including presentation before a court a if a person fails to file a statement as required by subsection a or fails to submit to an examination as required by subsection b the attorney general may file in district court a complaint for an order to compel the person to within a period stated by court order i file the statement required by subsection a or ii submit to the examination required by subsection b b failure to comply with an order entered under subsection a is punishable as contempt a civil investigative demand shall a state the rule or statute under which the alleged violation of this chapter part is being investigated b describe the i general subject matter of the investigation and ii class or classes of documentary material to be produced with reasonable specificity to fairly indicate the documentary material demanded c designate a date within which the documentary material is to be produced and d identify an authorized employee of the attorney general to whom the documentary material is to be made available for inspection and copying a civil investigative demand may require disclosure of any documentary material that is discoverable under the utah rules of civil procedure service of a civil investigative demand may be made by a delivering an executed copy of the demand to the person to be served or to a partner an officer or an agent authorized by appointment or by law to receive service of process on behalf of that person b delivering an executed copy of the demand to the principal place of business in this state of the person to be served or c mailing by registered or certified mail an executed copy of the demand addressed to the person to be served i at the person s principal place of business in this state or ii if the person has no place of business in this state to the person s principal office or place of business documentary material demanded in a civil investigative demand shall be produced for inspection and copying during normal business hours at the office of the attorney general or as agreed by the person served and the attorney general the attorney general may not produce for inspection or copying or otherwise disclose the contents of documentary material obtained pursuant to a civil investigative demand except a by court order for good cause shown b with the consent of the person who produced the information c to an employee of the attorney general or the department d to an agency of this state the united states or another state e to a special assistant attorney general representing the state in a civil action f to a political subdivision of this state or g to a person authorized by the attorney general to receive the information a with respect to documentary material obtained pursuant to a civil investigative demand the attorney general shall prescribe reasonable terms and conditions allowing such documentary material to be available for inspection and copying by the person who produced the material or by an authorized representative of that person b the attorney general may use such documentary material or copies of it as the attorney general determines necessary in the enforcement of this chapter part including presentation before a court a a person may file a complaint stating good cause to extend the return date for the demand or to modify or set aside the demand b a complaint under this subsection shall be filed in district court before the earlier of a i the return date specified in the demand or b ii the th day after the date the demand is served except as provided by court order a person who has been served with a civil investigative demand shall comply with the terms of the demand a a person who has committed a violation of this chapter part in relation to the medicaid program in this state or to any other medical benefit program administered by the state has submitted to the jurisdiction of this state b personal service of a civil investigative demand under this section may be made on the person described in subsection a outside of this state this section does not limit the authority of the attorney general to conduct investigations or to access a person s documentary materials or other information under another state or federal law the utah rules of civil procedure or the federal rules of civil procedure the attorney general may file a complaint in district court for an order to enforce the civil investigative demand if a a person fails to comply with a civil investigative demand or b copying and reproduction of the documentary material demanded i cannot be satisfactorily accomplished and ii the person refuses to surrender the documentary material if a complaint is filed under subsection the court may determine the matter presented and may enter an order to enforce the civil investigative demand failure to comply with a final order entered under subsection is punishable by contempt section section b which is renumbered from section is renumbered and amended to read b limitation of actions civil acts antedating this section civil burden of proof estoppel joint civil liability venue an action under this chapter part may not be brought after the later of a six years after the date on which the violation was committed or b three years after the date an official of the state charged with responsibility to act in the circumstances discovers the violation but in no event more than years after the date on which the violation was committed a civil action brought under this chapter part may be brought for acts occurring prior to the effective date of this section if the limitations period set forth in subsection has not lapsed in any civil action brought under this chapter part the state shall be required to prove by a preponderance of evidence all essential elements of the cause of action including damages notwithstanding any other provision of law a final judgment rendered in favor of the state in any criminal proceeding under this chapter part whether upon a verdict after trial or upon a plea of guilty or nolo contendere shall estop the defendant from denying the essential elements of the offense in any civil action under this chapter part which involves the same transaction civil liability under this chapter part shall be joint and several for a violation committed by two or more persons any action brought by the state under this chapter part shall be brought in district court in salt lake county or in any county where the defendant resides or does business section section b is amended to read chapter health data vital statistics and utah medical examiner part vital statistics b definitions reserved as used in this part adoption document means an adoption related document filed with the office a petition for adoption a decree of adoption an original birth certificate or evidence submitted in support of a supplementary birth certificate certified nurse midwife means an individual who a is licensed to practice as a certified nurse midwife under title chapter a nurse midwife practice act and b has completed an education program regarding the completion of a certificate of death developed by the department by rule made in accordance with title g chapter utah administrative rulemaking act custodial funeral service director means a funeral service director who a is employed by a licensed funeral establishment and b has custody of a dead body dead body means a human body or parts of a human body from the condition of which it reasonably may be concluded that death occurred decedent means the same as a dead body dead fetus means a product of human conception other than those circumstances described in subsection a of weeks gestation or more calculated from the date the last normal menstrual period began to the date of delivery and b that was not born alive declarant father means a male who claims to be the genetic father of a child and along with the biological mother signs a voluntary declaration of paternity to establish the child s paternity dispositioner means a a person designated in a written instrument under subsection as having the right and duty to control the disposition of the decedent if the person voluntarily acts as the dispositioner or b the next of kin of the decedent if i a a person has not been designated as described in subsection a or b the person described in subsection a is unable or unwilling to exercise the right and duty described in subsection a and ii the next of kin voluntarily acts as the dispositioner fetal remains means a an aborted fetus as that term is defined in section b or b a miscarried fetus as that term is defined in section b file means the submission of a completed certificate or other similar document record or report as provided under this part for registration by the state registrar or a local registrar funeral service director means the same as that term is defined in section health care facility means the same as that term is defined in section b health care professional means a physician physician assistant nurse practitioner or certified nurse midwife licensed funeral establishment means a if located in utah a funeral service establishment as that term is defined in section that is licensed under title chapter funeral services licensing act or b if located in a state district or territory of the united states other than utah a funeral service establishment that complies with the licensing laws of the jurisdiction where the establishment is located live birth means the birth of a child who shows evidence of life after the child is entirely outside of the mother local registrar means a person appointed under subsection b b nurse practitioner means an individual who a is licensed to practice as an advanced practice registered nurse under title chapter b nurse practice act and b has completed an education program regarding the completion of a certificate of death developed by the department by administrative rule made in accordance with title g chapter utah administrative rulemaking act office means the office of vital records and statistics within the department physician means a person licensed to practice as a physician or osteopath in this state under title chapter utah medical practice act or title chapter utah osteopathic medical practice act physician assistant means an individual who a is licensed to practice as a physician assistant under title chapter a utah physician assistant act and b has completed an education program regarding the completion of a certificate of death developed by the department by administrative rule made in accordance with title g chapter utah administrative rulemaking act presumed father means the father of a child conceived or born during a marriage as defined in section registration or register means acceptance by the local or state registrar of a certificate and incorporation of the certificate into the permanent records of the state state registrar means the state registrar of vital records appointed under section b vital records means a registered certificates or reports of birth death fetal death marriage divorce dissolution of marriage or annulment b amendments to any of the registered certificates or reports described in subsection a c an adoption document and d other similar documents vital statistics means the data derived from registered certificates and reports of birth death fetal death induced termination of pregnancy marriage divorce dissolution of marriage or annulment section section b which is renumbered from section is renumbered and amended to read b department duties and authority as used in this section a compact means the compact for interstate sharing of putative father registry information created in section b effective on may b putative father i means the same as that term is as defined in section b and ii includes an unmarried biological father c state registrar means the state registrar of vital records appointed under subsection e d unmarried biological father means the same as that term is defined in section b the department shall a provide offices properly equipped for the preservation of vital records made or received under this chapter part b establish a statewide vital records system for the registration collection preservation amendment and certification of vital records and other similar documents required by this chapter part and activities related to them including the tabulation analysis and publication of vital statistics c prescribe forms for certificates certification reports and other documents and records necessary to establish and maintain a statewide system of vital records d prepare an annual compilation analysis and publication of statistics derived from vital records and e appoint a state registrar to direct the statewide system of vital records the department may a divide the state from time to time into registration districts and b appoint local registrars for registration districts who under the direction and supervision of the state registrar shall perform all duties required of them by this chapter part and department rules the state registrar appointed under subsection e shall with the input of utah stakeholders and the uniform law commission study the following items for the state s implementation of the compact a the feasibility of using systems developed by the national association for public health statistics and information systems including the state and territorial exchange of vital events steve system and the electronic verification of vital events evve system or similar systems to exchange putative father registry information with states that are parties to the compact b procedures necessary to share putative father information located in the confidential registry maintained by the state registrar upon request from the state registrar of another state that is a party to the compact c procedures necessary for the state registrar to access putative father information located in a state that is a party to the compact and share that information with persons who request a certificate from the state registrar d procedures necessary to ensure that the name of the mother of the child who is the subject of a putative father s notice of commencement filed pursuant to section b is kept confidential when a state that is a party to the compact accesses this state s confidential registry through the state registrar and e procedures necessary to ensure that a putative father s registration with a state that is a party to the compact is given the same effect as a putative father s notice of commencement filed pursuant to section b section section b which is renumbered from section is renumbered and amended to read b content and form of certificates and reports as used in this section a additional information means information that is beyond the information necessary to comply with federal standards or state law for registering a birth b diacritical mark means a mark on a letter from the iso basic latin alphabet used to indicate a special pronunciation c diacritical mark includes accents tildes graves umlauts and cedillas except as provided in subsection to promote and maintain nationwide uniformity in the vital records system the forms of certificates certification reports and other documents and records required by this chapter part or the rules implementing this chapter part shall include as a minimum the items recommended by the federal agency responsible for national vital statistics subject to approval additions and modifications by the department certificates certifications forms reports other documents and records and the form of communications between persons required by this chapter part shall be prepared in the format prescribed by department rule all vital records shall include the date of filing certificates certifications forms reports other documents and records and communications between persons required by this chapter part may be signed filed verified registered and stored by photographic electronic or other means as prescribed by department rule a an individual may use a diacritical mark in an application for a vital record b the office shall record a diacritical mark on a vital record as indicated on the application for the vital record the absence of a diacritical mark on a vital record does not render the document invalid or affect any constructive notice imparted by proper recordation of the document a the state i may collect the social security number of a deceased individual and ii may not include the social security number of an individual on a certificate of death b for registering a birth the department may not require an individual to provide additional information c the department may request additional information if the department provides a written statement that i discloses that providing the additional information is voluntary ii discloses how the additional information will be used and the duration of use iii describes how the department prevents the additional information from being used in a manner different from the disclosure given under subsection c ii c ii and iv includes a notice that the individual is consenting to the department s use of the additional information by providing the additional information d i beginning july an individual may submit a written request to the department to de identify the individual s additional information contained in the department s databases ii upon receiving the written request the department shall de identify the additional information e the department shall de identify additional information contained in the department s databases before the additional information is held by the department for longer than six years section section b which is renumbered from section is renumbered and amended to read b birth certificates execution and registration requirements as used in this section birthing facility means a general acute hospital or birthing center as defined in section b for each live birth occurring in the state a certificate shall be filed with the local registrar for the district in which the birth occurred within days following the birth the certificate shall be registered if it is completed and filed in accordance with this chapter part a for each live birth that occurs in a birthing facility the administrator of the birthing facility or his designee shall obtain and enter the information required under this chapter part on the certificate securing the required signatures and filing the certificate b i the date time place of birth and required medical information shall be certified by the birthing facility administrator or his designee ii the attending physician or nurse midwife may sign the certificate but if the attending physician or nurse midwife has not signed the certificate within seven days of the date of birth the birthing facility administrator or his designee shall enter the attending physician s or nurse midwife s name and transmit the certificate to the local registrar iii the information on the certificate about the parents shall be provided and certified by the mother or father or in their incapacity or absence by a person with knowledge of the facts a for live births that occur outside a birthing facility the birth certificate shall be completed and filed by the physician physician assistant nurse midwife or other person primarily responsible for providing assistance to the mother at the birth if there is no such person either the presumed or declarant father shall complete and file the certificate in his absence the mother shall complete and file the certificate and in the event of her death or disability the owner or operator of the premises where the birth occurred shall do so b the certificate shall be completed as fully as possible and shall include the date time and place of birth the mother s name and the signature of the person completing the certificate a for each live birth to an unmarried mother that occurs in a birthing facility the administrator or director of that facility or his designee shall i provide the birth mother and declarant father if present with a a voluntary declaration of paternity form published by the state registrar b oral and written notice to the birth mother and declarant father of the alternatives to the legal consequences of and the rights and responsibilities that arise from signing the declaration and c the opportunity to sign the declaration ii witness the signature of a birth mother or declarant father in accordance with section b if the signature occurs at the facility iii enter the declarant father s information on the original birth certificate but only if the mother and declarant father have signed a voluntary declaration of paternity or a court or administrative agency has issued an adjudication of paternity and iv file the completed declaration with the original birth certificate
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+enrolled copy s b health and human services recodification health care assistance and data general session state of utah chief sponsor jacob l anderegg house sponsor raymond p ward long title general description this bill recodifies portions of the utah health code and utah human services code highlighted provisions this bill recodifies provisions regarding health care administration and assistance and vital statistics health data and the utah medical examiner and makes technical and corresponding changes money appropriated in this bill none other special clauses this bill provides a coordination clause this bill provides revisor instructions utah code sections affected amends b as enacted by laws of utah chapter b as enacted by laws of utah chapter renumbers and amends b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah sixth special session chapter b renumbered from as last amended by laws of utah fifth special session chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah fifth special session chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from c as last amended by laws of utah chapter b renumbered from c as enacted by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as enacted by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as repealed and reenacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as repealed and reenacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter utah code sections affected by coordination clause as last amended by laws of utah chapter as last amended by laws of utah chapter b as enacted by laws of utah chapter b utah code annotated be it enacted by the legislature of the state of utah section section b is amended to read chapter health care administration and assistance part health care assistance b definitions reserved as used in this chapter applicant means any person who requests assistance under the medical programs of the state cms means the centers for medicare and medicaid services within the united states department of health and human services division means the division of integrated healthcare within the department established under section b enrollee or member means an individual whom the department has determined to be eligible for assistance under the medicaid program medicaid program means the state program for medical assistance for persons who are eligible under the state plan adopted pursuant to title xix of the federal social security act medical assistance means services furnished or payments made to or on behalf of a member a passenger vehicle means a self propelled two axle vehicle intended primarily for operation on highways and used by an applicant or recipient to meet basic transportation needs and has a fair market value below of the applicable amount of the federal luxury passenger automobile tax established in u s c sec and adjusted annually for inflation b passenger vehicle does not include i a commercial vehicle as defined in section a ii an off highway vehicle as defined in section a or iii a motor home as defined in section ppaca means the same as that term is defined in section a recipient means a person who has received medical assistance under the medicaid program section section b which is renumbered from section is renumbered and amended to read b division creation there is created within the department the division of medicaid and health financing integrated healthcare which shall be responsible for implementing organizing and maintaining the medicaid program and the children s health insurance program established in section b in accordance with the provisions of this chapter and applicable federal law section section b which is renumbered from section is renumbered and amended to read b state medicaid director appointment responsibilities the state medicaid director shall be appointed by the governor after consultation with the executive director with the advice and consent of the senate the state medicaid director may employ other employees as necessary to implement the provisions of this chapter and shall a administer the responsibilities of the division as set forth in this chapter b administer the division s budget and c establish and maintain a state plan for the medicaid program in compliance with federal law and regulations section section b which is renumbered from section is renumbered and amended to read b division responsibilities emphasis periodic assessment in accordance with the requirements of title xix of the social security act and applicable federal regulations the division is responsible for the effective and impartial administration of this chapter in an efficient economical manner the division shall a establish on a statewide basis a program to safeguard against unnecessary or inappropriate use of medicaid services excessive payments and unnecessary or inappropriate hospital admissions or lengths of stay b deny any provider claim for services that fail to meet criteria established by the division concerning medical necessity or appropriateness and c place its emphasis on high quality care to recipients in the most economical and cost effective manner possible with regard to both publicly and privately provided services the division shall implement and utilize cost containment methods where possible which may include a prepayment and postpayment review systems to determine if utilization is reasonable and necessary b preadmission certification of nonemergency admissions c mandatory outpatient rather than inpatient surgery in appropriate cases d second surgical opinions e procedures for encouraging the use of outpatient services f consistent with sections b and b a medicaid drug program g coordination of benefits and h review and exclusion of providers who are not cost effective or who have abused the medicaid program in accordance with the procedures and provisions of federal law and regulation the state medicaid director shall periodically assess the cost effectiveness and health implications of the existing medicaid program and consider alternative approaches to the provision of covered health and medical services through the medicaid program in order to reduce unnecessary or unreasonable utilization a the department shall ensure medicaid program integrity by conducting internal audits of the medicaid program for efficiencies best practices and cost avoidance b the department shall coordinate with the office of the inspector general for medicaid services created in section a to implement subsection and to address medicaid fraud waste or abuse as described in section a section section b which is renumbered from section is renumbered and amended to read b medicaid drug program preferred drug list a medicaid drug program developed by the department under subsection b f a shall notwithstanding subsection b b be based on clinical and cost related factors which include medical necessity as determined by a provider in accordance with administrative rules established by the drug utilization review board b may include therapeutic categories of drugs that may be exempted from the drug program c may include placing some drugs except the drugs described in subsection on a preferred drug list i to the extent determined appropriate by the department and ii in the manner described in subsection for psychotropic drugs d notwithstanding the requirements of part sections b through b regarding the drug utilization review board and except as provided in subsection shall immediately implement the prior authorization requirements for a nonpreferred drug that is in the same therapeutic class as a drug that is i on the preferred drug list on the date that this act takes effect or ii added to the preferred drug list after this act takes effect and e except as prohibited by subsections b and shall establish the prior authorization requirements established under subsections c and d which shall permit a health care provider or the health care provider s agent to obtain a prior authorization override of the preferred drug list through the department s pharmacy prior authorization review process and which shall i provide either telephone or fax approval or denial of the request within hours of the receipt of a request that is submitted during normal business hours of monday through friday from a m to p m ii provide for the dispensing of a limited supply of a requested drug as determined appropriate by the department in an emergency situation if the request for an override is received outside of the department s normal business hours and iii require the health care provider to provide the department with documentation of the medical need for the preferred drug list override in accordance with criteria established by the department in consultation with the pharmacy and therapeutics committee a for purposes of as used in this subsection i immunosuppressive drug a means a drug that is used in immunosuppressive therapy to inhibit or prevent activity of the immune system to aid the body in preventing the rejection of transplanted organs and tissue and b does not include drugs used for the treatment of autoimmune disease or diseases that are most likely of autoimmune origin ii stabilized means a health care provider has documented in the patient s medical chart that a patient has achieved a stable or steadfast medical state within the past days using a particular psychotropic drug b a preferred drug list developed under the provisions of this section may not include an immunosuppressive drug c i the state medicaid program shall reimburse for a prescription for an immunosuppressive drug as written by the health care provider for a patient who has undergone an organ transplant ii for purposes of subsection b and with respect to patients who have undergone an organ transplant the prescription for a particular immunosuppressive drug as written by a health care provider meets the criteria of demonstrating to the department a medical necessity for dispensing the prescribed immunosuppressive drug d notwithstanding the requirements of part sections b through b regarding the drug utilization review board the state medicaid drug program may not require the use of step therapy for immunosuppressive drugs without the written or oral consent of the health care provider and the patient e the department may include a sedative hypnotic on a preferred drug list in accordance with subsection f f the department shall grant a prior authorization for a sedative hypnotic that is not on the preferred drug list under subsection e if the health care provider has documentation related to one of the following conditions for the medicaid client i a trial and failure of at least one preferred agent in the drug class including the name of the preferred drug that was tried the length of therapy and the reason for the discontinuation ii detailed evidence of a potential drug interaction between current medication and the preferred drug iii detailed evidence of a condition or contraindication that prevents the use of the preferred drug iv objective clinical evidence that a patient is at high risk of adverse events due to a therapeutic interchange with a preferred drug v the patient is a new or previous medicaid client with an existing diagnosis previously stabilized with a nonpreferred drug or vi other valid reasons as determined by the department g a prior authorization granted under subsection f is valid for one year from the date the department grants the prior authorization and shall be renewed in accordance with subsection f a for purposes of as used in this subsection psychotropic drug means the following classes of drugs i atypical anti psychotic ii anti depressant iii anti convulsant mood stabilizer iv anti anxiety and v attention deficit hyperactivity disorder stimulant b i the department shall develop a preferred drug list for psychotropic drugs ii except as provided in subsection d a preferred drug list for psychotropic drugs developed under this section shall allow a health care provider to override the preferred drug list by writing dispense as written on the prescription for the psychotropic drug iii a health care provider may not override section b by writing dispense as written on a prescription c the department and a medicaid accountable care organization that is responsible for providing behavioral health shall i establish a system to a track health care provider prescribing patterns for psychotropic drugs b educate health care providers who are not complying with the preferred drug list and c implement peer to peer education for health care providers whose prescribing practices continue to not comply with the preferred drug list and ii determine whether health care provider compliance with the preferred drug list is at least a of prescriptions by july b of prescriptions by july and c of prescriptions by july d beginning october the department shall eliminate the dispense as written override for the preferred drug list and shall implement a prior authorization system for psychotropic drugs in accordance with subsection f if by july the department has not realized annual savings from implementing the preferred drug list for psychotropic drugs of at least general fund savings section section b which is renumbered from section is renumbered and amended to read b simplified enrollment and renewal process for medicaid and other state medical programs financial institutions the department may apply for grants and accept donations to make technology system improvements necessary to implement a simplified enrollment and renewal process for the medicaid program utah premium partnership and primary care network demonstration project programs a the department may enter into an agreement with a financial institution doing business in the state to develop and operate a data match system to identify an applicant s or enrollee s assets that i uses automated data exchanges to the maximum extent feasible and ii requires a financial institution each month to provide the name record address social security number other taxpayer identification number or other identifying information for each applicant or enrollee who maintains an account at the financial institution b the department may pay a reasonable fee to a financial institution for compliance with this subsection as provided in section c a financial institution may not be liable under any federal or state law to any person for any disclosure of information or action taken in good faith under this subsection d the department may disclose a financial record obtained from a financial institution under this section only for the purpose of and to the extent necessary in verifying eligibility as provided in this section and section b section section b which is renumbered from section is renumbered and amended to read b dental benefits a except as provided in subsection the division may establish a competitive bid process to bid out medicaid dental benefits under this chapter b the division may bid out the medicaid dental benefits separately from other program benefits the division shall use the following criteria to evaluate dental bids a ability to manage dental expenses b proven ability to handle dental insurance c efficiency of claim paying procedures d provider contracting discounts and adequacy of network and e other criteria established by the department the division shall request bids for the program s benefits at least once every five years the division s contract with dental plans for the program s benefits shall include risk sharing provisions in which the dental plan must accept of the risk for any difference between the division s premium payments per client and actual dental expenditures the division may not award contracts to a more than three responsive bidders under this section or b an insurer that does not have a current license in the state a the division may cancel the request for proposals if i there are no responsive bidders or ii the division determines that accepting the bids would increase the program s costs b if the division cancels a request for proposal or a contract that results from a request for proposal described in subsection a the division shall report to the health and human services interim committee regarding the reasons for the decision title g chapter a utah procurement code shall apply to this section a the division may i establish a dental health care delivery system and payment reform pilot program for medicaid dental benefits to increase access to cost effective and quality dental health care by increasing the number of dentists available for medicaid dental services and ii target specific medicaid populations or geographic areas in the state b the pilot program shall establish compensation models for dentists and dental hygienists that i increase access to quality cost effective dental care and ii use funds from the division of family health and preparedness that are available to reimburse dentists for educational loans in exchange for the dentist agreeing to serve medicaid and under served populations c the division may amend the state plan and apply to the secretary of the united states department of health and human services for waivers or pilot programs if necessary to establish the new dental care delivery and payment reform model d the division shall evaluate the pilot program s effect on the cost of dental care and access to dental care for the targeted medicaid populations a as used in this subsection dental hygienist means an individual who is licensed as a dental hygienist under section b the department shall reimburse a dental hygienist for dental services performed in a public health setting and in accordance with subsection c beginning on the earlier of i january or ii days after the date on which the replacement of the department s medicaid management information system software is complete c the department shall reimburse a dental hygienist directly for a service provided through the medicaid program if i the dental hygienist requests to be reimbursed directly and ii the dental hygienist provides the service within the scope of practice described in section d before november of each year in which the department reimburses dental hygienists in accordance with subsection c the department shall report to the health and human services interim committee for the previous fiscal year i the number and geographic distribution of dental hygienists who requested to be reimbursed directly ii the total number of medicaid enrollees who were served by a dental hygienist who were reimbursed under this subsection iii the total amount reimbursed directly to dental hygienists under this subsection iv the specific services and billing codes that are reimbursed under this subsection and v the aggregate amount reimbursed for each service and billing code described in subsection d iv e i except as provided in this subsection nothing in this subsection shall be interpreted as expanding or otherwise altering the limitations and scope of practice for a dental hygienist ii a dental hygienist may only directly bill and receive compensation for billing codes that fall within the scope of practice of a dental hygienist section section b which is renumbered from section is renumbered and amended to read b administration of medicaid program by department reporting to the legislature disciplinary measures and sanctions funds collected eligibility standards internal audits health opportunity accounts the department shall be the single state agency responsible for the administration of the medicaid program in connection with the united states department of health and human services pursuant to title xix of the social security act a the department shall implement the medicaid program through administrative rules in conformity with this chapter title g chapter utah administrative rulemaking act the requirements of title xix and applicable federal regulations b the rules adopted under subsection a shall include in addition to other rules necessary to implement the program i the standards used by the department for determining eligibility for medicaid services ii the services and benefits to be covered by the medicaid program iii reimbursement methodologies for providers under the medicaid program and iv a requirement that a a person receiving medicaid services shall participate in the electronic exchange of clinical health records established in accordance with section b unless the individual opts out of participation b prior to enrollment in the electronic exchange of clinical health records the enrollee shall receive notice of enrollment in the electronic exchange of clinical health records and the right to opt out of participation at any time and c beginning july when the program sends enrollment or renewal information to the enrollee and when the enrollee logs onto the program s website the enrollee shall receive notice of the right to opt out of the electronic exchange of clinical health records a the department shall in accordance with subsection b report to the social services appropriations subcommittee when the department i implements a change in the medicaid state plan ii initiates a new medicaid waiver iii initiates an amendment to an existing medicaid waiver iv applies for an extension of an application for a waiver or an existing medicaid waiver v applies for or receives approval for a change in any capitation rate within the medicaid program or vi initiates a rate change that requires public notice under state or federal law b the report required by subsection a shall i be submitted to the social services appropriations subcommittee prior to the department implementing the proposed change and ii include a a description of the department s current practice or policy that the department is proposing to change b an explanation of why the department is proposing the change c the proposed change in services or reimbursement including a description of the effect of the change d the effect of an increase or decrease in services or benefits on individuals and families e the degree to which any proposed cut may result in cost shifting to more expensive services in health or human service programs and f the fiscal impact of the proposed change including i the effect of the proposed change on current or future appropriations from the legislature to the department ii the effect the proposed change may have on federal matching dollars received by the state medicaid program iii any cost shifting or cost savings within the department s budget that may result from the proposed change and iv identification of the funds that will be used for the proposed change including any transfer of funds within the department s budget any rules adopted by the department under subsection are subject to review and reauthorization by the legislature in accordance with section g the department may in its discretion contract with the department of human services or other qualified agencies for services in connection with the administration of the medicaid program including a the determination of the eligibility of individuals for the program b recovery of overpayments and c consistent with section b and to the extent permitted by law and quality control services enforcement of fraud and abuse laws the department shall provide by rule disciplinary measures and sanctions for medicaid providers who fail to comply with the rules and procedures of the program provided that sanctions imposed administratively may not extend beyond a termination from the program b recovery of claim reimbursements incorrectly paid and c those specified in section of title xix of the federal social security act a funds collected as a result of a sanction imposed under section of title xix of the federal social security act shall be deposited in the general fund as dedicated credits to be used by the division in accordance with the requirements of section of title xix of the federal social security act b in accordance with section j sanctions collected under this subsection are nonlapsing a in determining whether an applicant or recipient is eligible for a service or benefit under this part or chapter part utah children s health insurance act program the department shall if subsection b is satisfied exclude from consideration one passenger vehicle designated by the applicant or recipient b before subsection a may be applied i the federal government shall a determine that subsection a may be implemented within the state s existing public assistance related waivers as of january b extend a waiver to the state permitting the implementation of subsection a or c determine that the state s waivers that permit dual eligibility determinations for cash assistance and medicaid are no longer valid and ii the department shall determine that subsection a can be implemented within existing funding a for purposes of as used in this subsection i aged blind or has a disability means an aged blind or disabled individual as defined in u s c sec c a and ii spend down means an amount of income in excess of the allowable income standard that shall be paid in cash to the department or incurred through the medical services not paid by medicaid b in determining whether an applicant or recipient who is aged blind or has a disability is eligible for a service or benefit under this chapter the department shall use of the federal poverty level as i the allowable income standard for eligibility for services or benefits and ii the allowable income standard for eligibility as a result of spend down the department shall conduct internal audits of the medicaid program a the department may apply for and if approved implement a demonstration program for health opportunity accounts as provided for in u s c sec u b a health opportunity account established under subsection a shall be an alternative to the existing benefits received by an individual eligible to receive medicaid under this chapter c subsection a is not intended to expand the coverage of the medicaid program a i the department shall apply for and if approved implement an amendment to the state plan under this subsection for benefits for a medically needy pregnant women b medically needy children and c medically needy parents and caretaker relatives ii the department may implement the eligibility standards of subsection b for eligibility determinations made on or after the date of the approval of the amendment to the state plan b in determining whether an applicant is eligible for benefits described in subsection a i the department shall i disregard resources held in an account in the savings plan created under title b chapter a utah educational savings plan if the beneficiary of the account is a under the age of and b living with the account owner as that term is defined in section b a or temporarily absent from the residence of the account owner and ii include the withdrawals from an account in the utah educational savings plan as resources for a benefit determination if the withdrawal was not used for qualified higher education costs as that term is defined in section b a a the department may not deny or terminate eligibility for medicaid solely because an individual is i incarcerated and ii not an inmate as defined in section b subsection a does not require the medicaid program to provide coverage for any services for an individual while the individual is incarcerated the department is a party to and may intervene at any time in any judicial or administrative action a to which the department of workforce services is a party and b that involves medical assistance under this chapter i title chapter medical assistance act or ii title chapter utah children s health insurance act section section b which is renumbered from section is renumbered and amended to read b medicaid expansion the purpose of this section is to expand the coverage of the medicaid program to persons who are in categories traditionally not served by that program within appropriations from the legislature the department may amend the state plan for medical assistance to provide for eligibility for medicaid a on or after july for children to years old who live in households below the federal poverty income guideline and b on or after july for persons who have incomes below the federal poverty income guideline and who are aged blind or have a disability a within appropriations from the legislature on or after july the medicaid program may provide for eligibility for persons who have incomes below the federal poverty income guideline b in order to meet the provisions of this subsection the department may seek approval for a demonstration project under u s c sec from the secretary of the united states department of health and human services the medicaid program shall provide for eligibility for persons as required by subsection b services available for persons described in this section shall include required medicaid services and may include one or more optional medicaid services if those services are funded by the legislature the department may also require persons described in subsections through to meet an asset test section section b which is renumbered from section is renumbered and amended to read b copayments by recipients employer sponsored plans the department shall selectively provide for enrollment fees premiums deductions cost sharing or other similar charges to be paid by recipients their spouses and parents within the limitations of federal law and regulation beginning may within appropriations by the legislature and as a means to increase health care coverage among the uninsured the department shall take steps to promote increased participation in employer sponsored health insurance including a maximizing the health insurance premium subsidy provided under the state s demonstration waiver by i ensuring that state funds are matched by federal funds to the greatest extent allowable and ii as the department determines appropriate seeking federal approval to do one or more of the following a eliminate or otherwise modify the annual enrollment fee b eliminate or otherwise modify the schedule used to determine the level of subsidy provided to an enrollee each year c reduce the maximum number of participants allowable under the subsidy program or d otherwise modify the program in a manner that promotes enrollment in employer sponsored health insurance and b exploring the use of other options including the development of a waiver under the medicaid health insurance flexibility demonstration initiative or other federal authority section section b which is renumbered from section is renumbered and amended to read b income and resources from institutionalized spouses as used in this section a community spouse means the spouse of an institutionalized spouse b i community spouse monthly income allowance means an amount by which the minimum monthly maintenance needs allowance for the spouse exceeds the amount of monthly income otherwise available to the community spouse determined without regard to the allowance except as provided in subsection b ii ii if a court has entered an order against an institutionalized spouse for monthly income for the support of the community spouse the community spouse monthly income allowance for the spouse may not be less than the amount of the monthly income so ordered c community spouse resource allowance is the amount of combined resources that are protected for a community spouse living in the community which the division shall establish by rule made in accordance with title g chapter utah administrative rulemaking act based on the amounts established by the united states department of health and human services d excess shelter allowance for a community spouse means the amount by which the sum of the spouse s expense for rent or mortgage payment taxes and insurance and in the case of condominium or cooperative required maintenance charge for the community spouse s principal residence and the spouse s actual expenses for electricity natural gas and water utilities or at the discretion of the department the federal standard utility allowance under snap as defined in section a exceeds of the amount described in subsection e family member means a minor dependent child dependent parents or dependent sibling of the institutionalized spouse or community spouse who are residing with the community spouse f i institutionalized spouse means a person who is residing in a nursing facility and is married to a spouse who is not in a nursing facility ii an institutionalized spouse does not include a person who is not likely to reside in a nursing facility for at least consecutive days g nursing care facility means the same as that term is defined in section b the division shall comply with this section when determining eligibility for medical assistance for an institutionalized spouse for services furnished during a calendar year beginning on or after january the community spouse resource allowance shall be increased by the division by an amount as determined annually by cms the division shall compute as of the beginning of the first continuous period of institutionalization of the institutionalized spouse a the total value of the resources to the extent either the institutionalized spouse or the community spouse has an ownership interest and b a spousal share which is of the resources described in subsection a at the request of an institutionalized spouse or a community spouse at the beginning of the first continuous period of institutionalization of the institutionalized spouse and upon the receipt of relevant documentation of resources the division shall promptly assess and document the total value described in subsection a and shall provide a copy of that assessment and documentation to each spouse and shall retain a copy of the assessment when the division provides a copy of the assessment it shall include a notice stating that the spouse may request a hearing under subsection when determining eligibility for medical assistance under this chapter a except as provided in subsection b all resources held by either the institutionalized spouse community spouse or both are considered to be available to the institutionalized spouse b resources are considered to be available to the institutionalized spouse only to the extent that the amount of those resources exceeds the community spouse resource allowance at the time of application for medical assistance under this chapter a the division may not find an institutionalized spouse to be ineligible for medical assistance by reason of resources determined under subsection to be available for the cost of care when i the institutionalized spouse has assigned to the state any rights to support from the community spouse ii except as provided in subsection b the institutionalized spouse lacks the ability to execute an assignment due to physical or mental impairment or iii the division determines that denial of medical assistance would cause an undue burden b subsection a ii does not prevent the division from seeking a court order for an assignment of support during the continuous period in which an institutionalized spouse is in an institution and after the month in which an institutionalized spouse is eligible for medical assistance the resources of the community spouse may not be considered to be available to the institutionalized spouse when an institutionalized spouse is determined to be eligible for medical assistance in determining the amount of the spouse s income that is to be applied monthly for the cost of care in the nursing care facility the division shall deduct from the spouse s monthly income the following amounts in the following order a a personal needs allowance the amount of which is determined by the division b a community spouse monthly income allowance but only to the extent that the income of the institutionalized spouse is made available to or for the benefit of the community spouse c a family allowance for each family member equal to at least of the amount that the amount described in subsection a exceeds the amount of the family member s monthly income and d amounts for incurred expenses for the medical or remedial care for the institutionalized spouse the division shall establish a minimum monthly maintenance needs allowance for each community spouse that includes a an amount established by the division by rule made in accordance with title g chapter utah administrative rulemaking act based on the amounts established by the united states department of health and human services and b an excess shelter allowance a an institutionalized spouse or a community spouse may request a hearing with respect to the determinations described in subsections e i through v if an application for medical assistance has been made on behalf of the institutionalized spouse b a hearing under this subsection regarding the community spouse resource allowance shall be held by the division within days from the date of the request for the hearing c if either spouse establishes that the community spouse needs income above the level otherwise provided by the minimum monthly maintenance needs allowance due to exceptional circumstances resulting in significant financial duress there shall be substituted for the minimum monthly maintenance needs allowance provided under subsection an amount adequate to provide additional income as is necessary d if either spouse establishes that the community spouse resource allowance in relation to the amount of income generated by the allowance is inadequate to raise the community spouse s income to the minimum monthly maintenance needs allowance there shall be substituted for the community spouse resource allowance an amount adequate to provide a minimum monthly maintenance needs allowance e a hearing may be held under this subsection if either the institutionalized spouse or community spouse is dissatisfied with a determination of i the community spouse monthly income allowance ii the amount of monthly income otherwise available to the community spouse iii the computation of the spousal share of resources under subsection iv the attribution of resources under subsection or v the determination of the community spouse resource allocation a an institutionalized spouse may transfer an amount equal to the community spouse resource allowance but only to the extent the resources of the institutionalized spouse are transferred to or for the sole benefit of the community spouse b the transfer under subsection a shall be made as soon as practicable after the date of the initial determination of eligibility taking into account the time necessary to obtain a court order under subsection c c chapter medical benefits recovery act part medical benefits recovery does not apply if a court has entered an order against an institutionalized spouse for the support of the community spouse section section b which is renumbered from section is renumbered and amended to read b maximizing use of premium assistance programs utah s premium partnership for health insurance a the department shall seek to maximize the use of medicaid and children s health insurance program funds for assistance in the purchase of private health insurance coverage for medicaid eligible and non medicaid eligible individuals b the department s efforts to expand the use of premium assistance shall i include as necessary seeking federal approval under all medicaid and children s health insurance program premium assistance provisions of federal law including provisions of the patient protection and affordable care act public law ppaca ii give priority to but not be limited to expanding the state s utah premium partnership for health insurance program including as required under subsection and iii encourage the enrollment of all individuals within a household in the same plan where possible including enrollment in a plan that allows individuals within the household transitioning out of medicaid to retain the same network and benefits they had while enrolled in medicaid the department shall seek federal approval of an amendment to the state s utah premium partnership for health insurance program to adjust the eligibility determination for single adults and parents who have an offer of employer sponsored insurance the amendment shall a be within existing appropriations for the utah premium partnership for health insurance program and b provide that adults who are up to of the federal poverty level are eligible for premium subsidies in the utah premium partnership for health insurance program for the fiscal year the department shall seek authority to increase the maximum premium subsidy per month for adults under the utah premium partnership for health insurance program to beginning with the fiscal year and in each subsequent fiscal year the department may increase premium subsidies for single adults and parents who have an offer of employer sponsored insurance to keep pace with the increase in insurance premium costs subject to appropriation of additional funding section section b which is renumbered from section is renumbered and amended to read b expanding the medicaid program as used in this section a cms means the centers for medicare and medicaid services in the united states department of health and human services b a federal poverty level means the same as that term is defined in section b c b medicaid expansion means an expansion of the medicaid program in accordance with this section d c medicaid expansion fund means the medicaid expansion fund created in section b b a as set forth in subsections through eligibility criteria for the medicaid program shall be expanded to cover additional low income individuals b the department shall continue to seek approval from cms to implement the medicaid waiver expansion as defined in section b c the department may implement any provision described in subsections b b iii through viii in a medicaid expansion if the department receives approval from cms to implement that provision the department shall expand the medicaid program in accordance with this subsection if the department a receives approval from cms to i expand medicaid coverage to eligible individuals whose income is below of the federal poverty level ii obtain maximum federal financial participation under u s c sec d b for enrolling an individual in the medicaid expansion under this subsection and iii permit the state to close enrollment in the medicaid expansion under this subsection if the department has insufficient funds to provide services to new enrollment under the medicaid expansion under this subsection b pays the state portion of costs for the medicaid expansion under this subsection with funds from i the medicaid expansion fund ii county contributions to the nonfederal share of medicaid expenditures or iii any other contributions funds or transfers from a nonstate agency for medicaid expenditures and c closes the medicaid program to new enrollment under the medicaid expansion under this subsection if the department projects that the cost of the medicaid expansion under this subsection will exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act a the department shall expand the medicaid program in accordance with this subsection if the department i receives approval from cms to a expand medicaid coverage to eligible individuals whose income is below of the federal poverty level b obtain maximum federal financial participation under u s c sec d y for enrolling an individual in the medicaid expansion under this subsection and c permit the state to close enrollment in the medicaid expansion under this subsection if the department has insufficient funds to provide services to new enrollment under the medicaid expansion under this subsection ii pays the state portion of costs for the medicaid expansion under this subsection with funds from a the medicaid expansion fund b county contributions to the nonfederal share of medicaid expenditures or c any other contributions funds or transfers from a nonstate agency for medicaid expenditures and iii closes the medicaid program to new enrollment under the medicaid expansion under this subsection if the department projects that the cost of the medicaid expansion under this subsection will exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act b the department shall submit a waiver an amendment to an existing waiver or a state plan amendment to cms to i administer federal funds for the medicaid expansion under this subsection according to a per capita cap developed by the department that includes an annual inflationary adjustment accounts for differences in cost among categories of medicaid expansion enrollees and provides greater flexibility to the state than the current medicaid payment model ii limit in certain circumstances as defined by the department the ability of a qualified entity to determine presumptive eligibility for medicaid coverage for an individual enrolled in a medicaid expansion under this subsection iii impose a lock out period if an individual enrolled in a medicaid expansion under this subsection violates certain program requirements as defined by the department iv allow an individual enrolled in a medicaid expansion under this subsection to remain in the medicaid program for up to a month certification period as defined by the department and v allow federal medicaid funds to be used for housing support for eligible enrollees in the medicaid expansion under this subsection a i if cms does not approve a waiver to expand the medicaid program in accordance with subsection a on or before january the department shall develop proposals to implement additional flexibilities and cost controls including cost sharing tools within a medicaid expansion under this subsection through a request to cms for a waiver or state plan amendment ii the request for a waiver or state plan amendment described in subsection a i shall include a a path to self sufficiency for qualified adults in the medicaid expansion that includes employment and training as defined in u s c sec d and b a requirement that an individual who is offered a private health benefit plan by an employer to enroll in the employer s health plan iii the department shall submit the request for a waiver or state plan amendment developed under subsection a i on or before march b notwithstanding sections b and j and in accordance with this subsection eligibility for the medicaid program shall be expanded to include all persons in the optional medicaid expansion population under the patient protection and affordable care act pub l no ppaca and the health care education reconciliation act of pub l no and related federal regulations and guidance on the earlier of i the day on which cms approves a waiver to implement the provisions described in subsections a ii a and b or ii july c the department shall seek a waiver or an amendment to an existing waiver from federal law to i implement each provision described in subsections b b iii through viii in a medicaid expansion under this subsection ii limit in certain circumstances as defined by the department the ability of a qualified entity to determine presumptive eligibility for medicaid coverage for an individual enrolled in a medicaid expansion under this subsection and iii impose a lock out period if an individual enrolled in a medicaid expansion under this subsection violates certain program requirements as defined by the department d the eligibility criteria in this subsection shall be construed to include all individuals eligible for the health coverage improvement program under section b e the department shall pay the state portion of costs for a medicaid expansion under this subsection entirely from i the medicaid expansion fund ii county contributions to the nonfederal share of medicaid expenditures or iii any other contributions funds or transfers from a nonstate agency for medicaid expenditures f if the costs of the medicaid expansion under this subsection exceed the funds available under subsection e i the department may reduce or eliminate optional medicaid services under this chapter and ii savings as determined by the department from the reduction or elimination of optional medicaid services under subsection f i shall be deposited into the medicaid expansion fund and iii the department may submit to cms a request for waivers or an amendment of existing waivers from federal law necessary to implement budget controls within the medicaid program to address the deficiency g if the costs of the medicaid expansion under this subsection are projected by the department to exceed the funds available in the current fiscal year under subsection e including savings resulting from any action taken under subsection f i the governor shall direct the department of health department of human services department and department of workforce services to reduce commitments and expenditures by an amount sufficient to offset the deficiency a proportionate to the share of total current fiscal year general fund appropriations for each of those agencies and b up to of each agency s total current fiscal year general fund appropriations ii the division of finance shall reduce allotments to the department of health department of human services department and department of workforce services by a percentage a proportionate to the amount of the deficiency and b up to of each agency s total current fiscal year general fund appropriations and iii the division of finance shall deposit the total amount from the reduced allotments described in subsection g ii into the medicaid expansion fund the department shall maximize federal financial participation in implementing this section including by seeking to obtain any necessary federal approvals or waivers notwithstanding sections and a county does not have to provide matching funds to the state for the cost of providing medicaid services to newly enrolled individuals who qualify for medicaid coverage under a medicaid expansion the department shall report to the social services appropriations subcommittee on or before november of each year that a medicaid expansion is operational a the number of individuals who enrolled in the medicaid expansion b costs to the state for the medicaid expansion c estimated costs to the state for the medicaid expansion for the current and following fiscal years d recommendations to control costs of the medicaid expansion and e as calculated in accordance with subsections b b and c b the state s net cost of the qualified medicaid expansion section section b which is renumbered from section is renumbered and amended to read b department standards for eligibility under medicaid funds for abortions a the department may develop standards and administer policies relating to eligibility under the medicaid program as long as they are consistent with subsection b b an applicant receiving medicaid assistance may be limited to particular types of care or services or to payment of part or all costs of care determined to be medically necessary the department may not provide any funds for medical hospital or other medical expenditures or medical services to otherwise eligible persons where the purpose of the assistance is to perform an abortion unless the life of the mother would be endangered if an abortion were not performed any employee of the department who authorizes payment for an abortion contrary to the provisions of this section is guilty of a class b misdemeanor and subject to forfeiture of office any person or organization that under the guise of other medical treatment provides an abortion under auspices of the medicaid program is guilty of a third degree felony and subject to forfeiture of license to practice medicine or authority to provide medical services and treatment section section b which is renumbered from section is renumbered and amended to read b contracts for provision of medical services federal provisions modifying department rules compliance with social security act the department may contract with other public or private agencies to purchase or provide medical services in connection with the programs of the division where these programs are used by other government entities contracts shall provide that other government entities in compliance with state and federal law regarding intergovernmental transfers transfer the state matching funds to the department in amounts sufficient to satisfy needs of the specified program contract terms shall include provisions for maintenance administration and service costs if a federal legislative or executive provision requires modifications or revisions in an eligibility factor established under this chapter as a condition for participation in medical assistance the department may modify or change its rules as necessary to qualify for participation the provisions of this section do not apply to department rules governing abortion the department shall comply with all pertinent requirements of the social security act and all orders rules and regulations adopted thereunder when required as a condition of participation in benefits under the social security act section section b which is renumbered from section is renumbered and amended to read b liability insurance required the medicaid program may not reimburse a home health agency as defined in section b for home health services provided to an enrollee unless the home health agency has liability coverage of at least per incident or an amount established by department rule made in accordance with title g chapter utah administrative rulemaking act section section b which is renumbered from section is renumbered and amended to read b federal aid authority of executive director the executive director with the approval of the governor may bind the state to any executive or legislative provisions promulgated or enacted by the federal government which invite the state to participate in the distribution disbursement or administration of any fund or service advanced offered or contributed in whole or in part by the federal government for purposes consistent with the powers and duties of the department such funds shall be used as provided in this chapter and be administered by the department for purposes related to medical assistance programs section section b which is renumbered from section is renumbered and amended to read b medical vendor rates medical vendor payments made to providers of services for and in behalf of recipient households shall be based upon predetermined rates from standards developed by the division in cooperation with providers of services for each type of service purchased by the division as far as possible the rates paid for services shall be established in advance of the fiscal year for which funds are to be requested section section b which is renumbered from section is renumbered and amended to read b enforcement of public assistance statutes the department shall enforce or contract for the enforcement of sections a a a a a and a to the extent that these sections pertain to benefits conferred or administered by the division under this chapter to the extent allowed under federal law or regulation the department may contract for services covered in section a insofar as that section pertains to benefits conferred or administered by the division under this chapter section section b which is renumbered from section is renumbered and amended to read b prohibited acts of state or local employees of medicaid program violation a misdemeanor each state or local employee responsible for the expenditure of funds under the state medicaid program each individual who formerly was such an officer or employee and each partner of such an officer or employee is prohibited for a period of one year after termination of such responsibility from committing any act the commission of which by an officer or employee of the united states government an individual who was such an officer or employee or a partner of such an officer or employee is prohibited by section or section of title united states code violation of this section is a class a misdemeanor section section b which is renumbered from section is renumbered and amended to read b rural hospitals for purposes of as used in this section rural hospital means a hospital located outside of a standard metropolitan statistical area as designated by the united states bureau of the census for purposes of the medicaid program the division of medicaid and health financing division may not discriminate among rural hospitals on the basis of size section section b which is renumbered from section is renumbered and amended to read b telemedicine reimbursement rulemaking a as used in this section communication by telemedicine is considered face to face contact between a health care provider and a patient under the state s medical assistance program if i the communication by telemedicine meets the requirements of administrative rules adopted in accordance with subsection and ii the health care services are eligible for reimbursement under the state s medical assistance program b this subsection applies to any managed care organization that contracts with the state s medical assistance program the reimbursement rate for telemedicine services approved under this section a shall be subject to reimbursement policies set by the state plan and b may be based on i a monthly reimbursement rate ii a daily reimbursement rate or iii an encounter rate the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act which establish a the particular telemedicine services that are considered face to face encounters for reimbursement purposes under the state s medical assistance program and b the reimbursement methodology for the telemedicine services designated under subsection a section section b which is renumbered from section is renumbered and amended to read b reimbursement of telemedicine services and telepsychiatric consultations as used in this section a telehealth services means the same as that term is defined in section b b telemedicine services means the same as that term is defined in section b c telepsychiatric consultation means a consultation between a physician and a board certified psychiatrist both of whom are licensed to engage in the practice of medicine in the state that utilizes i the health records of the patient provided from the patient or the referring physician ii a written evidence based patient questionnaire and iii telehealth services that meet industry security and privacy standards including compliance with the a health insurance portability and accountability act and b health information technology for economic and clinical health act pub l no stat as amended this section applies to a a managed care organization that contracts with the medicaid program and b a provider who is reimbursed for health care services under the medicaid program the medicaid program shall reimburse for telemedicine services at the same rate that the medicaid program reimburses for other health care services the medicaid program shall reimburse for telepsychiatric consultations at a rate set by the medicaid program section section b which is renumbered from section is renumbered and amended to read b process to promote health insurance coverage for children the department in collaboration with the department of workforce services and the state board of education shall develop a process to promote health insurance coverage for a child in school when a the child applies for free or reduced price school lunch b a child enrolls in or registers in school and c other appropriate school related opportunities the department in collaboration with the department of workforce services shall promote and facilitate the enrollment of children identified under subsection without health insurance in the utah children s health insurance program the medicaid program or the utah premium partnership for health insurance program section section b which is renumbered from section is renumbered and amended to read b medicaid continuous eligibility promoting payment and delivery reform in accordance with subsection and within appropriations from the legislature the department may amend the state medicaid plan to a create continuous eligibility for up to months for an individual who has qualified for the state medicaid program b provide incentives in managed care contracts for an individual to obtain appropriate care in appropriate settings and c require the managed care system to accept the risk of managing the medicaid population assigned to the plan amendment in return for receiving the benefits of providing quality and cost effective care if the department amends the state medicaid plan under subsection a or b the department a shall ensure that the plan amendment i is cost effective for the state medicaid program ii increases the quality and continuity of care for recipients and iii calculates and transfers administrative savings from continuous enrollment from the department of workforce services to the department of health department and b may limit the plan amendment under subsection a or b to select geographic areas or specific medicaid populations the department may seek approval for a state plan amendment waiver or a demonstration project from the secretary of the united states department of health and human services if necessary to implement a plan amendment under subsection a or b section section b which is renumbered from section is renumbered and amended to read b patient notice of health care provider privacy practices a for purposes of this section i health care provider means a health care provider as defined in section b who a receives payment for medical services from the medicaid program established in this chapter or the children s health insurance program established in chapter utah children s health insurance act section b and b submits a patient s personally identifiable information to the medicaid eligibility database or the children s health insurance program eligibility database ii hipaa means c f r parts and health insurance portability and accountability act of as amended b beginning july this section applies to the medicaid program the children s health insurance program created in chapter utah children s health insurance act section b and a health care provider a health care provider shall as part of the notice of privacy practices required by hipaa provide notice to the patient or the patient s personal representative that the health care provider either has or may submit personally identifiable information about the patient to the medicaid eligibility database and the children s health insurance program eligibility database the medicaid program and the children s health insurance program may not give a health care provider access to the medicaid eligibility database or the children s health insurance program eligibility database unless the health care provider s notice of privacy practices complies with subsection the department may adopt an administrative rule to establish uniform language for the state requirement regarding notice of privacy practices to patients required under subsection section section b which is renumbered from section is renumbered and amended to read b optional medicaid expansion the department and the governor may not expand the state s medicaid program under ppaca unless a the department expands medicaid in accordance with section b or b i the governor or the governor s designee has reported the intention to expand the state medicaid program under ppaca to the legislature in compliance with the legislative review process in section b and ii the governor submits the request for expansion of the medicaid program for optional populations to the legislature under the high impact federal funds request process required by section j a the department shall request approval from cms for waivers from federal statutory and regulatory law necessary to implement the health coverage improvement program under section b b the health coverage improvement program under section b is not subject to the requirements in subsection section section b which is renumbered from section is renumbered and amended to read b medicaid vision services request for proposals the department may select one or more contractors in accordance with title g chapter a utah procurement code to provide vision services to the medicaid populations that are eligible for vision services as described in department rules without restricting provider participation and within existing appropriations from the legislature section section b which is renumbered from section is renumbered and amended to read b review of claims audit and investigation procedures a the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act and in consultation with providers and health care professionals subject to audit and investigation under the state medicaid program to establish procedures for audits and investigations that are fair and consistent with the duties of the department as the single state agency responsible for the administration of the medicaid program under section b and title xix of the social security act b if the providers and health care professionals do not agree with the rules proposed or adopted by the department under subsection a the providers or health care professionals may i request a hearing for the proposed administrative rule or seek any other remedies under the provisions of title g chapter utah administrative rulemaking act and ii request a review of the rule by the legislature s administrative rules review and general oversight committee created in section g the department shall a notify and educate providers and health care professionals subject to audit and investigation under the medicaid program of the providers and health care professionals responsibilities and rights under the administrative rules adopted by the department under the provisions of this section b ensure that the department or any entity that contracts with the department to conduct audits i has on staff or contracts with a medical or dental professional who is experienced in the treatment billing and coding procedures used by the type of provider being audited and ii uses the services of the appropriate professional described in subsection b i if the provider who is the subject of the audit disputes the findings of the audit c ensure that a finding of overpayment or underpayment to a provider is not based on extrapolation as defined in section a unless i there is a determination that the level of payment error involving the provider exceeds a error rate a for a sample of claims for a particular service code and b over a three year period of time ii documented education intervention has failed to correct the level of payment error and iii the value of the claims for the provider in aggregate exceeds in reimbursement for a particular service code on an annual basis and d require that any entity with which the office contracts for the purpose of conducting an audit of a service provider shall be paid on a flat fee basis for identifying both overpayments and underpayments a if the department or a contractor on behalf of the department i intends to implement the use of extrapolation as a method of auditing claims the department shall prior to adopting the extrapolation method of auditing report its intent to use extrapolation to the social services appropriations subcommittee and ii determines subsections c i through iii are applicable to a provider the department or the contractor may use extrapolation only for the service code associated with the findings under subsections c i through iii b i if extrapolation is used under this section a provider may at the provider s option appeal the results of the audit based on a each individual claim or b the extrapolation sample ii nothing in this section limits a provider s right to appeal the audit under title g general government title g chapter administrative procedures act the medicaid program and its manual or rules or other laws or rules that may provide remedies to providers section section b which is renumbered from section is renumbered and amended to read b medicaid intergovernmental transfer report approval requirements as used in this section a i intergovernmental transfer means the transfer of public funds from a a local government entity to another nonfederal governmental entity or b from a nonfederal government owned health care facility regulated under chapter health care facility licensing and inspection act chapter part health care facility licensing and inspection to another nonfederal governmental entity ii intergovernmental transfer does not include a the transfer of public funds from one state agency to another state agency or b a transfer of funds from the university of utah hospitals and clinics b i intergovernmental transfer program means a federally approved reimbursement program or category that is authorized by the medicaid state plan or waiver authority for intergovernmental transfers ii intergovernmental transfer program does not include the addition of a provider to an existing intergovernmental transfer program c local government entity means a county city town special service district local district or local education agency as that term is defined in section j d non state government entity means a hospital authority hospital district health care district special service district county or city a an entity that receives federal medicaid dollars from the department as a result of an intergovernmental transfer shall on or before august and on or before august each year thereafter provide the department with i information regarding the payments funded with the intergovernmental transfer as authorized by and consistent with state and federal law ii information regarding the entity s ability to repay federal funds to the extent required by the department in the contract for the intergovernmental transfer and iii other information reasonably related to the intergovernmental transfer that may be required by the department in the contract for the intergovernmental transfer b on or before october and on or before october each subsequent year the department shall prepare a report for the executive appropriations committee that includes i the amount of each intergovernmental transfer under subsection a ii a summary of changes to cms regulations and practices that are known by the department regarding federal funds related to an intergovernmental transfer program and iii other information the department gathers about the intergovernmental transfer under subsection a the department shall not create a new intergovernmental transfer program after july unless the department reports to the executive appropriations committee in accordance with section j before submitting the new intergovernmental transfer program for federal approval the report shall include information required by subsection j d and the analysis required in subsections a and b a the department shall enter into new nursing care facility non state government owned upper payment limit program contracts and contract amendments adding new nursing care facilities and new non state government entity operators in accordance with this subsection b i if the nursing care facility expects to receive less than in federal funds each year from the nursing care facility non state government owned upper payment limit program excluding seed funding and administrative fees paid by the non state government entity the department shall enter into a nursing care facility non state government owned upper payment limit program contract with the non state government entity operator of the nursing care facility ii if the nursing care facility expects to receive between and in federal funds each year from the nursing care facility non state government owned upper payment limit program excluding seed funding and administrative fees paid by the non state government entity the department shall enter into a nursing care facility non state government owned upper payment limit program contract with the non state government entity operator of the nursing care facility after receiving the approval of the executive appropriations committee iii if the nursing care facility expects to receive more than in federal funds each year from the nursing care facility non state government owned upper payment limit program excluding seed funding and administrative fees paid by the non state government entity the department may not approve the application without obtaining approval from the legislature and the governor c a non state government entity may not participate in the nursing care facility non state government owned upper payment limit program unless the non state government entity is a special service district county or city that operates a hospital or holds a license under chapter health care facility licensing and inspection act chapter part health care facility licensing and inspection d each non state government entity that participates in the nursing care facility non state government owned upper payment limit program shall certify to the department that i the non state government entity is a local government entity that is able to make an intergovernmental transfer under applicable state and federal law ii the non state government entity has sufficient public funds or other permissible sources of seed funding that comply with the requirements in c f r part subpart b iii the funds received from the nursing care facility non state government owned upper payment limit program are a for each nursing care facility available for patient care until the end of the non state government entity s fiscal year and b used exclusively for operating expenses for nursing care facility operations patient care capital expenses rent royalties and other operating expenses and iv the non state government entity has completed all licensing enrollment and other forms and documents required by federal and state law to register a change of ownership with the department and with cms the department shall add a nursing care facility to an existing nursing care facility non state government owned upper payment limit program contract if a the nursing care facility is managed by or affiliated with the same non state government entity that also manages one or more nursing care facilities that are included in an existing nursing care facility non state government owned upper payment limit program contract and b the non state government entity makes the certification described in subsection d ii the department may not increase the percentage of the administrative fee paid by a non state government entity to the department under the nursing care facility non state government owned upper payment limit program the department may not condition participation in the nursing care facility non state government owned upper payment limit program on a a requirement that the department be allowed to direct or determine the types of patients that a non state government entity will treat or the course of treatment for a patient in a non state government nursing care facility or b a requirement that a non state government entity or nursing care facility post a bond purchase insurance or create a reserve account of any kind the non state government entity shall have the primary responsibility for ensuring compliance with subsection d ii a the department may not enter into a new nursing care facility non state government owned upper payment limit program contract before january b subsection a does not apply to i a new nursing care facility non state government owned upper payment limit program contract that was included in the federal funds request summary under section j for fiscal year or ii a nursing care facility that is operated or managed by the same company as a nursing care facility that was included in the federal funds request summary under section j for fiscal year section section b which is renumbered from section is renumbered and amended to read b screening brief intervention and referral to treatment medicaid reimbursement as used in this section a controlled substance prescriber means a controlled substance prescriber as that term is defined in section who i has a record of having completed sbirt training in accordance with subsection before providing the sbirt services and ii is a medicaid enrolled health care provider b sbirt means the same as that term is defined in section the department shall reimburse a controlled substance prescriber who provides sbirt services to a medicaid enrollee who is years of age old or older for the sbirt services section section b which is renumbered from section is renumbered and amended to read b prescribing policies for opioid prescriptions the department may implement a prescribing policy for certain opioid prescriptions that is substantially similar to the prescribing policies required in section a the department may amend the state program and apply for waivers for the state program if necessary to implement subsection section section b which is renumbered from section is renumbered and amended to read b reimbursement for long acting reversible contraception immediately following childbirth as used in this section long acting reversible contraception means a contraception method that requires administration less than once per month including a an intrauterine device and b a contraceptive implant the division shall separately identify and reimburse from other labor and delivery services within the medicaid program the provision and insertion of long acting reversible contraception immediately after childbirth section section b which is renumbered from section is renumbered and amended to read b coverage of exome sequence testing as used in this section exome sequence testing means a genomic technique for sequencing the genome of an individual for diagnostic purposes the medicaid program shall reimburse for exome sequence testing a for an enrollee who i is younger than years of age old and ii who remains undiagnosed after exhausting all other appropriate diagnostic related tests b performed by a nationally recognized provider with significant experience in exome sequence testing c that is medically necessary and d at a rate set by the medicaid program section section b which is renumbered from section is renumbered and amended to read b reimbursement for nonemergency secured behavioral health transport providers the department may not reimburse a nonemergency secured behavioral health transport provider that is designated under section a b section section b which is renumbered from section is renumbered and amended to read b children s health care coverage program as used in this section a chip means the children s health insurance program created in section b b program means the children s health care coverage program created in subsection a there is created the children s health care coverage program within the department b the purpose of the program is to i promote health insurance coverage for children in accordance with section b ii conduct research regarding families who are eligible for medicaid and chip to determine awareness and understanding of available coverage iii analyze trends in disenrollment and identify reasons that families may not be renewing enrollment including any barriers in the process of renewing enrollment iv administer surveys to recently enrolled chip and children s medicaid enrollees to identify a how the enrollees learned about coverage and b any barriers during the application process v develop promotional material regarding chip and children s medicaid eligibility including outreach through social media video production and other media platforms vi identify ways that the eligibility website for enrollment in chip and children s medicaid can be redesigned to increase accessibility and enhance the user experience vii identify outreach opportunities including partnerships with community organizations including a schools b small businesses c unemployment centers d parent teacher associations and e youth athlete clubs and associations and viii develop messaging to increase awareness of coverage options that are available through the department a the department may not delegate implementation of the program to a private entity b notwithstanding subsection a the department may contract with a media agency to conduct the activities described in subsection b iv and vii section section b which is renumbered from section is renumbered and amended to read b reimbursement for diabetes prevention program as used in this section dpp means the national diabetes prevention program developed by the united states centers for disease control and prevention beginning july the medicaid program shall reimburse a provider for an enrollee s participation in the dpp if the enrollee a meets the dpp s eligibility requirements and b has not previously participated in the dpp after july while enrolled in the medicaid program subject to appropriation the medicaid program may set the rate for reimbursement the department may apply for a state plan amendment if necessary to implement this section a on or after july but before october the department shall provide a written report regarding the efficacy of the dpp and reimbursement under this section to the health and human services interim committee b the report described in subsection a shall include i the total number of enrollees with a prediabetic condition as of july ii the total number of enrollees as of july with a diagnosis of type diabetes iii the total number of enrollees who participated in the dpp iv the total cost incurred by the state to implement this section and v any conclusions that can be drawn regarding the impact of the dpp on the rate of type diabetes for enrollees section section b which is renumbered from section is renumbered and amended to read b behavioral health delivery working group as used in this section targeted adult medicaid program means the same as that term is defined in section b on or before may the department shall convene a working group to collaborate with the department on a establishing specific and measurable metrics regarding i compliance of managed care organizations in the state with federal medicaid managed care requirements ii timeliness and accuracy of authorization and claims processing in accordance with medicaid policy and contract requirements iii reimbursement by managed care organizations in the state to providers to maintain adequacy of access to care iv availability of care management services to meet the needs of medicaid eligible individuals enrolled in the plans of managed care organizations in the state and v timeliness of resolution for disputes between a managed care organization and the managed care organization s providers and enrollees b improving the delivery of behavioral health services in the medicaid program c proposals to implement the delivery system adjustments authorized under subsection b and d issues that are identified by managed care organizations behavioral health service providers and the department the working group convened under subsection shall a meet quarterly and b consist of at least the following individuals i the executive director or the executive director s designee ii for each medicaid accountable care organization with which the department contracts an individual selected by the accountable care organization iii five individuals selected by the department to represent various types of behavioral health services providers including at a minimum individuals who represent providers who provide the following types of services a acute inpatient behavioral health treatment b residential treatment c intensive outpatient or partial hospitalization treatment and d general outpatient treatment iv a representative of an association that represents behavioral health treatment providers in the state designated by the utah behavioral healthcare council convened by the utah association of counties v a representative of an organization representing behavioral health organizations vi the chair of the utah substance use and mental health advisory council created in section m vii a representative of an association that represents local authorities who provide public behavioral health care designated by the department viii one member of the senate appointed by the president of the senate and ix one member of the house of representatives appointed by the speaker of the house of representatives the working group convened under this section shall recommend to the department a specific and measurable metrics under subsection a b how physical and behavioral health services may be integrated for the targeted adult medicaid program including ways the department may address issues regarding i filing of claims ii authorization and reauthorization for treatment services iii reimbursement rates and iv other issues identified by the department behavioral health services providers or medicaid managed care organizations c ways to improve delivery of behavioral health services to enrollees including changes to statute or administrative rule and d wraparound service coverage for enrollees who need specific nonclinical services to ensure a path to success section section b which is renumbered from section is renumbered and amended to read b adjudicative proceedings related to medicaid funds if a proceeding of the department under title g chapter administrative procedures act relates in any way to recovery of medicaid funds a the presiding officer shall be designated by the executive director of the department and report directly to the executive director or in the discretion of the executive director report directly to the director of the office of internal audit and b the decision of the presiding officer is the recommended decision to the executive director of the department or a designee of the executive director who is not in the division subsection does not apply to hearings conducted by the department of workforce services relating to medical assistance eligibility determinations if a proceeding of the department under title g chapter administrative procedures act relates in any way to medicaid or medicaid funds the following may attend and present evidence or testimony at the proceeding a the director of the office of internal audit or the director s designee and b the inspector general of medicaid services or the inspector general s designee in relation to a proceeding of the department under title g chapter administrative procedures act a person may not outside of the actual proceeding attempt to influence the decision of the presiding officer section section b which is renumbered from section is renumbered and amended to read b medical assistance accountability division duties reporting as used in this section a abuse means i an action or practice that a is inconsistent with sound fiscal business or medical practices and b results or may result in unnecessary medicaid related costs or other medical or hospital assistance costs or ii reckless or negligent upcoding b fraud means intentional or knowing i deception misrepresentation or upcoding in relation to medicaid funds costs claims reimbursement or practice or ii deception or misrepresentation in relation to medical or hospital assistance funds costs claims reimbursement or practice c upcoding means assigning an inaccurate billing code for a service that is payable or reimbursable by medicaid funds if the correct billing code for the service taking into account reasonable opinions derived from official published coding definitions would result in a lower medicaid payment or reimbursement d waste means overutilization of resources or inappropriate payment the division shall a develop and implement procedures relating to medicaid funds and medical or hospital assistance funds to ensure that providers do not receive a i duplicate payments for the same goods or services b ii payment for goods or services by resubmitting a claim for which i a payment has been disallowed on the grounds that payment would be a violation of federal or state law administrative rule or the state plan and ii b the decision to disallow the payment has become final c iii payment for goods or services provided after a recipient s death including payment for pharmaceuticals or long term care or d iv payment for transporting an unborn infant b consult with the centers for medicaid and medicare services cms other states and the office of inspector general of medicaid services to determine and implement best practices for discovering and eliminating fraud waste and abuse of medicaid funds and medical or hospital assistance funds c actively seek repayment from providers for improperly used or paid a i medicaid funds and b ii medical or hospital assistance funds d coordinate track and keep records of all division efforts to obtain repayment of the funds described in subsection c and the results of those efforts e keep medicaid pharmaceutical costs as low as possible by actively seeking to obtain pharmaceuticals at the lowest price possible including on a quarterly basis for the pharmaceuticals that represent the highest of state medicaid expenditures for pharmaceuticals and on an annual basis for the remaining pharmaceuticals a i tracking changes in the price of pharmaceuticals b ii checking the availability and price of generic drugs c iii reviewing and updating the state s maximum allowable cost list and d iv comparing pharmaceutical costs of the state medicaid program to available pharmacy price lists and f provide training on an annual basis to the employees of the division who make decisions on billing codes or who are in the best position to observe and identify upcoding in order to avoid and detect upcoding section section b which is renumbered from section is renumbered and amended to read b medical assistance from division or department of workforce services and compliance under adoption assistance interstate compact penalty for fraudulent claim as used in this section a adoption assistance means the same as that term is defined in section b adoption assistance agreement means the same as that term is defined in section c adoption assistance interstate compact means an agreement executed by the division of child and family services with any other state in accordance with section a a child who is a resident of this state and is the subject of an adoption assistance interstate compact is entitled to receive medical assistance from the division and the department of workforce services by filing a certified copy of the child s adoption assistance agreement with the division or the department of workforce services b the adoptive parent of the child described in subsection a shall annually provide the division or the department of workforce services with evidence verifying that the adoption assistance agreement is still effective the department of workforce services shall consider the recipient of medical assistance under this section as the department of workforce services does any other recipient of medical assistance under an adoption assistance agreement executed by the division of child and family services a a person may not submit a claim for payment or reimbursement under this section that the person knows is false misleading or fraudulent b a violation of subsection a is a third degree felony the division and the department of workforce services shall a cooperate with the division of child and family services in regard to an adoption assistance interstate compact and b comply with an adoption assistance interstate compact section section b which is renumbered from section is renumbered and amended to read part medicaid waivers b medicaid waiver for independent foster care adolescents for purposes of as used in this section an independent foster care adolescent includes any individual who reached years of age old while in the custody of the division of child and family services or the department of human services department if the division of child and family services department was the primary case manager or a federally recognized indian tribe an independent foster care adolescent is eligible when funds are available for medicaid coverage until the individual reaches years of age old before july the division shall submit a state medicaid plan amendment to the center for medicaid services cms to provide medical coverage for independent foster care adolescents effective fiscal year section section b which is renumbered from section is renumbered and amended to read b waivers to maximize replacement of fee for service delivery model cost of mandated program changes the department shall develop a waiver program in the medicaid program to replace the fee for service delivery model with one or more risk based delivery models the waiver program shall a restructure the program s provider payment provisions to reward health care providers for delivering the most appropriate services at the lowest cost and in ways that compared to services delivered before implementation of the waiver program maintain or improve recipient health status b restructure the program s cost sharing provisions and other incentives to reward recipients for personal efforts to i maintain or improve their health status and ii use providers that deliver the most appropriate services at the lowest cost c identify the evidence based practices and measures risk adjustment methodologies payment systems funding sources and other mechanisms necessary to reward providers for delivering the most appropriate services at the lowest cost including mechanisms that i pay providers for packages of services delivered over entire episodes of illness rather than for individual services delivered during each patient encounter and ii reward providers for delivering services that make the most positive contribution to a recipient s health status d limit total annual per patient per month expenditures for services delivered through fee for service arrangements to total annual per patient per month expenditures for services delivered through risk based arrangements covering similar recipient populations and services and e except as provided in subsection limit the rate of growth in per patient per month general fund expenditures for the program to the rate of growth in general fund expenditures for all other programs when the rate of growth in the general fund expenditures for all other programs is greater than zero to the extent possible the department shall operate the waiver program with the input of stakeholder groups representing those who will be affected by the waiver program a for purposes of this subsection mandated program change shall be determined by the department in consultation with the medicaid accountable care organizations and may include a change to the state medicaid program that is required by state or federal law state or federal guidance policy or the state medicaid plan b a mandated program change shall be included in the base budget for the medicaid program for the fiscal year in which the medicaid program adopted the mandated program change c the mandated program change is not subject to the limit on the rate of growth in per patient per month general fund expenditures for the program established in subsection e until the fiscal year following the fiscal year in which the medicaid program adopted the mandated program change a managed care organization or a pharmacy benefit manager that provides a pharmacy benefit to an enrollee shall establish a unique group number payment classification number or bank identification number for each medicaid managed care organization plan for which the managed care organization or pharmacy benefit manager provides a pharmacy benefit section section b which is renumbered from section is renumbered and amended to read b base budget appropriations for medicaid accountable care organizations and behavioral health plans forecast of behavioral health services cost as used in this section a aco means an accountable care organization that contracts with the state s medicaid program for i physical health services or ii integrated physical and behavioral health services b base budget means the same as that term is defined in legislative rule c behavioral health plan means a managed care or fee for service delivery system that contracts with or is operated by the department to provide behavioral health services to medicaid eligible individuals d behavioral health services means mental health or substance use treatment or services e general fund growth factor means the amount determined by dividing the next fiscal year ongoing general fund revenue estimate by current fiscal year ongoing appropriations from the general fund f next fiscal year ongoing general fund revenue estimate means the next fiscal year ongoing general fund revenue estimate identified by the executive appropriations committee in accordance with legislative rule for use by the office of the legislative fiscal analyst in preparing budget recommendations g pmpm means per member per month funding if the general fund growth factor is less than the next fiscal year base budget shall subject to subsection include an appropriation to the department in an amount necessary to ensure that the next fiscal year pmpm for acos and behavioral health plans equals the current fiscal year pmpm for the acos and behavioral health plans multiplied by if the general fund growth factor is greater than or equal to but less than the next fiscal year base budget shall subject to subsection include an appropriation to the department in an amount necessary to ensure that the next fiscal year pmpm for acos and behavioral health plans equals the current fiscal year pmpm for the acos and behavioral health plans multiplied by the general fund growth factor if the general fund growth factor is greater than or equal to the next fiscal year base budget shall subject to subsection include an appropriation to the department in an amount necessary to ensure that the next fiscal year pmpm for acos and behavioral health plans is greater than or equal to the current fiscal year pmpm for the acos and behavioral health plans multiplied by and less than or equal to the current fiscal year pmpm for the acos and behavioral health plans multiplied by the general fund growth factor the appropriations provided to the department for behavioral health plans under this section shall be reduced by the amount contributed by counties in the current fiscal year for behavioral health plans in accordance with subsections k and a x in order for the department to estimate the impact of subsections through before identification of the next fiscal year ongoing general fund revenue estimate the governor s office of planning and budget shall in cooperation with the office of the legislative fiscal analyst develop an estimate of ongoing general fund revenue for the next fiscal year and provide the estimate to the department no later than november of each year the office of the legislative fiscal analyst shall include an estimate of the cost of behavioral health services in any state medicaid funding or savings forecast that is completed in coordination with the department and the governor s office of planning and budget section section b which is renumbered from section is renumbered and amended to read b incentives to appropriately use emergency department services a this section applies to the medicaid program and to the utah children s health insurance program created in chapter utah children s health insurance act section b b as used in this section i managed care organization means a comprehensive full risk managed care delivery system that contracts with the medicaid program or the children s health insurance program to deliver health care through a managed care plan ii managed care plan means a risk based delivery service model authorized by section b and administered by a managed care organization iii non emergent care a means use of the emergency department to receive health care that is non emergent as defined by the department by administrative rule adopted in accordance with title g chapter utah administrative rulemaking act and the emergency medical treatment and active labor act and b does not mean the medical services provided to an individual required by the emergency medical treatment and active labor act including services to conduct a medical screening examination to determine if the recipient has an emergent or non emergent condition iv professional compensation means payment made for services rendered to a medicaid recipient by an individual licensed to provide health care services v super utilizer means a medicaid recipient who has been identified by the recipient s managed care organization as a person who uses the emergency department excessively as defined by the managed care organization a a managed care organization may in accordance with subsections b and c i audit emergency department services provided to a recipient enrolled in the managed care plan to determine if non emergent care was provided to the recipient and ii establish differential payment for emergent and non emergent care provided in an emergency department b i the differential payments under subsection a ii do not apply to professional compensation for services rendered in an emergency department ii except in cases of suspected fraud waste and abuse a managed care organization s audit of payment under subsection a i is limited to the month period of time after the date on which the medical services were provided to the recipient if fraud waste or abuse is alleged the managed care organization s audit of payment under subsection a i is limited to three years after the date on which the medical services were provided to the recipient c the audits and differential payments under subsections a and b apply to services provided to a recipient on or after july a managed care organization shall a use the savings under subsection to maintain and improve access to primary care and urgent care services for all medicaid or chip recipients enrolled in the managed care plan b provide viable alternatives for increasing primary care provider reimbursement rates to incentivize after hours primary care access for recipients and c report to the department on how the managed care organization complied with this subsection the department may a through administrative rule adopted by the department develop quality measurements that evaluate a managed care organization s delivery of i appropriate emergency department services to recipients enrolled in the managed care plan ii expanded primary care and urgent care for recipients enrolled in the managed care plan with consideration of the managed care organization s a delivery of primary care urgent care and after hours care through means other than the emergency department b recipient access to primary care providers and community health centers including evening and weekend access and c other innovations for expanding access to primary care and iii quality of care for the managed care plan members b compare the quality measures developed under subsection a for each managed care organization and c develop by administrative rule an algorithm to determine assignment of new unassigned recipients to specific managed care plans based on the plan s performance in relation to the quality measures developed pursuant to subsection a section section b which is renumbered from section is renumbered and amended to read b long term care insurance partnership as used in this section a qualified long term care insurance contract is as defined in u s c sec b b b qualified long term care insurance partnership is as defined in u s c sec p b c iii c state plan amendment means an amendment to the state medicaid plan drafted by the department in compliance with this section no later than july the department shall seek federal approval of a state plan amendment that creates a qualified long term care insurance partnership the department may make rules to comply with federal laws and regulations relating to qualified long term care insurance partnerships and qualified long term care insurance contracts section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for children with disabilities and complex medical needs as used in this section a additional eligibility criteria means the additional eligibility criteria set by the department under subsection e b complex medical condition means a physical condition of an individual that i results in severe functional limitations for the individual and ii is likely to a last at least months or b result in death c program means the program for children with complex medical conditions created in subsection d qualified child means a child who i is less than years old ii is diagnosed with a complex medical condition iii has a condition that meets the definition of disability in u s c sec and iv meets the additional eligibility criteria the department shall apply for a medicaid home and community based waiver with cms to implement within the state medicaid program the program described in subsection if the waiver described in subsection is approved the department shall offer a program that a as funding permits provides treatment for qualified children b if approved by cms and as funding permits beginning in fiscal year provides on an ongoing basis treatment for more qualified children than the program provided treatment for during fiscal year and c accepts applications for the program on an ongoing basis i d requires periodic reevaluations of an enrolled child s eligibility and other applicants or eligible children waiting for services in the program based on the additional eligibility criteria and ii e at the time of reevaluation allows the department to disenroll a child based on the prioritization described in subsection a and additional eligibility criteria the department shall a establish by rule made in accordance with title g chapter utah administrative rulemaking act criteria to prioritize qualified children s participation in the program based on the following factors in the following priority order i the complexity of a qualified child s medical condition and ii the financial needs of the qualified child and the qualified child s family b convene a public process to determine the benefits and services to offer a qualified child under the program c evaluate on an ongoing basis the cost and effectiveness of the program d if funding for the program is reduced develop an evaluation process to reduce the number of children served based on the participation criteria established under subsection a and e establish by rule made in accordance with title g chapter utah administrative rulemaking act additional eligibility criteria based on the factors described in subsections a i and ii section section b which is renumbered from section is renumbered and amended to read b health coverage improvement program eligibility annual report expansion of eligibility for adults with dependent children as used in this section a adult in the expansion population means an individual who i is described in u s c sec a a a i viii and ii is not otherwise eligible for medicaid as a mandatory categorically needy individual b enhancement waiver program means the primary care network enhancement waiver program described in section b c federal poverty level means the poverty guidelines established by the secretary of the united states department of health and human services under u s c sec d health coverage improvement program means the health coverage improvement program described in subsections through e homeless i means an individual who is chronically homeless as determined by the department and ii includes someone who was chronically homeless and is currently living in supported housing for the chronically homeless f income eligibility ceiling means the percent of federal poverty level i established by the state in an appropriations act adopted pursuant to title j chapter budgetary procedures act and ii under which an individual may qualify for medicaid coverage in accordance with this section g targeted adult medicaid program means the program implemented by the department under subsections through beginning july the department shall amend the state medicaid plan to allow temporary residential treatment for substance abuse use for the traditional medicaid population in a short term non institutional hour facility without a bed capacity limit that provides rehabilitation services that are medically necessary and in accordance with an individualized treatment plan as approved by cms and as long as the county makes the required match under section beginning july the department shall amend the state medicaid plan to increase the income eligibility ceiling to a percentage of the federal poverty level designated by the department based on appropriations for the program for an individual with a dependent child before july the division shall submit to cms a request for waivers or an amendment of existing waivers from federal statutory and regulatory law necessary for the state to implement the health coverage improvement program in the medicaid program in accordance with this section a an adult in the expansion population is eligible for medicaid if the adult meets the income eligibility and other criteria established under subsection b an adult who qualifies under subsection shall receive medicaid coverage i through the traditional fee for service medicaid model in counties without medicaid accountable care organizations or the state s medicaid accountable care organization delivery system where implemented and subject to section b ii except as provided in subsection b iii for behavioral health through the counties in accordance with sections and iii that subject to section b integrates behavioral health services and physical health services with medicaid accountable care organizations in select geographic areas of the state that choose an integrated model and iv that permits temporary residential treatment for substance abuse use in a short term non institutional hour facility without a bed capacity limit as approved by cms that provides rehabilitation services that are medically necessary and in accordance with an individualized treatment plan a an individual is eligible for the health coverage improvement program under subsection if i at the time of enrollment the individual s annual income is below the income eligibility ceiling established by the state under subsection f and ii the individual meets the eligibility criteria established by the department under subsection b b based on available funding and approval from cms the department shall select the criteria for an individual to qualify for the medicaid program under subsection a ii based on the following priority i a chronically homeless individual ii if funding is available an individual a involved in the justice system through probation parole or court ordered treatment and b in need of substance abuse use treatment or mental health treatment as determined by the department or iii if funding is available an individual in need of substance abuse use treatment or mental health treatment as determined by the department c an individual who qualifies for medicaid coverage under subsections a and b may remain on the medicaid program for a month certification period as defined by the department eligibility changes made by the department under subsection f or b shall not apply to an individual during the month certification period the state may request a modification of the income eligibility ceiling and other eligibility criteria under subsection each fiscal year based on projected enrollment costs to the state and the state budget the current medicaid program and the health coverage improvement program when implemented shall coordinate with a state prison or county jail to expedite medicaid enrollment for an individual who is released from custody and was eligible for or enrolled in medicaid before incarceration notwithstanding sections and a county does not have to provide matching funds to the state for the cost of providing medicaid services to newly enrolled individuals who qualify for medicaid coverage under the health coverage improvement program under subsection if the enhancement waiver program is implemented the department a may not accept any new enrollees into the health coverage improvement program after the day on which the enhancement waiver program is implemented b shall transition all individuals who are enrolled in the health coverage improvement program into the enhancement waiver program c shall suspend the health coverage improvement program within one year after the day on which the enhancement waiver program is implemented d shall within one year after the day on which the enhancement waiver program is implemented use all appropriations for the health coverage improvement program to implement the enhancement waiver program and e shall work with cms to maintain any waiver for the health coverage improvement program while the health coverage improvement program is suspended under subsection c if after the enhancement waiver program takes effect the enhancement waiver program is repealed or suspended by either the state or federal government the department shall reinstate the health coverage improvement program and continue to accept new enrollees into the health coverage improvement program in accordance with the provisions of this section section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for delivery of adult dental services a before june the department shall ask cms to grant waivers from federal statutory and regulatory law necessary for the medicaid program to provide dental services in the manner described in subsection a b before june the department shall submit to cms a request for waivers or an amendment of existing waivers from federal law necessary for the state to provide dental services in accordance with subsections b i and d through g to an individual described in subsection b i c before june the department shall submit to the centers for medicare and medicaid services a request for waivers or an amendment to existing waivers from federal law necessary for the state to i provide dental services in accordance with subsections b ii and d through g to an individual described in subsection b ii and ii provide the services described in subsection h a to the extent funded the department shall provide services to only blind or disabled individuals as defined in u s c sec c a who are years old or older and eligible for the program b notwithstanding subsection a i if a waiver is approved under subsection b the department shall provide dental services to an individual who a qualifies for the health coverage improvement program described in section b and b is receiving treatment in a substance abuse treatment program as defined in section a b licensed under title a chapter licensure of programs and facilities chapter part human services programs and facilities and ii if a waiver is approved under subsection c i the department shall provide dental services to an individual who is an aged individual as defined in u s c sec c a c to the extent possible services to individuals described in subsection a shall be provided through the university of utah school of dentistry and the university of utah school of dentistry s associated statewide network d the department shall provide the services to individuals described in subsection b i by contracting with an entity that a has demonstrated experience working with individuals who are being treated for both a substance use disorder and a major oral health disease b operates a program targeted at the individuals described in subsection b that has demonstrated through a peer reviewed evaluation the effectiveness of providing dental treatment to those individuals described in subsection b c is willing to pay for an amount equal to the program s non federal share of the cost of providing dental services to the population described in subsection b and d is willing to pay all state costs associated with applying for the waiver described in subsection b and administering the program described in subsection b and ii through a fee for service payment model e the entity that receives the contract under subsection d i shall cover all state costs of the program described in subsection b f each fiscal year the university of utah school of dentistry shall in compliance with state and federal regulations regarding intergovernmental transfers transfer funds to the program in an amount equal to the program s non federal share of the cost of providing services under this section through the school during the fiscal year g if a waiver is approved under subsection c ii the department shall provide coverage for porcelain and porcelain to metal crowns if the services are provided i to an individual who qualifies for dental services under subsection b and ii by an entity that covers all state costs of a providing the coverage described in this subsection h g and b applying for the waiver described in subsection c h where possible the department shall ensure that services described in subsection a that are not provided by the university of utah school of dentistry or the university of utah school of dentistry s associated network are provided i through fee for service reimbursement until july and ii after july through the method of reimbursement used by the division for medicaid dental benefits i subject to appropriations by the legislature and as determined by the department the scope amount duration and frequency of services may be limited a if the waivers requested under subsection a are granted the medicaid program shall begin providing dental services in the manner described in subsection no later than july b if the waivers requested under subsection b are granted the medicaid program shall begin providing dental services to the population described in subsection b within days from the day on which the waivers are granted c if the waivers requested under subsection c i are granted the medicaid program shall begin providing dental services to the population described in subsection b ii within days after the day on which the waivers are granted if the federal share of the cost of providing dental services under this section will be less than during any portion of the next fiscal year the medicaid program shall cease providing dental services under this section no later than the end of the current fiscal year section section b which is renumbered from section is renumbered and amended to read b medicaid long term support services housing coordinator there is created within the medicaid program a full time equivalent position of medicaid long term support services housing coordinator the coordinator shall help medicaid recipients receive long term support services in a home or other community based setting rather than in a nursing home or other institutional setting by a working with municipalities counties the housing and community development division within the department of workforce services and others to identify community based settings available to recipients b working with the same entities to promote the development construction and availability of additional community based settings c training medicaid case managers and support coordinators on how to help medicaid recipients move from an institutional setting to a community based setting and d performing other related duties section section b which is renumbered from section is renumbered and amended to read b medicaid waiver expansion as used in this section a federal poverty level means the same as that term is defined in section b b medicaid waiver expansion means an expansion of the medicaid program in accordance with this section a before january the department shall apply to cms for approval of a waiver or state plan amendment to implement the medicaid waiver expansion b the medicaid waiver expansion shall i expand medicaid coverage to eligible individuals whose income is below of the federal poverty level ii obtain maximum federal financial participation under u s c sec d y for enrolling an individual in the medicaid program iii provide medicaid benefits through the state s medicaid accountable care organizations in areas where a medicaid accountable care organization is implemented iv integrate the delivery of behavioral health services and physical health services with medicaid accountable care organizations in select geographic areas of the state that choose an integrated model v include a path to self sufficiency including work activities as defined in u s c sec d for qualified adults vi require an individual who is offered a private health benefit plan by an employer to enroll in the employer s health plan vii sunset in accordance with subsection a and viii permit the state to close enrollment in the medicaid waiver expansion if the department has insufficient funding to provide services to additional eligible individuals if the medicaid waiver described in subsection a is approved the department may only pay the state portion of costs for the medicaid waiver expansion with appropriations from a the medicaid expansion fund created in section b b b county contributions to the non federal share of medicaid expenditures and c any other contributions funds or transfers from a non state agency for medicaid expenditures a in consultation with the department medicaid accountable care organizations and counties that elect to integrate care under subsection b iv shall collaborate on enrollment engagement of patients and coordination of services b as part of the provision described in subsection b iv the department shall apply for a waiver to permit the creation of an integrated delivery system i for any geographic area that expresses interest in integrating the delivery of services under subsection b iv and ii in which the department a may permit a local mental health authority to integrate the delivery of behavioral health services and physical health services b may permit a county local mental health authority or medicaid accountable care organization to integrate the delivery of behavioral health services and physical health services to select groups within the population that are newly eligible under the medicaid waiver expansion and c may make rules in accordance with title g chapter utah administrative rulemaking act to integrate payments for behavioral health services and physical health services to plans or providers a if federal financial participation for the medicaid waiver expansion is reduced below the authority of the department to implement the medicaid waiver expansion shall sunset no later than the next july after the date on which the federal financial participation is reduced b the department shall close the program to new enrollment if the cost of the medicaid waiver expansion is projected to exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act if the medicaid waiver expansion is approved by cms the department shall report to the social services appropriations subcommittee on or before november of each year that the medicaid waiver expansion is operational a the number of individuals who enrolled in the medicaid waiver program b costs to the state for the medicaid waiver program c estimated costs for the current and following state fiscal year and d recommendations to control costs of the medicaid waiver expansion section section b which is renumbered from section is renumbered and amended to read b primary care network enhancement waiver program as used in this section a enhancement waiver program means the primary care network enhancement waiver program described in this section b federal poverty level means the poverty guidelines established by the secretary of the united states department of health and human services under u s c sec c health coverage improvement program means the same as that term is defined in section b d income eligibility ceiling means the percentage of federal poverty level i established by the legislature in an appropriations act adopted pursuant to title j chapter budgetary procedures act and ii under which an individual may qualify for coverage in the enhancement waiver program in accordance with this section e optional population means the optional expansion population under ppaca if the expansion provides coverage for individuals at or above of the federal poverty level f primary care network means the state primary care network program created by the medicaid primary care network demonstration waiver obtained under section b the department shall continue to implement the primary care network program for qualified individuals under the primary care network program a the division shall apply for a medicaid waiver or a state plan amendment with cms to implement within the state medicaid program the enhancement waiver program described in this section within six months after the day on which i the division receives a notice from cms that the waiver for the medicaid waiver expansion submitted under section b medicaid waiver expansion will not be approved or ii the division withdraws the waiver for the medicaid waiver expansion submitted under section b medicaid waiver expansion b the division may not apply for a waiver under subsection a while a waiver request under section b medicaid waiver expansion is pending with cms an individual who is eligible for the enhancement waiver program may receive the following benefits under the enhancement waiver program a the benefits offered under the primary care network program b diagnostic testing and procedures c medical specialty care d inpatient hospital services e outpatient hospital services f outpatient behavioral health care including outpatient substance abuse use care and g for an individual who qualifies for the health coverage improvement program as approved by cms temporary residential treatment for substance abuse use in a short term non institutional hour facility without a bed capacity limit that provides rehabilitation services that are medically necessary and in accordance with an individualized treatment plan an individual is eligible for the enhancement waiver program if at the time of enrollment a the individual is qualified to enroll in the primary care network or the health coverage improvement program b the individual s annual income is below the income eligibility ceiling established by the legislature under subsection d and c the individual meets the eligibility criteria established by the department under subsection a based on available funding and approval from cms the department shall determine the criteria for an individual to qualify for the enhancement waiver program based on the following priority i adults in the expansion population as defined in section b who qualify for the health coverage improvement program ii adults with dependent children who qualify for the health coverage improvement program under subsection b iii adults with dependent children who do not qualify for the health coverage improvement program and iv if funding is available adults without dependent children b the number of individuals enrolled in the enhancement waiver program may not exceed of the number of individuals who were enrolled in the primary care network on december c the department may only use appropriations from the medicaid expansion fund created in section b b to fund the state portion of the enhancement waiver program the department may request a modification of the income eligibility ceiling and the eligibility criteria under subsection from cms each fiscal year based on enrollment in the enhancement waiver program projected enrollment in the enhancement waiver program costs to the state and the state budget the department may implement the enhancement waiver program by contracting with medicaid accountable care organizations to administer the enhancement waiver program in accordance with subsections and b and the department may use funds that have been appropriated for the health coverage improvement program to implement the enhancement waiver program if the department expands the state medicaid program to the optional population the department a except as provided in subsection may not accept any new enrollees into the enhancement waiver program after the day on which the expansion to the optional population is effective b shall suspend the enhancement waiver program within one year after the day on which the expansion to the optional population is effective and c shall work with cms to maintain the waiver for the enhancement waiver program submitted under subsection while the enhancement waiver program is suspended under subsection b if after the expansion to the optional population described in subsection takes effect the expansion to the optional population is repealed by either the state or the federal government the department shall reinstate the enhancement waiver program and continue to accept new enrollees into the enhancement waiver program in accordance with the provisions of this section section section b which is renumbered from section is renumbered and amended to read b limited family planning services for low income individuals as used in this section a i family planning services means family planning services that are provided under the state medicaid program including a sexual health education and family planning counseling and b other medical diagnosis treatment or preventative care routinely provided as part of a family planning service visit ii family planning services do not include an abortion as that term is defined in section b low income individual means an individual who i has an income level that is equal to or below of the federal poverty level and ii does not qualify for full coverage under the medicaid program before july the division shall apply for a medicaid waiver or a state plan amendment with cms to a offer a program that provides family planning services to low income individuals and b receive a federal match rate of of state expenditures for family planning services provided under the waiver or state plan amendment section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for mental health crisis lines and mobile crisis outreach teams as used in this section a local mental health crisis line means the same as that term is defined in section a b b mental health crisis means i a mental health condition that manifests itself in an individual by symptoms of sufficient severity that a prudent layperson who possesses an average knowledge of mental health issues could reasonably expect the absence of immediate attention or intervention to result in a serious danger to the individual s health or well being or b a danger to the health or well being of others or ii a mental health condition that in the opinion of a mental health therapist or the therapist s designee requires direct professional observation or the intervention of a mental health therapist c i mental health crisis services means direct mental health services and on site intervention that a mobile crisis outreach team provides to an individual suffering from a mental health crisis including the provision of safety and care plans prolonged mental health services for up to days and referrals to other community resources ii mental health crisis services includes a local mental health crisis lines and b the statewide mental health crisis line d mental health therapist means the same as that term is defined in section e mobile crisis outreach team or mcot means a mobile team of medical and mental health professionals that in coordination with local law enforcement and emergency medical service personnel provides mental health crisis services f statewide mental health crisis line means the same as that term is defined in section a b in consultation with the department of human services and the behavioral health crisis response commission created in section c the department shall develop a proposal to amend the state medicaid plan to include mental health crisis services including the statewide mental health crisis line local mental health crisis lines and mobile crisis outreach teams by january the department shall apply for a medicaid waiver with cms if necessary to implement within the state medicaid program the mental health crisis services described in subsection section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for coverage of mental health services in schools as used in this section local education agency means a a school district b a charter school or c the utah schools for the deaf and the blind in consultation with the department of human services and the state board of education the department shall develop a proposal to allow the state medicaid program to reimburse a local education agency a local mental health authority or a private provider for covered mental health services provided a in accordance with section e and b i at a local education agency building or facility or ii by an employee or contractor of a local education agency before january the department shall apply to cms for a state plan amendment to implement the coverage described in subsection section section b which is renumbered from section is renumbered and amended to read b coverage for in vitro fertilization and genetic testing as used in this section a qualified condition means i cystic fibrosis ii spinal muscular atrophy iii morquio syndrome iv myotonic dystrophy or v sickle cell anemia b qualified enrollee means an individual who i is enrolled in the medicaid program ii has been diagnosed by a physician as having a genetic trait associated with a qualified condition and iii intends to get pregnant with a partner who is diagnosed by a physician as having a genetic trait associated with the same qualified condition as the individual before january the department shall apply for a medicaid waiver or a state plan amendment with the centers for medicare and medicaid services within the united states department of health and human services to implement the coverage described in subsection if the waiver described in subsection is approved the medicaid program shall provide coverage to a qualified enrollee for a in vitro fertilization services and b genetic testing of a qualified enrollee who receives in vitro fertilization services under subsection a the medicaid program may not provide the coverage described in subsection before the later of a the day on which the waiver described in subsection is approved and b january before november and before november of every third year thereafter the department shall a calculate the change in state spending attributable to the coverage under this section and b report the amount described in subsection a a to the health and human services interim committee and the social services appropriations subcommittee section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for fertility preservation services as used in this section a iatrogenic infertility means an impairment of fertility or reproductive functioning caused by surgery chemotherapy radiation or other medical treatment b physician means an individual licensed to practice under title chapter utah medical practice act or title chapter utah osteopathic medical practice act c qualified enrollee means an individual who i is enrolled in the medicaid program ii has been diagnosed with a form of cancer by a physician and iii needs treatment for that cancer that may cause a substantial risk of sterility or iatrogenic infertility including surgery radiation or chemotherapy d standard fertility preservation service means a fertility preservation procedure and service that i is not considered experimental or investigational by the american society for reproductive medicine or the american society of clinical oncology and ii is consistent with established medical practices or professional guidelines published by the american society for reproductive medicine or the american society of clinical oncology including a sperm banking b oocyte banking c embryo banking d banking of reproductive tissues and e storage of reproductive cells and tissues before january the department shall apply for a medicaid waiver or a state plan amendment with cms to implement the coverage described in subsection if the waiver or state plan amendment described in subsection is approved the medicaid program shall provide coverage to a qualified enrollee for standard fertility preservation services the medicaid program may not provide the coverage described in subsection before the later of a the day on which the waiver described in subsection is approved and b january before november and before november of each third year after the department shall a calculate the change in state spending attributable to the coverage described in this section and b report the amount described in subsection a to the health and human services interim committee and the social services appropriations subcommittee section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for coverage of qualified inmates leaving prison or jail as used in this section a correctional facility means i a county jail ii the department of corrections created in section or iii a prison penitentiary or other institution operated by or under contract with the department of corrections for the confinement of an offender as defined in section b qualified inmate means an individual who i is incarcerated in a correctional facility and ii has a a chronic physical or behavioral health condition b a mental illness as defined in section a b or c an opioid use disorder before july the division shall apply for a medicaid waiver or a state plan amendment with cms to offer a program to provide medicaid coverage to a qualified inmate for up to days immediately before the day on which the qualified inmate is released from a correctional facility if the waiver or state plan amendment described in subsection is approved the department shall report to the health and human services interim committee each year before november while the waiver or state plan amendment is in effect regarding a the number of qualified inmates served under the program b the cost of the program and c the effectiveness of the program including i any reduction in the number of emergency room visits or hospitalizations by inmates after release from a correctional facility ii any reduction in the number of inmates undergoing inpatient treatment after release from a correctional facility iii any reduction in overdose rates and deaths of inmates after release from a correctional facility and iv any other costs or benefits as a result of the program if the waiver or state plan amendment described in subsection is approved a county that is responsible for the cost of a qualified inmate s medical care shall provide the required matching funds to the state for a any costs to enroll the qualified inmate for the medicaid coverage described in subsection b any administrative fees for the medicaid coverage described in subsection and c the medicaid coverage that is provided to the qualified inmate under subsection section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for inpatient care in an institution for mental diseases as used in this section institution for mental diseases means the same as that term is defined in c f r sec before august the division shall apply for a medicaid waiver or a state plan amendment with cms to offer a program that provides reimbursement for mental health services that are provided a in an institution for mental diseases that includes more than beds and b to an individual who receives mental health services in an institution for mental diseases for a period of more than days in a calendar month if the waiver or state plan amendment described in subsection is approved the department shall a coordinate with the department of human services to develop and offer the program described in subsection and b submit to the health and human services interim committee and the social services appropriations subcommittee any report that the department submits to cms that relates to the budget neutrality independent waiver evaluation or performance metrics of the program described in subsection within days after the day on which the report is submitted to cms notwithstanding sections and if the waiver or state plan amendment described in subsection is approved a county does not have to provide matching funds to the state for the mental health services described in subsection that are provided to an individual who qualifies for medicaid coverage under section or section b or b section section b which is renumbered from section is renumbered and amended to read b reimbursement for crisis management services provided in a behavioral health receiving center integration of payment for physical health services as used in this section a accountable care organization means the same as that term is defined in section b b behavioral health receiving center means the same as that term is defined in section a b c crisis management services means behavioral health services provided to an individual who is experiencing a mental health crisis d managed care organization means the same as that term is defined in c f r sec before july the division shall apply for a medicaid waiver or state plan amendment with cms to offer a program that provides reimbursement through a bundled daily rate for crisis management services that are delivered to an individual during the individual s stay at a behavioral health receiving center if the waiver or state plan amendment described in subsection is approved the department shall a implement the program described in subsection and b require a managed care organization that contracts with the state s medicaid program for behavioral health services or integrated health services to provide coverage for crisis management services that are delivered to an individual during the individual s stay at a behavioral health receiving center a the department may elect to integrate payment for physical health services provided in a behavioral health receiving center b in determining whether to integrate payment under subsection a the department shall consult with accountable care organizations and counties in the state section section b which is renumbered from section is renumbered and amended to read b crisis services reimbursement the department department shall submit a waiver or state plan amendment to allow for reimbursement for services provided to an individual who is eligible and enrolled in medicaid at the time this service is provided section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for respite care facility that provides services to homeless individuals as used in this section a adult in the expansion population means an adult i described in u s c sec a a a i viii and ii not otherwise eligible for medicaid as a mandatory categorically needy individual b homeless means the same as that term is defined in section b c medical respite care means short term housing with supportive medical services d medical respite facility means a residential facility that provides medical respite care to homeless individuals before january the department shall apply for a medicaid waiver or state plan amendment with cms to choose a single medical respite facility to reimburse for services provided to an individual who is a homeless and b an adult in the expansion population the department shall choose a medical respite facility best able to serve homeless individuals who are adults in the expansion population if the waiver or state plan amendment described in subsection is approved while the waiver or state plan amendment is in effect the department shall submit a report to the health and human services interim committee each year before november detailing a the number of homeless individuals served at the facility b the cost of the program and c the reduction of health care costs due to the program s implementation through administrative rule made in accordance with title g chapter utah administrative rulemaking act the department shall further define and limit the services described in this section provided to a homeless individual section section b which is renumbered from section is renumbered and amended to read b medicaid waiver expansion for extraordinary care reimbursement as used in this section a existing home and community based services waiver means an existing home and community based services waiver in the state that serves an individual i with an acquired brain injury ii with an intellectual or physical disability or iii who is years old or older b personal care services means a service that i is furnished to an individual who is not an inpatient nor a resident of a hospital nursing facility intermediate care facility or institution for mental diseases ii is authorized for an individual described in subsection b i in accordance with a plan of treatment iii is provided by an individual who is qualified to provide the services and iv is furnished in a home or another community based setting c waiver enrollee means an individual who is enrolled in an existing home and community based services waiver before july the department shall apply with cms for an amendment to an existing home and community based services waiver to implement a program to offer reimbursement to an individual who provides personal care services that constitute extraordinary care to a waiver enrollee who is the individual s spouse if cms approves the amendment described in subsection the department shall implement the program described in subsection the department shall by rule made in accordance with title g chapter utah administrative rulemaking act define extraordinary care for purposes of subsection section section b which is renumbered from section is renumbered and amended to read b delivery system adjustments for the targeted adult medicaid program as used in this section targeted adult medicaid program means the same as that term is defined in section b the department may implement the delivery system adjustments authorized under subsection only on the later of a july and b the department determining that the medicaid program including providers and managed care organizations are satisfying the metrics established in collaboration with the working group convened under subsection b the department may for individuals who are enrolled in the targeted adult medicaid program a integrate the delivery of behavioral and physical health in certain counties and b deliver behavioral health services through an accountable care organization where implemented before implementing the delivery system adjustments described in subsection in a county the department shall at a minimum seek input from a individuals who qualify for the targeted adult medicaid program who reside in the county b the county s executive officer legislative body and other county officials who are involved in the delivery of behavioral health services c the local mental health authority and local substance use abuse authority that serves the county d medicaid managed care organizations operating in the state including medicaid accountable care organizations e providers of physical or behavioral health services in the county who provide services to enrollees in the targeted adult medicaid program in the county and f other individuals that the department deems necessary if the department provides medicaid coverage through a managed care delivery system under this section the department shall include language in the department s managed care contracts that require the managed care plan to a be in compliance with federal medicaid managed care requirements b timely and accurately process authorizations and claims in accordance with medicaid policy and contract requirements c adequately reimburse providers to maintain adequacy of access to care d provide care management services sufficient to meet the needs of medicaid eligible individuals enrolled in the managed care plan s plan and e timely resolve any disputes between a provider or enrollee with the managed care plan the department may take corrective action if the managed care organization fails to comply with the terms of the managed care organization s contract section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for increased integrated health care reimbursement as used in this section a integrated health care setting means a health care or behavioral health care setting that provides integrated physical and behavioral health care services b local mental health authority means a local mental health authority described in section the department shall develop a proposal to allow the state medicaid program to reimburse a local mental health authority for covered physical health care services provided in an integrated health care setting to medicaid eligible individuals before december the department shall apply for a medicaid waiver or a state plan amendment with cms to implement the proposal described in subsection if the waiver or state plan amendment described in subsection is approved the department shall a implement the proposal described in subsection and b while the waiver or state plan amendment is in effect submit a report to the health and human services interim committee each year before november detailing i the number of patients served under the waiver or state plan amendment ii the cost of the waiver or state plan amendment and iii any benefits of the waiver or state plan amendment section section b which is renumbered from section is renumbered and amended to read part administration of medicaid programs drug utilization review and long term care facility certification b definitions as used in this part appropriate and medically necessary means regarding drug prescribing dispensing and patient usage that it is in conformity with the criteria and standards developed in accordance with this part board means the drug utilization review board created in section b certified program means a nursing care facility program with medicaid certification compendia means resources widely accepted by the medical profession in the efficacious use of drugs including american hospital formulary services service drug information u s pharmacopeia drug information a m a drug evaluations peer reviewed medical literature and information provided by manufacturers of drug products counseling means the activities conducted by a pharmacist to inform medicaid recipients about the proper use of drugs as required by the board under this part criteria means those predetermined and explicitly accepted elements used to measure drug use on an ongoing basis in order to determine if the use is appropriate medically necessary and not likely to result in adverse medical outcomes drug disease contraindications means that the therapeutic effect of a drug is adversely altered by the presence of another disease condition drug interactions means that two or more drugs taken by a recipient lead to clinically significant toxicity that is characteristic of one or any of the drugs present or that leads to interference with the effectiveness of one or any of the drugs drug utilization review or dur means the program designed to measure and assess on a retrospective and prospective basis the proper use of outpatient drugs in the medicaid program intervention means a form of communication utilized by the board with a prescriber or pharmacist to inform about or influence prescribing or dispensing practices medicaid certification means the right of a nursing care facility as a provider of a nursing care facility program to receive medicaid reimbursement for a specified number of beds within the facility a nursing care facility means the following facilities licensed by the department under chapter part health care facility licensing and inspection i skilled nursing facilities ii intermediate care facilities and iii an intermediate care facility for people with an intellectual disability b nursing care facility does not mean a critical access hospital that meets the criteria of u s c sec i c nursing care facility program means the personnel licenses services contracts and all other requirements that shall be met for a nursing care facility to be eligible for medicaid certification under this part and division rule overutilization or underutilization means the use of a drug in such quantities that the desired therapeutic goal is not achieved pharmacist means a person licensed in this state to engage in the practice of pharmacy under title chapter b pharmacy practice act physical facility means the buildings or other physical structures where a nursing care facility program is operated physician means a person licensed in this state to practice medicine and surgery under section or osteopathic medicine under section prospective dur means that part of the drug utilization review program that occurs before a drug is dispensed and that is designed to screen for potential drug therapy problems based on explicit and predetermined criteria and standards retrospective dur means that part of the drug utilization review program that assesses or measures drug use based on an historical review of drug use data against predetermined and explicit criteria and standards on an ongoing basis with professional input rural county means a county with a population of less than as determined by a the most recent official census or census estimate of the united states bureau of the census or b the most recent population estimate for the county from the utah population committee if a population figure for the county is not available under subsection a service area means the boundaries of the distinct geographic area served by a certified program as determined by the division in accordance with this part and division rule standards means the acceptable range of deviation from the criteria that reflects local medical practice and that is tested on the medicaid recipient database surs means the surveillance utilization review system of the medicaid program therapeutic appropriateness means drug prescribing and dispensing based on rational drug therapy that is consistent with criteria and standards therapeutic duplication means prescribing and dispensing the same drug or two or more drugs from the same therapeutic class where periods of drug administration overlap and where that practice is not medically indicated urban county means a county that is not a rural county section section b which is renumbered from section is renumbered and amended to read b dur board creation and membership expenses there is created a member drug utilization review board responsible for implementation of a retrospective and prospective dur program a except as required by subsection b as terms of current board members expire the executive director shall appoint each new member or reappointed member to a four year term b notwithstanding the requirements of subsection a the executive director shall at the time of appointment or reappointment adjust the length of terms to ensure that the terms of board members are staggered so that approximately half of the board is appointed every two years c persons appointed to the board may be reappointed upon completion of their terms but may not serve more than two consecutive terms d the executive director shall provide for geographic balance in representation on the board when a vacancy occurs in the membership for any reason the replacement shall be appointed for the unexpired term the membership shall be comprised of the following a four physicians who are actively engaged in the practice of medicine or osteopathic medicine in this state to be selected from a list of nominees provided by the utah medical association b one physician in this state who is actively engaged in academic medicine c three pharmacists who are actively practicing in retail pharmacy in this state to be selected from a list of nominees provided by the utah pharmaceutical association d one pharmacist who is actively engaged in academic pharmacy e one person who shall represent consumers f one person who shall represent pharmaceutical manufacturers to be recommended by the pharmaceutical manufacturers association and g one dentist licensed to practice in this state under title chapter dentist and dental hygienist practice act who is actively engaged in the practice of dentistry nominated by the utah dental association physician and pharmacist members of the board shall have expertise in clinically appropriate prescribing and dispensing of outpatient drugs the board shall elect a chair from among its members who shall serve a one year term and may serve consecutive terms a member may not receive compensation or benefits for the member s service but may receive per diem and travel expenses in accordance with a section a b section a and c rules made by the division of finance pursuant to sections a and a section section b which is renumbered from section is renumbered and amended to read b dur board responsibilities the board shall develop rules necessary to carry out its responsibilities as defined in this part oversee the implementation of a medicaid retrospective and prospective dur program in accordance with this part including responsibility for approving provisions of contractual agreements between the medicaid program and any other entity that will process and review medicaid drug claims and profiles for the dur program in accordance with this part develop and apply predetermined criteria and standards to be used in retrospective and prospective dur ensuring that the criteria and standards are based on the compendia and that they are developed with professional input in a consensus fashion with provisions for timely revision and assessment as necessary the dur standards developed by the board shall reflect the local practices of physicians in order to monitor a therapeutic appropriateness b overutilization or underutilization c therapeutic duplication d drug disease contraindications e drug drug interactions f incorrect drug dosage or duration of drug treatment and g clinical abuse and misuse develop select apply and assess interventions and remedial strategies for physicians pharmacists and recipients that are educational and not punitive in nature in order to improve the quality of care disseminate information to physicians and pharmacists to ensure that they are aware of the board s duties and powers provide written oral or electronic reminders of patient specific or drug specific information designed to ensure recipient physician and pharmacist confidentiality and suggest changes in prescribing or dispensing practices designed to improve the quality of care utilize face to face discussions between experts in drug therapy and the prescriber or pharmacist who has been targeted for educational intervention conduct intensified reviews or monitoring of selected prescribers or pharmacists create an educational program using data provided through dur to provide active and ongoing educational outreach programs to improve prescribing and dispensing practices either directly or by contract with other governmental or private entities provide a timely evaluation of intervention to determine if those interventions have improved the quality of care publish the annual drug utilization review report required under c f r sec develop a working agreement with related boards or agencies including the state board of pharmacy physicians licensing board and surs staff within the division in order to clarify areas of responsibility for each where those areas may overlap establish a grievance process for physicians and pharmacists under this part in accordance with title g chapter administrative procedures act publish and disseminate educational information to physicians and pharmacists concerning the board and the dur program including information regarding a identification and reduction of the frequency of patterns of fraud abuse gross overuse inappropriate or medically unnecessary care among physicians pharmacists and recipients b potential or actual severe or adverse reactions to drugs c therapeutic appropriateness d overutilization or underutilization e appropriate use of generics f therapeutic duplication g drug disease contraindications h drug drug interactions i incorrect drug dosage and duration of drug treatment j drug allergy interactions and k clinical abuse and misuse develop and publish with the input of the state board of pharmacy guidelines and standards to be used by pharmacists in counseling medicaid recipients in accordance with this part the guidelines shall ensure that the recipient may refuse counseling and that the refusal is to be documented by the pharmacist items to be discussed as part of that counseling include a the name and description of the medication b administration form and duration of therapy c special directions and precautions for use d common severe side effects or interactions and therapeutic interactions and how to avoid those occurrences e techniques for self monitoring drug therapy f proper storage g prescription refill information and h action to be taken in the event of a missed dose and establish procedures in cooperation with the state board of pharmacy for pharmacists to record information to be collected under this part the recorded information shall include a the name address age and gender of the recipient b individual history of the recipient where significant including disease state known allergies and drug reactions and a comprehensive list of medications and relevant devices c the pharmacist s comments on the individual s drug therapy d name of prescriber and e name of drug dose duration of therapy and directions for use section section b which is renumbered from section is renumbered and amended to read b confidentiality of records information obtained under this part shall be treated as confidential or controlled information under title g chapter government records access and management act the board shall establish procedures insuring ensuring that the information described in subsection b is held confidential by the pharmacist being provided to the physician only upon request the board shall adopt and implement procedures designed to ensure the confidentiality of all information collected stored retrieved assessed or analyzed by the board staff to the board or contractors to the dur program that identifies individual physicians pharmacists or recipients the board may have access to identifying information for purposes of carrying out intervention activities but that identifying information may not be released to anyone other than a member of the board the board may release cumulative nonidentifying information for research purposes section section b which is renumbered from section is renumbered and amended to read b drug prior approval program a drug prior approval program approved or implemented by the board shall meet the following conditions a except as provided in subsection a drug may not be placed on prior approval for other than medical reasons b the board shall hold a public hearing at least days prior to placing a drug on prior approval c notwithstanding the provisions of section the board shall provide not less than days notice to the public before holding a public hearing under subsection b d the board shall consider written and oral comments submitted by interested parties prior to or during the hearing held in accordance with subsection b e the board shall provide evidence that placing a drug class on prior approval i will not impede quality of recipient care and ii that the drug class is subject to clinical abuse or misuse f the board shall reconsider its decision to place a drug on prior approval i no later than nine months after any drug class is placed on prior approval and ii at a public hearing with notice as provided in subsection b g the program shall provide an approval or denial of a request for prior approval i by either a fax b telephone or c electronic transmission ii at least monday through friday except for state holidays and iii within hours after receipt of the prior approval request h the program shall provide for the dispensing of at least a hour supply of the drug on the prior approval program i in an emergency situation or ii on weekends or state holidays i the program may be applied to allow acceptable medical use of a drug on prior approval for appropriate off label indications and j before placing a drug class on the prior approval program the board shall i determine that the requirements of subsections a through i have been met and ii by majority vote place the drug class on prior approval the board may only after complying with subsections b through j consider the cost a of a drug when placing a drug on the prior approval program and b associated with including or excluding a drug from the prior approval process including i potential side effects associated with a drug or ii potential hospitalizations or other complications that may occur as a result of a drug s inclusion on the prior approval process section section b which is renumbered from section is renumbered and amended to read b advisory committees the board may establish advisory committees to assist it in carrying out its duties under this part sections b through b section section b which is renumbered from section is renumbered and amended to read b retrospective and prospective dur the board in cooperation with the division shall include in its state plan the creation and implementation of a retrospective and prospective dur program for medicaid outpatient drugs to ensure that prescriptions are appropriate medically necessary and not likely to result in adverse medical outcomes the retrospective and prospective dur program shall be operated under guidelines established by the board under subsections and the retrospective dur program shall be based on guidelines established by the board using the mechanized drug claims processing and information retrieval system to analyze claims data in order to a identify patterns of fraud abuse gross overuse and inappropriate or medically unnecessary care and b assess data on drug use against explicit predetermined standards that are based on the compendia and other sources for the purpose of monitoring i therapeutic appropriateness ii overutilization or underutilization iii therapeutic duplication iv drug disease contraindications v drug drug interactions vi incorrect drug dosage or duration of drug treatment and vii clinical abuse and misuse the prospective dur program shall be based on guidelines established by the board and shall provide that before a prescription is filled or delivered a review will be conducted by the pharmacist at the point of sale to screen for potential drug therapy problems resulting from a therapeutic duplication b drug drug interactions c incorrect dosage or duration of treatment d drug allergy interactions and e clinical abuse or misuse in conducting the prospective dur a pharmacist may not alter the prescribed outpatient drug therapy without the consent of the prescribing physician or physician assistant this section does not effect the ability of a pharmacist to substitute a generic equivalent section section b which is renumbered from section is renumbered and amended to read b penalties any person who violates the confidentiality provisions of this part sections b through b is guilty of a class b misdemeanor section section b which is renumbered from section is renumbered and amended to read b immunity there is no liability on the part of and no cause of action of any nature arises against any member of the board its agents or employees for any action or omission by them in effecting the provisions of this part sections b through b section section b which is renumbered from section is renumbered and amended to read b purpose medicaid certification of nursing care facilities the legislature finds a that an oversupply of nursing care facilities in the state adversely affects the state medicaid program and the health of the people in the state b it is in the best interest of the state to prohibit nursing care facilities from receiving medicaid certification except as provided by this part sections b through b and c it is in the best interest of the state to encourage aging nursing care facilities with medicaid certification to renovate the nursing care facilities physical facilities so that the quality of life and clinical services for medicaid residents are preserved medicaid reimbursement of nursing care facility programs is limited to a the number of nursing care facility programs with medicaid certification as of may and b additional nursing care facility programs approved for medicaid certification under the provisions of subsections b and the division may not a except as authorized by section b i process initial applications for medicaid certification or execute provider agreements with nursing care facility programs or ii reinstate medicaid certification for a nursing care facility whose certification expired or was terminated by action of the federal or state government or b execute a medicaid provider agreement with a certified program that moves to a different physical facility except as authorized by subsection b notwithstanding section b beginning may the division may not approve a new or additional bed in an intermediate care facility for individuals with an intellectual disability for medicaid certification unless certification of the bed by the division does not increase the total number in the state of medicaid certified beds in intermediate care facilities for individuals with an intellectual disability section section b which is renumbered from section is renumbered and amended to read b authorization to renew transfer or increase medicaid certified programs reimbursement methodology a the division may renew medicaid certification of a certified program if the program without lapse in service to medicaid recipients has its nursing care facility program certified by the division at the same physical facility as long as the licensed and certified bed capacity at the facility has not been expanded unless the director has approved additional beds in accordance with subsection b the division may renew medicaid certification of a nursing care facility program that is not currently certified if i since the day on which the program last operated with medicaid certification a the physical facility where the program operated has functioned solely and continuously as a nursing care facility and b the owner of the program has not under this section or section b transferred to another nursing care facility program the license for any of the medicaid beds in the program and ii except as provided in subsection b the number of beds granted renewed medicaid certification does not exceed the number of beds certified at the time the program last operated with medicaid certification excluding a period of time where the program operated with temporary certification under subsection b a the division may issue a medicaid certification for a new nursing care facility program if a current owner of the medicaid certified program transfers its ownership of the medicaid certification to the new nursing care facility program and the new nursing care facility program meets all of the following conditions i the new nursing care facility program operates at the same physical facility as the previous medicaid certified program ii the new nursing care facility program gives a written assurance to the director in accordance with subsection iii the new nursing care facility program receives the medicaid certification within one year of the date the previously certified program ceased to provide medical assistance to a medicaid recipient and iv the licensed and certified bed capacity at the facility has not been expanded unless the director has approved additional beds in accordance with subsection b a nursing care facility program that receives medicaid certification under the provisions of subsection a does not assume the medicaid liabilities of the previous nursing care facility program if the new nursing care facility program i is not owned in whole or in part by the previous nursing care facility program or ii is not a successor in interest of the previous nursing care facility program the division may issue a medicaid certification to a nursing care facility program that was previously a certified program but now resides in a new or renovated physical facility if the nursing care facility program meets all of the following a the nursing care facility program met all applicable requirements for medicaid certification at the time of closure b the new or renovated physical facility is in the same county or within a five mile radius of the original physical facility c the time between which the certified program ceased to operate in the original facility and will begin to operate in the new physical facility is not more than three years unless i an emergency is declared by the president of the united states or the governor affecting the building or renovation of the physical facility ii the director approves an exception to the three year requirement for any nursing care facility program within the three year requirement iii the provider submits documentation supporting a request for an extension to the director that demonstrates a need for an extension and iv the exception does not extend for more than two years beyond the three year requirement d if subsection c applies the certified program notifies the department within days after ceasing operations in its original facility of its intent to retain its medicaid certification e the provider gives written assurance to the director in accordance with subsection that no third party has a legitimate claim to operate a certified program at the previous physical facility and f the bed capacity in the physical facility has not been expanded unless the director has approved additional beds in accordance with subsection a the entity requesting medicaid certification under subsections and shall give written assurances satisfactory to the director or the director s designee that i no third party has a legitimate claim to operate the certified program ii the requesting entity agrees to defend and indemnify the department against any claims by a third party who may assert a right to operate the certified program and iii if a third party is found by final agency action of the department after exhaustion of all administrative and judicial appeal rights to be entitled to operate a certified program at the physical facility the certified program shall voluntarily comply with subsection b b if a finding is made under the provisions of subsection a iii i the certified program shall immediately surrender its medicaid certification and comply with division rules regarding billing for medicaid and the provision of services to medicaid patients and ii the department shall transfer the surrendered medicaid certification to the third party who prevailed under subsection a iii a the director may approve additional nursing care facility programs for medicaid certification or additional beds for medicaid certification within an existing nursing care facility program if a nursing care facility or other interested party requests medicaid certification for a nursing care facility program or additional beds within an existing nursing care facility program and the nursing care facility program or other interested party complies with this section b the nursing care facility or other interested party requesting medicaid certification for a nursing care facility program or additional beds within an existing nursing care facility program under subsection a shall submit to the director i proof of the following as reasonable evidence that bed capacity provided by medicaid certified programs within the county or group of counties impacted by the requested additional medicaid certification is insufficient a nursing care facility occupancy levels for all existing and proposed facilities will be at least for the next three years b current nursing care facility occupancy is or more or c there is no other nursing care facility within a mile radius of the nursing care facility requesting the additional certification and ii an independent analysis demonstrating that at projected occupancy rates the nursing care facility s after tax net income is sufficient for the facility to be financially viable c any request for additional beds as part of a renovation project are limited to the maximum number of beds allowed in subsection d the director shall determine whether to issue additional medicaid certification by considering i whether bed capacity provided by certified programs within the county or group of counties impacted by the requested additional medicaid certification is insufficient based on the information submitted to the director under subsection b ii whether the county or group of counties impacted by the requested additional medicaid certification is underserved by specialized or unique services that would be provided by the nursing care facility iii whether any medicaid certified beds are subject to a claim by a previous certified program that may reopen under the provisions of subsections and iv how additional bed capacity should be added to the long term care delivery system to best meet the needs of medicaid recipients and v a whether the existing certified programs within the county or group of counties have provided services of sufficient quality to merit at least a two star rating in the medicare five star quality rating system over the previous three year period and b information obtained under subsection the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act to adjust the medicaid nursing care facility property reimbursement methodology to a only pay that portion of the property component of rates representing actual bed usage by medicaid clients as a percentage of the greater of i actual occupancy or ii a for a nursing care facility other than a facility described in subsection a ii b of total bed capacity or b for a rural nursing care facility of total bed capacity and b not allow for increases in reimbursement for property values without major renovation or replacement projects as defined by the department by rule a except as provided in subsection b if a nursing care facility does not seek medicaid certification for a bed under subsections through the department shall notwithstanding subsections b a and b grant medicaid certification for additional beds in an existing medicaid certified nursing care facility that has or fewer licensed beds including medicaid certified beds in the facility if i the nursing care facility program was previously a certified program for all beds but now resides in a new facility or in a facility that underwent major renovations involving major structural changes with or greater facility square footage design changes requiring review and approval by the department ii the nursing care facility meets the quality of care regulations issued by cms and iii the total number of additional beds in the facility granted medicaid certification under this section does not exceed of the number of licensed beds in the facility b the department may not revoke the medicaid certification of a bed under this subsection as long as the provisions of subsection a ii are met a if a nursing care facility or other interested party indicates in its request for additional medicaid certification under subsection a that the facility will offer specialized or unique services but the facility does not offer those services after receiving additional medicaid certification the director shall revoke the additional medicaid certification b the nursing care facility program shall obtain medicaid certification for any additional medicaid beds approved under subsection or within three years of the date of the director s approval or the approval is void a if the director makes an initial determination that quality standards under subsection d v have not been met in a rural county or group of rural counties over the previous three year period the director shall before approving certification of additional medicaid beds in the rural county or group of counties i notify the certified program that has not met the quality standards in subsection d v that the director intends to certify additional medicaid beds under the provisions of subsection d v and ii consider additional information submitted to the director by the certified program in a rural county that has not met the quality standards under subsection d v b the notice under subsection a does not give the certified program that has not met the quality standards under subsection d v the right to legally challenge or appeal the director s decision to certify additional medicaid beds under subsection d v section section b which is renumbered from section is renumbered and amended to read b appeals of division decision rulemaking authority application of act a decision by the director under this part to deny medicaid certification for a nursing care facility program or to deny additional bed capacity for an existing certified program is subject to review under the procedures and requirements of title g chapter administrative procedures act the department shall make rules to administer and enforce this part sections b through b in accordance with title g chapter utah administrative rulemaking act a in the event the department is at risk for a federal disallowance with regard to a medicaid recipient being served in a nursing care facility program that is not medicaid certified the department may grant temporary medicaid certification to that facility for up to months b i the department may extend a temporary medicaid certification granted to a facility under subsection a a for the number of beds in the nursing care facility occupied by a medicaid recipient and b for the period of time during which the medicaid recipient resides at the facility ii a temporary medicaid certification granted under this subsection is revoked upon a the discharge of the patient from the facility or b the patient no longer residing at the facility for any reason c the department may place conditions on the temporary certification granted under subsections a and b such as i not allowing additional admissions of medicaid recipients to the program and ii not paying for the care of the patient after october with state only dollars section section b which is renumbered from section is renumbered and amended to read b authorization to sell or transfer licensed medicaid beds duties of transferor duties of transferee duties of division this section provides a method to transfer or sell the license for a medicaid bed from a nursing care facility program to another entity that is in addition to the authorization to transfer under section b a a nursing care facility program may transfer or sell one or more of its licenses for medicaid beds in accordance with subsection b if i at the time of the transfer and with respect to the license for the medicaid bed that will be transferred the nursing care facility program that will transfer the medicaid license meets all applicable regulations for medicaid certification ii the nursing care facility program gives a written assurance which is postmarked or has proof of delivery days before the transfer to the director and to the transferee in accordance with subsection b iii the nursing care facility program that will transfer the license for a medicaid bed notifies the division in writing which is postmarked or has proof of delivery days before the transfer of a the number of bed licenses that will be transferred b the date of the transfer and c the identity and location of the entity receiving the transferred licenses and iv if the nursing care facility program for which the license will be transferred or purchased is located in an urban county with a nursing care facility average annual occupancy rate over the previous two years less than or equal to the nursing care facility program transferring or selling the license demonstrates to the satisfaction of the director that the sale or transfer a will not result in an excessive number of medicaid certified beds within the county or group of counties that would be impacted by the transfer or sale and b best meets the needs of medicaid recipients b except as provided in subsection c a nursing care facility program may transfer or sell one or more of its licenses for medicaid beds to i a nursing care facility program that has the same owner or successor in interest of the same owner ii a nursing care facility program that has a different owner or iii a related party nonnursing care facility entity that wants to hold one or more of the licenses for a nursing care facility program not yet identified as long as a the licenses are subsequently transferred or sold to a nursing care facility program within three years and b the nursing care facility program notifies the director of the transfer or sale in accordance with subsection a iii c a nursing care facility program may not transfer or sell one or more of its licenses for medicaid beds to an entity under subsection b i ii or iii that is located in a rural county unless the entity requests and the director issues medicaid certification for the beds under subsection b a nursing care facility program or entity under subsection b i ii or iii that receives or purchases a license for a medicaid bed under subsection b a may receive a license for a medicaid bed from more than one nursing care facility program b shall give the division notice which is postmarked or has proof of delivery within days of the nursing care facility program or entity seeking medicaid certification of beds in the nursing care facility program or entity of the total number of licenses for medicaid beds that the entity received and who it received the licenses from c may only seek medicaid certification for the number of licensed beds in the nursing care facility program equal to the total number of licenses for medicaid beds received by the entity d does not have to demonstrate need or seek approval for the medicaid licensed bed under subsection b except as provided in subsections a iv and c e shall meet the standards for medicaid certification other than those in subsection b including personnel services contracts and licensing of facilities under chapter health care facility licensing and inspection act chapter part health care facility licensing and inspection and f shall obtain medicaid certification for the licensed medicaid beds within three years of the date of transfer as documented under subsection a iii b a when the division receives notice of a transfer of a license for a medicaid bed under subsection a iii a the department shall reduce the number of licenses for medicaid beds at the transferring nursing care facility i equal to the number of licenses transferred and ii effective on the date of the transfer as reported under subsection a iii b b for purposes of section b the division shall approve medicaid certification for the receiving nursing care facility program or entity i in accordance with the formula established in subsection c and ii if a the nursing care facility seeks medicaid certification for the transferred licenses within the time limit required by subsection f and b the nursing care facility program meets other requirements for medicaid certification under subsection e c a license for a medicaid bed may not be approved for medicaid certification without meeting the requirements of sections and b and b if i the license for a medicaid bed is transferred under this section but the receiving entity does not obtain medicaid certification for the licensed bed within the time required by subsection f or ii the license for a medicaid bed is transferred under this section but the license is no longer eligible for medicaid certification section section b which is renumbered from section a is renumbered and amended to read part nursing care facility assessment a b definitions as used in this chapter part a nursing care facility means i a nursing care facility described in subsection as defined in section b ii beginning january a designated swing bed in a a general acute hospital as defined in subsection section b and b a critical access hospital which meets the criteria of u s c sec i c and iii an intermediate care facility for people with an intellectual disability that is licensed under section b b nursing care facility does not include i the utah state developmental center ii the utah state hospital iii a general acute hospital specialty hospital or small health care facility as those terms are defined in section b or iv a utah state veterans home patient day means each calendar day in which an individual patient is admitted to the nursing care facility during a calendar month even if on a temporary leave of absence from the facility section section b which is renumbered from section a is renumbered and amended to read a b legislative findings the legislature finds that there is an important state purpose to improve the quality of care given to persons who are elderly and to people who have a disability in long term care nursing facilities the legislature finds that in order to improve the quality of care to those persons described in subsection the rates paid to the nursing care facilities by the medicaid program must be adequate to encourage and support quality care the legislature finds that in order to meet the objectives in subsections and adequate funding must be provided to increase the rates paid to nursing care facilities providing services pursuant to the medicaid program section section b which is renumbered from section a is renumbered and amended to read a b collection remittance and payment of nursing care facilities assessment a beginning july an assessment is imposed upon each nursing care facility in the amount designated in subsection c b i the department shall establish by rule a uniform rate per non medicare patient day that may not exceed of the total gross revenue for services provided to patients of all nursing care facilities licensed in this state ii for purposes of subsection b i total revenue does not include charitable contribution received by a nursing care facility c the department shall calculate the assessment imposed under subsection a by multiplying the total number of patient days of care provided to non medicare patients by the nursing care facility as provided to the department pursuant to subsection a by the uniform rate established by the department pursuant to subsection b a the assessment imposed by this chapter part is due and payable on a monthly basis on or before the last day of the month next succeeding each monthly period b the collecting agent for this assessment shall be the department which is vested with the administration and enforcement of this chapter part including the right to audit records of a nursing care facility related to patient days of care for the facility c the department shall forward proceeds from the assessment imposed by this chapter part to the state treasurer for deposit in the expendable special revenue fund as specified in section a b each nursing care facility shall on or before the end of the month next succeeding each calendar monthly period file with the department a a report which includes i the total number of patient days of care the facility provided to non medicare patients during the preceding month ii the total gross revenue the facility earned as compensation for services provided to patients during the preceding month and iii any other information required by the department and b a return for the monthly period and shall remit with the return the assessment required by this chapter part to be paid for the period covered by the return each return shall contain information and be in the form the department prescribes by rule the assessment as computed in the return is an allowable cost for medicaid reimbursement purposes the department may by rule extend the time for making returns and paying the assessment each nursing care facility that fails to pay any assessment required to be paid to the state within the time required by this chapter part or that fails to file a return as required by this chapter part shall pay in addition to the assessment penalties and interest as provided in section a b section section b which is renumbered from section a is renumbered and amended to read a b penalties and interest the penalty for failure to file a return or pay the assessment due within the time prescribed by this chapter part is the greater of or of the assessment due on the return for failure to pay within days of a notice of deficiency of assessment required to be paid the penalty is the greater of or of the assessment due the penalty for underpayment of the assessment is as follows a if any underpayment of assessment is due to negligence the penalty is of the underpayment b if the underpayment of the assessment is due to intentional disregard of law or rule the penalty is of the underpayment for intent to evade the assessment the penalty is of the underpayment the rate of interest applicable to an underpayment of an assessment under this chapter part or an unpaid penalty under this chapter part is annually the department may waive the imposition of a penalty for good cause section section b which is renumbered from section a is renumbered and amended to read a b adjustment to nursing care facility medicaid reimbursement rates if federal law or regulation prohibits the money in the nursing care facilities provider assessment fund from being used in the manner set forth in subsection a b b the rates paid to nursing care facilities for providing services pursuant to the medicaid program shall be changed except as otherwise provided in subsection to the rates paid to nursing care facilities on june or if the legislature or the department has on or after july changed the rates paid to facilities through a manner other than the use of expenditures from the nursing care facilities provider assessment fund to the rates provided for by the legislature or the department section section b which is renumbered from section a is renumbered and amended to read a b intermediate care facility for people with an intellectual disability uniform rate an intermediate care facility for people with an intellectual disability is subject to all the provisions of this chapter part except that the department shall establish a uniform rate for an intermediate care facility for people with an intellectual disability that is based on the same formula specified for nursing care facilities under the provisions of subsection a b b and may be different than the uniform rate established for other nursing care facilities section section b which is renumbered from section b is renumbered and amended to read part inpatient hospital assessment b b definitions as used in this chapter part assessment means the inpatient hospital assessment established by this chapter part cms means the centers for medicare and medicaid services within the united states department of health and human services discharges means the number of total hospital discharges reported on a worksheet s part i column lines and of the medicare cost report for the applicable assessment year or b a similar report adopted by the department by administrative rule if the report under subsection a is no longer available division means the division of health care financing integrated healthcare within the department enhancement waiver program means the program established by the primary care network enhancement waiver program described in section b health coverage improvement program means the health coverage improvement program described in section b hospital share means the hospital share described in section b b medicaid accountable care organization means a managed care organization as defined in c f r sec that contracts with the department under the provisions of section b medicaid waiver expansion means a medicaid expansion in accordance with section or b or b medicare cost report means cms the cost report for electronic filing of hospitals a non state government hospital means a hospital owned by a non state government entity b non state government hospital does not include i the utah state hospital or ii a hospital owned by the federal government including the veterans administration hospital a private hospital means i a general acute hospital as defined in section b that is privately owned and operating in the state and ii a privately owned specialty hospital operating in the state including a privately owned hospital whose inpatient admissions are predominantly for a rehabilitation b psychiatric care c chemical dependency services or d long term acute care services b private hospital does not include a facility for residential treatment as defined in section a b state teaching hospital means a state owned teaching hospital that is part of an institution of higher education upper payment limit gap means the difference between the private hospital outpatient upper payment limit and the private hospital medicaid outpatient payments as determined in accordance with c f r sec section section b which is renumbered from section b is renumbered and amended to read b b application other than for the imposition of the assessment described in this chapter part nothing in this chapter part shall affect the nonprofit or tax exempt status of any nonprofit charitable religious or educational health care provider under any a state law b ad valorem property taxes c sales or use taxes or d other taxes fees or assessments whether imposed or sought to be imposed by the state or any political subdivision of the state all assessments paid under this chapter part may be included as an allowable cost of a hospital for purposes of any applicable medicaid reimbursement formula this chapter part does not authorize a political subdivision of the state to a license a hospital for revenue b impose a tax or assessment upon a hospital or c impose a tax or assessment measured by the income or earnings of a hospital section section b which is renumbered from section b is renumbered and amended to read b b assessment an assessment is imposed on each private hospital a beginning upon the later of cms approval of i the health coverage improvement program waiver under section b and ii the assessment under this chapter part b in the amount designated in sections b and b b and b and c in accordance with section b b subject to section b b the assessment imposed by this chapter part is due and payable on a quarterly basis after payment of the outpatient upper payment limit supplemental payments under section b b have been paid the first quarterly payment is not due until at least three months after the earlier of the effective dates of the coverage provided through a the health coverage improvement program b the enhancement waiver program or c the medicaid waiver expansion section section b which is renumbered from section b is renumbered and amended to read b b collection of assessment deposit of revenue rulemaking the collecting agent for the assessment imposed under section b b is the department the department is vested with the administration and enforcement of this chapter part and may make rules in accordance with title g chapter utah administrative rulemaking act necessary to a collect the assessment intergovernmental transfers and penalties imposed under this chapter part b audit records of a facility that i is subject to the assessment imposed by this chapter part and ii does not file a medicare cost report and c select a report similar to the medicare cost report if medicare no longer uses a medicare cost report the department shall a administer the assessment in this chapter part separately from the assessment in chapter d part hospital provider assessment act and b deposit assessments collected under this chapter part into the medicaid expansion fund created by section b b section section b which is renumbered from section b is renumbered and amended to read b b quarterly notice quarterly assessments imposed by this chapter part shall be paid to the division within business days after the original invoice date that appears on the invoice issued by the division the department may by rule extend the time for paying the assessment section section b which is renumbered from section b is renumbered and amended to read b b hospital financing of health coverage improvement program medicaid waiver expansion hospital share the hospital share is a of the state s net cost of the health coverage improvement program including medicaid coverage for individuals with dependent children up to the federal poverty level designated under section b b of the state s net cost of the enhancement waiver program c if the waiver for the medicaid waiver expansion is approved and d of the state s net cost of the upper payment limit gap a the hospital share is capped at no more than annually consisting of i an cap for the programs specified in subsections a through c and ii a cap for the program specified in subsection d b the department shall prorate the cap described in subsection a in any year in which the programs specified in subsections a and d are not in effect for the full fiscal year private hospitals shall be assessed under this chapter part for a of the portion of the hospital share for the programs specified in subsections a through c and b of the portion of the hospital share specified in subsection d a in the report described in subsection b the department shall calculate the state s net cost of each of the programs described in subsections a through c that are in effect for that year b if the assessment collected in the previous fiscal year is above or below the hospital share for private hospitals for the previous fiscal year the underpayment or overpayment of the assessment by the private hospitals shall be applied to the fiscal year in which the report is issued a medicaid accountable care organization shall on or before october of each year report to the department the following data from the prior state fiscal year for each private hospital state teaching hospital and non state government hospital provider that the medicaid accountable care organization contracts with a for the traditional medicaid population i hospital inpatient payments ii hospital inpatient discharges iii hospital inpatient days and iv hospital outpatient payments and b if the medicaid accountable care organization enrolls any individuals in the health coverage improvement program the enhancement waiver program or the medicaid waiver expansion for the population newly eligible for any of those programs i hospital inpatient payments ii hospital inpatient discharges iii hospital inpatient days and iv hospital outpatient payments the department shall by rule made in accordance with title g chapter utah administrative rulemaking act provide details surrounding specific content and format for the reporting by the medicaid accountable care organization section section b which is renumbered from section b is renumbered and amended to read b b calculation of assessment a except as provided in subsection b an annual assessment is payable on a quarterly basis for each private hospital in an amount calculated by the division at a uniform assessment rate for each hospital discharge in accordance with this section b a private teaching hospital with more than beds and residents shall pay an assessment rate times the uniform rate established under subsection c c the division shall calculate the uniform assessment rate described in subsection a by dividing the hospital share for assessed private hospitals described in subsections b and b b and by the sum of i the total number of discharges for assessed private hospitals that are not a private teaching hospital and ii times the number of discharges for a private teaching hospital described in subsection b d the division may by rule made in accordance with title g chapter utah administrative rulemaking act adjust the formula described in subsection c to address unforeseen circumstances in the administration of the assessment under this chapter part e any quarterly changes to the uniform assessment rate shall be applied uniformly to all assessed private hospitals except as provided in subsection for each state fiscal year the division shall determine a hospital s discharges as follows a for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june and b for each subsequent state fiscal year the hospital s cost report data for the hospital s fiscal year that ended in the state fiscal year two years before the assessment fiscal year a if a hospital s fiscal year medicare cost report is not contained in the cms healthcare cost report information system file i the hospital shall submit to the division a copy of the hospital s medicare cost report applicable to the assessment year and ii the division shall determine the hospital s discharges b if a hospital is not certified by the medicare program and is not required to file a medicare cost report i the hospital shall submit to the division the hospital s applicable fiscal year discharges with supporting documentation ii the division shall determine the hospital s discharges from the information submitted under subsection b i and iii failure to submit discharge information shall result in an audit of the hospital s records and a penalty equal to of the calculated assessment except as provided in subsection if a hospital is owned by an organization that owns more than one hospital in the state a the assessment for each hospital shall be separately calculated by the department and b each separate hospital shall pay the assessment imposed by this chapter part if multiple hospitals use the same medicaid provider number a the department shall calculate the assessment in the aggregate for the hospitals using the same medicaid provider number and b the hospitals may pay the assessment in the aggregate section section b which is renumbered from section b is renumbered and amended to read b b state teaching hospital and non state government hospital mandatory intergovernmental transfer the state teaching hospital and a non state government hospital shall make an intergovernmental transfer to the medicaid expansion fund created in section b b in accordance with this section the hospitals described in subsection shall pay the intergovernmental transfer beginning on the later of cms approval of a the health improvement program waiver under section b or b the assessment for private hospitals in this chapter part the intergovernmental transfer is apportioned as follows a the state teaching hospital is responsible for i of the portion of the hospital share specified in subsections b b a through c and ii of the hospital share specified in subsection b b d and b non state government hospitals are responsible for i of the portion of the hospital share specified in subsections b b a through c and ii of the hospital share specified in subsection b b d the department shall by rule made in accordance with title g chapter utah administrative rulemaking act designate a the method of calculating the amounts designated in subsection and b the schedule for the intergovernmental transfers section section b which is renumbered from section b is renumbered and amended to read b b penalties and interest a hospital that fails to pay a quarterly assessment make the mandated intergovernmental transfer or file a return as required under this chapter part within the time required by this chapter part shall pay penalties described in this section in addition to the assessment or intergovernmental transfer if a hospital fails to timely pay the full amount of a quarterly assessment or the mandated intergovernmental transfer the department shall add to the assessment or intergovernmental transfer a a penalty equal to of the quarterly amount not paid on or before the due date and b on the last day of each quarter after the due date until the assessed amount and the penalty imposed under subsection a are paid in full an additional penalty on i any unpaid quarterly assessment or intergovernmental transfer and ii any unpaid penalty assessment upon making a record of the division s actions and upon reasonable cause shown the division may waive reduce or compromise any of the penalties imposed under this chapter part section section b which is renumbered from section b is renumbered and amended to read b b hospital reimbursement if the health coverage improvement program the enhancement waiver program or the medicaid waiver expansion is implemented by contracting with a medicaid accountable care organization the department shall to the extent allowed by law include in a contract to provide benefits under the health coverage improvement program the enhancement waiver program or the medicaid waiver expansion a requirement that the medicaid accountable care organization reimburse hospitals in the accountable care organization s provider network at no less than the medicaid fee for service rate if the health coverage improvement program the enhancement waiver program or the medicaid waiver expansion is implemented by the department as a fee for service program the department shall reimburse hospitals at no less than the medicaid fee for service rate nothing in this section prohibits a medicaid accountable care organization from paying a rate that exceeds the medicaid fee for service rate section section b which is renumbered from section b is renumbered and amended to read b b outpatient upper payment limit supplemental payments beginning on the effective date of the assessment imposed under this chapter part and for each subsequent fiscal year the department shall implement an outpatient upper payment limit program for private hospitals that shall supplement the reimbursement to private hospitals in accordance with subsection the division shall ensure that supplemental payment to utah private hospitals under subsection a does not exceed the positive upper payment limit gap and b is allocated based on the medicaid state plan the department shall use the same outpatient data to allocate the payments under subsection and to calculate the upper payment limit gap the supplemental payments to private hospitals under subsection are payable for outpatient hospital services provided on or after the later of a july b the effective date of the medicaid state plan amendment necessary to implement the payments under this section or c the effective date of the coverage provided through the health coverage improvement program waiver section section b which is renumbered from section b is renumbered and amended to read b b repeal of assessment the assessment imposed by this chapter part shall be repealed when a the executive director certifies that i action by congress is in effect that disqualifies the assessment imposed by this chapter part from counting toward state medicaid funds available to be used to determine the amount of federal financial participation ii a decision enactment or other determination by the legislature or by any court officer department or agency of the state or of the federal government is in effect that a disqualifies the assessment from counting toward state medicaid funds available to be used to determine federal financial participation for medicaid matching funds or b creates for any reason a failure of the state to use the assessments for at least one of the medicaid programs described in this chapter part or iii a change is in effect that reduces the aggregate hospital inpatient and outpatient payment rate below the aggregate hospital inpatient and outpatient payment rate for july or b this chapter part is repealed in accordance with section i if the assessment is repealed under subsection a the division may not collect any assessment or intergovernmental transfer under this chapter part b the department shall disburse money in the special medicaid expansion fund in accordance with the requirements in subsection b b to the extent federal matching is not reduced by cms due to the repeal of the assessment c any money remaining in the medicaid expansion fund after the disbursement described in subsection b that was derived from assessments imposed by this chapter part shall be refunded to the hospitals in proportion to the amount paid by each hospital for the last three fiscal years and d any money remaining in the medicaid expansion fund after the disbursements described in subsections b and c shall be deposited into the general fund by the end of the fiscal year that the assessment is suspended section section b which is renumbered from section c is renumbered and amended to read part medicaid expansion hospital assessment c b definitions as used in this chapter part assessment means the medicaid expansion hospital assessment established by this chapter part cms means the centers for medicare and medicaid services within the united states department of health and human services discharges means the number of total hospital discharges reported on a worksheet s part i column lines and of the medicare cost report for the applicable assessment year or b a similar report adopted by the department by administrative rule if the report under subsection a is no longer available division means the division of health care financing integrated healthcare within the department hospital share means the hospital share described in section c b medicaid accountable care organization means a managed care organization as defined in c f r sec that contracts with the department under the provisions of section b medicaid expansion fund means the medicaid expansion fund created in section b b medicaid waiver expansion means the same as that term is defined in section b medicare cost report means cms the cost report for electronic filing of hospitals a non state government hospital means a hospital owned by a non state government entity b non state government hospital does not include i the utah state hospital or ii a hospital owned by the federal government including the veterans administration hospital a private hospital means i a privately owned general acute hospital operating in the state as defined in section b or ii a privately owned specialty hospital operating in the state including a privately owned hospital for which inpatient admissions are predominantly a rehabilitation b psychiatric c chemical dependency or d long term acute care services b private hospital does not include a facility for residential treatment as defined in section a b qualified medicaid expansion means an expansion of the medicaid program in accordance with subsection b state teaching hospital means a state owned teaching hospital that is part of an institution of higher education section section b which is renumbered from section c is renumbered and amended to read c b application other than for the imposition of the assessment described in this chapter part nothing in this chapter part shall affect the nonprofit or tax exempt status of any nonprofit charitable religious or educational health care provider under any a state law b ad valorem property tax requirement c sales or use tax requirement or d other requirements imposed by taxes fees or assessments whether imposed or sought to be imposed by the state or any political subdivision of the state a hospital paying an assessment under this chapter part may include the assessment as an allowable cost of a hospital for purposes of any applicable medicaid reimbursement formula this chapter part does not authorize a political subdivision of the state to a license a hospital for revenue b impose a tax or assessment upon a hospital or c impose a tax or assessment measured by the income or earnings of a hospital section section b which is renumbered from section c is renumbered and amended to read c b assessment an assessment is imposed on each private hospital a beginning upon the later of i april and ii cms approval of the assessment under this chapter part b in the amount designated in sections c and c b and b and c in accordance with section c b the assessment imposed by this chapter part is due and payable in accordance with subsection c b section section b which is renumbered from section c is renumbered and amended to read c b collection of assessment deposit of revenue rulemaking the department shall act as the collecting agent for the assessment imposed under section c b the department shall administer and enforce the provisions of this chapter part and may make rules in accordance with title g chapter utah administrative rulemaking act necessary to a collect the assessment intergovernmental transfers and penalties imposed under this chapter part b audit records of a facility that i is subject to the assessment imposed under this chapter part and ii does not file a medicare cost report and c select a report similar to the medicare cost report if medicare no longer uses a medicare cost report the department shall a administer the assessment in this part separately from the assessments in chapter d part hospital provider assessment act and chapter b and part inpatient hospital assessment act and b deposit assessments collected under this chapter part into the medicaid expansion fund a hospitals shall pay the quarterly assessments imposed by this chapter part to the division within business days after the original invoice date that appears on the invoice issued by the division b the department may make rules creating requirements to allow the time for paying the assessment to be extended section section b which is renumbered from section c is renumbered and amended to read c b hospital share the hospital share is a for the period from april through june and b beginning july of the state s net cost of the qualified medicaid expansion after deducting appropriate offsets and savings expected as a result of implementing the qualified medicaid expansion including i savings from a the primary care network program b the health coverage improvement program as defined in section b c the state portion of inpatient prison medical coverage d behavioral health coverage and e county contributions to the non federal share of medicaid expenditures and ii any funds appropriated to the medicaid expansion fund a beginning july the hospital share is capped at no more than annually b beginning july the division shall prorate the cap specified in subsection a in any year in which the qualified medicaid expansion is not in effect for the full fiscal year section section b which is renumbered from section c is renumbered and amended to read c b hospital financing private hospitals shall be assessed under this chapter part for the portion of the hospital share described in section c b in the report described in subsection b the department shall calculate the state s net cost of the qualified medicaid expansion if the assessment collected in the previous fiscal year is above or below the hospital share for private hospitals for the previous fiscal year the division shall apply the underpayment or overpayment of the assessment by the private hospitals to the fiscal year in which the report is issued section section b which is renumbered from section c is renumbered and amended to read c b calculation of assessment a except as provided in subsection b each private hospital shall pay an annual assessment due on the last day of each quarter in an amount calculated by the division at a uniform assessment rate for each hospital discharge in accordance with this section b a private teaching hospital with more than beds and more than residents shall pay an assessment rate times the uniform rate established under subsection c c the division shall calculate the uniform assessment rate described in subsection a by dividing the hospital share for assessed private hospitals as described in subsection c b by the sum of i the total number of discharges for assessed private hospitals that are not a private teaching hospital and ii times the number of discharges for a private teaching hospital described in subsection b d the division may make rules in accordance with title g chapter utah administrative rulemaking act to adjust the formula described in subsection c to address unforeseen circumstances in the administration of the assessment under this chapter part e the division shall apply any quarterly changes to the uniform assessment rate uniformly to all assessed private hospitals except as provided in subsection for each state fiscal year the division shall determine a hospital s discharges as follows a for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june and b for each subsequent state fiscal year the hospital s cost report data for the hospital s fiscal year that ended in the state fiscal year two years before the assessment fiscal year a if a hospital s fiscal year medicare cost report is not contained in the centers for medicare and medicaid services healthcare cost report information system file i the hospital shall submit to the division a copy of the hospital s medicare cost report applicable to the assessment year and ii the division shall determine the hospital s discharges b if a hospital is not certified by the medicare program and is not required to file a medicare cost report i the hospital shall submit to the division the hospital s applicable fiscal year discharges with supporting documentation ii the division shall determine the hospital s discharges from the information submitted under subsection b i and iii if the hospital fails to submit discharge information the division shall audit the hospital s records and may impose a penalty equal to of the calculated assessment except as provided in subsection if a hospital is owned by an organization that owns more than one hospital in the state a the division shall calculate the assessment for each hospital separately and b each separate hospital shall pay the assessment imposed by this chapter part if multiple hospitals use the same medicaid provider number a the department shall calculate the assessment in the aggregate for the hospitals using the same medicaid provider number and b the hospitals may pay the assessment in the aggregate section section b which is renumbered from section c is renumbered and amended to read c b state teaching hospital and non state government hospital mandatory intergovernmental transfer a state teaching hospital and a non state government hospital shall make an intergovernmental transfer to the medicaid expansion fund in accordance with this section the hospitals described in subsection shall pay the intergovernmental transfer beginning on the later of a april or b cms approval of the assessment for private hospitals in this chapter part the intergovernmental transfer is apportioned between the non state government hospitals as follows a the state teaching hospital shall pay for the portion of the hospital share described in section c b and b non state government hospitals shall pay for the portion of the hospital share described in section c b the department shall by rule made in accordance with title g chapter utah administrative rulemaking act designate a the method of calculating the amounts designated in subsection and b the schedule for the intergovernmental transfers section section b which is renumbered from section c is renumbered and amended to read c b penalties a hospital that fails to pay a quarterly assessment make the mandated intergovernmental transfer or file a return as required under this chapter part within the time required by this chapter part shall pay penalties described in this section in addition to the assessment or intergovernmental transfer if a hospital fails to timely pay the full amount of a quarterly assessment or the mandated intergovernmental transfer the department shall add to the assessment or intergovernmental transfer a a penalty equal to of the quarterly amount not paid on or before the due date and b on the last day of each quarter after the due date until the assessed amount and the penalty imposed under subsection a are paid in full an additional penalty on i any unpaid quarterly assessment or intergovernmental transfer and ii any unpaid penalty assessment upon making a record of the division s actions and upon reasonable cause shown the division may waive or reduce any of the penalties imposed under this chapter part section section b which is renumbered from section c is renumbered and amended to read c b hospital reimbursement if the qualified medicaid expansion is implemented by contracting with a medicaid accountable care organization the department shall to the extent allowed by law include in a contract to provide benefits under the qualified medicaid expansion a requirement that the accountable care organization reimburse hospitals in the accountable care organization s provider network at no less than the medicaid fee for service rate if the qualified medicaid expansion is implemented by the department as a fee for service program the department shall reimburse hospitals at no less than the medicaid fee for service rate nothing in this section prohibits the department or a medicaid accountable care organization from paying a rate that exceeds the medicaid fee for service rate section section b which is renumbered from section c is renumbered and amended to read c b hospital financing of the hospital share for the first two full fiscal years that the assessment is in effect the department shall a assess private hospitals under this chapter part for of the hospital share b require the state teaching hospital to make an intergovernmental transfer under this chapter part for of the hospital share and c require non state government hospitals to make an intergovernmental transfer under this chapter part for of the hospital share a at the beginning of the third full fiscal year that the assessment is in effect and at the beginning of each subsequent fiscal year the department may set a different percentage share for private hospitals the state teaching hospital and non state government hospitals by rule made in accordance with title g chapter utah administrative rulemaking act with input from private hospitals and private teaching hospitals b if the department does not set a different percentage share under subsection a the percentage shares in subsection shall apply section section b which is renumbered from section c is renumbered and amended to read c b suspension of assessment the department shall suspend the assessment imposed by this chapter part when the executive director certifies that a action by congress is in effect that disqualifies the assessment imposed by this chapter part from counting toward state medicaid funds available to be used to determine the amount of federal financial participation b a decision enactment or other determination by the legislature or by any court officer department or agency of the state or of the federal government is in effect that i disqualifies the assessment from counting toward state medicaid funds available to be used to determine federal financial participation for medicaid matching funds or ii creates for any reason a failure of the state to use the assessments for at least one of the medicaid programs described in this chapter part or c a change is in effect that reduces the aggregate hospital inpatient and outpatient payment rate below the aggregate hospital inpatient and outpatient payment rate for july if the assessment is suspended under subsection a the division may not collect any assessment or intergovernmental transfer under this chapter part b the division shall disburse money in the medicaid expansion fund that was derived from assessments imposed by this chapter part in accordance with the requirements in subsection b b to the extent federal matching is not reduced by cms due to the repeal of the assessment and c the division shall refund any money remaining in the medicaid expansion fund after the disbursement described in subsection b that was derived from assessments imposed by this chapter part to the hospitals in proportion to the amount paid by each hospital for the last three fiscal years section section b which is renumbered from section d is renumbered and amended to read part hospital provider assessment d b definitions as used in this chapter part accountable care organization means a managed care organization as defined in c f r sec that contracts with the department under the provisions of section b assessment means the medicaid hospital provider assessment established by this chapter part discharges means the number of total hospital discharges reported on worksheet s part i column lines and of the medicare cost report or on worksheet s part i column lines and of the medicare cost report for the applicable assessment year division means the division of health care financing integrated healthcare of the department hospital a means a privately owned i general acute hospital operating in the state as defined in section b and ii specialty hospital operating in the state which shall include a privately owned hospital whose inpatient admissions are predominantly a rehabilitation b psychiatric c chemical dependency or d long term acute care services and b does not include i a human services program as defined in section a b ii a hospital owned by the federal government including the veterans administration hospital or iii a hospital that is owned by the state government a state agency or a political subdivision of the state including a a state owned teaching hospital and b the utah state hospital medicare cost report means cms or cms the cost report for electronic filing of hospitals state plan amendment means a change or update to the state medicaid plan section section b which is renumbered from section d is renumbered and amended to read d b legislative findings the legislature finds that there is an important state purpose to improve the access of medicaid patients to quality care in utah hospitals because of continuous decreases in state revenues and increases in enrollment under the utah medicaid program the legislature finds that in order to improve this access to those persons described in subsection a the rates paid to utah hospitals shall be adequate to encourage and support improved access and b adequate funding shall be provided to increase the rates paid to utah hospitals providing services pursuant to the utah medicaid program section section b which is renumbered from section d is renumbered and amended to read d b application of part other than for the imposition of the assessment described in this chapter part nothing in this chapter part shall affect the nonprofit or tax exempt status of any nonprofit charitable religious or educational health care provider under a section c as amended of the internal revenue code b other applicable federal law c any state law d any ad valorem property taxes e any sales or use taxes or f any other taxes fees or assessments whether imposed or sought to be imposed by the state or any political subdivision county municipality district authority or any agency or department thereof all assessments paid under this chapter part may be included as an allowable cost of a hospital for purposes of any applicable medicaid reimbursement formula this chapter part does not authorize a political subdivision of the state to a license a hospital for revenue b impose a tax or assessment upon hospitals or c impose a tax or assessment measured by the income or earnings of a hospital section section b which is renumbered from section d is renumbered and amended to read d b assessment collection and payment of hospital provider assessment a uniform broad based assessment is imposed on each hospital as defined in subsection d b a a in the amount designated in section d b and b in accordance with section d b a the assessment imposed by this chapter part is due and payable on a quarterly basis in accordance with section d b b the collecting agent for this assessment is the department which is vested with the administration and enforcement of this chapter part including the right to adopt administrative rules in accordance with title g chapter utah administrative rulemaking act necessary to i implement and enforce the provisions of this act and ii audit records of a facility a that is subject to the assessment imposed by this chapter part and b does not file a medicare cost report c the department shall forward proceeds from the assessment imposed by this chapter part to the state treasurer for deposit in the expendable special revenue fund as specified in section d b the department may by rule extend the time for paying the assessment section section b which is renumbered from section d is renumbered and amended to read d b calculation of assessment a an annual assessment is payable on a quarterly basis for each hospital in an amount calculated at a uniform assessment rate for each hospital discharge in accordance with this section b the uniform assessment rate shall be determined using the total number of hospital discharges for assessed hospitals divided into the total non federal portion in an amount consistent with section d b that is needed to support capitated rates for accountable care organizations for purposes of hospital services provided to medicaid enrollees c any quarterly changes to the uniform assessment rate shall be applied uniformly to all assessed hospitals d the annual uniform assessment rate may not generate more than i to offset medicaid mandatory expenditures and ii the non federal share to seed amounts needed to support capitated rates for accountable care organizations as provided for in subsection b a for each state fiscal year discharges shall be determined using the data from each hospital s medicare cost report contained in the centers for medicare and medicaid services healthcare cost report information system file the hospital s discharge data will be derived as follows i for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june ii for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june iii for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june iv for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june and v for each subsequent state fiscal year the hospital s cost report data for the hospital s fiscal year that ended in the state fiscal year two years prior to the assessment fiscal year b if a hospital s fiscal year medicare cost report is not contained in the centers for medicare and medicaid services healthcare cost report information system file i the hospital shall submit to the division a copy of the hospital s medicare cost report applicable to the assessment year and ii the division shall determine the hospital s discharges c if a hospital is not certified by the medicare program and is not required to file a medicare cost report i the hospital shall submit to the division its applicable fiscal year discharges with supporting documentation ii the division shall determine the hospital s discharges from the information submitted under subsection c i and iii the failure to submit discharge information shall result in an audit of the hospital s records and a penalty equal to of the calculated assessment except as provided in subsection if a hospital is owned by an organization that owns more than one hospital in the state a the assessment for each hospital shall be separately calculated by the department and b each separate hospital shall pay the assessment imposed by this chapter part notwithstanding the requirement of subsection if multiple hospitals use the same medicaid provider number a the department shall calculate the assessment in the aggregate for the hospitals using the same medicaid provider number and b the hospitals may pay the assessment in the aggregate section section b which is renumbered from section d is renumbered and amended to read d b quarterly notice collection quarterly assessments imposed by this chapter part shall be paid to the division within business days after the original invoice date that appears on the invoice issued by the division section section b which is renumbered from section d is renumbered and amended to read d b medicaid hospital adjustment under accountable care organization rates to preserve and improve access to hospital services the division shall for accountable care organization rates effective on or after april incorporate into the accountable care organization rate structure calculation consistent with the certified actuarial rate range to be allocated toward the hospital inpatient directed payments for the medicaid eligibility categories covered in utah before january and an amount equal to the difference between payments made to hospitals by accountable care organizations for the medicaid eligibility categories covered in utah before january based on submitted encounter data and the maximum amount that could be paid for those services using medicare payment principles to be used for directed payments to hospitals for outpatient services section section b which is renumbered from section d is renumbered and amended to read d b penalties and interest a facility that fails to pay any assessment or file a return as required under this chapter part within the time required by this chapter part shall pay in addition to the assessment penalties and interest established by the department a consistent with subsection b the department shall adopt rules in accordance with title g chapter utah administrative rulemaking act which establish reasonable penalties and interest for the violations described in subsection b if a hospital fails to timely pay the full amount of a quarterly assessment the department shall add to the assessment i a penalty equal to of the quarterly amount not paid on or before the due date and ii on the last day of each quarter after the due date until the assessed amount and the penalty imposed under subsection b i are paid in full an additional penalty on a any unpaid quarterly assessment and b any unpaid penalty assessment c upon making a record of its actions and upon reasonable cause shown the division may waive reduce or compromise any of the penalties imposed under this part section section b which is renumbered from section d is renumbered and amended to read d b repeal of assessment the repeal of the assessment imposed by this chapter part shall occur upon the certification by the executive director of the department that the sooner of the following has occurred a the effective date of any action by congress that would disqualify the assessment imposed by this chapter part from counting toward state medicaid funds available to be used to determine the federal financial participation b the effective date of any decision enactment or other determination by the legislature or by any court officer department or agency of the state or of the federal government that has the effect of i disqualifying the assessment from counting towards state medicaid funds available to be used to determine federal financial participation for medicaid matching funds or ii creating for any reason a failure of the state to use the assessments for the medicaid program as described in this chapter part c the effective date of i an appropriation for any state fiscal year from the general fund for hospital payments under the state medicaid program that is less than the amount appropriated for state fiscal year ii the annual revenues of the state general fund budget return to the level that was appropriated for fiscal year iii a division change in rules that reduces any of the following below july payments a aggregate hospital inpatient payments b adjustment payment rates or c any cost settlement protocol or iv a division change in rules that reduces the aggregate outpatient payments below july payments and d the sunset of this chapter part in accordance with section i if the assessment is repealed under subsection money in the fund that was derived from assessments imposed by this chapter part before the determination made under subsection shall be disbursed under section d b to the extent federal matching is not reduced due to the impermissibility of the assessments any funds remaining in the special revenue fund shall be refunded to the hospitals in proportion to the amount paid by each hospital section section b which is renumbered from section a is renumbered and amended to read part ambulance service provider assessment a b definitions as used in this chapter part ambulance service provider means a an ambulance provider as defined in section a b or b a non service provider as defined in section a b assessment means the medicaid ambulance service provider assessment established by this chapter part division means the division of health care financing integrated healthcare within the department non federal portion means the non federal share the division needs to seed amounts that will support fee for service ambulance service provider rates as described in section a b total transports means the number of total ambulance transports applicable to a given fiscal year as determined under subsection a b section section b which is renumbered from section a is renumbered and amended to read a b assessment collection and payment of ambulance service provider assessment an ambulance service provider shall pay an assessment to the division a in the amount designated in section a b b in accordance with this chapter part c quarterly on a day determined by the division by rule made under subsection b and d no more than business days after the day on which the division issues the ambulance service provider notice of the assessment the division shall a collect the assessment described in subsection b determine by rule made in accordance with title g chapter utah administrative rulemaking act standards and procedures for implementing and enforcing the provisions of this chapter part and c transfer assessment proceeds to the state treasurer for deposit into the ambulance service provider assessment expendable revenue fund created in section a b section section b which is renumbered from section a is renumbered and amended to read a b calculation of assessment the division shall calculate a uniform assessment per transport as described in this section the assessment due from a given ambulance service provider equals the non federal portion divided by total transports multiplied by the number of transports for the ambulance service provider the division shall apply any quarterly changes to the assessment rate calculated as described in subsection uniformly to all assessed ambulance service providers the assessment may not generate more than the total of a an annual amount of to offset medicaid administration expenses and b the non federal portion a for each state fiscal year the division shall calculate total transports using data from the emergency medical system as follows i for state fiscal year the division shall use ambulance service provider transports during the calendar year and ii for a fiscal year after the division shall use ambulance service provider transports during the calendar year ending months before the end of the fiscal year b if an ambulance service provider fails to submit transport information to the emergency medical system the division may audit the ambulance service provider to determine the ambulance service provider s transports for a given fiscal year section section b which is renumbered from section a is renumbered and amended to read a b medicaid ambulance service provider adjustment under fee for service rates the division shall if the assessment imposed by this chapter part is approved by the centers for medicare and medicaid services for fee for service rates effective on or after july reimburse an ambulance service provider in an amount up to the emergency medical services ambulance rates adopted annually by the department section section b which is renumbered from section a is renumbered and amended to read a b penalties the division shall require an ambulance service provider that fails to pay an assessment due under this chapter part to pay the division in addition to the assessment a penalty determined by the division by rule made in accordance with title g chapter utah administrative rulemaking act section section b which is renumbered from section a is renumbered and amended to read a b repeal of assessment this chapter part is repealed when as certified by the executive director of the department any of the following occurs a an action by congress that disqualifies the assessment imposed by this chapter part from state medicaid funds available to be used to determine the federal financial participation takes legal effect or b an action decision enactment or other determination by the legislature or by any court officer department or agency of the state or federal government takes effect that i disqualifies the assessment from counting toward state medicaid funds available to be used to determine federal financial participation for medicaid matching funds or ii creates for any reason a failure of the state to use the assessments for the medicaid program as described in this chapter part if this chapter part is repealed under subsection a money in the ambulance service provider assessment expendable revenue fund that was derived from assessments imposed by this chapter part deposited before the determination made under subsection shall be disbursed under section a b to the extent federal matching is not reduced due to the impermissibility of the assessments and b any funds remaining in the special revenue fund shall be refunded to each ambulance service provider in proportion to the amount paid by the ambulance service provider section section b which is renumbered from section is renumbered and amended to read part utah children s health insurance program b definitions as used in this chapter part child means a person who is under years of age an individual who is younger than years old eligible child means a child who qualifies for enrollment in the program as provided in section b member means a child enrolled in the program plan means the department s plan submitted to the united states department of health and human services pursuant to u s c sec ff program means the utah children s health insurance program created by this chapter part section section b which is renumbered from section is renumbered and amended to read b creation and administration of the utah children s health insurance program there is created the utah children s health insurance program to be administered by the department in accordance with the provisions of a this chapter part and b the state children s health insurance program u s c sec aa et seq the department shall a prepare and submit the state s children s health insurance plan before may and any amendments to the federal united states department of health and human services in accordance with u s c sec ff and b make rules in accordance with title g chapter utah administrative rulemaking act regarding i eligibility requirements consistent with section b ii program benefits iii the level of coverage for each program benefit iv cost sharing requirements for members which may not a exceed the guidelines set forth in u s c sec ee or b impose deductible copayment or coinsurance requirements on a member for well child well baby and immunizations v the administration of the program and vi a requirement that a members in the program shall participate in the electronic exchange of clinical health records established in accordance with section b unless the member opts out of participation b prior to enrollment in the electronic exchange of clinical health records the member shall receive notice of the enrollment in the electronic exchange of clinical health records and the right to opt out of participation at any time and c beginning july when the program sends enrollment or renewal information to the member and when the member logs onto the program s website the member shall receive notice of the right to opt out of the electronic exchange of clinical health records section section b which is renumbered from section is renumbered and amended to read b eligibility a child is eligible to enroll in the program if the child a is a bona fide utah resident b is a citizen or legal resident of the united states c is under years of age d does not have access to or coverage under other health insurance including any coverage available through a parent or legal guardian s employer e is ineligible for medicaid benefits f resides in a household whose gross family income as defined by rule is at or below of the federal poverty level and g is not an inmate of a public institution or a patient in an institution for mental diseases a child who qualifies for enrollment in the program under subsection may not be denied enrollment due to a diagnosis or pre existing condition a the department shall determine eligibility and send notification of the eligibility decision within days after receiving the application for coverage b if the department cannot reach a decision because the applicant fails to take a required action or because there is an administrative or other emergency beyond the department s control the department shall i document the reason for the delay in the applicant s case record and ii inform the applicant of the status of the application and time frame for completion the department may not close enrollment in the program for a child who is eligible to enroll in the program under the provisions of subsection the program shall a apply for grants to make technology system improvements necessary to implement a simplified enrollment and renewal process in accordance with subsection b and b if funding is available implement a simplified enrollment and renewal process section section b which is renumbered from section is renumbered and amended to read b program benefits except as provided in subsection medical and dental program benefits shall be benchmarked in accordance with u s c sec cc as follows a medical program benefits including behavioral health care benefits shall be benchmarked effective july and on july every third year thereafter to i be substantially equal to a health benefit plan with the largest insured commercial enrollment offered by a health maintenance organization in the state and ii comply with the mental health parity and addiction equity act pub l no and b dental program benefits shall be benchmarked effective july and on july every third year thereafter in accordance with the children s health insurance program reauthorization act of to be substantially equal to a dental benefit plan that has the largest insured commercial non medicaid enrollment of covered lives that is offered in the state except that the utilization review mechanism for orthodontia shall be based on medical necessity on or before july of each year the department shall publish the benchmark for dental program benefits established under subsection b the program benefits a for enrollees who are at or below of the federal poverty level are exempt from the benchmark requirements of subsections and and b shall include treatment for autism spectrum disorder as defined in section a which i shall include coverage for applied behavioral analysis and ii if the benchmark described in subsection a does not include the coverage described in this subsection b the department shall exclude from the benchmark described in subsection a for any purpose other than providing benefits under the program section section b which is renumbered from section is renumbered and amended to read b limitation of benefits abortion is not a covered benefit except as provided in u s c sec ee section section b which is renumbered from section is renumbered and amended to read b funding the program shall be funded by federal matching funds received under together with state matching funds required by u s c sec ee program expenditures in the following categories may not exceed in the aggregate of all federal payments pursuant to u s c sec ee a other forms of child health assistance for children with gross family incomes below of the federal poverty level b other health services initiatives to improve low income children s health c outreach program expenditures and d administrative costs section section b which is renumbered from section is renumbered and amended to read b evaluation the department shall develop performance measures and annually evaluate the program s performance section section b which is renumbered from section is renumbered and amended to read b managed care contracting for services program benefits provided to a member under the program as described in section b shall be delivered by a managed care organization if the department determines that adequate services are available where the member lives or resides the department may contract with a managed care organization to provide program benefits the department shall evaluate a potential contract with a managed care organization based on a the managed care organization s i ability to manage medical expenses including mental health costs ii proven ability to handle accident and health insurance iii efficiency of claim paying procedures iv proven ability for managed care and quality assurance v provider contracting and discounts vi pharmacy benefit management vii estimated total charges for administering the pool viii ability to administer the pool in a cost efficient manner ix ability to provide adequate providers and services in the state and x ability to meet quality measures for emergency room use and access to primary care established by the department under subsection b and b other factors established by the department the department may enter into separate managed care organization contracts to provide dental benefits required by section b the department s contract with a managed care organization for the program s benefits shall include risk sharing provisions in which the plan shall accept at least of the risk for any difference between the department s premium payments per member and actual medical expenditures a the department may contract with the group insurance division within the utah state retirement office to provide services under subsection if no managed care organization is willing to contract with the department or the department determines no managed care organization meets the criteria established under subsection b in accordance with section a contract awarded under subsection a is not subject to the risk sharing required by subsection section section b which is renumbered from section is renumbered and amended to read b state contractor employee and dependent health benefit plan coverage for purposes of sections b a a b c and qualified health coverage means at the time the contract is entered into or renewed a a health benefit plan and employer contribution level with a combined actuarial value at least actuarially equivalent to the combined actuarial value of i the benchmark plan determined by the program under subsection b a and ii a contribution level at which the employer pays at least of the premium or contribution amounts for the employee and the dependents of the employee who reside or work in the state or b a federally qualified high deductible health plan that at a minimum i has a deductible that is a the lowest deductible permitted for a federally qualified high deductible health plan or b a deductible that is higher than the lowest deductible permitted for a federally qualified high deductible health plan but includes an employer contribution to a health savings account in a dollar amount at least equal to the dollar amount difference between the lowest deductible permitted for a federally qualified high deductible plan and the deductible for the employer offered federally qualified high deductible plan ii has an out of pocket maximum that does not exceed three times the amount of the annual deductible and iii provides that the employer pays of the premium or contribution amounts for the employee and the dependents of the employee who work or reside in the state the department shall a on or before july i determine the commercial equivalent of the benchmark plan described in subsection a and ii post the commercially equivalent benchmark plan described in subsection a i on the department s website noting the date posted and b update the posted commercially equivalent benchmark plan annually and at the time of any change in the benchmark section section b which is renumbered from section is renumbered and amended to read part medical benefits recovery b definitions as used in this chapter part annuity shall have the same meaning as provided in section a care facility means a a nursing facility b an intermediate care facility for an individual with an intellectual disability or c any other medical institution claim means a a request or demand for payment or b a cause of action for money or damages arising under any law employee welfare benefit plan means a medical insurance plan developed by an employer under u s c section sec et seq the employee retirement income security act of as amended health insurance entity means a an insurer b a person who administers manages provides offers sells carries or underwrites health insurance as defined in section a c a self insured plan d a group health plan as defined in subsection of the federal employee retirement income security act of e a service benefit plan f a managed care organization g a pharmacy benefit manager h an employee welfare benefit plan or i a person who is by statute contract or agreement legally responsible for payment of a claim for a health care item or service inpatient means an individual who is a patient and a resident of a care facility insurer includes a a group health plan as defined in subsection of the federal employee retirement income security act of b a health maintenance organization and c any entity offering a health service benefit plan medical assistance means a all funds expended for the benefit of a recipient under title chapter medical assistance act or under this chapter or titles xviii and xix federal social security act and b any other services provided for the benefit of a recipient by a prepaid health care delivery system under contract with the department office of recovery services means the office of recovery services within the department of human services department provider means a person or entity who provides services to a recipient recipient means a an individual who has applied for or received medical assistance from the state b the guardian conservator or other personal representative of an individual under subsection a if the individual is a minor or an incapacitated person or c the estate and survivors of an individual under subsection a if the individual is deceased recovery estate means regarding a deceased recipient a all real and personal property or other assets included within a decedent s estate as defined in section b the decedent s augmented estate as defined in section and c that part of other real or personal property in which the decedent had a legal interest at the time of death including assets conveyed to a survivor heir or assign of the decedent through joint tenancy tenancy in common survivorship life estate living trust or other arrangement state plan means the state medicaid program as enacted in accordance with title xix federal social security act tefra lien means a lien authorized under the tax equity and fiscal responsibility act of against the real property of an individual prior to the individual s death as described in u s c sec p third party includes a an individual institution corporation public or private agency trust estate insurance carrier employee welfare benefit plan health maintenance organization health service organization preferred provider organization governmental program such as medicare champus and workers compensation which may be obligated to pay all or part of the medical costs of injury disease or disability of a recipient unless any of these are excluded by department rule and b a spouse or a parent who i may be obligated to pay all or part of the medical costs of a recipient under law or by court or administrative order or ii has been ordered to maintain health dental or accident and health insurance to cover medical expenses of a spouse or dependent child by court or administrative order trust shall have the same meaning as provided in section section section b which is renumbered from section is renumbered and amended to read b program established by department promulgation of rules the department shall establish and maintain a program for the recoupment of medical assistance the department may promulgate rules to implement the purposes of this chapter part section section b which is renumbered from section is renumbered and amended to read b assignment of rights to benefits a except as provided in subsection b to the extent that medical assistance is actually provided to a recipient all benefits for medical services or payments from a third party otherwise payable to or on behalf of a recipient are assigned by operation of law to the department if the department provides or becomes obligated to provide medical assistance regardless of who made application for the benefits on behalf of the recipient b the assignment i authorizes the department to submit its claim to the third party and authorizes payment of benefits directly to the department and ii is effective for all medical assistance the department may recover the assigned benefits or payments in accordance with section b and as otherwise provided by law a the assignment of benefits includes medical support and third party payments ordered decreed or adjudged by any court of this state or any other state or territory of the united states b the assignment is not in lieu of and does not supersede or alter any other court order decree or judgment when an assignment takes effect the recipient is entitled to receive medical assistance and the benefits paid to the department are a reimbursement to the department section section b which is renumbered from section is renumbered and amended to read b health insurance entity duties related to state claims for medicaid payment or recovery as a condition of doing business in the state a health insurance entity shall with respect to an individual who is eligible for or is provided medical assistance under the state plan upon the request of the department of health department provide information to determine a during what period the individual or the spouse or dependent of the individual may be or may have been covered by the health insurance entity and b the nature of the coverage that is or was provided by the health insurance entity described in subsection a including the name address and identifying number of the plan accept the state s right of recovery and the assignment to the state of any right of an individual to payment from a party for an item or service for which payment has been made under the state plan respond to any inquiry by the department of health department regarding a claim for payment for any health care item or service that is submitted no later than three years after the day on which the health care item or service is provided and not deny a claim submitted by the department of health department solely on the basis of the date of submission of the claim the type or format of the claim form or failure to present proper documentation at the point of sale that is the basis for the claim if a the claim is submitted no later than three years after the day on which the item or service is furnished and b any action by the department of health department to enforce the rights of the state with respect to the claim is commenced no later than six years after the day on which the claim is submitted section section b which is renumbered from section is renumbered and amended to read b insurance policies not to deny or reduce benefits of individuals eligible for state medical assistance exemptions a policy of accident or sickness insurance may not contain any provision denying or reducing benefits because services are rendered to an insured or dependent who is eligible for or receiving medical assistance from the state an association corporation or organization may not deliver issue for delivery or renew any subscriber s contract which contains any provisions denying or reducing benefits because services are rendered to a subscriber or dependent who is eligible for or receiving medical assistance from the state an association corporation business or organization authorized to do business in this state and which provides or pays for any health care benefits may not deny or reduce benefits because services are rendered to a beneficiary who is eligible for or receiving medical assistance from the state notwithstanding subsection or the utah state public employees health program administered by the utah state retirement board is not required to reimburse any agency of state government for custodial care which the agency provides through its staff or facilities to members of the utah state public employees health program section section b which is renumbered from section is renumbered and amended to read b availability of insurance policy if the third party does not pay the department s claim or lien within days from the date the claim or lien is received the third party shall provide a written explanation if the claim is denied specifically describe and request any additional information from the department that is necessary to process the claim and provide the department or its agent a copy of any relevant or applicable insurance or benefit policy section section b which is renumbered from section is renumbered and amended to read b employee benefit plans as allowed pursuant to u s c section sec an employee benefit plan may not include any provision that has the effect of limiting or excluding coverage or payment for any health care for an individual who would otherwise be covered or entitled to benefits or services under the terms of the employee benefit plan based on the fact that the individual is eligible for or is provided services under the state plan section section b which is renumbered from section is renumbered and amended to read b statute of limitations survival of right of action insurance policy not to limit time allowed for recovery a subject to subsection action commenced by the department under this chapter part against a health insurance entity shall be commenced within i subject to subsection six years after the day on which the department submits the claim for recovery or payment for the health care item or service upon which the action is based or ii six months after the date of the last payment for medical assistance whichever is later b an action against any other third party the recipient or anyone to whom the proceeds are payable shall be commenced within i four years after the date of the injury or onset of the illness or ii six months after the date of the last payment for medical assistance whichever is later the death of the recipient does not abate any right of action established by this chapter part a no insurance policy issued or renewed after june may contain any provision that limits the time in which the department may submit its claim to recover medical assistance benefits to a period of less than months from the date the provider furnishes services or goods to the recipient b no insurance policy issued or renewed after april may contain any provision that limits the time in which the department may submit its claim to recover medical assistance benefits to a period of less than that described in subsection a the provisions of this section do not apply to section or part tefra liens b or sections b through b the provisions of this section supercede supersede any other sections regarding the time limit in which an action shall be commenced including section a subsection a extends the statute of limitations on a cause of action described in subsection a that was not time barred on or before april b subsection a does not revive a cause of action that was time barred on or before april an action described in subsection a may not be commenced if the claim for recovery or payment described in subsection a i is submitted later than three years after the day on which the health care item or service upon which the claim is based was provided section section b which is renumbered from section is renumbered and amended to read b recovery of medical assistance from third party lien notice action compromise or waiver recipient s right to action protected a except as provided in subsection c if the department provides or becomes obligated to provide medical assistance to a recipient that a third party is obligated to pay for the department may recover the medical assistance directly from the third party b i a claim under subsection a or section b to recover medical assistance provided to a recipient is a lien against any proceeds payable to or on behalf of the recipient by the third party ii the lien described in subsection b i has priority over all other claims to the proceeds except claims for attorney fees and costs authorized under subsection b c ii c i the department may not recover medical assistance under subsection a if a the third party is obligated to pay the recipient for an injury to the recipient s child that occurred while the child was in the physical custody of the child s foster parent b the child s injury is a physical or mental impairment that requires ongoing medical attention or limits activities of daily living for at least one year c the third party s payment to the recipient is placed in a trust annuity financial account or other financial instrument for the benefit of the child and d the recipient makes reasonable efforts to mitigate any other medical assistance costs for the recipient to the state ii the department is responsible for any repayment to the federal government related to the medical assistance the department is prohibited from recovering under subsection c i a the department shall mail or deliver written notice of the department s claim or lien to the third party at the third party s principal place of business or last known address b the notice shall include i the recipient s name ii the approximate date of illness or injury iii a general description of the type of illness or injury and iv if applicable the general location where the injury is alleged to have occurred the department may commence an action on the department s claim or lien in the department s name but the claim or lien is not enforceable as to a third party unless a the third party receives written notice of the department s claim or lien before the third party settles with the recipient or b the department has evidence that the third party had knowledge that the department provided or was obligated to provide medical assistance the department may a waive a claim or lien against a third party in whole or in part or b compromise settle or release a claim or lien an action commenced under this section does not bar an action by a recipient or a dependent of a recipient for loss or damage not included in the department s action except as provided in subsection c the department s claim or lien on proceeds under this section is not affected by the transfer of the proceeds to a trust annuity financial account or other financial instrument section section b which is renumbered from section is renumbered and amended to read b action by department notice to recipient a within days after commencing an action under subsection b the department shall give the recipient the recipient s guardian personal representative trustee estate or survivor whichever is appropriate written notice of the action by i personal service or certified mail to the last known address of the person receiving the notice or ii if no last known address is available by publishing a notice a once a week for three successive weeks in a newspaper of general circulation in the county where the recipient resides and b in accordance with section for three weeks b proof of service shall be filed in the action c the recipient may intervene in the department s action at any time before trial the notice required by subsection shall name the court in which the action is commenced and advise the recipient of a the right to intervene in the proceeding b the right to obtain a private attorney and c the department s right to recover medical assistance directly from the third party section section b which is renumbered from section is renumbered and amended to read b notice of claim by recipient department response conditions for proceeding collection agreements a a recipient may not file a claim commence an action or settle compromise release or waive a claim against a third party for recovery of medical costs for an injury disease or disability for which the department has provided or has become obligated to provide medical assistance without the department s written consent as provided in subsection b or b for purposes of subsection a consent may be obtained if i a recipient who files a claim or commences an action against a third party notifies the department in accordance with subsection d within days of the recipient making the claim or commencing an action or ii an attorney who has been retained by the recipient to file a claim or commence an action against a third party notifies the department in accordance with subsection d of the recipient s claim a within days after being retained by the recipient for that purpose or b within days from the date the attorney either knew or should have known that the recipient received medical assistance from the department c service of the notice of claim to the department shall be made by certified mail personal service or by e mail in accordance with rule of the utah rules of civil procedure to the director of the office of recovery services d the notice of claim shall include the following information i the name of the recipient ii the recipient s social security number iii the recipient s date of birth iv the name of the recipient s attorney if applicable v the name or names of individuals or entities against whom the recipient is making the claim if known vi the name of the third party s insurance carrier if known vii the date of the incident giving rise to the claim and viii a short statement identifying the nature of the recipient s claim a within days of receipt of the notice of the claim required in subsection the department shall acknowledge receipt of the notice of the claim to the recipient or the recipient s attorney and shall notify the recipient or the recipient s attorney in writing of the following i if the department has a claim or lien pursuant to section b or has become obligated to provide medical assistance and ii whether the department is denying or granting written consent in accordance with subsection a b the department shall provide the recipient s attorney the opportunity to enter into a collection agreement with the department with the recipient s consent unless i the department prior to the receipt of the notice of the recipient s claim pursuant to subsection filed a written claim with the third party the third party agreed to make payment to the department before the date the department received notice of the recipient s claim and the agreement is documented in the department s record or ii there has been a failure by the recipient s attorney to comply with any provision of this section by a failing to comply with the notice provisions of this section b failing or refusing to enter into a collection agreement c failing to comply with the terms of a collection agreement with the department or d failing to disburse funds owed to the state in accordance with this section c i the collection agreement shall be a consistent with this section and the attorney s obligation to represent the recipient and represent the state s claim and b state the terms under which the interests of the department may be represented in an action commenced by the recipient ii if the recipient s attorney enters into a written collection agreement with the department or includes the department s claim in the recipient s claim or action pursuant to subsection the department shall pay attorney fees at the rate of of the department s total recovery and shall pay a proportionate share of the litigation expenses directly related to the action d the department is not required to enter into a collection agreement with the recipient s attorney for collection of personal injury protection under subsection a a if the department receives notice pursuant to subsection and notifies the recipient and the recipient s attorney that the department will not enter into a collection agreement with the recipient s attorney the recipient may proceed with the recipient s claim or action against the third party if the recipient excludes from the claim i any medical expenses paid by the department or ii any medical costs for which the department is obligated to provide medical assistance b when a recipient proceeds with a claim under subsection a the recipient shall provide written notice to the third party of the exclusion of the department s claim for expenses under subsection a i or ii if the department receives notice pursuant to subsection and does not respond within days to the recipient or the recipient s attorney the recipient or the recipient s attorney a may proceed with the recipient s claim or action against the third party b may include the state s claim in the recipient s claim or action and c may not negotiate compromise settle or waive the department s claim without the department s consent section section b which is renumbered from section is renumbered and amended to read b department s right to intervene department s interests protected remitting funds disbursements liability and penalty for noncompliance the department has an unconditional right to intervene in an action commenced by a recipient against a third party for the purpose of recovering medical costs for which the department has provided or has become obligated to provide medical assistance a if the recipient proceeds without complying with the provisions of section b the department is not bound by any decision judgment agreement settlement or compromise rendered or made on the claim or in the action b the department i may recover in full from the recipient or any party to which the proceeds were made payable all medical assistance that the department has provided and ii retains its right to commence an independent action against the third party subject to subsection b any amounts assigned to and recoverable by the department pursuant to sections and b and b collected directly by the recipient shall be remitted to the bureau of medical collections within the office of recovery services no later than five business days after receipt a any amounts assigned to and recoverable by the department pursuant to sections and b and b collected directly by the recipient s attorney shall be remitted to the bureau of medical collections within the office of recovery services no later than days after the funds are placed in the attorney s trust account b the date by which the funds shall be remitted to the department may be modified based on agreement between the department and the recipient s attorney c the department s consent to another date for remittance may not be unreasonably withheld d if the funds are received by the recipient s attorney no disbursements shall be made to the recipient or the recipient s attorney until the department s claim has been paid a recipient or recipient s attorney who knowingly and intentionally fails to comply with this section is liable to the department for a the amount of the department s claim or lien pursuant to subsection b a penalty equal to of the amount of the department s claim and c attorney fees and litigation expenses related to recovering the department s claim section section b which is renumbered from section is renumbered and amended to read b estate and trust recovery a except as provided in subsection b upon a recipient s death the department may recover from the recipient s recovery estate and any trust in which the recipient is the grantor and a beneficiary medical assistance correctly provided for the benefit of the recipient when the recipient was years of age old or older b the department may not make an adjustment or a recovery under subsection a i while the deceased recipient s spouse is still living or ii if the deceased recipient has a surviving child who is a under age years old or b blind or disabled as defined in the state plan a the amount of medical assistance correctly provided for the benefit of a recipient and recoverable under this section is a lien against the deceased recipient s recovery estate or any trust when the recipient is the grantor and a beneficiary b the lien holds the same priority as reasonable and necessary medical expenses of the last illness as provided in section a for a lien described in subsection the department shall provide notice in accordance with section b before final distribution the department shall perfect the lien as follows i for an estate by presenting the lien to the estate s personal representative in accordance with section and ii for a trust by presenting the lien to the trustee in accordance with section c the department may file an amended lien before the entry of the final order to close the estate or trust claims against a deceased recipient s inter vivos trust shall be presented in accordance with sections and any trust provision that denies recovery for medical assistance is void at the time of its making nothing in this section affects the right of the department to recover medicaid assistance before a recipient s death under section or section b or b a lien imposed under this section is of indefinite duration section section b which is renumbered from section is renumbered and amended to read b recovery from recipient of incorrectly provided medical assistance the department may recover medical assistance incorrectly provided whether due to administrative or factual error or fraud from the recipient or the recipient s recovery estate and pursuant to a judgment impose a lien against real property of the recipient section section b which is renumbered from section is renumbered and amended to read b tefra liens authorized grounds for tefra liens exemptions except as provided in subsections and the department may impose a tefra lien on the real property of an individual for the amount of medical assistance provided for or to the individual while the individual is an inpatient in a care facility if a the individual is an inpatient in a care facility b the individual is required as a condition of receiving services under the state plan to spend for costs of medical care all but a minimal amount of the individual s income required for personal needs and c the department determines that the individual cannot reasonably be expected to i be discharged from the care facility and ii return to the individual s home the department may not impose a lien on the home of an individual described in subsection if any of the following individuals are lawfully residing in the home a the spouse of the individual b a child of the individual if the child is i under years of age old or ii blind or permanently and totally disabled as defined in title u s c sec c a f or c a sibling of the individual if the sibling i has an equity interest in the home and ii resided in the home for at least one year immediately preceding the day on which the individual was admitted to the care facility the department may not impose a tefra lien on the real property of an individual unless a the individual has been an inpatient in a care facility for the day period immediately preceding the day on which the lien is imposed b the department serves i a preliminary notice of intent to impose a tefra lien relating to the real property in accordance with section b and ii a final notice of intent to impose a tefra lien relating to the real property in accordance with section b and c i the individual does not file a timely request for review of the department s decision under title g chapter administrative procedures act or ii the department s decision is upheld upon final review or appeal under title g chapter administrative procedures act section section b which is renumbered from section is renumbered and amended to read b presumption of permanency there is a rebuttable presumption that an individual who is an inpatient in a care facility cannot reasonably be expected to be discharged from a care facility and return to the individual s home if the individual has been an inpatient in a care facility for a period of at least consecutive days section section b which is renumbered from section is renumbered and amended to read b preliminary notice of intent to impose a tefra lien prior to imposing a tefra lien on real property the department shall serve a preliminary notice of intent to impose a tefra lien on the individual described in subsection b who owns the property the preliminary notice of intent shall a be served in person or by certified mail on the individual described in subsection b and if the department is aware that the individual has a legally authorized representative on the representative b include a statement indicating that according to the department s records the individual i meets the criteria described in subsections b a and b ii has been an inpatient in a care facility for a period of at least days immediately preceding the day on which the department provides the notice to the individual and iii is legally presumed to be in a condition where it cannot reasonably be expected that the individual will be discharged from the care facility and return to the individual s home c indicate that the department intends to impose a tefra lien on real property belonging to the individual d describe the real property that the tefra lien will apply to e describe the current amount of and purpose of the tefra lien f indicate that the amount of the lien may continue to increase as the individual continues to receive medical assistance g indicate that the individual may seek to prevent the tefra lien from being imposed on the real property by providing documentation to the department that i establishes that the individual does not meet the criteria described in subsection b a or b ii establishes that the individual has not been an inpatient in a care facility for a period of at least days iii rebuts the presumption described in section b or iv establishes that the real property is exempt from imposition of a tefra lien under subsection b h indicate that if the owner fails to provide the documentation described in subsection g within days after the day on which the preliminary notice of intent is served the department will issue a final notice of intent to impose a tefra lien on the real property and will proceed to impose the lien i identify the type of documentation that the owner may provide to comply with subsection g j describe the circumstances under which a tefra lien is required to be released and k describe the circumstances under which the department may seek to recover the lien section section b which is renumbered from section is renumbered and amended to read b final notice of intent to impose a tefra lien the department may issue a final notice of intent to impose a tefra lien on real property if a a preliminary notice of intent relating to the property is served in accordance with section b b it is at least days after the day on which the preliminary notice of intent was served and c the department has not received documentation or other evidence that adequately establishes that a tefra lien may not be imposed on the real property the final notice of intent to impose a tefra lien on real property shall a be served in person or by certified mail on the individual described in subsection b who owns the property and if the department is aware that the individual has a legally authorized representative on the representative b indicate that the department has complied with the requirements for filing the final notice of intent under subsection c include a statement indicating that according to the department s records the individual i meets the criteria described in subsections b a and b ii has been an inpatient in a care facility for a period of at least days immediately preceding the day on which the department provides the notice to the individual and iii is legally presumed to be in a condition where it cannot reasonably be expected that the individual will be discharged from the care facility and return to the individual s home d indicate that the department intends to impose a tefra lien on real property belonging to the individual e describe the real property that the tefra lien will apply to f describe the current amount of and purpose of the tefra lien g indicate that the amount of the lien may continue to increase as the individual continues to receive medical assistance h describe the circumstances under which a tefra lien is required to be released i describe the circumstances under which the department may seek to recover the lien j describe the right of the individual to challenge the decision of the department in an adjudicative proceeding and k indicate that failure by the individual to successfully challenge the decision of the department will result in the tefra lien being imposed section section b which is renumbered from section is renumbered and amended to read b review of department decision an individual who has been served with a final notice of intent to impose a tefra lien under section b may seek agency or judicial review of that decision under title g chapter administrative procedures act section section b which is renumbered from section is renumbered and amended to read b dissolution and removal of tefra lien a tefra lien shall dissolve and be removed by the department if the individual described in subsection b a i is discharged from the care facility and ii returns to the individual s home or b provides sufficient documentation to the department that i rebuts the presumption described in section b or ii any of the following individuals are lawfully residing in the individual s home a the spouse of the individual b a child of the individual if the child is under years of age old or blind or permanently and totally disabled as defined in title u s c sec c a f or c a sibling of the individual if the sibling has an equity interest in the home and resided in the home for at least one year immediately preceding the day on which the individual was admitted to the care facility an individual described in subsection b a may at any time after the department has imposed a lien under this part sections b through b file a request for the department to remove the lien a request filed under subsection shall be considered and reviewed pursuant to title g chapter administrative procedures act section section b which is renumbered from section is renumbered and amended to read b expenditures included in lien other proceedings a tefra lien imposed on real property under this part sections b through b includes all expenses relating to medical assistance provided or paid for under the state plan from the first day that the individual is placed in a care facility regardless of when the lien is imposed or filed on the property nothing in this part affects or prevents sections b through b affect or prevent the department from bringing or pursuing any other legally authorized action to recover medical assistance or to set aside a fraudulent or improper conveyance section section b which is renumbered from section is renumbered and amended to read b contract with another government agency if the department contracts with another government agency to recover funds paid for medical assistance under this chapter part that government agency shall be the sole agency that determines whether to impose or remove a tefra lien under this part sections b through b section section b which is renumbered from section is renumbered and amended to read b precedence of the tax equity and fiscal responsibility act of if any provision of this part conflicts sections b through b conflict with the requirements of the tax equity and fiscal responsibility act of for imposing a lien against the property of an individual prior to the individual s death under u s c sec p the provisions of the tax equity and fiscal responsibility act of take precedence and shall be complied with by the department section section b which is renumbered from section is renumbered and amended to read b legal recognition of electronic claims records pursuant to title chapter uniform electronic transactions act a claim submitted to the department for payment may not be denied legal effect enforceability or admissibility as evidence in any court in any civil action because it is in electronic form and a third party shall accept an electronic record of payments by the department for medical services on behalf of a recipient as evidence in support of the department s claim section section b which is renumbered from section is renumbered and amended to read b direct payment to the department by third party any third party required to make payment to the department pursuant to this chapter part shall make the payment directly to the department or its designee the department may negotiate a payment or payment instrument it receives in connection with subsection without the cosignature or other participation of the recipient or any other party section section b which is renumbered from section is renumbered and amended to read b attorney general or county attorney to represent department the attorney general or a county attorney shall represent the department in any action commenced under this chapter part section section b which is renumbered from section is renumbered and amended to read b department s right to attorney fees and costs in any action brought by the department under this chapter part in which it prevails the department shall recover along with the principal sum and interest a reasonable attorney fee and costs incurred section section b which is renumbered from section is renumbered and amended to read b application of provisions contrary to federal law prohibited in no event shall any provision contained in this chapter part be applied contrary to existing federal law section section b which is renumbered from section is renumbered and amended to read part utah false claims act b definitions as used in this chapter part benefit means the receipt of money goods or any other thing of pecuniary value claim means any request or demand for money or property a made to any i employee officer or agent of the state ii contractor with the state or iii grantee or other recipient whether or not under contract with the state and b if i any portion of the money or property requested or demanded was issued from or provided by the state or ii the state will reimburse the contractor grantee or other recipient for any portion of the money or property false statement or false representation means a wholly or partially untrue statement or representation which is a knowingly made and b a material fact with respect to the claim knowing and knowingly a for purposes of criminal prosecutions for violations of this chapter part is one of the culpable mental states described in subsection b and b for purposes of civil prosecutions for violations of this chapter part is the required culpable mental state as defined in subsection b medical benefit means a benefit paid or payable to a recipient or a provider under a program administered by the state under a titles v and xix of the federal social security act b title x of the federal public health services act c the federal child nutrition act of as amended by p l pub l no and d any programs for medical assistance of the state person means an individual corporation unincorporated association professional corporation partnership or other form of business association section section b which is renumbered from section is renumbered and amended to read b false statement or representation relating to medical benefits a person may not make or cause to be made a false statement or false representation of a material fact in an application for medical benefits a person may not make or cause to be made a false statement or false representation of a material fact for use in determining rights to a medical benefit a person who having knowledge of the occurrence of an event affecting the person s initial or continued right to receive a medical benefit or the initial or continued right of any other person on whose behalf the person has applied for or is receiving a medical benefit may not conceal or fail to disclose that event with intent to obtain a medical benefit to which the person or any other person is not entitled or in an amount greater than that to which the person or any other person is entitled section section b which is renumbered from section is renumbered and amended to read b kickbacks or bribes prohibited for purposes of this section kickback or bribe a includes rebates compensation or any other form of remuneration which is i direct or indirect ii overt or covert or iii in cash or in kind and b does not include a rebate paid to the state under u s c sec r or any state supplemental rebates a person may not solicit offer pay or receive a kickback or bribe in return for or to induce a the purchasing leasing or ordering of any goods or services for which payment is or may be made in whole or in part pursuant to a medical benefit program or b the referral of an individual to another person for the furnishing of any goods or services for which payment is or may be made in whole or in part pursuant to a medical benefit program section section b which is renumbered from section is renumbered and amended to read b false statements or false representations relating to qualification of health institution or facility prohibited felony a person may not knowingly intentionally or recklessly make induce or seek to induce the making of a false statement or false representation of a material fact with respect to the conditions or operation of an institution or facility in order that the institution or facility may qualify upon initial certification or upon recertification as a hospital skilled nursing facility intermediate care facility or home health agency a person who violates this section is guilty of a second degree felony section section b which is renumbered from section is renumbered and amended to read b conspiracy to defraud prohibited a person may not enter into an agreement combination or conspiracy to defraud the state by obtaining or aiding another to obtain the payment or allowance of a false fictitious or fraudulent claim for a medical benefit section section b which is renumbered from section is renumbered and amended to read b false claims for medical benefits prohibited a person may not make or present or cause to be made or presented to an employee or officer of the state a claim for a medical benefit a which is wholly or partially false fictitious or fraudulent b for services which were not rendered or for items or materials which were not delivered c which misrepresents the type quality or quantity of items or services rendered d representing charges at a higher rate than those charged by the provider to the general public e for items or services which the person or the provider knew were not medically necessary in accordance with professionally recognized standards f which has previously been paid g for services also covered by one or more private sources when the person or provider knew of the private sources without disclosing those sources on the claim or h where a provider i unbundles a product procedure or group of procedures usually and customarily provided or performed as a single billable product or procedure into artificial components or separate procedures and ii bills for each component of the product procedure or group of procedures a as if they had been provided or performed independently and at separate times and b the aggregate billing for the components exceeds the amount otherwise billable for the usual and customary single product or procedure in addition to the prohibitions in subsection a person may not a fail to credit the state for payments received from other sources b recover or attempt to recover payment in violation of the provider agreement from i a recipient under a medical benefit program or ii the recipient s family c falsify or alter with intent to deceive any report or document required by state or federal law rule or medicaid provider agreement d retain any unauthorized payment as a result of acts described by this section or e aid or abet the commission of any act prohibited by this section section section b which is renumbered from section is renumbered and amended to read b knowledge of past acts not necessary to establish fact that false statement or representation knowingly made in prosecution under this chapter part it is not necessary to show that the person had knowledge of similar acts having been performed in the past on the part of persons acting on his behalf nor to show that the person had actual notice that the acts by the persons acting on his behalf occurred to establish the fact that a false statement or representation was knowingly made section section b which is renumbered from section is renumbered and amended to read b criminal penalties a except as provided in subsection b the culpable mental state required for a criminal violation of this chapter part is knowingly intentionally or recklessly as defined in section b the culpable mental state required for a criminal violation of this chapter part for kickbacks and bribes under section b is knowingly and intentionally as defined in section the punishment for a criminal violation of any provision of this chapter part except as provided under section b is determined by the cumulative value of the funds or other benefits received or claimed in the commission of all violations of a similar nature and not by each separate violation punishment for criminal violation of this chapter part except as provided under section b is a felony of the second degree felony of the third degree class a misdemeanor or class b misdemeanor based on the dollar amounts as prescribed by subsection for theft of property and services section section b which is renumbered from section is renumbered and amended to read b civil penalties the culpable mental state required for a civil violation of this chapter part is knowing or knowingly which a means that person with respect to information i has actual knowledge of the information ii acts in deliberate ignorance of the truth or falsity of the information or iii acts in reckless disregard of the truth or falsity of the information and b does not require a specific intent to defraud any person who violates this chapter part shall in all cases in addition to other penalties provided by law be required to a make full and complete restitution to the state of all damages that the state sustains because of the person s violation of this chapter part b pay to the state its costs of enforcement of this chapter part in that case including the cost of investigators attorneys and other public employees as determined by the state and c pay to the state a civil penalty equal to i three times the amount of damages that the state sustains because of the person s violation of this chapter part and ii not less than or more than for each claim filed or act done in violation of this chapter part any civil penalties assessed under subsection shall be awarded by the court as part of its judgment in both criminal and civil actions a criminal action need not be brought against a person in order for that person to be civilly liable under this section section section b which is renumbered from section is renumbered and amended to read b revocation of license of assisted living facility appointment of receiver if the license of an assisted living facility is revoked for violation of this chapter part the county attorney may file a petition with the district court for the county in which the facility is located for the appointment of a receiver the district court shall issue an order to show cause why a receiver should not be appointed returnable within five days after the filing of the petition a if the court finds that the facts warrant the granting of the petition the court shall appoint a receiver to take charge of the facility b the court may determine fair compensation for the receiver a receiver appointed pursuant to this section shall have the powers and duties prescribed by the court section section b which is renumbered from section is renumbered and amended to read b presumption based on paid state warrant value of medical benefits repayment of benefits in any civil or criminal action brought under this chapter part a paid state warrant made payable to the order of a party creates a presumption that the party received funds from the state in any civil or criminal action brought under this chapter part the value of the benefits received shall be the ordinary or usual charge for similar benefits in the private sector in any criminal action under this chapter part the repayment of funds or other benefits obtained in violation of the provisions of this chapter part does not constitute a defense to or grounds for dismissal of that action section section b which is renumbered from section is renumbered and amended to read b violation of other laws the provisions of this chapter part are a not exclusive and the remedies provided for in this chapter part are in addition to any other remedies provided for under i any other applicable law or ii common law and b to be liberally construed and applied to i effectuate the chapter s remedial and deterrent purposes and ii serve the public interest if any provision of this chapter part or the application of this chapter part to any person or circumstance is held unconstitutional a the remaining provisions of this chapter part are not affected and b the application of this chapter part to other persons or circumstances are not affected section section b which is renumbered from section is renumbered and amended to read b medicaid fraud enforcement this chapter part shall be enforced in accordance with this section the department is responsible for a i investigating and prosecuting suspected civil violations of this chapter part or ii referring suspected civil violations of this chapter part to the attorney general for investigation and prosecution and b promptly referring suspected criminal violations of this chapter part to the attorney general for criminal investigation and prosecution the attorney general has a concurrent jurisdiction with the department for investigating and prosecuting suspected civil violations of this chapter part and b exclusive jurisdiction to investigate and prosecute all suspected criminal violations of this chapter part the department and the attorney general share concurrent civil enforcement authority under this chapter part and may enter into an interagency agreement regarding the investigation and prosecution of violations of this chapter part in accordance with this section the requirements of title xix of the federal social security act and applicable federal regulations a any violation of this chapter part which comes to the attention of any state government officer or agency shall be reported to the attorney general or the department b all state government officers and agencies shall cooperate with and assist in any prosecution for violation of this chapter part section section b which is renumbered from section is renumbered and amended to read b investigations civil investigative demands the attorney general may take investigative action under subsection if the attorney general has reason to believe that a a person has information or custody or control of documentary material relevant to the subject matter of an investigation of an alleged violation of this chapter part b a person is committing has committed or is about to commit a violation of this chapter part or c it is in the public interest to conduct an investigation to ascertain whether or not a person is committing has committed or is about to commit a violation of this chapter part in taking investigative action the attorney general may a require the person to file on a prescribed form a statement in writing under oath or affirmation describing i the facts and circumstances concerning the alleged violation of this chapter part and ii other information considered necessary by the attorney general b examine under oath a person in connection with the alleged violation of this chapter part and c in accordance with subsections through execute in writing and serve on the person a civil investigative demand requiring the person to produce the documentary material and permit inspection and copying of the material the attorney general may not release or disclose information that is obtained under subsection a or b or any documentary material or other record derived from the information obtained under subsection a or b except a by court order for good cause shown b with the consent of the person who provided the information c to an employee of the attorney general or the department d to an agency of this state the united states or another state e to a special assistant attorney general representing the state in a civil action f to a political subdivision of this state or g to a person authorized by the attorney general to receive the information the attorney general may use documentary material derived from information obtained under subsection a or b or copies of that material as the attorney general determines necessary in the enforcement of this chapter part including presentation before a court a if a person fails to file a statement as required by subsection a or fails to submit to an examination as required by subsection b the attorney general may file in district court a complaint for an order to compel the person to within a period stated by court order i file the statement required by subsection a or ii submit to the examination required by subsection b b failure to comply with an order entered under subsection a is punishable as contempt a civil investigative demand shall a state the rule or statute under which the alleged violation of this chapter part is being investigated b describe the i general subject matter of the investigation and ii class or classes of documentary material to be produced with reasonable specificity to fairly indicate the documentary material demanded c designate a date within which the documentary material is to be produced and d identify an authorized employee of the attorney general to whom the documentary material is to be made available for inspection and copying a civil investigative demand may require disclosure of any documentary material that is discoverable under the utah rules of civil procedure service of a civil investigative demand may be made by a delivering an executed copy of the demand to the person to be served or to a partner an officer or an agent authorized by appointment or by law to receive service of process on behalf of that person b delivering an executed copy of the demand to the principal place of business in this state of the person to be served or c mailing by registered or certified mail an executed copy of the demand addressed to the person to be served i at the person s principal place of business in this state or ii if the person has no place of business in this state to the person s principal office or place of business documentary material demanded in a civil investigative demand shall be produced for inspection and copying during normal business hours at the office of the attorney general or as agreed by the person served and the attorney general the attorney general may not produce for inspection or copying or otherwise disclose the contents of documentary material obtained pursuant to a civil investigative demand except a by court order for good cause shown b with the consent of the person who produced the information c to an employee of the attorney general or the department d to an agency of this state the united states or another state e to a special assistant attorney general representing the state in a civil action f to a political subdivision of this state or g to a person authorized by the attorney general to receive the information a with respect to documentary material obtained pursuant to a civil investigative demand the attorney general shall prescribe reasonable terms and conditions allowing such documentary material to be available for inspection and copying by the person who produced the material or by an authorized representative of that person b the attorney general may use such documentary material or copies of it as the attorney general determines necessary in the enforcement of this chapter part including presentation before a court a a person may file a complaint stating good cause to extend the return date for the demand or to modify or set aside the demand b a complaint under this subsection shall be filed in district court before the earlier of a i the return date specified in the demand or b ii the th day after the date the demand is served except as provided by court order a person who has been served with a civil investigative demand shall comply with the terms of the demand a a person who has committed a violation of this chapter part in relation to the medicaid program in this state or to any other medical benefit program administered by the state has submitted to the jurisdiction of this state b personal service of a civil investigative demand under this section may be made on the person described in subsection a outside of this state this section does not limit the authority of the attorney general to conduct investigations or to access a person s documentary materials or other information under another state or federal law the utah rules of civil procedure or the federal rules of civil procedure the attorney general may file a complaint in district court for an order to enforce the civil investigative demand if a a person fails to comply with a civil investigative demand or b copying and reproduction of the documentary material demanded i cannot be satisfactorily accomplished and ii the person refuses to surrender the documentary material if a complaint is filed under subsection the court may determine the matter presented and may enter an order to enforce the civil investigative demand failure to comply with a final order entered under subsection is punishable by contempt section section b which is renumbered from section is renumbered and amended to read b limitation of actions civil acts antedating this section civil burden of proof estoppel joint civil liability venue an action under this chapter part may not be brought after the later of a six years after the date on which the violation was committed or b three years after the date an official of the state charged with responsibility to act in the circumstances discovers the violation but in no event more than years after the date on which the violation was committed a civil action brought under this chapter part may be brought for acts occurring prior to the effective date of this section if the limitations period set forth in subsection has not lapsed in any civil action brought under this chapter part the state shall be required to prove by a preponderance of evidence all essential elements of the cause of action including damages notwithstanding any other provision of law a final judgment rendered in favor of the state in any criminal proceeding under this chapter part whether upon a verdict after trial or upon a plea of guilty or nolo contendere shall estop the defendant from denying the essential elements of the offense in any civil action under this chapter part which involves the same transaction civil liability under this chapter part shall be joint and several for a violation committed by two or more persons any action brought by the state under this chapter part shall be brought in district court in salt lake county or in any county where the defendant resides or does business section section b is amended to read chapter health data vital statistics and utah medical examiner part vital statistics b definitions reserved as used in this part adoption document means an adoption related document filed with the office a petition for adoption a decree of adoption an original birth certificate or evidence submitted in support of a supplementary birth certificate certified nurse midwife means an individual who a is licensed to practice as a certified nurse midwife under title chapter a nurse midwife practice act and b has completed an education program regarding the completion of a certificate of death developed by the department by rule made in accordance with title g chapter utah administrative rulemaking act custodial funeral service director means a funeral service director who a is employed by a licensed funeral establishment and b has custody of a dead body dead body means a human body or parts of a human body from the condition of which it reasonably may be concluded that death occurred decedent means the same as a dead body dead fetus means a product of human conception other than those circumstances described in subsection a of weeks gestation or more calculated from the date the last normal menstrual period began to the date of delivery and b that was not born alive declarant father means a male who claims to be the genetic father of a child and along with the biological mother signs a voluntary declaration of paternity to establish the child s paternity dispositioner means a a person designated in a written instrument under subsection as having the right and duty to control the disposition of the decedent if the person voluntarily acts as the dispositioner or b the next of kin of the decedent if i a a person has not been designated as described in subsection a or b the person described in subsection a is unable or unwilling to exercise the right and duty described in subsection a and ii the next of kin voluntarily acts as the dispositioner fetal remains means a an aborted fetus as that term is defined in section b or b a miscarried fetus as that term is defined in section b file means the submission of a completed certificate or other similar document record or report as provided under this part for registration by the state registrar or a local registrar funeral service director means the same as that term is defined in section health care facility means the same as that term is defined in section b health care professional means a physician physician assistant nurse practitioner or certified nurse midwife licensed funeral establishment means a if located in utah a funeral service establishment as that term is defined in section that is licensed under title chapter funeral services licensing act or b if located in a state district or territory of the united states other than utah a funeral service establishment that complies with the licensing laws of the jurisdiction where the establishment is located live birth means the birth of a child who shows evidence of life after the child is entirely outside of the mother local registrar means a person appointed under subsection b b nurse practitioner means an individual who a is licensed to practice as an advanced practice registered nurse under title chapter b nurse practice act and b has completed an education program regarding the completion of a certificate of death developed by the department by administrative rule made in accordance with title g chapter utah administrative rulemaking act office means the office of vital records and statistics within the department physician means a person licensed to practice as a physician or osteopath in this state under title chapter utah medical practice act or title chapter utah osteopathic medical practice act physician assistant means an individual who a is licensed to practice as a physician assistant under title chapter a utah physician assistant act and b has completed an education program regarding the completion of a certificate of death developed by the department by administrative rule made in accordance with title g chapter utah administrative rulemaking act presumed father means the father of a child conceived or born during a marriage as defined in section registration or register means acceptance by the local or state registrar of a certificate and incorporation of the certificate into the permanent records of the state state registrar means the state registrar of vital records appointed under section b vital records means a registered certificates or reports of birth death fetal death marriage divorce dissolution of marriage or annulment b amendments to any of the registered certificates or reports described in subsection a c an adoption document and d other similar documents vital statistics means the data derived from registered certificates and reports of birth death fetal death induced termination of pregnancy marriage divorce dissolution of marriage or annulment section section b which is renumbered from section is renumbered and amended to read b department duties and authority as used in this section a compact means the compact for interstate sharing of putative father registry information created in section b effective on may b putative father i means the same as that term is as defined in section b and ii includes an unmarried biological father c state registrar means the state registrar of vital records appointed under subsection e d unmarried biological father means the same as that term is defined in section b the department shall a provide offices properly equipped for the preservation of vital records made or received under this chapter part b establish a statewide vital records system for the registration collection preservation amendment and certification of vital records and other similar documents required by this chapter part and activities related to them including the tabulation analysis and publication of vital statistics c prescribe forms for certificates certification reports and other documents and records necessary to establish and maintain a statewide system of vital records d prepare an annual compilation analysis and publication of statistics derived from vital records and e appoint a state registrar to direct the statewide system of vital records the department may a divide the state from time to time into registration districts and b appoint local registrars for registration districts who under the direction and supervision of the state registrar shall perform all duties required of them by this chapter part and department rules the state registrar appointed under subsection e shall with the input of utah stakeholders and the uniform law commission study the following items for the state s implementation of the compact a the feasibility of using systems developed by the national association for public health statistics and information systems including the state and territorial exchange of vital events steve system and the electronic verification of vital events evve system or similar systems to exchange putative father registry information with states that are parties to the compact b procedures necessary to share putative father information located in the confidential registry maintained by the state registrar upon request from the state registrar of another state that is a party to the compact c procedures necessary for the state registrar to access putative father information located in a state that is a party to the compact and share that information with persons who request a certificate from the state registrar d procedures necessary to ensure that the name of the mother of the child who is the subject of a putative father s notice of commencement filed pursuant to section b is kept confidential when a state that is a party to the compact accesses this state s confidential registry through the state registrar and e procedures necessary to ensure that a putative father s registration with a state that is a party to the compact is given the same effect as a putative father s notice of commencement filed pursuant to section b section section b which is renumbered from section is renumbered and amended to read b content and form of certificates and reports as used in this section a additional information means information that is beyond the information necessary to comply with federal standards or state law for registering a birth b diacritical mark means a mark on a letter from the iso basic latin alphabet used to indicate a special pronunciation c diacritical mark includes accents tildes graves umlauts and cedillas except as provided in subsection to promote and maintain nationwide uniformity in the vital records system the forms of certificates certification reports and other documents and records required by this chapter part or the rules implementing this chapter part shall include as a minimum the items recommended by the federal agency responsible for national vital statistics subject to approval additions and modifications by the department certificates certifications forms reports other documents and records and the form of communications between persons required by this chapter part shall be prepared in the format prescribed by department rule all vital records shall include the date of filing certificates certifications forms reports other documents and records and communications between persons required by this chapter part may be signed filed verified registered and stored by photographic electronic or other means as prescribed by department rule a an individual may use a diacritical mark in an application for a vital record b the office shall record a diacritical mark on a vital record as indicated on the application for the vital record the absence of a diacritical mark on a vital record does not render the document invalid or affect any constructive notice imparted by proper recordation of the document a the state i may collect the social security number of a deceased individual and ii may not include the social security number of an individual on a certificate of death b for registering a birth the department may not require an individual to provide additional information c the department may request additional information if the department provides a written statement that i discloses that providing the additional information is voluntary ii discloses how the additional information will be used and the duration of use iii describes how the department prevents the additional information from being used in a manner different from the disclosure given under subsection c ii c ii and iv includes a notice that the individual is consenting to the department s use of the additional information by providing the additional information d i beginning july an individual may submit a written request to the department to de identify the individual s additional information contained in the department s databases ii upon receiving the written request the department shall de identify the additional information e the department shall de identify additional information contained in the department s databases before the additional information is held by the department for longer than six years section section b which is renumbered from section is renumbered and amended to read b birth certificates execution and registration requirements as used in this section birthing facility means a general acute hospital or birthing center as defined in section b for each live birth occurring in the state a certificate shall be filed with the local registrar for the district in which the birth occurred within days following the birth the certificate shall be registered if it is completed and filed in accordance with this chapter part a for each live birth that occurs in a birthing facility the administrator of the birthing facility or his designee shall obtain and enter the information required under this chapter part on the certificate securing the required signatures and filing the certificate b i the date time place of birth and required medical information shall be certified by the birthing facility administrator or his designee ii the attending physician or nurse midwife may sign the certificate but if the attending physician or nurse midwife has not signed the certificate within seven days of the date of birth the birthing facility administrator or his designee shall enter the attending physician s or nurse midwife s name and transmit the certificate to the local registrar iii the information on the certificate about the parents shall be provided and certified by the mother or father or in their incapacity or absence by a person with knowledge of the facts a for live births that occur outside a birthing facility the birth certificate shall be completed and filed by the physician physician assistant nurse midwife or other person primarily responsible for providing assistance to the mother at the birth if there is no such person either the presumed or declarant father shall complete and file the certificate in his absence the mother shall complete and file the certificate and in the event of her death or disability the owner or operator of the premises where the birth occurred shall do so b the certificate shall be completed as fully as possible and shall include the date time and place of birth the mother s name and the signature of the person completing the certificate a for each live birth to an unmarried mother that occurs in a birthing facility the administrator or director of that facility or his designee shall i provide the birth mother and declarant father if present with a a voluntary declaration of paternity form published by the state registrar b oral and written notice to the birth mother and declarant father of the alternatives to the legal consequences of and the rights and responsibilities that arise from signing the declaration and c the opportunity to sign the declaration ii witness the signature of a birth mother or declarant father in accordance with section b if the signature occurs at the facility iii enter the declarant father s information on the original birth certificate but only if the mother and declarant father have signed a voluntary declaration of paternity or a court or administrative agency has issued an adjudication of paternity and iv file the completed declaration with the original birth certificate b if there is a presumed father the voluntary declaration will only be valid if the presumed father also signs the voluntary declaration c the state registrar shall file the information provided on the voluntary declaration of paternity form with the original birth certificate and may provide certified copies of the declaration of paternity as otherwise provided under title b chapter utah uniform parentage act a the state registrar shall publish a form for the voluntary declaration of paternity a description of the process for filing a voluntary declaration of paternity and of the rights and responsibilities established or effected by that filing in accordance with title b chapter utah uniform parentage act b information regarding the form and services related to voluntary paternity establishment shall be made available to birthing facilities and to any other entity or individual upon request the name of a declarant father may only be included on the birth certificate of a child of unmarried parents if a the mother and declarant father have signed a voluntary declaration of paternity or b a court or administrative agency has issued an adjudication of paternity voluntary declarations of paternity adjudications of paternity by judicial or administrative agencies and voluntary rescissions of paternity shall be filed with and maintained by the state registrar for the purpose of comparing information with the state case registry maintained by the office of recovery services pursuant to section a b section section b which is renumbered from section is renumbered and amended to read b requirement to obtain parents social security numbers for each live birth that occurs in this state the administrator of the birthing facility as defined in section b or other person responsible for completing and filing the birth certificate under section b shall obtain the social security numbers of each parent and provide those numbers to the state registrar each parent shall furnish his or her social security number to the person authorized to obtain the numbers under subsection unless a court or administrative agency has determined there is good cause for not furnishing a number under subsection the state registrar shall as soon as practicable supply those social security numbers to the office of recovery services within the department of human services department the social security numbers obtained under this section may not be recorded on the child s birth certificate the state may not use any social security number obtained under this section for any reason other than enforcement of child support orders in accordance with the federal family support act of public law pub l no section section b which is renumbered from section is renumbered and amended to read b foundling certificates a foundling certificate shall be filed for each infant of unknown parentage found in the state the certificate shall be prepared and filed with the local registrar of the district in which the infant was found by the person assuming custody the certificate shall be filed within days after the infant is found and is acceptable for all purposes in lieu of a certificate of birth section section b which is renumbered from section is renumbered and amended to read b correction of errors or omissions in vital records conflicting birth and foundling certificates rulemaking in accordance with title g chapter utah administrative rulemaking act the department may make rules governing applications to correct alleged errors or omissions on any vital record establishing procedures to resolve conflicting birth and foundling certificates and allowing for the correction and reissuance of a vital record that was originally created omitting a diacritical mark section section b which is renumbered from section is renumbered and amended to read b birth certificates delayed registration when a certificate of birth of a person born in this state has not been filed within the time provided in subsection b a certificate of birth may be filed in accordance with department rules and subject to this section a the registrar shall mark a certificate of birth as delayed and show the date of registration if the certificate is registered one year or more after the date of birth b the registrar shall abstract a summary statement of the evidence submitted in support of delayed registration onto the certificate when the minimum evidence required for delayed registration is not submitted or when the state registrar has reasonable cause to question the validity or adequacy of the evidence supporting the application and the deficiencies are not corrected the state registrar a may not register the certificate and b shall provide the applicant with a written statement indicating the reasons for denial of registration the state registrar has no duty to take further action regarding an application which is not actively pursued section section b which is renumbered from section is renumbered and amended to read b birth certificates petition for issuance of delayed certificate court procedure a if registration of a certificate of birth under section b is denied the person seeking registration may bring an action by a verified petition in the utah district court encompassing where the petitioner resides or in the district encompassing salt lake city b the petition shall request an order establishing a record of the date and place of the birth and the parentage of the person whose birth is to be registered the petition shall be on a form furnished by the state registrar and shall allege a the person for whom registration of a delayed certificate is sought was born in this state and is still living b no registered certificate of birth of the person can be found in the state office of vital statistics or the office of any local registrar c diligent efforts by the petitioner have failed to obtain the evidence required by department rule and d the state registrar has denied the petitioner s request to register a delayed certificate of birth the petition shall be accompanied by a written statement of the state registrar indicating the reasons for denial of registration and all documentary evidence which was submitted in support of registration the court shall fix a time and place for hearing the petition and shall give the state registrar days days notice of the hearing the state registrar or his authorized representative may appear and testify at the hearing a if the court finds the person for whom registration of a certificate of birth is sought under section b was born in this state it shall make findings as to the place and date of birth parentage and other findings as may be required and shall issue an order on a form prescribed and furnished by the state registrar to establish a court ordered delayed certificate of birth b the order shall include the birth data to be registered a description of the evidence presented and the date of the court s action b c the clerk of the court shall forward each order to the state registrar not later than the tenth day of the calendar month following the month in which the order was entered d the order described in subsection a shall be registered by the state registrar and constitutes the certificate of birth section section b which is renumbered from section is renumbered and amended to read b supplementary certificate of birth an individual born in this state may request the state registrar to register a supplementary birth certificate for the individual if a the individual is legally recognized as a child of the individual s natural parents when the individual s natural parents are subsequently married b the individual s parentage has been determined by a state court of the united states or a canadian provincial court with jurisdiction or c the individual has been legally adopted as a child or as an adult under the law of this state any other state or any province of canada the application for registration of a supplementary birth certificate may be made by a the individual requesting registration under subsection if the individual is of legal age b a legal representative or c any agency authorized to receive children for placement or adoption under the laws of this or any other state a the state registrar shall require that an applicant submit identification and proof according to department rules b in the case of an adopted individual that proof may be established by order of the court in which the adoption proceedings were held a after the supplementary birth certificate is registered any information disclosed from the record shall be from the supplementary birth certificate b access to the original birth certificate and to the evidence submitted in support of the supplementary birth certificate are not open to inspection except upon the order of a utah district court or as described in section b or section b section section b which is renumbered from section is renumbered and amended to read b name or sex change registration of court order and amendment of birth certificate when a person born in this state has a name change or sex change approved by an order of a utah district court or a court of competent jurisdiction of another state or a province of canada a certified copy of the order may be filed with the state registrar with an application form provided by the registrar a upon receipt of the application a certified copy of the order and payment of the required fee the state registrar shall review the application and if complete register it and note the fact of the amendment on the otherwise unaltered original certificate b the amendment shall be registered with and become a part of the original certificate and a certified copy shall be issued to the applicant without additional cost section section b which is renumbered from section is renumbered and amended to read b certified copies of birth certificates fees credited to children s account in addition to the fees provided for in section b the department and local registrars authorized to issue certified copies shall charge an additional fee for each certified copy of a birth certificate including certified copies of supplementary and amended birth certificates under sections through b through b this the additional fee described in subsection may be charged only for the first copy requested at any one time the fee shall be transmitted monthly to the state treasurer and credited to the children s account established created in section section section b which is renumbered from section is renumbered and amended to read b fee waived for certified copy of birth certificate notwithstanding section sections b and section b the department shall waive a fee that would otherwise be charged for a certified copy of a birth certificate if the individual whose birth is confirmed by the birth certificate is a the individual requesting the certified copy of the birth certificate and b i homeless as defined in section b ii a person who is homeless as defined in section a iii an individual whose primary nighttime residence is a location that is not designed for or ordinarily used as a sleeping accommodation for an individual iv a homeless service provider as verified by the department of workforce services or v a homeless child or youth as defined in u s c sec a to satisfy the requirement in subsection b the department shall accept written verification that the individual is homeless or a person child or youth who is homeless from a a homeless shelter b a permanent housing permanent supportive or transitional facility as defined in section a c the department of workforce services d a homeless service provider as verified by the department of workforce services or e a local educational agency liaison for homeless children and youth designated under u s c sec g j ii section section b which is renumbered from section is renumbered and amended to read b certificate of death execution and registration requirements information provided to lieutenant governor a a certificate of death for each death that occurs in this state shall be filed with the local registrar of the district in which the death occurs or as otherwise directed by the state registrar within five days after death and prior to the decedent s interment any other disposal or removal from the registration district where the death occurred b a certificate of death shall be registered if the certificate of death is completed and filed in accordance with this chapter part a if the place of death is unknown but the dead body is found in this state i the certificate of death shall be completed and filed in accordance with this section and ii the place where the dead body is found shall be shown as the place of death b if the date of death is unknown the date shall be determined by approximation a when death occurs in a moving conveyance in the united states and the decedent is first removed from the conveyance in this state i the certificate of death shall be filed with a the local registrar of the district where the decedent is removed or b a person designated by the state registrar and ii the place where the decedent is removed shall be considered the place of death b when a death occurs on a moving conveyance outside the united states and the decedent is first removed from the conveyance in this state i the certificate of death shall be filed with a the local registrar of the district where the decedent is removed or b a person designated by the state registrar and ii the certificate of death shall show the actual place of death to the extent it can be determined a subject to subsections d and a custodial funeral service director or if a funeral service director is not retained a dispositioner shall sign the certificate of death b the custodial funeral service director an agent of the custodial funeral service director or if a funeral service director is not retained a dispositioner shall i file the certificate of death prior to any disposition of a dead body or fetus and ii obtain the decedent s personal data from the next of kin or the best qualified person or source available including the decedent s social security number if known c the certificate of death may not include the decedent s social security number d a dispositioner may not sign a certificate of death unless the signature is witnessed by the state registrar or a local registrar a except as provided in section b fetal death certificates the medical section of the certificate of death shall be completed signed and returned to the funeral service director or if a funeral service director is not retained a dispositioner within hours after death by the health care professional who was in charge of the decedent s care for the illness or condition which resulted in death except when inquiry is required by title chapter utah medical examiner act part utah medical examiner b in the absence of the health care professional or with the health care professional s approval the certificate of death may be completed and signed by an associate physician the chief medical officer of the institution in which death occurred or a physician who performed an autopsy upon the decedent if i the person has access to the medical history of the case ii the person views the decedent at or after death and iii the death is not due to causes required to be investigated by the medical examiner when death occurs more than days after the day on which the decedent was last treated by a health care professional the case shall be referred to the medical examiner for investigation to determine and certify the cause date and place of death when inquiry is required by title chapter utah medical examiner act part utah medical examiner the medical examiner shall make an investigation and complete and sign the medical section of the certificate of death within hours after taking charge of the case if the cause of death cannot be determined within hours after death a the medical section of the certificate of death shall be completed as provided by department rule b the attending health care professional or medical examiner shall give the funeral service director or if a funeral service director is not retained a dispositioner notice of the reason for the delay and c final disposition of the decedent may not be made until authorized by the attending health care professional or medical examiner a when a death is presumed to have occurred within this state but the dead body cannot be located a certificate of death may be prepared by the state registrar upon receipt of an order of a utah district court b the order described in subsection a shall include a finding of fact stating the name of the decedent the date of death and the place of death c a certificate of death prepared under subsection a shall i show the date of registration and ii identify the court and the date of the order it is unlawful for a dispositioner to charge for or accept any remuneration for a signing a certificate of death or b performing any other duty of a dispositioner as described in this section the state registrar shall within five business days after the day on which the state registrar or local registrar registers a certificate of death for a utah resident inform the lieutenant governor of a the decedent s name last known residential address date of birth and date of death and b any other information requested by the lieutenant governor to assist the county clerk in identifying the decedent for the purpose of removing the decedent from the official register of voters the lieutenant governor shall within one business day after the day on which the lieutenant governor receives the information described in subsection provide the information to the county clerks section section b which is renumbered from section is renumbered and amended to read b fetal death certificate filing and registration requirements a fetal death certificate shall be filed for each fetal death which occurs in this state the certificate shall be filed within five days after delivery with the local registrar or as otherwise directed by the state registrar the certificate shall be registered if it is completed and filed in accordance with this chapter part when a dead fetus is delivered in an institution the institution administrator or his designated representative shall prepare and file the fetal death certificate the attending physician shall state in the certificate the cause of death and sign the certificate when a dead fetus is delivered outside an institution the physician in attendance at or immediately after delivery shall complete sign and file the fetal death certificate when a fetal death occurs without medical attendance at or immediately after the delivery or when inquiry is required by title chapter utah medical examiner act part utah medical examiner the medical examiner shall investigate the cause of death and prepare and file the certificate of fetal death within five days after taking charge of the case when a fetal death occurs in a moving conveyance and the dead fetus is first removed from the conveyance in this state or when a dead fetus is found in this state and the place of death is unknown the death shall be registered in this state the place where the dead fetus was first removed from the conveyance or found shall be considered the place of death final disposition of the dead fetus may not be made until the fetal death certificate has been registered section section b which is renumbered from section is renumbered and amended to read b certificate of birth resulting in stillbirth for purposes of this section and section as used in this section stillbirth and stillborn child shall have the same meaning mean the same as dead fetus as defined in section b a in addition to the requirements of section b the state registrar shall establish a certificate of birth resulting in stillbirth on a form approved by the state registrar for each stillbirth occurring in this state b this certificate shall be offered to the parent or parents of a stillborn child the certificate of birth resulting in stillbirth shall meet all of the format and filing requirements of sections and b and b relating to a live birth the person who prepares a certificate pursuant to this section shall leave blank any references to the stillborn child s name if the stillborn child s parent or parents do not wish to provide a name for the stillborn child notwithstanding subsections and the certificate of birth resulting in stillbirth shall be filed with the designated registrar within days following the delivery and prior to cremation or removal of the fetus from the registration district section section b which is renumbered from section is renumbered and amended to read b delayed registration of birth resulting in stillbirth when a birth resulting in stillbirth occurring in this state has not been registered within one year after the date of delivery a certificate marked delayed may be filed and registered in accordance with department rule relating to evidentiary and other requirements sufficient to substantiate the alleged facts of birth resulting in stillbirth section section b which is renumbered from section is renumbered and amended to read b certificate of early term stillbirth as used in this section early term stillborn child means a product of human conception other than in the circumstances described in subsection that a is of at least weeks gestation but less than weeks gestation calculated from the day on which the mother s last normal menstrual period began to the day of delivery and b is not born alive the state registrar shall issue a certificate of early term stillbirth to a parent of an early term stillborn child if a the parent requests on a form created by the state registrar that the state registrar register and issue a certificate of early term stillbirth for the early term stillborn child and b the parent files with the state registrar i a a signed statement from a physician confirming the delivery of the early term stillborn child or b an accurate copy of the parent s medical records related to the early term stillborn child and ii any other record the state registrar determines by rule made in accordance with title g chapter utah administrative rulemaking act is necessary for accurate recordkeeping the certificate of early term stillbirth described in subsection shall meet all of the format and filing requirements of section b a person who prepares a certificate of early term stillbirth under this section shall leave blank any references to an early term stillborn child s name if the early term stillborn child s parent does not wish to provide a name for the early term stillborn child section section b which is renumbered from section is renumbered and amended to read b petition for establishment of unregistered birth or death court procedure a person holding a direct tangible and legitimate interest as described in subsection b a or b may petition for a court order establishing the fact time and place of a birth or death that is not registered or for which a certified copy of the registered birth or death certificate is not obtainable the person shall verify the petition and file the petition in the utah district court for the county where a the birth or death is alleged to have occurred b the person resides whose birth is to be established or c the decedent named in the petition resided at the date of death in order for the court to have jurisdiction the petition shall a allege the date time and place of the birth or death and b state either that no certificate of birth or death has been registered or that a copy of the registered certificate cannot be obtained the court shall set a hearing for five to days after the day on which the petition is filed a if the time and place of birth or death are in question the court shall hear available evidence and determine the time and place of the birth or death b if the time and place of birth or death are not in question the court shall determine the time and place of birth or death to be those alleged in the petition a court order under this section shall be made on a form prescribed and furnished by the department and is effective upon the filing of a certified copy of the order with the state registrar a for purposes of this section the birth certificate of an adopted alien child as defined in section b is considered to be unobtainable if the child was born in a country that is not recognized by department rule as having an established vital records registration system b if the adopted child was born in a country recognized by department rule but a person described in subsection is unable to obtain a certified copy of the birth certificate the state registrar shall authorize the preparation of a birth certificate if the state registrar receives a written statement signed by the registrar of the child s birth country stating a certified copy of the birth certificate is not available section section b which is renumbered from section is renumbered and amended to read b certificate of death duties of a custodial funeral service director an agent of a funeral service director or a dispositioner medical certification records of funeral service director or dispositioner information filed with local registrar unlawful signing of certificate of death the custodial funeral service director or if a funeral service director is not retained a dispositioner shall sign the certificate of death prior to any disposition of a dead body or dead fetus the custodial funeral service director an agent of the custodial funeral service director or if a funeral service director is not retained a dispositioner shall a obtain personal and statistical information regarding the decedent from the available persons best qualified to provide the information b present the certificate of death to the attending health care professional if any or to the medical examiner who shall certify the cause of death and other information required on the certificate of death c provide the address of the custodial funeral service director or if a funeral service director is not retained a dispositioner d certify the date and place of burial and e file the certificate of death with the state or local registrar a funeral service director dispositioner embalmer or other person who removes a dead body or dead fetus from the place of death or transports or is in charge of final disposal of a dead body or dead fetus shall keep a record identifying the dead body or dead fetus and containing information pertaining to receipt removal and delivery of the dead body or dead fetus as prescribed by department rule a not later than the tenth day of each month every licensed funeral service establishment shall send to the local registrar and the department a list of the information required in subsection for each casket furnished and for funerals performed when no casket was furnished during the preceding month b the list described in subsection a shall be in the form prescribed by the state registrar any person who intentionally signs the portion of a certificate of death that is required to be signed by a funeral service director or a dispositioner under subsection is guilty of a class b misdemeanor unless the person a i is a funeral service director and ii is employed by a licensed funeral establishment or b is a dispositioner if a funeral service director is not retained the state registrar shall post information on the state registrar s website providing instructions to a dispositioner for complying with the requirements of law relating to the dispositioner s responsibilities for a completing and filing a certificate of death and b possessing transporting and disposing of a dead body or dead fetus the provisions of this chapter part shall be construed to avoid interference to the fullest extent possible with the ceremonies customs rites or beliefs of the decedent and the decedent s next of kin for disposing of a dead body or dead fetus section section b which is renumbered from section is renumbered and amended to read b certificate of death registration prerequisite to interment burial transit permits procedure where body donated under anatomical gift law permit for disinterment a a dead body or dead fetus may not be interred or otherwise disposed of or removed from the registration district in which death or fetal death occurred or the remains are found until a certificate of death is registered b subsection a does not apply to fetal remains for a fetus that is less than weeks in gestational age a for deaths or fetal deaths which occur in this state no burial transit permit is required for final disposition of the remains if i disposition occurs in the state and is performed by a funeral service director or ii the disposition takes place with authorization of the next of kin and in a a general acute hospital as that term is defined in section b that is licensed by the department or b in a pathology laboratory operated under contract with a general acute hospital licensed by the department b for an abortion or miscarriage that occurs at a health care facility no burial transit permit is required for final disposition of the fetal remains if i disposition occurs in the state and is performed by a funeral service director or ii the disposition takes place a with authorization of the parent of a miscarried fetus or the pregnant woman for an aborted fetus and b in a general acute hospital as that term is defined in section b or a pathology laboratory operated under contract with a general acute hospital a a burial transit permit shall be issued by the local registrar of the district where the certificate of death or fetal death is registered i for a dead body or a dead fetus to be transported out of the state for final disposition or ii when disposition of the dead body or dead fetus is made by a person other than a funeral service director b for fetal remains that are less than weeks in gestational age a burial transit permit shall be issued by the local registrar of the district where the health care facility that is in possession of the fetal remains is located i for the fetal remains to be transported out of the state for final disposition or ii when disposition of the fetal remains is made by a person other than a funeral service director c a local registrar issuing a burial transit permit issued under subsection b i may not require an individual to designate a name for the fetal remains and ii may leave the space for a name on the burial transit permit blank and d shall redact from any public records maintained under this chapter part any information i that is submitted under subsection c and ii that may be used to identify the parent or pregnant woman a burial transit permit issued under the law of another state which accompanies a dead body dead fetus or fetal remains brought into this state is authority for final disposition of the dead body dead fetus or fetal remains in this state when a dead body or dead fetus or any part of the dead body or dead fetus has been donated under the part revised uniform anatomical gift act or similar laws of another state and the preservation of the gift requires the immediate transportation of the dead body dead fetus or any part of the body or fetus outside of the registration district in which death occurs or the remains are found or into this state from another state the dead body or dead fetus or any part of the body or fetus may be transported and the burial transit permit required by this section obtained within a reasonable time after transportation a permit for disinterment and reinterment is required prior to disinterment of a dead body dead fetus or fetal remains except as otherwise provided by statute or department rule section section b which is renumbered from section is renumbered and amended to read b interments duties of sexton or person in charge record of interments information filed with local registrar a a sexton or person in charge of any premises in which interments are made may not inter or permit the interment of any dead body dead fetus or fetal remains unless the interment is made by a funeral service director or by a person holding a burial transit permit b the right and duty to control the disposition of a deceased person shall be governed by sections through a the sexton or the person in charge of any premises where interments are made shall keep a record of all interments made in the premises under their charge stating the name of the decedent place of death date of burial and name and address of the funeral service director or other person making the interment b the record described in this subsection shall be open to public inspection c a city or county clerk may at the clerk s option maintain the interment records described in this subsection on behalf of the sexton or person in charge of any premises in which interments are made a not later than the tenth day of each month the sexton person in charge of the premises or city or county clerk who maintains the interment records shall send to the local registrar and the department a list of all interments made in the premises during the preceding month b the list described in subsection a shall be in the form prescribed by the state registrar section section b which is renumbered from section is renumbered and amended to read b rules of department for transmittal of certificates and keeping of records by local registrar each local registrar shall transmit all records registered by him to the department in accordance with department rules the manner of keeping local copies of vital records and the uses of them shall be prescribed by department rules section section b which is renumbered from section is renumbered and amended to read b local registrars authorized to issue certified copies of records the state registrar may authorize local registrars to issue certified copies of vital records section section b which is renumbered from section is renumbered and amended to read b inspection of vital records as used in this section a designated legal representative means an attorney physician funeral service director genealogist or other agent of the subject or an immediate family member of the subject who has been delegated the authority to access vital records b drug use intervention or suicide prevention effort means a program that studies or promotes the prevention of drug overdose deaths or suicides in the state c immediate family member means a spouse child parent sibling grandparent or grandchild a the vital records shall be open to inspection but only in compliance with the provisions of this chapter part department rules and sections b and b b it is unlawful for any state or local officer or employee to disclose data contained in vital records contrary to this chapter part department rule section b or section b c i an adoption document is open to inspection as provided in section b or section b ii a birth parent may not access an adoption document under subsection b d a custodian of vital records may permit inspection of a vital record or issue a certified copy of a record or a part of a record when the custodian is satisfied that the applicant has demonstrated a direct tangible and legitimate interest except as provided in subsection a direct tangible and legitimate interest in a vital record is present only if a the request is from i the subject ii an immediate family member of the subject iii the guardian of the subject iv a designated legal representative of the subject or v a person including a child placing agency as defined in section b with whom a child has been placed pending finalization of an adoption of the child b the request involves a personal or property right of the subject of the record c the request is for official purposes of a public health authority or a state local or federal governmental agency d the request is for a drug use intervention or suicide prevention effort or a statistical or medical research program and prior consent has been obtained from the state registrar or e the request is a certified copy of an order of a court of record specifying the record to be examined or copied a except as provided in title b chapter part utah adoption act a parent or an immediate family member of a parent who does not have legal or physical custody of or visitation or parent time rights for a child because of the termination of parental rights under title chapter termination and restoration of parental rights or by virtue of consenting to or relinquishing a child for adoption pursuant to title b chapter part utah adoption act may not be considered as having a direct tangible and legitimate interest under this section b except as provided in subsection d a commercial firm or agency requesting names addresses or similar information may not be considered as having a direct tangible and legitimate interest under this section upon payment of a fee established in accordance with section j the office shall make the following records available to the public a except as provided in subsection b b a birth record excluding confidential information collected for medical and health use if years or more have passed since the date of birth b a death record if years or more have passed since the date of death and c a vital record not subject to subsection a or b if years or more have passed since the date of the event upon which the record is based upon payment of a fee established in accordance with section j the office shall make an adoption document available as provided in sections b and b the office shall make rules in accordance with title g chapter utah administrative rulemaking act establishing procedures and the content of forms as follows a for the inspection of adoption documents under subsection b b for a birth parent s election to permit identifying information about the birth parent to be made available under section b c for the release of information by the mutual consent voluntary adoption registry under section b d for collecting fees and donations under section b and e for the review and approval of a request described in subsection d section section b which is renumbered from section is renumbered and amended to read b records required to be kept by health care institutions information filed with local registrar and department a all administrators or other persons in charge of hospitals nursing homes or other institutions public or private to which persons resort for treatment of diseases confinements or are committed by law shall record all the personal and statistical information about patients of their institutions as required in certificates prescribed by this chapter part b the information described in subsection a shall i be recorded for collection at the time of admission of a patient ii be obtained from the patient if possible and iii if the information cannot be obtained from the patient the information shall be secured in as complete a manner as possible from other persons acquainted with the facts a when a dead body or dead fetus is released or disposed of by an institution the person in charge of the institution shall keep a record showing i the name of the deceased ii the date of death of the deceased iii the name and address of the person to whom the dead body or dead fetus is released and iv the date that the dead body or dead fetus is removed from the institution b if final disposal is by the institution the date place manner of disposition and the name of the person authorizing disposition shall be recorded by the person in charge of the institution not later than the tenth day of each month the administrator of each institution shall cause to be sent to the local registrar and the department a list of all births deaths fetal deaths and induced abortions occurring in the institution during the preceding month the list shall be in the form prescribed by the state registrar a person or institution who in good faith releases a dead body or dead fetus under this section to a funeral service director or a dispositioner is immune from civil liability connected directly or indirectly with release of the dead body or dead fetus section section b which is renumbered from section is renumbered and amended to read b marriage licenses execution and filing requirements the state registrar shall supply county clerks with application forms for marriage licenses completed applications shall be transmitted by the clerks to the state registrar monthly the personal identification information contained on each application for a marriage license filed with the county clerk shall be entered on a form supplied by the state registrar the person performing the marriage shall furnish the date and place of marriage and his name and address the form described in subsection shall be completed and certified by the county clerk before it is filed with the state registrar section section b which is renumbered from section is renumbered and amended to read b divorce or adoption duty of court clerk to file certificates or reports for each adoption annulment of adoption divorce and annulment of marriage ordered or decreed in this state the clerk of the court shall prepare a divorce certificate or report of adoption on a form furnished by the state registrar the petitioner shall provide the information necessary to prepare the certificate or report under subsection the clerk shall a prepare the certificate or report under subsection and b complete the remaining entries for the certificate or report immediately after the decree or order becomes final on or before the th day of each month the clerk shall forward the divorce certificates and reports of adoption under subsection completed by the clerk during the preceding month to the state registrar a a report of adoption under subsection may be provided to the attorney who is providing representation of a party to the adoption or the child placing agency as defined in section b that is placing the child b if a report of adoption is provided to the attorney or the child placing agency as defined in section b the attorney or the child placing agency shall immediately provide the report of adoption to the state registrar section section b which is renumbered from section is renumbered and amended to read b certified copies of vital records preparation by state and local registrars evidentiary value the state registrar and local registrars authorized by the department under section b may prepare typewritten photographic electronic or other reproductions of vital records and certify their correctness certified copies of the vital record or authorized reproductions of the original issued by either the state registrar or a designated local registrar are prima facie evidence in all courts of the state with like effect as the vital record section section b which is renumbered from section is renumbered and amended to read b identifying birth certificates of missing persons procedures as used in this section a division means the criminal investigations and technical services division department of public safety in title chapter criminal investigations and technical services act b missing child means a person younger than years of age old who is missing from the person s home environment or a temporary placement facility for any reason and whose whereabouts cannot be determined by the person responsible for the child s care c missing person means a person who i is missing from the person s home environment and ii a has a physical or mental disability b is missing under circumstances that indicate that the person is endangered missing involuntarily or a victim of a catastrophe or c is a missing child a in accordance with section upon the state registrar s notification by the division that a person who was born in this state is missing the state and local registrars shall flag the registered birth certificate of that person so that when a copy of the registered birth certificate or information regarding the birth record is requested the state and local registrars are alerted to the fact the registered birth certificate is that of a missing person b upon notification by the division the missing person has been recovered the state and local registrars shall remove the flag from that person s registered birth certificate the state and local registrars may not provide a copy of a registered birth certificate of any person whose record is flagged under subsection except as approved by the division a when a copy of the registered birth certificate of a person whose record has been flagged is requested in person the state or local registrar shall require that person to complete a form supplying that person s name address telephone number and relationship to the missing person and the name and birth date of the missing person b the state or local registrar shall inform the requester that a copy of the registered birth certificate will be mailed to the requester c the state or local registrar shall note the physical description of the person making the request and shall immediately notify the division of the request and the information obtained pursuant to this subsection when a copy of the registered birth certificate of a person whose record has been
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+enrolled copy s b health and human services recodification health care assistance and data general session state of utah chief sponsor jacob l anderegg house sponsor raymond p ward long title general description this bill recodifies portions of the utah health code and utah human services code highlighted provisions this bill recodifies provisions regarding health care administration and assistance and vital statistics health data and the utah medical examiner and makes technical and corresponding changes money appropriated in this bill none other special clauses this bill provides a coordination clause this bill provides revisor instructions utah code sections affected amends b as enacted by laws of utah chapter b as enacted by laws of utah chapter renumbers and amends b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah sixth special session chapter b renumbered from as last amended by laws of utah fifth special session chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah fifth special session chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from c as last amended by laws of utah chapter b renumbered from c as enacted by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as enacted by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as repealed and reenacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as repealed and reenacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter utah code sections affected by coordination clause as last amended by laws of utah chapter as last amended by laws of utah chapter b as enacted by laws of utah chapter b utah code annotated be it enacted by the legislature of the state of utah section section b is amended to read chapter health care administration and assistance part health care assistance b definitions reserved as used in this chapter applicant means any person who requests assistance under the medical programs of the state cms means the centers for medicare and medicaid services within the united states department of health and human services division means the division of integrated healthcare within the department established under section b enrollee or member means an individual whom the department has determined to be eligible for assistance under the medicaid program medicaid program means the state program for medical assistance for persons who are eligible under the state plan adopted pursuant to title xix of the federal social security act medical assistance means services furnished or payments made to or on behalf of a member a passenger vehicle means a self propelled two axle vehicle intended primarily for operation on highways and used by an applicant or recipient to meet basic transportation needs and has a fair market value below of the applicable amount of the federal luxury passenger automobile tax established in u s c sec and adjusted annually for inflation b passenger vehicle does not include i a commercial vehicle as defined in section a ii an off highway vehicle as defined in section a or iii a motor home as defined in section ppaca means the same as that term is defined in section a recipient means a person who has received medical assistance under the medicaid program section section b which is renumbered from section is renumbered and amended to read b division creation there is created within the department the division of medicaid and health financing integrated healthcare which shall be responsible for implementing organizing and maintaining the medicaid program and the children s health insurance program established in section b in accordance with the provisions of this chapter and applicable federal law section section b which is renumbered from section is renumbered and amended to read b state medicaid director appointment responsibilities the state medicaid director shall be appointed by the governor after consultation with the executive director with the advice and consent of the senate the state medicaid director may employ other employees as necessary to implement the provisions of this chapter and shall a administer the responsibilities of the division as set forth in this chapter b administer the division s budget and c establish and maintain a state plan for the medicaid program in compliance with federal law and regulations section section b which is renumbered from section is renumbered and amended to read b division responsibilities emphasis periodic assessment in accordance with the requirements of title xix of the social security act and applicable federal regulations the division is responsible for the effective and impartial administration of this chapter in an efficient economical manner the division shall a establish on a statewide basis a program to safeguard against unnecessary or inappropriate use of medicaid services excessive payments and unnecessary or inappropriate hospital admissions or lengths of stay b deny any provider claim for services that fail to meet criteria established by the division concerning medical necessity or appropriateness and c place its emphasis on high quality care to recipients in the most economical and cost effective manner possible with regard to both publicly and privately provided services the division shall implement and utilize cost containment methods where possible which may include a prepayment and postpayment review systems to determine if utilization is reasonable and necessary b preadmission certification of nonemergency admissions c mandatory outpatient rather than inpatient surgery in appropriate cases d second surgical opinions e procedures for encouraging the use of outpatient services f consistent with sections b and b a medicaid drug program g coordination of benefits and h review and exclusion of providers who are not cost effective or who have abused the medicaid program in accordance with the procedures and provisions of federal law and regulation the state medicaid director shall periodically assess the cost effectiveness and health implications of the existing medicaid program and consider alternative approaches to the provision of covered health and medical services through the medicaid program in order to reduce unnecessary or unreasonable utilization a the department shall ensure medicaid program integrity by conducting internal audits of the medicaid program for efficiencies best practices and cost avoidance b the department shall coordinate with the office of the inspector general for medicaid services created in section a to implement subsection and to address medicaid fraud waste or abuse as described in section a section section b which is renumbered from section is renumbered and amended to read b medicaid drug program preferred drug list a medicaid drug program developed by the department under subsection b f a shall notwithstanding subsection b b be based on clinical and cost related factors which include medical necessity as determined by a provider in accordance with administrative rules established by the drug utilization review board b may include therapeutic categories of drugs that may be exempted from the drug program c may include placing some drugs except the drugs described in subsection on a preferred drug list i to the extent determined appropriate by the department and ii in the manner described in subsection for psychotropic drugs d notwithstanding the requirements of part sections b through b regarding the drug utilization review board and except as provided in subsection shall immediately implement the prior authorization requirements for a nonpreferred drug that is in the same therapeutic class as a drug that is i on the preferred drug list on the date that this act takes effect or ii added to the preferred drug list after this act takes effect and e except as prohibited by subsections b and shall establish the prior authorization requirements established under subsections c and d which shall permit a health care provider or the health care provider s agent to obtain a prior authorization override of the preferred drug list through the department s pharmacy prior authorization review process and which shall i provide either telephone or fax approval or denial of the request within hours of the receipt of a request that is submitted during normal business hours of monday through friday from a m to p m ii provide for the dispensing of a limited supply of a requested drug as determined appropriate by the department in an emergency situation if the request for an override is received outside of the department s normal business hours and iii require the health care provider to provide the department with documentation of the medical need for the preferred drug list override in accordance with criteria established by the department in consultation with the pharmacy and therapeutics committee a for purposes of as used in this subsection i immunosuppressive drug a means a drug that is used in immunosuppressive therapy to inhibit or prevent activity of the immune system to aid the body in preventing the rejection of transplanted organs and tissue and b does not include drugs used for the treatment of autoimmune disease or diseases that are most likely of autoimmune origin ii stabilized means a health care provider has documented in the patient s medical chart that a patient has achieved a stable or steadfast medical state within the past days using a particular psychotropic drug b a preferred drug list developed under the provisions of this section may not include an immunosuppressive drug c i the state medicaid program shall reimburse for a prescription for an immunosuppressive drug as written by the health care provider for a patient who has undergone an organ transplant ii for purposes of subsection b and with respect to patients who have undergone an organ transplant the prescription for a particular immunosuppressive drug as written by a health care provider meets the criteria of demonstrating to the department a medical necessity for dispensing the prescribed immunosuppressive drug d notwithstanding the requirements of part sections b through b regarding the drug utilization review board the state medicaid drug program may not require the use of step therapy for immunosuppressive drugs without the written or oral consent of the health care provider and the patient e the department may include a sedative hypnotic on a preferred drug list in accordance with subsection f f the department shall grant a prior authorization for a sedative hypnotic that is not on the preferred drug list under subsection e if the health care provider has documentation related to one of the following conditions for the medicaid client i a trial and failure of at least one preferred agent in the drug class including the name of the preferred drug that was tried the length of therapy and the reason for the discontinuation ii detailed evidence of a potential drug interaction between current medication and the preferred drug iii detailed evidence of a condition or contraindication that prevents the use of the preferred drug iv objective clinical evidence that a patient is at high risk of adverse events due to a therapeutic interchange with a preferred drug v the patient is a new or previous medicaid client with an existing diagnosis previously stabilized with a nonpreferred drug or vi other valid reasons as determined by the department g a prior authorization granted under subsection f is valid for one year from the date the department grants the prior authorization and shall be renewed in accordance with subsection f a for purposes of as used in this subsection psychotropic drug means the following classes of drugs i atypical anti psychotic ii anti depressant iii anti convulsant mood stabilizer iv anti anxiety and v attention deficit hyperactivity disorder stimulant b i the department shall develop a preferred drug list for psychotropic drugs ii except as provided in subsection d a preferred drug list for psychotropic drugs developed under this section shall allow a health care provider to override the preferred drug list by writing dispense as written on the prescription for the psychotropic drug iii a health care provider may not override section b by writing dispense as written on a prescription c the department and a medicaid accountable care organization that is responsible for providing behavioral health shall i establish a system to a track health care provider prescribing patterns for psychotropic drugs b educate health care providers who are not complying with the preferred drug list and c implement peer to peer education for health care providers whose prescribing practices continue to not comply with the preferred drug list and ii determine whether health care provider compliance with the preferred drug list is at least a of prescriptions by july b of prescriptions by july and c of prescriptions by july d beginning october the department shall eliminate the dispense as written override for the preferred drug list and shall implement a prior authorization system for psychotropic drugs in accordance with subsection f if by july the department has not realized annual savings from implementing the preferred drug list for psychotropic drugs of at least general fund savings section section b which is renumbered from section is renumbered and amended to read b simplified enrollment and renewal process for medicaid and other state medical programs financial institutions the department may apply for grants and accept donations to make technology system improvements necessary to implement a simplified enrollment and renewal process for the medicaid program utah premium partnership and primary care network demonstration project programs a the department may enter into an agreement with a financial institution doing business in the state to develop and operate a data match system to identify an applicant s or enrollee s assets that i uses automated data exchanges to the maximum extent feasible and ii requires a financial institution each month to provide the name record address social security number other taxpayer identification number or other identifying information for each applicant or enrollee who maintains an account at the financial institution b the department may pay a reasonable fee to a financial institution for compliance with this subsection as provided in section c a financial institution may not be liable under any federal or state law to any person for any disclosure of information or action taken in good faith under this subsection d the department may disclose a financial record obtained from a financial institution under this section only for the purpose of and to the extent necessary in verifying eligibility as provided in this section and section b section section b which is renumbered from section is renumbered and amended to read b dental benefits a except as provided in subsection the division may establish a competitive bid process to bid out medicaid dental benefits under this chapter b the division may bid out the medicaid dental benefits separately from other program benefits the division shall use the following criteria to evaluate dental bids a ability to manage dental expenses b proven ability to handle dental insurance c efficiency of claim paying procedures d provider contracting discounts and adequacy of network and e other criteria established by the department the division shall request bids for the program s benefits at least once every five years the division s contract with dental plans for the program s benefits shall include risk sharing provisions in which the dental plan must accept of the risk for any difference between the division s premium payments per client and actual dental expenditures the division may not award contracts to a more than three responsive bidders under this section or b an insurer that does not have a current license in the state a the division may cancel the request for proposals if i there are no responsive bidders or ii the division determines that accepting the bids would increase the program s costs b if the division cancels a request for proposal or a contract that results from a request for proposal described in subsection a the division shall report to the health and human services interim committee regarding the reasons for the decision title g chapter a utah procurement code shall apply to this section a the division may i establish a dental health care delivery system and payment reform pilot program for medicaid dental benefits to increase access to cost effective and quality dental health care by increasing the number of dentists available for medicaid dental services and ii target specific medicaid populations or geographic areas in the state b the pilot program shall establish compensation models for dentists and dental hygienists that i increase access to quality cost effective dental care and ii use funds from the division of family health and preparedness that are available to reimburse dentists for educational loans in exchange for the dentist agreeing to serve medicaid and under served populations c the division may amend the state plan and apply to the secretary of the united states department of health and human services for waivers or pilot programs if necessary to establish the new dental care delivery and payment reform model d the division shall evaluate the pilot program s effect on the cost of dental care and access to dental care for the targeted medicaid populations a as used in this subsection dental hygienist means an individual who is licensed as a dental hygienist under section b the department shall reimburse a dental hygienist for dental services performed in a public health setting and in accordance with subsection c beginning on the earlier of i january or ii days after the date on which the replacement of the department s medicaid management information system software is complete c the department shall reimburse a dental hygienist directly for a service provided through the medicaid program if i the dental hygienist requests to be reimbursed directly and ii the dental hygienist provides the service within the scope of practice described in section d before november of each year in which the department reimburses dental hygienists in accordance with subsection c the department shall report to the health and human services interim committee for the previous fiscal year i the number and geographic distribution of dental hygienists who requested to be reimbursed directly ii the total number of medicaid enrollees who were served by a dental hygienist who were reimbursed under this subsection iii the total amount reimbursed directly to dental hygienists under this subsection iv the specific services and billing codes that are reimbursed under this subsection and v the aggregate amount reimbursed for each service and billing code described in subsection d iv e i except as provided in this subsection nothing in this subsection shall be interpreted as expanding or otherwise altering the limitations and scope of practice for a dental hygienist ii a dental hygienist may only directly bill and receive compensation for billing codes that fall within the scope of practice of a dental hygienist section section b which is renumbered from section is renumbered and amended to read b administration of medicaid program by department reporting to the legislature disciplinary measures and sanctions funds collected eligibility standards internal audits health opportunity accounts the department shall be the single state agency responsible for the administration of the medicaid program in connection with the united states department of health and human services pursuant to title xix of the social security act a the department shall implement the medicaid program through administrative rules in conformity with this chapter title g chapter utah administrative rulemaking act the requirements of title xix and applicable federal regulations b the rules adopted under subsection a shall include in addition to other rules necessary to implement the program i the standards used by the department for determining eligibility for medicaid services ii the services and benefits to be covered by the medicaid program iii reimbursement methodologies for providers under the medicaid program and iv a requirement that a a person receiving medicaid services shall participate in the electronic exchange of clinical health records established in accordance with section b unless the individual opts out of participation b prior to enrollment in the electronic exchange of clinical health records the enrollee shall receive notice of enrollment in the electronic exchange of clinical health records and the right to opt out of participation at any time and c beginning july when the program sends enrollment or renewal information to the enrollee and when the enrollee logs onto the program s website the enrollee shall receive notice of the right to opt out of the electronic exchange of clinical health records a the department shall in accordance with subsection b report to the social services appropriations subcommittee when the department i implements a change in the medicaid state plan ii initiates a new medicaid waiver iii initiates an amendment to an existing medicaid waiver iv applies for an extension of an application for a waiver or an existing medicaid waiver v applies for or receives approval for a change in any capitation rate within the medicaid program or vi initiates a rate change that requires public notice under state or federal law b the report required by subsection a shall i be submitted to the social services appropriations subcommittee prior to the department implementing the proposed change and ii include a a description of the department s current practice or policy that the department is proposing to change b an explanation of why the department is proposing the change c the proposed change in services or reimbursement including a description of the effect of the change d the effect of an increase or decrease in services or benefits on individuals and families e the degree to which any proposed cut may result in cost shifting to more expensive services in health or human service programs and f the fiscal impact of the proposed change including i the effect of the proposed change on current or future appropriations from the legislature to the department ii the effect the proposed change may have on federal matching dollars received by the state medicaid program iii any cost shifting or cost savings within the department s budget that may result from the proposed change and iv identification of the funds that will be used for the proposed change including any transfer of funds within the department s budget any rules adopted by the department under subsection are subject to review and reauthorization by the legislature in accordance with section g the department may in its discretion contract with the department of human services or other qualified agencies for services in connection with the administration of the medicaid program including a the determination of the eligibility of individuals for the program b recovery of overpayments and c consistent with section b and to the extent permitted by law and quality control services enforcement of fraud and abuse laws the department shall provide by rule disciplinary measures and sanctions for medicaid providers who fail to comply with the rules and procedures of the program provided that sanctions imposed administratively may not extend beyond a termination from the program b recovery of claim reimbursements incorrectly paid and c those specified in section of title xix of the federal social security act a funds collected as a result of a sanction imposed under section of title xix of the federal social security act shall be deposited in the general fund as dedicated credits to be used by the division in accordance with the requirements of section of title xix of the federal social security act b in accordance with section j sanctions collected under this subsection are nonlapsing a in determining whether an applicant or recipient is eligible for a service or benefit under this part or chapter part utah children s health insurance act program the department shall if subsection b is satisfied exclude from consideration one passenger vehicle designated by the applicant or recipient b before subsection a may be applied i the federal government shall a determine that subsection a may be implemented within the state s existing public assistance related waivers as of january b extend a waiver to the state permitting the implementation of subsection a or c determine that the state s waivers that permit dual eligibility determinations for cash assistance and medicaid are no longer valid and ii the department shall determine that subsection a can be implemented within existing funding a for purposes of as used in this subsection i aged blind or has a disability means an aged blind or disabled individual as defined in u s c sec c a and ii spend down means an amount of income in excess of the allowable income standard that shall be paid in cash to the department or incurred through the medical services not paid by medicaid b in determining whether an applicant or recipient who is aged blind or has a disability is eligible for a service or benefit under this chapter the department shall use of the federal poverty level as i the allowable income standard for eligibility for services or benefits and ii the allowable income standard for eligibility as a result of spend down the department shall conduct internal audits of the medicaid program a the department may apply for and if approved implement a demonstration program for health opportunity accounts as provided for in u s c sec u b a health opportunity account established under subsection a shall be an alternative to the existing benefits received by an individual eligible to receive medicaid under this chapter c subsection a is not intended to expand the coverage of the medicaid program a i the department shall apply for and if approved implement an amendment to the state plan under this subsection for benefits for a medically needy pregnant women b medically needy children and c medically needy parents and caretaker relatives ii the department may implement the eligibility standards of subsection b for eligibility determinations made on or after the date of the approval of the amendment to the state plan b in determining whether an applicant is eligible for benefits described in subsection a i the department shall i disregard resources held in an account in the savings plan created under title b chapter a utah educational savings plan if the beneficiary of the account is a under the age of and b living with the account owner as that term is defined in section b a or temporarily absent from the residence of the account owner and ii include the withdrawals from an account in the utah educational savings plan as resources for a benefit determination if the withdrawal was not used for qualified higher education costs as that term is defined in section b a a the department may not deny or terminate eligibility for medicaid solely because an individual is i incarcerated and ii not an inmate as defined in section b subsection a does not require the medicaid program to provide coverage for any services for an individual while the individual is incarcerated the department is a party to and may intervene at any time in any judicial or administrative action a to which the department of workforce services is a party and b that involves medical assistance under this chapter i title chapter medical assistance act or ii title chapter utah children s health insurance act section section b which is renumbered from section is renumbered and amended to read b medicaid expansion the purpose of this section is to expand the coverage of the medicaid program to persons who are in categories traditionally not served by that program within appropriations from the legislature the department may amend the state plan for medical assistance to provide for eligibility for medicaid a on or after july for children to years old who live in households below the federal poverty income guideline and b on or after july for persons who have incomes below the federal poverty income guideline and who are aged blind or have a disability a within appropriations from the legislature on or after july the medicaid program may provide for eligibility for persons who have incomes below the federal poverty income guideline b in order to meet the provisions of this subsection the department may seek approval for a demonstration project under u s c sec from the secretary of the united states department of health and human services the medicaid program shall provide for eligibility for persons as required by subsection b services available for persons described in this section shall include required medicaid services and may include one or more optional medicaid services if those services are funded by the legislature the department may also require persons described in subsections through to meet an asset test section section b which is renumbered from section is renumbered and amended to read b copayments by recipients employer sponsored plans the department shall selectively provide for enrollment fees premiums deductions cost sharing or other similar charges to be paid by recipients their spouses and parents within the limitations of federal law and regulation beginning may within appropriations by the legislature and as a means to increase health care coverage among the uninsured the department shall take steps to promote increased participation in employer sponsored health insurance including a maximizing the health insurance premium subsidy provided under the state s demonstration waiver by i ensuring that state funds are matched by federal funds to the greatest extent allowable and ii as the department determines appropriate seeking federal approval to do one or more of the following a eliminate or otherwise modify the annual enrollment fee b eliminate or otherwise modify the schedule used to determine the level of subsidy provided to an enrollee each year c reduce the maximum number of participants allowable under the subsidy program or d otherwise modify the program in a manner that promotes enrollment in employer sponsored health insurance and b exploring the use of other options including the development of a waiver under the medicaid health insurance flexibility demonstration initiative or other federal authority section section b which is renumbered from section is renumbered and amended to read b income and resources from institutionalized spouses as used in this section a community spouse means the spouse of an institutionalized spouse b i community spouse monthly income allowance means an amount by which the minimum monthly maintenance needs allowance for the spouse exceeds the amount of monthly income otherwise available to the community spouse determined without regard to the allowance except as provided in subsection b ii ii if a court has entered an order against an institutionalized spouse for monthly income for the support of the community spouse the community spouse monthly income allowance for the spouse may not be less than the amount of the monthly income so ordered c community spouse resource allowance is the amount of combined resources that are protected for a community spouse living in the community which the division shall establish by rule made in accordance with title g chapter utah administrative rulemaking act based on the amounts established by the united states department of health and human services d excess shelter allowance for a community spouse means the amount by which the sum of the spouse s expense for rent or mortgage payment taxes and insurance and in the case of condominium or cooperative required maintenance charge for the community spouse s principal residence and the spouse s actual expenses for electricity natural gas and water utilities or at the discretion of the department the federal standard utility allowance under snap as defined in section a exceeds of the amount described in subsection e family member means a minor dependent child dependent parents or dependent sibling of the institutionalized spouse or community spouse who are residing with the community spouse f i institutionalized spouse means a person who is residing in a nursing facility and is married to a spouse who is not in a nursing facility ii an institutionalized spouse does not include a person who is not likely to reside in a nursing facility for at least consecutive days g nursing care facility means the same as that term is defined in section b the division shall comply with this section when determining eligibility for medical assistance for an institutionalized spouse for services furnished during a calendar year beginning on or after january the community spouse resource allowance shall be increased by the division by an amount as determined annually by cms the division shall compute as of the beginning of the first continuous period of institutionalization of the institutionalized spouse a the total value of the resources to the extent either the institutionalized spouse or the community spouse has an ownership interest and b a spousal share which is of the resources described in subsection a at the request of an institutionalized spouse or a community spouse at the beginning of the first continuous period of institutionalization of the institutionalized spouse and upon the receipt of relevant documentation of resources the division shall promptly assess and document the total value described in subsection a and shall provide a copy of that assessment and documentation to each spouse and shall retain a copy of the assessment when the division provides a copy of the assessment it shall include a notice stating that the spouse may request a hearing under subsection when determining eligibility for medical assistance under this chapter a except as provided in subsection b all resources held by either the institutionalized spouse community spouse or both are considered to be available to the institutionalized spouse b resources are considered to be available to the institutionalized spouse only to the extent that the amount of those resources exceeds the community spouse resource allowance at the time of application for medical assistance under this chapter a the division may not find an institutionalized spouse to be ineligible for medical assistance by reason of resources determined under subsection to be available for the cost of care when i the institutionalized spouse has assigned to the state any rights to support from the community spouse ii except as provided in subsection b the institutionalized spouse lacks the ability to execute an assignment due to physical or mental impairment or iii the division determines that denial of medical assistance would cause an undue burden b subsection a ii does not prevent the division from seeking a court order for an assignment of support during the continuous period in which an institutionalized spouse is in an institution and after the month in which an institutionalized spouse is eligible for medical assistance the resources of the community spouse may not be considered to be available to the institutionalized spouse when an institutionalized spouse is determined to be eligible for medical assistance in determining the amount of the spouse s income that is to be applied monthly for the cost of care in the nursing care facility the division shall deduct from the spouse s monthly income the following amounts in the following order a a personal needs allowance the amount of which is determined by the division b a community spouse monthly income allowance but only to the extent that the income of the institutionalized spouse is made available to or for the benefit of the community spouse c a family allowance for each family member equal to at least of the amount that the amount described in subsection a exceeds the amount of the family member s monthly income and d amounts for incurred expenses for the medical or remedial care for the institutionalized spouse the division shall establish a minimum monthly maintenance needs allowance for each community spouse that includes a an amount established by the division by rule made in accordance with title g chapter utah administrative rulemaking act based on the amounts established by the united states department of health and human services and b an excess shelter allowance a an institutionalized spouse or a community spouse may request a hearing with respect to the determinations described in subsections e i through v if an application for medical assistance has been made on behalf of the institutionalized spouse b a hearing under this subsection regarding the community spouse resource allowance shall be held by the division within days from the date of the request for the hearing c if either spouse establishes that the community spouse needs income above the level otherwise provided by the minimum monthly maintenance needs allowance due to exceptional circumstances resulting in significant financial duress there shall be substituted for the minimum monthly maintenance needs allowance provided under subsection an amount adequate to provide additional income as is necessary d if either spouse establishes that the community spouse resource allowance in relation to the amount of income generated by the allowance is inadequate to raise the community spouse s income to the minimum monthly maintenance needs allowance there shall be substituted for the community spouse resource allowance an amount adequate to provide a minimum monthly maintenance needs allowance e a hearing may be held under this subsection if either the institutionalized spouse or community spouse is dissatisfied with a determination of i the community spouse monthly income allowance ii the amount of monthly income otherwise available to the community spouse iii the computation of the spousal share of resources under subsection iv the attribution of resources under subsection or v the determination of the community spouse resource allocation a an institutionalized spouse may transfer an amount equal to the community spouse resource allowance but only to the extent the resources of the institutionalized spouse are transferred to or for the sole benefit of the community spouse b the transfer under subsection a shall be made as soon as practicable after the date of the initial determination of eligibility taking into account the time necessary to obtain a court order under subsection c c chapter medical benefits recovery act part medical benefits recovery does not apply if a court has entered an order against an institutionalized spouse for the support of the community spouse section section b which is renumbered from section is renumbered and amended to read b maximizing use of premium assistance programs utah s premium partnership for health insurance a the department shall seek to maximize the use of medicaid and children s health insurance program funds for assistance in the purchase of private health insurance coverage for medicaid eligible and non medicaid eligible individuals b the department s efforts to expand the use of premium assistance shall i include as necessary seeking federal approval under all medicaid and children s health insurance program premium assistance provisions of federal law including provisions of the patient protection and affordable care act public law ppaca ii give priority to but not be limited to expanding the state s utah premium partnership for health insurance program including as required under subsection and iii encourage the enrollment of all individuals within a household in the same plan where possible including enrollment in a plan that allows individuals within the household transitioning out of medicaid to retain the same network and benefits they had while enrolled in medicaid the department shall seek federal approval of an amendment to the state s utah premium partnership for health insurance program to adjust the eligibility determination for single adults and parents who have an offer of employer sponsored insurance the amendment shall a be within existing appropriations for the utah premium partnership for health insurance program and b provide that adults who are up to of the federal poverty level are eligible for premium subsidies in the utah premium partnership for health insurance program for the fiscal year the department shall seek authority to increase the maximum premium subsidy per month for adults under the utah premium partnership for health insurance program to beginning with the fiscal year and in each subsequent fiscal year the department may increase premium subsidies for single adults and parents who have an offer of employer sponsored insurance to keep pace with the increase in insurance premium costs subject to appropriation of additional funding section section b which is renumbered from section is renumbered and amended to read b expanding the medicaid program as used in this section a cms means the centers for medicare and medicaid services in the united states department of health and human services b a federal poverty level means the same as that term is defined in section b c b medicaid expansion means an expansion of the medicaid program in accordance with this section d c medicaid expansion fund means the medicaid expansion fund created in section b b a as set forth in subsections through eligibility criteria for the medicaid program shall be expanded to cover additional low income individuals b the department shall continue to seek approval from cms to implement the medicaid waiver expansion as defined in section b c the department may implement any provision described in subsections b b iii through viii in a medicaid expansion if the department receives approval from cms to implement that provision the department shall expand the medicaid program in accordance with this subsection if the department a receives approval from cms to i expand medicaid coverage to eligible individuals whose income is below of the federal poverty level ii obtain maximum federal financial participation under u s c sec d b for enrolling an individual in the medicaid expansion under this subsection and iii permit the state to close enrollment in the medicaid expansion under this subsection if the department has insufficient funds to provide services to new enrollment under the medicaid expansion under this subsection b pays the state portion of costs for the medicaid expansion under this subsection with funds from i the medicaid expansion fund ii county contributions to the nonfederal share of medicaid expenditures or iii any other contributions funds or transfers from a nonstate agency for medicaid expenditures and c closes the medicaid program to new enrollment under the medicaid expansion under this subsection if the department projects that the cost of the medicaid expansion under this subsection will exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act a the department shall expand the medicaid program in accordance with this subsection if the department i receives approval from cms to a expand medicaid coverage to eligible individuals whose income is below of the federal poverty level b obtain maximum federal financial participation under u s c sec d y for enrolling an individual in the medicaid expansion under this subsection and c permit the state to close enrollment in the medicaid expansion under this subsection if the department has insufficient funds to provide services to new enrollment under the medicaid expansion under this subsection ii pays the state portion of costs for the medicaid expansion under this subsection with funds from a the medicaid expansion fund b county contributions to the nonfederal share of medicaid expenditures or c any other contributions funds or transfers from a nonstate agency for medicaid expenditures and iii closes the medicaid program to new enrollment under the medicaid expansion under this subsection if the department projects that the cost of the medicaid expansion under this subsection will exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act b the department shall submit a waiver an amendment to an existing waiver or a state plan amendment to cms to i administer federal funds for the medicaid expansion under this subsection according to a per capita cap developed by the department that includes an annual inflationary adjustment accounts for differences in cost among categories of medicaid expansion enrollees and provides greater flexibility to the state than the current medicaid payment model ii limit in certain circumstances as defined by the department the ability of a qualified entity to determine presumptive eligibility for medicaid coverage for an individual enrolled in a medicaid expansion under this subsection iii impose a lock out period if an individual enrolled in a medicaid expansion under this subsection violates certain program requirements as defined by the department iv allow an individual enrolled in a medicaid expansion under this subsection to remain in the medicaid program for up to a month certification period as defined by the department and v allow federal medicaid funds to be used for housing support for eligible enrollees in the medicaid expansion under this subsection a i if cms does not approve a waiver to expand the medicaid program in accordance with subsection a on or before january the department shall develop proposals to implement additional flexibilities and cost controls including cost sharing tools within a medicaid expansion under this subsection through a request to cms for a waiver or state plan amendment ii the request for a waiver or state plan amendment described in subsection a i shall include a a path to self sufficiency for qualified adults in the medicaid expansion that includes employment and training as defined in u s c sec d and b a requirement that an individual who is offered a private health benefit plan by an employer to enroll in the employer s health plan iii the department shall submit the request for a waiver or state plan amendment developed under subsection a i on or before march b notwithstanding sections b and j and in accordance with this subsection eligibility for the medicaid program shall be expanded to include all persons in the optional medicaid expansion population under the patient protection and affordable care act pub l no ppaca and the health care education reconciliation act of pub l no and related federal regulations and guidance on the earlier of i the day on which cms approves a waiver to implement the provisions described in subsections a ii a and b or ii july c the department shall seek a waiver or an amendment to an existing waiver from federal law to i implement each provision described in subsections b b iii through viii in a medicaid expansion under this subsection ii limit in certain circumstances as defined by the department the ability of a qualified entity to determine presumptive eligibility for medicaid coverage for an individual enrolled in a medicaid expansion under this subsection and iii impose a lock out period if an individual enrolled in a medicaid expansion under this subsection violates certain program requirements as defined by the department d the eligibility criteria in this subsection shall be construed to include all individuals eligible for the health coverage improvement program under section b e the department shall pay the state portion of costs for a medicaid expansion under this subsection entirely from i the medicaid expansion fund ii county contributions to the nonfederal share of medicaid expenditures or iii any other contributions funds or transfers from a nonstate agency for medicaid expenditures f if the costs of the medicaid expansion under this subsection exceed the funds available under subsection e i the department may reduce or eliminate optional medicaid services under this chapter and ii savings as determined by the department from the reduction or elimination of optional medicaid services under subsection f i shall be deposited into the medicaid expansion fund and iii the department may submit to cms a request for waivers or an amendment of existing waivers from federal law necessary to implement budget controls within the medicaid program to address the deficiency g if the costs of the medicaid expansion under this subsection are projected by the department to exceed the funds available in the current fiscal year under subsection e including savings resulting from any action taken under subsection f i the governor shall direct the department of health department of human services department and department of workforce services to reduce commitments and expenditures by an amount sufficient to offset the deficiency a proportionate to the share of total current fiscal year general fund appropriations for each of those agencies and b up to of each agency s total current fiscal year general fund appropriations ii the division of finance shall reduce allotments to the department of health department of human services department and department of workforce services by a percentage a proportionate to the amount of the deficiency and b up to of each agency s total current fiscal year general fund appropriations and iii the division of finance shall deposit the total amount from the reduced allotments described in subsection g ii into the medicaid expansion fund the department shall maximize federal financial participation in implementing this section including by seeking to obtain any necessary federal approvals or waivers notwithstanding sections and a county does not have to provide matching funds to the state for the cost of providing medicaid services to newly enrolled individuals who qualify for medicaid coverage under a medicaid expansion the department shall report to the social services appropriations subcommittee on or before november of each year that a medicaid expansion is operational a the number of individuals who enrolled in the medicaid expansion b costs to the state for the medicaid expansion c estimated costs to the state for the medicaid expansion for the current and following fiscal years d recommendations to control costs of the medicaid expansion and e as calculated in accordance with subsections b b and c b the state s net cost of the qualified medicaid expansion section section b which is renumbered from section is renumbered and amended to read b department standards for eligibility under medicaid funds for abortions a the department may develop standards and administer policies relating to eligibility under the medicaid program as long as they are consistent with subsection b b an applicant receiving medicaid assistance may be limited to particular types of care or services or to payment of part or all costs of care determined to be medically necessary the department may not provide any funds for medical hospital or other medical expenditures or medical services to otherwise eligible persons where the purpose of the assistance is to perform an abortion unless the life of the mother would be endangered if an abortion were not performed any employee of the department who authorizes payment for an abortion contrary to the provisions of this section is guilty of a class b misdemeanor and subject to forfeiture of office any person or organization that under the guise of other medical treatment provides an abortion under auspices of the medicaid program is guilty of a third degree felony and subject to forfeiture of license to practice medicine or authority to provide medical services and treatment section section b which is renumbered from section is renumbered and amended to read b contracts for provision of medical services federal provisions modifying department rules compliance with social security act the department may contract with other public or private agencies to purchase or provide medical services in connection with the programs of the division where these programs are used by other government entities contracts shall provide that other government entities in compliance with state and federal law regarding intergovernmental transfers transfer the state matching funds to the department in amounts sufficient to satisfy needs of the specified program contract terms shall include provisions for maintenance administration and service costs if a federal legislative or executive provision requires modifications or revisions in an eligibility factor established under this chapter as a condition for participation in medical assistance the department may modify or change its rules as necessary to qualify for participation the provisions of this section do not apply to department rules governing abortion the department shall comply with all pertinent requirements of the social security act and all orders rules and regulations adopted thereunder when required as a condition of participation in benefits under the social security act section section b which is renumbered from section is renumbered and amended to read b liability insurance required the medicaid program may not reimburse a home health agency as defined in section b for home health services provided to an enrollee unless the home health agency has liability coverage of at least per incident or an amount established by department rule made in accordance with title g chapter utah administrative rulemaking act section section b which is renumbered from section is renumbered and amended to read b federal aid authority of executive director the executive director with the approval of the governor may bind the state to any executive or legislative provisions promulgated or enacted by the federal government which invite the state to participate in the distribution disbursement or administration of any fund or service advanced offered or contributed in whole or in part by the federal government for purposes consistent with the powers and duties of the department such funds shall be used as provided in this chapter and be administered by the department for purposes related to medical assistance programs section section b which is renumbered from section is renumbered and amended to read b medical vendor rates medical vendor payments made to providers of services for and in behalf of recipient households shall be based upon predetermined rates from standards developed by the division in cooperation with providers of services for each type of service purchased by the division as far as possible the rates paid for services shall be established in advance of the fiscal year for which funds are to be requested section section b which is renumbered from section is renumbered and amended to read b enforcement of public assistance statutes the department shall enforce or contract for the enforcement of sections a a a a a and a to the extent that these sections pertain to benefits conferred or administered by the division under this chapter to the extent allowed under federal law or regulation the department may contract for services covered in section a insofar as that section pertains to benefits conferred or administered by the division under this chapter section section b which is renumbered from section is renumbered and amended to read b prohibited acts of state or local employees of medicaid program violation a misdemeanor each state or local employee responsible for the expenditure of funds under the state medicaid program each individual who formerly was such an officer or employee and each partner of such an officer or employee is prohibited for a period of one year after termination of such responsibility from committing any act the commission of which by an officer or employee of the united states government an individual who was such an officer or employee or a partner of such an officer or employee is prohibited by section or section of title united states code violation of this section is a class a misdemeanor section section b which is renumbered from section is renumbered and amended to read b rural hospitals for purposes of as used in this section rural hospital means a hospital located outside of a standard metropolitan statistical area as designated by the united states bureau of the census for purposes of the medicaid program the division of medicaid and health financing division may not discriminate among rural hospitals on the basis of size section section b which is renumbered from section is renumbered and amended to read b telemedicine reimbursement rulemaking a as used in this section communication by telemedicine is considered face to face contact between a health care provider and a patient under the state s medical assistance program if i the communication by telemedicine meets the requirements of administrative rules adopted in accordance with subsection and ii the health care services are eligible for reimbursement under the state s medical assistance program b this subsection applies to any managed care organization that contracts with the state s medical assistance program the reimbursement rate for telemedicine services approved under this section a shall be subject to reimbursement policies set by the state plan and b may be based on i a monthly reimbursement rate ii a daily reimbursement rate or iii an encounter rate the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act which establish a the particular telemedicine services that are considered face to face encounters for reimbursement purposes under the state s medical assistance program and b the reimbursement methodology for the telemedicine services designated under subsection a section section b which is renumbered from section is renumbered and amended to read b reimbursement of telemedicine services and telepsychiatric consultations as used in this section a telehealth services means the same as that term is defined in section b b telemedicine services means the same as that term is defined in section b c telepsychiatric consultation means a consultation between a physician and a board certified psychiatrist both of whom are licensed to engage in the practice of medicine in the state that utilizes i the health records of the patient provided from the patient or the referring physician ii a written evidence based patient questionnaire and iii telehealth services that meet industry security and privacy standards including compliance with the a health insurance portability and accountability act and b health information technology for economic and clinical health act pub l no stat as amended this section applies to a a managed care organization that contracts with the medicaid program and b a provider who is reimbursed for health care services under the medicaid program the medicaid program shall reimburse for telemedicine services at the same rate that the medicaid program reimburses for other health care services the medicaid program shall reimburse for telepsychiatric consultations at a rate set by the medicaid program section section b which is renumbered from section is renumbered and amended to read b process to promote health insurance coverage for children the department in collaboration with the department of workforce services and the state board of education shall develop a process to promote health insurance coverage for a child in school when a the child applies for free or reduced price school lunch b a child enrolls in or registers in school and c other appropriate school related opportunities the department in collaboration with the department of workforce services shall promote and facilitate the enrollment of children identified under subsection without health insurance in the utah children s health insurance program the medicaid program or the utah premium partnership for health insurance program section section b which is renumbered from section is renumbered and amended to read b medicaid continuous eligibility promoting payment and delivery reform in accordance with subsection and within appropriations from the legislature the department may amend the state medicaid plan to a create continuous eligibility for up to months for an individual who has qualified for the state medicaid program b provide incentives in managed care contracts for an individual to obtain appropriate care in appropriate settings and c require the managed care system to accept the risk of managing the medicaid population assigned to the plan amendment in return for receiving the benefits of providing quality and cost effective care if the department amends the state medicaid plan under subsection a or b the department a shall ensure that the plan amendment i is cost effective for the state medicaid program ii increases the quality and continuity of care for recipients and iii calculates and transfers administrative savings from continuous enrollment from the department of workforce services to the department of health department and b may limit the plan amendment under subsection a or b to select geographic areas or specific medicaid populations the department may seek approval for a state plan amendment waiver or a demonstration project from the secretary of the united states department of health and human services if necessary to implement a plan amendment under subsection a or b section section b which is renumbered from section is renumbered and amended to read b patient notice of health care provider privacy practices a for purposes of this section i health care provider means a health care provider as defined in section b who a receives payment for medical services from the medicaid program established in this chapter or the children s health insurance program established in chapter utah children s health insurance act section b and b submits a patient s personally identifiable information to the medicaid eligibility database or the children s health insurance program eligibility database ii hipaa means c f r parts and health insurance portability and accountability act of as amended b beginning july this section applies to the medicaid program the children s health insurance program created in chapter utah children s health insurance act section b and a health care provider a health care provider shall as part of the notice of privacy practices required by hipaa provide notice to the patient or the patient s personal representative that the health care provider either has or may submit personally identifiable information about the patient to the medicaid eligibility database and the children s health insurance program eligibility database the medicaid program and the children s health insurance program may not give a health care provider access to the medicaid eligibility database or the children s health insurance program eligibility database unless the health care provider s notice of privacy practices complies with subsection the department may adopt an administrative rule to establish uniform language for the state requirement regarding notice of privacy practices to patients required under subsection section section b which is renumbered from section is renumbered and amended to read b optional medicaid expansion the department and the governor may not expand the state s medicaid program under ppaca unless a the department expands medicaid in accordance with section b or b i the governor or the governor s designee has reported the intention to expand the state medicaid program under ppaca to the legislature in compliance with the legislative review process in section b and ii the governor submits the request for expansion of the medicaid program for optional populations to the legislature under the high impact federal funds request process required by section j a the department shall request approval from cms for waivers from federal statutory and regulatory law necessary to implement the health coverage improvement program under section b b the health coverage improvement program under section b is not subject to the requirements in subsection section section b which is renumbered from section is renumbered and amended to read b medicaid vision services request for proposals the department may select one or more contractors in accordance with title g chapter a utah procurement code to provide vision services to the medicaid populations that are eligible for vision services as described in department rules without restricting provider participation and within existing appropriations from the legislature section section b which is renumbered from section is renumbered and amended to read b review of claims audit and investigation procedures a the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act and in consultation with providers and health care professionals subject to audit and investigation under the state medicaid program to establish procedures for audits and investigations that are fair and consistent with the duties of the department as the single state agency responsible for the administration of the medicaid program under section b and title xix of the social security act b if the providers and health care professionals do not agree with the rules proposed or adopted by the department under subsection a the providers or health care professionals may i request a hearing for the proposed administrative rule or seek any other remedies under the provisions of title g chapter utah administrative rulemaking act and ii request a review of the rule by the legislature s administrative rules review and general oversight committee created in section g the department shall a notify and educate providers and health care professionals subject to audit and investigation under the medicaid program of the providers and health care professionals responsibilities and rights under the administrative rules adopted by the department under the provisions of this section b ensure that the department or any entity that contracts with the department to conduct audits i has on staff or contracts with a medical or dental professional who is experienced in the treatment billing and coding procedures used by the type of provider being audited and ii uses the services of the appropriate professional described in subsection b i if the provider who is the subject of the audit disputes the findings of the audit c ensure that a finding of overpayment or underpayment to a provider is not based on extrapolation as defined in section a unless i there is a determination that the level of payment error involving the provider exceeds a error rate a for a sample of claims for a particular service code and b over a three year period of time ii documented education intervention has failed to correct the level of payment error and iii the value of the claims for the provider in aggregate exceeds in reimbursement for a particular service code on an annual basis and d require that any entity with which the office contracts for the purpose of conducting an audit of a service provider shall be paid on a flat fee basis for identifying both overpayments and underpayments a if the department or a contractor on behalf of the department i intends to implement the use of extrapolation as a method of auditing claims the department shall prior to adopting the extrapolation method of auditing report its intent to use extrapolation to the social services appropriations subcommittee and ii determines subsections c i through iii are applicable to a provider the department or the contractor may use extrapolation only for the service code associated with the findings under subsections c i through iii b i if extrapolation is used under this section a provider may at the provider s option appeal the results of the audit based on a each individual claim or b the extrapolation sample ii nothing in this section limits a provider s right to appeal the audit under title g general government title g chapter administrative procedures act the medicaid program and its manual or rules or other laws or rules that may provide remedies to providers section section b which is renumbered from section is renumbered and amended to read b medicaid intergovernmental transfer report approval requirements as used in this section a i intergovernmental transfer means the transfer of public funds from a a local government entity to another nonfederal governmental entity or b from a nonfederal government owned health care facility regulated under chapter health care facility licensing and inspection act chapter part health care facility licensing and inspection to another nonfederal governmental entity ii intergovernmental transfer does not include a the transfer of public funds from one state agency to another state agency or b a transfer of funds from the university of utah hospitals and clinics b i intergovernmental transfer program means a federally approved reimbursement program or category that is authorized by the medicaid state plan or waiver authority for intergovernmental transfers ii intergovernmental transfer program does not include the addition of a provider to an existing intergovernmental transfer program c local government entity means a county city town special service district local district or local education agency as that term is defined in section j d non state government entity means a hospital authority hospital district health care district special service district county or city a an entity that receives federal medicaid dollars from the department as a result of an intergovernmental transfer shall on or before august and on or before august each year thereafter provide the department with i information regarding the payments funded with the intergovernmental transfer as authorized by and consistent with state and federal law ii information regarding the entity s ability to repay federal funds to the extent required by the department in the contract for the intergovernmental transfer and iii other information reasonably related to the intergovernmental transfer that may be required by the department in the contract for the intergovernmental transfer b on or before october and on or before october each subsequent year the department shall prepare a report for the executive appropriations committee that includes i the amount of each intergovernmental transfer under subsection a ii a summary of changes to cms regulations and practices that are known by the department regarding federal funds related to an intergovernmental transfer program and iii other information the department gathers about the intergovernmental transfer under subsection a the department shall not create a new intergovernmental transfer program after july unless the department reports to the executive appropriations committee in accordance with section j before submitting the new intergovernmental transfer program for federal approval the report shall include information required by subsection j d and the analysis required in subsections a and b a the department shall enter into new nursing care facility non state government owned upper payment limit program contracts and contract amendments adding new nursing care facilities and new non state government entity operators in accordance with this subsection b i if the nursing care facility expects to receive less than in federal funds each year from the nursing care facility non state government owned upper payment limit program excluding seed funding and administrative fees paid by the non state government entity the department shall enter into a nursing care facility non state government owned upper payment limit program contract with the non state government entity operator of the nursing care facility ii if the nursing care facility expects to receive between and in federal funds each year from the nursing care facility non state government owned upper payment limit program excluding seed funding and administrative fees paid by the non state government entity the department shall enter into a nursing care facility non state government owned upper payment limit program contract with the non state government entity operator of the nursing care facility after receiving the approval of the executive appropriations committee iii if the nursing care facility expects to receive more than in federal funds each year from the nursing care facility non state government owned upper payment limit program excluding seed funding and administrative fees paid by the non state government entity the department may not approve the application without obtaining approval from the legislature and the governor c a non state government entity may not participate in the nursing care facility non state government owned upper payment limit program unless the non state government entity is a special service district county or city that operates a hospital or holds a license under chapter health care facility licensing and inspection act chapter part health care facility licensing and inspection d each non state government entity that participates in the nursing care facility non state government owned upper payment limit program shall certify to the department that i the non state government entity is a local government entity that is able to make an intergovernmental transfer under applicable state and federal law ii the non state government entity has sufficient public funds or other permissible sources of seed funding that comply with the requirements in c f r part subpart b iii the funds received from the nursing care facility non state government owned upper payment limit program are a for each nursing care facility available for patient care until the end of the non state government entity s fiscal year and b used exclusively for operating expenses for nursing care facility operations patient care capital expenses rent royalties and other operating expenses and iv the non state government entity has completed all licensing enrollment and other forms and documents required by federal and state law to register a change of ownership with the department and with cms the department shall add a nursing care facility to an existing nursing care facility non state government owned upper payment limit program contract if a the nursing care facility is managed by or affiliated with the same non state government entity that also manages one or more nursing care facilities that are included in an existing nursing care facility non state government owned upper payment limit program contract and b the non state government entity makes the certification described in subsection d ii the department may not increase the percentage of the administrative fee paid by a non state government entity to the department under the nursing care facility non state government owned upper payment limit program the department may not condition participation in the nursing care facility non state government owned upper payment limit program on a a requirement that the department be allowed to direct or determine the types of patients that a non state government entity will treat or the course of treatment for a patient in a non state government nursing care facility or b a requirement that a non state government entity or nursing care facility post a bond purchase insurance or create a reserve account of any kind the non state government entity shall have the primary responsibility for ensuring compliance with subsection d ii a the department may not enter into a new nursing care facility non state government owned upper payment limit program contract before january b subsection a does not apply to i a new nursing care facility non state government owned upper payment limit program contract that was included in the federal funds request summary under section j for fiscal year or ii a nursing care facility that is operated or managed by the same company as a nursing care facility that was included in the federal funds request summary under section j for fiscal year section section b which is renumbered from section is renumbered and amended to read b screening brief intervention and referral to treatment medicaid reimbursement as used in this section a controlled substance prescriber means a controlled substance prescriber as that term is defined in section who i has a record of having completed sbirt training in accordance with subsection before providing the sbirt services and ii is a medicaid enrolled health care provider b sbirt means the same as that term is defined in section the department shall reimburse a controlled substance prescriber who provides sbirt services to a medicaid enrollee who is years of age old or older for the sbirt services section section b which is renumbered from section is renumbered and amended to read b prescribing policies for opioid prescriptions the department may implement a prescribing policy for certain opioid prescriptions that is substantially similar to the prescribing policies required in section a the department may amend the state program and apply for waivers for the state program if necessary to implement subsection section section b which is renumbered from section is renumbered and amended to read b reimbursement for long acting reversible contraception immediately following childbirth as used in this section long acting reversible contraception means a contraception method that requires administration less than once per month including a an intrauterine device and b a contraceptive implant the division shall separately identify and reimburse from other labor and delivery services within the medicaid program the provision and insertion of long acting reversible contraception immediately after childbirth section section b which is renumbered from section is renumbered and amended to read b coverage of exome sequence testing as used in this section exome sequence testing means a genomic technique for sequencing the genome of an individual for diagnostic purposes the medicaid program shall reimburse for exome sequence testing a for an enrollee who i is younger than years of age old and ii who remains undiagnosed after exhausting all other appropriate diagnostic related tests b performed by a nationally recognized provider with significant experience in exome sequence testing c that is medically necessary and d at a rate set by the medicaid program section section b which is renumbered from section is renumbered and amended to read b reimbursement for nonemergency secured behavioral health transport providers the department may not reimburse a nonemergency secured behavioral health transport provider that is designated under section a b section section b which is renumbered from section is renumbered and amended to read b children s health care coverage program as used in this section a chip means the children s health insurance program created in section b b program means the children s health care coverage program created in subsection a there is created the children s health care coverage program within the department b the purpose of the program is to i promote health insurance coverage for children in accordance with section b ii conduct research regarding families who are eligible for medicaid and chip to determine awareness and understanding of available coverage iii analyze trends in disenrollment and identify reasons that families may not be renewing enrollment including any barriers in the process of renewing enrollment iv administer surveys to recently enrolled chip and children s medicaid enrollees to identify a how the enrollees learned about coverage and b any barriers during the application process v develop promotional material regarding chip and children s medicaid eligibility including outreach through social media video production and other media platforms vi identify ways that the eligibility website for enrollment in chip and children s medicaid can be redesigned to increase accessibility and enhance the user experience vii identify outreach opportunities including partnerships with community organizations including a schools b small businesses c unemployment centers d parent teacher associations and e youth athlete clubs and associations and viii develop messaging to increase awareness of coverage options that are available through the department a the department may not delegate implementation of the program to a private entity b notwithstanding subsection a the department may contract with a media agency to conduct the activities described in subsection b iv and vii section section b which is renumbered from section is renumbered and amended to read b reimbursement for diabetes prevention program as used in this section dpp means the national diabetes prevention program developed by the united states centers for disease control and prevention beginning july the medicaid program shall reimburse a provider for an enrollee s participation in the dpp if the enrollee a meets the dpp s eligibility requirements and b has not previously participated in the dpp after july while enrolled in the medicaid program subject to appropriation the medicaid program may set the rate for reimbursement the department may apply for a state plan amendment if necessary to implement this section a on or after july but before october the department shall provide a written report regarding the efficacy of the dpp and reimbursement under this section to the health and human services interim committee b the report described in subsection a shall include i the total number of enrollees with a prediabetic condition as of july ii the total number of enrollees as of july with a diagnosis of type diabetes iii the total number of enrollees who participated in the dpp iv the total cost incurred by the state to implement this section and v any conclusions that can be drawn regarding the impact of the dpp on the rate of type diabetes for enrollees section section b which is renumbered from section is renumbered and amended to read b behavioral health delivery working group as used in this section targeted adult medicaid program means the same as that term is defined in section b on or before may the department shall convene a working group to collaborate with the department on a establishing specific and measurable metrics regarding i compliance of managed care organizations in the state with federal medicaid managed care requirements ii timeliness and accuracy of authorization and claims processing in accordance with medicaid policy and contract requirements iii reimbursement by managed care organizations in the state to providers to maintain adequacy of access to care iv availability of care management services to meet the needs of medicaid eligible individuals enrolled in the plans of managed care organizations in the state and v timeliness of resolution for disputes between a managed care organization and the managed care organization s providers and enrollees b improving the delivery of behavioral health services in the medicaid program c proposals to implement the delivery system adjustments authorized under subsection b and d issues that are identified by managed care organizations behavioral health service providers and the department the working group convened under subsection shall a meet quarterly and b consist of at least the following individuals i the executive director or the executive director s designee ii for each medicaid accountable care organization with which the department contracts an individual selected by the accountable care organization iii five individuals selected by the department to represent various types of behavioral health services providers including at a minimum individuals who represent providers who provide the following types of services a acute inpatient behavioral health treatment b residential treatment c intensive outpatient or partial hospitalization treatment and d general outpatient treatment iv a representative of an association that represents behavioral health treatment providers in the state designated by the utah behavioral healthcare council convened by the utah association of counties v a representative of an organization representing behavioral health organizations vi the chair of the utah substance use and mental health advisory council created in section m vii a representative of an association that represents local authorities who provide public behavioral health care designated by the department viii one member of the senate appointed by the president of the senate and ix one member of the house of representatives appointed by the speaker of the house of representatives the working group convened under this section shall recommend to the department a specific and measurable metrics under subsection a b how physical and behavioral health services may be integrated for the targeted adult medicaid program including ways the department may address issues regarding i filing of claims ii authorization and reauthorization for treatment services iii reimbursement rates and iv other issues identified by the department behavioral health services providers or medicaid managed care organizations c ways to improve delivery of behavioral health services to enrollees including changes to statute or administrative rule and d wraparound service coverage for enrollees who need specific nonclinical services to ensure a path to success section section b which is renumbered from section is renumbered and amended to read b adjudicative proceedings related to medicaid funds if a proceeding of the department under title g chapter administrative procedures act relates in any way to recovery of medicaid funds a the presiding officer shall be designated by the executive director of the department and report directly to the executive director or in the discretion of the executive director report directly to the director of the office of internal audit and b the decision of the presiding officer is the recommended decision to the executive director of the department or a designee of the executive director who is not in the division subsection does not apply to hearings conducted by the department of workforce services relating to medical assistance eligibility determinations if a proceeding of the department under title g chapter administrative procedures act relates in any way to medicaid or medicaid funds the following may attend and present evidence or testimony at the proceeding a the director of the office of internal audit or the director s designee and b the inspector general of medicaid services or the inspector general s designee in relation to a proceeding of the department under title g chapter administrative procedures act a person may not outside of the actual proceeding attempt to influence the decision of the presiding officer section section b which is renumbered from section is renumbered and amended to read b medical assistance accountability division duties reporting as used in this section a abuse means i an action or practice that a is inconsistent with sound fiscal business or medical practices and b results or may result in unnecessary medicaid related costs or other medical or hospital assistance costs or ii reckless or negligent upcoding b fraud means intentional or knowing i deception misrepresentation or upcoding in relation to medicaid funds costs claims reimbursement or practice or ii deception or misrepresentation in relation to medical or hospital assistance funds costs claims reimbursement or practice c upcoding means assigning an inaccurate billing code for a service that is payable or reimbursable by medicaid funds if the correct billing code for the service taking into account reasonable opinions derived from official published coding definitions would result in a lower medicaid payment or reimbursement d waste means overutilization of resources or inappropriate payment the division shall a develop and implement procedures relating to medicaid funds and medical or hospital assistance funds to ensure that providers do not receive a i duplicate payments for the same goods or services b ii payment for goods or services by resubmitting a claim for which i a payment has been disallowed on the grounds that payment would be a violation of federal or state law administrative rule or the state plan and ii b the decision to disallow the payment has become final c iii payment for goods or services provided after a recipient s death including payment for pharmaceuticals or long term care or d iv payment for transporting an unborn infant b consult with the centers for medicaid and medicare services cms other states and the office of inspector general of medicaid services to determine and implement best practices for discovering and eliminating fraud waste and abuse of medicaid funds and medical or hospital assistance funds c actively seek repayment from providers for improperly used or paid a i medicaid funds and b ii medical or hospital assistance funds d coordinate track and keep records of all division efforts to obtain repayment of the funds described in subsection c and the results of those efforts e keep medicaid pharmaceutical costs as low as possible by actively seeking to obtain pharmaceuticals at the lowest price possible including on a quarterly basis for the pharmaceuticals that represent the highest of state medicaid expenditures for pharmaceuticals and on an annual basis for the remaining pharmaceuticals a i tracking changes in the price of pharmaceuticals b ii checking the availability and price of generic drugs c iii reviewing and updating the state s maximum allowable cost list and d iv comparing pharmaceutical costs of the state medicaid program to available pharmacy price lists and f provide training on an annual basis to the employees of the division who make decisions on billing codes or who are in the best position to observe and identify upcoding in order to avoid and detect upcoding section section b which is renumbered from section is renumbered and amended to read b medical assistance from division or department of workforce services and compliance under adoption assistance interstate compact penalty for fraudulent claim as used in this section a adoption assistance means the same as that term is defined in section b adoption assistance agreement means the same as that term is defined in section c adoption assistance interstate compact means an agreement executed by the division of child and family services with any other state in accordance with section a a child who is a resident of this state and is the subject of an adoption assistance interstate compact is entitled to receive medical assistance from the division and the department of workforce services by filing a certified copy of the child s adoption assistance agreement with the division or the department of workforce services b the adoptive parent of the child described in subsection a shall annually provide the division or the department of workforce services with evidence verifying that the adoption assistance agreement is still effective the department of workforce services shall consider the recipient of medical assistance under this section as the department of workforce services does any other recipient of medical assistance under an adoption assistance agreement executed by the division of child and family services a a person may not submit a claim for payment or reimbursement under this section that the person knows is false misleading or fraudulent b a violation of subsection a is a third degree felony the division and the department of workforce services shall a cooperate with the division of child and family services in regard to an adoption assistance interstate compact and b comply with an adoption assistance interstate compact section section b which is renumbered from section is renumbered and amended to read part medicaid waivers b medicaid waiver for independent foster care adolescents for purposes of as used in this section an independent foster care adolescent includes any individual who reached years of age old while in the custody of the division of child and family services or the department of human services department if the division of child and family services department was the primary case manager or a federally recognized indian tribe an independent foster care adolescent is eligible when funds are available for medicaid coverage until the individual reaches years of age old before july the division shall submit a state medicaid plan amendment to the center for medicaid services cms to provide medical coverage for independent foster care adolescents effective fiscal year section section b which is renumbered from section is renumbered and amended to read b waivers to maximize replacement of fee for service delivery model cost of mandated program changes the department shall develop a waiver program in the medicaid program to replace the fee for service delivery model with one or more risk based delivery models the waiver program shall a restructure the program s provider payment provisions to reward health care providers for delivering the most appropriate services at the lowest cost and in ways that compared to services delivered before implementation of the waiver program maintain or improve recipient health status b restructure the program s cost sharing provisions and other incentives to reward recipients for personal efforts to i maintain or improve their health status and ii use providers that deliver the most appropriate services at the lowest cost c identify the evidence based practices and measures risk adjustment methodologies payment systems funding sources and other mechanisms necessary to reward providers for delivering the most appropriate services at the lowest cost including mechanisms that i pay providers for packages of services delivered over entire episodes of illness rather than for individual services delivered during each patient encounter and ii reward providers for delivering services that make the most positive contribution to a recipient s health status d limit total annual per patient per month expenditures for services delivered through fee for service arrangements to total annual per patient per month expenditures for services delivered through risk based arrangements covering similar recipient populations and services and e except as provided in subsection limit the rate of growth in per patient per month general fund expenditures for the program to the rate of growth in general fund expenditures for all other programs when the rate of growth in the general fund expenditures for all other programs is greater than zero to the extent possible the department shall operate the waiver program with the input of stakeholder groups representing those who will be affected by the waiver program a for purposes of this subsection mandated program change shall be determined by the department in consultation with the medicaid accountable care organizations and may include a change to the state medicaid program that is required by state or federal law state or federal guidance policy or the state medicaid plan b a mandated program change shall be included in the base budget for the medicaid program for the fiscal year in which the medicaid program adopted the mandated program change c the mandated program change is not subject to the limit on the rate of growth in per patient per month general fund expenditures for the program established in subsection e until the fiscal year following the fiscal year in which the medicaid program adopted the mandated program change a managed care organization or a pharmacy benefit manager that provides a pharmacy benefit to an enrollee shall establish a unique group number payment classification number or bank identification number for each medicaid managed care organization plan for which the managed care organization or pharmacy benefit manager provides a pharmacy benefit section section b which is renumbered from section is renumbered and amended to read b base budget appropriations for medicaid accountable care organizations and behavioral health plans forecast of behavioral health services cost as used in this section a aco means an accountable care organization that contracts with the state s medicaid program for i physical health services or ii integrated physical and behavioral health services b base budget means the same as that term is defined in legislative rule c behavioral health plan means a managed care or fee for service delivery system that contracts with or is operated by the department to provide behavioral health services to medicaid eligible individuals d behavioral health services means mental health or substance use treatment or services e general fund growth factor means the amount determined by dividing the next fiscal year ongoing general fund revenue estimate by current fiscal year ongoing appropriations from the general fund f next fiscal year ongoing general fund revenue estimate means the next fiscal year ongoing general fund revenue estimate identified by the executive appropriations committee in accordance with legislative rule for use by the office of the legislative fiscal analyst in preparing budget recommendations g pmpm means per member per month funding if the general fund growth factor is less than the next fiscal year base budget shall subject to subsection include an appropriation to the department in an amount necessary to ensure that the next fiscal year pmpm for acos and behavioral health plans equals the current fiscal year pmpm for the acos and behavioral health plans multiplied by if the general fund growth factor is greater than or equal to but less than the next fiscal year base budget shall subject to subsection include an appropriation to the department in an amount necessary to ensure that the next fiscal year pmpm for acos and behavioral health plans equals the current fiscal year pmpm for the acos and behavioral health plans multiplied by the general fund growth factor if the general fund growth factor is greater than or equal to the next fiscal year base budget shall subject to subsection include an appropriation to the department in an amount necessary to ensure that the next fiscal year pmpm for acos and behavioral health plans is greater than or equal to the current fiscal year pmpm for the acos and behavioral health plans multiplied by and less than or equal to the current fiscal year pmpm for the acos and behavioral health plans multiplied by the general fund growth factor the appropriations provided to the department for behavioral health plans under this section shall be reduced by the amount contributed by counties in the current fiscal year for behavioral health plans in accordance with subsections k and a x in order for the department to estimate the impact of subsections through before identification of the next fiscal year ongoing general fund revenue estimate the governor s office of planning and budget shall in cooperation with the office of the legislative fiscal analyst develop an estimate of ongoing general fund revenue for the next fiscal year and provide the estimate to the department no later than november of each year the office of the legislative fiscal analyst shall include an estimate of the cost of behavioral health services in any state medicaid funding or savings forecast that is completed in coordination with the department and the governor s office of planning and budget section section b which is renumbered from section is renumbered and amended to read b incentives to appropriately use emergency department services a this section applies to the medicaid program and to the utah children s health insurance program created in chapter utah children s health insurance act section b b as used in this section i managed care organization means a comprehensive full risk managed care delivery system that contracts with the medicaid program or the children s health insurance program to deliver health care through a managed care plan ii managed care plan means a risk based delivery service model authorized by section b and administered by a managed care organization iii non emergent care a means use of the emergency department to receive health care that is non emergent as defined by the department by administrative rule adopted in accordance with title g chapter utah administrative rulemaking act and the emergency medical treatment and active labor act and b does not mean the medical services provided to an individual required by the emergency medical treatment and active labor act including services to conduct a medical screening examination to determine if the recipient has an emergent or non emergent condition iv professional compensation means payment made for services rendered to a medicaid recipient by an individual licensed to provide health care services v super utilizer means a medicaid recipient who has been identified by the recipient s managed care organization as a person who uses the emergency department excessively as defined by the managed care organization a a managed care organization may in accordance with subsections b and c i audit emergency department services provided to a recipient enrolled in the managed care plan to determine if non emergent care was provided to the recipient and ii establish differential payment for emergent and non emergent care provided in an emergency department b i the differential payments under subsection a ii do not apply to professional compensation for services rendered in an emergency department ii except in cases of suspected fraud waste and abuse a managed care organization s audit of payment under subsection a i is limited to the month period of time after the date on which the medical services were provided to the recipient if fraud waste or abuse is alleged the managed care organization s audit of payment under subsection a i is limited to three years after the date on which the medical services were provided to the recipient c the audits and differential payments under subsections a and b apply to services provided to a recipient on or after july a managed care organization shall a use the savings under subsection to maintain and improve access to primary care and urgent care services for all medicaid or chip recipients enrolled in the managed care plan b provide viable alternatives for increasing primary care provider reimbursement rates to incentivize after hours primary care access for recipients and c report to the department on how the managed care organization complied with this subsection the department may a through administrative rule adopted by the department develop quality measurements that evaluate a managed care organization s delivery of i appropriate emergency department services to recipients enrolled in the managed care plan ii expanded primary care and urgent care for recipients enrolled in the managed care plan with consideration of the managed care organization s a delivery of primary care urgent care and after hours care through means other than the emergency department b recipient access to primary care providers and community health centers including evening and weekend access and c other innovations for expanding access to primary care and iii quality of care for the managed care plan members b compare the quality measures developed under subsection a for each managed care organization and c develop by administrative rule an algorithm to determine assignment of new unassigned recipients to specific managed care plans based on the plan s performance in relation to the quality measures developed pursuant to subsection a section section b which is renumbered from section is renumbered and amended to read b long term care insurance partnership as used in this section a qualified long term care insurance contract is as defined in u s c sec b b b qualified long term care insurance partnership is as defined in u s c sec p b c iii c state plan amendment means an amendment to the state medicaid plan drafted by the department in compliance with this section no later than july the department shall seek federal approval of a state plan amendment that creates a qualified long term care insurance partnership the department may make rules to comply with federal laws and regulations relating to qualified long term care insurance partnerships and qualified long term care insurance contracts section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for children with disabilities and complex medical needs as used in this section a additional eligibility criteria means the additional eligibility criteria set by the department under subsection e b complex medical condition means a physical condition of an individual that i results in severe functional limitations for the individual and ii is likely to a last at least months or b result in death c program means the program for children with complex medical conditions created in subsection d qualified child means a child who i is less than years old ii is diagnosed with a complex medical condition iii has a condition that meets the definition of disability in u s c sec and iv meets the additional eligibility criteria the department shall apply for a medicaid home and community based waiver with cms to implement within the state medicaid program the program described in subsection if the waiver described in subsection is approved the department shall offer a program that a as funding permits provides treatment for qualified children b if approved by cms and as funding permits beginning in fiscal year provides on an ongoing basis treatment for more qualified children than the program provided treatment for during fiscal year and c accepts applications for the program on an ongoing basis i d requires periodic reevaluations of an enrolled child s eligibility and other applicants or eligible children waiting for services in the program based on the additional eligibility criteria and ii e at the time of reevaluation allows the department to disenroll a child based on the prioritization described in subsection a and additional eligibility criteria the department shall a establish by rule made in accordance with title g chapter utah administrative rulemaking act criteria to prioritize qualified children s participation in the program based on the following factors in the following priority order i the complexity of a qualified child s medical condition and ii the financial needs of the qualified child and the qualified child s family b convene a public process to determine the benefits and services to offer a qualified child under the program c evaluate on an ongoing basis the cost and effectiveness of the program d if funding for the program is reduced develop an evaluation process to reduce the number of children served based on the participation criteria established under subsection a and e establish by rule made in accordance with title g chapter utah administrative rulemaking act additional eligibility criteria based on the factors described in subsections a i and ii section section b which is renumbered from section is renumbered and amended to read b health coverage improvement program eligibility annual report expansion of eligibility for adults with dependent children as used in this section a adult in the expansion population means an individual who i is described in u s c sec a a a i viii and ii is not otherwise eligible for medicaid as a mandatory categorically needy individual b enhancement waiver program means the primary care network enhancement waiver program described in section b c federal poverty level means the poverty guidelines established by the secretary of the united states department of health and human services under u s c sec d health coverage improvement program means the health coverage improvement program described in subsections through e homeless i means an individual who is chronically homeless as determined by the department and ii includes someone who was chronically homeless and is currently living in supported housing for the chronically homeless f income eligibility ceiling means the percent of federal poverty level i established by the state in an appropriations act adopted pursuant to title j chapter budgetary procedures act and ii under which an individual may qualify for medicaid coverage in accordance with this section g targeted adult medicaid program means the program implemented by the department under subsections through beginning july the department shall amend the state medicaid plan to allow temporary residential treatment for substance abuse use for the traditional medicaid population in a short term non institutional hour facility without a bed capacity limit that provides rehabilitation services that are medically necessary and in accordance with an individualized treatment plan as approved by cms and as long as the county makes the required match under section beginning july the department shall amend the state medicaid plan to increase the income eligibility ceiling to a percentage of the federal poverty level designated by the department based on appropriations for the program for an individual with a dependent child before july the division shall submit to cms a request for waivers or an amendment of existing waivers from federal statutory and regulatory law necessary for the state to implement the health coverage improvement program in the medicaid program in accordance with this section a an adult in the expansion population is eligible for medicaid if the adult meets the income eligibility and other criteria established under subsection b an adult who qualifies under subsection shall receive medicaid coverage i through the traditional fee for service medicaid model in counties without medicaid accountable care organizations or the state s medicaid accountable care organization delivery system where implemented and subject to section b ii except as provided in subsection b iii for behavioral health through the counties in accordance with sections and iii that subject to section b integrates behavioral health services and physical health services with medicaid accountable care organizations in select geographic areas of the state that choose an integrated model and iv that permits temporary residential treatment for substance abuse use in a short term non institutional hour facility without a bed capacity limit as approved by cms that provides rehabilitation services that are medically necessary and in accordance with an individualized treatment plan a an individual is eligible for the health coverage improvement program under subsection if i at the time of enrollment the individual s annual income is below the income eligibility ceiling established by the state under subsection f and ii the individual meets the eligibility criteria established by the department under subsection b b based on available funding and approval from cms the department shall select the criteria for an individual to qualify for the medicaid program under subsection a ii based on the following priority i a chronically homeless individual ii if funding is available an individual a involved in the justice system through probation parole or court ordered treatment and b in need of substance abuse use treatment or mental health treatment as determined by the department or iii if funding is available an individual in need of substance abuse use treatment or mental health treatment as determined by the department c an individual who qualifies for medicaid coverage under subsections a and b may remain on the medicaid program for a month certification period as defined by the department eligibility changes made by the department under subsection f or b shall not apply to an individual during the month certification period the state may request a modification of the income eligibility ceiling and other eligibility criteria under subsection each fiscal year based on projected enrollment costs to the state and the state budget the current medicaid program and the health coverage improvement program when implemented shall coordinate with a state prison or county jail to expedite medicaid enrollment for an individual who is released from custody and was eligible for or enrolled in medicaid before incarceration notwithstanding sections and a county does not have to provide matching funds to the state for the cost of providing medicaid services to newly enrolled individuals who qualify for medicaid coverage under the health coverage improvement program under subsection if the enhancement waiver program is implemented the department a may not accept any new enrollees into the health coverage improvement program after the day on which the enhancement waiver program is implemented b shall transition all individuals who are enrolled in the health coverage improvement program into the enhancement waiver program c shall suspend the health coverage improvement program within one year after the day on which the enhancement waiver program is implemented d shall within one year after the day on which the enhancement waiver program is implemented use all appropriations for the health coverage improvement program to implement the enhancement waiver program and e shall work with cms to maintain any waiver for the health coverage improvement program while the health coverage improvement program is suspended under subsection c if after the enhancement waiver program takes effect the enhancement waiver program is repealed or suspended by either the state or federal government the department shall reinstate the health coverage improvement program and continue to accept new enrollees into the health coverage improvement program in accordance with the provisions of this section section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for delivery of adult dental services a before june the department shall ask cms to grant waivers from federal statutory and regulatory law necessary for the medicaid program to provide dental services in the manner described in subsection a b before june the department shall submit to cms a request for waivers or an amendment of existing waivers from federal law necessary for the state to provide dental services in accordance with subsections b i and d through g to an individual described in subsection b i c before june the department shall submit to the centers for medicare and medicaid services a request for waivers or an amendment to existing waivers from federal law necessary for the state to i provide dental services in accordance with subsections b ii and d through g to an individual described in subsection b ii and ii provide the services described in subsection h a to the extent funded the department shall provide services to only blind or disabled individuals as defined in u s c sec c a who are years old or older and eligible for the program b notwithstanding subsection a i if a waiver is approved under subsection b the department shall provide dental services to an individual who a qualifies for the health coverage improvement program described in section b and b is receiving treatment in a substance abuse treatment program as defined in section a b licensed under title a chapter licensure of programs and facilities chapter part human services programs and facilities and ii if a waiver is approved under subsection c i the department shall provide dental services to an individual who is an aged individual as defined in u s c sec c a c to the extent possible services to individuals described in subsection a shall be provided through the university of utah school of dentistry and the university of utah school of dentistry s associated statewide network d the department shall provide the services to individuals described in subsection b i by contracting with an entity that a has demonstrated experience working with individuals who are being treated for both a substance use disorder and a major oral health disease b operates a program targeted at the individuals described in subsection b that has demonstrated through a peer reviewed evaluation the effectiveness of providing dental treatment to those individuals described in subsection b c is willing to pay for an amount equal to the program s non federal share of the cost of providing dental services to the population described in subsection b and d is willing to pay all state costs associated with applying for the waiver described in subsection b and administering the program described in subsection b and ii through a fee for service payment model e the entity that receives the contract under subsection d i shall cover all state costs of the program described in subsection b f each fiscal year the university of utah school of dentistry shall in compliance with state and federal regulations regarding intergovernmental transfers transfer funds to the program in an amount equal to the program s non federal share of the cost of providing services under this section through the school during the fiscal year g if a waiver is approved under subsection c ii the department shall provide coverage for porcelain and porcelain to metal crowns if the services are provided i to an individual who qualifies for dental services under subsection b and ii by an entity that covers all state costs of a providing the coverage described in this subsection h g and b applying for the waiver described in subsection c h where possible the department shall ensure that services described in subsection a that are not provided by the university of utah school of dentistry or the university of utah school of dentistry s associated network are provided i through fee for service reimbursement until july and ii after july through the method of reimbursement used by the division for medicaid dental benefits i subject to appropriations by the legislature and as determined by the department the scope amount duration and frequency of services may be limited a if the waivers requested under subsection a are granted the medicaid program shall begin providing dental services in the manner described in subsection no later than july b if the waivers requested under subsection b are granted the medicaid program shall begin providing dental services to the population described in subsection b within days from the day on which the waivers are granted c if the waivers requested under subsection c i are granted the medicaid program shall begin providing dental services to the population described in subsection b ii within days after the day on which the waivers are granted if the federal share of the cost of providing dental services under this section will be less than during any portion of the next fiscal year the medicaid program shall cease providing dental services under this section no later than the end of the current fiscal year section section b which is renumbered from section is renumbered and amended to read b medicaid long term support services housing coordinator there is created within the medicaid program a full time equivalent position of medicaid long term support services housing coordinator the coordinator shall help medicaid recipients receive long term support services in a home or other community based setting rather than in a nursing home or other institutional setting by a working with municipalities counties the housing and community development division within the department of workforce services and others to identify community based settings available to recipients b working with the same entities to promote the development construction and availability of additional community based settings c training medicaid case managers and support coordinators on how to help medicaid recipients move from an institutional setting to a community based setting and d performing other related duties section section b which is renumbered from section is renumbered and amended to read b medicaid waiver expansion as used in this section a federal poverty level means the same as that term is defined in section b b medicaid waiver expansion means an expansion of the medicaid program in accordance with this section a before january the department shall apply to cms for approval of a waiver or state plan amendment to implement the medicaid waiver expansion b the medicaid waiver expansion shall i expand medicaid coverage to eligible individuals whose income is below of the federal poverty level ii obtain maximum federal financial participation under u s c sec d y for enrolling an individual in the medicaid program iii provide medicaid benefits through the state s medicaid accountable care organizations in areas where a medicaid accountable care organization is implemented iv integrate the delivery of behavioral health services and physical health services with medicaid accountable care organizations in select geographic areas of the state that choose an integrated model v include a path to self sufficiency including work activities as defined in u s c sec d for qualified adults vi require an individual who is offered a private health benefit plan by an employer to enroll in the employer s health plan vii sunset in accordance with subsection a and viii permit the state to close enrollment in the medicaid waiver expansion if the department has insufficient funding to provide services to additional eligible individuals if the medicaid waiver described in subsection a is approved the department may only pay the state portion of costs for the medicaid waiver expansion with appropriations from a the medicaid expansion fund created in section b b b county contributions to the non federal share of medicaid expenditures and c any other contributions funds or transfers from a non state agency for medicaid expenditures a in consultation with the department medicaid accountable care organizations and counties that elect to integrate care under subsection b iv shall collaborate on enrollment engagement of patients and coordination of services b as part of the provision described in subsection b iv the department shall apply for a waiver to permit the creation of an integrated delivery system i for any geographic area that expresses interest in integrating the delivery of services under subsection b iv and ii in which the department a may permit a local mental health authority to integrate the delivery of behavioral health services and physical health services b may permit a county local mental health authority or medicaid accountable care organization to integrate the delivery of behavioral health services and physical health services to select groups within the population that are newly eligible under the medicaid waiver expansion and c may make rules in accordance with title g chapter utah administrative rulemaking act to integrate payments for behavioral health services and physical health services to plans or providers a if federal financial participation for the medicaid waiver expansion is reduced below the authority of the department to implement the medicaid waiver expansion shall sunset no later than the next july after the date on which the federal financial participation is reduced b the department shall close the program to new enrollment if the cost of the medicaid waiver expansion is projected to exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act if the medicaid waiver expansion is approved by cms the department shall report to the social services appropriations subcommittee on or before november of each year that the medicaid waiver expansion is operational a the number of individuals who enrolled in the medicaid waiver program b costs to the state for the medicaid waiver program c estimated costs for the current and following state fiscal year and d recommendations to control costs of the medicaid waiver expansion section section b which is renumbered from section is renumbered and amended to read b primary care network enhancement waiver program as used in this section a enhancement waiver program means the primary care network enhancement waiver program described in this section b federal poverty level means the poverty guidelines established by the secretary of the united states department of health and human services under u s c sec c health coverage improvement program means the same as that term is defined in section b d income eligibility ceiling means the percentage of federal poverty level i established by the legislature in an appropriations act adopted pursuant to title j chapter budgetary procedures act and ii under which an individual may qualify for coverage in the enhancement waiver program in accordance with this section e optional population means the optional expansion population under ppaca if the expansion provides coverage for individuals at or above of the federal poverty level f primary care network means the state primary care network program created by the medicaid primary care network demonstration waiver obtained under section b the department shall continue to implement the primary care network program for qualified individuals under the primary care network program a the division shall apply for a medicaid waiver or a state plan amendment with cms to implement within the state medicaid program the enhancement waiver program described in this section within six months after the day on which i the division receives a notice from cms that the waiver for the medicaid waiver expansion submitted under section b medicaid waiver expansion will not be approved or ii the division withdraws the waiver for the medicaid waiver expansion submitted under section b medicaid waiver expansion b the division may not apply for a waiver under subsection a while a waiver request under section b medicaid waiver expansion is pending with cms an individual who is eligible for the enhancement waiver program may receive the following benefits under the enhancement waiver program a the benefits offered under the primary care network program b diagnostic testing and procedures c medical specialty care d inpatient hospital services e outpatient hospital services f outpatient behavioral health care including outpatient substance abuse use care and g for an individual who qualifies for the health coverage improvement program as approved by cms temporary residential treatment for substance abuse use in a short term non institutional hour facility without a bed capacity limit that provides rehabilitation services that are medically necessary and in accordance with an individualized treatment plan an individual is eligible for the enhancement waiver program if at the time of enrollment a the individual is qualified to enroll in the primary care network or the health coverage improvement program b the individual s annual income is below the income eligibility ceiling established by the legislature under subsection d and c the individual meets the eligibility criteria established by the department under subsection a based on available funding and approval from cms the department shall determine the criteria for an individual to qualify for the enhancement waiver program based on the following priority i adults in the expansion population as defined in section b who qualify for the health coverage improvement program ii adults with dependent children who qualify for the health coverage improvement program under subsection b iii adults with dependent children who do not qualify for the health coverage improvement program and iv if funding is available adults without dependent children b the number of individuals enrolled in the enhancement waiver program may not exceed of the number of individuals who were enrolled in the primary care network on december c the department may only use appropriations from the medicaid expansion fund created in section b b to fund the state portion of the enhancement waiver program the department may request a modification of the income eligibility ceiling and the eligibility criteria under subsection from cms each fiscal year based on enrollment in the enhancement waiver program projected enrollment in the enhancement waiver program costs to the state and the state budget the department may implement the enhancement waiver program by contracting with medicaid accountable care organizations to administer the enhancement waiver program in accordance with subsections and b and the department may use funds that have been appropriated for the health coverage improvement program to implement the enhancement waiver program if the department expands the state medicaid program to the optional population the department a except as provided in subsection may not accept any new enrollees into the enhancement waiver program after the day on which the expansion to the optional population is effective b shall suspend the enhancement waiver program within one year after the day on which the expansion to the optional population is effective and c shall work with cms to maintain the waiver for the enhancement waiver program submitted under subsection while the enhancement waiver program is suspended under subsection b if after the expansion to the optional population described in subsection takes effect the expansion to the optional population is repealed by either the state or the federal government the department shall reinstate the enhancement waiver program and continue to accept new enrollees into the enhancement waiver program in accordance with the provisions of this section section section b which is renumbered from section is renumbered and amended to read b limited family planning services for low income individuals as used in this section a i family planning services means family planning services that are provided under the state medicaid program including a sexual health education and family planning counseling and b other medical diagnosis treatment or preventative care routinely provided as part of a family planning service visit ii family planning services do not include an abortion as that term is defined in section b low income individual means an individual who i has an income level that is equal to or below of the federal poverty level and ii does not qualify for full coverage under the medicaid program before july the division shall apply for a medicaid waiver or a state plan amendment with cms to a offer a program that provides family planning services to low income individuals and b receive a federal match rate of of state expenditures for family planning services provided under the waiver or state plan amendment section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for mental health crisis lines and mobile crisis outreach teams as used in this section a local mental health crisis line means the same as that term is defined in section a b b mental health crisis means i a mental health condition that manifests itself in an individual by symptoms of sufficient severity that a prudent layperson who possesses an average knowledge of mental health issues could reasonably expect the absence of immediate attention or intervention to result in a serious danger to the individual s health or well being or b a danger to the health or well being of others or ii a mental health condition that in the opinion of a mental health therapist or the therapist s designee requires direct professional observation or the intervention of a mental health therapist c i mental health crisis services means direct mental health services and on site intervention that a mobile crisis outreach team provides to an individual suffering from a mental health crisis including the provision of safety and care plans prolonged mental health services for up to days and referrals to other community resources ii mental health crisis services includes a local mental health crisis lines and b the statewide mental health crisis line d mental health therapist means the same as that term is defined in section e mobile crisis outreach team or mcot means a mobile team of medical and mental health professionals that in coordination with local law enforcement and emergency medical service personnel provides mental health crisis services f statewide mental health crisis line means the same as that term is defined in section a b in consultation with the department of human services and the behavioral health crisis response commission created in section c the department shall develop a proposal to amend the state medicaid plan to include mental health crisis services including the statewide mental health crisis line local mental health crisis lines and mobile crisis outreach teams by january the department shall apply for a medicaid waiver with cms if necessary to implement within the state medicaid program the mental health crisis services described in subsection section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for coverage of mental health services in schools as used in this section local education agency means a a school district b a charter school or c the utah schools for the deaf and the blind in consultation with the department of human services and the state board of education the department shall develop a proposal to allow the state medicaid program to reimburse a local education agency a local mental health authority or a private provider for covered mental health services provided a in accordance with section e and b i at a local education agency building or facility or ii by an employee or contractor of a local education agency before january the department shall apply to cms for a state plan amendment to implement the coverage described in subsection section section b which is renumbered from section is renumbered and amended to read b coverage for in vitro fertilization and genetic testing as used in this section a qualified condition means i cystic fibrosis ii spinal muscular atrophy iii morquio syndrome iv myotonic dystrophy or v sickle cell anemia b qualified enrollee means an individual who i is enrolled in the medicaid program ii has been diagnosed by a physician as having a genetic trait associated with a qualified condition and iii intends to get pregnant with a partner who is diagnosed by a physician as having a genetic trait associated with the same qualified condition as the individual before january the department shall apply for a medicaid waiver or a state plan amendment with the centers for medicare and medicaid services within the united states department of health and human services to implement the coverage described in subsection if the waiver described in subsection is approved the medicaid program shall provide coverage to a qualified enrollee for a in vitro fertilization services and b genetic testing of a qualified enrollee who receives in vitro fertilization services under subsection a the medicaid program may not provide the coverage described in subsection before the later of a the day on which the waiver described in subsection is approved and b january before november and before november of every third year thereafter the department shall a calculate the change in state spending attributable to the coverage under this section and b report the amount described in subsection a a to the health and human services interim committee and the social services appropriations subcommittee section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for fertility preservation services as used in this section a iatrogenic infertility means an impairment of fertility or reproductive functioning caused by surgery chemotherapy radiation or other medical treatment b physician means an individual licensed to practice under title chapter utah medical practice act or title chapter utah osteopathic medical practice act c qualified enrollee means an individual who i is enrolled in the medicaid program ii has been diagnosed with a form of cancer by a physician and iii needs treatment for that cancer that may cause a substantial risk of sterility or iatrogenic infertility including surgery radiation or chemotherapy d standard fertility preservation service means a fertility preservation procedure and service that i is not considered experimental or investigational by the american society for reproductive medicine or the american society of clinical oncology and ii is consistent with established medical practices or professional guidelines published by the american society for reproductive medicine or the american society of clinical oncology including a sperm banking b oocyte banking c embryo banking d banking of reproductive tissues and e storage of reproductive cells and tissues before january the department shall apply for a medicaid waiver or a state plan amendment with cms to implement the coverage described in subsection if the waiver or state plan amendment described in subsection is approved the medicaid program shall provide coverage to a qualified enrollee for standard fertility preservation services the medicaid program may not provide the coverage described in subsection before the later of a the day on which the waiver described in subsection is approved and b january before november and before november of each third year after the department shall a calculate the change in state spending attributable to the coverage described in this section and b report the amount described in subsection a to the health and human services interim committee and the social services appropriations subcommittee section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for coverage of qualified inmates leaving prison or jail as used in this section a correctional facility means i a county jail ii the department of corrections created in section or iii a prison penitentiary or other institution operated by or under contract with the department of corrections for the confinement of an offender as defined in section b qualified inmate means an individual who i is incarcerated in a correctional facility and ii has a a chronic physical or behavioral health condition b a mental illness as defined in section a b or c an opioid use disorder before july the division shall apply for a medicaid waiver or a state plan amendment with cms to offer a program to provide medicaid coverage to a qualified inmate for up to days immediately before the day on which the qualified inmate is released from a correctional facility if the waiver or state plan amendment described in subsection is approved the department shall report to the health and human services interim committee each year before november while the waiver or state plan amendment is in effect regarding a the number of qualified inmates served under the program b the cost of the program and c the effectiveness of the program including i any reduction in the number of emergency room visits or hospitalizations by inmates after release from a correctional facility ii any reduction in the number of inmates undergoing inpatient treatment after release from a correctional facility iii any reduction in overdose rates and deaths of inmates after release from a correctional facility and iv any other costs or benefits as a result of the program if the waiver or state plan amendment described in subsection is approved a county that is responsible for the cost of a qualified inmate s medical care shall provide the required matching funds to the state for a any costs to enroll the qualified inmate for the medicaid coverage described in subsection b any administrative fees for the medicaid coverage described in subsection and c the medicaid coverage that is provided to the qualified inmate under subsection section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for inpatient care in an institution for mental diseases as used in this section institution for mental diseases means the same as that term is defined in c f r sec before august the division shall apply for a medicaid waiver or a state plan amendment with cms to offer a program that provides reimbursement for mental health services that are provided a in an institution for mental diseases that includes more than beds and b to an individual who receives mental health services in an institution for mental diseases for a period of more than days in a calendar month if the waiver or state plan amendment described in subsection is approved the department shall a coordinate with the department of human services to develop and offer the program described in subsection and b submit to the health and human services interim committee and the social services appropriations subcommittee any report that the department submits to cms that relates to the budget neutrality independent waiver evaluation or performance metrics of the program described in subsection within days after the day on which the report is submitted to cms notwithstanding sections and if the waiver or state plan amendment described in subsection is approved a county does not have to provide matching funds to the state for the mental health services described in subsection that are provided to an individual who qualifies for medicaid coverage under section or section b or b section section b which is renumbered from section is renumbered and amended to read b reimbursement for crisis management services provided in a behavioral health receiving center integration of payment for physical health services as used in this section a accountable care organization means the same as that term is defined in section b b behavioral health receiving center means the same as that term is defined in section a b c crisis management services means behavioral health services provided to an individual who is experiencing a mental health crisis d managed care organization means the same as that term is defined in c f r sec before july the division shall apply for a medicaid waiver or state plan amendment with cms to offer a program that provides reimbursement through a bundled daily rate for crisis management services that are delivered to an individual during the individual s stay at a behavioral health receiving center if the waiver or state plan amendment described in subsection is approved the department shall a implement the program described in subsection and b require a managed care organization that contracts with the state s medicaid program for behavioral health services or integrated health services to provide coverage for crisis management services that are delivered to an individual during the individual s stay at a behavioral health receiving center a the department may elect to integrate payment for physical health services provided in a behavioral health receiving center b in determining whether to integrate payment under subsection a the department shall consult with accountable care organizations and counties in the state section section b which is renumbered from section is renumbered and amended to read b crisis services reimbursement the department department shall submit a waiver or state plan amendment to allow for reimbursement for services provided to an individual who is eligible and enrolled in medicaid at the time this service is provided section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for respite care facility that provides services to homeless individuals as used in this section a adult in the expansion population means an adult i described in u s c sec a a a i viii and ii not otherwise eligible for medicaid as a mandatory categorically needy individual b homeless means the same as that term is defined in section b c medical respite care means short term housing with supportive medical services d medical respite facility means a residential facility that provides medical respite care to homeless individuals before january the department shall apply for a medicaid waiver or state plan amendment with cms to choose a single medical respite facility to reimburse for services provided to an individual who is a homeless and b an adult in the expansion population the department shall choose a medical respite facility best able to serve homeless individuals who are adults in the expansion population if the waiver or state plan amendment described in subsection is approved while the waiver or state plan amendment is in effect the department shall submit a report to the health and human services interim committee each year before november detailing a the number of homeless individuals served at the facility b the cost of the program and c the reduction of health care costs due to the program s implementation through administrative rule made in accordance with title g chapter utah administrative rulemaking act the department shall further define and limit the services described in this section provided to a homeless individual section section b which is renumbered from section is renumbered and amended to read b medicaid waiver expansion for extraordinary care reimbursement as used in this section a existing home and community based services waiver means an existing home and community based services waiver in the state that serves an individual i with an acquired brain injury ii with an intellectual or physical disability or iii who is years old or older b personal care services means a service that i is furnished to an individual who is not an inpatient nor a resident of a hospital nursing facility intermediate care facility or institution for mental diseases ii is authorized for an individual described in subsection b i in accordance with a plan of treatment iii is provided by an individual who is qualified to provide the services and iv is furnished in a home or another community based setting c waiver enrollee means an individual who is enrolled in an existing home and community based services waiver before july the department shall apply with cms for an amendment to an existing home and community based services waiver to implement a program to offer reimbursement to an individual who provides personal care services that constitute extraordinary care to a waiver enrollee who is the individual s spouse if cms approves the amendment described in subsection the department shall implement the program described in subsection the department shall by rule made in accordance with title g chapter utah administrative rulemaking act define extraordinary care for purposes of subsection section section b which is renumbered from section is renumbered and amended to read b delivery system adjustments for the targeted adult medicaid program as used in this section targeted adult medicaid program means the same as that term is defined in section b the department may implement the delivery system adjustments authorized under subsection only on the later of a july and b the department determining that the medicaid program including providers and managed care organizations are satisfying the metrics established in collaboration with the working group convened under subsection b the department may for individuals who are enrolled in the targeted adult medicaid program a integrate the delivery of behavioral and physical health in certain counties and b deliver behavioral health services through an accountable care organization where implemented before implementing the delivery system adjustments described in subsection in a county the department shall at a minimum seek input from a individuals who qualify for the targeted adult medicaid program who reside in the county b the county s executive officer legislative body and other county officials who are involved in the delivery of behavioral health services c the local mental health authority and local substance use abuse authority that serves the county d medicaid managed care organizations operating in the state including medicaid accountable care organizations e providers of physical or behavioral health services in the county who provide services to enrollees in the targeted adult medicaid program in the county and f other individuals that the department deems necessary if the department provides medicaid coverage through a managed care delivery system under this section the department shall include language in the department s managed care contracts that require the managed care plan to a be in compliance with federal medicaid managed care requirements b timely and accurately process authorizations and claims in accordance with medicaid policy and contract requirements c adequately reimburse providers to maintain adequacy of access to care d provide care management services sufficient to meet the needs of medicaid eligible individuals enrolled in the managed care plan s plan and e timely resolve any disputes between a provider or enrollee with the managed care plan the department may take corrective action if the managed care organization fails to comply with the terms of the managed care organization s contract section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for increased integrated health care reimbursement as used in this section a integrated health care setting means a health care or behavioral health care setting that provides integrated physical and behavioral health care services b local mental health authority means a local mental health authority described in section the department shall develop a proposal to allow the state medicaid program to reimburse a local mental health authority for covered physical health care services provided in an integrated health care setting to medicaid eligible individuals before december the department shall apply for a medicaid waiver or a state plan amendment with cms to implement the proposal described in subsection if the waiver or state plan amendment described in subsection is approved the department shall a implement the proposal described in subsection and b while the waiver or state plan amendment is in effect submit a report to the health and human services interim committee each year before november detailing i the number of patients served under the waiver or state plan amendment ii the cost of the waiver or state plan amendment and iii any benefits of the waiver or state plan amendment section section b which is renumbered from section is renumbered and amended to read part administration of medicaid programs drug utilization review and long term care facility certification b definitions as used in this part appropriate and medically necessary means regarding drug prescribing dispensing and patient usage that it is in conformity with the criteria and standards developed in accordance with this part board means the drug utilization review board created in section b certified program means a nursing care facility program with medicaid certification compendia means resources widely accepted by the medical profession in the efficacious use of drugs including american hospital formulary services service drug information u s pharmacopeia drug information a m a drug evaluations peer reviewed medical literature and information provided by manufacturers of drug products counseling means the activities conducted by a pharmacist to inform medicaid recipients about the proper use of drugs as required by the board under this part criteria means those predetermined and explicitly accepted elements used to measure drug use on an ongoing basis in order to determine if the use is appropriate medically necessary and not likely to result in adverse medical outcomes drug disease contraindications means that the therapeutic effect of a drug is adversely altered by the presence of another disease condition drug interactions means that two or more drugs taken by a recipient lead to clinically significant toxicity that is characteristic of one or any of the drugs present or that leads to interference with the effectiveness of one or any of the drugs drug utilization review or dur means the program designed to measure and assess on a retrospective and prospective basis the proper use of outpatient drugs in the medicaid program intervention means a form of communication utilized by the board with a prescriber or pharmacist to inform about or influence prescribing or dispensing practices medicaid certification means the right of a nursing care facility as a provider of a nursing care facility program to receive medicaid reimbursement for a specified number of beds within the facility a nursing care facility means the following facilities licensed by the department under chapter part health care facility licensing and inspection i skilled nursing facilities ii intermediate care facilities and iii an intermediate care facility for people with an intellectual disability b nursing care facility does not mean a critical access hospital that meets the criteria of u s c sec i c nursing care facility program means the personnel licenses services contracts and all other requirements that shall be met for a nursing care facility to be eligible for medicaid certification under this part and division rule overutilization or underutilization means the use of a drug in such quantities that the desired therapeutic goal is not achieved pharmacist means a person licensed in this state to engage in the practice of pharmacy under title chapter b pharmacy practice act physical facility means the buildings or other physical structures where a nursing care facility program is operated physician means a person licensed in this state to practice medicine and surgery under section or osteopathic medicine under section prospective dur means that part of the drug utilization review program that occurs before a drug is dispensed and that is designed to screen for potential drug therapy problems based on explicit and predetermined criteria and standards retrospective dur means that part of the drug utilization review program that assesses or measures drug use based on an historical review of drug use data against predetermined and explicit criteria and standards on an ongoing basis with professional input rural county means a county with a population of less than as determined by a the most recent official census or census estimate of the united states bureau of the census or b the most recent population estimate for the county from the utah population committee if a population figure for the county is not available under subsection a service area means the boundaries of the distinct geographic area served by a certified program as determined by the division in accordance with this part and division rule standards means the acceptable range of deviation from the criteria that reflects local medical practice and that is tested on the medicaid recipient database surs means the surveillance utilization review system of the medicaid program therapeutic appropriateness means drug prescribing and dispensing based on rational drug therapy that is consistent with criteria and standards therapeutic duplication means prescribing and dispensing the same drug or two or more drugs from the same therapeutic class where periods of drug administration overlap and where that practice is not medically indicated urban county means a county that is not a rural county section section b which is renumbered from section is renumbered and amended to read b dur board creation and membership expenses there is created a member drug utilization review board responsible for implementation of a retrospective and prospective dur program a except as required by subsection b as terms of current board members expire the executive director shall appoint each new member or reappointed member to a four year term b notwithstanding the requirements of subsection a the executive director shall at the time of appointment or reappointment adjust the length of terms to ensure that the terms of board members are staggered so that approximately half of the board is appointed every two years c persons appointed to the board may be reappointed upon completion of their terms but may not serve more than two consecutive terms d the executive director shall provide for geographic balance in representation on the board when a vacancy occurs in the membership for any reason the replacement shall be appointed for the unexpired term the membership shall be comprised of the following a four physicians who are actively engaged in the practice of medicine or osteopathic medicine in this state to be selected from a list of nominees provided by the utah medical association b one physician in this state who is actively engaged in academic medicine c three pharmacists who are actively practicing in retail pharmacy in this state to be selected from a list of nominees provided by the utah pharmaceutical association d one pharmacist who is actively engaged in academic pharmacy e one person who shall represent consumers f one person who shall represent pharmaceutical manufacturers to be recommended by the pharmaceutical manufacturers association and g one dentist licensed to practice in this state under title chapter dentist and dental hygienist practice act who is actively engaged in the practice of dentistry nominated by the utah dental association physician and pharmacist members of the board shall have expertise in clinically appropriate prescribing and dispensing of outpatient drugs the board shall elect a chair from among its members who shall serve a one year term and may serve consecutive terms a member may not receive compensation or benefits for the member s service but may receive per diem and travel expenses in accordance with a section a b section a and c rules made by the division of finance pursuant to sections a and a section section b which is renumbered from section is renumbered and amended to read b dur board responsibilities the board shall develop rules necessary to carry out its responsibilities as defined in this part oversee the implementation of a medicaid retrospective and prospective dur program in accordance with this part including responsibility for approving provisions of contractual agreements between the medicaid program and any other entity that will process and review medicaid drug claims and profiles for the dur program in accordance with this part develop and apply predetermined criteria and standards to be used in retrospective and prospective dur ensuring that the criteria and standards are based on the compendia and that they are developed with professional input in a consensus fashion with provisions for timely revision and assessment as necessary the dur standards developed by the board shall reflect the local practices of physicians in order to monitor a therapeutic appropriateness b overutilization or underutilization c therapeutic duplication d drug disease contraindications e drug drug interactions f incorrect drug dosage or duration of drug treatment and g clinical abuse and misuse develop select apply and assess interventions and remedial strategies for physicians pharmacists and recipients that are educational and not punitive in nature in order to improve the quality of care disseminate information to physicians and pharmacists to ensure that they are aware of the board s duties and powers provide written oral or electronic reminders of patient specific or drug specific information designed to ensure recipient physician and pharmacist confidentiality and suggest changes in prescribing or dispensing practices designed to improve the quality of care utilize face to face discussions between experts in drug therapy and the prescriber or pharmacist who has been targeted for educational intervention conduct intensified reviews or monitoring of selected prescribers or pharmacists create an educational program using data provided through dur to provide active and ongoing educational outreach programs to improve prescribing and dispensing practices either directly or by contract with other governmental or private entities provide a timely evaluation of intervention to determine if those interventions have improved the quality of care publish the annual drug utilization review report required under c f r sec develop a working agreement with related boards or agencies including the state board of pharmacy physicians licensing board and surs staff within the division in order to clarify areas of responsibility for each where those areas may overlap establish a grievance process for physicians and pharmacists under this part in accordance with title g chapter administrative procedures act publish and disseminate educational information to physicians and pharmacists concerning the board and the dur program including information regarding a identification and reduction of the frequency of patterns of fraud abuse gross overuse inappropriate or medically unnecessary care among physicians pharmacists and recipients b potential or actual severe or adverse reactions to drugs c therapeutic appropriateness d overutilization or underutilization e appropriate use of generics f therapeutic duplication g drug disease contraindications h drug drug interactions i incorrect drug dosage and duration of drug treatment j drug allergy interactions and k clinical abuse and misuse develop and publish with the input of the state board of pharmacy guidelines and standards to be used by pharmacists in counseling medicaid recipients in accordance with this part the guidelines shall ensure that the recipient may refuse counseling and that the refusal is to be documented by the pharmacist items to be discussed as part of that counseling include a the name and description of the medication b administration form and duration of therapy c special directions and precautions for use d common severe side effects or interactions and therapeutic interactions and how to avoid those occurrences e techniques for self monitoring drug therapy f proper storage g prescription refill information and h action to be taken in the event of a missed dose and establish procedures in cooperation with the state board of pharmacy for pharmacists to record information to be collected under this part the recorded information shall include a the name address age and gender of the recipient b individual history of the recipient where significant including disease state known allergies and drug reactions and a comprehensive list of medications and relevant devices c the pharmacist s comments on the individual s drug therapy d name of prescriber and e name of drug dose duration of therapy and directions for use section section b which is renumbered from section is renumbered and amended to read b confidentiality of records information obtained under this part shall be treated as confidential or controlled information under title g chapter government records access and management act the board shall establish procedures insuring ensuring that the information described in subsection b is held confidential by the pharmacist being provided to the physician only upon request the board shall adopt and implement procedures designed to ensure the confidentiality of all information collected stored retrieved assessed or analyzed by the board staff to the board or contractors to the dur program that identifies individual physicians pharmacists or recipients the board may have access to identifying information for purposes of carrying out intervention activities but that identifying information may not be released to anyone other than a member of the board the board may release cumulative nonidentifying information for research purposes section section b which is renumbered from section is renumbered and amended to read b drug prior approval program a drug prior approval program approved or implemented by the board shall meet the following conditions a except as provided in subsection a drug may not be placed on prior approval for other than medical reasons b the board shall hold a public hearing at least days prior to placing a drug on prior approval c notwithstanding the provisions of section the board shall provide not less than days notice to the public before holding a public hearing under subsection b d the board shall consider written and oral comments submitted by interested parties prior to or during the hearing held in accordance with subsection b e the board shall provide evidence that placing a drug class on prior approval i will not impede quality of recipient care and ii that the drug class is subject to clinical abuse or misuse f the board shall reconsider its decision to place a drug on prior approval i no later than nine months after any drug class is placed on prior approval and ii at a public hearing with notice as provided in subsection b g the program shall provide an approval or denial of a request for prior approval i by either a fax b telephone or c electronic transmission ii at least monday through friday except for state holidays and iii within hours after receipt of the prior approval request h the program shall provide for the dispensing of at least a hour supply of the drug on the prior approval program i in an emergency situation or ii on weekends or state holidays i the program may be applied to allow acceptable medical use of a drug on prior approval for appropriate off label indications and j before placing a drug class on the prior approval program the board shall i determine that the requirements of subsections a through i have been met and ii by majority vote place the drug class on prior approval the board may only after complying with subsections b through j consider the cost a of a drug when placing a drug on the prior approval program and b associated with including or excluding a drug from the prior approval process including i potential side effects associated with a drug or ii potential hospitalizations or other complications that may occur as a result of a drug s inclusion on the prior approval process section section b which is renumbered from section is renumbered and amended to read b advisory committees the board may establish advisory committees to assist it in carrying out its duties under this part sections b through b section section b which is renumbered from section is renumbered and amended to read b retrospective and prospective dur the board in cooperation with the division shall include in its state plan the creation and implementation of a retrospective and prospective dur program for medicaid outpatient drugs to ensure that prescriptions are appropriate medically necessary and not likely to result in adverse medical outcomes the retrospective and prospective dur program shall be operated under guidelines established by the board under subsections and the retrospective dur program shall be based on guidelines established by the board using the mechanized drug claims processing and information retrieval system to analyze claims data in order to a identify patterns of fraud abuse gross overuse and inappropriate or medically unnecessary care and b assess data on drug use against explicit predetermined standards that are based on the compendia and other sources for the purpose of monitoring i therapeutic appropriateness ii overutilization or underutilization iii therapeutic duplication iv drug disease contraindications v drug drug interactions vi incorrect drug dosage or duration of drug treatment and vii clinical abuse and misuse the prospective dur program shall be based on guidelines established by the board and shall provide that before a prescription is filled or delivered a review will be conducted by the pharmacist at the point of sale to screen for potential drug therapy problems resulting from a therapeutic duplication b drug drug interactions c incorrect dosage or duration of treatment d drug allergy interactions and e clinical abuse or misuse in conducting the prospective dur a pharmacist may not alter the prescribed outpatient drug therapy without the consent of the prescribing physician or physician assistant this section does not effect the ability of a pharmacist to substitute a generic equivalent section section b which is renumbered from section is renumbered and amended to read b penalties any person who violates the confidentiality provisions of this part sections b through b is guilty of a class b misdemeanor section section b which is renumbered from section is renumbered and amended to read b immunity there is no liability on the part of and no cause of action of any nature arises against any member of the board its agents or employees for any action or omission by them in effecting the provisions of this part sections b through b section section b which is renumbered from section is renumbered and amended to read b purpose medicaid certification of nursing care facilities the legislature finds a that an oversupply of nursing care facilities in the state adversely affects the state medicaid program and the health of the people in the state b it is in the best interest of the state to prohibit nursing care facilities from receiving medicaid certification except as provided by this part sections b through b and c it is in the best interest of the state to encourage aging nursing care facilities with medicaid certification to renovate the nursing care facilities physical facilities so that the quality of life and clinical services for medicaid residents are preserved medicaid reimbursement of nursing care facility programs is limited to a the number of nursing care facility programs with medicaid certification as of may and b additional nursing care facility programs approved for medicaid certification under the provisions of subsections b and the division may not a except as authorized by section b i process initial applications for medicaid certification or execute provider agreements with nursing care facility programs or ii reinstate medicaid certification for a nursing care facility whose certification expired or was terminated by action of the federal or state government or b execute a medicaid provider agreement with a certified program that moves to a different physical facility except as authorized by subsection b notwithstanding section b beginning may the division may not approve a new or additional bed in an intermediate care facility for individuals with an intellectual disability for medicaid certification unless certification of the bed by the division does not increase the total number in the state of medicaid certified beds in intermediate care facilities for individuals with an intellectual disability section section b which is renumbered from section is renumbered and amended to read b authorization to renew transfer or increase medicaid certified programs reimbursement methodology a the division may renew medicaid certification of a certified program if the program without lapse in service to medicaid recipients has its nursing care facility program certified by the division at the same physical facility as long as the licensed and certified bed capacity at the facility has not been expanded unless the director has approved additional beds in accordance with subsection b the division may renew medicaid certification of a nursing care facility program that is not currently certified if i since the day on which the program last operated with medicaid certification a the physical facility where the program operated has functioned solely and continuously as a nursing care facility and b the owner of the program has not under this section or section b transferred to another nursing care facility program the license for any of the medicaid beds in the program and ii except as provided in subsection b the number of beds granted renewed medicaid certification does not exceed the number of beds certified at the time the program last operated with medicaid certification excluding a period of time where the program operated with temporary certification under subsection b a the division may issue a medicaid certification for a new nursing care facility program if a current owner of the medicaid certified program transfers its ownership of the medicaid certification to the new nursing care facility program and the new nursing care facility program meets all of the following conditions i the new nursing care facility program operates at the same physical facility as the previous medicaid certified program ii the new nursing care facility program gives a written assurance to the director in accordance with subsection iii the new nursing care facility program receives the medicaid certification within one year of the date the previously certified program ceased to provide medical assistance to a medicaid recipient and iv the licensed and certified bed capacity at the facility has not been expanded unless the director has approved additional beds in accordance with subsection b a nursing care facility program that receives medicaid certification under the provisions of subsection a does not assume the medicaid liabilities of the previous nursing care facility program if the new nursing care facility program i is not owned in whole or in part by the previous nursing care facility program or ii is not a successor in interest of the previous nursing care facility program the division may issue a medicaid certification to a nursing care facility program that was previously a certified program but now resides in a new or renovated physical facility if the nursing care facility program meets all of the following a the nursing care facility program met all applicable requirements for medicaid certification at the time of closure b the new or renovated physical facility is in the same county or within a five mile radius of the original physical facility c the time between which the certified program ceased to operate in the original facility and will begin to operate in the new physical facility is not more than three years unless i an emergency is declared by the president of the united states or the governor affecting the building or renovation of the physical facility ii the director approves an exception to the three year requirement for any nursing care facility program within the three year requirement iii the provider submits documentation supporting a request for an extension to the director that demonstrates a need for an extension and iv the exception does not extend for more than two years beyond the three year requirement d if subsection c applies the certified program notifies the department within days after ceasing operations in its original facility of its intent to retain its medicaid certification e the provider gives written assurance to the director in accordance with subsection that no third party has a legitimate claim to operate a certified program at the previous physical facility and f the bed capacity in the physical facility has not been expanded unless the director has approved additional beds in accordance with subsection a the entity requesting medicaid certification under subsections and shall give written assurances satisfactory to the director or the director s designee that i no third party has a legitimate claim to operate the certified program ii the requesting entity agrees to defend and indemnify the department against any claims by a third party who may assert a right to operate the certified program and iii if a third party is found by final agency action of the department after exhaustion of all administrative and judicial appeal rights to be entitled to operate a certified program at the physical facility the certified program shall voluntarily comply with subsection b b if a finding is made under the provisions of subsection a iii i the certified program shall immediately surrender its medicaid certification and comply with division rules regarding billing for medicaid and the provision of services to medicaid patients and ii the department shall transfer the surrendered medicaid certification to the third party who prevailed under subsection a iii a the director may approve additional nursing care facility programs for medicaid certification or additional beds for medicaid certification within an existing nursing care facility program if a nursing care facility or other interested party requests medicaid certification for a nursing care facility program or additional beds within an existing nursing care facility program and the nursing care facility program or other interested party complies with this section b the nursing care facility or other interested party requesting medicaid certification for a nursing care facility program or additional beds within an existing nursing care facility program under subsection a shall submit to the director i proof of the following as reasonable evidence that bed capacity provided by medicaid certified programs within the county or group of counties impacted by the requested additional medicaid certification is insufficient a nursing care facility occupancy levels for all existing and proposed facilities will be at least for the next three years b current nursing care facility occupancy is or more or c there is no other nursing care facility within a mile radius of the nursing care facility requesting the additional certification and ii an independent analysis demonstrating that at projected occupancy rates the nursing care facility s after tax net income is sufficient for the facility to be financially viable c any request for additional beds as part of a renovation project are limited to the maximum number of beds allowed in subsection d the director shall determine whether to issue additional medicaid certification by considering i whether bed capacity provided by certified programs within the county or group of counties impacted by the requested additional medicaid certification is insufficient based on the information submitted to the director under subsection b ii whether the county or group of counties impacted by the requested additional medicaid certification is underserved by specialized or unique services that would be provided by the nursing care facility iii whether any medicaid certified beds are subject to a claim by a previous certified program that may reopen under the provisions of subsections and iv how additional bed capacity should be added to the long term care delivery system to best meet the needs of medicaid recipients and v a whether the existing certified programs within the county or group of counties have provided services of sufficient quality to merit at least a two star rating in the medicare five star quality rating system over the previous three year period and b information obtained under subsection the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act to adjust the medicaid nursing care facility property reimbursement methodology to a only pay that portion of the property component of rates representing actual bed usage by medicaid clients as a percentage of the greater of i actual occupancy or ii a for a nursing care facility other than a facility described in subsection a ii b of total bed capacity or b for a rural nursing care facility of total bed capacity and b not allow for increases in reimbursement for property values without major renovation or replacement projects as defined by the department by rule a except as provided in subsection b if a nursing care facility does not seek medicaid certification for a bed under subsections through the department shall notwithstanding subsections b a and b grant medicaid certification for additional beds in an existing medicaid certified nursing care facility that has or fewer licensed beds including medicaid certified beds in the facility if i the nursing care facility program was previously a certified program for all beds but now resides in a new facility or in a facility that underwent major renovations involving major structural changes with or greater facility square footage design changes requiring review and approval by the department ii the nursing care facility meets the quality of care regulations issued by cms and iii the total number of additional beds in the facility granted medicaid certification under this section does not exceed of the number of licensed beds in the facility b the department may not revoke the medicaid certification of a bed under this subsection as long as the provisions of subsection a ii are met a if a nursing care facility or other interested party indicates in its request for additional medicaid certification under subsection a that the facility will offer specialized or unique services but the facility does not offer those services after receiving additional medicaid certification the director shall revoke the additional medicaid certification b the nursing care facility program shall obtain medicaid certification for any additional medicaid beds approved under subsection or within three years of the date of the director s approval or the approval is void a if the director makes an initial determination that quality standards under subsection d v have not been met in a rural county or group of rural counties over the previous three year period the director shall before approving certification of additional medicaid beds in the rural county or group of counties i notify the certified program that has not met the quality standards in subsection d v that the director intends to certify additional medicaid beds under the provisions of subsection d v and ii consider additional information submitted to the director by the certified program in a rural county that has not met the quality standards under subsection d v b the notice under subsection a does not give the certified program that has not met the quality standards under subsection d v the right to legally challenge or appeal the director s decision to certify additional medicaid beds under subsection d v section section b which is renumbered from section is renumbered and amended to read b appeals of division decision rulemaking authority application of act a decision by the director under this part to deny medicaid certification for a nursing care facility program or to deny additional bed capacity for an existing certified program is subject to review under the procedures and requirements of title g chapter administrative procedures act the department shall make rules to administer and enforce this part sections b through b in accordance with title g chapter utah administrative rulemaking act a in the event the department is at risk for a federal disallowance with regard to a medicaid recipient being served in a nursing care facility program that is not medicaid certified the department may grant temporary medicaid certification to that facility for up to months b i the department may extend a temporary medicaid certification granted to a facility under subsection a a for the number of beds in the nursing care facility occupied by a medicaid recipient and b for the period of time during which the medicaid recipient resides at the facility ii a temporary medicaid certification granted under this subsection is revoked upon a the discharge of the patient from the facility or b the patient no longer residing at the facility for any reason c the department may place conditions on the temporary certification granted under subsections a and b such as i not allowing additional admissions of medicaid recipients to the program and ii not paying for the care of the patient after october with state only dollars section section b which is renumbered from section is renumbered and amended to read b authorization to sell or transfer licensed medicaid beds duties of transferor duties of transferee duties of division this section provides a method to transfer or sell the license for a medicaid bed from a nursing care facility program to another entity that is in addition to the authorization to transfer under section b a a nursing care facility program may transfer or sell one or more of its licenses for medicaid beds in accordance with subsection b if i at the time of the transfer and with respect to the license for the medicaid bed that will be transferred the nursing care facility program that will transfer the medicaid license meets all applicable regulations for medicaid certification ii the nursing care facility program gives a written assurance which is postmarked or has proof of delivery days before the transfer to the director and to the transferee in accordance with subsection b iii the nursing care facility program that will transfer the license for a medicaid bed notifies the division in writing which is postmarked or has proof of delivery days before the transfer of a the number of bed licenses that will be transferred b the date of the transfer and c the identity and location of the entity receiving the transferred licenses and iv if the nursing care facility program for which the license will be transferred or purchased is located in an urban county with a nursing care facility average annual occupancy rate over the previous two years less than or equal to the nursing care facility program transferring or selling the license demonstrates to the satisfaction of the director that the sale or transfer a will not result in an excessive number of medicaid certified beds within the county or group of counties that would be impacted by the transfer or sale and b best meets the needs of medicaid recipients b except as provided in subsection c a nursing care facility program may transfer or sell one or more of its licenses for medicaid beds to i a nursing care facility program that has the same owner or successor in interest of the same owner ii a nursing care facility program that has a different owner or iii a related party nonnursing care facility entity that wants to hold one or more of the licenses for a nursing care facility program not yet identified as long as a the licenses are subsequently transferred or sold to a nursing care facility program within three years and b the nursing care facility program notifies the director of the transfer or sale in accordance with subsection a iii c a nursing care facility program may not transfer or sell one or more of its licenses for medicaid beds to an entity under subsection b i ii or iii that is located in a rural county unless the entity requests and the director issues medicaid certification for the beds under subsection b a nursing care facility program or entity under subsection b i ii or iii that receives or purchases a license for a medicaid bed under subsection b a may receive a license for a medicaid bed from more than one nursing care facility program b shall give the division notice which is postmarked or has proof of delivery within days of the nursing care facility program or entity seeking medicaid certification of beds in the nursing care facility program or entity of the total number of licenses for medicaid beds that the entity received and who it received the licenses from c may only seek medicaid certification for the number of licensed beds in the nursing care facility program equal to the total number of licenses for medicaid beds received by the entity d does not have to demonstrate need or seek approval for the medicaid licensed bed under subsection b except as provided in subsections a iv and c e shall meet the standards for medicaid certification other than those in subsection b including personnel services contracts and licensing of facilities under chapter health care facility licensing and inspection act chapter part health care facility licensing and inspection and f shall obtain medicaid certification for the licensed medicaid beds within three years of the date of transfer as documented under subsection a iii b a when the division receives notice of a transfer of a license for a medicaid bed under subsection a iii a the department shall reduce the number of licenses for medicaid beds at the transferring nursing care facility i equal to the number of licenses transferred and ii effective on the date of the transfer as reported under subsection a iii b b for purposes of section b the division shall approve medicaid certification for the receiving nursing care facility program or entity i in accordance with the formula established in subsection c and ii if a the nursing care facility seeks medicaid certification for the transferred licenses within the time limit required by subsection f and b the nursing care facility program meets other requirements for medicaid certification under subsection e c a license for a medicaid bed may not be approved for medicaid certification without meeting the requirements of sections and b and b if i the license for a medicaid bed is transferred under this section but the receiving entity does not obtain medicaid certification for the licensed bed within the time required by subsection f or ii the license for a medicaid bed is transferred under this section but the license is no longer eligible for medicaid certification section section b which is renumbered from section a is renumbered and amended to read part nursing care facility assessment a b definitions as used in this chapter part a nursing care facility means i a nursing care facility described in subsection as defined in section b ii beginning january a designated swing bed in a a general acute hospital as defined in subsection section b and b a critical access hospital which meets the criteria of u s c sec i c and iii an intermediate care facility for people with an intellectual disability that is licensed under section b b nursing care facility does not include i the utah state developmental center ii the utah state hospital iii a general acute hospital specialty hospital or small health care facility as those terms are defined in section b or iv a utah state veterans home patient day means each calendar day in which an individual patient is admitted to the nursing care facility during a calendar month even if on a temporary leave of absence from the facility section section b which is renumbered from section a is renumbered and amended to read a b legislative findings the legislature finds that there is an important state purpose to improve the quality of care given to persons who are elderly and to people who have a disability in long term care nursing facilities the legislature finds that in order to improve the quality of care to those persons described in subsection the rates paid to the nursing care facilities by the medicaid program must be adequate to encourage and support quality care the legislature finds that in order to meet the objectives in subsections and adequate funding must be provided to increase the rates paid to nursing care facilities providing services pursuant to the medicaid program section section b which is renumbered from section a is renumbered and amended to read a b collection remittance and payment of nursing care facilities assessment a beginning july an assessment is imposed upon each nursing care facility in the amount designated in subsection c b i the department shall establish by rule a uniform rate per non medicare patient day that may not exceed of the total gross revenue for services provided to patients of all nursing care facilities licensed in this state ii for purposes of subsection b i total revenue does not include charitable contribution received by a nursing care facility c the department shall calculate the assessment imposed under subsection a by multiplying the total number of patient days of care provided to non medicare patients by the nursing care facility as provided to the department pursuant to subsection a by the uniform rate established by the department pursuant to subsection b a the assessment imposed by this chapter part is due and payable on a monthly basis on or before the last day of the month next succeeding each monthly period b the collecting agent for this assessment shall be the department which is vested with the administration and enforcement of this chapter part including the right to audit records of a nursing care facility related to patient days of care for the facility c the department shall forward proceeds from the assessment imposed by this chapter part to the state treasurer for deposit in the expendable special revenue fund as specified in section a b each nursing care facility shall on or before the end of the month next succeeding each calendar monthly period file with the department a a report which includes i the total number of patient days of care the facility provided to non medicare patients during the preceding month ii the total gross revenue the facility earned as compensation for services provided to patients during the preceding month and iii any other information required by the department and b a return for the monthly period and shall remit with the return the assessment required by this chapter part to be paid for the period covered by the return each return shall contain information and be in the form the department prescribes by rule the assessment as computed in the return is an allowable cost for medicaid reimbursement purposes the department may by rule extend the time for making returns and paying the assessment each nursing care facility that fails to pay any assessment required to be paid to the state within the time required by this chapter part or that fails to file a return as required by this chapter part shall pay in addition to the assessment penalties and interest as provided in section a b section section b which is renumbered from section a is renumbered and amended to read a b penalties and interest the penalty for failure to file a return or pay the assessment due within the time prescribed by this chapter part is the greater of or of the assessment due on the return for failure to pay within days of a notice of deficiency of assessment required to be paid the penalty is the greater of or of the assessment due the penalty for underpayment of the assessment is as follows a if any underpayment of assessment is due to negligence the penalty is of the underpayment b if the underpayment of the assessment is due to intentional disregard of law or rule the penalty is of the underpayment for intent to evade the assessment the penalty is of the underpayment the rate of interest applicable to an underpayment of an assessment under this chapter part or an unpaid penalty under this chapter part is annually the department may waive the imposition of a penalty for good cause section section b which is renumbered from section a is renumbered and amended to read a b adjustment to nursing care facility medicaid reimbursement rates if federal law or regulation prohibits the money in the nursing care facilities provider assessment fund from being used in the manner set forth in subsection a b b the rates paid to nursing care facilities for providing services pursuant to the medicaid program shall be changed except as otherwise provided in subsection to the rates paid to nursing care facilities on june or if the legislature or the department has on or after july changed the rates paid to facilities through a manner other than the use of expenditures from the nursing care facilities provider assessment fund to the rates provided for by the legislature or the department section section b which is renumbered from section a is renumbered and amended to read a b intermediate care facility for people with an intellectual disability uniform rate an intermediate care facility for people with an intellectual disability is subject to all the provisions of this chapter part except that the department shall establish a uniform rate for an intermediate care facility for people with an intellectual disability that is based on the same formula specified for nursing care facilities under the provisions of subsection a b b and may be different than the uniform rate established for other nursing care facilities section section b which is renumbered from section b is renumbered and amended to read part inpatient hospital assessment b b definitions as used in this chapter part assessment means the inpatient hospital assessment established by this chapter part cms means the centers for medicare and medicaid services within the united states department of health and human services discharges means the number of total hospital discharges reported on a worksheet s part i column lines and of the medicare cost report for the applicable assessment year or b a similar report adopted by the department by administrative rule if the report under subsection a is no longer available division means the division of health care financing integrated healthcare within the department enhancement waiver program means the program established by the primary care network enhancement waiver program described in section b health coverage improvement program means the health coverage improvement program described in section b hospital share means the hospital share described in section b b medicaid accountable care organization means a managed care organization as defined in c f r sec that contracts with the department under the provisions of section b medicaid waiver expansion means a medicaid expansion in accordance with section or b or b medicare cost report means cms the cost report for electronic filing of hospitals a non state government hospital means a hospital owned by a non state government entity b non state government hospital does not include i the utah state hospital or ii a hospital owned by the federal government including the veterans administration hospital a private hospital means i a general acute hospital as defined in section b that is privately owned and operating in the state and ii a privately owned specialty hospital operating in the state including a privately owned hospital whose inpatient admissions are predominantly for a rehabilitation b psychiatric care c chemical dependency services or d long term acute care services b private hospital does not include a facility for residential treatment as defined in section a b state teaching hospital means a state owned teaching hospital that is part of an institution of higher education upper payment limit gap means the difference between the private hospital outpatient upper payment limit and the private hospital medicaid outpatient payments as determined in accordance with c f r sec section section b which is renumbered from section b is renumbered and amended to read b b application other than for the imposition of the assessment described in this chapter part nothing in this chapter part shall affect the nonprofit or tax exempt status of any nonprofit charitable religious or educational health care provider under any a state law b ad valorem property taxes c sales or use taxes or d other taxes fees or assessments whether imposed or sought to be imposed by the state or any political subdivision of the state all assessments paid under this chapter part may be included as an allowable cost of a hospital for purposes of any applicable medicaid reimbursement formula this chapter part does not authorize a political subdivision of the state to a license a hospital for revenue b impose a tax or assessment upon a hospital or c impose a tax or assessment measured by the income or earnings of a hospital section section b which is renumbered from section b is renumbered and amended to read b b assessment an assessment is imposed on each private hospital a beginning upon the later of cms approval of i the health coverage improvement program waiver under section b and ii the assessment under this chapter part b in the amount designated in sections b and b b and b and c in accordance with section b b subject to section b b the assessment imposed by this chapter part is due and payable on a quarterly basis after payment of the outpatient upper payment limit supplemental payments under section b b have been paid the first quarterly payment is not due until at least three months after the earlier of the effective dates of the coverage provided through a the health coverage improvement program b the enhancement waiver program or c the medicaid waiver expansion section section b which is renumbered from section b is renumbered and amended to read b b collection of assessment deposit of revenue rulemaking the collecting agent for the assessment imposed under section b b is the department the department is vested with the administration and enforcement of this chapter part and may make rules in accordance with title g chapter utah administrative rulemaking act necessary to a collect the assessment intergovernmental transfers and penalties imposed under this chapter part b audit records of a facility that i is subject to the assessment imposed by this chapter part and ii does not file a medicare cost report and c select a report similar to the medicare cost report if medicare no longer uses a medicare cost report the department shall a administer the assessment in this chapter part separately from the assessment in chapter d part hospital provider assessment act and b deposit assessments collected under this chapter part into the medicaid expansion fund created by section b b section section b which is renumbered from section b is renumbered and amended to read b b quarterly notice quarterly assessments imposed by this chapter part shall be paid to the division within business days after the original invoice date that appears on the invoice issued by the division the department may by rule extend the time for paying the assessment section section b which is renumbered from section b is renumbered and amended to read b b hospital financing of health coverage improvement program medicaid waiver expansion hospital share the hospital share is a of the state s net cost of the health coverage improvement program including medicaid coverage for individuals with dependent children up to the federal poverty level designated under section b b of the state s net cost of the enhancement waiver program c if the waiver for the medicaid waiver expansion is approved and d of the state s net cost of the upper payment limit gap a the hospital share is capped at no more than annually consisting of i an cap for the programs specified in subsections a through c and ii a cap for the program specified in subsection d b the department shall prorate the cap described in subsection a in any year in which the programs specified in subsections a and d are not in effect for the full fiscal year private hospitals shall be assessed under this chapter part for a of the portion of the hospital share for the programs specified in subsections a through c and b of the portion of the hospital share specified in subsection d a in the report described in subsection b the department shall calculate the state s net cost of each of the programs described in subsections a through c that are in effect for that year b if the assessment collected in the previous fiscal year is above or below the hospital share for private hospitals for the previous fiscal year the underpayment or overpayment of the assessment by the private hospitals shall be applied to the fiscal year in which the report is issued a medicaid accountable care organization shall on or before october of each year report to the department the following data from the prior state fiscal year for each private hospital state teaching hospital and non state government hospital provider that the medicaid accountable care organization contracts with a for the traditional medicaid population i hospital inpatient payments ii hospital inpatient discharges iii hospital inpatient days and iv hospital outpatient payments and b if the medicaid accountable care organization enrolls any individuals in the health coverage improvement program the enhancement waiver program or the medicaid waiver expansion for the population newly eligible for any of those programs i hospital inpatient payments ii hospital inpatient discharges iii hospital inpatient days and iv hospital outpatient payments the department shall by rule made in accordance with title g chapter utah administrative rulemaking act provide details surrounding specific content and format for the reporting by the medicaid accountable care organization section section b which is renumbered from section b is renumbered and amended to read b b calculation of assessment a except as provided in subsection b an annual assessment is payable on a quarterly basis for each private hospital in an amount calculated by the division at a uniform assessment rate for each hospital discharge in accordance with this section b a private teaching hospital with more than beds and residents shall pay an assessment rate times the uniform rate established under subsection c c the division shall calculate the uniform assessment rate described in subsection a by dividing the hospital share for assessed private hospitals described in subsections b and b b and by the sum of i the total number of discharges for assessed private hospitals that are not a private teaching hospital and ii times the number of discharges for a private teaching hospital described in subsection b d the division may by rule made in accordance with title g chapter utah administrative rulemaking act adjust the formula described in subsection c to address unforeseen circumstances in the administration of the assessment under this chapter part e any quarterly changes to the uniform assessment rate shall be applied uniformly to all assessed private hospitals except as provided in subsection for each state fiscal year the division shall determine a hospital s discharges as follows a for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june and b for each subsequent state fiscal year the hospital s cost report data for the hospital s fiscal year that ended in the state fiscal year two years before the assessment fiscal year a if a hospital s fiscal year medicare cost report is not contained in the cms healthcare cost report information system file i the hospital shall submit to the division a copy of the hospital s medicare cost report applicable to the assessment year and ii the division shall determine the hospital s discharges b if a hospital is not certified by the medicare program and is not required to file a medicare cost report i the hospital shall submit to the division the hospital s applicable fiscal year discharges with supporting documentation ii the division shall determine the hospital s discharges from the information submitted under subsection b i and iii failure to submit discharge information shall result in an audit of the hospital s records and a penalty equal to of the calculated assessment except as provided in subsection if a hospital is owned by an organization that owns more than one hospital in the state a the assessment for each hospital shall be separately calculated by the department and b each separate hospital shall pay the assessment imposed by this chapter part if multiple hospitals use the same medicaid provider number a the department shall calculate the assessment in the aggregate for the hospitals using the same medicaid provider number and b the hospitals may pay the assessment in the aggregate section section b which is renumbered from section b is renumbered and amended to read b b state teaching hospital and non state government hospital mandatory intergovernmental transfer the state teaching hospital and a non state government hospital shall make an intergovernmental transfer to the medicaid expansion fund created in section b b in accordance with this section the hospitals described in subsection shall pay the intergovernmental transfer beginning on the later of cms approval of a the health improvement program waiver under section b or b the assessment for private hospitals in this chapter part the intergovernmental transfer is apportioned as follows a the state teaching hospital is responsible for i of the portion of the hospital share specified in subsections b b a through c and ii of the hospital share specified in subsection b b d and b non state government hospitals are responsible for i of the portion of the hospital share specified in subsections b b a through c and ii of the hospital share specified in subsection b b d the department shall by rule made in accordance with title g chapter utah administrative rulemaking act designate a the method of calculating the amounts designated in subsection and b the schedule for the intergovernmental transfers section section b which is renumbered from section b is renumbered and amended to read b b penalties and interest a hospital that fails to pay a quarterly assessment make the mandated intergovernmental transfer or file a return as required under this chapter part within the time required by this chapter part shall pay penalties described in this section in addition to the assessment or intergovernmental transfer if a hospital fails to timely pay the full amount of a quarterly assessment or the mandated intergovernmental transfer the department shall add to the assessment or intergovernmental transfer a a penalty equal to of the quarterly amount not paid on or before the due date and b on the last day of each quarter after the due date until the assessed amount and the penalty imposed under subsection a are paid in full an additional penalty on i any unpaid quarterly assessment or intergovernmental transfer and ii any unpaid penalty assessment upon making a record of the division s actions and upon reasonable cause shown the division may waive reduce or compromise any of the penalties imposed under this chapter part section section b which is renumbered from section b is renumbered and amended to read b b hospital reimbursement if the health coverage improvement program the enhancement waiver program or the medicaid waiver expansion is implemented by contracting with a medicaid accountable care organization the department shall to the extent allowed by law include in a contract to provide benefits under the health coverage improvement program the enhancement waiver program or the medicaid waiver expansion a requirement that the medicaid accountable care organization reimburse hospitals in the accountable care organization s provider network at no less than the medicaid fee for service rate if the health coverage improvement program the enhancement waiver program or the medicaid waiver expansion is implemented by the department as a fee for service program the department shall reimburse hospitals at no less than the medicaid fee for service rate nothing in this section prohibits a medicaid accountable care organization from paying a rate that exceeds the medicaid fee for service rate section section b which is renumbered from section b is renumbered and amended to read b b outpatient upper payment limit supplemental payments beginning on the effective date of the assessment imposed under this chapter part and for each subsequent fiscal year the department shall implement an outpatient upper payment limit program for private hospitals that shall supplement the reimbursement to private hospitals in accordance with subsection the division shall ensure that supplemental payment to utah private hospitals under subsection a does not exceed the positive upper payment limit gap and b is allocated based on the medicaid state plan the department shall use the same outpatient data to allocate the payments under subsection and to calculate the upper payment limit gap the supplemental payments to private hospitals under subsection are payable for outpatient hospital services provided on or after the later of a july b the effective date of the medicaid state plan amendment necessary to implement the payments under this section or c the effective date of the coverage provided through the health coverage improvement program waiver section section b which is renumbered from section b is renumbered and amended to read b b repeal of assessment the assessment imposed by this chapter part shall be repealed when a the executive director certifies that i action by congress is in effect that disqualifies the assessment imposed by this chapter part from counting toward state medicaid funds available to be used to determine the amount of federal financial participation ii a decision enactment or other determination by the legislature or by any court officer department or agency of the state or of the federal government is in effect that a disqualifies the assessment from counting toward state medicaid funds available to be used to determine federal financial participation for medicaid matching funds or b creates for any reason a failure of the state to use the assessments for at least one of the medicaid programs described in this chapter part or iii a change is in effect that reduces the aggregate hospital inpatient and outpatient payment rate below the aggregate hospital inpatient and outpatient payment rate for july or b this chapter part is repealed in accordance with section i if the assessment is repealed under subsection a the division may not collect any assessment or intergovernmental transfer under this chapter part b the department shall disburse money in the special medicaid expansion fund in accordance with the requirements in subsection b b to the extent federal matching is not reduced by cms due to the repeal of the assessment c any money remaining in the medicaid expansion fund after the disbursement described in subsection b that was derived from assessments imposed by this chapter part shall be refunded to the hospitals in proportion to the amount paid by each hospital for the last three fiscal years and d any money remaining in the medicaid expansion fund after the disbursements described in subsections b and c shall be deposited into the general fund by the end of the fiscal year that the assessment is suspended section section b which is renumbered from section c is renumbered and amended to read part medicaid expansion hospital assessment c b definitions as used in this chapter part assessment means the medicaid expansion hospital assessment established by this chapter part cms means the centers for medicare and medicaid services within the united states department of health and human services discharges means the number of total hospital discharges reported on a worksheet s part i column lines and of the medicare cost report for the applicable assessment year or b a similar report adopted by the department by administrative rule if the report under subsection a is no longer available division means the division of health care financing integrated healthcare within the department hospital share means the hospital share described in section c b medicaid accountable care organization means a managed care organization as defined in c f r sec that contracts with the department under the provisions of section b medicaid expansion fund means the medicaid expansion fund created in section b b medicaid waiver expansion means the same as that term is defined in section b medicare cost report means cms the cost report for electronic filing of hospitals a non state government hospital means a hospital owned by a non state government entity b non state government hospital does not include i the utah state hospital or ii a hospital owned by the federal government including the veterans administration hospital a private hospital means i a privately owned general acute hospital operating in the state as defined in section b or ii a privately owned specialty hospital operating in the state including a privately owned hospital for which inpatient admissions are predominantly a rehabilitation b psychiatric c chemical dependency or d long term acute care services b private hospital does not include a facility for residential treatment as defined in section a b qualified medicaid expansion means an expansion of the medicaid program in accordance with subsection b state teaching hospital means a state owned teaching hospital that is part of an institution of higher education section section b which is renumbered from section c is renumbered and amended to read c b application other than for the imposition of the assessment described in this chapter part nothing in this chapter part shall affect the nonprofit or tax exempt status of any nonprofit charitable religious or educational health care provider under any a state law b ad valorem property tax requirement c sales or use tax requirement or d other requirements imposed by taxes fees or assessments whether imposed or sought to be imposed by the state or any political subdivision of the state a hospital paying an assessment under this chapter part may include the assessment as an allowable cost of a hospital for purposes of any applicable medicaid reimbursement formula this chapter part does not authorize a political subdivision of the state to a license a hospital for revenue b impose a tax or assessment upon a hospital or c impose a tax or assessment measured by the income or earnings of a hospital section section b which is renumbered from section c is renumbered and amended to read c b assessment an assessment is imposed on each private hospital a beginning upon the later of i april and ii cms approval of the assessment under this chapter part b in the amount designated in sections c and c b and b and c in accordance with section c b the assessment imposed by this chapter part is due and payable in accordance with subsection c b section section b which is renumbered from section c is renumbered and amended to read c b collection of assessment deposit of revenue rulemaking the department shall act as the collecting agent for the assessment imposed under section c b the department shall administer and enforce the provisions of this chapter part and may make rules in accordance with title g chapter utah administrative rulemaking act necessary to a collect the assessment intergovernmental transfers and penalties imposed under this chapter part b audit records of a facility that i is subject to the assessment imposed under this chapter part and ii does not file a medicare cost report and c select a report similar to the medicare cost report if medicare no longer uses a medicare cost report the department shall a administer the assessment in this part separately from the assessments in chapter d part hospital provider assessment act and chapter b and part inpatient hospital assessment act and b deposit assessments collected under this chapter part into the medicaid expansion fund a hospitals shall pay the quarterly assessments imposed by this chapter part to the division within business days after the original invoice date that appears on the invoice issued by the division b the department may make rules creating requirements to allow the time for paying the assessment to be extended section section b which is renumbered from section c is renumbered and amended to read c b hospital share the hospital share is a for the period from april through june and b beginning july of the state s net cost of the qualified medicaid expansion after deducting appropriate offsets and savings expected as a result of implementing the qualified medicaid expansion including i savings from a the primary care network program b the health coverage improvement program as defined in section b c the state portion of inpatient prison medical coverage d behavioral health coverage and e county contributions to the non federal share of medicaid expenditures and ii any funds appropriated to the medicaid expansion fund a beginning july the hospital share is capped at no more than annually b beginning july the division shall prorate the cap specified in subsection a in any year in which the qualified medicaid expansion is not in effect for the full fiscal year section section b which is renumbered from section c is renumbered and amended to read c b hospital financing private hospitals shall be assessed under this chapter part for the portion of the hospital share described in section c b in the report described in subsection b the department shall calculate the state s net cost of the qualified medicaid expansion if the assessment collected in the previous fiscal year is above or below the hospital share for private hospitals for the previous fiscal year the division shall apply the underpayment or overpayment of the assessment by the private hospitals to the fiscal year in which the report is issued section section b which is renumbered from section c is renumbered and amended to read c b calculation of assessment a except as provided in subsection b each private hospital shall pay an annual assessment due on the last day of each quarter in an amount calculated by the division at a uniform assessment rate for each hospital discharge in accordance with this section b a private teaching hospital with more than beds and more than residents shall pay an assessment rate times the uniform rate established under subsection c c the division shall calculate the uniform assessment rate described in subsection a by dividing the hospital share for assessed private hospitals as described in subsection c b by the sum of i the total number of discharges for assessed private hospitals that are not a private teaching hospital and ii times the number of discharges for a private teaching hospital described in subsection b d the division may make rules in accordance with title g chapter utah administrative rulemaking act to adjust the formula described in subsection c to address unforeseen circumstances in the administration of the assessment under this chapter part e the division shall apply any quarterly changes to the uniform assessment rate uniformly to all assessed private hospitals except as provided in subsection for each state fiscal year the division shall determine a hospital s discharges as follows a for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june and b for each subsequent state fiscal year the hospital s cost report data for the hospital s fiscal year that ended in the state fiscal year two years before the assessment fiscal year a if a hospital s fiscal year medicare cost report is not contained in the centers for medicare and medicaid services healthcare cost report information system file i the hospital shall submit to the division a copy of the hospital s medicare cost report applicable to the assessment year and ii the division shall determine the hospital s discharges b if a hospital is not certified by the medicare program and is not required to file a medicare cost report i the hospital shall submit to the division the hospital s applicable fiscal year discharges with supporting documentation ii the division shall determine the hospital s discharges from the information submitted under subsection b i and iii if the hospital fails to submit discharge information the division shall audit the hospital s records and may impose a penalty equal to of the calculated assessment except as provided in subsection if a hospital is owned by an organization that owns more than one hospital in the state a the division shall calculate the assessment for each hospital separately and b each separate hospital shall pay the assessment imposed by this chapter part if multiple hospitals use the same medicaid provider number a the department shall calculate the assessment in the aggregate for the hospitals using the same medicaid provider number and b the hospitals may pay the assessment in the aggregate section section b which is renumbered from section c is renumbered and amended to read c b state teaching hospital and non state government hospital mandatory intergovernmental transfer a state teaching hospital and a non state government hospital shall make an intergovernmental transfer to the medicaid expansion fund in accordance with this section the hospitals described in subsection shall pay the intergovernmental transfer beginning on the later of a april or b cms approval of the assessment for private hospitals in this chapter part the intergovernmental transfer is apportioned between the non state government hospitals as follows a the state teaching hospital shall pay for the portion of the hospital share described in section c b and b non state government hospitals shall pay for the portion of the hospital share described in section c b the department shall by rule made in accordance with title g chapter utah administrative rulemaking act designate a the method of calculating the amounts designated in subsection and b the schedule for the intergovernmental transfers section section b which is renumbered from section c is renumbered and amended to read c b penalties a hospital that fails to pay a quarterly assessment make the mandated intergovernmental transfer or file a return as required under this chapter part within the time required by this chapter part shall pay penalties described in this section in addition to the assessment or intergovernmental transfer if a hospital fails to timely pay the full amount of a quarterly assessment or the mandated intergovernmental transfer the department shall add to the assessment or intergovernmental transfer a a penalty equal to of the quarterly amount not paid on or before the due date and b on the last day of each quarter after the due date until the assessed amount and the penalty imposed under subsection a are paid in full an additional penalty on i any unpaid quarterly assessment or intergovernmental transfer and ii any unpaid penalty assessment upon making a record of the division s actions and upon reasonable cause shown the division may waive or reduce any of the penalties imposed under this chapter part section section b which is renumbered from section c is renumbered and amended to read c b hospital reimbursement if the qualified medicaid expansion is implemented by contracting with a medicaid accountable care organization the department shall to the extent allowed by law include in a contract to provide benefits under the qualified medicaid expansion a requirement that the accountable care organization reimburse hospitals in the accountable care organization s provider network at no less than the medicaid fee for service rate if the qualified medicaid expansion is implemented by the department as a fee for service program the department shall reimburse hospitals at no less than the medicaid fee for service rate nothing in this section prohibits the department or a medicaid accountable care organization from paying a rate that exceeds the medicaid fee for service rate section section b which is renumbered from section c is renumbered and amended to read c b hospital financing of the hospital share for the first two full fiscal years that the assessment is in effect the department shall a assess private hospitals under this chapter part for of the hospital share b require the state teaching hospital to make an intergovernmental transfer under this chapter part for of the hospital share and c require non state government hospitals to make an intergovernmental transfer under this chapter part for of the hospital share a at the beginning of the third full fiscal year that the assessment is in effect and at the beginning of each subsequent fiscal year the department may set a different percentage share for private hospitals the state teaching hospital and non state government hospitals by rule made in accordance with title g chapter utah administrative rulemaking act with input from private hospitals and private teaching hospitals b if the department does not set a different percentage share under subsection a the percentage shares in subsection shall apply section section b which is renumbered from section c is renumbered and amended to read c b suspension of assessment the department shall suspend the assessment imposed by this chapter part when the executive director certifies that a action by congress is in effect that disqualifies the assessment imposed by this chapter part from counting toward state medicaid funds available to be used to determine the amount of federal financial participation b a decision enactment or other determination by the legislature or by any court officer department or agency of the state or of the federal government is in effect that i disqualifies the assessment from counting toward state medicaid funds available to be used to determine federal financial participation for medicaid matching funds or ii creates for any reason a failure of the state to use the assessments for at least one of the medicaid programs described in this chapter part or c a change is in effect that reduces the aggregate hospital inpatient and outpatient payment rate below the aggregate hospital inpatient and outpatient payment rate for july if the assessment is suspended under subsection a the division may not collect any assessment or intergovernmental transfer under this chapter part b the division shall disburse money in the medicaid expansion fund that was derived from assessments imposed by this chapter part in accordance with the requirements in subsection b b to the extent federal matching is not reduced by cms due to the repeal of the assessment and c the division shall refund any money remaining in the medicaid expansion fund after the disbursement described in subsection b that was derived from assessments imposed by this chapter part to the hospitals in proportion to the amount paid by each hospital for the last three fiscal years section section b which is renumbered from section d is renumbered and amended to read part hospital provider assessment d b definitions as used in this chapter part accountable care organization means a managed care organization as defined in c f r sec that contracts with the department under the provisions of section b assessment means the medicaid hospital provider assessment established by this chapter part discharges means the number of total hospital discharges reported on worksheet s part i column lines and of the medicare cost report or on worksheet s part i column lines and of the medicare cost report for the applicable assessment year division means the division of health care financing integrated healthcare of the department hospital a means a privately owned i general acute hospital operating in the state as defined in section b and ii specialty hospital operating in the state which shall include a privately owned hospital whose inpatient admissions are predominantly a rehabilitation b psychiatric c chemical dependency or d long term acute care services and b does not include i a human services program as defined in section a b ii a hospital owned by the federal government including the veterans administration hospital or iii a hospital that is owned by the state government a state agency or a political subdivision of the state including a a state owned teaching hospital and b the utah state hospital medicare cost report means cms or cms the cost report for electronic filing of hospitals state plan amendment means a change or update to the state medicaid plan section section b which is renumbered from section d is renumbered and amended to read d b legislative findings the legislature finds that there is an important state purpose to improve the access of medicaid patients to quality care in utah hospitals because of continuous decreases in state revenues and increases in enrollment under the utah medicaid program the legislature finds that in order to improve this access to those persons described in subsection a the rates paid to utah hospitals shall be adequate to encourage and support improved access and b adequate funding shall be provided to increase the rates paid to utah hospitals providing services pursuant to the utah medicaid program section section b which is renumbered from section d is renumbered and amended to read d b application of part other than for the imposition of the assessment described in this chapter part nothing in this chapter part shall affect the nonprofit or tax exempt status of any nonprofit charitable religious or educational health care provider under a section c as amended of the internal revenue code b other applicable federal law c any state law d any ad valorem property taxes e any sales or use taxes or f any other taxes fees or assessments whether imposed or sought to be imposed by the state or any political subdivision county municipality district authority or any agency or department thereof all assessments paid under this chapter part may be included as an allowable cost of a hospital for purposes of any applicable medicaid reimbursement formula this chapter part does not authorize a political subdivision of the state to a license a hospital for revenue b impose a tax or assessment upon hospitals or c impose a tax or assessment measured by the income or earnings of a hospital section section b which is renumbered from section d is renumbered and amended to read d b assessment collection and payment of hospital provider assessment a uniform broad based assessment is imposed on each hospital as defined in subsection d b a a in the amount designated in section d b and b in accordance with section d b a the assessment imposed by this chapter part is due and payable on a quarterly basis in accordance with section d b b the collecting agent for this assessment is the department which is vested with the administration and enforcement of this chapter part including the right to adopt administrative rules in accordance with title g chapter utah administrative rulemaking act necessary to i implement and enforce the provisions of this act and ii audit records of a facility a that is subject to the assessment imposed by this chapter part and b does not file a medicare cost report c the department shall forward proceeds from the assessment imposed by this chapter part to the state treasurer for deposit in the expendable special revenue fund as specified in section d b the department may by rule extend the time for paying the assessment section section b which is renumbered from section d is renumbered and amended to read d b calculation of assessment a an annual assessment is payable on a quarterly basis for each hospital in an amount calculated at a uniform assessment rate for each hospital discharge in accordance with this section b the uniform assessment rate shall be determined using the total number of hospital discharges for assessed hospitals divided into the total non federal portion in an amount consistent with section d b that is needed to support capitated rates for accountable care organizations for purposes of hospital services provided to medicaid enrollees c any quarterly changes to the uniform assessment rate shall be applied uniformly to all assessed hospitals d the annual uniform assessment rate may not generate more than i to offset medicaid mandatory expenditures and ii the non federal share to seed amounts needed to support capitated rates for accountable care organizations as provided for in subsection b a for each state fiscal year discharges shall be determined using the data from each hospital s medicare cost report contained in the centers for medicare and medicaid services healthcare cost report information system file the hospital s discharge data will be derived as follows i for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june ii for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june iii for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june iv for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june and v for each subsequent state fiscal year the hospital s cost report data for the hospital s fiscal year that ended in the state fiscal year two years prior to the assessment fiscal year b if a hospital s fiscal year medicare cost report is not contained in the centers for medicare and medicaid services healthcare cost report information system file i the hospital shall submit to the division a copy of the hospital s medicare cost report applicable to the assessment year and ii the division shall determine the hospital s discharges c if a hospital is not certified by the medicare program and is not required to file a medicare cost report i the hospital shall submit to the division its applicable fiscal year discharges with supporting documentation ii the division shall determine the hospital s discharges from the information submitted under subsection c i and iii the failure to submit discharge information shall result in an audit of the hospital s records and a penalty equal to of the calculated assessment except as provided in subsection if a hospital is owned by an organization that owns more than one hospital in the state a the assessment for each hospital shall be separately calculated by the department and b each separate hospital shall pay the assessment imposed by this chapter part notwithstanding the requirement of subsection if multiple hospitals use the same medicaid provider number a the department shall calculate the assessment in the aggregate for the hospitals using the same medicaid provider number and b the hospitals may pay the assessment in the aggregate section section b which is renumbered from section d is renumbered and amended to read d b quarterly notice collection quarterly assessments imposed by this chapter part shall be paid to the division within business days after the original invoice date that appears on the invoice issued by the division section section b which is renumbered from section d is renumbered and amended to read d b medicaid hospital adjustment under accountable care organization rates to preserve and improve access to hospital services the division shall for accountable care organization rates effective on or after april incorporate into the accountable care organization rate structure calculation consistent with the certified actuarial rate range to be allocated toward the hospital inpatient directed payments for the medicaid eligibility categories covered in utah before january and an amount equal to the difference between payments made to hospitals by accountable care organizations for the medicaid eligibility categories covered in utah before january based on submitted encounter data and the maximum amount that could be paid for those services using medicare payment principles to be used for directed payments to hospitals for outpatient services section section b which is renumbered from section d is renumbered and amended to read d b penalties and interest a facility that fails to pay any assessment or file a return as required under this chapter part within the time required by this chapter part shall pay in addition to the assessment penalties and interest established by the department a consistent with subsection b the department shall adopt rules in accordance with title g chapter utah administrative rulemaking act which establish reasonable penalties and interest for the violations described in subsection b if a hospital fails to timely pay the full amount of a quarterly assessment the department shall add to the assessment i a penalty equal to of the quarterly amount not paid on or before the due date and ii on the last day of each quarter after the due date until the assessed amount and the penalty imposed under subsection b i are paid in full an additional penalty on a any unpaid quarterly assessment and b any unpaid penalty assessment c upon making a record of its actions and upon reasonable cause shown the division may waive reduce or compromise any of the penalties imposed under this part section section b which is renumbered from section d is renumbered and amended to read d b repeal of assessment the repeal of the assessment imposed by this chapter part shall occur upon the certification by the executive director of the department that the sooner of the following has occurred a the effective date of any action by congress that would disqualify the assessment imposed by this chapter part from counting toward state medicaid funds available to be used to determine the federal financial participation b the effective date of any decision enactment or other determination by the legislature or by any court officer department or agency of the state or of the federal government that has the effect of i disqualifying the assessment from counting towards state medicaid funds available to be used to determine federal financial participation for medicaid matching funds or ii creating for any reason a failure of the state to use the assessments for the medicaid program as described in this chapter part c the effective date of i an appropriation for any state fiscal year from the general fund for hospital payments under the state medicaid program that is less than the amount appropriated for state fiscal year ii the annual revenues of the state general fund budget return to the level that was appropriated for fiscal year iii a division change in rules that reduces any of the following below july payments a aggregate hospital inpatient payments b adjustment payment rates or c any cost settlement protocol or iv a division change in rules that reduces the aggregate outpatient payments below july payments and d the sunset of this chapter part in accordance with section i if the assessment is repealed under subsection money in the fund that was derived from assessments imposed by this chapter part before the determination made under subsection shall be disbursed under section d b to the extent federal matching is not reduced due to the impermissibility of the assessments any funds remaining in the special revenue fund shall be refunded to the hospitals in proportion to the amount paid by each hospital section section b which is renumbered from section a is renumbered and amended to read part ambulance service provider assessment a b definitions as used in this chapter part ambulance service provider means a an ambulance provider as defined in section a b or b a non service provider as defined in section a b assessment means the medicaid ambulance service provider assessment established by this chapter part division means the division of health care financing integrated healthcare within the department non federal portion means the non federal share the division needs to seed amounts that will support fee for service ambulance service provider rates as described in section a b total transports means the number of total ambulance transports applicable to a given fiscal year as determined under subsection a b section section b which is renumbered from section a is renumbered and amended to read a b assessment collection and payment of ambulance service provider assessment an ambulance service provider shall pay an assessment to the division a in the amount designated in section a b b in accordance with this chapter part c quarterly on a day determined by the division by rule made under subsection b and d no more than business days after the day on which the division issues the ambulance service provider notice of the assessment the division shall a collect the assessment described in subsection b determine by rule made in accordance with title g chapter utah administrative rulemaking act standards and procedures for implementing and enforcing the provisions of this chapter part and c transfer assessment proceeds to the state treasurer for deposit into the ambulance service provider assessment expendable revenue fund created in section a b section section b which is renumbered from section a is renumbered and amended to read a b calculation of assessment the division shall calculate a uniform assessment per transport as described in this section the assessment due from a given ambulance service provider equals the non federal portion divided by total transports multiplied by the number of transports for the ambulance service provider the division shall apply any quarterly changes to the assessment rate calculated as described in subsection uniformly to all assessed ambulance service providers the assessment may not generate more than the total of a an annual amount of to offset medicaid administration expenses and b the non federal portion a for each state fiscal year the division shall calculate total transports using data from the emergency medical system as follows i for state fiscal year the division shall use ambulance service provider transports during the calendar year and ii for a fiscal year after the division shall use ambulance service provider transports during the calendar year ending months before the end of the fiscal year b if an ambulance service provider fails to submit transport information to the emergency medical system the division may audit the ambulance service provider to determine the ambulance service provider s transports for a given fiscal year section section b which is renumbered from section a is renumbered and amended to read a b medicaid ambulance service provider adjustment under fee for service rates the division shall if the assessment imposed by this chapter part is approved by the centers for medicare and medicaid services for fee for service rates effective on or after july reimburse an ambulance service provider in an amount up to the emergency medical services ambulance rates adopted annually by the department section section b which is renumbered from section a is renumbered and amended to read a b penalties the division shall require an ambulance service provider that fails to pay an assessment due under this chapter part to pay the division in addition to the assessment a penalty determined by the division by rule made in accordance with title g chapter utah administrative rulemaking act section section b which is renumbered from section a is renumbered and amended to read a b repeal of assessment this chapter part is repealed when as certified by the executive director of the department any of the following occurs a an action by congress that disqualifies the assessment imposed by this chapter part from state medicaid funds available to be used to determine the federal financial participation takes legal effect or b an action decision enactment or other determination by the legislature or by any court officer department or agency of the state or federal government takes effect that i disqualifies the assessment from counting toward state medicaid funds available to be used to determine federal financial participation for medicaid matching funds or ii creates for any reason a failure of the state to use the assessments for the medicaid program as described in this chapter part if this chapter part is repealed under subsection a money in the ambulance service provider assessment expendable revenue fund that was derived from assessments imposed by this chapter part deposited before the determination made under subsection shall be disbursed under section a b to the extent federal matching is not reduced due to the impermissibility of the assessments and b any funds remaining in the special revenue fund shall be refunded to each ambulance service provider in proportion to the amount paid by the ambulance service provider section section b which is renumbered from section is renumbered and amended to read part utah children s health insurance program b definitions as used in this chapter part child means a person who is under years of age an individual who is younger than years old eligible child means a child who qualifies for enrollment in the program as provided in section b member means a child enrolled in the program plan means the department s plan submitted to the united states department of health and human services pursuant to u s c sec ff program means the utah children s health insurance program created by this chapter part section section b which is renumbered from section is renumbered and amended to read b creation and administration of the utah children s health insurance program there is created the utah children s health insurance program to be administered by the department in accordance with the provisions of a this chapter part and b the state children s health insurance program u s c sec aa et seq the department shall a prepare and submit the state s children s health insurance plan before may and any amendments to the federal united states department of health and human services in accordance with u s c sec ff and b make rules in accordance with title g chapter utah administrative rulemaking act regarding i eligibility requirements consistent with section b ii program benefits iii the level of coverage for each program benefit iv cost sharing requirements for members which may not a exceed the guidelines set forth in u s c sec ee or b impose deductible copayment or coinsurance requirements on a member for well child well baby and immunizations v the administration of the program and vi a requirement that a members in the program shall participate in the electronic exchange of clinical health records established in accordance with section b unless the member opts out of participation b prior to enrollment in the electronic exchange of clinical health records the member shall receive notice of the enrollment in the electronic exchange of clinical health records and the right to opt out of participation at any time and c beginning july when the program sends enrollment or renewal information to the member and when the member logs onto the program s website the member shall receive notice of the right to opt out of the electronic exchange of clinical health records section section b which is renumbered from section is renumbered and amended to read b eligibility a child is eligible to enroll in the program if the child a is a bona fide utah resident b is a citizen or legal resident of the united states c is under years of age d does not have access to or coverage under other health insurance including any coverage available through a parent or legal guardian s employer e is ineligible for medicaid benefits f resides in a household whose gross family income as defined by rule is at or below of the federal poverty level and g is not an inmate of a public institution or a patient in an institution for mental diseases a child who qualifies for enrollment in the program under subsection may not be denied enrollment due to a diagnosis or pre existing condition a the department shall determine eligibility and send notification of the eligibility decision within days after receiving the application for coverage b if the department cannot reach a decision because the applicant fails to take a required action or because there is an administrative or other emergency beyond the department s control the department shall i document the reason for the delay in the applicant s case record and ii inform the applicant of the status of the application and time frame for completion the department may not close enrollment in the program for a child who is eligible to enroll in the program under the provisions of subsection the program shall a apply for grants to make technology system improvements necessary to implement a simplified enrollment and renewal process in accordance with subsection b and b if funding is available implement a simplified enrollment and renewal process section section b which is renumbered from section is renumbered and amended to read b program benefits except as provided in subsection medical and dental program benefits shall be benchmarked in accordance with u s c sec cc as follows a medical program benefits including behavioral health care benefits shall be benchmarked effective july and on july every third year thereafter to i be substantially equal to a health benefit plan with the largest insured commercial enrollment offered by a health maintenance organization in the state and ii comply with the mental health parity and addiction equity act pub l no and b dental program benefits shall be benchmarked effective july and on july every third year thereafter in accordance with the children s health insurance program reauthorization act of to be substantially equal to a dental benefit plan that has the largest insured commercial non medicaid enrollment of covered lives that is offered in the state except that the utilization review mechanism for orthodontia shall be based on medical necessity on or before july of each year the department shall publish the benchmark for dental program benefits established under subsection b the program benefits a for enrollees who are at or below of the federal poverty level are exempt from the benchmark requirements of subsections and and b shall include treatment for autism spectrum disorder as defined in section a which i shall include coverage for applied behavioral analysis and ii if the benchmark described in subsection a does not include the coverage described in this subsection b the department shall exclude from the benchmark described in subsection a for any purpose other than providing benefits under the program section section b which is renumbered from section is renumbered and amended to read b limitation of benefits abortion is not a covered benefit except as provided in u s c sec ee section section b which is renumbered from section is renumbered and amended to read b funding the program shall be funded by federal matching funds received under together with state matching funds required by u s c sec ee program expenditures in the following categories may not exceed in the aggregate of all federal payments pursuant to u s c sec ee a other forms of child health assistance for children with gross family incomes below of the federal poverty level b other health services initiatives to improve low income children s health c outreach program expenditures and d administrative costs section section b which is renumbered from section is renumbered and amended to read b evaluation the department shall develop performance measures and annually evaluate the program s performance section section b which is renumbered from section is renumbered and amended to read b managed care contracting for services program benefits provided to a member under the program as described in section b shall be delivered by a managed care organization if the department determines that adequate services are available where the member lives or resides the department may contract with a managed care organization to provide program benefits the department shall evaluate a potential contract with a managed care organization based on a the managed care organization s i ability to manage medical expenses including mental health costs ii proven ability to handle accident and health insurance iii efficiency of claim paying procedures iv proven ability for managed care and quality assurance v provider contracting and discounts vi pharmacy benefit management vii estimated total charges for administering the pool viii ability to administer the pool in a cost efficient manner ix ability to provide adequate providers and services in the state and x ability to meet quality measures for emergency room use and access to primary care established by the department under subsection b and b other factors established by the department the department may enter into separate managed care organization contracts to provide dental benefits required by section b the department s contract with a managed care organization for the program s benefits shall include risk sharing provisions in which the plan shall accept at least of the risk for any difference between the department s premium payments per member and actual medical expenditures a the department may contract with the group insurance division within the utah state retirement office to provide services under subsection if no managed care organization is willing to contract with the department or the department determines no managed care organization meets the criteria established under subsection b in accordance with section a contract awarded under subsection a is not subject to the risk sharing required by subsection section section b which is renumbered from section is renumbered and amended to read b state contractor employee and dependent health benefit plan coverage for purposes of sections b a a b c and qualified health coverage means at the time the contract is entered into or renewed a a health benefit plan and employer contribution level with a combined actuarial value at least actuarially equivalent to the combined actuarial value of i the benchmark plan determined by the program under subsection b a and ii a contribution level at which the employer pays at least of the premium or contribution amounts for the employee and the dependents of the employee who reside or work in the state or b a federally qualified high deductible health plan that at a minimum i has a deductible that is a the lowest deductible permitted for a federally qualified high deductible health plan or b a deductible that is higher than the lowest deductible permitted for a federally qualified high deductible health plan but includes an employer contribution to a health savings account in a dollar amount at least equal to the dollar amount difference between the lowest deductible permitted for a federally qualified high deductible plan and the deductible for the employer offered federally qualified high deductible plan ii has an out of pocket maximum that does not exceed three times the amount of the annual deductible and iii provides that the employer pays of the premium or contribution amounts for the employee and the dependents of the employee who work or reside in the state the department shall a on or before july i determine the commercial equivalent of the benchmark plan described in subsection a and ii post the commercially equivalent benchmark plan described in subsection a i on the department s website noting the date posted and b update the posted commercially equivalent benchmark plan annually and at the time of any change in the benchmark section section b which is renumbered from section is renumbered and amended to read part medical benefits recovery b definitions as used in this chapter part annuity shall have the same meaning as provided in section a care facility means a a nursing facility b an intermediate care facility for an individual with an intellectual disability or c any other medical institution claim means a a request or demand for payment or b a cause of action for money or damages arising under any law employee welfare benefit plan means a medical insurance plan developed by an employer under u s c section sec et seq the employee retirement income security act of as amended health insurance entity means a an insurer b a person who administers manages provides offers sells carries or underwrites health insurance as defined in section a c a self insured plan d a group health plan as defined in subsection of the federal employee retirement income security act of e a service benefit plan f a managed care organization g a pharmacy benefit manager h an employee welfare benefit plan or i a person who is by statute contract or agreement legally responsible for payment of a claim for a health care item or service inpatient means an individual who is a patient and a resident of a care facility insurer includes a a group health plan as defined in subsection of the federal employee retirement income security act of b a health maintenance organization and c any entity offering a health service benefit plan medical assistance means a all funds expended for the benefit of a recipient under title chapter medical assistance act or under this chapter or titles xviii and xix federal social security act and b any other services provided for the benefit of a recipient by a prepaid health care delivery system under contract with the department office of recovery services means the office of recovery services within the department of human services department provider means a person or entity who provides services to a recipient recipient means a an individual who has applied for or received medical assistance from the state b the guardian conservator or other personal representative of an individual under subsection a if the individual is a minor or an incapacitated person or c the estate and survivors of an individual under subsection a if the individual is deceased recovery estate means regarding a deceased recipient a all real and personal property or other assets included within a decedent s estate as defined in section b the decedent s augmented estate as defined in section and c that part of other real or personal property in which the decedent had a legal interest at the time of death including assets conveyed to a survivor heir or assign of the decedent through joint tenancy tenancy in common survivorship life estate living trust or other arrangement state plan means the state medicaid program as enacted in accordance with title xix federal social security act tefra lien means a lien authorized under the tax equity and fiscal responsibility act of against the real property of an individual prior to the individual s death as described in u s c sec p third party includes a an individual institution corporation public or private agency trust estate insurance carrier employee welfare benefit plan health maintenance organization health service organization preferred provider organization governmental program such as medicare champus and workers compensation which may be obligated to pay all or part of the medical costs of injury disease or disability of a recipient unless any of these are excluded by department rule and b a spouse or a parent who i may be obligated to pay all or part of the medical costs of a recipient under law or by court or administrative order or ii has been ordered to maintain health dental or accident and health insurance to cover medical expenses of a spouse or dependent child by court or administrative order trust shall have the same meaning as provided in section section section b which is renumbered from section is renumbered and amended to read b program established by department promulgation of rules the department shall establish and maintain a program for the recoupment of medical assistance the department may promulgate rules to implement the purposes of this chapter part section section b which is renumbered from section is renumbered and amended to read b assignment of rights to benefits a except as provided in subsection b to the extent that medical assistance is actually provided to a recipient all benefits for medical services or payments from a third party otherwise payable to or on behalf of a recipient are assigned by operation of law to the department if the department provides or becomes obligated to provide medical assistance regardless of who made application for the benefits on behalf of the recipient b the assignment i authorizes the department to submit its claim to the third party and authorizes payment of benefits directly to the department and ii is effective for all medical assistance the department may recover the assigned benefits or payments in accordance with section b and as otherwise provided by law a the assignment of benefits includes medical support and third party payments ordered decreed or adjudged by any court of this state or any other state or territory of the united states b the assignment is not in lieu of and does not supersede or alter any other court order decree or judgment when an assignment takes effect the recipient is entitled to receive medical assistance and the benefits paid to the department are a reimbursement to the department section section b which is renumbered from section is renumbered and amended to read b health insurance entity duties related to state claims for medicaid payment or recovery as a condition of doing business in the state a health insurance entity shall with respect to an individual who is eligible for or is provided medical assistance under the state plan upon the request of the department of health department provide information to determine a during what period the individual or the spouse or dependent of the individual may be or may have been covered by the health insurance entity and b the nature of the coverage that is or was provided by the health insurance entity described in subsection a including the name address and identifying number of the plan accept the state s right of recovery and the assignment to the state of any right of an individual to payment from a party for an item or service for which payment has been made under the state plan respond to any inquiry by the department of health department regarding a claim for payment for any health care item or service that is submitted no later than three years after the day on which the health care item or service is provided and not deny a claim submitted by the department of health department solely on the basis of the date of submission of the claim the type or format of the claim form or failure to present proper documentation at the point of sale that is the basis for the claim if a the claim is submitted no later than three years after the day on which the item or service is furnished and b any action by the department of health department to enforce the rights of the state with respect to the claim is commenced no later than six years after the day on which the claim is submitted section section b which is renumbered from section is renumbered and amended to read b insurance policies not to deny or reduce benefits of individuals eligible for state medical assistance exemptions a policy of accident or sickness insurance may not contain any provision denying or reducing benefits because services are rendered to an insured or dependent who is eligible for or receiving medical assistance from the state an association corporation or organization may not deliver issue for delivery or renew any subscriber s contract which contains any provisions denying or reducing benefits because services are rendered to a subscriber or dependent who is eligible for or receiving medical assistance from the state an association corporation business or organization authorized to do business in this state and which provides or pays for any health care benefits may not deny or reduce benefits because services are rendered to a beneficiary who is eligible for or receiving medical assistance from the state notwithstanding subsection or the utah state public employees health program administered by the utah state retirement board is not required to reimburse any agency of state government for custodial care which the agency provides through its staff or facilities to members of the utah state public employees health program section section b which is renumbered from section is renumbered and amended to read b availability of insurance policy if the third party does not pay the department s claim or lien within days from the date the claim or lien is received the third party shall provide a written explanation if the claim is denied specifically describe and request any additional information from the department that is necessary to process the claim and provide the department or its agent a copy of any relevant or applicable insurance or benefit policy section section b which is renumbered from section is renumbered and amended to read b employee benefit plans as allowed pursuant to u s c section sec an employee benefit plan may not include any provision that has the effect of limiting or excluding coverage or payment for any health care for an individual who would otherwise be covered or entitled to benefits or services under the terms of the employee benefit plan based on the fact that the individual is eligible for or is provided services under the state plan section section b which is renumbered from section is renumbered and amended to read b statute of limitations survival of right of action insurance policy not to limit time allowed for recovery a subject to subsection action commenced by the department under this chapter part against a health insurance entity shall be commenced within i subject to subsection six years after the day on which the department submits the claim for recovery or payment for the health care item or service upon which the action is based or ii six months after the date of the last payment for medical assistance whichever is later b an action against any other third party the recipient or anyone to whom the proceeds are payable shall be commenced within i four years after the date of the injury or onset of the illness or ii six months after the date of the last payment for medical assistance whichever is later the death of the recipient does not abate any right of action established by this chapter part a no insurance policy issued or renewed after june may contain any provision that limits the time in which the department may submit its claim to recover medical assistance benefits to a period of less than months from the date the provider furnishes services or goods to the recipient b no insurance policy issued or renewed after april may contain any provision that limits the time in which the department may submit its claim to recover medical assistance benefits to a period of less than that described in subsection a the provisions of this section do not apply to section or part tefra liens b or sections b through b the provisions of this section supercede supersede any other sections regarding the time limit in which an action shall be commenced including section a subsection a extends the statute of limitations on a cause of action described in subsection a that was not time barred on or before april b subsection a does not revive a cause of action that was time barred on or before april an action described in subsection a may not be commenced if the claim for recovery or payment described in subsection a i is submitted later than three years after the day on which the health care item or service upon which the claim is based was provided section section b which is renumbered from section is renumbered and amended to read b recovery of medical assistance from third party lien notice action compromise or waiver recipient s right to action protected a except as provided in subsection c if the department provides or becomes obligated to provide medical assistance to a recipient that a third party is obligated to pay for the department may recover the medical assistance directly from the third party b i a claim under subsection a or section b to recover medical assistance provided to a recipient is a lien against any proceeds payable to or on behalf of the recipient by the third party ii the lien described in subsection b i has priority over all other claims to the proceeds except claims for attorney fees and costs authorized under subsection b c ii c i the department may not recover medical assistance under subsection a if a the third party is obligated to pay the recipient for an injury to the recipient s child that occurred while the child was in the physical custody of the child s foster parent b the child s injury is a physical or mental impairment that requires ongoing medical attention or limits activities of daily living for at least one year c the third party s payment to the recipient is placed in a trust annuity financial account or other financial instrument for the benefit of the child and d the recipient makes reasonable efforts to mitigate any other medical assistance costs for the recipient to the state ii the department is responsible for any repayment to the federal government related to the medical assistance the department is prohibited from recovering under subsection c i a the department shall mail or deliver written notice of the department s claim or lien to the third party at the third party s principal place of business or last known address b the notice shall include i the recipient s name ii the approximate date of illness or injury iii a general description of the type of illness or injury and iv if applicable the general location where the injury is alleged to have occurred the department may commence an action on the department s claim or lien in the department s name but the claim or lien is not enforceable as to a third party unless a the third party receives written notice of the department s claim or lien before the third party settles with the recipient or b the department has evidence that the third party had knowledge that the department provided or was obligated to provide medical assistance the department may a waive a claim or lien against a third party in whole or in part or b compromise settle or release a claim or lien an action commenced under this section does not bar an action by a recipient or a dependent of a recipient for loss or damage not included in the department s action except as provided in subsection c the department s claim or lien on proceeds under this section is not affected by the transfer of the proceeds to a trust annuity financial account or other financial instrument section section b which is renumbered from section is renumbered and amended to read b action by department notice to recipient a within days after commencing an action under subsection b the department shall give the recipient the recipient s guardian personal representative trustee estate or survivor whichever is appropriate written notice of the action by i personal service or certified mail to the last known address of the person receiving the notice or ii if no last known address is available by publishing a notice a once a week for three successive weeks in a newspaper of general circulation in the county where the recipient resides and b in accordance with section for three weeks b proof of service shall be filed in the action c the recipient may intervene in the department s action at any time before trial the notice required by subsection shall name the court in which the action is commenced and advise the recipient of a the right to intervene in the proceeding b the right to obtain a private attorney and c the department s right to recover medical assistance directly from the third party section section b which is renumbered from section is renumbered and amended to read b notice of claim by recipient department response conditions for proceeding collection agreements a a recipient may not file a claim commence an action or settle compromise release or waive a claim against a third party for recovery of medical costs for an injury disease or disability for which the department has provided or has become obligated to provide medical assistance without the department s written consent as provided in subsection b or b for purposes of subsection a consent may be obtained if i a recipient who files a claim or commences an action against a third party notifies the department in accordance with subsection d within days of the recipient making the claim or commencing an action or ii an attorney who has been retained by the recipient to file a claim or commence an action against a third party notifies the department in accordance with subsection d of the recipient s claim a within days after being retained by the recipient for that purpose or b within days from the date the attorney either knew or should have known that the recipient received medical assistance from the department c service of the notice of claim to the department shall be made by certified mail personal service or by e mail in accordance with rule of the utah rules of civil procedure to the director of the office of recovery services d the notice of claim shall include the following information i the name of the recipient ii the recipient s social security number iii the recipient s date of birth iv the name of the recipient s attorney if applicable v the name or names of individuals or entities against whom the recipient is making the claim if known vi the name of the third party s insurance carrier if known vii the date of the incident giving rise to the claim and viii a short statement identifying the nature of the recipient s claim a within days of receipt of the notice of the claim required in subsection the department shall acknowledge receipt of the notice of the claim to the recipient or the recipient s attorney and shall notify the recipient or the recipient s attorney in writing of the following i if the department has a claim or lien pursuant to section b or has become obligated to provide medical assistance and ii whether the department is denying or granting written consent in accordance with subsection a b the department shall provide the recipient s attorney the opportunity to enter into a collection agreement with the department with the recipient s consent unless i the department prior to the receipt of the notice of the recipient s claim pursuant to subsection filed a written claim with the third party the third party agreed to make payment to the department before the date the department received notice of the recipient s claim and the agreement is documented in the department s record or ii there has been a failure by the recipient s attorney to comply with any provision of this section by a failing to comply with the notice provisions of this section b failing or refusing to enter into a collection agreement c failing to comply with the terms of a collection agreement with the department or d failing to disburse funds owed to the state in accordance with this section c i the collection agreement shall be a consistent with this section and the attorney s obligation to represent the recipient and represent the state s claim and b state the terms under which the interests of the department may be represented in an action commenced by the recipient ii if the recipient s attorney enters into a written collection agreement with the department or includes the department s claim in the recipient s claim or action pursuant to subsection the department shall pay attorney fees at the rate of of the department s total recovery and shall pay a proportionate share of the litigation expenses directly related to the action d the department is not required to enter into a collection agreement with the recipient s attorney for collection of personal injury protection under subsection a a if the department receives notice pursuant to subsection and notifies the recipient and the recipient s attorney that the department will not enter into a collection agreement with the recipient s attorney the recipient may proceed with the recipient s claim or action against the third party if the recipient excludes from the claim i any medical expenses paid by the department or ii any medical costs for which the department is obligated to provide medical assistance b when a recipient proceeds with a claim under subsection a the recipient shall provide written notice to the third party of the exclusion of the department s claim for expenses under subsection a i or ii if the department receives notice pursuant to subsection and does not respond within days to the recipient or the recipient s attorney the recipient or the recipient s attorney a may proceed with the recipient s claim or action against the third party b may include the state s claim in the recipient s claim or action and c may not negotiate compromise settle or waive the department s claim without the department s consent section section b which is renumbered from section is renumbered and amended to read b department s right to intervene department s interests protected remitting funds disbursements liability and penalty for noncompliance the department has an unconditional right to intervene in an action commenced by a recipient against a third party for the purpose of recovering medical costs for which the department has provided or has become obligated to provide medical assistance a if the recipient proceeds without complying with the provisions of section b the department is not bound by any decision judgment agreement settlement or compromise rendered or made on the claim or in the action b the department i may recover in full from the recipient or any party to which the proceeds were made payable all medical assistance that the department has provided and ii retains its right to commence an independent action against the third party subject to subsection b any amounts assigned to and recoverable by the department pursuant to sections and b and b collected directly by the recipient shall be remitted to the bureau of medical collections within the office of recovery services no later than five business days after receipt a any amounts assigned to and recoverable by the department pursuant to sections and b and b collected directly by the recipient s attorney shall be remitted to the bureau of medical collections within the office of recovery services no later than days after the funds are placed in the attorney s trust account b the date by which the funds shall be remitted to the department may be modified based on agreement between the department and the recipient s attorney c the department s consent to another date for remittance may not be unreasonably withheld d if the funds are received by the recipient s attorney no disbursements shall be made to the recipient or the recipient s attorney until the department s claim has been paid a recipient or recipient s attorney who knowingly and intentionally fails to comply with this section is liable to the department for a the amount of the department s claim or lien pursuant to subsection b a penalty equal to of the amount of the department s claim and c attorney fees and litigation expenses related to recovering the department s claim section section b which is renumbered from section is renumbered and amended to read b estate and trust recovery a except as provided in subsection b upon a recipient s death the department may recover from the recipient s recovery estate and any trust in which the recipient is the grantor and a beneficiary medical assistance correctly provided for the benefit of the recipient when the recipient was years of age old or older b the department may not make an adjustment or a recovery under subsection a i while the deceased recipient s spouse is still living or ii if the deceased recipient has a surviving child who is a under age years old or b blind or disabled as defined in the state plan a the amount of medical assistance correctly provided for the benefit of a recipient and recoverable under this section is a lien against the deceased recipient s recovery estate or any trust when the recipient is the grantor and a beneficiary b the lien holds the same priority as reasonable and necessary medical expenses of the last illness as provided in section a for a lien described in subsection the department shall provide notice in accordance with section b before final distribution the department shall perfect the lien as follows i for an estate by presenting the lien to the estate s personal representative in accordance with section and ii for a trust by presenting the lien to the trustee in accordance with section c the department may file an amended lien before the entry of the final order to close the estate or trust claims against a deceased recipient s inter vivos trust shall be presented in accordance with sections and any trust provision that denies recovery for medical assistance is void at the time of its making nothing in this section affects the right of the department to recover medicaid assistance before a recipient s death under section or section b or b a lien imposed under this section is of indefinite duration section section b which is renumbered from section is renumbered and amended to read b recovery from recipient of incorrectly provided medical assistance the department may recover medical assistance incorrectly provided whether due to administrative or factual error or fraud from the recipient or the recipient s recovery estate and pursuant to a judgment impose a lien against real property of the recipient section section b which is renumbered from section is renumbered and amended to read b tefra liens authorized grounds for tefra liens exemptions except as provided in subsections and the department may impose a tefra lien on the real property of an individual for the amount of medical assistance provided for or to the individual while the individual is an inpatient in a care facility if a the individual is an inpatient in a care facility b the individual is required as a condition of receiving services under the state plan to spend for costs of medical care all but a minimal amount of the individual s income required for personal needs and c the department determines that the individual cannot reasonably be expected to i be discharged from the care facility and ii return to the individual s home the department may not impose a lien on the home of an individual described in subsection if any of the following individuals are lawfully residing in the home a the spouse of the individual b a child of the individual if the child is i under years of age old or ii blind or permanently and totally disabled as defined in title u s c sec c a f or c a sibling of the individual if the sibling i has an equity interest in the home and ii resided in the home for at least one year immediately preceding the day on which the individual was admitted to the care facility the department may not impose a tefra lien on the real property of an individual unless a the individual has been an inpatient in a care facility for the day period immediately preceding the day on which the lien is imposed b the department serves i a preliminary notice of intent to impose a tefra lien relating to the real property in accordance with section b and ii a final notice of intent to impose a tefra lien relating to the real property in accordance with section b and c i the individual does not file a timely request for review of the department s decision under title g chapter administrative procedures act or ii the department s decision is upheld upon final review or appeal under title g chapter administrative procedures act section section b which is renumbered from section is renumbered and amended to read b presumption of permanency there is a rebuttable presumption that an individual who is an inpatient in a care facility cannot reasonably be expected to be discharged from a care facility and return to the individual s home if the individual has been an inpatient in a care facility for a period of at least consecutive days section section b which is renumbered from section is renumbered and amended to read b preliminary notice of intent to impose a tefra lien prior to imposing a tefra lien on real property the department shall serve a preliminary notice of intent to impose a tefra lien on the individual described in subsection b who owns the property the preliminary notice of intent shall a be served in person or by certified mail on the individual described in subsection b and if the department is aware that the individual has a legally authorized representative on the representative b include a statement indicating that according to the department s records the individual i meets the criteria described in subsections b a and b ii has been an inpatient in a care facility for a period of at least days immediately preceding the day on which the department provides the notice to the individual and iii is legally presumed to be in a condition where it cannot reasonably be expected that the individual will be discharged from the care facility and return to the individual s home c indicate that the department intends to impose a tefra lien on real property belonging to the individual d describe the real property that the tefra lien will apply to e describe the current amount of and purpose of the tefra lien f indicate that the amount of the lien may continue to increase as the individual continues to receive medical assistance g indicate that the individual may seek to prevent the tefra lien from being imposed on the real property by providing documentation to the department that i establishes that the individual does not meet the criteria described in subsection b a or b ii establishes that the individual has not been an inpatient in a care facility for a period of at least days iii rebuts the presumption described in section b or iv establishes that the real property is exempt from imposition of a tefra lien under subsection b h indicate that if the owner fails to provide the documentation described in subsection g within days after the day on which the preliminary notice of intent is served the department will issue a final notice of intent to impose a tefra lien on the real property and will proceed to impose the lien i identify the type of documentation that the owner may provide to comply with subsection g j describe the circumstances under which a tefra lien is required to be released and k describe the circumstances under which the department may seek to recover the lien section section b which is renumbered from section is renumbered and amended to read b final notice of intent to impose a tefra lien the department may issue a final notice of intent to impose a tefra lien on real property if a a preliminary notice of intent relating to the property is served in accordance with section b b it is at least days after the day on which the preliminary notice of intent was served and c the department has not received documentation or other evidence that adequately establishes that a tefra lien may not be imposed on the real property the final notice of intent to impose a tefra lien on real property shall a be served in person or by certified mail on the individual described in subsection b who owns the property and if the department is aware that the individual has a legally authorized representative on the representative b indicate that the department has complied with the requirements for filing the final notice of intent under subsection c include a statement indicating that according to the department s records the individual i meets the criteria described in subsections b a and b ii has been an inpatient in a care facility for a period of at least days immediately preceding the day on which the department provides the notice to the individual and iii is legally presumed to be in a condition where it cannot reasonably be expected that the individual will be discharged from the care facility and return to the individual s home d indicate that the department intends to impose a tefra lien on real property belonging to the individual e describe the real property that the tefra lien will apply to f describe the current amount of and purpose of the tefra lien g indicate that the amount of the lien may continue to increase as the individual continues to receive medical assistance h describe the circumstances under which a tefra lien is required to be released i describe the circumstances under which the department may seek to recover the lien j describe the right of the individual to challenge the decision of the department in an adjudicative proceeding and k indicate that failure by the individual to successfully challenge the decision of the department will result in the tefra lien being imposed section section b which is renumbered from section is renumbered and amended to read b review of department decision an individual who has been served with a final notice of intent to impose a tefra lien under section b may seek agency or judicial review of that decision under title g chapter administrative procedures act section section b which is renumbered from section is renumbered and amended to read b dissolution and removal of tefra lien a tefra lien shall dissolve and be removed by the department if the individual described in subsection b a i is discharged from the care facility and ii returns to the individual s home or b provides sufficient documentation to the department that i rebuts the presumption described in section b or ii any of the following individuals are lawfully residing in the individual s home a the spouse of the individual b a child of the individual if the child is under years of age old or blind or permanently and totally disabled as defined in title u s c sec c a f or c a sibling of the individual if the sibling has an equity interest in the home and resided in the home for at least one year immediately preceding the day on which the individual was admitted to the care facility an individual described in subsection b a may at any time after the department has imposed a lien under this part sections b through b file a request for the department to remove the lien a request filed under subsection shall be considered and reviewed pursuant to title g chapter administrative procedures act section section b which is renumbered from section is renumbered and amended to read b expenditures included in lien other proceedings a tefra lien imposed on real property under this part sections b through b includes all expenses relating to medical assistance provided or paid for under the state plan from the first day that the individual is placed in a care facility regardless of when the lien is imposed or filed on the property nothing in this part affects or prevents sections b through b affect or prevent the department from bringing or pursuing any other legally authorized action to recover medical assistance or to set aside a fraudulent or improper conveyance section section b which is renumbered from section is renumbered and amended to read b contract with another government agency if the department contracts with another government agency to recover funds paid for medical assistance under this chapter part that government agency shall be the sole agency that determines whether to impose or remove a tefra lien under this part sections b through b section section b which is renumbered from section is renumbered and amended to read b precedence of the tax equity and fiscal responsibility act of if any provision of this part conflicts sections b through b conflict with the requirements of the tax equity and fiscal responsibility act of for imposing a lien against the property of an individual prior to the individual s death under u s c sec p the provisions of the tax equity and fiscal responsibility act of take precedence and shall be complied with by the department section section b which is renumbered from section is renumbered and amended to read b legal recognition of electronic claims records pursuant to title chapter uniform electronic transactions act a claim submitted to the department for payment may not be denied legal effect enforceability or admissibility as evidence in any court in any civil action because it is in electronic form and a third party shall accept an electronic record of payments by the department for medical services on behalf of a recipient as evidence in support of the department s claim section section b which is renumbered from section is renumbered and amended to read b direct payment to the department by third party any third party required to make payment to the department pursuant to this chapter part shall make the payment directly to the department or its designee the department may negotiate a payment or payment instrument it receives in connection with subsection without the cosignature or other participation of the recipient or any other party section section b which is renumbered from section is renumbered and amended to read b attorney general or county attorney to represent department the attorney general or a county attorney shall represent the department in any action commenced under this chapter part section section b which is renumbered from section is renumbered and amended to read b department s right to attorney fees and costs in any action brought by the department under this chapter part in which it prevails the department shall recover along with the principal sum and interest a reasonable attorney fee and costs incurred section section b which is renumbered from section is renumbered and amended to read b application of provisions contrary to federal law prohibited in no event shall any provision contained in this chapter part be applied contrary to existing federal law section section b which is renumbered from section is renumbered and amended to read part utah false claims act b definitions as used in this chapter part benefit means the receipt of money goods or any other thing of pecuniary value claim means any request or demand for money or property a made to any i employee officer or agent of the state ii contractor with the state or iii grantee or other recipient whether or not under contract with the state and b if i any portion of the money or property requested or demanded was issued from or provided by the state or ii the state will reimburse the contractor grantee or other recipient for any portion of the money or property false statement or false representation means a wholly or partially untrue statement or representation which is a knowingly made and b a material fact with respect to the claim knowing and knowingly a for purposes of criminal prosecutions for violations of this chapter part is one of the culpable mental states described in subsection b and b for purposes of civil prosecutions for violations of this chapter part is the required culpable mental state as defined in subsection b medical benefit means a benefit paid or payable to a recipient or a provider under a program administered by the state under a titles v and xix of the federal social security act b title x of the federal public health services act c the federal child nutrition act of as amended by p l pub l no and d any programs for medical assistance of the state person means an individual corporation unincorporated association professional corporation partnership or other form of business association section section b which is renumbered from section is renumbered and amended to read b false statement or representation relating to medical benefits a person may not make or cause to be made a false statement or false representation of a material fact in an application for medical benefits a person may not make or cause to be made a false statement or false representation of a material fact for use in determining rights to a medical benefit a person who having knowledge of the occurrence of an event affecting the person s initial or continued right to receive a medical benefit or the initial or continued right of any other person on whose behalf the person has applied for or is receiving a medical benefit may not conceal or fail to disclose that event with intent to obtain a medical benefit to which the person or any other person is not entitled or in an amount greater than that to which the person or any other person is entitled section section b which is renumbered from section is renumbered and amended to read b kickbacks or bribes prohibited for purposes of this section kickback or bribe a includes rebates compensation or any other form of remuneration which is i direct or indirect ii overt or covert or iii in cash or in kind and b does not include a rebate paid to the state under u s c sec r or any state supplemental rebates a person may not solicit offer pay or receive a kickback or bribe in return for or to induce a the purchasing leasing or ordering of any goods or services for which payment is or may be made in whole or in part pursuant to a medical benefit program or b the referral of an individual to another person for the furnishing of any goods or services for which payment is or may be made in whole or in part pursuant to a medical benefit program section section b which is renumbered from section is renumbered and amended to read b false statements or false representations relating to qualification of health institution or facility prohibited felony a person may not knowingly intentionally or recklessly make induce or seek to induce the making of a false statement or false representation of a material fact with respect to the conditions or operation of an institution or facility in order that the institution or facility may qualify upon initial certification or upon recertification as a hospital skilled nursing facility intermediate care facility or home health agency a person who violates this section is guilty of a second degree felony section section b which is renumbered from section is renumbered and amended to read b conspiracy to defraud prohibited a person may not enter into an agreement combination or conspiracy to defraud the state by obtaining or aiding another to obtain the payment or allowance of a false fictitious or fraudulent claim for a medical benefit section section b which is renumbered from section is renumbered and amended to read b false claims for medical benefits prohibited a person may not make or present or cause to be made or presented to an employee or officer of the state a claim for a medical benefit a which is wholly or partially false fictitious or fraudulent b for services which were not rendered or for items or materials which were not delivered c which misrepresents the type quality or quantity of items or services rendered d representing charges at a higher rate than those charged by the provider to the general public e for items or services which the person or the provider knew were not medically necessary in accordance with professionally recognized standards f which has previously been paid g for services also covered by one or more private sources when the person or provider knew of the private sources without disclosing those sources on the claim or h where a provider i unbundles a product procedure or group of procedures usually and customarily provided or performed as a single billable product or procedure into artificial components or separate procedures and ii bills for each component of the product procedure or group of procedures a as if they had been provided or performed independently and at separate times and b the aggregate billing for the components exceeds the amount otherwise billable for the usual and customary single product or procedure in addition to the prohibitions in subsection a person may not a fail to credit the state for payments received from other sources b recover or attempt to recover payment in violation of the provider agreement from i a recipient under a medical benefit program or ii the recipient s family c falsify or alter with intent to deceive any report or document required by state or federal law rule or medicaid provider agreement d retain any unauthorized payment as a result of acts described by this section or e aid or abet the commission of any act prohibited by this section section section b which is renumbered from section is renumbered and amended to read b knowledge of past acts not necessary to establish fact that false statement or representation knowingly made in prosecution under this chapter part it is not necessary to show that the person had knowledge of similar acts having been performed in the past on the part of persons acting on his behalf nor to show that the person had actual notice that the acts by the persons acting on his behalf occurred to establish the fact that a false statement or representation was knowingly made section section b which is renumbered from section is renumbered and amended to read b criminal penalties a except as provided in subsection b the culpable mental state required for a criminal violation of this chapter part is knowingly intentionally or recklessly as defined in section b the culpable mental state required for a criminal violation of this chapter part for kickbacks and bribes under section b is knowingly and intentionally as defined in section the punishment for a criminal violation of any provision of this chapter part except as provided under section b is determined by the cumulative value of the funds or other benefits received or claimed in the commission of all violations of a similar nature and not by each separate violation punishment for criminal violation of this chapter part except as provided under section b is a felony of the second degree felony of the third degree class a misdemeanor or class b misdemeanor based on the dollar amounts as prescribed by subsection for theft of property and services section section b which is renumbered from section is renumbered and amended to read b civil penalties the culpable mental state required for a civil violation of this chapter part is knowing or knowingly which a means that person with respect to information i has actual knowledge of the information ii acts in deliberate ignorance of the truth or falsity of the information or iii acts in reckless disregard of the truth or falsity of the information and b does not require a specific intent to defraud any person who violates this chapter part shall in all cases in addition to other penalties provided by law be required to a make full and complete restitution to the state of all damages that the state sustains because of the person s violation of this chapter part b pay to the state its costs of enforcement of this chapter part in that case including the cost of investigators attorneys and other public employees as determined by the state and c pay to the state a civil penalty equal to i three times the amount of damages that the state sustains because of the person s violation of this chapter part and ii not less than or more than for each claim filed or act done in violation of this chapter part any civil penalties assessed under subsection shall be awarded by the court as part of its judgment in both criminal and civil actions a criminal action need not be brought against a person in order for that person to be civilly liable under this section section section b which is renumbered from section is renumbered and amended to read b revocation of license of assisted living facility appointment of receiver if the license of an assisted living facility is revoked for violation of this chapter part the county attorney may file a petition with the district court for the county in which the facility is located for the appointment of a receiver the district court shall issue an order to show cause why a receiver should not be appointed returnable within five days after the filing of the petition a if the court finds that the facts warrant the granting of the petition the court shall appoint a receiver to take charge of the facility b the court may determine fair compensation for the receiver a receiver appointed pursuant to this section shall have the powers and duties prescribed by the court section section b which is renumbered from section is renumbered and amended to read b presumption based on paid state warrant value of medical benefits repayment of benefits in any civil or criminal action brought under this chapter part a paid state warrant made payable to the order of a party creates a presumption that the party received funds from the state in any civil or criminal action brought under this chapter part the value of the benefits received shall be the ordinary or usual charge for similar benefits in the private sector in any criminal action under this chapter part the repayment of funds or other benefits obtained in violation of the provisions of this chapter part does not constitute a defense to or grounds for dismissal of that action section section b which is renumbered from section is renumbered and amended to read b violation of other laws the provisions of this chapter part are a not exclusive and the remedies provided for in this chapter part are in addition to any other remedies provided for under i any other applicable law or ii common law and b to be liberally construed and applied to i effectuate the chapter s remedial and deterrent purposes and ii serve the public interest if any provision of this chapter part or the application of this chapter part to any person or circumstance is held unconstitutional a the remaining provisions of this chapter part are not affected and b the application of this chapter part to other persons or circumstances are not affected section section b which is renumbered from section is renumbered and amended to read b medicaid fraud enforcement this chapter part shall be enforced in accordance with this section the department is responsible for a i investigating and prosecuting suspected civil violations of this chapter part or ii referring suspected civil violations of this chapter part to the attorney general for investigation and prosecution and b promptly referring suspected criminal violations of this chapter part to the attorney general for criminal investigation and prosecution the attorney general has a concurrent jurisdiction with the department for investigating and prosecuting suspected civil violations of this chapter part and b exclusive jurisdiction to investigate and prosecute all suspected criminal violations of this chapter part the department and the attorney general share concurrent civil enforcement authority under this chapter part and may enter into an interagency agreement regarding the investigation and prosecution of violations of this chapter part in accordance with this section the requirements of title xix of the federal social security act and applicable federal regulations a any violation of this chapter part which comes to the attention of any state government officer or agency shall be reported to the attorney general or the department b all state government officers and agencies shall cooperate with and assist in any prosecution for violation of this chapter part section section b which is renumbered from section is renumbered and amended to read b investigations civil investigative demands the attorney general may take investigative action under subsection if the attorney general has reason to believe that a a person has information or custody or control of documentary material relevant to the subject matter of an investigation of an alleged violation of this chapter part b a person is committing has committed or is about to commit a violation of this chapter part or c it is in the public interest to conduct an investigation to ascertain whether or not a person is committing has committed or is about to commit a violation of this chapter part in taking investigative action the attorney general may a require the person to file on a prescribed form a statement in writing under oath or affirmation describing i the facts and circumstances concerning the alleged violation of this chapter part and ii other information considered necessary by the attorney general b examine under oath a person in connection with the alleged violation of this chapter part and c in accordance with subsections through execute in writing and serve on the person a civil investigative demand requiring the person to produce the documentary material and permit inspection and copying of the material the attorney general may not release or disclose information that is obtained under subsection a or b or any documentary material or other record derived from the information obtained under subsection a or b except a by court order for good cause shown b with the consent of the person who provided the information c to an employee of the attorney general or the department d to an agency of this state the united states or another state e to a special assistant attorney general representing the state in a civil action f to a political subdivision of this state or g to a person authorized by the attorney general to receive the information the attorney general may use documentary material derived from information obtained under subsection a or b or copies of that material as the attorney general determines necessary in the enforcement of this chapter part including presentation before a court a if a person fails to file a statement as required by subsection a or fails to submit to an examination as required by subsection b the attorney general may file in district court a complaint for an order to compel the person to within a period stated by court order i file the statement required by subsection a or ii submit to the examination required by subsection b b failure to comply with an order entered under subsection a is punishable as contempt a civil investigative demand shall a state the rule or statute under which the alleged violation of this chapter part is being investigated b describe the i general subject matter of the investigation and ii class or classes of documentary material to be produced with reasonable specificity to fairly indicate the documentary material demanded c designate a date within which the documentary material is to be produced and d identify an authorized employee of the attorney general to whom the documentary material is to be made available for inspection and copying a civil investigative demand may require disclosure of any documentary material that is discoverable under the utah rules of civil procedure service of a civil investigative demand may be made by a delivering an executed copy of the demand to the person to be served or to a partner an officer or an agent authorized by appointment or by law to receive service of process on behalf of that person b delivering an executed copy of the demand to the principal place of business in this state of the person to be served or c mailing by registered or certified mail an executed copy of the demand addressed to the person to be served i at the person s principal place of business in this state or ii if the person has no place of business in this state to the person s principal office or place of business documentary material demanded in a civil investigative demand shall be produced for inspection and copying during normal business hours at the office of the attorney general or as agreed by the person served and the attorney general the attorney general may not produce for inspection or copying or otherwise disclose the contents of documentary material obtained pursuant to a civil investigative demand except a by court order for good cause shown b with the consent of the person who produced the information c to an employee of the attorney general or the department d to an agency of this state the united states or another state e to a special assistant attorney general representing the state in a civil action f to a political subdivision of this state or g to a person authorized by the attorney general to receive the information a with respect to documentary material obtained pursuant to a civil investigative demand the attorney general shall prescribe reasonable terms and conditions allowing such documentary material to be available for inspection and copying by the person who produced the material or by an authorized representative of that person b the attorney general may use such documentary material or copies of it as the attorney general determines necessary in the enforcement of this chapter part including presentation before a court a a person may file a complaint stating good cause to extend the return date for the demand or to modify or set aside the demand b a complaint under this subsection shall be filed in district court before the earlier of a i the return date specified in the demand or b ii the th day after the date the demand is served except as provided by court order a person who has been served with a civil investigative demand shall comply with the terms of the demand a a person who has committed a violation of this chapter part in relation to the medicaid program in this state or to any other medical benefit program administered by the state has submitted to the jurisdiction of this state b personal service of a civil investigative demand under this section may be made on the person described in subsection a outside of this state this section does not limit the authority of the attorney general to conduct investigations or to access a person s documentary materials or other information under another state or federal law the utah rules of civil procedure or the federal rules of civil procedure the attorney general may file a complaint in district court for an order to enforce the civil investigative demand if a a person fails to comply with a civil investigative demand or b copying and reproduction of the documentary material demanded i cannot be satisfactorily accomplished and ii the person refuses to surrender the documentary material if a complaint is filed under subsection the court may determine the matter presented and may enter an order to enforce the civil investigative demand failure to comply with a final order entered under subsection is punishable by contempt section section b which is renumbered from section is renumbered and amended to read b limitation of actions civil acts antedating this section civil burden of proof estoppel joint civil liability venue an action under this chapter part may not be brought after the later of a six years after the date on which the violation was committed or b three years after the date an official of the state charged with responsibility to act in the circumstances discovers the violation but in no event more than years after the date on which the violation was committed a civil action brought under this chapter part may be brought for acts occurring prior to the effective date of this section if the limitations period set forth in subsection has not lapsed in any civil action brought under this chapter part the state shall be required to prove by a preponderance of evidence all essential elements of the cause of action including damages notwithstanding any other provision of law a final judgment rendered in favor of the state in any criminal proceeding under this chapter part whether upon a verdict after trial or upon a plea of guilty or nolo contendere shall estop the defendant from denying the essential elements of the offense in any civil action under this chapter part which involves the same transaction civil liability under this chapter part shall be joint and several for a violation committed by two or more persons any action brought by the state under this chapter part shall be brought in district court in salt lake county or in any county where the defendant resides or does business section section b is amended to read chapter health data vital statistics and utah medical examiner part vital statistics b definitions reserved as used in this part adoption document means an adoption related document filed with the office a petition for adoption a decree of adoption an original birth certificate or evidence submitted in support of a supplementary birth certificate certified nurse midwife means an individual who a is licensed to practice as a certified nurse midwife under title chapter a nurse midwife practice act and b has completed an education program regarding the completion of a certificate of death developed by the department by rule made in accordance with title g chapter utah administrative rulemaking act custodial funeral service director means a funeral service director who a is employed by a licensed funeral establishment and b has custody of a dead body dead body means a human body or parts of a human body from the condition of which it reasonably may be concluded that death occurred decedent means the same as a dead body dead fetus means a product of human conception other than those circumstances described in subsection a of weeks gestation or more calculated from the date the last normal menstrual period began to the date of delivery and b that was not born alive declarant father means a male who claims to be the genetic father of a child and along with the biological mother signs a voluntary declaration of paternity to establish the child s paternity dispositioner means a a person designated in a written instrument under subsection as having the right and duty to control the disposition of the decedent if the person voluntarily acts as the dispositioner or b the next of kin of the decedent if i a a person has not been designated as described in subsection a or b the person described in subsection a is unable or unwilling to exercise the right and duty described in subsection a and ii the next of kin voluntarily acts as the dispositioner fetal remains means a an aborted fetus as that term is defined in section b or b a miscarried fetus as that term is defined in section b file means the submission of a completed certificate or other similar document record or report as provided under this part for registration by the state registrar or a local registrar funeral service director means the same as that term is defined in section health care facility means the same as that term is defined in section b health care professional means a physician physician assistant nurse practitioner or certified nurse midwife licensed funeral establishment means a if located in utah a funeral service establishment as that term is defined in section that is licensed under title chapter funeral services licensing act or b if located in a state district or territory of the united states other than utah a funeral service establishment that complies with the licensing laws of the jurisdiction where the establishment is located live birth means the birth of a child who shows evidence of life after the child is entirely outside of the mother local registrar means a person appointed under subsection b b nurse practitioner means an individual who a is licensed to practice as an advanced practice registered nurse under title chapter b nurse practice act and b has completed an education program regarding the completion of a certificate of death developed by the department by administrative rule made in accordance with title g chapter utah administrative rulemaking act office means the office of vital records and statistics within the department physician means a person licensed to practice as a physician or osteopath in this state under title chapter utah medical practice act or title chapter utah osteopathic medical practice act physician assistant means an individual who a is licensed to practice as a physician assistant under title chapter a utah physician assistant act and b has completed an education program regarding the completion of a certificate of death developed by the department by administrative rule made in accordance with title g chapter utah administrative rulemaking act presumed father means the father of a child conceived or born during a marriage as defined in section registration or register means acceptance by the local or state registrar of a certificate and incorporation of the certificate into the permanent records of the state state registrar means the state registrar of vital records appointed under section b vital records means a registered certificates or reports of birth death fetal death marriage divorce dissolution of marriage or annulment b amendments to any of the registered certificates or reports described in subsection a c an adoption document and d other similar documents vital statistics means the data derived from registered certificates and reports of birth death fetal death induced termination of pregnancy marriage divorce dissolution of marriage or annulment section section b which is renumbered from section is renumbered and amended to read b department duties and authority as used in this section a compact means the compact for interstate sharing of putative father registry information created in section b effective on may b putative father i means the same as that term is as defined in section b and ii includes an unmarried biological father c state registrar means the state registrar of vital records appointed under subsection e d unmarried biological father means the same as that term is defined in section b the department shall a provide offices properly equipped for the preservation of vital records made or received under this chapter part b establish a statewide vital records system for the registration collection preservation amendment and certification of vital records and other similar documents required by this chapter part and activities related to them including the tabulation analysis and publication of vital statistics c prescribe forms for certificates certification reports and other documents and records necessary to establish and maintain a statewide system of vital records d prepare an annual compilation analysis and publication of statistics derived from vital records and e appoint a state registrar to direct the statewide system of vital records the department may a divide the state from time to time into registration districts and b appoint local registrars for registration districts who under the direction and supervision of the state registrar shall perform all duties required of them by this chapter part and department rules the state registrar appointed under subsection e shall with the input of utah stakeholders and the uniform law commission study the following items for the state s implementation of the compact a the feasibility of using systems developed by the national association for public health statistics and information systems including the state and territorial exchange of vital events steve system and the electronic verification of vital events evve system or similar systems to exchange putative father registry information with states that are parties to the compact b procedures necessary to share putative father information located in the confidential registry maintained by the state registrar upon request from the state registrar of another state that is a party to the compact c procedures necessary for the state registrar to access putative father information located in a state that is a party to the compact and share that information with persons who request a certificate from the state registrar d procedures necessary to ensure that the name of the mother of the child who is the subject of a putative father s notice of commencement filed pursuant to section b is kept confidential when a state that is a party to the compact accesses this state s confidential registry through the state registrar and e procedures necessary to ensure that a putative father s registration with a state that is a party to the compact is given the same effect as a putative father s notice of commencement filed pursuant to section b section section b which is renumbered from section is renumbered and amended to read b content and form of certificates and reports as used in this section a additional information means information that is beyond the information necessary to comply with federal standards or state law for registering a birth b diacritical mark means a mark on a letter from the iso basic latin alphabet used to indicate a special pronunciation c diacritical mark includes accents tildes graves umlauts and cedillas except as provided in subsection to promote and maintain nationwide uniformity in the vital records system the forms of certificates certification reports and other documents and records required by this chapter part or the rules implementing this chapter part shall include as a minimum the items recommended by the federal agency responsible for national vital statistics subject to approval additions and modifications by the department certificates certifications forms reports other documents and records and the form of communications between persons required by this chapter part shall be prepared in the format prescribed by department rule all vital records shall include the date of filing certificates certifications forms reports other documents and records and communications between persons required by this chapter part may be signed filed verified registered and stored by photographic electronic or other means as prescribed by department rule a an individual may use a diacritical mark in an application for a vital record b the office shall record a diacritical mark on a vital record as indicated on the application for the vital record the absence of a diacritical mark on a vital record does not render the document invalid or affect any constructive notice imparted by proper recordation of the document a the state i may collect the social security number of a deceased individual and ii may not include the social security number of an individual on a certificate of death b for registering a birth the department may not require an individual to provide additional information c the department may request additional information if the department provides a written statement that i discloses that providing the additional information is voluntary ii discloses how the additional information will be used and the duration of use iii describes how the department prevents the additional information from being used in a manner different from the disclosure given under subsection c ii c ii and iv includes a notice that the individual is consenting to the department s use of the additional information by providing the additional information d i beginning july an individual may submit a written request to the department to de identify the individual s additional information contained in the department s databases ii upon receiving the written request the department shall de identify the additional information e the department shall de identify additional information contained in the department s databases before the additional information is held by the department for longer than six years section section b which is renumbered from section is renumbered and amended to read b birth certificates execution and registration requirements as used in this section birthing facility means a general acute hospital or birthing center as defined in section b for each live birth occurring in the state a certificate shall be filed with the local registrar for the district in which the birth occurred within days following the birth the certificate shall be registered if it is completed and filed in accordance with this chapter part a for each live birth that occurs in a birthing facility the administrator of the birthing facility or his designee shall obtain and enter the information required under this chapter part on the certificate securing the required signatures and filing the certificate b i the date time place of birth and required medical information shall be certified by the birthing facility administrator or his designee ii the attending physician or nurse midwife may sign the certificate but if the attending physician or nurse midwife has not signed the certificate within seven days of the date of birth the birthing facility administrator or his designee shall enter the attending physician s or nurse midwife s name and transmit the certificate to the local registrar iii the information on the certificate about the parents shall be provided and certified by the mother or father or in their incapacity or absence by a person with knowledge of the facts a for live births that occur outside a birthing facility the birth certificate shall be completed and filed by the physician physician assistant nurse midwife or other person primarily responsible for providing assistance to the mother at the birth if there is no such person either the presumed or declarant father shall complete and file the certificate in his absence the mother shall complete and file the certificate and in the event of her death or disability the owner or operator of the premises where the birth occurred shall do so b the certificate shall be completed as fully as possible and shall include the date time and place of birth the mother s name and the signature of the person completing the certificate a for each live birth to an unmarried mother that occurs in a birthing facility the administrator or director of that facility or his designee shall i provide the birth mother and declarant father if present with a a voluntary declaration of paternity form published by the state registrar b oral and written notice to the birth mother and declarant father of the alternatives to the legal consequences of and the rights and responsibilities that arise from signing the declaration and c the opportunity to sign the declaration ii witness the signature of a birth mother or declarant father in accordance with section b if the signature occurs at the facility iii enter the declarant father s information on the original birth certificate but only if the mother and declarant father have signed a voluntary declaration of paternity or a court or administrative agency has issued an adjudication of paternity and iv file the completed declaration with the original birth certificate b if there is a presumed father the voluntary declaration will only be valid if the presumed father also signs the voluntary declaration c the state registrar shall file the information provided on the voluntary declaration of paternity form with the original birth certificate and may provide certified copies of the declaration of paternity as otherwise provided under title b chapter utah uniform parentage act a the state registrar shall publish a form for the voluntary declaration of paternity a description of the process for filing a voluntary declaration of paternity and of the rights and responsibilities established or effected by that filing in accordance with title b chapter utah uniform parentage act b information regarding the form and services related to voluntary paternity establishment shall be made available to birthing facilities and to any other entity or individual upon request the name of a declarant father may only be included on the birth certificate of a child of unmarried parents if a the mother and declarant father have signed a voluntary declaration of paternity or b a court or administrative agency has issued an adjudication of paternity voluntary declarations of paternity adjudications of paternity by judicial or administrative agencies and voluntary rescissions of paternity shall be filed with and maintained by the state registrar for the purpose of comparing information with the state case registry maintained by the office of recovery services pursuant to section a b section section b which is renumbered from section is renumbered and amended to read b requirement to obtain parents social security numbers for each live birth that occurs in this state the administrator of the birthing facility as defined in section b or other person responsible for completing and filing the birth certificate under section b shall obtain the social security numbers of each parent and provide those numbers to the state registrar each parent shall furnish his or her social security number to the person authorized to obtain the numbers under subsection unless a court or administrative agency has determined there is good cause for not furnishing a number under subsection the state registrar shall as soon as practicable supply those social security numbers to the office of recovery services within the department of human services department the social security numbers obtained under this section may not be recorded on the child s birth certificate the state may not use any social security number obtained under this section for any reason other than enforcement of child support orders in accordance with the federal family support act of public law pub l no section section b which is renumbered from section is renumbered and amended to read b foundling certificates a foundling certificate shall be filed for each infant of unknown parentage found in the state the certificate shall be prepared and filed with the local registrar of the district in which the infant was found by the person assuming custody the certificate shall be filed within days after the infant is found and is acceptable for all purposes in lieu of a certificate of birth section section b which is renumbered from section is renumbered and amended to read b correction of errors or omissions in vital records conflicting birth and foundling certificates rulemaking in accordance with title g chapter utah administrative rulemaking act the department may make rules governing applications to correct alleged errors or omissions on any vital record establishing procedures to resolve conflicting birth and foundling certificates and allowing for the correction and reissuance of a vital record that was originally created omitting a diacritical mark section section b which is renumbered from section is renumbered and amended to read b birth certificates delayed registration when a certificate of birth of a person born in this state has not been filed within the time provided in subsection b a certificate of birth may be filed in accordance with department rules and subject to this section a the registrar shall mark a certificate of birth as delayed and show the date of registration if the certificate is registered one year or more after the date of birth b the registrar shall abstract a summary statement of the evidence submitted in support of delayed registration onto the certificate when the minimum evidence required for delayed registration is not submitted or when the state registrar has reasonable cause to question the validity or adequacy of the evidence supporting the application and the deficiencies are not corrected the state registrar a may not register the certificate and b shall provide the applicant with a written statement indicating the reasons for denial of registration the state registrar has no duty to take further action regarding an application which is not actively pursued section section b which is renumbered from section is renumbered and amended to read b birth certificates petition for issuance of delayed certificate court procedure a if registration of a certificate of birth under section b is denied the person seeking registration may bring an action by a verified petition in the utah district court encompassing where the petitioner resides or in the district encompassing salt lake city b the petition shall request an order establishing a record of the date and place of the birth and the parentage of the person whose birth is to be registered the petition shall be on a form furnished by the state registrar and shall allege a the person for whom registration of a delayed certificate is sought was born in this state and is still living b no registered certificate of birth of the person can be found in the state office of vital statistics or the office of any local registrar c diligent efforts by the petitioner have failed to obtain the evidence required by department rule and d the state registrar has denied the petitioner s request to register a delayed certificate of birth the petition shall be accompanied by a written statement of the state registrar indicating the reasons for denial of registration and all documentary evidence which was submitted in support of registration the court shall fix a time and place for hearing the petition and shall give the state registrar days days notice of the hearing the state registrar or his authorized representative may appear and testify at the hearing a if the court finds the person for whom registration of a certificate of birth is sought under section b was born in this state it shall make findings as to the place and date of birth parentage and other findings as may be required and shall issue an order on a form prescribed and furnished by the state registrar to establish a court ordered delayed certificate of birth b the order shall include the birth data to be registered a description of the evidence presented and the date of the court s action b c the clerk of the court shall forward each order to the state registrar not later than the tenth day of the calendar month following the month in which the order was entered d the order described in subsection a shall be registered by the state registrar and constitutes the certificate of birth section section b which is renumbered from section is renumbered and amended to read b supplementary certificate of birth an individual born in this state may request the state registrar to register a supplementary birth certificate for the individual if a the individual is legally recognized as a child of the individual s natural parents when the individual s natural parents are subsequently married b the individual s parentage has been determined by a state court of the united states or a canadian provincial court with jurisdiction or c the individual has been legally adopted as a child or as an adult under the law of this state any other state or any province of canada the application for registration of a supplementary birth certificate may be made by a the individual requesting registration under subsection if the individual is of legal age b a legal representative or c any agency authorized to receive children for placement or adoption under the laws of this or any other state a the state registrar shall require that an applicant submit identification and proof according to department rules b in the case of an adopted individual that proof may be established by order of the court in which the adoption proceedings were held a after the supplementary birth certificate is registered any information disclosed from the record shall be from the supplementary birth certificate b access to the original birth certificate and to the evidence submitted in support of the supplementary birth certificate are not open to inspection except upon the order of a utah district court or as described in section b or section b section section b which is renumbered from section is renumbered and amended to read b name or sex change registration of court order and amendment of birth certificate when a person born in this state has a name change or sex change approved by an order of a utah district court or a court of competent jurisdiction of another state or a province of canada a certified copy of the order may be filed with the state registrar with an application form provided by the registrar a upon receipt of the application a certified copy of the order and payment of the required fee the state registrar shall review the application and if complete register it and note the fact of the amendment on the otherwise unaltered original certificate b the amendment shall be registered with and become a part of the original certificate and a certified copy shall be issued to the applicant without additional cost section section b which is renumbered from section is renumbered and amended to read b certified copies of birth certificates fees credited to children s account in addition to the fees provided for in section b the department and local registrars authorized to issue certified copies shall charge an additional fee for each certified copy of a birth certificate including certified copies of supplementary and amended birth certificates under sections through b through b this the additional fee described in subsection may be charged only for the first copy requested at any one time the fee shall be transmitted monthly to the state treasurer and credited to the children s account established created in section section section b which is renumbered from section is renumbered and amended to read b fee waived for certified copy of birth certificate notwithstanding section sections b and section b the department shall waive a fee that would otherwise be charged for a certified copy of a birth certificate if the individual whose birth is confirmed by the birth certificate is a the individual requesting the certified copy of the birth certificate and b i homeless as defined in section b ii a person who is homeless as defined in section a iii an individual whose primary nighttime residence is a location that is not designed for or ordinarily used as a sleeping accommodation for an individual iv a homeless service provider as verified by the department of workforce services or v a homeless child or youth as defined in u s c sec a to satisfy the requirement in subsection b the department shall accept written verification that the individual is homeless or a person child or youth who is homeless from a a homeless shelter b a permanent housing permanent supportive or transitional facility as defined in section a c the department of workforce services d a homeless service provider as verified by the department of workforce services or e a local educational agency liaison for homeless children and youth designated under u s c sec g j ii section section b which is renumbered from section is renumbered and amended to read b certificate of death execution and registration requirements information provided to lieutenant governor a a certificate of death for each death that occurs in this state shall be filed with the local registrar of the district in which the death occurs or as otherwise directed by the state registrar within five days after death and prior to the decedent s interment any other disposal or removal from the registration district where the death occurred b a certificate of death shall be registered if the certificate of death is completed and filed in accordance with this chapter part a if the place of death is unknown but the dead body is found in this state i the certificate of death shall be completed and filed in accordance with this section and ii the place where the dead body is found shall be shown as the place of death b if the date of death is unknown the date shall be determined by approximation a when death occurs in a moving conveyance in the united states and the decedent is first removed from the conveyance in this state i the certificate of death shall be filed with a the local registrar of the district where the decedent is removed or b a person designated by the state registrar and ii the place where the decedent is removed shall be considered the place of death b when a death occurs on a moving conveyance outside the united states and the decedent is first removed from the conveyance in this state i the certificate of death shall be filed with a the local registrar of the district where the decedent is removed or b a person designated by the state registrar and ii the certificate of death shall show the actual place of death to the extent it can be determined a subject to subsections d and a custodial funeral service director or if a funeral service director is not retained a dispositioner shall sign the certificate of death b the custodial funeral service director an agent of the custodial funeral service director or if a funeral service director is not retained a dispositioner shall i file the certificate of death prior to any disposition of a dead body or fetus and ii obtain the decedent s personal data from the next of kin or the best qualified person or source available including the decedent s social security number if known c the certificate of death may not include the decedent s social security number d a dispositioner may not sign a certificate of death unless the signature is witnessed by the state registrar or a local registrar a except as provided in section b fetal death certificates the medical section of the certificate of death shall be completed signed and returned to the funeral service director or if a funeral service director is not retained a dispositioner within hours after death by the health care professional who was in charge of the decedent s care for the illness or condition which resulted in death except when inquiry is required by title chapter utah medical examiner act part utah medical examiner b in the absence of the health care professional or with the health care professional s approval the certificate of death may be completed and signed by an associate physician the chief medical officer of the institution in which death occurred or a physician who performed an autopsy upon the decedent if i the person has access to the medical history of the case ii the person views the decedent at or after death and iii the death is not due to causes required to be investigated by the medical examiner when death occurs more than days after the day on which the decedent was last treated by a health care professional the case shall be referred to the medical examiner for investigation to determine and certify the cause date and place of death when inquiry is required by title chapter utah medical examiner act part utah medical examiner the medical examiner shall make an investigation and complete and sign the medical section of the certificate of death within hours after taking charge of the case if the cause of death cannot be determined within hours after death a the medical section of the certificate of death shall be completed as provided by department rule b the attending health care professional or medical examiner shall give the funeral service director or if a funeral service director is not retained a dispositioner notice of the reason for the delay and c final disposition of the decedent may not be made until authorized by the attending health care professional or medical examiner a when a death is presumed to have occurred within this state but the dead body cannot be located a certificate of death may be prepared by the state registrar upon receipt of an order of a utah district court b the order described in subsection a shall include a finding of fact stating the name of the decedent the date of death and the place of death c a certificate of death prepared under subsection a shall i show the date of registration and ii identify the court and the date of the order it is unlawful for a dispositioner to charge for or accept any remuneration for a signing a certificate of death or b performing any other duty of a dispositioner as described in this section the state registrar shall within five business days after the day on which the state registrar or local registrar registers a certificate of death for a utah resident inform the lieutenant governor of a the decedent s name last known residential address date of birth and date of death and b any other information requested by the lieutenant governor to assist the county clerk in identifying the decedent for the purpose of removing the decedent from the official register of voters the lieutenant governor shall within one business day after the day on which the lieutenant governor receives the information described in subsection provide the information to the county clerks section section b which is renumbered from section is renumbered and amended to read b fetal death certificate filing and registration requirements a fetal death certificate shall be filed for each fetal death which occurs in this state the certificate shall be filed within five days after delivery with the local registrar or as otherwise directed by the state registrar the certificate shall be registered if it is completed and filed in accordance with this chapter part when a dead fetus is delivered in an institution the institution administrator or his designated representative shall prepare and file the fetal death certificate the attending physician shall state in the certificate the cause of death and sign the certificate when a dead fetus is delivered outside an institution the physician in attendance at or immediately after delivery shall complete sign and file the fetal death certificate when a fetal death occurs without medical attendance at or immediately after the delivery or when inquiry is required by title chapter utah medical examiner act part utah medical examiner the medical examiner shall investigate the cause of death and prepare and file the certificate of fetal death within five days after taking charge of the case when a fetal death occurs in a moving conveyance and the dead fetus is first removed from the conveyance in this state or when a dead fetus is found in this state and the place of death is unknown the death shall be registered in this state the place where the dead fetus was first removed from the conveyance or found shall be considered the place of death final disposition of the dead fetus may not be made until the fetal death certificate has been registered section section b which is renumbered from section is renumbered and amended to read b certificate of birth resulting in stillbirth for purposes of this section and section as used in this section stillbirth and stillborn child shall have the same meaning mean the same as dead fetus as defined in section b a in addition to the requirements of section b the state registrar shall establish a certificate of birth resulting in stillbirth on a form approved by the state registrar for each stillbirth occurring in this state b this certificate shall be offered to the parent or parents of a stillborn child the certificate of birth resulting in stillbirth shall meet all of the format and filing requirements of sections and b and b relating to a live birth the person who prepares a certificate pursuant to this section shall leave blank any references to the stillborn child s name if the stillborn child s parent or parents do not wish to provide a name for the stillborn child notwithstanding subsections and the certificate of birth resulting in stillbirth shall be filed with the designated registrar within days following the delivery and prior to cremation or removal of the fetus from the registration district section section b which is renumbered from section is renumbered and amended to read b delayed registration of birth resulting in stillbirth when a birth resulting in stillbirth occurring in this state has not been registered within one year after the date of delivery a certificate marked delayed may be filed and registered in accordance with department rule relating to evidentiary and other requirements sufficient to substantiate the alleged facts of birth resulting in stillbirth section section b which is renumbered from section is renumbered and amended to read b certificate of early term stillbirth as used in this section early term stillborn child means a product of human conception other than in the circumstances described in subsection that a is of at least weeks gestation but less than weeks gestation calculated from the day on which the mother s last normal menstrual period began to the day of delivery and b is not born alive the state registrar shall issue a certificate of early term stillbirth to a parent of an early term stillborn child if a the parent requests on a form created by the state registrar that the state registrar register and issue a certificate of early term stillbirth for the early term stillborn child and b the parent files with the state registrar i a a signed statement from a physician confirming the delivery of the early term stillborn child or b an accurate copy of the parent s medical records related to the early term stillborn child and ii any other record the state registrar determines by rule made in accordance with title g chapter utah administrative rulemaking act is necessary for accurate recordkeeping the certificate of early term stillbirth described in subsection shall meet all of the format and filing requirements of section b a person who prepares a certificate of early term stillbirth under this section shall leave blank any references to an early term stillborn child s name if the early term stillborn child s parent does not wish to provide a name for the early term stillborn child section section b which is renumbered from section is renumbered and amended to read b petition for establishment of unregistered birth or death court procedure a person holding a direct tangible and legitimate interest as described in subsection b a or b may petition for a court order establishing the fact time and place of a birth or death that is not registered or for which a certified copy of the registered birth or death certificate is not obtainable the person shall verify the petition and file the petition in the utah district court for the county where a the birth or death is alleged to have occurred b the person resides whose birth is to be established or c the decedent named in the petition resided at the date of death in order for the court to have jurisdiction the petition shall a allege the date time and place of the birth or death and b state either that no certificate of birth or death has been registered or that a copy of the registered certificate cannot be obtained the court shall set a hearing for five to days after the day on which the petition is filed a if the time and place of birth or death are in question the court shall hear available evidence and determine the time and place of the birth or death b if the time and place of birth or death are not in question the court shall determine the time and place of birth or death to be those alleged in the petition a court order under this section shall be made on a form prescribed and furnished by the department and is effective upon the filing of a certified copy of the order with the state registrar a for purposes of this section the birth certificate of an adopted alien child as defined in section b is considered to be unobtainable if the child was born in a country that is not recognized by department rule as having an established vital records registration system b if the adopted child was born in a country recognized by department rule but a person described in subsection is unable to obtain a certified copy of the birth certificate the state registrar shall authorize the preparation of a birth certificate if the state registrar receives a written statement signed by the registrar of the child s birth country stating a certified copy of the birth certificate is not available section section b which is renumbered from section is renumbered and amended to read b certificate of death duties of a custodial funeral service director an agent of a funeral service director or a dispositioner medical certification records of funeral service director or dispositioner information filed with local registrar unlawful signing of certificate of death the custodial funeral service director or if a funeral service director is not retained a dispositioner shall sign the certificate of death prior to any disposition of a dead body or dead fetus the custodial funeral service director an agent of the custodial funeral service director or if a funeral service director is not retained a dispositioner shall a obtain personal and statistical information regarding the decedent from the available persons best qualified to provide the information b present the certificate of death to the attending health care professional if any or to the medical examiner who shall certify the cause of death and other information required on the certificate of death c provide the address of the custodial funeral service director or if a funeral service director is not retained a dispositioner d certify the date and place of burial and e file the certificate of death with the state or local registrar a funeral service director dispositioner embalmer or other person who removes a dead body or dead fetus from the place of death or transports or is in charge of final disposal of a dead body or dead fetus shall keep a record identifying the dead body or dead fetus and containing information pertaining to receipt removal and delivery of the dead body or dead fetus as prescribed by department rule a not later than the tenth day of each month every licensed funeral service establishment shall send to the local registrar and the department a list of the information required in subsection for each casket furnished and for funerals performed when no casket was furnished during the preceding month b the list described in subsection a shall be in the form prescribed by the state registrar any person who intentionally signs the portion of a certificate of death that is required to be signed by a funeral service director or a dispositioner under subsection is guilty of a class b misdemeanor unless the person a i is a funeral service director and ii is employed by a licensed funeral establishment or b is a dispositioner if a funeral service director is not retained the state registrar shall post information on the state registrar s website providing instructions to a dispositioner for complying with the requirements of law relating to the dispositioner s responsibilities for a completing and filing a certificate of death and b possessing transporting and disposing of a dead body or dead fetus the provisions of this chapter part shall be construed to avoid interference to the fullest extent possible with the ceremonies customs rites or beliefs of the decedent and the decedent s next of kin for disposing of a dead body or dead fetus section section b which is renumbered from section is renumbered and amended to read b certificate of death registration prerequisite to interment burial transit permits procedure where body donated under anatomical gift law permit for disinterment a a dead body or dead fetus may not be interred or otherwise disposed of or removed from the registration district in which death or fetal death occurred or the remains are found until a certificate of death is registered b subsection a does not apply to fetal remains for a fetus that is less than weeks in gestational age a for deaths or fetal deaths which occur in this state no burial transit permit is required for final disposition of the remains if i disposition occurs in the state and is performed by a funeral service director or ii the disposition takes place with authorization of the next of kin and in a a general acute hospital as that term is defined in section b that is licensed by the department or b in a pathology laboratory operated under contract with a general acute hospital licensed by the department b for an abortion or miscarriage that occurs at a health care facility no burial transit permit is required for final disposition of the fetal remains if i disposition occurs in the state and is performed by a funeral service director or ii the disposition takes place a with authorization of the parent of a miscarried fetus or the pregnant woman for an aborted fetus and b in a general acute hospital as that term is defined in section b or a pathology laboratory operated under contract with a general acute hospital a a burial transit permit shall be issued by the local registrar of the district where the certificate of death or fetal death is registered i for a dead body or a dead fetus to be transported out of the state for final disposition or ii when disposition of the dead body or dead fetus is made by a person other than a funeral service director b for fetal remains that are less than weeks in gestational age a burial transit permit shall be issued by the local registrar of the district where the health care facility that is in possession of the fetal remains is located i for the fetal remains to be transported out of the state for final disposition or ii when disposition of the fetal remains is made by a person other than a funeral service director c a local registrar issuing a burial transit permit issued under subsection b i may not require an individual to designate a name for the fetal remains and ii may leave the space for a name on the burial transit permit blank and d shall redact from any public records maintained under this chapter part any information i that is submitted under subsection c and ii that may be used to identify the parent or pregnant woman a burial transit permit issued under the law of another state which accompanies a dead body dead fetus or fetal remains brought into this state is authority for final disposition of the dead body dead fetus or fetal remains in this state when a dead body or dead fetus or any part of the dead body or dead fetus has been donated under the part revised uniform anatomical gift act or similar laws of another state and the preservation of the gift requires the immediate transportation of the dead body dead fetus or any part of the body or fetus outside of the registration district in which death occurs or the remains are found or into this state from another state the dead body or dead fetus or any part of the body or fetus may be transported and the burial transit permit required by this section obtained within a reasonable time after transportation a permit for disinterment and reinterment is required prior to disinterment of a dead body dead fetus or fetal remains except as otherwise provided by statute or department rule section section b which is renumbered from section is renumbered and amended to read b interments duties of sexton or person in charge record of interments information filed with local registrar a a sexton or person in charge of any premises in which interments are made may not inter or permit the interment of any dead body dead fetus or fetal remains unless the interment is made by a funeral service director or by a person holding a burial transit permit b the right and duty to control the disposition of a deceased person shall be governed by sections through a the sexton or the person in charge of any premises where interments are made shall keep a record of all interments made in the premises under their charge stating the name of the decedent place of death date of burial and name and address of the funeral service director or other person making the interment b the record described in this subsection shall be open to public inspection c a city or county clerk may at the clerk s option maintain the interment records described in this subsection on behalf of the sexton or person in charge of any premises in which interments are made a not later than the tenth day of each month the sexton person in charge of the premises or city or county clerk who maintains the interment records shall send to the local registrar and the department a list of all interments made in the premises during the preceding month b the list described in subsection a shall be in the form prescribed by the state registrar section section b which is renumbered from section is renumbered and amended to read b rules of department for transmittal of certificates and keeping of records by local registrar each local registrar shall transmit all records registered by him to the department in accordance with department rules the manner of keeping local copies of vital records and the uses of them shall be prescribed by department rules section section b which is renumbered from section is renumbered and amended to read b local registrars authorized to issue certified copies of records the state registrar may authorize local registrars to issue certified copies of vital records section section b which is renumbered from section is renumbered and amended to read b inspection of vital records as used in this section a designated legal representative means an attorney physician funeral service director genealogist or other agent of the subject or an immediate family member of the subject who has been delegated the authority to access vital records b drug use intervention or suicide prevention effort means a program that studies or promotes the prevention of drug overdose deaths or suicides in the state c immediate family member means a spouse child parent sibling grandparent or grandchild a the vital records shall be open to inspection but only in compliance with the provisions of this chapter part department rules and sections b and b b it is unlawful for any state or local officer or employee to disclose data contained in vital records contrary to this chapter part department rule section b or section b c i an adoption document is open to inspection as provided in section b or section b ii a birth parent may not access an adoption document under subsection b d a custodian of vital records may permit inspection of a vital record or issue a certified copy of a record or a part of a record when the custodian is satisfied that the applicant has demonstrated a direct tangible and legitimate interest except as provided in subsection a direct tangible and legitimate interest in a vital record is present only if a the request is from i the subject ii an immediate family member of the subject iii the guardian of the subject iv a designated legal representative of the subject or v a person including a child placing agency as defined in section b with whom a child has been placed pending finalization of an adoption of the child b the request involves a personal or property right of the subject of the record c the request is for official purposes of a public health authority or a state local or federal governmental agency d the request is for a drug use intervention or suicide prevention effort or a statistical or medical research program and prior consent has been obtained from the state registrar or e the request is a certified copy of an order of a court of record specifying the record to be examined or copied a except as provided in title b chapter part utah adoption act a parent or an immediate family member of a parent who does not have legal or physical custody of or visitation or parent time rights for a child because of the termination of parental rights under title chapter termination and restoration of parental rights or by virtue of consenting to or relinquishing a child for adoption pursuant to title b chapter part utah adoption act may not be considered as having a direct tangible and legitimate interest under this section b except as provided in subsection d a commercial firm or agency requesting names addresses or similar information may not be considered as having a direct tangible and legitimate interest under this section upon payment of a fee established in accordance with section j the office shall make the following records available to the public a except as provided in subsection b b a birth record excluding confidential information collected for medical and health use if years or more have passed since the date of birth b a death record if years or more have passed since the date of death and c a vital record not subject to subsection a or b if years or more have passed since the date of the event upon which the record is based upon payment of a fee established in accordance with section j the office shall make an adoption document available as provided in sections b and b the office shall make rules in accordance with title g chapter utah administrative rulemaking act establishing procedures and the content of forms as follows a for the inspection of adoption documents under subsection b b for a birth parent s election to permit identifying information about the birth parent to be made available under section b c for the release of information by the mutual consent voluntary adoption registry under section b d for collecting fees and donations under section b and e for the review and approval of a request described in subsection d section section b which is renumbered from section is renumbered and amended to read b records required to be kept by health care institutions information filed with local registrar and department a all administrators or other persons in charge of hospitals nursing homes or other institutions public or private to which persons resort for treatment of diseases confinements or are committed by law shall record all the personal and statistical information about patients of their institutions as required in certificates prescribed by this chapter part b the information described in subsection a shall i be recorded for collection at the time of admission of a patient ii be obtained from the patient if possible and iii if the information cannot be obtained from the patient the information shall be secured in as complete a manner as possible from other persons acquainted with the facts a when a dead body or dead fetus is released or disposed of by an institution the person in charge of the institution shall keep a record showing i the name of the deceased ii the date of death of the deceased iii the name and address of the person to whom the dead body or dead fetus is released and iv the date that the dead body or dead fetus is removed from the institution b if final disposal is by the institution the date place manner of disposition and the name of the person authorizing disposition shall be recorded by the person in charge of the institution not later than the tenth day of each month the administrator of each institution shall cause to be sent to the local registrar and the department a list of all births deaths fetal deaths and induced abortions occurring in the institution during the preceding month the list shall be in the form prescribed by the state registrar a person or institution who in good faith releases a dead body or dead fetus under this section to a funeral service director or a dispositioner is immune from civil liability connected directly or indirectly with release of the dead body or dead fetus section section b which is renumbered from section is renumbered and amended to read b marriage licenses execution and filing requirements the state registrar shall supply county clerks with application forms for marriage licenses completed applications shall be transmitted by the clerks to the state registrar monthly the personal identification information contained on each application for a marriage license filed with the county clerk shall be entered on a form supplied by the state registrar the person performing the marriage shall furnish the date and place of marriage and his name and address the form described in subsection shall be completed and certified by the county clerk before it is filed with the state registrar section section b which is renumbered from section is renumbered and amended to read b divorce or adoption duty of court clerk to file certificates or reports for each adoption annulment of adoption divorce and annulment of marriage ordered or decreed in this state the clerk of the court shall prepare a divorce certificate or report of adoption on a form furnished by the state registrar the petitioner shall provide the information necessary to prepare the certificate or report under subsection the clerk shall a prepare the certificate or report under subsection and b complete the remaining entries for the certificate or report immediately after the decree or order becomes final on or before the th day of each month the clerk shall forward the divorce certificates and reports of adoption under subsection completed by the clerk during the preceding month to the state registrar a a report of adoption under subsection may be provided to the attorney who is providing representation of a party to the adoption or the child placing agency as defined in section b that is placing the child b if a report of adoption is provided to the attorney or the child placing agency as defined in section b the attorney or the child placing agency shall immediately provide the report of adoption to the state registrar section section b which is renumbered from section is renumbered and amended to read b certified copies of vital records preparation by state and local registrars evidentiary value the state registrar and local registrars authorized by the department under section b may prepare typewritten photographic electronic or other reproductions of vital records and certify their correctness certified copies of the vital record or authorized reproductions of the original issued by either the state registrar or a designated local registrar are prima facie evidence in all courts of the state with like effect as the vital record section section b which is renumbered from section is renumbered and amended to read b identifying birth certificates of missing persons procedures as used in this section a division means the criminal investigations and technical services division department of public safety in title chapter criminal investigations and technical services act b missing child means a person younger than years of age old who is missing from the person s home environment or a temporary placement facility for any reason and whose whereabouts cannot be determined by the person responsible for the child s care c missing person means a person who i is missing from the person s home environment and ii a has a physical or mental disability b is missing under circumstances that indicate that the person is endangered missing involuntarily or a victim of a catastrophe or c is a missing child a in accordance with section upon the state registrar s notification by the division that a person who was born in this state is missing the state and local registrars shall flag the registered birth certificate of that person so that when a copy of the registered birth certificate or information regarding the birth record is requested the state and local registrars are alerted to the fact the registered birth certificate is that of a missing person b upon notification by the division the missing person has been recovered the state and local registrars shall remove the flag from that person s registered birth certificate the state and local registrars may not provide a copy of a registered birth certificate of any person whose record is flagged under subsection except as approved by the division a when a copy of the registered birth certificate of a person whose record has been flagged is requested in person the state or local registrar shall require that person to complete a form supplying that person s name address telephone number and relationship to the missing person and the name and birth date of the missing person b the state or local registrar shall inform the requester that a copy of the registered birth certificate will be mailed to the requester c the state or local registrar shall note the physical description of the person making the request and shall immediately notify the division of the request and the information obtained pursuant to this subsection when a copy of the registered birth certificate of a person whose record has been flagged is requested in writing the state or local registrar or personnel of the state or local registrar shall immediately notify the division and provide it with a copy of the written request section section b which is renumbered from section is renumbered and amended to read b birth certificate for foreign adoptees upon presentation of a court order of adoption and an order establishing the fact time and place of birth under section b the department shall prepare a birth certificate for an individual who was adopted under the laws of this state and was at the time of adoption as a child or as an adult considered an alien child or adult for whom the court received documentary evidence of lawful admission under section b section section b which is renumbered from section is renumbered and amended to read b determination of death made by registered nurse as used in this section a health care facility means the same as that term is defined in section b physician means a physician licensed under i title chapter utah medical practice act or ii title chapter utah osteopathic medical practice act c registered registered nurse means a registered nurse licensed under title chapter b nurse practice act a an individual is dead if the individual has sustained either i irreversible cessation of circulatory and respiratory functions or ii irreversible cessation of all functions of the entire brain including the brain stem b a determination of death shall be made in accordance with this part and accepted medical standards a registered nurse may make a determination of death of an individual if a an attending physician has i documented in the individual s medical or clinical record that the individual s death is anticipated due to illness infirmity or disease no later than days after the day on which the physician makes the documentation and ii established clear assessment procedures for determining death b the death actually occurs within the day period described in subsection a and c at the time of the documentation described in subsection a the physician authorized the following in writing to make the determination of death i one or more specific registered nurses or ii if the individual is in a health care facility that has complied with subsection all registered nurses that the facility employs a registered nurse who has determined death under this section shall a document the clinical criteria for the determination in the individual s medical or clinical record b notify the physician described in subsection and c ensure that the death certificate includes i the name of the deceased ii the presence of a contagious disease if known and iii the date and time of death except as otherwise provided by law or rule a physician licensed under title chapter utah medical practice act or title chapter utah osteopathic medical practice act shall certify a determination of death described in subsection within hours after the registered nurse makes the determination of death a for a health care facility to be eligible for a general authorization described in subsection c the facility shall adopt written policies and procedures that provide for the determination of death by a registered nurse under this section b a registered nurse that a health care facility employs may not make a determination of death under this section unless the facility has adopted the written policies and procedures described in subsection a the department may make rules in accordance with title g chapter utah administrative rulemaking act to ensure the appropriate determination of death under this section section section b which is renumbered from section is renumbered and amended to read b unlawful acts concerning certificates records and reports unlawful transportation or acceptance of dead human body it is unlawful for any person association or corporation and the officers of any of them to willfully and knowingly make any false statement in a certificate record or report required to be filed with the department or in an application for a certified copy of a vital record or to willfully and knowingly supply false information intending that the information be used in the preparation of any report record or certificate or an amendment to any of these to make counterfeit alter amend or mutilate any certificate record or report required to be filed under this code or a certified copy of the certificate record or report without lawful authority and with the intent to deceive to willfully and knowingly obtain possess use sell furnish or attempt to obtain possess use sell or furnish to another for any purpose of deception any certificate record report or certified copy of any of them including any that are counterfeited altered amended or mutilated without lawful authority to possess any certificate record or report required by the department or a copy or certified copy of the certificate record or report knowing it to have been stolen or otherwise unlawfully obtained or to willfully and knowingly transport or accept for transportation interment or other disposition a dead human body without a permit required by law section section b which is renumbered from section is renumbered and amended to read b illegal use of birth certificate penalties it is a third degree felony for any person to willfully and knowingly a and with the intent to deceive obtain possess use sell furnish or attempt to obtain possess use sell or furnish to another any certificate of birth or certified copy of a certificate of birth knowing that the certificate or certified copy was issued upon information which is false in whole or in part or which relates to the birth of another person whether living or deceased or b furnish or process a certificate of birth or certified copy of a certificate of birth with the knowledge or intention that it be used for the purpose of deception by a person other than the person to whom the certificate of birth relates the specific criminal violations and the criminal penalty under this section take precedence over any more general criminal offense as described in section b section section b which is renumbered from section is renumbered and amended to read part utah medical examiner b definitions as used in this chapter part dead body means the same as that term is defined in section b a death by violence means death that resulted by the decedent s exposure to physical mechanical or chemical forces b death by violence includes death that appears to have been due to homicide death that occurred during or in an attempt to commit rape mayhem kidnapping robbery burglary housebreaking extortion or blackmail accompanied by threats of violence assault with a dangerous weapon assault with intent to commit any offense punishable by imprisonment for more than one year arson punishable by imprisonment for more than one year or any attempt to commit any of the foregoing offenses immediate relative means an individual s spouse child parent sibling grandparent or grandchild health care professional means any of the following while acting in a professional capacity a a physician licensed under title chapter utah medical practice act or title chapter utah osteopathic medical practice act b a physician assistant licensed under title chapter a utah physician assistant act or c an advance practice registered nurse licensed under subsection b e medical examiner means the state medical examiner appointed pursuant to section b or a deputy appointed by the medical examiner medical examiner record means a all information that the medical examiner obtains regarding a decedent and b reports that the medical examiner makes regarding a decedent regional pathologist means a trained pathologist licensed to practice medicine and surgery in the state appointed by the medical examiner pursuant to subsection b sudden death while in apparent good health means apparently instantaneous death without obvious natural cause death during or following an unexplained syncope or coma or death during an acute or unexplained rapidly fatal illness sudden infant death syndrome means the death of a child who was thought to be in good health or whose terminal illness appeared to be so mild that the possibility of a fatal outcome was not anticipated suicide means death caused by an intentional and voluntary act of an individual who understands the physical nature of the act and intends by such act to accomplish self destruction unattended death means a death that occurs more than days after the day on which a health care professional examined or treated the deceased individual for any purpose including writing a prescription a unavailable for postmortem investigation means that a dead body is i transported out of state ii buried at sea iii cremated iv processed by alkaline hydrolysis or v otherwise made unavailable to the medical examiner for postmortem investigation or autopsy b unavailable for postmortem investigation does not include embalming or burial of a dead body pursuant to the requirements of law within the scope of the decedent s employment means all acts reasonably necessary or incident to the performance of work including matters of personal convenience and comfort not in conflict with specific instructions section section b which is renumbered from section is renumbered and amended to read b chief medical examiner appointment qualifications authority the executive director with the advice of an advisory board consisting of the chairman of the department of pathology at the university of utah medical school and the dean of the law school at the university of utah shall appoint a chief medical examiner who shall be licensed to practice medicine in the state and shall meet the qualifications of a forensic pathologist certified by the american board of pathologists pathology a the medical examiner shall serve at the will of the executive director b the medical examiner has authority to i employ medical technical and clerical personnel as may be required to effectively administer this chapter subject to the rules of the department and the state merit system ii conduct investigations and pathological examinations iii perform autopsies authorized in this title iv conduct or authorize necessary examinations on dead bodies and v notwithstanding the provisions of subsection b retain tissues and biological samples a for scientific purposes b where necessary to accurately certify the cause and manner of death or c for tissue from an unclaimed body subject to section b in order to donate the tissue or biological sample to an individual who is affiliated with an established search and rescue dog organization for the purpose of training a dog to search for human remains c in the case of an unidentified body the medical examiner shall authorize or conduct investigations tests and processes in order to determine its identity as well as the cause of death the medical examiner may appoint regional pathologists each of whom shall be approved by the executive director section section b which is renumbered from section is renumbered and amended to read b county medical examiners the county executive with the advice and consent of the county legislative body may appoint medical examiners for their respective counties section section b which is renumbered from section is renumbered and amended to read b investigation of deaths requests for autopsies the following have authority to investigate a death described in section b and any other case which may be within their jurisdiction a the attorney general or an assistant attorney general b the district attorney or county attorney who has criminal jurisdiction over the death or case c a deputy of the district attorney or county attorney described in subsection b or d a peace officer within the jurisdiction described in subsection b if in the opinion of the medical examiner an autopsy should be performed or if an autopsy is requested by the district attorney or county attorney having criminal jurisdiction or by the attorney general the autopsy shall be performed by the medical examiner or a regional pathologist section section b which is renumbered from section is renumbered and amended to read b custody by medical examiner upon notification under section b or investigation by the medical examiner s office the medical examiner shall assume custody of a deceased body if it appears that death was by violence gunshot suicide or accident was sudden death while in apparent good health occurred unattended except that an autopsy may only be performed in accordance with the provisions of subsection b occurred under suspicious or unusual circumstances resulted from poisoning or overdose of drugs resulted from a disease that may constitute a threat to the public health resulted from disease injury toxic effect or unusual exertion incurred within the scope of the decedent s employment was due to sudden infant death syndrome occurred while the decedent was in prison jail police custody the state hospital or in a detention or medical facility operated for the treatment of persons with a mental illness persons who are emotionally disturbed or delinquent persons resulted directly from the actions of a law enforcement officer as defined in section was associated with diagnostic or therapeutic procedures or was described in this section when request is made to assume custody by a county or district attorney or law enforcement agency in connection with a potential homicide investigation or prosecution section section b which is renumbered from section is renumbered and amended to read b discovery of dead body notice requirements procedure when death occurs under circumstances listed in section b the person or persons finding or having custody of the body shall immediately notify the nearest law enforcement agency the law enforcement agency having jurisdiction over the case shall then proceed to the place where the body is and conduct an investigation concerning the cause and circumstances of death for the purpose of determining whether there exists any criminal responsibility for the death on a determination by the law enforcement agency that death may have occurred in any of the ways described in section b the death shall be reported to the district attorney or county attorney having criminal jurisdiction and to the medical examiner by the law enforcement agency having jurisdiction over the investigation the report shall be made by the most expeditious means available failure to give notification or report to the district attorney or county attorney having criminal jurisdiction and medical examiner is a class b misdemeanor section section b which is renumbered from section is renumbered and amended to read b custody of dead body and personal effects examination of scene of death preservation of body autopsies a upon notification of a death under section b the medical examiner shall assume custody of the deceased body clothing on the body biological samples taken and any article on or near the body which may aid the medical examiner in determining the cause of death except those articles which will assist the investigative agency to proceed without delay with the investigation b in all cases the scene of the event may not be disturbed until authorization is given by the senior ranking peace officer from the law enforcement agency having jurisdiction of the case and conducting the investigation c where death appears to have occurred under circumstances listed in section b the person or persons finding or having custody of the body or jurisdiction over the investigation of the death shall take reasonable precautions to preserve the body and body fluids so that minimum deterioration takes place d a person may not move a body in the custody of the medical examiner unless i the medical examiner or district attorney or county attorney that has criminal jurisdiction authorizes the person to move the body ii a designee of an individual listed in this subsection d authorizes the person to move the body iii not moving the body would be an affront to public decency or impractical or iv the medical examiner determines the cause of death is likely due to natural causes e the body can under direction of the medical examiner or the medical examiner s designee be moved to a place specified by the medical examiner or the medical examiner s designee a if the medical examiner has custody of a body a person may not clean or embalm the body without first obtaining the medical examiner s permission b an intentional or knowing violation of subsection a is a class b misdemeanor a when the medical examiner assumes lawful custody of a body under subsection b solely because the death was unattended an autopsy may not be performed unless requested by the district attorney county attorney having criminal jurisdiction or law enforcement agency having jurisdiction of the place where the body is found b the county attorney or district attorney and law enforcement agency having jurisdiction shall consult with the medical examiner to determine the need for an autopsy c if the deceased chose not to be seen or treated by a health care professional for a spiritual or religious reason a district attorney county attorney or law enforcement agency may not request an autopsy or inquest under subsection a solely because of the deceased s choice d the medical examiner or medical examiner s designee may not conduct a requested autopsy described in subsection a if the medical examiner or medical examiner s designee determines i the request violates subsection c or ii the cause of death can be determined without performing an autopsy section section b which is renumbered from section is renumbered and amended to read b rendering a dead body unavailable for postmortem investigation as used in this section a medical examiner means the same as that term is defined in section b b unavailable for postmortem investigation means the same as that term is defined in section b it is unlawful for a person to engage in any conduct that makes a dead body unavailable for postmortem investigation unless before engaging in that conduct the person obtains a permit from the medical examiner to render the dead body unavailable for postmortem investigation under section b if the person intends to make the body unavailable for postmortem investigation a person who violates subsection is guilty of a third degree felony if a person engages in conduct that constitutes both a violation of this section and a violation of section the provisions and penalties of section supersede the provisions and penalties of this section section section b which is renumbered from section is renumbered and amended to read b certification of cause of death a for a death under any of the circumstances described in section b only the medical examiner or the medical examiner s designee may certify the cause of death b an individual who knowingly certifies the cause of death in violation of subsection a is guilty of a class b misdemeanor a for a death described in section b an individual may not knowingly give false information with the intent to mislead to the medical examiner or the medical examiner s designee b a violation of subsection a is a class b misdemeanor section section b which is renumbered from section is renumbered and amended to read b medical examiner to report death caused by prescribed controlled substance poisoning or overdose if a medical examiner determines that the death of a person who is years old or older at the time of death resulted from poisoning or overdose involving a prescribed controlled substance the medical examiner shall within three business days after the day on which the medical examiner determines the cause of death send a written report to the division of professional licensing created in section that includes a the decedent s name b each drug or other substance found in the decedent s system that may have contributed to the poisoning or overdose if known and c the name of each person the medical examiner has reason to believe may have prescribed a controlled substance described in subsection b to the decedent this section does not create a new cause of action section section b which is renumbered from section is renumbered and amended to read b records and reports of investigations a complete copy of all written records and reports of investigations and facts resulting from medical care treatment autopsies conducted by any person on the body of the deceased who died in any manner listed in section b and the written reports of any investigative agency making inquiry into the incident shall be promptly made and filed with the medical examiner the judiciary or a state or local government entity that retains a record other than a document described in subsection of the decedent shall provide a copy of the record to the medical examiner a in accordance with federal law and b upon receipt of the medical examiner s written request for the record failure to submit reports or records described in subsection or other than reports of a county attorney district attorney or law enforcement agency within days after the day on which the person in possession of the report or record receives the medical examiner s written request for the report or record is a class b misdemeanor section section b which is renumbered from section is renumbered and amended to read b order to exhume body procedure in case of any death described in section b when a body is buried without an investigation by the medical examiner as to the cause and manner of death it shall be the duty of the medical examiner upon being advised of the fact to notify the district attorney or county attorney having criminal jurisdiction where the body is buried or death occurred upon notification the district attorney or county attorney having criminal jurisdiction may file an action in the district court to obtain an order to exhume the body a district judge may order the body exhumed upon an ex parte hearing a a body may not be exhumed until notice of the order has been served upon the executor or administrator of the deceased s estate or if no executor or administrator has been appointed upon the nearest heir of the deceased determined as if the deceased had died intestate if the nearest heir of the deceased cannot be located within the jurisdiction then the next heir in succession within the jurisdiction may be served b the executor administrator or heir shall have hours to notify the issuing court of any objection to the order prior to the time the body is exhumed if no heirs can be located within the jurisdiction within hours the facts shall be reported to the issuing court which may order that the body be exhumed forthwith c notification to the executor administrator or heir shall specifically state the nature of the action and the fact that any objection shall be filed with the issuing court within hours of the time of service d in the event an heir files an objection the court shall set hearing on the matter at the earliest possible time and issue an order on the matter immediately at the conclusion of the hearing upon the receipt of notice of objection the court shall immediately notify the county attorney who requested the order so that the interest of the state may be represented at the hearing e when there is reason to believe that death occurred in a manner described in section b the district attorney or county attorney having criminal jurisdiction may make a motion that the court upon ex parte hearing order the body exhumed forthwith and without notice upon a showing of exigent circumstances the court may order the body exhumed forthwith and without notice in any event upon motion of the district attorney or county attorney having criminal jurisdiction and upon the personal appearance of the medical examiner the court for good cause may order the body exhumed forthwith and without notice an order to exhume a body shall be directed to the medical examiner commanding the medical examiner to cause the body to be exhumed perform the required autopsy and properly cause the body to be reburied upon completion of the examination the examination shall be completed and the complete autopsy report shall be made to the district attorney or county attorney having criminal jurisdiction for any action the attorney considers appropriate the district attorney or county attorney shall submit the return of the order to exhume within days in the manner prescribed by the issuing court section section b which is renumbered from section is renumbered and amended to read b autopsies when authorized the medical examiner shall perform an autopsy to a aid in the discovery and prosecution of a crime b protect an innocent person accused of a crime and c disclose hazards to public health the medical examiner may perform an autopsy a to aid in the administration of civil justice in life and accident insurance problems in accordance with title a chapter workers compensation act and b in other cases involving questions of civil liability section section b which is renumbered from section is renumbered and amended to read b certification of death by attending health care professional deaths without medical attendance cause of death uncertain notice requirements a a health care professional who treats or examines an individual within days from the day on which the individual dies shall certify the individual s cause of death to the best of the health care professional s knowledge and belief unless the health care professional determines the individual may have died in a manner described in section b b if a health care professional is unable to determine an individual s cause of death in accordance with subsection a the health care professional shall notify the medical examiner for an unattended death the person with custody of the body shall notify the medical examiner of the death if the medical examiner determines there may be criminal responsibility for a death the medical examiner shall notify a the district attorney or county attorney that has criminal jurisdiction or b the head of the law enforcement agency that has jurisdiction to investigate the death section section b which is renumbered from section is renumbered and amended to read b deaths in medical centers and federal facilities all death certificates of any decedent who died in a teaching medical center or a federal medical facility unattended or in the care of an unlicensed physician or other medical personnel shall be signed by the licensed supervisory physician attending physician or licensed resident physician of the medical center or facility section section b which is renumbered from section is renumbered and amended to read b release of body for funeral preparations a where a body is held for investigation or autopsy under this chapter or for a medical investigation permitted by law the body shall if requested by the person given priority under section be released for funeral preparations no later than hours after the arrival at the office of the medical examiner or regional medical facility b an extension may be ordered only by a district court the right and duty to control the disposition of a deceased person is governed by sections through section section b which is renumbered from section is renumbered and amended to read b records of medical examiner confidentiality the medical examiner shall maintain complete original records for the medical examiner record which shall a be properly indexed giving the name if known or otherwise identifying every individual whose death is investigated b indicate the place where the body was found c indicate the date of death d indicate the cause and manner of death e indicate the occupation of the decedent if available f include all other relevant information concerning the death and g include a full report and detailed findings of the autopsy or report of the investigation a upon written request from an individual described in subsections a i through iv the medical examiner shall provide a copy of the medical examiner s final report of examination for the decedent including the autopsy report toxicology report lab reports and investigative reports to any of the following i a decedent s immediate relative ii a decedent s legal representative iii a physician or physician assistant who attended the decedent during the year before the decedent s death or iv a county attorney a district attorney a criminal defense attorney or other law enforcement official with jurisdiction as necessary for the performance of the attorney or official s professional duties b upon written request from the director or a designee of the director of an entity described in subsections b i through iv the medical examiner may provide a copy of the of the medical examiner s final report of examination for the decedent including any other reports described in subsection a to any of the following entities as necessary for performance of the entity s official purposes i a local health department ii a local mental health authority iii a public health authority or iv another state or federal governmental agency c the medical examiner may provide a copy of the medical examiner s final report of examination including any other reports described in subsection a if the final report relates to an issue of public health or safety as further defined by rule made by the department in accordance with title g chapter utah administrative rulemaking act reports provided under subsection may not include records that the medical examiner obtains from a third party in the course of investigating the decedent s death the medical examiner may provide a medical examiner record to a researcher who a has an advanced degree b i is affiliated with an accredited college or university a hospital or another system of care including an emergency medical response or a local health agency or ii is part of a research firm contracted with an accredited college or university a hospital or another system of care c requests a medical examiner record for a research project or a quality improvement initiative that will have a public health benefit as determined by the department and d provides to the medical examiner an approval from i the researcher s sponsoring organization and ii the utah department of health and human services institutional review board records provided under subsection may not include a third party record unless a a court has ordered disclosure of the third party record and b disclosure is conducted in compliance with state and federal law a person who obtains a medical examiner record under subsection shall a maintain the confidentiality of the medical examiner record by removing personally identifying information about a decedent or the decedent s family and any other information that may be used to identify a decedent before using the medical examiner record in research b conduct any research within and under the supervision of the office of the medical examiner if the medical examiner record contains a third party record with personally identifiable information c limit the use of a medical examiner record to the purpose for which the person requested the medical examiner record d destroy a medical examiner record and the data abstracted from the medical examiner record at the conclusion of the research for which the person requested the medical examiner record e reimburse the medical examiner as provided in section b for any costs incurred by the medical examiner in providing a medical examiner record f allow the medical examiner to review before public release a publication in which data from a medical examiner record is referenced or analyzed and g provide the medical examiner access to the researcher s database containing data from a medical examiner record until the day on which the researcher permanently destroys the medical examiner record and all data obtained from the medical examiner record the department may make rules in accordance with title g chapter utah administrative rulemaking act and in consideration of applicable state and federal law to establish permissible uses and disclosures of a medical examiner record or other record obtained under this section except as provided in this chapter or ordered by a court the medical examiner may not disclose any part of a medical examiner record a person who obtains a medical examiner record under subsection is guilty of a class b misdemeanor if the person fails to comply with the requirements of subsections a through d section section b which is renumbered from section is renumbered and amended to read b records of medical examiner admissibility as evidence subpoena of person who prepared record the records of the medical examiner or transcripts thereof certified by the medical examiner are admissible as evidence in any civil action in any court in this state except that statements by witnesses or other persons unless taken pursuant to section b as conclusions upon extraneous matters are not hereby made admissible the person who prepared a report or record offered in evidence hereunder may be subpoenaed as a witness in the case by any party section section b which is renumbered from section is renumbered and amended to read b personal property of deceased disposition personal property of the deceased not held as evidence shall be turned over to the legal representative of the deceased within days after completion of the investigation of the death of the deceased if no legal representative is known the county attorney district attorney or the medical examiner shall within days after the investigation turn the personal property over to the county treasurer to be handled pursuant to the escheat laws an affidavit shall be filed with the county treasurer by the county attorney district attorney or the medical examiner within days after investigation of the death of the deceased showing the money or other property belonging to the estate of the deceased person which has come into his possession and the disposition made of the property property required to be turned over to the legal representative of the deceased may be held longer than days if in the opinion of the county attorney district attorney or attorney general the property is necessary evidence in a court proceeding upon conclusion of the court proceedings the personal property shall be turned over as described in this section and in accordance with the rules of the court section section b which is renumbered from section is renumbered and amended to read b officials not liable for authorized acts except as provided in this chapter part a criminal or civil action may not arise against the county attorney district attorney or his deputies the medical examiner or his deputies or regional pathologists for authorizing or performing autopsies authorized by this chapter part or for any other act authorized by this chapter part section section b which is renumbered from section is renumbered and amended to read b authority of county attorney or district attorney to subpoena witnesses and compel testimony determination if decedent died by unlawful means the district attorney or county attorney having criminal jurisdiction may subpoena witnesses and compel testimony concerning the death of any person and have such testimony reduced to writing under his direction and may employ a shorthand reporter for that purpose at the same compensation as is allowed to reporters in the district courts when the testimony has been taken down by the shorthand reporter a transcript thereof duly certified shall constitute the deposition of the witness upon review of all facts and testimony taken concerning the death of a person the district attorney or county attorney having criminal jurisdiction shall determine if the decedent died by unlawful means and shall also determine if criminal prosecution shall be instituted section section b which is renumbered from section is renumbered and amended to read b additional powers and duties of department the department may establish rules to carry out the provisions of this chapter part arrange for the state health laboratory to perform toxicologic analysis for public or private institutions and fix fees for the services cooperate and train law enforcement personnel in the techniques of criminal investigation as related to medical and pathological matters and pay to private parties institutions or funeral directors the reasonable value of services performed for the medical examiner s office section section b which is renumbered from section is renumbered and amended to read b authority of examiner to provide organ or other tissue for transplant purposes when requested by the licensed physician of a patient who is in need of an organ or other tissue for transplant purpose by a legally created utah eye bank organ bank or medical facility the medical examiner may provide an organ or other tissue if a a decedent who may provide a suitable organ or other tissue for the transplant is in the custody of the medical examiner b the medical examiner is assured that the requesting party has made reasonable search for and inquiry of next of kin of the decedent and that no objection by the next of kin is known by the requesting party and c the removal of the organ or other tissue will not interfere with the investigation or autopsy or alter the post mortem facial appearance when the medical examiner is in custody of a decedent who may provide a suitable organ or other tissue for transplant purposes he may contact the appropriate eye bank organ bank or medical facility and notify them concerning the suitability of the organ or other tissue in such contact the medical examiner may disclose the name of the decedent so that necessary clearances can be obtained no person shall be held civilly or criminally liable for any acts performed pursuant to this section section section b which is renumbered from section is renumbered and amended to read b autopsies persons eligible to authorize autopsies may be authorized a by the commissioner of the labor commission or the commissioner s designee as provided in section a b by individuals by will or other written document c upon a decedent by the next of kin in the following order and as known surviving spouse child if years old or older otherwise the legal guardian of the child parent sibling uncle or aunt nephew or niece cousin others charged by law with the duty of burial or friend assuming the obligation of burial d by the county attorney district attorney or the district attorney s deputy or a district judge and e by the medical examiner as provided in this chapter part autopsies authorized under subsections a and d shall be performed by a certified pathologist no criminal or civil action arises against a pathologist or a physician who proceeds in good faith and performs an autopsy authorized by this section section section b which is renumbered from section is renumbered and amended to read b burial of an unclaimed body request by the school of medicine at the university of utah medical examiner may retain tissue for dog training except as described in subsection or a county shall provide at the county s expense decent burial for an unclaimed body found in the county a county is not responsible for decent burial of an unclaimed body found in the county if the body is requested by the dean of the school of medicine at the university of utah under section b for an unclaimed body that is temporarily in the medical examiner s custody before burial under subsection the medical examiner may retain tissue from the unclaimed body in order to donate the tissue to an individual who is affiliated with an established search and rescue dog organization for the purpose of training a dog to search for human remains section section b which is renumbered from section is renumbered and amended to read b social security number in certification of death a certification of death shall include if known the social security number of the deceased person and a copy of the certification shall be sent to the office of recovery services within the department of human services department upon request section section b which is renumbered from section is renumbered and amended to read b registry of unidentified deceased persons if the identity of a deceased person over which the medical examiner has jurisdiction under section b is unknown the medical examiner shall do the following before releasing the body to the county in which the body was found as provided in section b a assign a unique identifying number to the body b create and maintain a file under the assigned number c examine the body take samples and perform other related tasks for the purpose of deriving information that may be useful in ascertaining the identity of the deceased person d use the identifying number in all records created by the medical examiner that pertains to the body e record all information pertaining to the body in the file created and maintained under subsection b f communicate the unique identifying number to the county in which the body was found and g access information from available government sources and databases in an attempt to ascertain the identity of the deceased person a county which has received a body to which subsection applies a shall adopt and use the same identifying number assigned by subsection in all records created by the county that pertain to the body b require any funeral director or sexton who is involved in the disposition of the body to adopt and use the same identifying number assigned by subsection in all records created by the funeral director or sexton pertaining to the body and c shall provide a decent burial for the body within days of receiving a body to which subsection applies the county shall inform the medical examiner of the disposition of the body including the burial plot the medical examiner shall record this information in the file created and maintained under subsection b the requirements of subsections and apply to a county examiner appointed under section b with the additional requirements that the county examiner a obtain a unique identifying number from the medical examiner for the body and b send to the medical examiner a copy of the file created and maintained in accordance with subsection b including the disposition of the body and burial plot within days of releasing the body the medical examiner shall maintain a file received under subsection in the same way that it maintains a file created and maintained by the medical examiner in accordance with subsection b the medical examiner shall cooperate and share information generated and maintained under this section with a person who demonstrates a a legitimate personal or governmental interest in determining the identity of a deceased person and b a reasonable belief that the body of that deceased person may have come into the custody of the medical examiner section section b which is renumbered from section is renumbered and amended to read b testing for suspected suicides maintaining information compensation to deputy medical examiners in all cases where it is suspected that a death resulted from suicide including assisted suicide the medical examiner shall endeavor to have the following tests conducted upon samples taken from the body of the deceased a a test that detects all of the substances included in the volatiles panel of the bureau of forensic toxicology within the department of health department b a test that detects all of the substances included in the drugs of abuse panel of the bureau of forensic toxicology within the department of health department and c a test that detects all of the substances included in the prescription drug panel of the bureau of forensic toxicology within the department of health department the medical examiner shall maintain information regarding the types of substances found present in the samples taken from the body of a person who is suspected to have died as a result of suicide or assisted suicide within funds appropriated by the legislature for this purpose the medical examiner shall provide compensation at a standard rate determined by the medical examiner to a deputy medical examiner who collects samples for the purposes described in subsection section section b which is renumbered from section is renumbered and amended to read b psychological autopsy examiner with funds appropriated by the legislature for this purpose the department shall provide compensation at a standard rate determined by the department to a psychological autopsy examiner the psychological autopsy examiner shall a work with the medical examiner to compile data regarding suicide related deaths b as relatives of the deceased are willing gather information from relatives of the deceased regarding the psychological reasons for the decedent s death c maintain a database of information described in subsections a and b
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+enrolled copy s b health and human services recodification health care assistance and data general session state of utah chief sponsor jacob l anderegg house sponsor raymond p ward long title general description this bill recodifies portions of the utah health code and utah human services code highlighted provisions this bill recodifies provisions regarding health care administration and assistance and vital statistics health data and the utah medical examiner and makes technical and corresponding changes money appropriated in this bill none other special clauses this bill provides a coordination clause this bill provides revisor instructions utah code sections affected amends b as enacted by laws of utah chapter b as enacted by laws of utah chapter renumbers and amends b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah sixth special session chapter b renumbered from as last amended by laws of utah fifth special session chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah fifth special session chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapter b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from b as last amended by laws of utah chapters and b renumbered from c as last amended by laws of utah chapter b renumbered from c as enacted by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as enacted by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from c as last amended by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from d as repealed and reenacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as renumbered and amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as repealed and reenacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapters and b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as repealed and reenacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as last amended by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from a as enacted by laws of utah chapter b renumbered from as enacted by laws of utah chapter utah code sections affected by coordination clause as last amended by laws of utah chapter as last amended by laws of utah chapter b as enacted by laws of utah chapter b utah code annotated be it enacted by the legislature of the state of utah section section b is amended to read chapter health care administration and assistance part health care assistance b definitions reserved as used in this chapter applicant means any person who requests assistance under the medical programs of the state cms means the centers for medicare and medicaid services within the united states department of health and human services division means the division of integrated healthcare within the department established under section b enrollee or member means an individual whom the department has determined to be eligible for assistance under the medicaid program medicaid program means the state program for medical assistance for persons who are eligible under the state plan adopted pursuant to title xix of the federal social security act medical assistance means services furnished or payments made to or on behalf of a member a passenger vehicle means a self propelled two axle vehicle intended primarily for operation on highways and used by an applicant or recipient to meet basic transportation needs and has a fair market value below of the applicable amount of the federal luxury passenger automobile tax established in u s c sec and adjusted annually for inflation b passenger vehicle does not include i a commercial vehicle as defined in section a ii an off highway vehicle as defined in section a or iii a motor home as defined in section ppaca means the same as that term is defined in section a recipient means a person who has received medical assistance under the medicaid program section section b which is renumbered from section is renumbered and amended to read b division creation there is created within the department the division of medicaid and health financing integrated healthcare which shall be responsible for implementing organizing and maintaining the medicaid program and the children s health insurance program established in section b in accordance with the provisions of this chapter and applicable federal law section section b which is renumbered from section is renumbered and amended to read b state medicaid director appointment responsibilities the state medicaid director shall be appointed by the governor after consultation with the executive director with the advice and consent of the senate the state medicaid director may employ other employees as necessary to implement the provisions of this chapter and shall a administer the responsibilities of the division as set forth in this chapter b administer the division s budget and c establish and maintain a state plan for the medicaid program in compliance with federal law and regulations section section b which is renumbered from section is renumbered and amended to read b division responsibilities emphasis periodic assessment in accordance with the requirements of title xix of the social security act and applicable federal regulations the division is responsible for the effective and impartial administration of this chapter in an efficient economical manner the division shall a establish on a statewide basis a program to safeguard against unnecessary or inappropriate use of medicaid services excessive payments and unnecessary or inappropriate hospital admissions or lengths of stay b deny any provider claim for services that fail to meet criteria established by the division concerning medical necessity or appropriateness and c place its emphasis on high quality care to recipients in the most economical and cost effective manner possible with regard to both publicly and privately provided services the division shall implement and utilize cost containment methods where possible which may include a prepayment and postpayment review systems to determine if utilization is reasonable and necessary b preadmission certification of nonemergency admissions c mandatory outpatient rather than inpatient surgery in appropriate cases d second surgical opinions e procedures for encouraging the use of outpatient services f consistent with sections b and b a medicaid drug program g coordination of benefits and h review and exclusion of providers who are not cost effective or who have abused the medicaid program in accordance with the procedures and provisions of federal law and regulation the state medicaid director shall periodically assess the cost effectiveness and health implications of the existing medicaid program and consider alternative approaches to the provision of covered health and medical services through the medicaid program in order to reduce unnecessary or unreasonable utilization a the department shall ensure medicaid program integrity by conducting internal audits of the medicaid program for efficiencies best practices and cost avoidance b the department shall coordinate with the office of the inspector general for medicaid services created in section a to implement subsection and to address medicaid fraud waste or abuse as described in section a section section b which is renumbered from section is renumbered and amended to read b medicaid drug program preferred drug list a medicaid drug program developed by the department under subsection b f a shall notwithstanding subsection b b be based on clinical and cost related factors which include medical necessity as determined by a provider in accordance with administrative rules established by the drug utilization review board b may include therapeutic categories of drugs that may be exempted from the drug program c may include placing some drugs except the drugs described in subsection on a preferred drug list i to the extent determined appropriate by the department and ii in the manner described in subsection for psychotropic drugs d notwithstanding the requirements of part sections b through b regarding the drug utilization review board and except as provided in subsection shall immediately implement the prior authorization requirements for a nonpreferred drug that is in the same therapeutic class as a drug that is i on the preferred drug list on the date that this act takes effect or ii added to the preferred drug list after this act takes effect and e except as prohibited by subsections b and shall establish the prior authorization requirements established under subsections c and d which shall permit a health care provider or the health care provider s agent to obtain a prior authorization override of the preferred drug list through the department s pharmacy prior authorization review process and which shall i provide either telephone or fax approval or denial of the request within hours of the receipt of a request that is submitted during normal business hours of monday through friday from a m to p m ii provide for the dispensing of a limited supply of a requested drug as determined appropriate by the department in an emergency situation if the request for an override is received outside of the department s normal business hours and iii require the health care provider to provide the department with documentation of the medical need for the preferred drug list override in accordance with criteria established by the department in consultation with the pharmacy and therapeutics committee a for purposes of as used in this subsection i immunosuppressive drug a means a drug that is used in immunosuppressive therapy to inhibit or prevent activity of the immune system to aid the body in preventing the rejection of transplanted organs and tissue and b does not include drugs used for the treatment of autoimmune disease or diseases that are most likely of autoimmune origin ii stabilized means a health care provider has documented in the patient s medical chart that a patient has achieved a stable or steadfast medical state within the past days using a particular psychotropic drug b a preferred drug list developed under the provisions of this section may not include an immunosuppressive drug c i the state medicaid program shall reimburse for a prescription for an immunosuppressive drug as written by the health care provider for a patient who has undergone an organ transplant ii for purposes of subsection b and with respect to patients who have undergone an organ transplant the prescription for a particular immunosuppressive drug as written by a health care provider meets the criteria of demonstrating to the department a medical necessity for dispensing the prescribed immunosuppressive drug d notwithstanding the requirements of part sections b through b regarding the drug utilization review board the state medicaid drug program may not require the use of step therapy for immunosuppressive drugs without the written or oral consent of the health care provider and the patient e the department may include a sedative hypnotic on a preferred drug list in accordance with subsection f f the department shall grant a prior authorization for a sedative hypnotic that is not on the preferred drug list under subsection e if the health care provider has documentation related to one of the following conditions for the medicaid client i a trial and failure of at least one preferred agent in the drug class including the name of the preferred drug that was tried the length of therapy and the reason for the discontinuation ii detailed evidence of a potential drug interaction between current medication and the preferred drug iii detailed evidence of a condition or contraindication that prevents the use of the preferred drug iv objective clinical evidence that a patient is at high risk of adverse events due to a therapeutic interchange with a preferred drug v the patient is a new or previous medicaid client with an existing diagnosis previously stabilized with a nonpreferred drug or vi other valid reasons as determined by the department g a prior authorization granted under subsection f is valid for one year from the date the department grants the prior authorization and shall be renewed in accordance with subsection f a for purposes of as used in this subsection psychotropic drug means the following classes of drugs i atypical anti psychotic ii anti depressant iii anti convulsant mood stabilizer iv anti anxiety and v attention deficit hyperactivity disorder stimulant b i the department shall develop a preferred drug list for psychotropic drugs ii except as provided in subsection d a preferred drug list for psychotropic drugs developed under this section shall allow a health care provider to override the preferred drug list by writing dispense as written on the prescription for the psychotropic drug iii a health care provider may not override section b by writing dispense as written on a prescription c the department and a medicaid accountable care organization that is responsible for providing behavioral health shall i establish a system to a track health care provider prescribing patterns for psychotropic drugs b educate health care providers who are not complying with the preferred drug list and c implement peer to peer education for health care providers whose prescribing practices continue to not comply with the preferred drug list and ii determine whether health care provider compliance with the preferred drug list is at least a of prescriptions by july b of prescriptions by july and c of prescriptions by july d beginning october the department shall eliminate the dispense as written override for the preferred drug list and shall implement a prior authorization system for psychotropic drugs in accordance with subsection f if by july the department has not realized annual savings from implementing the preferred drug list for psychotropic drugs of at least general fund savings section section b which is renumbered from section is renumbered and amended to read b simplified enrollment and renewal process for medicaid and other state medical programs financial institutions the department may apply for grants and accept donations to make technology system improvements necessary to implement a simplified enrollment and renewal process for the medicaid program utah premium partnership and primary care network demonstration project programs a the department may enter into an agreement with a financial institution doing business in the state to develop and operate a data match system to identify an applicant s or enrollee s assets that i uses automated data exchanges to the maximum extent feasible and ii requires a financial institution each month to provide the name record address social security number other taxpayer identification number or other identifying information for each applicant or enrollee who maintains an account at the financial institution b the department may pay a reasonable fee to a financial institution for compliance with this subsection as provided in section c a financial institution may not be liable under any federal or state law to any person for any disclosure of information or action taken in good faith under this subsection d the department may disclose a financial record obtained from a financial institution under this section only for the purpose of and to the extent necessary in verifying eligibility as provided in this section and section b section section b which is renumbered from section is renumbered and amended to read b dental benefits a except as provided in subsection the division may establish a competitive bid process to bid out medicaid dental benefits under this chapter b the division may bid out the medicaid dental benefits separately from other program benefits the division shall use the following criteria to evaluate dental bids a ability to manage dental expenses b proven ability to handle dental insurance c efficiency of claim paying procedures d provider contracting discounts and adequacy of network and e other criteria established by the department the division shall request bids for the program s benefits at least once every five years the division s contract with dental plans for the program s benefits shall include risk sharing provisions in which the dental plan must accept of the risk for any difference between the division s premium payments per client and actual dental expenditures the division may not award contracts to a more than three responsive bidders under this section or b an insurer that does not have a current license in the state a the division may cancel the request for proposals if i there are no responsive bidders or ii the division determines that accepting the bids would increase the program s costs b if the division cancels a request for proposal or a contract that results from a request for proposal described in subsection a the division shall report to the health and human services interim committee regarding the reasons for the decision title g chapter a utah procurement code shall apply to this section a the division may i establish a dental health care delivery system and payment reform pilot program for medicaid dental benefits to increase access to cost effective and quality dental health care by increasing the number of dentists available for medicaid dental services and ii target specific medicaid populations or geographic areas in the state b the pilot program shall establish compensation models for dentists and dental hygienists that i increase access to quality cost effective dental care and ii use funds from the division of family health and preparedness that are available to reimburse dentists for educational loans in exchange for the dentist agreeing to serve medicaid and under served populations c the division may amend the state plan and apply to the secretary of the united states department of health and human services for waivers or pilot programs if necessary to establish the new dental care delivery and payment reform model d the division shall evaluate the pilot program s effect on the cost of dental care and access to dental care for the targeted medicaid populations a as used in this subsection dental hygienist means an individual who is licensed as a dental hygienist under section b the department shall reimburse a dental hygienist for dental services performed in a public health setting and in accordance with subsection c beginning on the earlier of i january or ii days after the date on which the replacement of the department s medicaid management information system software is complete c the department shall reimburse a dental hygienist directly for a service provided through the medicaid program if i the dental hygienist requests to be reimbursed directly and ii the dental hygienist provides the service within the scope of practice described in section d before november of each year in which the department reimburses dental hygienists in accordance with subsection c the department shall report to the health and human services interim committee for the previous fiscal year i the number and geographic distribution of dental hygienists who requested to be reimbursed directly ii the total number of medicaid enrollees who were served by a dental hygienist who were reimbursed under this subsection iii the total amount reimbursed directly to dental hygienists under this subsection iv the specific services and billing codes that are reimbursed under this subsection and v the aggregate amount reimbursed for each service and billing code described in subsection d iv e i except as provided in this subsection nothing in this subsection shall be interpreted as expanding or otherwise altering the limitations and scope of practice for a dental hygienist ii a dental hygienist may only directly bill and receive compensation for billing codes that fall within the scope of practice of a dental hygienist section section b which is renumbered from section is renumbered and amended to read b administration of medicaid program by department reporting to the legislature disciplinary measures and sanctions funds collected eligibility standards internal audits health opportunity accounts the department shall be the single state agency responsible for the administration of the medicaid program in connection with the united states department of health and human services pursuant to title xix of the social security act a the department shall implement the medicaid program through administrative rules in conformity with this chapter title g chapter utah administrative rulemaking act the requirements of title xix and applicable federal regulations b the rules adopted under subsection a shall include in addition to other rules necessary to implement the program i the standards used by the department for determining eligibility for medicaid services ii the services and benefits to be covered by the medicaid program iii reimbursement methodologies for providers under the medicaid program and iv a requirement that a a person receiving medicaid services shall participate in the electronic exchange of clinical health records established in accordance with section b unless the individual opts out of participation b prior to enrollment in the electronic exchange of clinical health records the enrollee shall receive notice of enrollment in the electronic exchange of clinical health records and the right to opt out of participation at any time and c beginning july when the program sends enrollment or renewal information to the enrollee and when the enrollee logs onto the program s website the enrollee shall receive notice of the right to opt out of the electronic exchange of clinical health records a the department shall in accordance with subsection b report to the social services appropriations subcommittee when the department i implements a change in the medicaid state plan ii initiates a new medicaid waiver iii initiates an amendment to an existing medicaid waiver iv applies for an extension of an application for a waiver or an existing medicaid waiver v applies for or receives approval for a change in any capitation rate within the medicaid program or vi initiates a rate change that requires public notice under state or federal law b the report required by subsection a shall i be submitted to the social services appropriations subcommittee prior to the department implementing the proposed change and ii include a a description of the department s current practice or policy that the department is proposing to change b an explanation of why the department is proposing the change c the proposed change in services or reimbursement including a description of the effect of the change d the effect of an increase or decrease in services or benefits on individuals and families e the degree to which any proposed cut may result in cost shifting to more expensive services in health or human service programs and f the fiscal impact of the proposed change including i the effect of the proposed change on current or future appropriations from the legislature to the department ii the effect the proposed change may have on federal matching dollars received by the state medicaid program iii any cost shifting or cost savings within the department s budget that may result from the proposed change and iv identification of the funds that will be used for the proposed change including any transfer of funds within the department s budget any rules adopted by the department under subsection are subject to review and reauthorization by the legislature in accordance with section g the department may in its discretion contract with the department of human services or other qualified agencies for services in connection with the administration of the medicaid program including a the determination of the eligibility of individuals for the program b recovery of overpayments and c consistent with section b and to the extent permitted by law and quality control services enforcement of fraud and abuse laws the department shall provide by rule disciplinary measures and sanctions for medicaid providers who fail to comply with the rules and procedures of the program provided that sanctions imposed administratively may not extend beyond a termination from the program b recovery of claim reimbursements incorrectly paid and c those specified in section of title xix of the federal social security act a funds collected as a result of a sanction imposed under section of title xix of the federal social security act shall be deposited in the general fund as dedicated credits to be used by the division in accordance with the requirements of section of title xix of the federal social security act b in accordance with section j sanctions collected under this subsection are nonlapsing a in determining whether an applicant or recipient is eligible for a service or benefit under this part or chapter part utah children s health insurance act program the department shall if subsection b is satisfied exclude from consideration one passenger vehicle designated by the applicant or recipient b before subsection a may be applied i the federal government shall a determine that subsection a may be implemented within the state s existing public assistance related waivers as of january b extend a waiver to the state permitting the implementation of subsection a or c determine that the state s waivers that permit dual eligibility determinations for cash assistance and medicaid are no longer valid and ii the department shall determine that subsection a can be implemented within existing funding a for purposes of as used in this subsection i aged blind or has a disability means an aged blind or disabled individual as defined in u s c sec c a and ii spend down means an amount of income in excess of the allowable income standard that shall be paid in cash to the department or incurred through the medical services not paid by medicaid b in determining whether an applicant or recipient who is aged blind or has a disability is eligible for a service or benefit under this chapter the department shall use of the federal poverty level as i the allowable income standard for eligibility for services or benefits and ii the allowable income standard for eligibility as a result of spend down the department shall conduct internal audits of the medicaid program a the department may apply for and if approved implement a demonstration program for health opportunity accounts as provided for in u s c sec u b a health opportunity account established under subsection a shall be an alternative to the existing benefits received by an individual eligible to receive medicaid under this chapter c subsection a is not intended to expand the coverage of the medicaid program a i the department shall apply for and if approved implement an amendment to the state plan under this subsection for benefits for a medically needy pregnant women b medically needy children and c medically needy parents and caretaker relatives ii the department may implement the eligibility standards of subsection b for eligibility determinations made on or after the date of the approval of the amendment to the state plan b in determining whether an applicant is eligible for benefits described in subsection a i the department shall i disregard resources held in an account in the savings plan created under title b chapter a utah educational savings plan if the beneficiary of the account is a under the age of and b living with the account owner as that term is defined in section b a or temporarily absent from the residence of the account owner and ii include the withdrawals from an account in the utah educational savings plan as resources for a benefit determination if the withdrawal was not used for qualified higher education costs as that term is defined in section b a a the department may not deny or terminate eligibility for medicaid solely because an individual is i incarcerated and ii not an inmate as defined in section b subsection a does not require the medicaid program to provide coverage for any services for an individual while the individual is incarcerated the department is a party to and may intervene at any time in any judicial or administrative action a to which the department of workforce services is a party and b that involves medical assistance under this chapter i title chapter medical assistance act or ii title chapter utah children s health insurance act section section b which is renumbered from section is renumbered and amended to read b medicaid expansion the purpose of this section is to expand the coverage of the medicaid program to persons who are in categories traditionally not served by that program within appropriations from the legislature the department may amend the state plan for medical assistance to provide for eligibility for medicaid a on or after july for children to years old who live in households below the federal poverty income guideline and b on or after july for persons who have incomes below the federal poverty income guideline and who are aged blind or have a disability a within appropriations from the legislature on or after july the medicaid program may provide for eligibility for persons who have incomes below the federal poverty income guideline b in order to meet the provisions of this subsection the department may seek approval for a demonstration project under u s c sec from the secretary of the united states department of health and human services the medicaid program shall provide for eligibility for persons as required by subsection b services available for persons described in this section shall include required medicaid services and may include one or more optional medicaid services if those services are funded by the legislature the department may also require persons described in subsections through to meet an asset test section section b which is renumbered from section is renumbered and amended to read b copayments by recipients employer sponsored plans the department shall selectively provide for enrollment fees premiums deductions cost sharing or other similar charges to be paid by recipients their spouses and parents within the limitations of federal law and regulation beginning may within appropriations by the legislature and as a means to increase health care coverage among the uninsured the department shall take steps to promote increased participation in employer sponsored health insurance including a maximizing the health insurance premium subsidy provided under the state s demonstration waiver by i ensuring that state funds are matched by federal funds to the greatest extent allowable and ii as the department determines appropriate seeking federal approval to do one or more of the following a eliminate or otherwise modify the annual enrollment fee b eliminate or otherwise modify the schedule used to determine the level of subsidy provided to an enrollee each year c reduce the maximum number of participants allowable under the subsidy program or d otherwise modify the program in a manner that promotes enrollment in employer sponsored health insurance and b exploring the use of other options including the development of a waiver under the medicaid health insurance flexibility demonstration initiative or other federal authority section section b which is renumbered from section is renumbered and amended to read b income and resources from institutionalized spouses as used in this section a community spouse means the spouse of an institutionalized spouse b i community spouse monthly income allowance means an amount by which the minimum monthly maintenance needs allowance for the spouse exceeds the amount of monthly income otherwise available to the community spouse determined without regard to the allowance except as provided in subsection b ii ii if a court has entered an order against an institutionalized spouse for monthly income for the support of the community spouse the community spouse monthly income allowance for the spouse may not be less than the amount of the monthly income so ordered c community spouse resource allowance is the amount of combined resources that are protected for a community spouse living in the community which the division shall establish by rule made in accordance with title g chapter utah administrative rulemaking act based on the amounts established by the united states department of health and human services d excess shelter allowance for a community spouse means the amount by which the sum of the spouse s expense for rent or mortgage payment taxes and insurance and in the case of condominium or cooperative required maintenance charge for the community spouse s principal residence and the spouse s actual expenses for electricity natural gas and water utilities or at the discretion of the department the federal standard utility allowance under snap as defined in section a exceeds of the amount described in subsection e family member means a minor dependent child dependent parents or dependent sibling of the institutionalized spouse or community spouse who are residing with the community spouse f i institutionalized spouse means a person who is residing in a nursing facility and is married to a spouse who is not in a nursing facility ii an institutionalized spouse does not include a person who is not likely to reside in a nursing facility for at least consecutive days g nursing care facility means the same as that term is defined in section b the division shall comply with this section when determining eligibility for medical assistance for an institutionalized spouse for services furnished during a calendar year beginning on or after january the community spouse resource allowance shall be increased by the division by an amount as determined annually by cms the division shall compute as of the beginning of the first continuous period of institutionalization of the institutionalized spouse a the total value of the resources to the extent either the institutionalized spouse or the community spouse has an ownership interest and b a spousal share which is of the resources described in subsection a at the request of an institutionalized spouse or a community spouse at the beginning of the first continuous period of institutionalization of the institutionalized spouse and upon the receipt of relevant documentation of resources the division shall promptly assess and document the total value described in subsection a and shall provide a copy of that assessment and documentation to each spouse and shall retain a copy of the assessment when the division provides a copy of the assessment it shall include a notice stating that the spouse may request a hearing under subsection when determining eligibility for medical assistance under this chapter a except as provided in subsection b all resources held by either the institutionalized spouse community spouse or both are considered to be available to the institutionalized spouse b resources are considered to be available to the institutionalized spouse only to the extent that the amount of those resources exceeds the community spouse resource allowance at the time of application for medical assistance under this chapter a the division may not find an institutionalized spouse to be ineligible for medical assistance by reason of resources determined under subsection to be available for the cost of care when i the institutionalized spouse has assigned to the state any rights to support from the community spouse ii except as provided in subsection b the institutionalized spouse lacks the ability to execute an assignment due to physical or mental impairment or iii the division determines that denial of medical assistance would cause an undue burden b subsection a ii does not prevent the division from seeking a court order for an assignment of support during the continuous period in which an institutionalized spouse is in an institution and after the month in which an institutionalized spouse is eligible for medical assistance the resources of the community spouse may not be considered to be available to the institutionalized spouse when an institutionalized spouse is determined to be eligible for medical assistance in determining the amount of the spouse s income that is to be applied monthly for the cost of care in the nursing care facility the division shall deduct from the spouse s monthly income the following amounts in the following order a a personal needs allowance the amount of which is determined by the division b a community spouse monthly income allowance but only to the extent that the income of the institutionalized spouse is made available to or for the benefit of the community spouse c a family allowance for each family member equal to at least of the amount that the amount described in subsection a exceeds the amount of the family member s monthly income and d amounts for incurred expenses for the medical or remedial care for the institutionalized spouse the division shall establish a minimum monthly maintenance needs allowance for each community spouse that includes a an amount established by the division by rule made in accordance with title g chapter utah administrative rulemaking act based on the amounts established by the united states department of health and human services and b an excess shelter allowance a an institutionalized spouse or a community spouse may request a hearing with respect to the determinations described in subsections e i through v if an application for medical assistance has been made on behalf of the institutionalized spouse b a hearing under this subsection regarding the community spouse resource allowance shall be held by the division within days from the date of the request for the hearing c if either spouse establishes that the community spouse needs income above the level otherwise provided by the minimum monthly maintenance needs allowance due to exceptional circumstances resulting in significant financial duress there shall be substituted for the minimum monthly maintenance needs allowance provided under subsection an amount adequate to provide additional income as is necessary d if either spouse establishes that the community spouse resource allowance in relation to the amount of income generated by the allowance is inadequate to raise the community spouse s income to the minimum monthly maintenance needs allowance there shall be substituted for the community spouse resource allowance an amount adequate to provide a minimum monthly maintenance needs allowance e a hearing may be held under this subsection if either the institutionalized spouse or community spouse is dissatisfied with a determination of i the community spouse monthly income allowance ii the amount of monthly income otherwise available to the community spouse iii the computation of the spousal share of resources under subsection iv the attribution of resources under subsection or v the determination of the community spouse resource allocation a an institutionalized spouse may transfer an amount equal to the community spouse resource allowance but only to the extent the resources of the institutionalized spouse are transferred to or for the sole benefit of the community spouse b the transfer under subsection a shall be made as soon as practicable after the date of the initial determination of eligibility taking into account the time necessary to obtain a court order under subsection c c chapter medical benefits recovery act part medical benefits recovery does not apply if a court has entered an order against an institutionalized spouse for the support of the community spouse section section b which is renumbered from section is renumbered and amended to read b maximizing use of premium assistance programs utah s premium partnership for health insurance a the department shall seek to maximize the use of medicaid and children s health insurance program funds for assistance in the purchase of private health insurance coverage for medicaid eligible and non medicaid eligible individuals b the department s efforts to expand the use of premium assistance shall i include as necessary seeking federal approval under all medicaid and children s health insurance program premium assistance provisions of federal law including provisions of the patient protection and affordable care act public law ppaca ii give priority to but not be limited to expanding the state s utah premium partnership for health insurance program including as required under subsection and iii encourage the enrollment of all individuals within a household in the same plan where possible including enrollment in a plan that allows individuals within the household transitioning out of medicaid to retain the same network and benefits they had while enrolled in medicaid the department shall seek federal approval of an amendment to the state s utah premium partnership for health insurance program to adjust the eligibility determination for single adults and parents who have an offer of employer sponsored insurance the amendment shall a be within existing appropriations for the utah premium partnership for health insurance program and b provide that adults who are up to of the federal poverty level are eligible for premium subsidies in the utah premium partnership for health insurance program for the fiscal year the department shall seek authority to increase the maximum premium subsidy per month for adults under the utah premium partnership for health insurance program to beginning with the fiscal year and in each subsequent fiscal year the department may increase premium subsidies for single adults and parents who have an offer of employer sponsored insurance to keep pace with the increase in insurance premium costs subject to appropriation of additional funding section section b which is renumbered from section is renumbered and amended to read b expanding the medicaid program as used in this section a cms means the centers for medicare and medicaid services in the united states department of health and human services b a federal poverty level means the same as that term is defined in section b c b medicaid expansion means an expansion of the medicaid program in accordance with this section d c medicaid expansion fund means the medicaid expansion fund created in section b b a as set forth in subsections through eligibility criteria for the medicaid program shall be expanded to cover additional low income individuals b the department shall continue to seek approval from cms to implement the medicaid waiver expansion as defined in section b c the department may implement any provision described in subsections b b iii through viii in a medicaid expansion if the department receives approval from cms to implement that provision the department shall expand the medicaid program in accordance with this subsection if the department a receives approval from cms to i expand medicaid coverage to eligible individuals whose income is below of the federal poverty level ii obtain maximum federal financial participation under u s c sec d b for enrolling an individual in the medicaid expansion under this subsection and iii permit the state to close enrollment in the medicaid expansion under this subsection if the department has insufficient funds to provide services to new enrollment under the medicaid expansion under this subsection b pays the state portion of costs for the medicaid expansion under this subsection with funds from i the medicaid expansion fund ii county contributions to the nonfederal share of medicaid expenditures or iii any other contributions funds or transfers from a nonstate agency for medicaid expenditures and c closes the medicaid program to new enrollment under the medicaid expansion under this subsection if the department projects that the cost of the medicaid expansion under this subsection will exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act a the department shall expand the medicaid program in accordance with this subsection if the department i receives approval from cms to a expand medicaid coverage to eligible individuals whose income is below of the federal poverty level b obtain maximum federal financial participation under u s c sec d y for enrolling an individual in the medicaid expansion under this subsection and c permit the state to close enrollment in the medicaid expansion under this subsection if the department has insufficient funds to provide services to new enrollment under the medicaid expansion under this subsection ii pays the state portion of costs for the medicaid expansion under this subsection with funds from a the medicaid expansion fund b county contributions to the nonfederal share of medicaid expenditures or c any other contributions funds or transfers from a nonstate agency for medicaid expenditures and iii closes the medicaid program to new enrollment under the medicaid expansion under this subsection if the department projects that the cost of the medicaid expansion under this subsection will exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act b the department shall submit a waiver an amendment to an existing waiver or a state plan amendment to cms to i administer federal funds for the medicaid expansion under this subsection according to a per capita cap developed by the department that includes an annual inflationary adjustment accounts for differences in cost among categories of medicaid expansion enrollees and provides greater flexibility to the state than the current medicaid payment model ii limit in certain circumstances as defined by the department the ability of a qualified entity to determine presumptive eligibility for medicaid coverage for an individual enrolled in a medicaid expansion under this subsection iii impose a lock out period if an individual enrolled in a medicaid expansion under this subsection violates certain program requirements as defined by the department iv allow an individual enrolled in a medicaid expansion under this subsection to remain in the medicaid program for up to a month certification period as defined by the department and v allow federal medicaid funds to be used for housing support for eligible enrollees in the medicaid expansion under this subsection a i if cms does not approve a waiver to expand the medicaid program in accordance with subsection a on or before january the department shall develop proposals to implement additional flexibilities and cost controls including cost sharing tools within a medicaid expansion under this subsection through a request to cms for a waiver or state plan amendment ii the request for a waiver or state plan amendment described in subsection a i shall include a a path to self sufficiency for qualified adults in the medicaid expansion that includes employment and training as defined in u s c sec d and b a requirement that an individual who is offered a private health benefit plan by an employer to enroll in the employer s health plan iii the department shall submit the request for a waiver or state plan amendment developed under subsection a i on or before march b notwithstanding sections b and j and in accordance with this subsection eligibility for the medicaid program shall be expanded to include all persons in the optional medicaid expansion population under the patient protection and affordable care act pub l no ppaca and the health care education reconciliation act of pub l no and related federal regulations and guidance on the earlier of i the day on which cms approves a waiver to implement the provisions described in subsections a ii a and b or ii july c the department shall seek a waiver or an amendment to an existing waiver from federal law to i implement each provision described in subsections b b iii through viii in a medicaid expansion under this subsection ii limit in certain circumstances as defined by the department the ability of a qualified entity to determine presumptive eligibility for medicaid coverage for an individual enrolled in a medicaid expansion under this subsection and iii impose a lock out period if an individual enrolled in a medicaid expansion under this subsection violates certain program requirements as defined by the department d the eligibility criteria in this subsection shall be construed to include all individuals eligible for the health coverage improvement program under section b e the department shall pay the state portion of costs for a medicaid expansion under this subsection entirely from i the medicaid expansion fund ii county contributions to the nonfederal share of medicaid expenditures or iii any other contributions funds or transfers from a nonstate agency for medicaid expenditures f if the costs of the medicaid expansion under this subsection exceed the funds available under subsection e i the department may reduce or eliminate optional medicaid services under this chapter and ii savings as determined by the department from the reduction or elimination of optional medicaid services under subsection f i shall be deposited into the medicaid expansion fund and iii the department may submit to cms a request for waivers or an amendment of existing waivers from federal law necessary to implement budget controls within the medicaid program to address the deficiency g if the costs of the medicaid expansion under this subsection are projected by the department to exceed the funds available in the current fiscal year under subsection e including savings resulting from any action taken under subsection f i the governor shall direct the department of health department of human services department and department of workforce services to reduce commitments and expenditures by an amount sufficient to offset the deficiency a proportionate to the share of total current fiscal year general fund appropriations for each of those agencies and b up to of each agency s total current fiscal year general fund appropriations ii the division of finance shall reduce allotments to the department of health department of human services department and department of workforce services by a percentage a proportionate to the amount of the deficiency and b up to of each agency s total current fiscal year general fund appropriations and iii the division of finance shall deposit the total amount from the reduced allotments described in subsection g ii into the medicaid expansion fund the department shall maximize federal financial participation in implementing this section including by seeking to obtain any necessary federal approvals or waivers notwithstanding sections and a county does not have to provide matching funds to the state for the cost of providing medicaid services to newly enrolled individuals who qualify for medicaid coverage under a medicaid expansion the department shall report to the social services appropriations subcommittee on or before november of each year that a medicaid expansion is operational a the number of individuals who enrolled in the medicaid expansion b costs to the state for the medicaid expansion c estimated costs to the state for the medicaid expansion for the current and following fiscal years d recommendations to control costs of the medicaid expansion and e as calculated in accordance with subsections b b and c b the state s net cost of the qualified medicaid expansion section section b which is renumbered from section is renumbered and amended to read b department standards for eligibility under medicaid funds for abortions a the department may develop standards and administer policies relating to eligibility under the medicaid program as long as they are consistent with subsection b b an applicant receiving medicaid assistance may be limited to particular types of care or services or to payment of part or all costs of care determined to be medically necessary the department may not provide any funds for medical hospital or other medical expenditures or medical services to otherwise eligible persons where the purpose of the assistance is to perform an abortion unless the life of the mother would be endangered if an abortion were not performed any employee of the department who authorizes payment for an abortion contrary to the provisions of this section is guilty of a class b misdemeanor and subject to forfeiture of office any person or organization that under the guise of other medical treatment provides an abortion under auspices of the medicaid program is guilty of a third degree felony and subject to forfeiture of license to practice medicine or authority to provide medical services and treatment section section b which is renumbered from section is renumbered and amended to read b contracts for provision of medical services federal provisions modifying department rules compliance with social security act the department may contract with other public or private agencies to purchase or provide medical services in connection with the programs of the division where these programs are used by other government entities contracts shall provide that other government entities in compliance with state and federal law regarding intergovernmental transfers transfer the state matching funds to the department in amounts sufficient to satisfy needs of the specified program contract terms shall include provisions for maintenance administration and service costs if a federal legislative or executive provision requires modifications or revisions in an eligibility factor established under this chapter as a condition for participation in medical assistance the department may modify or change its rules as necessary to qualify for participation the provisions of this section do not apply to department rules governing abortion the department shall comply with all pertinent requirements of the social security act and all orders rules and regulations adopted thereunder when required as a condition of participation in benefits under the social security act section section b which is renumbered from section is renumbered and amended to read b liability insurance required the medicaid program may not reimburse a home health agency as defined in section b for home health services provided to an enrollee unless the home health agency has liability coverage of at least per incident or an amount established by department rule made in accordance with title g chapter utah administrative rulemaking act section section b which is renumbered from section is renumbered and amended to read b federal aid authority of executive director the executive director with the approval of the governor may bind the state to any executive or legislative provisions promulgated or enacted by the federal government which invite the state to participate in the distribution disbursement or administration of any fund or service advanced offered or contributed in whole or in part by the federal government for purposes consistent with the powers and duties of the department such funds shall be used as provided in this chapter and be administered by the department for purposes related to medical assistance programs section section b which is renumbered from section is renumbered and amended to read b medical vendor rates medical vendor payments made to providers of services for and in behalf of recipient households shall be based upon predetermined rates from standards developed by the division in cooperation with providers of services for each type of service purchased by the division as far as possible the rates paid for services shall be established in advance of the fiscal year for which funds are to be requested section section b which is renumbered from section is renumbered and amended to read b enforcement of public assistance statutes the department shall enforce or contract for the enforcement of sections a a a a a and a to the extent that these sections pertain to benefits conferred or administered by the division under this chapter to the extent allowed under federal law or regulation the department may contract for services covered in section a insofar as that section pertains to benefits conferred or administered by the division under this chapter section section b which is renumbered from section is renumbered and amended to read b prohibited acts of state or local employees of medicaid program violation a misdemeanor each state or local employee responsible for the expenditure of funds under the state medicaid program each individual who formerly was such an officer or employee and each partner of such an officer or employee is prohibited for a period of one year after termination of such responsibility from committing any act the commission of which by an officer or employee of the united states government an individual who was such an officer or employee or a partner of such an officer or employee is prohibited by section or section of title united states code violation of this section is a class a misdemeanor section section b which is renumbered from section is renumbered and amended to read b rural hospitals for purposes of as used in this section rural hospital means a hospital located outside of a standard metropolitan statistical area as designated by the united states bureau of the census for purposes of the medicaid program the division of medicaid and health financing division may not discriminate among rural hospitals on the basis of size section section b which is renumbered from section is renumbered and amended to read b telemedicine reimbursement rulemaking a as used in this section communication by telemedicine is considered face to face contact between a health care provider and a patient under the state s medical assistance program if i the communication by telemedicine meets the requirements of administrative rules adopted in accordance with subsection and ii the health care services are eligible for reimbursement under the state s medical assistance program b this subsection applies to any managed care organization that contracts with the state s medical assistance program the reimbursement rate for telemedicine services approved under this section a shall be subject to reimbursement policies set by the state plan and b may be based on i a monthly reimbursement rate ii a daily reimbursement rate or iii an encounter rate the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act which establish a the particular telemedicine services that are considered face to face encounters for reimbursement purposes under the state s medical assistance program and b the reimbursement methodology for the telemedicine services designated under subsection a section section b which is renumbered from section is renumbered and amended to read b reimbursement of telemedicine services and telepsychiatric consultations as used in this section a telehealth services means the same as that term is defined in section b b telemedicine services means the same as that term is defined in section b c telepsychiatric consultation means a consultation between a physician and a board certified psychiatrist both of whom are licensed to engage in the practice of medicine in the state that utilizes i the health records of the patient provided from the patient or the referring physician ii a written evidence based patient questionnaire and iii telehealth services that meet industry security and privacy standards including compliance with the a health insurance portability and accountability act and b health information technology for economic and clinical health act pub l no stat as amended this section applies to a a managed care organization that contracts with the medicaid program and b a provider who is reimbursed for health care services under the medicaid program the medicaid program shall reimburse for telemedicine services at the same rate that the medicaid program reimburses for other health care services the medicaid program shall reimburse for telepsychiatric consultations at a rate set by the medicaid program section section b which is renumbered from section is renumbered and amended to read b process to promote health insurance coverage for children the department in collaboration with the department of workforce services and the state board of education shall develop a process to promote health insurance coverage for a child in school when a the child applies for free or reduced price school lunch b a child enrolls in or registers in school and c other appropriate school related opportunities the department in collaboration with the department of workforce services shall promote and facilitate the enrollment of children identified under subsection without health insurance in the utah children s health insurance program the medicaid program or the utah premium partnership for health insurance program section section b which is renumbered from section is renumbered and amended to read b medicaid continuous eligibility promoting payment and delivery reform in accordance with subsection and within appropriations from the legislature the department may amend the state medicaid plan to a create continuous eligibility for up to months for an individual who has qualified for the state medicaid program b provide incentives in managed care contracts for an individual to obtain appropriate care in appropriate settings and c require the managed care system to accept the risk of managing the medicaid population assigned to the plan amendment in return for receiving the benefits of providing quality and cost effective care if the department amends the state medicaid plan under subsection a or b the department a shall ensure that the plan amendment i is cost effective for the state medicaid program ii increases the quality and continuity of care for recipients and iii calculates and transfers administrative savings from continuous enrollment from the department of workforce services to the department of health department and b may limit the plan amendment under subsection a or b to select geographic areas or specific medicaid populations the department may seek approval for a state plan amendment waiver or a demonstration project from the secretary of the united states department of health and human services if necessary to implement a plan amendment under subsection a or b section section b which is renumbered from section is renumbered and amended to read b patient notice of health care provider privacy practices a for purposes of this section i health care provider means a health care provider as defined in section b who a receives payment for medical services from the medicaid program established in this chapter or the children s health insurance program established in chapter utah children s health insurance act section b and b submits a patient s personally identifiable information to the medicaid eligibility database or the children s health insurance program eligibility database ii hipaa means c f r parts and health insurance portability and accountability act of as amended b beginning july this section applies to the medicaid program the children s health insurance program created in chapter utah children s health insurance act section b and a health care provider a health care provider shall as part of the notice of privacy practices required by hipaa provide notice to the patient or the patient s personal representative that the health care provider either has or may submit personally identifiable information about the patient to the medicaid eligibility database and the children s health insurance program eligibility database the medicaid program and the children s health insurance program may not give a health care provider access to the medicaid eligibility database or the children s health insurance program eligibility database unless the health care provider s notice of privacy practices complies with subsection the department may adopt an administrative rule to establish uniform language for the state requirement regarding notice of privacy practices to patients required under subsection section section b which is renumbered from section is renumbered and amended to read b optional medicaid expansion the department and the governor may not expand the state s medicaid program under ppaca unless a the department expands medicaid in accordance with section b or b i the governor or the governor s designee has reported the intention to expand the state medicaid program under ppaca to the legislature in compliance with the legislative review process in section b and ii the governor submits the request for expansion of the medicaid program for optional populations to the legislature under the high impact federal funds request process required by section j a the department shall request approval from cms for waivers from federal statutory and regulatory law necessary to implement the health coverage improvement program under section b b the health coverage improvement program under section b is not subject to the requirements in subsection section section b which is renumbered from section is renumbered and amended to read b medicaid vision services request for proposals the department may select one or more contractors in accordance with title g chapter a utah procurement code to provide vision services to the medicaid populations that are eligible for vision services as described in department rules without restricting provider participation and within existing appropriations from the legislature section section b which is renumbered from section is renumbered and amended to read b review of claims audit and investigation procedures a the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act and in consultation with providers and health care professionals subject to audit and investigation under the state medicaid program to establish procedures for audits and investigations that are fair and consistent with the duties of the department as the single state agency responsible for the administration of the medicaid program under section b and title xix of the social security act b if the providers and health care professionals do not agree with the rules proposed or adopted by the department under subsection a the providers or health care professionals may i request a hearing for the proposed administrative rule or seek any other remedies under the provisions of title g chapter utah administrative rulemaking act and ii request a review of the rule by the legislature s administrative rules review and general oversight committee created in section g the department shall a notify and educate providers and health care professionals subject to audit and investigation under the medicaid program of the providers and health care professionals responsibilities and rights under the administrative rules adopted by the department under the provisions of this section b ensure that the department or any entity that contracts with the department to conduct audits i has on staff or contracts with a medical or dental professional who is experienced in the treatment billing and coding procedures used by the type of provider being audited and ii uses the services of the appropriate professional described in subsection b i if the provider who is the subject of the audit disputes the findings of the audit c ensure that a finding of overpayment or underpayment to a provider is not based on extrapolation as defined in section a unless i there is a determination that the level of payment error involving the provider exceeds a error rate a for a sample of claims for a particular service code and b over a three year period of time ii documented education intervention has failed to correct the level of payment error and iii the value of the claims for the provider in aggregate exceeds in reimbursement for a particular service code on an annual basis and d require that any entity with which the office contracts for the purpose of conducting an audit of a service provider shall be paid on a flat fee basis for identifying both overpayments and underpayments a if the department or a contractor on behalf of the department i intends to implement the use of extrapolation as a method of auditing claims the department shall prior to adopting the extrapolation method of auditing report its intent to use extrapolation to the social services appropriations subcommittee and ii determines subsections c i through iii are applicable to a provider the department or the contractor may use extrapolation only for the service code associated with the findings under subsections c i through iii b i if extrapolation is used under this section a provider may at the provider s option appeal the results of the audit based on a each individual claim or b the extrapolation sample ii nothing in this section limits a provider s right to appeal the audit under title g general government title g chapter administrative procedures act the medicaid program and its manual or rules or other laws or rules that may provide remedies to providers section section b which is renumbered from section is renumbered and amended to read b medicaid intergovernmental transfer report approval requirements as used in this section a i intergovernmental transfer means the transfer of public funds from a a local government entity to another nonfederal governmental entity or b from a nonfederal government owned health care facility regulated under chapter health care facility licensing and inspection act chapter part health care facility licensing and inspection to another nonfederal governmental entity ii intergovernmental transfer does not include a the transfer of public funds from one state agency to another state agency or b a transfer of funds from the university of utah hospitals and clinics b i intergovernmental transfer program means a federally approved reimbursement program or category that is authorized by the medicaid state plan or waiver authority for intergovernmental transfers ii intergovernmental transfer program does not include the addition of a provider to an existing intergovernmental transfer program c local government entity means a county city town special service district local district or local education agency as that term is defined in section j d non state government entity means a hospital authority hospital district health care district special service district county or city a an entity that receives federal medicaid dollars from the department as a result of an intergovernmental transfer shall on or before august and on or before august each year thereafter provide the department with i information regarding the payments funded with the intergovernmental transfer as authorized by and consistent with state and federal law ii information regarding the entity s ability to repay federal funds to the extent required by the department in the contract for the intergovernmental transfer and iii other information reasonably related to the intergovernmental transfer that may be required by the department in the contract for the intergovernmental transfer b on or before october and on or before october each subsequent year the department shall prepare a report for the executive appropriations committee that includes i the amount of each intergovernmental transfer under subsection a ii a summary of changes to cms regulations and practices that are known by the department regarding federal funds related to an intergovernmental transfer program and iii other information the department gathers about the intergovernmental transfer under subsection a the department shall not create a new intergovernmental transfer program after july unless the department reports to the executive appropriations committee in accordance with section j before submitting the new intergovernmental transfer program for federal approval the report shall include information required by subsection j d and the analysis required in subsections a and b a the department shall enter into new nursing care facility non state government owned upper payment limit program contracts and contract amendments adding new nursing care facilities and new non state government entity operators in accordance with this subsection b i if the nursing care facility expects to receive less than in federal funds each year from the nursing care facility non state government owned upper payment limit program excluding seed funding and administrative fees paid by the non state government entity the department shall enter into a nursing care facility non state government owned upper payment limit program contract with the non state government entity operator of the nursing care facility ii if the nursing care facility expects to receive between and in federal funds each year from the nursing care facility non state government owned upper payment limit program excluding seed funding and administrative fees paid by the non state government entity the department shall enter into a nursing care facility non state government owned upper payment limit program contract with the non state government entity operator of the nursing care facility after receiving the approval of the executive appropriations committee iii if the nursing care facility expects to receive more than in federal funds each year from the nursing care facility non state government owned upper payment limit program excluding seed funding and administrative fees paid by the non state government entity the department may not approve the application without obtaining approval from the legislature and the governor c a non state government entity may not participate in the nursing care facility non state government owned upper payment limit program unless the non state government entity is a special service district county or city that operates a hospital or holds a license under chapter health care facility licensing and inspection act chapter part health care facility licensing and inspection d each non state government entity that participates in the nursing care facility non state government owned upper payment limit program shall certify to the department that i the non state government entity is a local government entity that is able to make an intergovernmental transfer under applicable state and federal law ii the non state government entity has sufficient public funds or other permissible sources of seed funding that comply with the requirements in c f r part subpart b iii the funds received from the nursing care facility non state government owned upper payment limit program are a for each nursing care facility available for patient care until the end of the non state government entity s fiscal year and b used exclusively for operating expenses for nursing care facility operations patient care capital expenses rent royalties and other operating expenses and iv the non state government entity has completed all licensing enrollment and other forms and documents required by federal and state law to register a change of ownership with the department and with cms the department shall add a nursing care facility to an existing nursing care facility non state government owned upper payment limit program contract if a the nursing care facility is managed by or affiliated with the same non state government entity that also manages one or more nursing care facilities that are included in an existing nursing care facility non state government owned upper payment limit program contract and b the non state government entity makes the certification described in subsection d ii the department may not increase the percentage of the administrative fee paid by a non state government entity to the department under the nursing care facility non state government owned upper payment limit program the department may not condition participation in the nursing care facility non state government owned upper payment limit program on a a requirement that the department be allowed to direct or determine the types of patients that a non state government entity will treat or the course of treatment for a patient in a non state government nursing care facility or b a requirement that a non state government entity or nursing care facility post a bond purchase insurance or create a reserve account of any kind the non state government entity shall have the primary responsibility for ensuring compliance with subsection d ii a the department may not enter into a new nursing care facility non state government owned upper payment limit program contract before january b subsection a does not apply to i a new nursing care facility non state government owned upper payment limit program contract that was included in the federal funds request summary under section j for fiscal year or ii a nursing care facility that is operated or managed by the same company as a nursing care facility that was included in the federal funds request summary under section j for fiscal year section section b which is renumbered from section is renumbered and amended to read b screening brief intervention and referral to treatment medicaid reimbursement as used in this section a controlled substance prescriber means a controlled substance prescriber as that term is defined in section who i has a record of having completed sbirt training in accordance with subsection before providing the sbirt services and ii is a medicaid enrolled health care provider b sbirt means the same as that term is defined in section the department shall reimburse a controlled substance prescriber who provides sbirt services to a medicaid enrollee who is years of age old or older for the sbirt services section section b which is renumbered from section is renumbered and amended to read b prescribing policies for opioid prescriptions the department may implement a prescribing policy for certain opioid prescriptions that is substantially similar to the prescribing policies required in section a the department may amend the state program and apply for waivers for the state program if necessary to implement subsection section section b which is renumbered from section is renumbered and amended to read b reimbursement for long acting reversible contraception immediately following childbirth as used in this section long acting reversible contraception means a contraception method that requires administration less than once per month including a an intrauterine device and b a contraceptive implant the division shall separately identify and reimburse from other labor and delivery services within the medicaid program the provision and insertion of long acting reversible contraception immediately after childbirth section section b which is renumbered from section is renumbered and amended to read b coverage of exome sequence testing as used in this section exome sequence testing means a genomic technique for sequencing the genome of an individual for diagnostic purposes the medicaid program shall reimburse for exome sequence testing a for an enrollee who i is younger than years of age old and ii who remains undiagnosed after exhausting all other appropriate diagnostic related tests b performed by a nationally recognized provider with significant experience in exome sequence testing c that is medically necessary and d at a rate set by the medicaid program section section b which is renumbered from section is renumbered and amended to read b reimbursement for nonemergency secured behavioral health transport providers the department may not reimburse a nonemergency secured behavioral health transport provider that is designated under section a b section section b which is renumbered from section is renumbered and amended to read b children s health care coverage program as used in this section a chip means the children s health insurance program created in section b b program means the children s health care coverage program created in subsection a there is created the children s health care coverage program within the department b the purpose of the program is to i promote health insurance coverage for children in accordance with section b ii conduct research regarding families who are eligible for medicaid and chip to determine awareness and understanding of available coverage iii analyze trends in disenrollment and identify reasons that families may not be renewing enrollment including any barriers in the process of renewing enrollment iv administer surveys to recently enrolled chip and children s medicaid enrollees to identify a how the enrollees learned about coverage and b any barriers during the application process v develop promotional material regarding chip and children s medicaid eligibility including outreach through social media video production and other media platforms vi identify ways that the eligibility website for enrollment in chip and children s medicaid can be redesigned to increase accessibility and enhance the user experience vii identify outreach opportunities including partnerships with community organizations including a schools b small businesses c unemployment centers d parent teacher associations and e youth athlete clubs and associations and viii develop messaging to increase awareness of coverage options that are available through the department a the department may not delegate implementation of the program to a private entity b notwithstanding subsection a the department may contract with a media agency to conduct the activities described in subsection b iv and vii section section b which is renumbered from section is renumbered and amended to read b reimbursement for diabetes prevention program as used in this section dpp means the national diabetes prevention program developed by the united states centers for disease control and prevention beginning july the medicaid program shall reimburse a provider for an enrollee s participation in the dpp if the enrollee a meets the dpp s eligibility requirements and b has not previously participated in the dpp after july while enrolled in the medicaid program subject to appropriation the medicaid program may set the rate for reimbursement the department may apply for a state plan amendment if necessary to implement this section a on or after july but before october the department shall provide a written report regarding the efficacy of the dpp and reimbursement under this section to the health and human services interim committee b the report described in subsection a shall include i the total number of enrollees with a prediabetic condition as of july ii the total number of enrollees as of july with a diagnosis of type diabetes iii the total number of enrollees who participated in the dpp iv the total cost incurred by the state to implement this section and v any conclusions that can be drawn regarding the impact of the dpp on the rate of type diabetes for enrollees section section b which is renumbered from section is renumbered and amended to read b behavioral health delivery working group as used in this section targeted adult medicaid program means the same as that term is defined in section b on or before may the department shall convene a working group to collaborate with the department on a establishing specific and measurable metrics regarding i compliance of managed care organizations in the state with federal medicaid managed care requirements ii timeliness and accuracy of authorization and claims processing in accordance with medicaid policy and contract requirements iii reimbursement by managed care organizations in the state to providers to maintain adequacy of access to care iv availability of care management services to meet the needs of medicaid eligible individuals enrolled in the plans of managed care organizations in the state and v timeliness of resolution for disputes between a managed care organization and the managed care organization s providers and enrollees b improving the delivery of behavioral health services in the medicaid program c proposals to implement the delivery system adjustments authorized under subsection b and d issues that are identified by managed care organizations behavioral health service providers and the department the working group convened under subsection shall a meet quarterly and b consist of at least the following individuals i the executive director or the executive director s designee ii for each medicaid accountable care organization with which the department contracts an individual selected by the accountable care organization iii five individuals selected by the department to represent various types of behavioral health services providers including at a minimum individuals who represent providers who provide the following types of services a acute inpatient behavioral health treatment b residential treatment c intensive outpatient or partial hospitalization treatment and d general outpatient treatment iv a representative of an association that represents behavioral health treatment providers in the state designated by the utah behavioral healthcare council convened by the utah association of counties v a representative of an organization representing behavioral health organizations vi the chair of the utah substance use and mental health advisory council created in section m vii a representative of an association that represents local authorities who provide public behavioral health care designated by the department viii one member of the senate appointed by the president of the senate and ix one member of the house of representatives appointed by the speaker of the house of representatives the working group convened under this section shall recommend to the department a specific and measurable metrics under subsection a b how physical and behavioral health services may be integrated for the targeted adult medicaid program including ways the department may address issues regarding i filing of claims ii authorization and reauthorization for treatment services iii reimbursement rates and iv other issues identified by the department behavioral health services providers or medicaid managed care organizations c ways to improve delivery of behavioral health services to enrollees including changes to statute or administrative rule and d wraparound service coverage for enrollees who need specific nonclinical services to ensure a path to success section section b which is renumbered from section is renumbered and amended to read b adjudicative proceedings related to medicaid funds if a proceeding of the department under title g chapter administrative procedures act relates in any way to recovery of medicaid funds a the presiding officer shall be designated by the executive director of the department and report directly to the executive director or in the discretion of the executive director report directly to the director of the office of internal audit and b the decision of the presiding officer is the recommended decision to the executive director of the department or a designee of the executive director who is not in the division subsection does not apply to hearings conducted by the department of workforce services relating to medical assistance eligibility determinations if a proceeding of the department under title g chapter administrative procedures act relates in any way to medicaid or medicaid funds the following may attend and present evidence or testimony at the proceeding a the director of the office of internal audit or the director s designee and b the inspector general of medicaid services or the inspector general s designee in relation to a proceeding of the department under title g chapter administrative procedures act a person may not outside of the actual proceeding attempt to influence the decision of the presiding officer section section b which is renumbered from section is renumbered and amended to read b medical assistance accountability division duties reporting as used in this section a abuse means i an action or practice that a is inconsistent with sound fiscal business or medical practices and b results or may result in unnecessary medicaid related costs or other medical or hospital assistance costs or ii reckless or negligent upcoding b fraud means intentional or knowing i deception misrepresentation or upcoding in relation to medicaid funds costs claims reimbursement or practice or ii deception or misrepresentation in relation to medical or hospital assistance funds costs claims reimbursement or practice c upcoding means assigning an inaccurate billing code for a service that is payable or reimbursable by medicaid funds if the correct billing code for the service taking into account reasonable opinions derived from official published coding definitions would result in a lower medicaid payment or reimbursement d waste means overutilization of resources or inappropriate payment the division shall a develop and implement procedures relating to medicaid funds and medical or hospital assistance funds to ensure that providers do not receive a i duplicate payments for the same goods or services b ii payment for goods or services by resubmitting a claim for which i a payment has been disallowed on the grounds that payment would be a violation of federal or state law administrative rule or the state plan and ii b the decision to disallow the payment has become final c iii payment for goods or services provided after a recipient s death including payment for pharmaceuticals or long term care or d iv payment for transporting an unborn infant b consult with the centers for medicaid and medicare services cms other states and the office of inspector general of medicaid services to determine and implement best practices for discovering and eliminating fraud waste and abuse of medicaid funds and medical or hospital assistance funds c actively seek repayment from providers for improperly used or paid a i medicaid funds and b ii medical or hospital assistance funds d coordinate track and keep records of all division efforts to obtain repayment of the funds described in subsection c and the results of those efforts e keep medicaid pharmaceutical costs as low as possible by actively seeking to obtain pharmaceuticals at the lowest price possible including on a quarterly basis for the pharmaceuticals that represent the highest of state medicaid expenditures for pharmaceuticals and on an annual basis for the remaining pharmaceuticals a i tracking changes in the price of pharmaceuticals b ii checking the availability and price of generic drugs c iii reviewing and updating the state s maximum allowable cost list and d iv comparing pharmaceutical costs of the state medicaid program to available pharmacy price lists and f provide training on an annual basis to the employees of the division who make decisions on billing codes or who are in the best position to observe and identify upcoding in order to avoid and detect upcoding section section b which is renumbered from section is renumbered and amended to read b medical assistance from division or department of workforce services and compliance under adoption assistance interstate compact penalty for fraudulent claim as used in this section a adoption assistance means the same as that term is defined in section b adoption assistance agreement means the same as that term is defined in section c adoption assistance interstate compact means an agreement executed by the division of child and family services with any other state in accordance with section a a child who is a resident of this state and is the subject of an adoption assistance interstate compact is entitled to receive medical assistance from the division and the department of workforce services by filing a certified copy of the child s adoption assistance agreement with the division or the department of workforce services b the adoptive parent of the child described in subsection a shall annually provide the division or the department of workforce services with evidence verifying that the adoption assistance agreement is still effective the department of workforce services shall consider the recipient of medical assistance under this section as the department of workforce services does any other recipient of medical assistance under an adoption assistance agreement executed by the division of child and family services a a person may not submit a claim for payment or reimbursement under this section that the person knows is false misleading or fraudulent b a violation of subsection a is a third degree felony the division and the department of workforce services shall a cooperate with the division of child and family services in regard to an adoption assistance interstate compact and b comply with an adoption assistance interstate compact section section b which is renumbered from section is renumbered and amended to read part medicaid waivers b medicaid waiver for independent foster care adolescents for purposes of as used in this section an independent foster care adolescent includes any individual who reached years of age old while in the custody of the division of child and family services or the department of human services department if the division of child and family services department was the primary case manager or a federally recognized indian tribe an independent foster care adolescent is eligible when funds are available for medicaid coverage until the individual reaches years of age old before july the division shall submit a state medicaid plan amendment to the center for medicaid services cms to provide medical coverage for independent foster care adolescents effective fiscal year section section b which is renumbered from section is renumbered and amended to read b waivers to maximize replacement of fee for service delivery model cost of mandated program changes the department shall develop a waiver program in the medicaid program to replace the fee for service delivery model with one or more risk based delivery models the waiver program shall a restructure the program s provider payment provisions to reward health care providers for delivering the most appropriate services at the lowest cost and in ways that compared to services delivered before implementation of the waiver program maintain or improve recipient health status b restructure the program s cost sharing provisions and other incentives to reward recipients for personal efforts to i maintain or improve their health status and ii use providers that deliver the most appropriate services at the lowest cost c identify the evidence based practices and measures risk adjustment methodologies payment systems funding sources and other mechanisms necessary to reward providers for delivering the most appropriate services at the lowest cost including mechanisms that i pay providers for packages of services delivered over entire episodes of illness rather than for individual services delivered during each patient encounter and ii reward providers for delivering services that make the most positive contribution to a recipient s health status d limit total annual per patient per month expenditures for services delivered through fee for service arrangements to total annual per patient per month expenditures for services delivered through risk based arrangements covering similar recipient populations and services and e except as provided in subsection limit the rate of growth in per patient per month general fund expenditures for the program to the rate of growth in general fund expenditures for all other programs when the rate of growth in the general fund expenditures for all other programs is greater than zero to the extent possible the department shall operate the waiver program with the input of stakeholder groups representing those who will be affected by the waiver program a for purposes of this subsection mandated program change shall be determined by the department in consultation with the medicaid accountable care organizations and may include a change to the state medicaid program that is required by state or federal law state or federal guidance policy or the state medicaid plan b a mandated program change shall be included in the base budget for the medicaid program for the fiscal year in which the medicaid program adopted the mandated program change c the mandated program change is not subject to the limit on the rate of growth in per patient per month general fund expenditures for the program established in subsection e until the fiscal year following the fiscal year in which the medicaid program adopted the mandated program change a managed care organization or a pharmacy benefit manager that provides a pharmacy benefit to an enrollee shall establish a unique group number payment classification number or bank identification number for each medicaid managed care organization plan for which the managed care organization or pharmacy benefit manager provides a pharmacy benefit section section b which is renumbered from section is renumbered and amended to read b base budget appropriations for medicaid accountable care organizations and behavioral health plans forecast of behavioral health services cost as used in this section a aco means an accountable care organization that contracts with the state s medicaid program for i physical health services or ii integrated physical and behavioral health services b base budget means the same as that term is defined in legislative rule c behavioral health plan means a managed care or fee for service delivery system that contracts with or is operated by the department to provide behavioral health services to medicaid eligible individuals d behavioral health services means mental health or substance use treatment or services e general fund growth factor means the amount determined by dividing the next fiscal year ongoing general fund revenue estimate by current fiscal year ongoing appropriations from the general fund f next fiscal year ongoing general fund revenue estimate means the next fiscal year ongoing general fund revenue estimate identified by the executive appropriations committee in accordance with legislative rule for use by the office of the legislative fiscal analyst in preparing budget recommendations g pmpm means per member per month funding if the general fund growth factor is less than the next fiscal year base budget shall subject to subsection include an appropriation to the department in an amount necessary to ensure that the next fiscal year pmpm for acos and behavioral health plans equals the current fiscal year pmpm for the acos and behavioral health plans multiplied by if the general fund growth factor is greater than or equal to but less than the next fiscal year base budget shall subject to subsection include an appropriation to the department in an amount necessary to ensure that the next fiscal year pmpm for acos and behavioral health plans equals the current fiscal year pmpm for the acos and behavioral health plans multiplied by the general fund growth factor if the general fund growth factor is greater than or equal to the next fiscal year base budget shall subject to subsection include an appropriation to the department in an amount necessary to ensure that the next fiscal year pmpm for acos and behavioral health plans is greater than or equal to the current fiscal year pmpm for the acos and behavioral health plans multiplied by and less than or equal to the current fiscal year pmpm for the acos and behavioral health plans multiplied by the general fund growth factor the appropriations provided to the department for behavioral health plans under this section shall be reduced by the amount contributed by counties in the current fiscal year for behavioral health plans in accordance with subsections k and a x in order for the department to estimate the impact of subsections through before identification of the next fiscal year ongoing general fund revenue estimate the governor s office of planning and budget shall in cooperation with the office of the legislative fiscal analyst develop an estimate of ongoing general fund revenue for the next fiscal year and provide the estimate to the department no later than november of each year the office of the legislative fiscal analyst shall include an estimate of the cost of behavioral health services in any state medicaid funding or savings forecast that is completed in coordination with the department and the governor s office of planning and budget section section b which is renumbered from section is renumbered and amended to read b incentives to appropriately use emergency department services a this section applies to the medicaid program and to the utah children s health insurance program created in chapter utah children s health insurance act section b b as used in this section i managed care organization means a comprehensive full risk managed care delivery system that contracts with the medicaid program or the children s health insurance program to deliver health care through a managed care plan ii managed care plan means a risk based delivery service model authorized by section b and administered by a managed care organization iii non emergent care a means use of the emergency department to receive health care that is non emergent as defined by the department by administrative rule adopted in accordance with title g chapter utah administrative rulemaking act and the emergency medical treatment and active labor act and b does not mean the medical services provided to an individual required by the emergency medical treatment and active labor act including services to conduct a medical screening examination to determine if the recipient has an emergent or non emergent condition iv professional compensation means payment made for services rendered to a medicaid recipient by an individual licensed to provide health care services v super utilizer means a medicaid recipient who has been identified by the recipient s managed care organization as a person who uses the emergency department excessively as defined by the managed care organization a a managed care organization may in accordance with subsections b and c i audit emergency department services provided to a recipient enrolled in the managed care plan to determine if non emergent care was provided to the recipient and ii establish differential payment for emergent and non emergent care provided in an emergency department b i the differential payments under subsection a ii do not apply to professional compensation for services rendered in an emergency department ii except in cases of suspected fraud waste and abuse a managed care organization s audit of payment under subsection a i is limited to the month period of time after the date on which the medical services were provided to the recipient if fraud waste or abuse is alleged the managed care organization s audit of payment under subsection a i is limited to three years after the date on which the medical services were provided to the recipient c the audits and differential payments under subsections a and b apply to services provided to a recipient on or after july a managed care organization shall a use the savings under subsection to maintain and improve access to primary care and urgent care services for all medicaid or chip recipients enrolled in the managed care plan b provide viable alternatives for increasing primary care provider reimbursement rates to incentivize after hours primary care access for recipients and c report to the department on how the managed care organization complied with this subsection the department may a through administrative rule adopted by the department develop quality measurements that evaluate a managed care organization s delivery of i appropriate emergency department services to recipients enrolled in the managed care plan ii expanded primary care and urgent care for recipients enrolled in the managed care plan with consideration of the managed care organization s a delivery of primary care urgent care and after hours care through means other than the emergency department b recipient access to primary care providers and community health centers including evening and weekend access and c other innovations for expanding access to primary care and iii quality of care for the managed care plan members b compare the quality measures developed under subsection a for each managed care organization and c develop by administrative rule an algorithm to determine assignment of new unassigned recipients to specific managed care plans based on the plan s performance in relation to the quality measures developed pursuant to subsection a section section b which is renumbered from section is renumbered and amended to read b long term care insurance partnership as used in this section a qualified long term care insurance contract is as defined in u s c sec b b b qualified long term care insurance partnership is as defined in u s c sec p b c iii c state plan amendment means an amendment to the state medicaid plan drafted by the department in compliance with this section no later than july the department shall seek federal approval of a state plan amendment that creates a qualified long term care insurance partnership the department may make rules to comply with federal laws and regulations relating to qualified long term care insurance partnerships and qualified long term care insurance contracts section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for children with disabilities and complex medical needs as used in this section a additional eligibility criteria means the additional eligibility criteria set by the department under subsection e b complex medical condition means a physical condition of an individual that i results in severe functional limitations for the individual and ii is likely to a last at least months or b result in death c program means the program for children with complex medical conditions created in subsection d qualified child means a child who i is less than years old ii is diagnosed with a complex medical condition iii has a condition that meets the definition of disability in u s c sec and iv meets the additional eligibility criteria the department shall apply for a medicaid home and community based waiver with cms to implement within the state medicaid program the program described in subsection if the waiver described in subsection is approved the department shall offer a program that a as funding permits provides treatment for qualified children b if approved by cms and as funding permits beginning in fiscal year provides on an ongoing basis treatment for more qualified children than the program provided treatment for during fiscal year and c accepts applications for the program on an ongoing basis i d requires periodic reevaluations of an enrolled child s eligibility and other applicants or eligible children waiting for services in the program based on the additional eligibility criteria and ii e at the time of reevaluation allows the department to disenroll a child based on the prioritization described in subsection a and additional eligibility criteria the department shall a establish by rule made in accordance with title g chapter utah administrative rulemaking act criteria to prioritize qualified children s participation in the program based on the following factors in the following priority order i the complexity of a qualified child s medical condition and ii the financial needs of the qualified child and the qualified child s family b convene a public process to determine the benefits and services to offer a qualified child under the program c evaluate on an ongoing basis the cost and effectiveness of the program d if funding for the program is reduced develop an evaluation process to reduce the number of children served based on the participation criteria established under subsection a and e establish by rule made in accordance with title g chapter utah administrative rulemaking act additional eligibility criteria based on the factors described in subsections a i and ii section section b which is renumbered from section is renumbered and amended to read b health coverage improvement program eligibility annual report expansion of eligibility for adults with dependent children as used in this section a adult in the expansion population means an individual who i is described in u s c sec a a a i viii and ii is not otherwise eligible for medicaid as a mandatory categorically needy individual b enhancement waiver program means the primary care network enhancement waiver program described in section b c federal poverty level means the poverty guidelines established by the secretary of the united states department of health and human services under u s c sec d health coverage improvement program means the health coverage improvement program described in subsections through e homeless i means an individual who is chronically homeless as determined by the department and ii includes someone who was chronically homeless and is currently living in supported housing for the chronically homeless f income eligibility ceiling means the percent of federal poverty level i established by the state in an appropriations act adopted pursuant to title j chapter budgetary procedures act and ii under which an individual may qualify for medicaid coverage in accordance with this section g targeted adult medicaid program means the program implemented by the department under subsections through beginning july the department shall amend the state medicaid plan to allow temporary residential treatment for substance abuse use for the traditional medicaid population in a short term non institutional hour facility without a bed capacity limit that provides rehabilitation services that are medically necessary and in accordance with an individualized treatment plan as approved by cms and as long as the county makes the required match under section beginning july the department shall amend the state medicaid plan to increase the income eligibility ceiling to a percentage of the federal poverty level designated by the department based on appropriations for the program for an individual with a dependent child before july the division shall submit to cms a request for waivers or an amendment of existing waivers from federal statutory and regulatory law necessary for the state to implement the health coverage improvement program in the medicaid program in accordance with this section a an adult in the expansion population is eligible for medicaid if the adult meets the income eligibility and other criteria established under subsection b an adult who qualifies under subsection shall receive medicaid coverage i through the traditional fee for service medicaid model in counties without medicaid accountable care organizations or the state s medicaid accountable care organization delivery system where implemented and subject to section b ii except as provided in subsection b iii for behavioral health through the counties in accordance with sections and iii that subject to section b integrates behavioral health services and physical health services with medicaid accountable care organizations in select geographic areas of the state that choose an integrated model and iv that permits temporary residential treatment for substance abuse use in a short term non institutional hour facility without a bed capacity limit as approved by cms that provides rehabilitation services that are medically necessary and in accordance with an individualized treatment plan a an individual is eligible for the health coverage improvement program under subsection if i at the time of enrollment the individual s annual income is below the income eligibility ceiling established by the state under subsection f and ii the individual meets the eligibility criteria established by the department under subsection b b based on available funding and approval from cms the department shall select the criteria for an individual to qualify for the medicaid program under subsection a ii based on the following priority i a chronically homeless individual ii if funding is available an individual a involved in the justice system through probation parole or court ordered treatment and b in need of substance abuse use treatment or mental health treatment as determined by the department or iii if funding is available an individual in need of substance abuse use treatment or mental health treatment as determined by the department c an individual who qualifies for medicaid coverage under subsections a and b may remain on the medicaid program for a month certification period as defined by the department eligibility changes made by the department under subsection f or b shall not apply to an individual during the month certification period the state may request a modification of the income eligibility ceiling and other eligibility criteria under subsection each fiscal year based on projected enrollment costs to the state and the state budget the current medicaid program and the health coverage improvement program when implemented shall coordinate with a state prison or county jail to expedite medicaid enrollment for an individual who is released from custody and was eligible for or enrolled in medicaid before incarceration notwithstanding sections and a county does not have to provide matching funds to the state for the cost of providing medicaid services to newly enrolled individuals who qualify for medicaid coverage under the health coverage improvement program under subsection if the enhancement waiver program is implemented the department a may not accept any new enrollees into the health coverage improvement program after the day on which the enhancement waiver program is implemented b shall transition all individuals who are enrolled in the health coverage improvement program into the enhancement waiver program c shall suspend the health coverage improvement program within one year after the day on which the enhancement waiver program is implemented d shall within one year after the day on which the enhancement waiver program is implemented use all appropriations for the health coverage improvement program to implement the enhancement waiver program and e shall work with cms to maintain any waiver for the health coverage improvement program while the health coverage improvement program is suspended under subsection c if after the enhancement waiver program takes effect the enhancement waiver program is repealed or suspended by either the state or federal government the department shall reinstate the health coverage improvement program and continue to accept new enrollees into the health coverage improvement program in accordance with the provisions of this section section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for delivery of adult dental services a before june the department shall ask cms to grant waivers from federal statutory and regulatory law necessary for the medicaid program to provide dental services in the manner described in subsection a b before june the department shall submit to cms a request for waivers or an amendment of existing waivers from federal law necessary for the state to provide dental services in accordance with subsections b i and d through g to an individual described in subsection b i c before june the department shall submit to the centers for medicare and medicaid services a request for waivers or an amendment to existing waivers from federal law necessary for the state to i provide dental services in accordance with subsections b ii and d through g to an individual described in subsection b ii and ii provide the services described in subsection h a to the extent funded the department shall provide services to only blind or disabled individuals as defined in u s c sec c a who are years old or older and eligible for the program b notwithstanding subsection a i if a waiver is approved under subsection b the department shall provide dental services to an individual who a qualifies for the health coverage improvement program described in section b and b is receiving treatment in a substance abuse treatment program as defined in section a b licensed under title a chapter licensure of programs and facilities chapter part human services programs and facilities and ii if a waiver is approved under subsection c i the department shall provide dental services to an individual who is an aged individual as defined in u s c sec c a c to the extent possible services to individuals described in subsection a shall be provided through the university of utah school of dentistry and the university of utah school of dentistry s associated statewide network d the department shall provide the services to individuals described in subsection b i by contracting with an entity that a has demonstrated experience working with individuals who are being treated for both a substance use disorder and a major oral health disease b operates a program targeted at the individuals described in subsection b that has demonstrated through a peer reviewed evaluation the effectiveness of providing dental treatment to those individuals described in subsection b c is willing to pay for an amount equal to the program s non federal share of the cost of providing dental services to the population described in subsection b and d is willing to pay all state costs associated with applying for the waiver described in subsection b and administering the program described in subsection b and ii through a fee for service payment model e the entity that receives the contract under subsection d i shall cover all state costs of the program described in subsection b f each fiscal year the university of utah school of dentistry shall in compliance with state and federal regulations regarding intergovernmental transfers transfer funds to the program in an amount equal to the program s non federal share of the cost of providing services under this section through the school during the fiscal year g if a waiver is approved under subsection c ii the department shall provide coverage for porcelain and porcelain to metal crowns if the services are provided i to an individual who qualifies for dental services under subsection b and ii by an entity that covers all state costs of a providing the coverage described in this subsection h g and b applying for the waiver described in subsection c h where possible the department shall ensure that services described in subsection a that are not provided by the university of utah school of dentistry or the university of utah school of dentistry s associated network are provided i through fee for service reimbursement until july and ii after july through the method of reimbursement used by the division for medicaid dental benefits i subject to appropriations by the legislature and as determined by the department the scope amount duration and frequency of services may be limited a if the waivers requested under subsection a are granted the medicaid program shall begin providing dental services in the manner described in subsection no later than july b if the waivers requested under subsection b are granted the medicaid program shall begin providing dental services to the population described in subsection b within days from the day on which the waivers are granted c if the waivers requested under subsection c i are granted the medicaid program shall begin providing dental services to the population described in subsection b ii within days after the day on which the waivers are granted if the federal share of the cost of providing dental services under this section will be less than during any portion of the next fiscal year the medicaid program shall cease providing dental services under this section no later than the end of the current fiscal year section section b which is renumbered from section is renumbered and amended to read b medicaid long term support services housing coordinator there is created within the medicaid program a full time equivalent position of medicaid long term support services housing coordinator the coordinator shall help medicaid recipients receive long term support services in a home or other community based setting rather than in a nursing home or other institutional setting by a working with municipalities counties the housing and community development division within the department of workforce services and others to identify community based settings available to recipients b working with the same entities to promote the development construction and availability of additional community based settings c training medicaid case managers and support coordinators on how to help medicaid recipients move from an institutional setting to a community based setting and d performing other related duties section section b which is renumbered from section is renumbered and amended to read b medicaid waiver expansion as used in this section a federal poverty level means the same as that term is defined in section b b medicaid waiver expansion means an expansion of the medicaid program in accordance with this section a before january the department shall apply to cms for approval of a waiver or state plan amendment to implement the medicaid waiver expansion b the medicaid waiver expansion shall i expand medicaid coverage to eligible individuals whose income is below of the federal poverty level ii obtain maximum federal financial participation under u s c sec d y for enrolling an individual in the medicaid program iii provide medicaid benefits through the state s medicaid accountable care organizations in areas where a medicaid accountable care organization is implemented iv integrate the delivery of behavioral health services and physical health services with medicaid accountable care organizations in select geographic areas of the state that choose an integrated model v include a path to self sufficiency including work activities as defined in u s c sec d for qualified adults vi require an individual who is offered a private health benefit plan by an employer to enroll in the employer s health plan vii sunset in accordance with subsection a and viii permit the state to close enrollment in the medicaid waiver expansion if the department has insufficient funding to provide services to additional eligible individuals if the medicaid waiver described in subsection a is approved the department may only pay the state portion of costs for the medicaid waiver expansion with appropriations from a the medicaid expansion fund created in section b b b county contributions to the non federal share of medicaid expenditures and c any other contributions funds or transfers from a non state agency for medicaid expenditures a in consultation with the department medicaid accountable care organizations and counties that elect to integrate care under subsection b iv shall collaborate on enrollment engagement of patients and coordination of services b as part of the provision described in subsection b iv the department shall apply for a waiver to permit the creation of an integrated delivery system i for any geographic area that expresses interest in integrating the delivery of services under subsection b iv and ii in which the department a may permit a local mental health authority to integrate the delivery of behavioral health services and physical health services b may permit a county local mental health authority or medicaid accountable care organization to integrate the delivery of behavioral health services and physical health services to select groups within the population that are newly eligible under the medicaid waiver expansion and c may make rules in accordance with title g chapter utah administrative rulemaking act to integrate payments for behavioral health services and physical health services to plans or providers a if federal financial participation for the medicaid waiver expansion is reduced below the authority of the department to implement the medicaid waiver expansion shall sunset no later than the next july after the date on which the federal financial participation is reduced b the department shall close the program to new enrollment if the cost of the medicaid waiver expansion is projected to exceed the appropriations for the fiscal year that are authorized by the legislature through an appropriations act adopted in accordance with title j chapter budgetary procedures act if the medicaid waiver expansion is approved by cms the department shall report to the social services appropriations subcommittee on or before november of each year that the medicaid waiver expansion is operational a the number of individuals who enrolled in the medicaid waiver program b costs to the state for the medicaid waiver program c estimated costs for the current and following state fiscal year and d recommendations to control costs of the medicaid waiver expansion section section b which is renumbered from section is renumbered and amended to read b primary care network enhancement waiver program as used in this section a enhancement waiver program means the primary care network enhancement waiver program described in this section b federal poverty level means the poverty guidelines established by the secretary of the united states department of health and human services under u s c sec c health coverage improvement program means the same as that term is defined in section b d income eligibility ceiling means the percentage of federal poverty level i established by the legislature in an appropriations act adopted pursuant to title j chapter budgetary procedures act and ii under which an individual may qualify for coverage in the enhancement waiver program in accordance with this section e optional population means the optional expansion population under ppaca if the expansion provides coverage for individuals at or above of the federal poverty level f primary care network means the state primary care network program created by the medicaid primary care network demonstration waiver obtained under section b the department shall continue to implement the primary care network program for qualified individuals under the primary care network program a the division shall apply for a medicaid waiver or a state plan amendment with cms to implement within the state medicaid program the enhancement waiver program described in this section within six months after the day on which i the division receives a notice from cms that the waiver for the medicaid waiver expansion submitted under section b medicaid waiver expansion will not be approved or ii the division withdraws the waiver for the medicaid waiver expansion submitted under section b medicaid waiver expansion b the division may not apply for a waiver under subsection a while a waiver request under section b medicaid waiver expansion is pending with cms an individual who is eligible for the enhancement waiver program may receive the following benefits under the enhancement waiver program a the benefits offered under the primary care network program b diagnostic testing and procedures c medical specialty care d inpatient hospital services e outpatient hospital services f outpatient behavioral health care including outpatient substance abuse use care and g for an individual who qualifies for the health coverage improvement program as approved by cms temporary residential treatment for substance abuse use in a short term non institutional hour facility without a bed capacity limit that provides rehabilitation services that are medically necessary and in accordance with an individualized treatment plan an individual is eligible for the enhancement waiver program if at the time of enrollment a the individual is qualified to enroll in the primary care network or the health coverage improvement program b the individual s annual income is below the income eligibility ceiling established by the legislature under subsection d and c the individual meets the eligibility criteria established by the department under subsection a based on available funding and approval from cms the department shall determine the criteria for an individual to qualify for the enhancement waiver program based on the following priority i adults in the expansion population as defined in section b who qualify for the health coverage improvement program ii adults with dependent children who qualify for the health coverage improvement program under subsection b iii adults with dependent children who do not qualify for the health coverage improvement program and iv if funding is available adults without dependent children b the number of individuals enrolled in the enhancement waiver program may not exceed of the number of individuals who were enrolled in the primary care network on december c the department may only use appropriations from the medicaid expansion fund created in section b b to fund the state portion of the enhancement waiver program the department may request a modification of the income eligibility ceiling and the eligibility criteria under subsection from cms each fiscal year based on enrollment in the enhancement waiver program projected enrollment in the enhancement waiver program costs to the state and the state budget the department may implement the enhancement waiver program by contracting with medicaid accountable care organizations to administer the enhancement waiver program in accordance with subsections and b and the department may use funds that have been appropriated for the health coverage improvement program to implement the enhancement waiver program if the department expands the state medicaid program to the optional population the department a except as provided in subsection may not accept any new enrollees into the enhancement waiver program after the day on which the expansion to the optional population is effective b shall suspend the enhancement waiver program within one year after the day on which the expansion to the optional population is effective and c shall work with cms to maintain the waiver for the enhancement waiver program submitted under subsection while the enhancement waiver program is suspended under subsection b if after the expansion to the optional population described in subsection takes effect the expansion to the optional population is repealed by either the state or the federal government the department shall reinstate the enhancement waiver program and continue to accept new enrollees into the enhancement waiver program in accordance with the provisions of this section section section b which is renumbered from section is renumbered and amended to read b limited family planning services for low income individuals as used in this section a i family planning services means family planning services that are provided under the state medicaid program including a sexual health education and family planning counseling and b other medical diagnosis treatment or preventative care routinely provided as part of a family planning service visit ii family planning services do not include an abortion as that term is defined in section b low income individual means an individual who i has an income level that is equal to or below of the federal poverty level and ii does not qualify for full coverage under the medicaid program before july the division shall apply for a medicaid waiver or a state plan amendment with cms to a offer a program that provides family planning services to low income individuals and b receive a federal match rate of of state expenditures for family planning services provided under the waiver or state plan amendment section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for mental health crisis lines and mobile crisis outreach teams as used in this section a local mental health crisis line means the same as that term is defined in section a b b mental health crisis means i a mental health condition that manifests itself in an individual by symptoms of sufficient severity that a prudent layperson who possesses an average knowledge of mental health issues could reasonably expect the absence of immediate attention or intervention to result in a serious danger to the individual s health or well being or b a danger to the health or well being of others or ii a mental health condition that in the opinion of a mental health therapist or the therapist s designee requires direct professional observation or the intervention of a mental health therapist c i mental health crisis services means direct mental health services and on site intervention that a mobile crisis outreach team provides to an individual suffering from a mental health crisis including the provision of safety and care plans prolonged mental health services for up to days and referrals to other community resources ii mental health crisis services includes a local mental health crisis lines and b the statewide mental health crisis line d mental health therapist means the same as that term is defined in section e mobile crisis outreach team or mcot means a mobile team of medical and mental health professionals that in coordination with local law enforcement and emergency medical service personnel provides mental health crisis services f statewide mental health crisis line means the same as that term is defined in section a b in consultation with the department of human services and the behavioral health crisis response commission created in section c the department shall develop a proposal to amend the state medicaid plan to include mental health crisis services including the statewide mental health crisis line local mental health crisis lines and mobile crisis outreach teams by january the department shall apply for a medicaid waiver with cms if necessary to implement within the state medicaid program the mental health crisis services described in subsection section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for coverage of mental health services in schools as used in this section local education agency means a a school district b a charter school or c the utah schools for the deaf and the blind in consultation with the department of human services and the state board of education the department shall develop a proposal to allow the state medicaid program to reimburse a local education agency a local mental health authority or a private provider for covered mental health services provided a in accordance with section e and b i at a local education agency building or facility or ii by an employee or contractor of a local education agency before january the department shall apply to cms for a state plan amendment to implement the coverage described in subsection section section b which is renumbered from section is renumbered and amended to read b coverage for in vitro fertilization and genetic testing as used in this section a qualified condition means i cystic fibrosis ii spinal muscular atrophy iii morquio syndrome iv myotonic dystrophy or v sickle cell anemia b qualified enrollee means an individual who i is enrolled in the medicaid program ii has been diagnosed by a physician as having a genetic trait associated with a qualified condition and iii intends to get pregnant with a partner who is diagnosed by a physician as having a genetic trait associated with the same qualified condition as the individual before january the department shall apply for a medicaid waiver or a state plan amendment with the centers for medicare and medicaid services within the united states department of health and human services to implement the coverage described in subsection if the waiver described in subsection is approved the medicaid program shall provide coverage to a qualified enrollee for a in vitro fertilization services and b genetic testing of a qualified enrollee who receives in vitro fertilization services under subsection a the medicaid program may not provide the coverage described in subsection before the later of a the day on which the waiver described in subsection is approved and b january before november and before november of every third year thereafter the department shall a calculate the change in state spending attributable to the coverage under this section and b report the amount described in subsection a a to the health and human services interim committee and the social services appropriations subcommittee section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for fertility preservation services as used in this section a iatrogenic infertility means an impairment of fertility or reproductive functioning caused by surgery chemotherapy radiation or other medical treatment b physician means an individual licensed to practice under title chapter utah medical practice act or title chapter utah osteopathic medical practice act c qualified enrollee means an individual who i is enrolled in the medicaid program ii has been diagnosed with a form of cancer by a physician and iii needs treatment for that cancer that may cause a substantial risk of sterility or iatrogenic infertility including surgery radiation or chemotherapy d standard fertility preservation service means a fertility preservation procedure and service that i is not considered experimental or investigational by the american society for reproductive medicine or the american society of clinical oncology and ii is consistent with established medical practices or professional guidelines published by the american society for reproductive medicine or the american society of clinical oncology including a sperm banking b oocyte banking c embryo banking d banking of reproductive tissues and e storage of reproductive cells and tissues before january the department shall apply for a medicaid waiver or a state plan amendment with cms to implement the coverage described in subsection if the waiver or state plan amendment described in subsection is approved the medicaid program shall provide coverage to a qualified enrollee for standard fertility preservation services the medicaid program may not provide the coverage described in subsection before the later of a the day on which the waiver described in subsection is approved and b january before november and before november of each third year after the department shall a calculate the change in state spending attributable to the coverage described in this section and b report the amount described in subsection a to the health and human services interim committee and the social services appropriations subcommittee section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for coverage of qualified inmates leaving prison or jail as used in this section a correctional facility means i a county jail ii the department of corrections created in section or iii a prison penitentiary or other institution operated by or under contract with the department of corrections for the confinement of an offender as defined in section b qualified inmate means an individual who i is incarcerated in a correctional facility and ii has a a chronic physical or behavioral health condition b a mental illness as defined in section a b or c an opioid use disorder before july the division shall apply for a medicaid waiver or a state plan amendment with cms to offer a program to provide medicaid coverage to a qualified inmate for up to days immediately before the day on which the qualified inmate is released from a correctional facility if the waiver or state plan amendment described in subsection is approved the department shall report to the health and human services interim committee each year before november while the waiver or state plan amendment is in effect regarding a the number of qualified inmates served under the program b the cost of the program and c the effectiveness of the program including i any reduction in the number of emergency room visits or hospitalizations by inmates after release from a correctional facility ii any reduction in the number of inmates undergoing inpatient treatment after release from a correctional facility iii any reduction in overdose rates and deaths of inmates after release from a correctional facility and iv any other costs or benefits as a result of the program if the waiver or state plan amendment described in subsection is approved a county that is responsible for the cost of a qualified inmate s medical care shall provide the required matching funds to the state for a any costs to enroll the qualified inmate for the medicaid coverage described in subsection b any administrative fees for the medicaid coverage described in subsection and c the medicaid coverage that is provided to the qualified inmate under subsection section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for inpatient care in an institution for mental diseases as used in this section institution for mental diseases means the same as that term is defined in c f r sec before august the division shall apply for a medicaid waiver or a state plan amendment with cms to offer a program that provides reimbursement for mental health services that are provided a in an institution for mental diseases that includes more than beds and b to an individual who receives mental health services in an institution for mental diseases for a period of more than days in a calendar month if the waiver or state plan amendment described in subsection is approved the department shall a coordinate with the department of human services to develop and offer the program described in subsection and b submit to the health and human services interim committee and the social services appropriations subcommittee any report that the department submits to cms that relates to the budget neutrality independent waiver evaluation or performance metrics of the program described in subsection within days after the day on which the report is submitted to cms notwithstanding sections and if the waiver or state plan amendment described in subsection is approved a county does not have to provide matching funds to the state for the mental health services described in subsection that are provided to an individual who qualifies for medicaid coverage under section or section b or b section section b which is renumbered from section is renumbered and amended to read b reimbursement for crisis management services provided in a behavioral health receiving center integration of payment for physical health services as used in this section a accountable care organization means the same as that term is defined in section b b behavioral health receiving center means the same as that term is defined in section a b c crisis management services means behavioral health services provided to an individual who is experiencing a mental health crisis d managed care organization means the same as that term is defined in c f r sec before july the division shall apply for a medicaid waiver or state plan amendment with cms to offer a program that provides reimbursement through a bundled daily rate for crisis management services that are delivered to an individual during the individual s stay at a behavioral health receiving center if the waiver or state plan amendment described in subsection is approved the department shall a implement the program described in subsection and b require a managed care organization that contracts with the state s medicaid program for behavioral health services or integrated health services to provide coverage for crisis management services that are delivered to an individual during the individual s stay at a behavioral health receiving center a the department may elect to integrate payment for physical health services provided in a behavioral health receiving center b in determining whether to integrate payment under subsection a the department shall consult with accountable care organizations and counties in the state section section b which is renumbered from section is renumbered and amended to read b crisis services reimbursement the department department shall submit a waiver or state plan amendment to allow for reimbursement for services provided to an individual who is eligible and enrolled in medicaid at the time this service is provided section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for respite care facility that provides services to homeless individuals as used in this section a adult in the expansion population means an adult i described in u s c sec a a a i viii and ii not otherwise eligible for medicaid as a mandatory categorically needy individual b homeless means the same as that term is defined in section b c medical respite care means short term housing with supportive medical services d medical respite facility means a residential facility that provides medical respite care to homeless individuals before january the department shall apply for a medicaid waiver or state plan amendment with cms to choose a single medical respite facility to reimburse for services provided to an individual who is a homeless and b an adult in the expansion population the department shall choose a medical respite facility best able to serve homeless individuals who are adults in the expansion population if the waiver or state plan amendment described in subsection is approved while the waiver or state plan amendment is in effect the department shall submit a report to the health and human services interim committee each year before november detailing a the number of homeless individuals served at the facility b the cost of the program and c the reduction of health care costs due to the program s implementation through administrative rule made in accordance with title g chapter utah administrative rulemaking act the department shall further define and limit the services described in this section provided to a homeless individual section section b which is renumbered from section is renumbered and amended to read b medicaid waiver expansion for extraordinary care reimbursement as used in this section a existing home and community based services waiver means an existing home and community based services waiver in the state that serves an individual i with an acquired brain injury ii with an intellectual or physical disability or iii who is years old or older b personal care services means a service that i is furnished to an individual who is not an inpatient nor a resident of a hospital nursing facility intermediate care facility or institution for mental diseases ii is authorized for an individual described in subsection b i in accordance with a plan of treatment iii is provided by an individual who is qualified to provide the services and iv is furnished in a home or another community based setting c waiver enrollee means an individual who is enrolled in an existing home and community based services waiver before july the department shall apply with cms for an amendment to an existing home and community based services waiver to implement a program to offer reimbursement to an individual who provides personal care services that constitute extraordinary care to a waiver enrollee who is the individual s spouse if cms approves the amendment described in subsection the department shall implement the program described in subsection the department shall by rule made in accordance with title g chapter utah administrative rulemaking act define extraordinary care for purposes of subsection section section b which is renumbered from section is renumbered and amended to read b delivery system adjustments for the targeted adult medicaid program as used in this section targeted adult medicaid program means the same as that term is defined in section b the department may implement the delivery system adjustments authorized under subsection only on the later of a july and b the department determining that the medicaid program including providers and managed care organizations are satisfying the metrics established in collaboration with the working group convened under subsection b the department may for individuals who are enrolled in the targeted adult medicaid program a integrate the delivery of behavioral and physical health in certain counties and b deliver behavioral health services through an accountable care organization where implemented before implementing the delivery system adjustments described in subsection in a county the department shall at a minimum seek input from a individuals who qualify for the targeted adult medicaid program who reside in the county b the county s executive officer legislative body and other county officials who are involved in the delivery of behavioral health services c the local mental health authority and local substance use abuse authority that serves the county d medicaid managed care organizations operating in the state including medicaid accountable care organizations e providers of physical or behavioral health services in the county who provide services to enrollees in the targeted adult medicaid program in the county and f other individuals that the department deems necessary if the department provides medicaid coverage through a managed care delivery system under this section the department shall include language in the department s managed care contracts that require the managed care plan to a be in compliance with federal medicaid managed care requirements b timely and accurately process authorizations and claims in accordance with medicaid policy and contract requirements c adequately reimburse providers to maintain adequacy of access to care d provide care management services sufficient to meet the needs of medicaid eligible individuals enrolled in the managed care plan s plan and e timely resolve any disputes between a provider or enrollee with the managed care plan the department may take corrective action if the managed care organization fails to comply with the terms of the managed care organization s contract section section b which is renumbered from section is renumbered and amended to read b medicaid waiver for increased integrated health care reimbursement as used in this section a integrated health care setting means a health care or behavioral health care setting that provides integrated physical and behavioral health care services b local mental health authority means a local mental health authority described in section the department shall develop a proposal to allow the state medicaid program to reimburse a local mental health authority for covered physical health care services provided in an integrated health care setting to medicaid eligible individuals before december the department shall apply for a medicaid waiver or a state plan amendment with cms to implement the proposal described in subsection if the waiver or state plan amendment described in subsection is approved the department shall a implement the proposal described in subsection and b while the waiver or state plan amendment is in effect submit a report to the health and human services interim committee each year before november detailing i the number of patients served under the waiver or state plan amendment ii the cost of the waiver or state plan amendment and iii any benefits of the waiver or state plan amendment section section b which is renumbered from section is renumbered and amended to read part administration of medicaid programs drug utilization review and long term care facility certification b definitions as used in this part appropriate and medically necessary means regarding drug prescribing dispensing and patient usage that it is in conformity with the criteria and standards developed in accordance with this part board means the drug utilization review board created in section b certified program means a nursing care facility program with medicaid certification compendia means resources widely accepted by the medical profession in the efficacious use of drugs including american hospital formulary services service drug information u s pharmacopeia drug information a m a drug evaluations peer reviewed medical literature and information provided by manufacturers of drug products counseling means the activities conducted by a pharmacist to inform medicaid recipients about the proper use of drugs as required by the board under this part criteria means those predetermined and explicitly accepted elements used to measure drug use on an ongoing basis in order to determine if the use is appropriate medically necessary and not likely to result in adverse medical outcomes drug disease contraindications means that the therapeutic effect of a drug is adversely altered by the presence of another disease condition drug interactions means that two or more drugs taken by a recipient lead to clinically significant toxicity that is characteristic of one or any of the drugs present or that leads to interference with the effectiveness of one or any of the drugs drug utilization review or dur means the program designed to measure and assess on a retrospective and prospective basis the proper use of outpatient drugs in the medicaid program intervention means a form of communication utilized by the board with a prescriber or pharmacist to inform about or influence prescribing or dispensing practices medicaid certification means the right of a nursing care facility as a provider of a nursing care facility program to receive medicaid reimbursement for a specified number of beds within the facility a nursing care facility means the following facilities licensed by the department under chapter part health care facility licensing and inspection i skilled nursing facilities ii intermediate care facilities and iii an intermediate care facility for people with an intellectual disability b nursing care facility does not mean a critical access hospital that meets the criteria of u s c sec i c nursing care facility program means the personnel licenses services contracts and all other requirements that shall be met for a nursing care facility to be eligible for medicaid certification under this part and division rule overutilization or underutilization means the use of a drug in such quantities that the desired therapeutic goal is not achieved pharmacist means a person licensed in this state to engage in the practice of pharmacy under title chapter b pharmacy practice act physical facility means the buildings or other physical structures where a nursing care facility program is operated physician means a person licensed in this state to practice medicine and surgery under section or osteopathic medicine under section prospective dur means that part of the drug utilization review program that occurs before a drug is dispensed and that is designed to screen for potential drug therapy problems based on explicit and predetermined criteria and standards retrospective dur means that part of the drug utilization review program that assesses or measures drug use based on an historical review of drug use data against predetermined and explicit criteria and standards on an ongoing basis with professional input rural county means a county with a population of less than as determined by a the most recent official census or census estimate of the united states bureau of the census or b the most recent population estimate for the county from the utah population committee if a population figure for the county is not available under subsection a service area means the boundaries of the distinct geographic area served by a certified program as determined by the division in accordance with this part and division rule standards means the acceptable range of deviation from the criteria that reflects local medical practice and that is tested on the medicaid recipient database surs means the surveillance utilization review system of the medicaid program therapeutic appropriateness means drug prescribing and dispensing based on rational drug therapy that is consistent with criteria and standards therapeutic duplication means prescribing and dispensing the same drug or two or more drugs from the same therapeutic class where periods of drug administration overlap and where that practice is not medically indicated urban county means a county that is not a rural county section section b which is renumbered from section is renumbered and amended to read b dur board creation and membership expenses there is created a member drug utilization review board responsible for implementation of a retrospective and prospective dur program a except as required by subsection b as terms of current board members expire the executive director shall appoint each new member or reappointed member to a four year term b notwithstanding the requirements of subsection a the executive director shall at the time of appointment or reappointment adjust the length of terms to ensure that the terms of board members are staggered so that approximately half of the board is appointed every two years c persons appointed to the board may be reappointed upon completion of their terms but may not serve more than two consecutive terms d the executive director shall provide for geographic balance in representation on the board when a vacancy occurs in the membership for any reason the replacement shall be appointed for the unexpired term the membership shall be comprised of the following a four physicians who are actively engaged in the practice of medicine or osteopathic medicine in this state to be selected from a list of nominees provided by the utah medical association b one physician in this state who is actively engaged in academic medicine c three pharmacists who are actively practicing in retail pharmacy in this state to be selected from a list of nominees provided by the utah pharmaceutical association d one pharmacist who is actively engaged in academic pharmacy e one person who shall represent consumers f one person who shall represent pharmaceutical manufacturers to be recommended by the pharmaceutical manufacturers association and g one dentist licensed to practice in this state under title chapter dentist and dental hygienist practice act who is actively engaged in the practice of dentistry nominated by the utah dental association physician and pharmacist members of the board shall have expertise in clinically appropriate prescribing and dispensing of outpatient drugs the board shall elect a chair from among its members who shall serve a one year term and may serve consecutive terms a member may not receive compensation or benefits for the member s service but may receive per diem and travel expenses in accordance with a section a b section a and c rules made by the division of finance pursuant to sections a and a section section b which is renumbered from section is renumbered and amended to read b dur board responsibilities the board shall develop rules necessary to carry out its responsibilities as defined in this part oversee the implementation of a medicaid retrospective and prospective dur program in accordance with this part including responsibility for approving provisions of contractual agreements between the medicaid program and any other entity that will process and review medicaid drug claims and profiles for the dur program in accordance with this part develop and apply predetermined criteria and standards to be used in retrospective and prospective dur ensuring that the criteria and standards are based on the compendia and that they are developed with professional input in a consensus fashion with provisions for timely revision and assessment as necessary the dur standards developed by the board shall reflect the local practices of physicians in order to monitor a therapeutic appropriateness b overutilization or underutilization c therapeutic duplication d drug disease contraindications e drug drug interactions f incorrect drug dosage or duration of drug treatment and g clinical abuse and misuse develop select apply and assess interventions and remedial strategies for physicians pharmacists and recipients that are educational and not punitive in nature in order to improve the quality of care disseminate information to physicians and pharmacists to ensure that they are aware of the board s duties and powers provide written oral or electronic reminders of patient specific or drug specific information designed to ensure recipient physician and pharmacist confidentiality and suggest changes in prescribing or dispensing practices designed to improve the quality of care utilize face to face discussions between experts in drug therapy and the prescriber or pharmacist who has been targeted for educational intervention conduct intensified reviews or monitoring of selected prescribers or pharmacists create an educational program using data provided through dur to provide active and ongoing educational outreach programs to improve prescribing and dispensing practices either directly or by contract with other governmental or private entities provide a timely evaluation of intervention to determine if those interventions have improved the quality of care publish the annual drug utilization review report required under c f r sec develop a working agreement with related boards or agencies including the state board of pharmacy physicians licensing board and surs staff within the division in order to clarify areas of responsibility for each where those areas may overlap establish a grievance process for physicians and pharmacists under this part in accordance with title g chapter administrative procedures act publish and disseminate educational information to physicians and pharmacists concerning the board and the dur program including information regarding a identification and reduction of the frequency of patterns of fraud abuse gross overuse inappropriate or medically unnecessary care among physicians pharmacists and recipients b potential or actual severe or adverse reactions to drugs c therapeutic appropriateness d overutilization or underutilization e appropriate use of generics f therapeutic duplication g drug disease contraindications h drug drug interactions i incorrect drug dosage and duration of drug treatment j drug allergy interactions and k clinical abuse and misuse develop and publish with the input of the state board of pharmacy guidelines and standards to be used by pharmacists in counseling medicaid recipients in accordance with this part the guidelines shall ensure that the recipient may refuse counseling and that the refusal is to be documented by the pharmacist items to be discussed as part of that counseling include a the name and description of the medication b administration form and duration of therapy c special directions and precautions for use d common severe side effects or interactions and therapeutic interactions and how to avoid those occurrences e techniques for self monitoring drug therapy f proper storage g prescription refill information and h action to be taken in the event of a missed dose and establish procedures in cooperation with the state board of pharmacy for pharmacists to record information to be collected under this part the recorded information shall include a the name address age and gender of the recipient b individual history of the recipient where significant including disease state known allergies and drug reactions and a comprehensive list of medications and relevant devices c the pharmacist s comments on the individual s drug therapy d name of prescriber and e name of drug dose duration of therapy and directions for use section section b which is renumbered from section is renumbered and amended to read b confidentiality of records information obtained under this part shall be treated as confidential or controlled information under title g chapter government records access and management act the board shall establish procedures insuring ensuring that the information described in subsection b is held confidential by the pharmacist being provided to the physician only upon request the board shall adopt and implement procedures designed to ensure the confidentiality of all information collected stored retrieved assessed or analyzed by the board staff to the board or contractors to the dur program that identifies individual physicians pharmacists or recipients the board may have access to identifying information for purposes of carrying out intervention activities but that identifying information may not be released to anyone other than a member of the board the board may release cumulative nonidentifying information for research purposes section section b which is renumbered from section is renumbered and amended to read b drug prior approval program a drug prior approval program approved or implemented by the board shall meet the following conditions a except as provided in subsection a drug may not be placed on prior approval for other than medical reasons b the board shall hold a public hearing at least days prior to placing a drug on prior approval c notwithstanding the provisions of section the board shall provide not less than days notice to the public before holding a public hearing under subsection b d the board shall consider written and oral comments submitted by interested parties prior to or during the hearing held in accordance with subsection b e the board shall provide evidence that placing a drug class on prior approval i will not impede quality of recipient care and ii that the drug class is subject to clinical abuse or misuse f the board shall reconsider its decision to place a drug on prior approval i no later than nine months after any drug class is placed on prior approval and ii at a public hearing with notice as provided in subsection b g the program shall provide an approval or denial of a request for prior approval i by either a fax b telephone or c electronic transmission ii at least monday through friday except for state holidays and iii within hours after receipt of the prior approval request h the program shall provide for the dispensing of at least a hour supply of the drug on the prior approval program i in an emergency situation or ii on weekends or state holidays i the program may be applied to allow acceptable medical use of a drug on prior approval for appropriate off label indications and j before placing a drug class on the prior approval program the board shall i determine that the requirements of subsections a through i have been met and ii by majority vote place the drug class on prior approval the board may only after complying with subsections b through j consider the cost a of a drug when placing a drug on the prior approval program and b associated with including or excluding a drug from the prior approval process including i potential side effects associated with a drug or ii potential hospitalizations or other complications that may occur as a result of a drug s inclusion on the prior approval process section section b which is renumbered from section is renumbered and amended to read b advisory committees the board may establish advisory committees to assist it in carrying out its duties under this part sections b through b section section b which is renumbered from section is renumbered and amended to read b retrospective and prospective dur the board in cooperation with the division shall include in its state plan the creation and implementation of a retrospective and prospective dur program for medicaid outpatient drugs to ensure that prescriptions are appropriate medically necessary and not likely to result in adverse medical outcomes the retrospective and prospective dur program shall be operated under guidelines established by the board under subsections and the retrospective dur program shall be based on guidelines established by the board using the mechanized drug claims processing and information retrieval system to analyze claims data in order to a identify patterns of fraud abuse gross overuse and inappropriate or medically unnecessary care and b assess data on drug use against explicit predetermined standards that are based on the compendia and other sources for the purpose of monitoring i therapeutic appropriateness ii overutilization or underutilization iii therapeutic duplication iv drug disease contraindications v drug drug interactions vi incorrect drug dosage or duration of drug treatment and vii clinical abuse and misuse the prospective dur program shall be based on guidelines established by the board and shall provide that before a prescription is filled or delivered a review will be conducted by the pharmacist at the point of sale to screen for potential drug therapy problems resulting from a therapeutic duplication b drug drug interactions c incorrect dosage or duration of treatment d drug allergy interactions and e clinical abuse or misuse in conducting the prospective dur a pharmacist may not alter the prescribed outpatient drug therapy without the consent of the prescribing physician or physician assistant this section does not effect the ability of a pharmacist to substitute a generic equivalent section section b which is renumbered from section is renumbered and amended to read b penalties any person who violates the confidentiality provisions of this part sections b through b is guilty of a class b misdemeanor section section b which is renumbered from section is renumbered and amended to read b immunity there is no liability on the part of and no cause of action of any nature arises against any member of the board its agents or employees for any action or omission by them in effecting the provisions of this part sections b through b section section b which is renumbered from section is renumbered and amended to read b purpose medicaid certification of nursing care facilities the legislature finds a that an oversupply of nursing care facilities in the state adversely affects the state medicaid program and the health of the people in the state b it is in the best interest of the state to prohibit nursing care facilities from receiving medicaid certification except as provided by this part sections b through b and c it is in the best interest of the state to encourage aging nursing care facilities with medicaid certification to renovate the nursing care facilities physical facilities so that the quality of life and clinical services for medicaid residents are preserved medicaid reimbursement of nursing care facility programs is limited to a the number of nursing care facility programs with medicaid certification as of may and b additional nursing care facility programs approved for medicaid certification under the provisions of subsections b and the division may not a except as authorized by section b i process initial applications for medicaid certification or execute provider agreements with nursing care facility programs or ii reinstate medicaid certification for a nursing care facility whose certification expired or was terminated by action of the federal or state government or b execute a medicaid provider agreement with a certified program that moves to a different physical facility except as authorized by subsection b notwithstanding section b beginning may the division may not approve a new or additional bed in an intermediate care facility for individuals with an intellectual disability for medicaid certification unless certification of the bed by the division does not increase the total number in the state of medicaid certified beds in intermediate care facilities for individuals with an intellectual disability section section b which is renumbered from section is renumbered and amended to read b authorization to renew transfer or increase medicaid certified programs reimbursement methodology a the division may renew medicaid certification of a certified program if the program without lapse in service to medicaid recipients has its nursing care facility program certified by the division at the same physical facility as long as the licensed and certified bed capacity at the facility has not been expanded unless the director has approved additional beds in accordance with subsection b the division may renew medicaid certification of a nursing care facility program that is not currently certified if i since the day on which the program last operated with medicaid certification a the physical facility where the program operated has functioned solely and continuously as a nursing care facility and b the owner of the program has not under this section or section b transferred to another nursing care facility program the license for any of the medicaid beds in the program and ii except as provided in subsection b the number of beds granted renewed medicaid certification does not exceed the number of beds certified at the time the program last operated with medicaid certification excluding a period of time where the program operated with temporary certification under subsection b a the division may issue a medicaid certification for a new nursing care facility program if a current owner of the medicaid certified program transfers its ownership of the medicaid certification to the new nursing care facility program and the new nursing care facility program meets all of the following conditions i the new nursing care facility program operates at the same physical facility as the previous medicaid certified program ii the new nursing care facility program gives a written assurance to the director in accordance with subsection iii the new nursing care facility program receives the medicaid certification within one year of the date the previously certified program ceased to provide medical assistance to a medicaid recipient and iv the licensed and certified bed capacity at the facility has not been expanded unless the director has approved additional beds in accordance with subsection b a nursing care facility program that receives medicaid certification under the provisions of subsection a does not assume the medicaid liabilities of the previous nursing care facility program if the new nursing care facility program i is not owned in whole or in part by the previous nursing care facility program or ii is not a successor in interest of the previous nursing care facility program the division may issue a medicaid certification to a nursing care facility program that was previously a certified program but now resides in a new or renovated physical facility if the nursing care facility program meets all of the following a the nursing care facility program met all applicable requirements for medicaid certification at the time of closure b the new or renovated physical facility is in the same county or within a five mile radius of the original physical facility c the time between which the certified program ceased to operate in the original facility and will begin to operate in the new physical facility is not more than three years unless i an emergency is declared by the president of the united states or the governor affecting the building or renovation of the physical facility ii the director approves an exception to the three year requirement for any nursing care facility program within the three year requirement iii the provider submits documentation supporting a request for an extension to the director that demonstrates a need for an extension and iv the exception does not extend for more than two years beyond the three year requirement d if subsection c applies the certified program notifies the department within days after ceasing operations in its original facility of its intent to retain its medicaid certification e the provider gives written assurance to the director in accordance with subsection that no third party has a legitimate claim to operate a certified program at the previous physical facility and f the bed capacity in the physical facility has not been expanded unless the director has approved additional beds in accordance with subsection a the entity requesting medicaid certification under subsections and shall give written assurances satisfactory to the director or the director s designee that i no third party has a legitimate claim to operate the certified program ii the requesting entity agrees to defend and indemnify the department against any claims by a third party who may assert a right to operate the certified program and iii if a third party is found by final agency action of the department after exhaustion of all administrative and judicial appeal rights to be entitled to operate a certified program at the physical facility the certified program shall voluntarily comply with subsection b b if a finding is made under the provisions of subsection a iii i the certified program shall immediately surrender its medicaid certification and comply with division rules regarding billing for medicaid and the provision of services to medicaid patients and ii the department shall transfer the surrendered medicaid certification to the third party who prevailed under subsection a iii a the director may approve additional nursing care facility programs for medicaid certification or additional beds for medicaid certification within an existing nursing care facility program if a nursing care facility or other interested party requests medicaid certification for a nursing care facility program or additional beds within an existing nursing care facility program and the nursing care facility program or other interested party complies with this section b the nursing care facility or other interested party requesting medicaid certification for a nursing care facility program or additional beds within an existing nursing care facility program under subsection a shall submit to the director i proof of the following as reasonable evidence that bed capacity provided by medicaid certified programs within the county or group of counties impacted by the requested additional medicaid certification is insufficient a nursing care facility occupancy levels for all existing and proposed facilities will be at least for the next three years b current nursing care facility occupancy is or more or c there is no other nursing care facility within a mile radius of the nursing care facility requesting the additional certification and ii an independent analysis demonstrating that at projected occupancy rates the nursing care facility s after tax net income is sufficient for the facility to be financially viable c any request for additional beds as part of a renovation project are limited to the maximum number of beds allowed in subsection d the director shall determine whether to issue additional medicaid certification by considering i whether bed capacity provided by certified programs within the county or group of counties impacted by the requested additional medicaid certification is insufficient based on the information submitted to the director under subsection b ii whether the county or group of counties impacted by the requested additional medicaid certification is underserved by specialized or unique services that would be provided by the nursing care facility iii whether any medicaid certified beds are subject to a claim by a previous certified program that may reopen under the provisions of subsections and iv how additional bed capacity should be added to the long term care delivery system to best meet the needs of medicaid recipients and v a whether the existing certified programs within the county or group of counties have provided services of sufficient quality to merit at least a two star rating in the medicare five star quality rating system over the previous three year period and b information obtained under subsection the department shall adopt administrative rules in accordance with title g chapter utah administrative rulemaking act to adjust the medicaid nursing care facility property reimbursement methodology to a only pay that portion of the property component of rates representing actual bed usage by medicaid clients as a percentage of the greater of i actual occupancy or ii a for a nursing care facility other than a facility described in subsection a ii b of total bed capacity or b for a rural nursing care facility of total bed capacity and b not allow for increases in reimbursement for property values without major renovation or replacement projects as defined by the department by rule a except as provided in subsection b if a nursing care facility does not seek medicaid certification for a bed under subsections through the department shall notwithstanding subsections b a and b grant medicaid certification for additional beds in an existing medicaid certified nursing care facility that has or fewer licensed beds including medicaid certified beds in the facility if i the nursing care facility program was previously a certified program for all beds but now resides in a new facility or in a facility that underwent major renovations involving major structural changes with or greater facility square footage design changes requiring review and approval by the department ii the nursing care facility meets the quality of care regulations issued by cms and iii the total number of additional beds in the facility granted medicaid certification under this section does not exceed of the number of licensed beds in the facility b the department may not revoke the medicaid certification of a bed under this subsection as long as the provisions of subsection a ii are met a if a nursing care facility or other interested party indicates in its request for additional medicaid certification under subsection a that the facility will offer specialized or unique services but the facility does not offer those services after receiving additional medicaid certification the director shall revoke the additional medicaid certification b the nursing care facility program shall obtain medicaid certification for any additional medicaid beds approved under subsection or within three years of the date of the director s approval or the approval is void a if the director makes an initial determination that quality standards under subsection d v have not been met in a rural county or group of rural counties over the previous three year period the director shall before approving certification of additional medicaid beds in the rural county or group of counties i notify the certified program that has not met the quality standards in subsection d v that the director intends to certify additional medicaid beds under the provisions of subsection d v and ii consider additional information submitted to the director by the certified program in a rural county that has not met the quality standards under subsection d v b the notice under subsection a does not give the certified program that has not met the quality standards under subsection d v the right to legally challenge or appeal the director s decision to certify additional medicaid beds under subsection d v section section b which is renumbered from section is renumbered and amended to read b appeals of division decision rulemaking authority application of act a decision by the director under this part to deny medicaid certification for a nursing care facility program or to deny additional bed capacity for an existing certified program is subject to review under the procedures and requirements of title g chapter administrative procedures act the department shall make rules to administer and enforce this part sections b through b in accordance with title g chapter utah administrative rulemaking act a in the event the department is at risk for a federal disallowance with regard to a medicaid recipient being served in a nursing care facility program that is not medicaid certified the department may grant temporary medicaid certification to that facility for up to months b i the department may extend a temporary medicaid certification granted to a facility under subsection a a for the number of beds in the nursing care facility occupied by a medicaid recipient and b for the period of time during which the medicaid recipient resides at the facility ii a temporary medicaid certification granted under this subsection is revoked upon a the discharge of the patient from the facility or b the patient no longer residing at the facility for any reason c the department may place conditions on the temporary certification granted under subsections a and b such as i not allowing additional admissions of medicaid recipients to the program and ii not paying for the care of the patient after october with state only dollars section section b which is renumbered from section is renumbered and amended to read b authorization to sell or transfer licensed medicaid beds duties of transferor duties of transferee duties of division this section provides a method to transfer or sell the license for a medicaid bed from a nursing care facility program to another entity that is in addition to the authorization to transfer under section b a a nursing care facility program may transfer or sell one or more of its licenses for medicaid beds in accordance with subsection b if i at the time of the transfer and with respect to the license for the medicaid bed that will be transferred the nursing care facility program that will transfer the medicaid license meets all applicable regulations for medicaid certification ii the nursing care facility program gives a written assurance which is postmarked or has proof of delivery days before the transfer to the director and to the transferee in accordance with subsection b iii the nursing care facility program that will transfer the license for a medicaid bed notifies the division in writing which is postmarked or has proof of delivery days before the transfer of a the number of bed licenses that will be transferred b the date of the transfer and c the identity and location of the entity receiving the transferred licenses and iv if the nursing care facility program for which the license will be transferred or purchased is located in an urban county with a nursing care facility average annual occupancy rate over the previous two years less than or equal to the nursing care facility program transferring or selling the license demonstrates to the satisfaction of the director that the sale or transfer a will not result in an excessive number of medicaid certified beds within the county or group of counties that would be impacted by the transfer or sale and b best meets the needs of medicaid recipients b except as provided in subsection c a nursing care facility program may transfer or sell one or more of its licenses for medicaid beds to i a nursing care facility program that has the same owner or successor in interest of the same owner ii a nursing care facility program that has a different owner or iii a related party nonnursing care facility entity that wants to hold one or more of the licenses for a nursing care facility program not yet identified as long as a the licenses are subsequently transferred or sold to a nursing care facility program within three years and b the nursing care facility program notifies the director of the transfer or sale in accordance with subsection a iii c a nursing care facility program may not transfer or sell one or more of its licenses for medicaid beds to an entity under subsection b i ii or iii that is located in a rural county unless the entity requests and the director issues medicaid certification for the beds under subsection b a nursing care facility program or entity under subsection b i ii or iii that receives or purchases a license for a medicaid bed under subsection b a may receive a license for a medicaid bed from more than one nursing care facility program b shall give the division notice which is postmarked or has proof of delivery within days of the nursing care facility program or entity seeking medicaid certification of beds in the nursing care facility program or entity of the total number of licenses for medicaid beds that the entity received and who it received the licenses from c may only seek medicaid certification for the number of licensed beds in the nursing care facility program equal to the total number of licenses for medicaid beds received by the entity d does not have to demonstrate need or seek approval for the medicaid licensed bed under subsection b except as provided in subsections a iv and c e shall meet the standards for medicaid certification other than those in subsection b including personnel services contracts and licensing of facilities under chapter health care facility licensing and inspection act chapter part health care facility licensing and inspection and f shall obtain medicaid certification for the licensed medicaid beds within three years of the date of transfer as documented under subsection a iii b a when the division receives notice of a transfer of a license for a medicaid bed under subsection a iii a the department shall reduce the number of licenses for medicaid beds at the transferring nursing care facility i equal to the number of licenses transferred and ii effective on the date of the transfer as reported under subsection a iii b b for purposes of section b the division shall approve medicaid certification for the receiving nursing care facility program or entity i in accordance with the formula established in subsection c and ii if a the nursing care facility seeks medicaid certification for the transferred licenses within the time limit required by subsection f and b the nursing care facility program meets other requirements for medicaid certification under subsection e c a license for a medicaid bed may not be approved for medicaid certification without meeting the requirements of sections and b and b if i the license for a medicaid bed is transferred under this section but the receiving entity does not obtain medicaid certification for the licensed bed within the time required by subsection f or ii the license for a medicaid bed is transferred under this section but the license is no longer eligible for medicaid certification section section b which is renumbered from section a is renumbered and amended to read part nursing care facility assessment a b definitions as used in this chapter part a nursing care facility means i a nursing care facility described in subsection as defined in section b ii beginning january a designated swing bed in a a general acute hospital as defined in subsection section b and b a critical access hospital which meets the criteria of u s c sec i c and iii an intermediate care facility for people with an intellectual disability that is licensed under section b b nursing care facility does not include i the utah state developmental center ii the utah state hospital iii a general acute hospital specialty hospital or small health care facility as those terms are defined in section b or iv a utah state veterans home patient day means each calendar day in which an individual patient is admitted to the nursing care facility during a calendar month even if on a temporary leave of absence from the facility section section b which is renumbered from section a is renumbered and amended to read a b legislative findings the legislature finds that there is an important state purpose to improve the quality of care given to persons who are elderly and to people who have a disability in long term care nursing facilities the legislature finds that in order to improve the quality of care to those persons described in subsection the rates paid to the nursing care facilities by the medicaid program must be adequate to encourage and support quality care the legislature finds that in order to meet the objectives in subsections and adequate funding must be provided to increase the rates paid to nursing care facilities providing services pursuant to the medicaid program section section b which is renumbered from section a is renumbered and amended to read a b collection remittance and payment of nursing care facilities assessment a beginning july an assessment is imposed upon each nursing care facility in the amount designated in subsection c b i the department shall establish by rule a uniform rate per non medicare patient day that may not exceed of the total gross revenue for services provided to patients of all nursing care facilities licensed in this state ii for purposes of subsection b i total revenue does not include charitable contribution received by a nursing care facility c the department shall calculate the assessment imposed under subsection a by multiplying the total number of patient days of care provided to non medicare patients by the nursing care facility as provided to the department pursuant to subsection a by the uniform rate established by the department pursuant to subsection b a the assessment imposed by this chapter part is due and payable on a monthly basis on or before the last day of the month next succeeding each monthly period b the collecting agent for this assessment shall be the department which is vested with the administration and enforcement of this chapter part including the right to audit records of a nursing care facility related to patient days of care for the facility c the department shall forward proceeds from the assessment imposed by this chapter part to the state treasurer for deposit in the expendable special revenue fund as specified in section a b each nursing care facility shall on or before the end of the month next succeeding each calendar monthly period file with the department a a report which includes i the total number of patient days of care the facility provided to non medicare patients during the preceding month ii the total gross revenue the facility earned as compensation for services provided to patients during the preceding month and iii any other information required by the department and b a return for the monthly period and shall remit with the return the assessment required by this chapter part to be paid for the period covered by the return each return shall contain information and be in the form the department prescribes by rule the assessment as computed in the return is an allowable cost for medicaid reimbursement purposes the department may by rule extend the time for making returns and paying the assessment each nursing care facility that fails to pay any assessment required to be paid to the state within the time required by this chapter part or that fails to file a return as required by this chapter part shall pay in addition to the assessment penalties and interest as provided in section a b section section b which is renumbered from section a is renumbered and amended to read a b penalties and interest the penalty for failure to file a return or pay the assessment due within the time prescribed by this chapter part is the greater of or of the assessment due on the return for failure to pay within days of a notice of deficiency of assessment required to be paid the penalty is the greater of or of the assessment due the penalty for underpayment of the assessment is as follows a if any underpayment of assessment is due to negligence the penalty is of the underpayment b if the underpayment of the assessment is due to intentional disregard of law or rule the penalty is of the underpayment for intent to evade the assessment the penalty is of the underpayment the rate of interest applicable to an underpayment of an assessment under this chapter part or an unpaid penalty under this chapter part is annually the department may waive the imposition of a penalty for good cause section section b which is renumbered from section a is renumbered and amended to read a b adjustment to nursing care facility medicaid reimbursement rates if federal law or regulation prohibits the money in the nursing care facilities provider assessment fund from being used in the manner set forth in subsection a b b the rates paid to nursing care facilities for providing services pursuant to the medicaid program shall be changed except as otherwise provided in subsection to the rates paid to nursing care facilities on june or if the legislature or the department has on or after july changed the rates paid to facilities through a manner other than the use of expenditures from the nursing care facilities provider assessment fund to the rates provided for by the legislature or the department section section b which is renumbered from section a is renumbered and amended to read a b intermediate care facility for people with an intellectual disability uniform rate an intermediate care facility for people with an intellectual disability is subject to all the provisions of this chapter part except that the department shall establish a uniform rate for an intermediate care facility for people with an intellectual disability that is based on the same formula specified for nursing care facilities under the provisions of subsection a b b and may be different than the uniform rate established for other nursing care facilities section section b which is renumbered from section b is renumbered and amended to read part inpatient hospital assessment b b definitions as used in this chapter part assessment means the inpatient hospital assessment established by this chapter part cms means the centers for medicare and medicaid services within the united states department of health and human services discharges means the number of total hospital discharges reported on a worksheet s part i column lines and of the medicare cost report for the applicable assessment year or b a similar report adopted by the department by administrative rule if the report under subsection a is no longer available division means the division of health care financing integrated healthcare within the department enhancement waiver program means the program established by the primary care network enhancement waiver program described in section b health coverage improvement program means the health coverage improvement program described in section b hospital share means the hospital share described in section b b medicaid accountable care organization means a managed care organization as defined in c f r sec that contracts with the department under the provisions of section b medicaid waiver expansion means a medicaid expansion in accordance with section or b or b medicare cost report means cms the cost report for electronic filing of hospitals a non state government hospital means a hospital owned by a non state government entity b non state government hospital does not include i the utah state hospital or ii a hospital owned by the federal government including the veterans administration hospital a private hospital means i a general acute hospital as defined in section b that is privately owned and operating in the state and ii a privately owned specialty hospital operating in the state including a privately owned hospital whose inpatient admissions are predominantly for a rehabilitation b psychiatric care c chemical dependency services or d long term acute care services b private hospital does not include a facility for residential treatment as defined in section a b state teaching hospital means a state owned teaching hospital that is part of an institution of higher education upper payment limit gap means the difference between the private hospital outpatient upper payment limit and the private hospital medicaid outpatient payments as determined in accordance with c f r sec section section b which is renumbered from section b is renumbered and amended to read b b application other than for the imposition of the assessment described in this chapter part nothing in this chapter part shall affect the nonprofit or tax exempt status of any nonprofit charitable religious or educational health care provider under any a state law b ad valorem property taxes c sales or use taxes or d other taxes fees or assessments whether imposed or sought to be imposed by the state or any political subdivision of the state all assessments paid under this chapter part may be included as an allowable cost of a hospital for purposes of any applicable medicaid reimbursement formula this chapter part does not authorize a political subdivision of the state to a license a hospital for revenue b impose a tax or assessment upon a hospital or c impose a tax or assessment measured by the income or earnings of a hospital section section b which is renumbered from section b is renumbered and amended to read b b assessment an assessment is imposed on each private hospital a beginning upon the later of cms approval of i the health coverage improvement program waiver under section b and ii the assessment under this chapter part b in the amount designated in sections b and b b and b and c in accordance with section b b subject to section b b the assessment imposed by this chapter part is due and payable on a quarterly basis after payment of the outpatient upper payment limit supplemental payments under section b b have been paid the first quarterly payment is not due until at least three months after the earlier of the effective dates of the coverage provided through a the health coverage improvement program b the enhancement waiver program or c the medicaid waiver expansion section section b which is renumbered from section b is renumbered and amended to read b b collection of assessment deposit of revenue rulemaking the collecting agent for the assessment imposed under section b b is the department the department is vested with the administration and enforcement of this chapter part and may make rules in accordance with title g chapter utah administrative rulemaking act necessary to a collect the assessment intergovernmental transfers and penalties imposed under this chapter part b audit records of a facility that i is subject to the assessment imposed by this chapter part and ii does not file a medicare cost report and c select a report similar to the medicare cost report if medicare no longer uses a medicare cost report the department shall a administer the assessment in this chapter part separately from the assessment in chapter d part hospital provider assessment act and b deposit assessments collected under this chapter part into the medicaid expansion fund created by section b b section section b which is renumbered from section b is renumbered and amended to read b b quarterly notice quarterly assessments imposed by this chapter part shall be paid to the division within business days after the original invoice date that appears on the invoice issued by the division the department may by rule extend the time for paying the assessment section section b which is renumbered from section b is renumbered and amended to read b b hospital financing of health coverage improvement program medicaid waiver expansion hospital share the hospital share is a of the state s net cost of the health coverage improvement program including medicaid coverage for individuals with dependent children up to the federal poverty level designated under section b b of the state s net cost of the enhancement waiver program c if the waiver for the medicaid waiver expansion is approved and d of the state s net cost of the upper payment limit gap a the hospital share is capped at no more than annually consisting of i an cap for the programs specified in subsections a through c and ii a cap for the program specified in subsection d b the department shall prorate the cap described in subsection a in any year in which the programs specified in subsections a and d are not in effect for the full fiscal year private hospitals shall be assessed under this chapter part for a of the portion of the hospital share for the programs specified in subsections a through c and b of the portion of the hospital share specified in subsection d a in the report described in subsection b the department shall calculate the state s net cost of each of the programs described in subsections a through c that are in effect for that year b if the assessment collected in the previous fiscal year is above or below the hospital share for private hospitals for the previous fiscal year the underpayment or overpayment of the assessment by the private hospitals shall be applied to the fiscal year in which the report is issued a medicaid accountable care organization shall on or before october of each year report to the department the following data from the prior state fiscal year for each private hospital state teaching hospital and non state government hospital provider that the medicaid accountable care organization contracts with a for the traditional medicaid population i hospital inpatient payments ii hospital inpatient discharges iii hospital inpatient days and iv hospital outpatient payments and b if the medicaid accountable care organization enrolls any individuals in the health coverage improvement program the enhancement waiver program or the medicaid waiver expansion for the population newly eligible for any of those programs i hospital inpatient payments ii hospital inpatient discharges iii hospital inpatient days and iv hospital outpatient payments the department shall by rule made in accordance with title g chapter utah administrative rulemaking act provide details surrounding specific content and format for the reporting by the medicaid accountable care organization section section b which is renumbered from section b is renumbered and amended to read b b calculation of assessment a except as provided in subsection b an annual assessment is payable on a quarterly basis for each private hospital in an amount calculated by the division at a uniform assessment rate for each hospital discharge in accordance with this section b a private teaching hospital with more than beds and residents shall pay an assessment rate times the uniform rate established under subsection c c the division shall calculate the uniform assessment rate described in subsection a by dividing the hospital share for assessed private hospitals described in subsections b and b b and by the sum of i the total number of discharges for assessed private hospitals that are not a private teaching hospital and ii times the number of discharges for a private teaching hospital described in subsection b d the division may by rule made in accordance with title g chapter utah administrative rulemaking act adjust the formula described in subsection c to address unforeseen circumstances in the administration of the assessment under this chapter part e any quarterly changes to the uniform assessment rate shall be applied uniformly to all assessed private hospitals except as provided in subsection for each state fiscal year the division shall determine a hospital s discharges as follows a for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june and b for each subsequent state fiscal year the hospital s cost report data for the hospital s fiscal year that ended in the state fiscal year two years before the assessment fiscal year a if a hospital s fiscal year medicare cost report is not contained in the cms healthcare cost report information system file i the hospital shall submit to the division a copy of the hospital s medicare cost report applicable to the assessment year and ii the division shall determine the hospital s discharges b if a hospital is not certified by the medicare program and is not required to file a medicare cost report i the hospital shall submit to the division the hospital s applicable fiscal year discharges with supporting documentation ii the division shall determine the hospital s discharges from the information submitted under subsection b i and iii failure to submit discharge information shall result in an audit of the hospital s records and a penalty equal to of the calculated assessment except as provided in subsection if a hospital is owned by an organization that owns more than one hospital in the state a the assessment for each hospital shall be separately calculated by the department and b each separate hospital shall pay the assessment imposed by this chapter part if multiple hospitals use the same medicaid provider number a the department shall calculate the assessment in the aggregate for the hospitals using the same medicaid provider number and b the hospitals may pay the assessment in the aggregate section section b which is renumbered from section b is renumbered and amended to read b b state teaching hospital and non state government hospital mandatory intergovernmental transfer the state teaching hospital and a non state government hospital shall make an intergovernmental transfer to the medicaid expansion fund created in section b b in accordance with this section the hospitals described in subsection shall pay the intergovernmental transfer beginning on the later of cms approval of a the health improvement program waiver under section b or b the assessment for private hospitals in this chapter part the intergovernmental transfer is apportioned as follows a the state teaching hospital is responsible for i of the portion of the hospital share specified in subsections b b a through c and ii of the hospital share specified in subsection b b d and b non state government hospitals are responsible for i of the portion of the hospital share specified in subsections b b a through c and ii of the hospital share specified in subsection b b d the department shall by rule made in accordance with title g chapter utah administrative rulemaking act designate a the method of calculating the amounts designated in subsection and b the schedule for the intergovernmental transfers section section b which is renumbered from section b is renumbered and amended to read b b penalties and interest a hospital that fails to pay a quarterly assessment make the mandated intergovernmental transfer or file a return as required under this chapter part within the time required by this chapter part shall pay penalties described in this section in addition to the assessment or intergovernmental transfer if a hospital fails to timely pay the full amount of a quarterly assessment or the mandated intergovernmental transfer the department shall add to the assessment or intergovernmental transfer a a penalty equal to of the quarterly amount not paid on or before the due date and b on the last day of each quarter after the due date until the assessed amount and the penalty imposed under subsection a are paid in full an additional penalty on i any unpaid quarterly assessment or intergovernmental transfer and ii any unpaid penalty assessment upon making a record of the division s actions and upon reasonable cause shown the division may waive reduce or compromise any of the penalties imposed under this chapter part section section b which is renumbered from section b is renumbered and amended to read b b hospital reimbursement if the health coverage improvement program the enhancement waiver program or the medicaid waiver expansion is implemented by contracting with a medicaid accountable care organization the department shall to the extent allowed by law include in a contract to provide benefits under the health coverage improvement program the enhancement waiver program or the medicaid waiver expansion a requirement that the medicaid accountable care organization reimburse hospitals in the accountable care organization s provider network at no less than the medicaid fee for service rate if the health coverage improvement program the enhancement waiver program or the medicaid waiver expansion is implemented by the department as a fee for service program the department shall reimburse hospitals at no less than the medicaid fee for service rate nothing in this section prohibits a medicaid accountable care organization from paying a rate that exceeds the medicaid fee for service rate section section b which is renumbered from section b is renumbered and amended to read b b outpatient upper payment limit supplemental payments beginning on the effective date of the assessment imposed under this chapter part and for each subsequent fiscal year the department shall implement an outpatient upper payment limit program for private hospitals that shall supplement the reimbursement to private hospitals in accordance with subsection the division shall ensure that supplemental payment to utah private hospitals under subsection a does not exceed the positive upper payment limit gap and b is allocated based on the medicaid state plan the department shall use the same outpatient data to allocate the payments under subsection and to calculate the upper payment limit gap the supplemental payments to private hospitals under subsection are payable for outpatient hospital services provided on or after the later of a july b the effective date of the medicaid state plan amendment necessary to implement the payments under this section or c the effective date of the coverage provided through the health coverage improvement program waiver section section b which is renumbered from section b is renumbered and amended to read b b repeal of assessment the assessment imposed by this chapter part shall be repealed when a the executive director certifies that i action by congress is in effect that disqualifies the assessment imposed by this chapter part from counting toward state medicaid funds available to be used to determine the amount of federal financial participation ii a decision enactment or other determination by the legislature or by any court officer department or agency of the state or of the federal government is in effect that a disqualifies the assessment from counting toward state medicaid funds available to be used to determine federal financial participation for medicaid matching funds or b creates for any reason a failure of the state to use the assessments for at least one of the medicaid programs described in this chapter part or iii a change is in effect that reduces the aggregate hospital inpatient and outpatient payment rate below the aggregate hospital inpatient and outpatient payment rate for july or b this chapter part is repealed in accordance with section i if the assessment is repealed under subsection a the division may not collect any assessment or intergovernmental transfer under this chapter part b the department shall disburse money in the special medicaid expansion fund in accordance with the requirements in subsection b b to the extent federal matching is not reduced by cms due to the repeal of the assessment c any money remaining in the medicaid expansion fund after the disbursement described in subsection b that was derived from assessments imposed by this chapter part shall be refunded to the hospitals in proportion to the amount paid by each hospital for the last three fiscal years and d any money remaining in the medicaid expansion fund after the disbursements described in subsections b and c shall be deposited into the general fund by the end of the fiscal year that the assessment is suspended section section b which is renumbered from section c is renumbered and amended to read part medicaid expansion hospital assessment c b definitions as used in this chapter part assessment means the medicaid expansion hospital assessment established by this chapter part cms means the centers for medicare and medicaid services within the united states department of health and human services discharges means the number of total hospital discharges reported on a worksheet s part i column lines and of the medicare cost report for the applicable assessment year or b a similar report adopted by the department by administrative rule if the report under subsection a is no longer available division means the division of health care financing integrated healthcare within the department hospital share means the hospital share described in section c b medicaid accountable care organization means a managed care organization as defined in c f r sec that contracts with the department under the provisions of section b medicaid expansion fund means the medicaid expansion fund created in section b b medicaid waiver expansion means the same as that term is defined in section b medicare cost report means cms the cost report for electronic filing of hospitals a non state government hospital means a hospital owned by a non state government entity b non state government hospital does not include i the utah state hospital or ii a hospital owned by the federal government including the veterans administration hospital a private hospital means i a privately owned general acute hospital operating in the state as defined in section b or ii a privately owned specialty hospital operating in the state including a privately owned hospital for which inpatient admissions are predominantly a rehabilitation b psychiatric c chemical dependency or d long term acute care services b private hospital does not include a facility for residential treatment as defined in section a b qualified medicaid expansion means an expansion of the medicaid program in accordance with subsection b state teaching hospital means a state owned teaching hospital that is part of an institution of higher education section section b which is renumbered from section c is renumbered and amended to read c b application other than for the imposition of the assessment described in this chapter part nothing in this chapter part shall affect the nonprofit or tax exempt status of any nonprofit charitable religious or educational health care provider under any a state law b ad valorem property tax requirement c sales or use tax requirement or d other requirements imposed by taxes fees or assessments whether imposed or sought to be imposed by the state or any political subdivision of the state a hospital paying an assessment under this chapter part may include the assessment as an allowable cost of a hospital for purposes of any applicable medicaid reimbursement formula this chapter part does not authorize a political subdivision of the state to a license a hospital for revenue b impose a tax or assessment upon a hospital or c impose a tax or assessment measured by the income or earnings of a hospital section section b which is renumbered from section c is renumbered and amended to read c b assessment an assessment is imposed on each private hospital a beginning upon the later of i april and ii cms approval of the assessment under this chapter part b in the amount designated in sections c and c b and b and c in accordance with section c b the assessment imposed by this chapter part is due and payable in accordance with subsection c b section section b which is renumbered from section c is renumbered and amended to read c b collection of assessment deposit of revenue rulemaking the department shall act as the collecting agent for the assessment imposed under section c b the department shall administer and enforce the provisions of this chapter part and may make rules in accordance with title g chapter utah administrative rulemaking act necessary to a collect the assessment intergovernmental transfers and penalties imposed under this chapter part b audit records of a facility that i is subject to the assessment imposed under this chapter part and ii does not file a medicare cost report and c select a report similar to the medicare cost report if medicare no longer uses a medicare cost report the department shall a administer the assessment in this part separately from the assessments in chapter d part hospital provider assessment act and chapter b and part inpatient hospital assessment act and b deposit assessments collected under this chapter part into the medicaid expansion fund a hospitals shall pay the quarterly assessments imposed by this chapter part to the division within business days after the original invoice date that appears on the invoice issued by the division b the department may make rules creating requirements to allow the time for paying the assessment to be extended section section b which is renumbered from section c is renumbered and amended to read c b hospital share the hospital share is a for the period from april through june and b beginning july of the state s net cost of the qualified medicaid expansion after deducting appropriate offsets and savings expected as a result of implementing the qualified medicaid expansion including i savings from a the primary care network program b the health coverage improvement program as defined in section b c the state portion of inpatient prison medical coverage d behavioral health coverage and e county contributions to the non federal share of medicaid expenditures and ii any funds appropriated to the medicaid expansion fund a beginning july the hospital share is capped at no more than annually b beginning july the division shall prorate the cap specified in subsection a in any year in which the qualified medicaid expansion is not in effect for the full fiscal year section section b which is renumbered from section c is renumbered and amended to read c b hospital financing private hospitals shall be assessed under this chapter part for the portion of the hospital share described in section c b in the report described in subsection b the department shall calculate the state s net cost of the qualified medicaid expansion if the assessment collected in the previous fiscal year is above or below the hospital share for private hospitals for the previous fiscal year the division shall apply the underpayment or overpayment of the assessment by the private hospitals to the fiscal year in which the report is issued section section b which is renumbered from section c is renumbered and amended to read c b calculation of assessment a except as provided in subsection b each private hospital shall pay an annual assessment due on the last day of each quarter in an amount calculated by the division at a uniform assessment rate for each hospital discharge in accordance with this section b a private teaching hospital with more than beds and more than residents shall pay an assessment rate times the uniform rate established under subsection c c the division shall calculate the uniform assessment rate described in subsection a by dividing the hospital share for assessed private hospitals as described in subsection c b by the sum of i the total number of discharges for assessed private hospitals that are not a private teaching hospital and ii times the number of discharges for a private teaching hospital described in subsection b d the division may make rules in accordance with title g chapter utah administrative rulemaking act to adjust the formula described in subsection c to address unforeseen circumstances in the administration of the assessment under this chapter part e the division shall apply any quarterly changes to the uniform assessment rate uniformly to all assessed private hospitals except as provided in subsection for each state fiscal year the division shall determine a hospital s discharges as follows a for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june and b for each subsequent state fiscal year the hospital s cost report data for the hospital s fiscal year that ended in the state fiscal year two years before the assessment fiscal year a if a hospital s fiscal year medicare cost report is not contained in the centers for medicare and medicaid services healthcare cost report information system file i the hospital shall submit to the division a copy of the hospital s medicare cost report applicable to the assessment year and ii the division shall determine the hospital s discharges b if a hospital is not certified by the medicare program and is not required to file a medicare cost report i the hospital shall submit to the division the hospital s applicable fiscal year discharges with supporting documentation ii the division shall determine the hospital s discharges from the information submitted under subsection b i and iii if the hospital fails to submit discharge information the division shall audit the hospital s records and may impose a penalty equal to of the calculated assessment except as provided in subsection if a hospital is owned by an organization that owns more than one hospital in the state a the division shall calculate the assessment for each hospital separately and b each separate hospital shall pay the assessment imposed by this chapter part if multiple hospitals use the same medicaid provider number a the department shall calculate the assessment in the aggregate for the hospitals using the same medicaid provider number and b the hospitals may pay the assessment in the aggregate section section b which is renumbered from section c is renumbered and amended to read c b state teaching hospital and non state government hospital mandatory intergovernmental transfer a state teaching hospital and a non state government hospital shall make an intergovernmental transfer to the medicaid expansion fund in accordance with this section the hospitals described in subsection shall pay the intergovernmental transfer beginning on the later of a april or b cms approval of the assessment for private hospitals in this chapter part the intergovernmental transfer is apportioned between the non state government hospitals as follows a the state teaching hospital shall pay for the portion of the hospital share described in section c b and b non state government hospitals shall pay for the portion of the hospital share described in section c b the department shall by rule made in accordance with title g chapter utah administrative rulemaking act designate a the method of calculating the amounts designated in subsection and b the schedule for the intergovernmental transfers section section b which is renumbered from section c is renumbered and amended to read c b penalties a hospital that fails to pay a quarterly assessment make the mandated intergovernmental transfer or file a return as required under this chapter part within the time required by this chapter part shall pay penalties described in this section in addition to the assessment or intergovernmental transfer if a hospital fails to timely pay the full amount of a quarterly assessment or the mandated intergovernmental transfer the department shall add to the assessment or intergovernmental transfer a a penalty equal to of the quarterly amount not paid on or before the due date and b on the last day of each quarter after the due date until the assessed amount and the penalty imposed under subsection a are paid in full an additional penalty on i any unpaid quarterly assessment or intergovernmental transfer and ii any unpaid penalty assessment upon making a record of the division s actions and upon reasonable cause shown the division may waive or reduce any of the penalties imposed under this chapter part section section b which is renumbered from section c is renumbered and amended to read c b hospital reimbursement if the qualified medicaid expansion is implemented by contracting with a medicaid accountable care organization the department shall to the extent allowed by law include in a contract to provide benefits under the qualified medicaid expansion a requirement that the accountable care organization reimburse hospitals in the accountable care organization s provider network at no less than the medicaid fee for service rate if the qualified medicaid expansion is implemented by the department as a fee for service program the department shall reimburse hospitals at no less than the medicaid fee for service rate nothing in this section prohibits the department or a medicaid accountable care organization from paying a rate that exceeds the medicaid fee for service rate section section b which is renumbered from section c is renumbered and amended to read c b hospital financing of the hospital share for the first two full fiscal years that the assessment is in effect the department shall a assess private hospitals under this chapter part for of the hospital share b require the state teaching hospital to make an intergovernmental transfer under this chapter part for of the hospital share and c require non state government hospitals to make an intergovernmental transfer under this chapter part for of the hospital share a at the beginning of the third full fiscal year that the assessment is in effect and at the beginning of each subsequent fiscal year the department may set a different percentage share for private hospitals the state teaching hospital and non state government hospitals by rule made in accordance with title g chapter utah administrative rulemaking act with input from private hospitals and private teaching hospitals b if the department does not set a different percentage share under subsection a the percentage shares in subsection shall apply section section b which is renumbered from section c is renumbered and amended to read c b suspension of assessment the department shall suspend the assessment imposed by this chapter part when the executive director certifies that a action by congress is in effect that disqualifies the assessment imposed by this chapter part from counting toward state medicaid funds available to be used to determine the amount of federal financial participation b a decision enactment or other determination by the legislature or by any court officer department or agency of the state or of the federal government is in effect that i disqualifies the assessment from counting toward state medicaid funds available to be used to determine federal financial participation for medicaid matching funds or ii creates for any reason a failure of the state to use the assessments for at least one of the medicaid programs described in this chapter part or c a change is in effect that reduces the aggregate hospital inpatient and outpatient payment rate below the aggregate hospital inpatient and outpatient payment rate for july if the assessment is suspended under subsection a the division may not collect any assessment or intergovernmental transfer under this chapter part b the division shall disburse money in the medicaid expansion fund that was derived from assessments imposed by this chapter part in accordance with the requirements in subsection b b to the extent federal matching is not reduced by cms due to the repeal of the assessment and c the division shall refund any money remaining in the medicaid expansion fund after the disbursement described in subsection b that was derived from assessments imposed by this chapter part to the hospitals in proportion to the amount paid by each hospital for the last three fiscal years section section b which is renumbered from section d is renumbered and amended to read part hospital provider assessment d b definitions as used in this chapter part accountable care organization means a managed care organization as defined in c f r sec that contracts with the department under the provisions of section b assessment means the medicaid hospital provider assessment established by this chapter part discharges means the number of total hospital discharges reported on worksheet s part i column lines and of the medicare cost report or on worksheet s part i column lines and of the medicare cost report for the applicable assessment year division means the division of health care financing integrated healthcare of the department hospital a means a privately owned i general acute hospital operating in the state as defined in section b and ii specialty hospital operating in the state which shall include a privately owned hospital whose inpatient admissions are predominantly a rehabilitation b psychiatric c chemical dependency or d long term acute care services and b does not include i a human services program as defined in section a b ii a hospital owned by the federal government including the veterans administration hospital or iii a hospital that is owned by the state government a state agency or a political subdivision of the state including a a state owned teaching hospital and b the utah state hospital medicare cost report means cms or cms the cost report for electronic filing of hospitals state plan amendment means a change or update to the state medicaid plan section section b which is renumbered from section d is renumbered and amended to read d b legislative findings the legislature finds that there is an important state purpose to improve the access of medicaid patients to quality care in utah hospitals because of continuous decreases in state revenues and increases in enrollment under the utah medicaid program the legislature finds that in order to improve this access to those persons described in subsection a the rates paid to utah hospitals shall be adequate to encourage and support improved access and b adequate funding shall be provided to increase the rates paid to utah hospitals providing services pursuant to the utah medicaid program section section b which is renumbered from section d is renumbered and amended to read d b application of part other than for the imposition of the assessment described in this chapter part nothing in this chapter part shall affect the nonprofit or tax exempt status of any nonprofit charitable religious or educational health care provider under a section c as amended of the internal revenue code b other applicable federal law c any state law d any ad valorem property taxes e any sales or use taxes or f any other taxes fees or assessments whether imposed or sought to be imposed by the state or any political subdivision county municipality district authority or any agency or department thereof all assessments paid under this chapter part may be included as an allowable cost of a hospital for purposes of any applicable medicaid reimbursement formula this chapter part does not authorize a political subdivision of the state to a license a hospital for revenue b impose a tax or assessment upon hospitals or c impose a tax or assessment measured by the income or earnings of a hospital section section b which is renumbered from section d is renumbered and amended to read d b assessment collection and payment of hospital provider assessment a uniform broad based assessment is imposed on each hospital as defined in subsection d b a a in the amount designated in section d b and b in accordance with section d b a the assessment imposed by this chapter part is due and payable on a quarterly basis in accordance with section d b b the collecting agent for this assessment is the department which is vested with the administration and enforcement of this chapter part including the right to adopt administrative rules in accordance with title g chapter utah administrative rulemaking act necessary to i implement and enforce the provisions of this act and ii audit records of a facility a that is subject to the assessment imposed by this chapter part and b does not file a medicare cost report c the department shall forward proceeds from the assessment imposed by this chapter part to the state treasurer for deposit in the expendable special revenue fund as specified in section d b the department may by rule extend the time for paying the assessment section section b which is renumbered from section d is renumbered and amended to read d b calculation of assessment a an annual assessment is payable on a quarterly basis for each hospital in an amount calculated at a uniform assessment rate for each hospital discharge in accordance with this section b the uniform assessment rate shall be determined using the total number of hospital discharges for assessed hospitals divided into the total non federal portion in an amount consistent with section d b that is needed to support capitated rates for accountable care organizations for purposes of hospital services provided to medicaid enrollees c any quarterly changes to the uniform assessment rate shall be applied uniformly to all assessed hospitals d the annual uniform assessment rate may not generate more than i to offset medicaid mandatory expenditures and ii the non federal share to seed amounts needed to support capitated rates for accountable care organizations as provided for in subsection b a for each state fiscal year discharges shall be determined using the data from each hospital s medicare cost report contained in the centers for medicare and medicaid services healthcare cost report information system file the hospital s discharge data will be derived as follows i for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june ii for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june iii for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june iv for state fiscal year the hospital s cost report data for the hospital s fiscal year ending between july and june and v for each subsequent state fiscal year the hospital s cost report data for the hospital s fiscal year that ended in the state fiscal year two years prior to the assessment fiscal year b if a hospital s fiscal year medicare cost report is not contained in the centers for medicare and medicaid services healthcare cost report information system file i the hospital shall submit to the division a copy of the hospital s medicare cost report applicable to the assessment year and ii the division shall determine the hospital s discharges c if a hospital is not certified by the medicare program and is not required to file a medicare cost report i the hospital shall submit to the division its applicable fiscal year discharges with supporting documentation ii the division shall determine the hospital s discharges from the information submitted under subsection c i and iii the failure to submit discharge information shall result in an audit of the hospital s records and a penalty equal to of the calculated assessment except as provided in subsection if a hospital is owned by an organization that owns more than one hospital in the state a the assessment for each hospital shall be separately calculated by the department and b each separate hospital shall pay the assessment imposed by this chapter part notwithstanding the requirement of subsection if multiple hospitals use the same medicaid provider number a the department shall calculate the assessment in the aggregate for the hospitals using the same medicaid provider number and b the hospitals may pay the assessment in the aggregate section section b which is renumbered from section d is renumbered and amended to read d b quarterly notice collection quarterly assessments imposed by this chapter part shall be paid to the division within business days after the original invoice date that appears on the invoice issued by the division section section b which is renumbered from section d is renumbered and amended to read d b medicaid hospital adjustment under accountable care organization rates to preserve and improve access to hospital services the division shall for accountable care organization rates effective on or after april incorporate into the accountable care organization rate structure calculation consistent with the certified actuarial rate range to be allocated toward the hospital inpatient directed payments for the medicaid eligibility categories covered in utah before january and an amount equal to the difference between payments made to hospitals by accountable care organizations for the medicaid eligibility categories covered in utah before january based on submitted encounter data and the maximum amount that could be paid for those services using medicare payment principles to be used for directed payments to hospitals for outpatient services section section b which is renumbered from section d is renumbered and amended to read d b penalties and interest a facility that fails to pay any assessment or file a return as required under this chapter part within the time required by this chapter part shall pay in addition to the assessment penalties and interest established by the department a consistent with subsection b the department shall adopt rules in accordance with title g chapter utah administrative rulemaking act which establish reasonable penalties and interest for the violations described in subsection b if a hospital fails to timely pay the full amount of a quarterly assessment the department shall add to the assessment i a penalty equal to of the quarterly amount not paid on or before the due date and ii on the last day of each quarter after the due date until the assessed amount and the penalty imposed under subsection b i are paid in full an additional penalty on a any unpaid quarterly assessment and b any unpaid penalty assessment c upon making a record of its actions and upon reasonable cause shown the division may waive reduce or compromise any of the penalties imposed under this part section section b which is renumbered from section d is renumbered and amended to read d b repeal of assessment the repeal of the assessment imposed by this chapter part shall occur upon the certification by the executive director of the department that the sooner of the following has occurred a the effective date of any action by congress that would disqualify the assessment imposed by this chapter part from counting toward state medicaid funds available to be used to determine the federal financial participation b the effective date of any decision enactment or other determination by the legislature or by any court officer department or agency of the state or of the federal government that has the effect of i disqualifying the assessment from counting towards state medicaid funds available to be used to determine federal financial participation for medicaid matching funds or ii creating for any reason a failure of the state to use the assessments for the medicaid program as described in this chapter part c the effective date of i an appropriation for any state fiscal year from the general fund for hospital payments under the state medicaid program that is less than the amount appropriated for state fiscal year ii the annual revenues of the state general fund budget return to the level that was appropriated for fiscal year iii a division change in rules that reduces any of the following below july payments a aggregate hospital inpatient payments b adjustment payment rates or c any cost settlement protocol or iv a division change in rules that reduces the aggregate outpatient payments below july payments and d the sunset of this chapter part in accordance with section i if the assessment is repealed under subsection money in the fund that was derived from assessments imposed by this chapter part before the determination made under subsection shall be disbursed under section d b to the extent federal matching is not reduced due to the impermissibility of the assessments any funds remaining in the special revenue fund shall be refunded to the hospitals in proportion to the amount paid by each hospital section section b which is renumbered from section a is renumbered and amended to read part ambulance service provider assessment a b definitions as used in this chapter part ambulance service provider means a an ambulance provider as defined in section a b or b a non service provider as defined in section a b assessment means the medicaid ambulance service provider assessment established by this chapter part division means the division of health care financing integrated healthcare within the department non federal portion means the non federal share the division needs to seed amounts that will support fee for service ambulance service provider rates as described in section a b total transports means the number of total ambulance transports applicable to a given fiscal year as determined under subsection a b section section b which is renumbered from section a is renumbered and amended to read a b assessment collection and payment of ambulance service provider assessment an ambulance service provider shall pay an assessment to the division a in the amount designated in section a b b in accordance with this chapter part c quarterly on a day determined by the division by rule made under subsection b and d no more than business days after the day on which the division issues the ambulance service provider notice of the assessment the division shall a collect the assessment described in subsection b determine by rule made in accordance with title g chapter utah administrative rulemaking act standards and procedures for implementing and enforcing the provisions of this chapter part and c transfer assessment proceeds to the state treasurer for deposit into the ambulance service provider assessment expendable revenue fund created in section a b section section b which is renumbered from section a is renumbered and amended to read a b calculation of assessment the division shall calculate a uniform assessment per transport as described in this section the assessment due from a given ambulance service provider equals the non federal portion divided by total transports multiplied by the number of transports for the ambulance service provider the division shall apply any quarterly changes to the assessment rate calculated as described in subsection uniformly to all assessed ambulance service providers the assessment may not generate more than the total of a an annual amount of to offset medicaid administration expenses and b the non federal portion a for each state fiscal year the division shall calculate total transports using data from the emergency medical system as follows i for state fiscal year the division shall use ambulance service provider transports during the calendar year and ii for a fiscal year after the division shall use ambulance service provider transports during the calendar year ending months before the end of the fiscal year b if an ambulance service provider fails to submit transport information to the emergency medical system the division may audit the ambulance service provider to determine the ambulance service provider s transports for a given fiscal year section section b which is renumbered from section a is renumbered and amended to read a b medicaid ambulance service provider adjustment under fee for service rates the division shall if the assessment imposed by this chapter part is approved by the centers for medicare and medicaid services for fee for service rates effective on or after july reimburse an ambulance service provider in an amount up to the emergency medical services ambulance rates adopted annually by the department section section b which is renumbered from section a is renumbered and amended to read a b penalties the division shall require an ambulance service provider that fails to pay an assessment due under this chapter part to pay the division in addition to the assessment a penalty determined by the division by rule made in accordance with title g chapter utah administrative rulemaking act section section b which is renumbered from section a is renumbered and amended to read a b repeal of assessment this chapter part is repealed when as certified by the executive director of the department any of the following occurs a an action by congress that disqualifies the assessment imposed by this chapter part from state medicaid funds available to be used to determine the federal financial participation takes legal effect or b an action decision enactment or other determination by the legislature or by any court officer department or agency of the state or federal government takes effect that i disqualifies the assessment from counting toward state medicaid funds available to be used to determine federal financial participation for medicaid matching funds or ii creates for any reason a failure of the state to use the assessments for the medicaid program as described in this chapter part if this chapter part is repealed under subsection a money in the ambulance service provider assessment expendable revenue fund that was derived from assessments imposed by this chapter part deposited before the determination made under subsection shall be disbursed under section a b to the extent federal matching is not reduced due to the impermissibility of the assessments and b any funds remaining in the special revenue fund shall be refunded to each ambulance service provider in proportion to the amount paid by the ambulance service provider section section b which is renumbered from section is renumbered and amended to read part utah children s health insurance program b definitions as used in this chapter part child means a person who is under years of age an individual who is younger than years old eligible child means a child who qualifies for enrollment in the program as provided in section b member means a child enrolled in the program plan means the department s plan submitted to the united states department of health and human services pursuant to u s c sec ff program means the utah children s health insurance program created by this chapter part section section b which is renumbered from section is renumbered and amended to read b creation and administration of the utah children s health insurance program there is created the utah children s health insurance program to be administered by the department in accordance with the provisions of a this chapter part and b the state children s health insurance program u s c sec aa et seq the department shall a prepare and submit the state s children s health insurance plan before may and any amendments to the federal united states department of health and human services in accordance with u s c sec ff and b make rules in accordance with title g chapter utah administrative rulemaking act regarding i eligibility requirements consistent with section b ii program benefits iii the level of coverage for each program benefit iv cost sharing requirements for members which may not a exceed the guidelines set forth in u s c sec ee or b impose deductible copayment or coinsurance requirements on a member for well child well baby and immunizations v the administration of the program and vi a requirement that a members in the program shall participate in the electronic exchange of clinical health records established in accordance with section b unless the member opts out of participation b prior to enrollment in the electronic exchange of clinical health records the member shall receive notice of the enrollment in the electronic exchange of clinical health records and the right to opt out of participation at any time and c beginning july when the program sends enrollment or renewal information to the member and when the member logs onto the program s website the member shall receive notice of the right to opt out of the electronic exchange of clinical health records section section b which is renumbered from section is renumbered and amended to read b eligibility a child is eligible to enroll in the program if the child a is a bona fide utah resident b is a citizen or legal resident of the united states c is under years of age d does not have access to or coverage under other health insurance including any coverage available through a parent or legal guardian s employer e is ineligible for medicaid benefits f resides in a household whose gross family income as defined by rule is at or below of the federal poverty level and g is not an inmate of a public institution or a patient in an institution for mental diseases a child who qualifies for enrollment in the program under subsection may not be denied enrollment due to a diagnosis or pre existing condition a the department shall determine eligibility and send notification of the eligibility decision within days after receiving the application for coverage b if the department cannot reach a decision because the applicant fails to take a required action or because there is an administrative or other emergency beyond the department s control the department shall i document the reason for the delay in the applicant s case record and ii inform the applicant of the status of the application and time frame for completion the department may not close enrollment in the program for a child who is eligible to enroll in the program under the provisions of subsection the program shall a apply for grants to make technology system improvements necessary to implement a simplified enrollment and renewal process in accordance with subsection b and b if funding is available implement a simplified enrollment and renewal process section section b which is renumbered from section is renumbered and amended to read b program benefits except as provided in subsection medical and dental program benefits shall be benchmarked in accordance with u s c sec cc as follows a medical program benefits including behavioral health care benefits shall be benchmarked effective july and on july every third year thereafter to i be substantially equal to a health benefit plan with the largest insured commercial enrollment offered by a health maintenance organization in the state and ii comply with the mental health parity and addiction equity act pub l no and b dental program benefits shall be benchmarked effective july and on july every third year thereafter in accordance with the children s health insurance program reauthorization act of to be substantially equal to a dental benefit plan that has the largest insured commercial non medicaid enrollment of covered lives that is offered in the state except that the utilization review mechanism for orthodontia shall be based on medical necessity on or before july of each year the department shall publish the benchmark for dental program benefits established under subsection b the program benefits a for enrollees who are at or below of the federal poverty level are exempt from the benchmark requirements of subsections and and b shall include treatment for autism spectrum disorder as defined in section a which i shall include coverage for applied behavioral analysis and ii if the benchmark described in subsection a does not include the coverage described in this subsection b the department shall exclude from the benchmark described in subsection a for any purpose other than providing benefits under the program section section b which is renumbered from section is renumbered and amended to read b limitation of benefits abortion is not a covered benefit except as provided in u s c sec ee section section b which is renumbered from section is renumbered and amended to read b funding the program shall be funded by federal matching funds received under together with state matching funds required by u s c sec ee program expenditures in the following categories may not exceed in the aggregate of all federal payments pursuant to u s c sec ee a other forms of child health assistance for children with gross family incomes below of the federal poverty level b other health services initiatives to improve low income children s health c outreach program expenditures and d administrative costs section section b which is renumbered from section is renumbered and amended to read b evaluation the department shall develop performance measures and annually evaluate the program s performance section section b which is renumbered from section is renumbered and amended to read b managed care contracting for services program benefits provided to a member under the program as described in section b shall be delivered by a managed care organization if the department determines that adequate services are available where the member lives or resides the department may contract with a managed care organization to provide program benefits the department shall evaluate a potential contract with a managed care organization based on a the managed care organization s i ability to manage medical expenses including mental health costs ii proven ability to handle accident and health insurance iii efficiency of claim paying procedures iv proven ability for managed care and quality assurance v provider contracting and discounts vi pharmacy benefit management vii estimated total charges for administering the pool viii ability to administer the pool in a cost efficient manner ix ability to provide adequate providers and services in the state and x ability to meet quality measures for emergency room use and access to primary care established by the department under subsection b and b other factors established by the department the department may enter into separate managed care organization contracts to provide dental benefits required by section b the department s contract with a managed care organization for the program s benefits shall include risk sharing provisions in which the plan shall accept at least of the risk for any difference between the department s premium payments per member and actual medical expenditures a the department may contract with the group insurance division within the utah state retirement office to provide services under subsection if no managed care organization is willing to contract with the department or the department determines no managed care organization meets the criteria established under subsection b in accordance with section a contract awarded under subsection a is not subject to the risk sharing required by subsection section section b which is renumbered from section is renumbered and amended to read b state contractor employee and dependent health benefit plan coverage for purposes of sections b a a b c and qualified health coverage means at the time the contract is entered into or renewed a a health benefit plan and employer contribution level with a combined actuarial value at least actuarially equivalent to the combined actuarial value of i the benchmark plan determined by the program under subsection b a and ii a contribution level at which the employer pays at least of the premium or contribution amounts for the employee and the dependents of the employee who reside or work in the state or b a federally qualified high deductible health plan that at a minimum i has a deductible that is a the lowest deductible permitted for a federally qualified high deductible health plan or b a deductible that is higher than the lowest deductible permitted for a federally qualified high deductible health plan but includes an employer contribution to a health savings account in a dollar amount at least equal to the dollar amount difference between the lowest deductible permitted for a federally qualified high deductible plan and the deductible for the employer offered federally qualified high deductible plan ii has an out of pocket maximum that does not exceed three times the amount of the annual deductible and iii provides that the employer pays of the premium or contribution amounts for the employee and the dependents of the employee who work or reside in the state the department shall a on or before july i determine the commercial equivalent of the benchmark plan described in subsection a and ii post the commercially equivalent benchmark plan described in subsection a i on the department s website noting the date posted and b update the posted commercially equivalent benchmark plan annually and at the time of any change in the benchmark section section b which is renumbered from section is renumbered and amended to read part medical benefits recovery b definitions as used in this chapter part annuity shall have the same meaning as provided in section a care facility means a a nursing facility b an intermediate care facility for an individual with an intellectual disability or c any other medical institution claim means a a request or demand for payment or b a cause of action for money or damages arising under any law employee welfare benefit plan means a medical insurance plan developed by an employer under u s c section sec et seq the employee retirement income security act of as amended health insurance entity means a an insurer b a person who administers manages provides offers sells carries or underwrites health insurance as defined in section a c a self insured plan d a group health plan as defined in subsection of the federal employee retirement income security act of e a service benefit plan f a managed care organization g a pharmacy benefit manager h an employee welfare benefit plan or i a person who is by statute contract or agreement legally responsible for payment of a claim for a health care item or service inpatient means an individual who is a patient and a resident of a care facility insurer includes a a group health plan as defined in subsection of the federal employee retirement income security act of b a health maintenance organization and c any entity offering a health service benefit plan medical assistance means a all funds expended for the benefit of a recipient under title chapter medical assistance act or under this chapter or titles xviii and xix federal social security act and b any other services provided for the benefit of a recipient by a prepaid health care delivery system under contract with the department office of recovery services means the office of recovery services within the department of human services department provider means a person or entity who provides services to a recipient recipient means a an individual who has applied for or received medical assistance from the state b the guardian conservator or other personal representative of an individual under subsection a if the individual is a minor or an incapacitated person or c the estate and survivors of an individual under subsection a if the individual is deceased recovery estate means regarding a deceased recipient a all real and personal property or other assets included within a decedent s estate as defined in section b the decedent s augmented estate as defined in section and c that part of other real or personal property in which the decedent had a legal interest at the time of death including assets conveyed to a survivor heir or assign of the decedent through joint tenancy tenancy in common survivorship life estate living trust or other arrangement state plan means the state medicaid program as enacted in accordance with title xix federal social security act tefra lien means a lien authorized under the tax equity and fiscal responsibility act of against the real property of an individual prior to the individual s death as described in u s c sec p third party includes a an individual institution corporation public or private agency trust estate insurance carrier employee welfare benefit plan health maintenance organization health service organization preferred provider organization governmental program such as medicare champus and workers compensation which may be obligated to pay all or part of the medical costs of injury disease or disability of a recipient unless any of these are excluded by department rule and b a spouse or a parent who i may be obligated to pay all or part of the medical costs of a recipient under law or by court or administrative order or ii has been ordered to maintain health dental or accident and health insurance to cover medical expenses of a spouse or dependent child by court or administrative order trust shall have the same meaning as provided in section section section b which is renumbered from section is renumbered and amended to read b program established by department promulgation of rules the department shall establish and maintain a program for the recoupment of medical assistance the department may promulgate rules to implement the purposes of this chapter part section section b which is renumbered from section is renumbered and amended to read b assignment of rights to benefits a except as provided in subsection b to the extent that medical assistance is actually provided to a recipient all benefits for medical services or payments from a third party otherwise payable to or on behalf of a recipient are assigned by operation of law to the department if the department provides or becomes obligated to provide medical assistance regardless of who made application for the benefits on behalf of the recipient b the assignment i authorizes the department to submit its claim to the third party and authorizes payment of benefits directly to the department and ii is effective for all medical assistance the department may recover the assigned benefits or payments in accordance with section b and as otherwise provided by law a the assignment of benefits includes medical support and third party payments ordered decreed or adjudged by any court of this state or any other state or territory of the united states b the assignment is not in lieu of and does not supersede or alter any other court order decree or judgment when an assignment takes effect the recipient is entitled to receive medical assistance and the benefits paid to the department are a reimbursement to the department section section b which is renumbered from section is renumbered and amended to read b health insurance entity duties related to state claims for medicaid payment or recovery as a condition of doing business in the state a health insurance entity shall with respect to an individual who is eligible for or is provided medical assistance under the state plan upon the request of the department of health department provide information to determine a during what period the individual or the spouse or dependent of the individual may be or may have been covered by the health insurance entity and b the nature of the coverage that is or was provided by the health insurance entity described in subsection a including the name address and identifying number of the plan accept the state s right of recovery and the assignment to the state of any right of an individual to payment from a party for an item or service for which payment has been made under the state plan respond to any inquiry by the department of health department regarding a claim for payment for any health care item or service that is submitted no later than three years after the day on which the health care item or service is provided and not deny a claim submitted by the department of health department solely on the basis of the date of submission of the claim the type or format of the claim form or failure to present proper documentation at the point of sale that is the basis for the claim if a the claim is submitted no later than three years after the day on which the item or service is furnished and b any action by the department of health department to enforce the rights of the state with respect to the claim is commenced no later than six years after the day on which the claim is submitted section section b which is renumbered from section is renumbered and amended to read b insurance policies not to deny or reduce benefits of individuals eligible for state medical assistance exemptions a policy of accident or sickness insurance may not contain any provision denying or reducing benefits because services are rendered to an insured or dependent who is eligible for or receiving medical assistance from the state an association corporation or organization may not deliver issue for delivery or renew any subscriber s contract which contains any provisions denying or reducing benefits because services are rendered to a subscriber or dependent who is eligible for or receiving medical assistance from the state an association corporation business or organization authorized to do business in this state and which provides or pays for any health care benefits may not deny or reduce benefits because services are rendered to a beneficiary who is eligible for or receiving medical assistance from the state notwithstanding subsection or the utah state public employees health program administered by the utah state retirement board is not required to reimburse any agency of state government for custodial care which the agency provides through its staff or facilities to members of the utah state public employees health program section section b which is renumbered from section is renumbered and amended to read b availability of insurance policy if the third party does not pay the department s claim or lien within days from the date the claim or lien is received the third party shall provide a written explanation if the claim is denied specifically describe and request any additional information from the department that is necessary to process the claim and provide the department or its agent a copy of any relevant or applicable insurance or benefit policy section section b which is renumbered from section is renumbered and amended to read b employee benefit plans as allowed pursuant to u s c section sec an employee benefit plan may not include any provision that has the effect of limiting or excluding coverage or payment for any health care for an individual who would otherwise be covered or entitled to benefits or services under the terms of the employee benefit plan based on the fact that the individual is eligible for or is provided services under the state plan section section b which is renumbered from section is renumbered and amended to read b statute of limitations survival of right of action insurance policy not to limit time allowed for recovery a subject to subsection action commenced by the department under this chapter part against a health insurance entity shall be commenced within i subject to subsection six years after the day on which the department submits the claim for recovery or payment for the health care item or service upon which the action is based or ii six months after the date of the last payment for medical assistance whichever is later b an action against any other third party the recipient or anyone to whom the proceeds are payable shall be commenced within i four years after the date of the injury or onset of the illness or ii six months after the date of the last payment for medical assistance whichever is later the death of the recipient does not abate any right of action established by this chapter part a no insurance policy issued or renewed after june may contain any provision that limits the time in which the department may submit its claim to recover medical assistance benefits to a period of less than months from the date the provider furnishes services or goods to the recipient b no insurance policy issued or renewed after april may contain any provision that limits the time in which the department may submit its claim to recover medical assistance benefits to a period of less than that described in subsection a the provisions of this section do not apply to section or part tefra liens b or sections b through b the provisions of this section supercede supersede any other sections regarding the time limit in which an action shall be commenced including section a subsection a extends the statute of limitations on a cause of action described in subsection a that was not time barred on or before april b subsection a does not revive a cause of action that was time barred on or before april an action described in subsection a may not be commenced if the claim for recovery or payment described in subsection a i is submitted later than three years after the day on which the health care item or service upon which the claim is based was provided section section b which is renumbered from section is renumbered and amended to read b recovery of medical assistance from third party lien notice action compromise or waiver recipient s right to action protected a except as provided in subsection c if the department provides or becomes obligated to provide medical assistance to a recipient that a third party is obligated to pay for the department may recover the medical assistance directly from the third party b i a claim under subsection a or section b to recover medical assistance provided to a recipient is a lien against any proceeds payable to or on behalf of the recipient by the third party ii the lien described in subsection b i has priority over all other claims to the proceeds except claims for attorney fees and costs authorized under subsection b c ii c i the department may not recover medical assistance under subsection a if a the third party is obligated to pay the recipient for an injury to the recipient s child that occurred while the child was in the physical custody of the child s foster parent b the child s injury is a physical or mental impairment that requires ongoing medical attention or limits activities of daily living for at least one year c the third party s payment to the recipient is placed in a trust annuity financial account or other financial instrument for the benefit of the child and d the recipient makes reasonable efforts to mitigate any other medical assistance costs for the recipient to the state ii the department is responsible for any repayment to the federal government related to the medical assistance the department is prohibited from recovering under subsection c i a the department shall mail or deliver written notice of the department s claim or lien to the third party at the third party s principal place of business or last known address b the notice shall include i the recipient s name ii the approximate date of illness or injury iii a general description of the type of illness or injury and iv if applicable the general location where the injury is alleged to have occurred the department may commence an action on the department s claim or lien in the department s name but the claim or lien is not enforceable as to a third party unless a the third party receives written notice of the department s claim or lien before the third party settles with the recipient or b the department has evidence that the third party had knowledge that the department provided or was obligated to provide medical assistance the department may a waive a claim or lien against a third party in whole or in part or b compromise settle or release a claim or lien an action commenced under this section does not bar an action by a recipient or a dependent of a recipient for loss or damage not included in the department s action except as provided in subsection c the department s claim or lien on proceeds under this section is not affected by the transfer of the proceeds to a trust annuity financial account or other financial instrument section section b which is renumbered from section is renumbered and amended to read b action by department notice to recipient a within days after commencing an action under subsection b the department shall give the recipient the recipient s guardian personal representative trustee estate or survivor whichever is appropriate written notice of the action by i personal service or certified mail to the last known address of the person receiving the notice or ii if no last known address is available by publishing a notice a once a week for three successive weeks in a newspaper of general circulation in the county where the recipient resides and b in accordance with section for three weeks b proof of service shall be filed in the action c the recipient may intervene in the department s action at any time before trial the notice required by subsection shall name the court in which the action is commenced and advise the recipient of a the right to intervene in the proceeding b the right to obtain a private attorney and c the department s right to recover medical assistance directly from the third party section section b which is renumbered from section is renumbered and amended to read b notice of claim by recipient department response conditions for proceeding collection agreements a a recipient may not file a claim commence an action or settle compromise release or waive a claim against a third party for recovery of medical costs for an injury disease or disability for which the department has provided or has become obligated to provide medical assistance without the department s written consent as provided in subsection b or b for purposes of subsection a consent may be obtained if i a recipient who files a claim or commences an action against a third party notifies the department in accordance with subsection d within days of the recipient making the claim or commencing an action or ii an attorney who has been retained by the recipient to file a claim or commence an action against a third party notifies the department in accordance with subsection d of the recipient s claim a within days after being retained by the recipient for that purpose or b within days from the date the attorney either knew or should have known that the recipient received medical assistance from the department c service of the notice of claim to the department shall be made by certified mail personal service or by e mail in accordance with rule of the utah rules of civil procedure to the director of the office of recovery services d the notice of claim shall include the following information i the name of the recipient ii the recipient s social security number iii the recipient s date of birth iv the name of the recipient s attorney if applicable v the name or names of individuals or entities against whom the recipient is making the claim if known vi the name of the third party s insurance carrier if known vii the date of the incident giving rise to the claim and viii a short statement identifying the nature of the recipient s claim a within days of receipt of the notice of the claim required in subsection the department shall acknowledge receipt of the notice of the claim to the recipient or the recipient s attorney and shall notify the recipient or the recipient s attorney in writing of the following i if the department has a claim or lien pursuant to section b or has become obligated to provide medical assistance and ii whether the department is denying or granting written consent in accordance with subsection a b the department shall provide the recipient s attorney the opportunity to enter into a collection agreement with the department with the recipient s consent unless i the department prior to the receipt of the notice of the recipient s claim pursuant to subsection filed a written claim with the third party the third party agreed to make payment to the department before the date the department received notice of the recipient s claim and the agreement is documented in the department s record or ii there has been a failure by the recipient s attorney to comply with any provision of this section by a failing to comply with the notice provisions of this section b failing or refusing to enter into a collection agreement c failing to comply with the terms of a collection agreement with the department or d failing to disburse funds owed to the state in accordance with this section c i the collection agreement shall be a consistent with this section and the attorney s obligation to represent the recipient and represent the state s claim and b state the terms under which the interests of the department may be represented in an action commenced by the recipient ii if the recipient s attorney enters into a written collection agreement with the department or includes the department s claim in the recipient s claim or action pursuant to subsection the department shall pay attorney fees at the rate of of the department s total recovery and shall pay a proportionate share of the litigation expenses directly related to the action d the department is not required to enter into a collection agreement with the recipient s attorney for collection of personal injury protection under subsection a a if the department receives notice pursuant to subsection and notifies the recipient and the recipient s attorney that the department will not enter into a collection agreement with the recipient s attorney the recipient may proceed with the recipient s claim or action against the third party if the recipient excludes from the claim i any medical expenses paid by the department or ii any medical costs for which the department is obligated to provide medical assistance b when a recipient proceeds with a claim under subsection a the recipient shall provide written notice to the third party of the exclusion of the department s claim for expenses under subsection a i or ii if the department receives notice pursuant to subsection and does not respond within days to the recipient or the recipient s attorney the recipient or the recipient s attorney a may proceed with the recipient s claim or action against the third party b may include the state s claim in the recipient s claim or action and c may not negotiate compromise settle or waive the department s claim without the department s consent section section b which is renumbered from section is renumbered and amended to read b department s right to intervene department s interests protected remitting funds disbursements liability and penalty for noncompliance the department has an unconditional right to intervene in an action commenced by a recipient against a third party for the purpose of recovering medical costs for which the department has provided or has become obligated to provide medical assistance a if the recipient proceeds without complying with the provisions of section b the department is not bound by any decision judgment agreement settlement or compromise rendered or made on the claim or in the action b the department i may recover in full from the recipient or any party to which the proceeds were made payable all medical assistance that the department has provided and ii retains its right to commence an independent action against the third party subject to subsection b any amounts assigned to and recoverable by the department pursuant to sections and b and b collected directly by the recipient shall be remitted to the bureau of medical collections within the office of recovery services no later than five business days after receipt a any amounts assigned to and recoverable by the department pursuant to sections and b and b collected directly by the recipient s attorney shall be remitted to the bureau of medical collections within the office of recovery services no later than days after the funds are placed in the attorney s trust account b the date by which the funds shall be remitted to the department may be modified based on agreement between the department and the recipient s attorney c the department s consent to another date for remittance may not be unreasonably withheld d if the funds are received by the recipient s attorney no disbursements shall be made to the recipient or the recipient s attorney until the department s claim has been paid a recipient or recipient s attorney who knowingly and intentionally fails to comply with this section is liable to the department for a the amount of the department s claim or lien pursuant to subsection b a penalty equal to of the amount of the department s claim and c attorney fees and litigation expenses related to recovering the department s claim section section b which is renumbered from section is renumbered and amended to read b estate and trust recovery a except as provided in subsection b upon a recipient s death the department may recover from the recipient s recovery estate and any trust in which the recipient is the grantor and a beneficiary medical assistance correctly provided for the benefit of the recipient when the recipient was years of age old or older b the department may not make an adjustment or a recovery under subsection a i while the deceased recipient s spouse is still living or ii if the deceased recipient has a surviving child who is a under age years old or b blind or disabled as defined in the state plan a the amount of medical assistance correctly provided for the benefit of a recipient and recoverable under this section is a lien against the deceased recipient s recovery estate or any trust when the recipient is the grantor and a beneficiary b the lien holds the same priority as reasonable and necessary medical expenses of the last illness as provided in section a for a lien described in subsection the department shall provide notice in accordance with section b before final distribution the department shall perfect the lien as follows i for an estate by presenting the lien to the estate s personal representative in accordance with section and ii for a trust by presenting the lien to the trustee in accordance with section c the department may file an amended lien before the entry of the final order to close the estate or trust claims against a deceased recipient s inter vivos trust shall be presented in accordance with sections and any trust provision that denies recovery for medical assistance is void at the time of its making nothing in this section affects the right of the department to recover medicaid assistance before a recipient s death under section or section b or b a lien imposed under this section is of indefinite duration section section b which is renumbered from section is renumbered and amended to read b recovery from recipient of incorrectly provided medical assistance the department may recover medical assistance incorrectly provided whether due to administrative or factual error or fraud from the recipient or the recipient s recovery estate and pursuant to a judgment impose a lien against real property of the recipient section section b which is renumbered from section is renumbered and amended to read b tefra liens authorized grounds for tefra liens exemptions except as provided in subsections and the department may impose a tefra lien on the real property of an individual for the amount of medical assistance provided for or to the individual while the individual is an inpatient in a care facility if a the individual is an inpatient in a care facility b the individual is required as a condition of receiving services under the state plan to spend for costs of medical care all but a minimal amount of the individual s income required for personal needs and c the department determines that the individual cannot reasonably be expected to i be discharged from the care facility and ii return to the individual s home the department may not impose a lien on the home of an individual described in subsection if any of the following individuals are lawfully residing in the home a the spouse of the individual b a child of the individual if the child is i under years of age old or ii blind or permanently and totally disabled as defined in title u s c sec c a f or c a sibling of the individual if the sibling i has an equity interest in the home and ii resided in the home for at least one year immediately preceding the day on which the individual was admitted to the care facility the department may not impose a tefra lien on the real property of an individual unless a the individual has been an inpatient in a care facility for the day period immediately preceding the day on which the lien is imposed b the department serves i a preliminary notice of intent to impose a tefra lien relating to the real property in accordance with section b and ii a final notice of intent to impose a tefra lien relating to the real property in accordance with section b and c i the individual does not file a timely request for review of the department s decision under title g chapter administrative procedures act or ii the department s decision is upheld upon final review or appeal under title g chapter administrative procedures act section section b which is renumbered from section is renumbered and amended to read b presumption of permanency there is a rebuttable presumption that an individual who is an inpatient in a care facility cannot reasonably be expected to be discharged from a care facility and return to the individual s home if the individual has been an inpatient in a care facility for a period of at least consecutive days section section b which is renumbered from section is renumbered and amended to read b preliminary notice of intent to impose a tefra lien prior to imposing a tefra lien on real property the department shall serve a preliminary notice of intent to impose a tefra lien on the individual described in subsection b who owns the property the preliminary notice of intent shall a be served in person or by certified mail on the individual described in subsection b and if the department is aware that the individual has a legally authorized representative on the representative b include a statement indicating that according to the department s records the individual i meets the criteria described in subsections b a and b ii has been an inpatient in a care facility for a period of at least days immediately preceding the day on which the department provides the notice to the individual and iii is legally presumed to be in a condition where it cannot reasonably be expected that the individual will be discharged from the care facility and return to the individual s home c indicate that the department intends to impose a tefra lien on real property belonging to the individual d describe the real property that the tefra lien will apply to e describe the current amount of and purpose of the tefra lien f indicate that the amount of the lien may continue to increase as the individual continues to receive medical assistance g indicate that the individual may seek to prevent the tefra lien from being imposed on the real property by providing documentation to the department that i establishes that the individual does not meet the criteria described in subsection b a or b ii establishes that the individual has not been an inpatient in a care facility for a period of at least days iii rebuts the presumption described in section b or iv establishes that the real property is exempt from imposition of a tefra lien under subsection b h indicate that if the owner fails to provide the documentation described in subsection g within days after the day on which the preliminary notice of intent is served the department will issue a final notice of intent to impose a tefra lien on the real property and will proceed to impose the lien i identify the type of documentation that the owner may provide to comply with subsection g j describe the circumstances under which a tefra lien is required to be released and k describe the circumstances under which the department may seek to recover the lien section section b which is renumbered from section is renumbered and amended to read b final notice of intent to impose a tefra lien the department may issue a final notice of intent to impose a tefra lien on real property if a a preliminary notice of intent relating to the property is served in accordance with section b b it is at least days after the day on which the preliminary notice of intent was served and c the department has not received documentation or other evidence that adequately establishes that a tefra lien may not be imposed on the real property the final notice of intent to impose a tefra lien on real property shall a be served in person or by certified mail on the individual described in subsection b who owns the property and if the department is aware that the individual has a legally authorized representative on the representative b indicate that the department has complied with the requirements for filing the final notice of intent under subsection c include a statement indicating that according to the department s records the individual i meets the criteria described in subsections b a and b ii has been an inpatient in a care facility for a period of at least days immediately preceding the day on which the department provides the notice to the individual and iii is legally presumed to be in a condition where it cannot reasonably be expected that the individual will be discharged from the care facility and return to the individual s home d indicate that the department intends to impose a tefra lien on real property belonging to the individual e describe the real property that the tefra lien will apply to f describe the current amount of and purpose of the tefra lien g indicate that the amount of the lien may continue to increase as the individual continues to receive medical assistance h describe the circumstances under which a tefra lien is required to be released i describe the circumstances under which the department may seek to recover the lien j describe the right of the individual to challenge the decision of the department in an adjudicative proceeding and k indicate that failure by the individual to successfully challenge the decision of the department will result in the tefra lien being imposed section section b which is renumbered from section is renumbered and amended to read b review of department decision an individual who has been served with a final notice of intent to impose a tefra lien under section b may seek agency or judicial review of that decision under title g chapter administrative procedures act section section b which is renumbered from section is renumbered and amended to read b dissolution and removal of tefra lien a tefra lien shall dissolve and be removed by the department if the individual described in subsection b a i is discharged from the care facility and ii returns to the individual s home or b provides sufficient documentation to the department that i rebuts the presumption described in section b or ii any of the following individuals are lawfully residing in the individual s home a the spouse of the individual b a child of the individual if the child is under years of age old or blind or permanently and totally disabled as defined in title u s c sec c a f or c a sibling of the individual if the sibling has an equity interest in the home and resided in the home for at least one year immediately preceding the day on which the individual was admitted to the care facility an individual described in subsection b a may at any time after the department has imposed a lien under this part sections b through b file a request for the department to remove the lien a request filed under subsection shall be considered and reviewed pursuant to title g chapter administrative procedures act section section b which is renumbered from section is renumbered and amended to read b expenditures included in lien other proceedings a tefra lien imposed on real property under this part sections b through b includes all expenses relating to medical assistance provided or paid for under the state plan from the first day that the individual is placed in a care facility regardless of when the lien is imposed or filed on the property nothing in this part affects or prevents sections b through b affect or prevent the department from bringing or pursuing any other legally authorized action to recover medical assistance or to set aside a fraudulent or improper conveyance section section b which is renumbered from section is renumbered and amended to read b contract with another government agency if the department contracts with another government agency to recover funds paid for medical assistance under this chapter part that government agency shall be the sole agency that determines whether to impose or remove a tefra lien under this part sections b through b section section b which is renumbered from section is renumbered and amended to read b precedence of the tax equity and fiscal responsibility act of if any provision of this part conflicts sections b through b conflict with the requirements of the tax equity and fiscal responsibility act of for imposing a lien against the property of an individual prior to the individual s death under u s c sec p the provisions of the tax equity and fiscal responsibility act of take precedence and shall be complied with by the department section section b which is renumbered from section is renumbered and amended to read b legal recognition of electronic claims records pursuant to title chapter uniform electronic transactions act a claim submitted to the department for payment may not be denied legal effect enforceability or admissibility as evidence in any court in any civil action because it is in electronic form and a third party shall accept an electronic record of payments by the department for medical services on behalf of a recipient as evidence in support of the department s claim section section b which is renumbered from section is renumbered and amended to read b direct payment to the department by third party any third party required to make payment to the department pursuant to this chapter part shall make the payment directly to the department or its designee the department may negotiate a payment or payment instrument it receives in connection with subsection without the cosignature or other participation of the recipient or any other party section section b which is renumbered from section is renumbered and amended to read b attorney general or county attorney to represent department the attorney general or a county attorney shall represent the department in any action commenced under this chapter part section section b which is renumbered from section is renumbered and amended to read b department s right to attorney fees and costs in any action brought by the department under this chapter part in which it prevails the department shall recover along with the principal sum and interest a reasonable attorney fee and costs incurred section section b which is renumbered from section is renumbered and amended to read b application of provisions contrary to federal law prohibited in no event shall any provision contained in this chapter part be applied contrary to existing federal law section section b which is renumbered from section is renumbered and amended to read part utah false claims act b definitions as used in this chapter part benefit means the receipt of money goods or any other thing of pecuniary value claim means any request or demand for money or property a made to any i employee officer or agent of the state ii contractor with the state or iii grantee or other recipient whether or not under contract with the state and b if i any portion of the money or property requested or demanded was issued from or provided by the state or ii the state will reimburse the contractor grantee or other recipient for any portion of the money or property false statement or false representation means a wholly or partially untrue statement or representation which is a knowingly made and b a material fact with respect to the claim knowing and knowingly a for purposes of criminal prosecutions for violations of this chapter part is one of the culpable mental states described in subsection b and b for purposes of civil prosecutions for violations of this chapter part is the required culpable mental state as defined in subsection b medical benefit means a benefit paid or payable to a recipient or a provider under a program administered by the state under a titles v and xix of the federal social security act b title x of the federal public health services act c the federal child nutrition act of as amended by p l pub l no and d any programs for medical assistance of the state person means an individual corporation unincorporated association professional corporation partnership or other form of business association section section b which is renumbered from section is renumbered and amended to read b false statement or representation relating to medical benefits a person may not make or cause to be made a false statement or false representation of a material fact in an application for medical benefits a person may not make or cause to be made a false statement or false representation of a material fact for use in determining rights to a medical benefit a person who having knowledge of the occurrence of an event affecting the person s initial or continued right to receive a medical benefit or the initial or continued right of any other person on whose behalf the person has applied for or is receiving a medical benefit may not conceal or fail to disclose that event with intent to obtain a medical benefit to which the person or any other person is not entitled or in an amount greater than that to which the person or any other person is entitled section section b which is renumbered from section is renumbered and amended to read b kickbacks or bribes prohibited for purposes of this section kickback or bribe a includes rebates compensation or any other form of remuneration which is i direct or indirect ii overt or covert or iii in cash or in kind and b does not include a rebate paid to the state under u s c sec r or any state supplemental rebates a person may not solicit offer pay or receive a kickback or bribe in return for or to induce a the purchasing leasing or ordering of any goods or services for which payment is or may be made in whole or in part pursuant to a medical benefit program or b the referral of an individual to another person for the furnishing of any goods or services for which payment is or may be made in whole or in part pursuant to a medical benefit program section section b which is renumbered from section is renumbered and amended to read b false statements or false representations relating to qualification of health institution or facility prohibited felony a person may not knowingly intentionally or recklessly make induce or seek to induce the making of a false statement or false representation of a material fact with respect to the conditions or operation of an institution or facility in order that the institution or facility may qualify upon initial certification or upon recertification as a hospital skilled nursing facility intermediate care facility or home health agency a person who violates this section is guilty of a second degree felony section section b which is renumbered from section is renumbered and amended to read b conspiracy to defraud prohibited a person may not enter into an agreement combination or conspiracy to defraud the state by obtaining or aiding another to obtain the payment or allowance of a false fictitious or fraudulent claim for a medical benefit section section b which is renumbered from section is renumbered and amended to read b false claims for medical benefits prohibited a person may not make or present or cause to be made or presented to an employee or officer of the state a claim for a medical benefit a which is wholly or partially false fictitious or fraudulent b for services which were not rendered or for items or materials which were not delivered c which misrepresents the type quality or quantity of items or services rendered d representing charges at a higher rate than those charged by the provider to the general public e for items or services which the person or the provider knew were not medically necessary in accordance with professionally recognized standards f which has previously been paid g for services also covered by one or more private sources when the person or provider knew of the private sources without disclosing those sources on the claim or h where a provider i unbundles a product procedure or group of procedures usually and customarily provided or performed as a single billable product or procedure into artificial components or separate procedures and ii bills for each component of the product procedure or group of procedures a as if they had been provided or performed independently and at separate times and b the aggregate billing for the components exceeds the amount otherwise billable for the usual and customary single product or procedure in addition to the prohibitions in subsection a person may not a fail to credit the state for payments received from other sources b recover or attempt to recover payment in violation of the provider agreement from i a recipient under a medical benefit program or ii the recipient s family c falsify or alter with intent to deceive any report or document required by state or federal law rule or medicaid provider agreement d retain any unauthorized payment as a result of acts described by this section or e aid or abet the commission of any act prohibited by this section section section b which is renumbered from section is renumbered and amended to read b knowledge of past acts not necessary to establish fact that false statement or representation knowingly made in prosecution under this chapter part it is not necessary to show that the person had knowledge of similar acts having been performed in the past on the part of persons acting on his behalf nor to show that the person had actual notice that the acts by the persons acting on his behalf occurred to establish the fact that a false statement or representation was knowingly made section section b which is renumbered from section is renumbered and amended to read b criminal penalties a except as provided in subsection b the culpable mental state required for a criminal violation of this chapter part is knowingly intentionally or recklessly as defined in section b the culpable mental state required for a criminal violation of this chapter part for kickbacks and bribes under section b is knowingly and intentionally as defined in section the punishment for a criminal violation of any provision of this chapter part except as provided under section b is determined by the cumulative value of the funds or other benefits received or claimed in the commission of all violations of a similar nature and not by each separate violation punishment for criminal violation of this chapter part except as provided under section b is a felony of the second degree felony of the third degree class a misdemeanor or class b misdemeanor based on the dollar amounts as prescribed by subsection for theft of property and services section section b which is renumbered from section is renumbered and amended to read b civil penalties the culpable mental state required for a civil violation of this chapter part is knowing or knowingly which a means that person with respect to information i has actual knowledge of the information ii acts in deliberate ignorance of the truth or falsity of the information or iii acts in reckless disregard of the truth or falsity of the information and b does not require a specific intent to defraud any person who violates this chapter part shall in all cases in addition to other penalties provided by law be required to a make full and complete restitution to the state of all damages that the state sustains because of the person s violation of this chapter part b pay to the state its costs of enforcement of this chapter part in that case including the cost of investigators attorneys and other public employees as determined by the state and c pay to the state a civil penalty equal to i three times the amount of damages that the state sustains because of the person s violation of this chapter part and ii not less than or more than for each claim filed or act done in violation of this chapter part any civil penalties assessed under subsection shall be awarded by the court as part of its judgment in both criminal and civil actions a criminal action need not be brought against a person in order for that person to be civilly liable under this section section section b which is renumbered from section is renumbered and amended to read b revocation of license of assisted living facility appointment of receiver if the license of an assisted living facility is revoked for violation of this chapter part the county attorney may file a petition with the district court for the county in which the facility is located for the appointment of a receiver the district court shall issue an order to show cause why a receiver should not be appointed returnable within five days after the filing of the petition a if the court finds that the facts warrant the granting of the petition the court shall appoint a receiver to take charge of the facility b the court may determine fair compensation for the receiver a receiver appointed pursuant to this section shall have the powers and duties prescribed by the court section section b which is renumbered from section is renumbered and amended to read b presumption based on paid state warrant value of medical benefits repayment of benefits in any civil or criminal action brought under this chapter part a paid state warrant made payable to the order of a party creates a presumption that the party received funds from the state in any civil or criminal action brought under this chapter part the value of the benefits received shall be the ordinary or usual charge for similar benefits in the private sector in any criminal action under this chapter part the repayment of funds or other benefits obtained in violation of the provisions of this chapter part does not constitute a defense to or grounds for dismissal of that action section section b which is renumbered from section is renumbered and amended to read b violation of other laws the provisions of this chapter part are a not exclusive and the remedies provided for in this chapter part are in addition to any other remedies provided for under i any other applicable law or ii common law and b to be liberally construed and applied to i effectuate the chapter s remedial and deterrent purposes and ii serve the public interest if any provision of this chapter part or the application of this chapter part to any person or circumstance is held unconstitutional a the remaining provisions of this chapter part are not affected and b the application of this chapter part to other persons or circumstances are not affected section section b which is renumbered from section is renumbered and amended to read b medicaid fraud enforcement this chapter part shall be enforced in accordance with this section the department is responsible for a i investigating and prosecuting suspected civil violations of this chapter part or ii referring suspected civil violations of this chapter part to the attorney general for investigation and prosecution and b promptly referring suspected criminal violations of this chapter part to the attorney general for criminal investigation and prosecution the attorney general has a concurrent jurisdiction with the department for investigating and prosecuting suspected civil violations of this chapter part and b exclusive jurisdiction to investigate and prosecute all suspected criminal violations of this chapter part the department and the attorney general share concurrent civil enforcement authority under this chapter part and may enter into an interagency agreement regarding the investigation and prosecution of violations of this chapter part in accordance with this section the requirements of title xix of the federal social security act and applicable federal regulations a any violation of this chapter part which comes to the attention of any state government officer or agency shall be reported to the attorney general or the department b all state government officers and agencies shall cooperate with and assist in any prosecution for violation of this chapter part section section b which is renumbered from section is renumbered and amended to read b investigations civil investigative demands the attorney general may take investigative action under subsection if the attorney general has reason to believe that a a person has information or custody or control of documentary material relevant to the subject matter of an investigation of an alleged violation of this chapter part b a person is committing has committed or is about to commit a violation of this chapter part or c it is in the public interest to conduct an investigation to ascertain whether or not a person is committing has committed or is about to commit a violation of this chapter part in taking investigative action the attorney general may a require the person to file on a prescribed form a statement in writing under oath or affirmation describing i the facts and circumstances concerning the alleged violation of this chapter part and ii other information considered necessary by the attorney general b examine under oath a person in connection with the alleged violation of this chapter part and c in accordance with subsections through execute in writing and serve on the person a civil investigative demand requiring the person to produce the documentary material and permit inspection and copying of the material the attorney general may not release or disclose information that is obtained under subsection a or b or any documentary material or other record derived from the information obtained under subsection a or b except a by court order for good cause shown b with the consent of the person who provided the information c to an employee of the attorney general or the department d to an agency of this state the united states or another state e to a special assistant attorney general representing the state in a civil action f to a political subdivision of this state or g to a person authorized by the attorney general to receive the information the attorney general may use documentary material derived from information obtained under subsection a or b or copies of that material as the attorney general determines necessary in the enforcement of this chapter part including presentation before a court a if a person fails to file a statement as required by subsection a or fails to submit to an examination as required by subsection b the attorney general may file in district court a complaint for an order to compel the person to within a period stated by court order i file the statement required by subsection a or ii submit to the examination required by subsection b b failure to comply with an order entered under subsection a is punishable as contempt a civil investigative demand shall a state the rule or statute under which the alleged violation of this chapter part is being investigated b describe the i general subject matter of the investigation and ii class or classes of documentary material to be produced with reasonable specificity to fairly indicate the documentary material demanded c designate a date within which the documentary material is to be produced and d identify an authorized employee of the attorney general to whom the documentary material is to be made available for inspection and copying a civil investigative demand may require disclosure of any documentary material that is discoverable under the utah rules of civil procedure service of a civil investigative demand may be made by a delivering an executed copy of the demand to the person to be served or to a partner an officer or an agent authorized by appointment or by law to receive service of process on behalf of that person b delivering an executed copy of the demand to the principal place of business in this state of the person to be served or c mailing by registered or certified mail an executed copy of the demand addressed to the person to be served i at the person s principal place of business in this state or ii if the person has no place of business in this state to the person s principal office or place of business documentary material demanded in a civil investigative demand shall be produced for inspection and copying during normal business hours at the office of the attorney general or as agreed by the person served and the attorney general the attorney general may not produce for inspection or copying or otherwise disclose the contents of documentary material obtained pursuant to a civil investigative demand except a by court order for good cause shown b with the consent of the person who produced the information c to an employee of the attorney general or the department d to an agency of this state the united states or another state e to a special assistant attorney general representing the state in a civil action f to a political subdivision of this state or g to a person authorized by the attorney general to receive the information a with respect to documentary material obtained pursuant to a civil investigative demand the attorney general shall prescribe reasonable terms and conditions allowing such documentary material to be available for inspection and copying by the person who produced the material or by an authorized representative of that person b the attorney general may use such documentary material or copies of it as the attorney general determines necessary in the enforcement of this chapter part including presentation before a court a a person may file a complaint stating good cause to extend the return date for the demand or to modify or set aside the demand b a complaint under this subsection shall be filed in district court before the earlier of a i the return date specified in the demand or b ii the th day after the date the demand is served except as provided by court order a person who has been served with a civil investigative demand shall comply with the terms of the demand a a person who has committed a violation of this chapter part in relation to the medicaid program in this state or to any other medical benefit program administered by the state has submitted to the jurisdiction of this state b personal service of a civil investigative demand under this section may be made on the person described in subsection a outside of this state this section does not limit the authority of the attorney general to conduct investigations or to access a person s documentary materials or other information under another state or federal law the utah rules of civil procedure or the federal rules of civil procedure the attorney general may file a complaint in district court for an order to enforce the civil investigative demand if a a person fails to comply with a civil investigative demand or b copying and reproduction of the documentary material demanded i cannot be satisfactorily accomplished and ii the person refuses to surrender the documentary material if a complaint is filed under subsection the court may determine the matter presented and may enter an order to enforce the civil investigative demand failure to comply with a final order entered under subsection is punishable by contempt section section b which is renumbered from section is renumbered and amended to read b limitation of actions civil acts antedating this section civil burden of proof estoppel joint civil liability venue an action under this chapter part may not be brought after the later of a six years after the date on which the violation was committed or b three years after the date an official of the state charged with responsibility to act in the circumstances discovers the violation but in no event more than years after the date on which the violation was committed a civil action brought under this chapter part may be brought for acts occurring prior to the effective date of this section if the limitations period set forth in subsection has not lapsed in any civil action brought under this chapter part the state shall be required to prove by a preponderance of evidence all essential elements of the cause of action including damages notwithstanding any other provision of law a final judgment rendered in favor of the state in any criminal proceeding under this chapter part whether upon a verdict after trial or upon a plea of guilty or nolo contendere shall estop the defendant from denying the essential elements of the offense in any civil action under this chapter part which involves the same transaction civil liability under this chapter part shall be joint and several for a violation committed by two or more persons any action brought by the state under this chapter part shall be brought in district court in salt lake county or in any county where the defendant resides or does business section section b is amended to read chapter health data vital statistics and utah medical examiner part vital statistics b definitions reserved as used in this part adoption document means an adoption related document filed with the office a petition for adoption a decree of adoption an original birth certificate or evidence submitted in support of a supplementary birth certificate certified nurse midwife means an individual who a is licensed to practice as a certified nurse midwife under title chapter a nurse midwife practice act and b has completed an education program regarding the completion of a certificate of death developed by the department by rule made in accordance with title g chapter utah administrative rulemaking act custodial funeral service director means a funeral service director who a is employed by a licensed funeral establishment and b has custody of a dead body dead body means a human body or parts of a human body from the condition of which it reasonably may be concluded that death occurred decedent means the same as a dead body dead fetus means a product of human conception other than those circumstances described in subsection a of weeks gestation or more calculated from the date the last normal menstrual period began to the date of delivery and b that was not born alive declarant father means a male who claims to be the genetic father of a child and along with the biological mother signs a voluntary declaration of paternity to establish the child s paternity dispositioner means a a person designated in a written instrument under subsection as having the right and duty to control the disposition of the decedent if the person voluntarily acts as the dispositioner or b the next of kin of the decedent if i a a person has not been designated as described in subsection a or b the person described in subsection a is unable or unwilling to exercise the right and duty described in subsection a and ii the next of kin voluntarily acts as the dispositioner fetal remains means a an aborted fetus as that term is defined in section b or b a miscarried fetus as that term is defined in section b file means the submission of a completed certificate or other similar document record or report as provided under this part for registration by the state registrar or a local registrar funeral service director means the same as that term is defined in section health care facility means the same as that term is defined in section b health care professional means a physician physician assistant nurse practitioner or certified nurse midwife licensed funeral establishment means a if located in utah a funeral service establishment as that term is defined in section that is licensed under title chapter funeral services licensing act or b if located in a state district or territory of the united states other than utah a funeral service establishment that complies with the licensing laws of the jurisdiction where the establishment is located live birth means the birth of a child who shows evidence of life after the child is entirely outside of the mother local registrar means a person appointed under subsection b b nurse practitioner means an individual who a is licensed to practice as an advanced practice registered nurse under title chapter b nurse practice act and b has completed an education program regarding the completion of a certificate of death developed by the department by administrative rule made in accordance with title g chapter utah administrative rulemaking act office means the office of vital records and statistics within the department physician means a person licensed to practice as a physician or osteopath in this state under title chapter utah medical practice act or title chapter utah osteopathic medical practice act physician assistant means an individual who a is licensed to practice as a physician assistant under title chapter a utah physician assistant act and b has completed an education program regarding the completion of a certificate of death developed by the department by administrative rule made in accordance with title g chapter utah administrative rulemaking act presumed father means the father of a child conceived or born during a marriage as defined in section registration or register means acceptance by the local or state registrar of a certificate and incorporation of the certificate into the permanent records of the state state registrar means the state registrar of vital records appointed under section b vital records means a registered certificates or reports of birth death fetal death marriage divorce dissolution of marriage or annulment b amendments to any of the registered certificates or reports described in subsection a c an adoption document and d other similar documents vital statistics means the data derived from registered certificates and reports of birth death fetal death induced termination of pregnancy marriage divorce dissolution of marriage or annulment section section b which is renumbered from section is renumbered and amended to read b department duties and authority as used in this section a compact means the compact for interstate sharing of putative father registry information created in section b effective on may b putative father i means the same as that term is as defined in section b and ii includes an unmarried biological father c state registrar means the state registrar of vital records appointed under subsection e d unmarried biological father means the same as that term is defined in section b the department shall a provide offices properly equipped for the preservation of vital records made or received under this chapter part b establish a statewide vital records system for the registration collection preservation amendment and certification of vital records and other similar documents required by this chapter part and activities related to them including the tabulation analysis and publication of vital statistics c prescribe forms for certificates certification reports and other documents and records necessary to establish and maintain a statewide system of vital records d prepare an annual compilation analysis and publication of statistics derived from vital records and e appoint a state registrar to direct the statewide system of vital records the department may a divide the state from time to time into registration districts and b appoint local registrars for registration districts who under the direction and supervision of the state registrar shall perform all duties required of them by this chapter part and department rules the state registrar appointed under subsection e shall with the input of utah stakeholders and the uniform law commission study the following items for the state s implementation of the compact a the feasibility of using systems developed by the national association for public health statistics and information systems including the state and territorial exchange of vital events steve system and the electronic verification of vital events evve system or similar systems to exchange putative father registry information with states that are parties to the compact b procedures necessary to share putative father information located in the confidential registry maintained by the state registrar upon request from the state registrar of another state that is a party to the compact c procedures necessary for the state registrar to access putative father information located in a state that is a party to the compact and share that information with persons who request a certificate from the state registrar d procedures necessary to ensure that the name of the mother of the child who is the subject of a putative father s notice of commencement filed pursuant to section b is kept confidential when a state that is a party to the compact accesses this state s confidential registry through the state registrar and e procedures necessary to ensure that a putative father s registration with a state that is a party to the compact is given the same effect as a putative father s notice of commencement filed pursuant to section b section section b which is renumbered from section is renumbered and amended to read b content and form of certificates and reports as used in this section a additional information means information that is beyond the information necessary to comply with federal standards or state law for registering a birth b diacritical mark means a mark on a letter from the iso basic latin alphabet used to indicate a special pronunciation c diacritical mark includes accents tildes graves umlauts and cedillas except as provided in subsection to promote and maintain nationwide uniformity in the vital records system the forms of certificates certification reports and other documents and records required by this chapter part or the rules implementing this chapter part shall include as a minimum the items recommended by the federal agency responsible for national vital statistics subject to approval additions and modifications by the department certificates certifications forms reports other documents and records and the form of communications between persons required by this chapter part shall be prepared in the format prescribed by department rule all vital records shall include the date of filing certificates certifications forms reports other documents and records and communications between persons required by this chapter part may be signed filed verified registered and stored by photographic electronic or other means as prescribed by department rule a an individual may use a diacritical mark in an application for a vital record b the office shall record a diacritical mark on a vital record as indicated on the application for the vital record the absence of a diacritical mark on a vital record does not render the document invalid or affect any constructive notice imparted by proper recordation of the document a the state i may collect the social security number of a deceased individual and ii may not include the social security number of an individual on a certificate of death b for registering a birth the department may not require an individual to provide additional information c the department may request additional information if the department provides a written statement that i discloses that providing the additional information is voluntary ii discloses how the additional information will be used and the duration of use iii describes how the department prevents the additional information from being used in a manner different from the disclosure given under subsection c ii c ii and iv includes a notice that the individual is consenting to the department s use of the additional information by providing the additional information d i beginning july an individual may submit a written request to the department to de identify the individual s additional information contained in the department s databases ii upon receiving the written request the department shall de identify the additional information e the department shall de identify additional information contained in the department s databases before the additional information is held by the department for longer than six years section section b which is renumbered from section is renumbered and amended to read b birth certificates execution and registration requirements as used in this section birthing facility means a general acute hospital or birthing center as defined in section b for each live birth occurring in the state a certificate shall be filed with the local registrar for the district in which the birth occurred within days following the birth the certificate shall be registered if it is completed and filed in accordance with this chapter part a for each live birth that occurs in a birthing facility the administrator of the birthing facility or his designee shall obtain and enter the information required under this chapter part on the certificate securing the required signatures and filing the certificate b i the date time place of birth and required medical information shall be certified by the birthing facility administrator or his designee ii the attending physician or nurse midwife may sign the certificate but if the attending physician or nurse midwife has not signed the certificate within seven days of the date of birth the birthing facility administrator or his designee shall enter the attending physician s or nurse midwife s name and transmit the certificate to the local registrar iii the information on the certificate about the parents shall be provided and certified by the mother or father or in their incapacity or absence by a person with knowledge of the facts a for live births that occur outside a birthing facility the birth certificate shall be completed and filed by the physician physician assistant nurse midwife or other person primarily responsible for providing assistance to the mother at the birth if there is no such person either the presumed or declarant father shall complete and file the certificate in his absence the mother shall complete and file the certificate and in the event of her death or disability the owner or operator of the premises where the birth occurred shall do so b the certificate shall be completed as fully as possible and shall include the date time and place of birth the mother s name and the signature of the person completing the certificate a for each live birth to an unmarried mother that occurs in a birthing facility the administrator or director of that facility or his designee shall i provide the birth mother and declarant father if present with a a voluntary declaration of paternity form published by the state registrar b oral and written notice to the birth mother and declarant father of the alternatives to the legal consequences of and the rights and responsibilities that arise from signing the declaration and c the opportunity to sign the declaration ii witness the signature of a birth mother or declarant father in accordance with section b if the signature occurs at the facility iii enter the declarant father s information on the original birth certificate but only if the mother and declarant father have signed a voluntary declaration of paternity or a court or administrative agency has issued an adjudication of paternity and iv file the completed declaration with the original birth certificate b if there is a presumed father the voluntary declaration will only be valid if the presumed father also signs the voluntary declaration c the state registrar shall file the information provided on the voluntary declaration of paternity form with the original birth certificate and may provide certified copies of the declaration of paternity as otherwise provided under title b chapter utah uniform parentage act a the state registrar shall publish a form for the voluntary declaration of paternity a description of the process for filing a voluntary declaration of paternity and of the rights and responsibilities established or effected by that filing in accordance with title b chapter utah uniform parentage act b information regarding the form and services related to voluntary paternity establishment shall be made available to birthing facilities and to any other entity or individual upon request the name of a declarant father may only be included on the birth certificate of a child of unmarried parents if a the mother and declarant father have signed a voluntary declaration of paternity or b a court or administrative agency has issued an adjudication of paternity voluntary declarations of paternity adjudications of paternity by judicial or administrative agencies and voluntary rescissions of paternity shall be filed with and maintained by the state registrar for the purpose of comparing information with the state case registry maintained by the office of recovery services pursuant to section a b section section b which is renumbered from section is renumbered and amended to read b requirement to obtain parents social security numbers for each live birth that occurs in this state the administrator of the birthing facility as defined in section b or other person responsible for completing and filing the birth certificate under section b shall obtain the social security numbers of each parent and provide those numbers to the state registrar each parent shall furnish his or her social security number to the person authorized to obtain the numbers under subsection unless a court or administrative agency has determined there is good cause for not furnishing a number under subsection the state registrar shall as soon as practicable supply those social security numbers to the office of recovery services within the department of human services department the social security numbers obtained under this section may not be recorded on the child s birth certificate the state may not use any social security number obtained under this section for any reason other than enforcement of child support orders in accordance with the federal family support act of public law pub l no section section b which is renumbered from section is renumbered and amended to read b foundling certificates a foundling certificate shall be filed for each infant of unknown parentage found in the state the certificate shall be prepared and filed with the local registrar of the district in which the infant was found by the person assuming custody the certificate shall be filed within days after the infant is found and is acceptable for all purposes in lieu of a certificate of birth section section b which is renumbered from section is renumbered and amended to read b correction of errors or omissions in vital records conflicting birth and foundling certificates rulemaking in accordance with title g chapter utah administrative rulemaking act the department may make rules governing applications to correct alleged errors or omissions on any vital record establishing procedures to resolve conflicting birth and foundling certificates and allowing for the correction and reissuance of a vital record that was originally created omitting a diacritical mark section section b which is renumbered from section is renumbered and amended to read b birth certificates delayed registration when a certificate of birth of a person born in this state has not been filed within the time provided in subsection b a certificate of birth may be filed in accordance with department rules and subject to this section a the registrar shall mark a certificate of birth as delayed and show the date of registration if the certificate is registered one year or more after the date of birth b the registrar shall abstract a summary statement of the evidence submitted in support of delayed registration onto the certificate when the minimum evidence required for delayed registration is not submitted or when the state registrar has reasonable cause to question the validity or adequacy of the evidence supporting the application and the deficiencies are not corrected the state registrar a may not register the certificate and b shall provide the applicant with a written statement indicating the reasons for denial of registration the state registrar has no duty to take further action regarding an application which is not actively pursued section section b which is renumbered from section is renumbered and amended to read b birth certificates petition for issuance of delayed certificate court procedure a if registration of a certificate of birth under section b is denied the person seeking registration may bring an action by a verified petition in the utah district court encompassing where the petitioner resides or in the district encompassing salt lake city b the petition shall request an order establishing a record of the date and place of the birth and the parentage of the person whose birth is to be registered the petition shall be on a form furnished by the state registrar and shall allege a the person for whom registration of a delayed certificate is sought was born in this state and is still living b no registered certificate of birth of the person can be found in the state office of vital statistics or the office of any local registrar c diligent efforts by the petitioner have failed to obtain the evidence required by department rule and d the state registrar has denied the petitioner s request to register a delayed certificate of birth the petition shall be accompanied by a written statement of the state registrar indicating the reasons for denial of registration and all documentary evidence which was submitted in support of registration the court shall fix a time and place for hearing the petition and shall give the state registrar days days notice of the hearing the state registrar or his authorized representative may appear and testify at the hearing a if the court finds the person for whom registration of a certificate of birth is sought under section b was born in this state it shall make findings as to the place and date of birth parentage and other findings as may be required and shall issue an order on a form prescribed and furnished by the state registrar to establish a court ordered delayed certificate of birth b the order shall include the birth data to be registered a description of the evidence presented and the date of the court s action b c the clerk of the court shall forward each order to the state registrar not later than the tenth day of the calendar month following the month in which the order was entered d the order described in subsection a shall be registered by the state registrar and constitutes the certificate of birth section section b which is renumbered from section is renumbered and amended to read b supplementary certificate of birth an individual born in this state may request the state registrar to register a supplementary birth certificate for the individual if a the individual is legally recognized as a child of the individual s natural parents when the individual s natural parents are subsequently married b the individual s parentage has been determined by a state court of the united states or a canadian provincial court with jurisdiction or c the individual has been legally adopted as a child or as an adult under the law of this state any other state or any province of canada the application for registration of a supplementary birth certificate may be made by a the individual requesting registration under subsection if the individual is of legal age b a legal representative or c any agency authorized to receive children for placement or adoption under the laws of this or any other state a the state registrar shall require that an applicant submit identification and proof according to department rules b in the case of an adopted individual that proof may be established by order of the court in which the adoption proceedings were held a after the supplementary birth certificate is registered any information disclosed from the record shall be from the supplementary birth certificate b access to the original birth certificate and to the evidence submitted in support of the supplementary birth certificate are not open to inspection except upon the order of a utah district court or as described in section b or section b section section b which is renumbered from section is renumbered and amended to read b name or sex change registration of court order and amendment of birth certificate when a person born in this state has a name change or sex change approved by an order of a utah district court or a court of competent jurisdiction of another state or a province of canada a certified copy of the order may be filed with the state registrar with an application form provided by the registrar a upon receipt of the application a certified copy of the order and payment of the required fee the state registrar shall review the application and if complete register it and note the fact of the amendment on the otherwise unaltered original certificate b the amendment shall be registered with and become a part of the original certificate and a certified copy shall be issued to the applicant without additional cost section section b which is renumbered from section is renumbered and amended to read b certified copies of birth certificates fees credited to children s account in addition to the fees provided for in section b the department and local registrars authorized to issue certified copies shall charge an additional fee for each certified copy of a birth certificate including certified copies of supplementary and amended birth certificates under sections through b through b this the additional fee described in subsection may be charged only for the first copy requested at any one time the fee shall be transmitted monthly to the state treasurer and credited to the children s account established created in section section section b which is renumbered from section is renumbered and amended to read b fee waived for certified copy of birth certificate notwithstanding section sections b and section b the department shall waive a fee that would otherwise be charged for a certified copy of a birth certificate if the individual whose birth is confirmed by the birth certificate is a the individual requesting the certified copy of the birth certificate and b i homeless as defined in section b ii a person who is homeless as defined in section a iii an individual whose primary nighttime residence is a location that is not designed for or ordinarily used as a sleeping accommodation for an individual iv a homeless service provider as verified by the department of workforce services or v a homeless child or youth as defined in u s c sec a to satisfy the requirement in subsection b the department shall accept written verification that the individual is homeless or a person child or youth who is homeless from a a homeless shelter b a permanent housing permanent supportive or transitional facility as defined in section a c the department of workforce services d a homeless service provider as verified by the department of workforce services or e a local educational agency liaison for homeless children and youth designated under u s c sec g j ii section section b which is renumbered from section is renumbered and amended to read b certificate of death execution and registration requirements information provided to lieutenant governor a a certificate of death for each death that occurs in this state shall be filed with the local registrar of the district in which the death occurs or as otherwise directed by the state registrar within five days after death and prior to the decedent s interment any other disposal or removal from the registration district where the death occurred b a certificate of death shall be registered if the certificate of death is completed and filed in accordance with this chapter part a if the place of death is unknown but the dead body is found in this state i the certificate of death shall be completed and filed in accordance with this section and ii the place where the dead body is found shall be shown as the place of death b if the date of death is unknown the date shall be determined by approximation a when death occurs in a moving conveyance in the united states and the decedent is first removed from the conveyance in this state i the certificate of death shall be filed with a the local registrar of the district where the decedent is removed or b a person designated by the state registrar and ii the place where the decedent is removed shall be considered the place of death b when a death occurs on a moving conveyance outside the united states and the decedent is first removed from the conveyance in this state i the certificate of death shall be filed with a the local registrar of the district where the decedent is removed or b a person designated by the state registrar and ii the certificate of death shall show the actual place of death to the extent it can be determined a subject to subsections d and a custodial funeral service director or if a funeral service director is not retained a dispositioner shall sign the certificate of death b the custodial funeral service director an agent of the custodial funeral service director or if a funeral service director is not retained a dispositioner shall i file the certificate of death prior to any disposition of a dead body or fetus and ii obtain the decedent s personal data from the next of kin or the best qualified person or source available including the decedent s social security number if known c the certificate of death may not include the decedent s social security number d a dispositioner may not sign a certificate of death unless the signature is witnessed by the state registrar or a local registrar a except as provided in section b fetal death certificates the medical section of the certificate of death shall be completed signed and returned to the funeral service director or if a funeral service director is not retained a dispositioner within hours after death by the health care professional who was in charge of the decedent s care for the illness or condition which resulted in death except when inquiry is required by title chapter utah medical examiner act part utah medical examiner b in the absence of the health care professional or with the health care professional s approval the certificate of death may be completed and signed by an associate physician the chief medical officer of the institution in which death occurred or a physician who performed an autopsy upon the decedent if i the person has access to the medical history of the case ii the person views the decedent at or after death and iii the death is not due to causes required to be investigated by the medical examiner when death occurs more than days after the day on which the decedent was last treated by a health care professional the case shall be referred to the medical examiner for investigation to determine and certify the cause date and place of death when inquiry is required by title chapter utah medical examiner act part utah medical examiner the medical examiner shall make an investigation and complete and sign the medical section of the certificate of death within hours after taking charge of the case if the cause of death cannot be determined within hours after death a the medical section of the certificate of death shall be completed as provided by department rule b the attending health care professional or medical examiner shall give the funeral service director or if a funeral service director is not retained a dispositioner notice of the reason for the delay and c final disposition of the decedent may not be made until authorized by the attending health care professional or medical examiner a when a death is presumed to have occurred within this state but the dead body cannot be located a certificate of death may be prepared by the state registrar upon receipt of an order of a utah district court b the order described in subsection a shall include a finding of fact stating the name of the decedent the date of death and the place of death c a certificate of death prepared under subsection a shall i show the date of registration and ii identify the court and the date of the order it is unlawful for a dispositioner to charge for or accept any remuneration for a signing a certificate of death or b performing any other duty of a dispositioner as described in this section the state registrar shall within five business days after the day on which the state registrar or local registrar registers a certificate of death for a utah resident inform the lieutenant governor of a the decedent s name last known residential address date of birth and date of death and b any other information requested by the lieutenant governor to assist the county clerk in identifying the decedent for the purpose of removing the decedent from the official register of voters the lieutenant governor shall within one business day after the day on which the lieutenant governor receives the information described in subsection provide the information to the county clerks section section b which is renumbered from section is renumbered and amended to read b fetal death certificate filing and registration requirements a fetal death certificate shall be filed for each fetal death which occurs in this state the certificate shall be filed within five days after delivery with the local registrar or as otherwise directed by the state registrar the certificate shall be registered if it is completed and filed in accordance with this chapter part when a dead fetus is delivered in an institution the institution administrator or his designated representative shall prepare and file the fetal death certificate the attending physician shall state in the certificate the cause of death and sign the certificate when a dead fetus is delivered outside an institution the physician in attendance at or immediately after delivery shall complete sign and file the fetal death certificate when a fetal death occurs without medical attendance at or immediately after the delivery or when inquiry is required by title chapter utah medical examiner act part utah medical examiner the medical examiner shall investigate the cause of death and prepare and file the certificate of fetal death within five days after taking charge of the case when a fetal death occurs in a moving conveyance and the dead fetus is first removed from the conveyance in this state or when a dead fetus is found in this state and the place of death is unknown the death shall be registered in this state the place where the dead fetus was first removed from the conveyance or found shall be considered the place of death final disposition of the dead fetus may not be made until the fetal death certificate has been registered section section b which is renumbered from section is renumbered and amended to read b certificate of birth resulting in stillbirth for purposes of this section and section as used in this section stillbirth and stillborn child shall have the same meaning mean the same as dead fetus as defined in section b a in addition to the requirements of section b the state registrar shall establish a certificate of birth resulting in stillbirth on a form approved by the state registrar for each stillbirth occurring in this state b this certificate shall be offered to the parent or parents of a stillborn child the certificate of birth resulting in stillbirth shall meet all of the format and filing requirements of sections and b and b relating to a live birth the person who prepares a certificate pursuant to this section shall leave blank any references to the stillborn child s name if the stillborn child s parent or parents do not wish to provide a name for the stillborn child notwithstanding subsections and the certificate of birth resulting in stillbirth shall be filed with the designated registrar within days following the delivery and prior to cremation or removal of the fetus from the registration district section section b which is renumbered from section is renumbered and amended to read b delayed registration of birth resulting in stillbirth when a birth resulting in stillbirth occurring in this state has not been registered within one year after the date of delivery a certificate marked delayed may be filed and registered in accordance with department rule relating to evidentiary and other requirements sufficient to substantiate the alleged facts of birth resulting in stillbirth section section b which is renumbered from section is renumbered and amended to read b certificate of early term stillbirth as used in this section early term stillborn child means a product of human conception other than in the circumstances described in subsection that a is of at least weeks gestation but less than weeks gestation calculated from the day on which the mother s last normal menstrual period began to the day of delivery and b is not born alive the state registrar shall issue a certificate of early term stillbirth to a parent of an early term stillborn child if a the parent requests on a form created by the state registrar that the state registrar register and issue a certificate of early term stillbirth for the early term stillborn child and b the parent files with the state registrar i a a signed statement from a physician confirming the delivery of the early term stillborn child or b an accurate copy of the parent s medical records related to the early term stillborn child and ii any other record the state registrar determines by rule made in accordance with title g chapter utah administrative rulemaking act is necessary for accurate recordkeeping the certificate of early term stillbirth described in subsection shall meet all of the format and filing requirements of section b a person who prepares a certificate of early term stillbirth under this section shall leave blank any references to an early term stillborn child s name if the early term stillborn child s parent does not wish to provide a name for the early term stillborn child section section b which is renumbered from section is renumbered and amended to read b petition for establishment of unregistered birth or death court procedure a person holding a direct tangible and legitimate interest as described in subsection b a or b may petition for a court order establishing the fact time and place of a birth or death that is not registered or for which a certified copy of the registered birth or death certificate is not obtainable the person shall verify the petition and file the petition in the utah district court for the county where a the birth or death is alleged to have occurred b the person resides whose birth is to be established or c the decedent named in the petition resided at the date of death in order for the court to have jurisdiction the petition shall a allege the date time and place of the birth or death and b state either that no certificate of birth or death has been registered or that a copy of the registered certificate cannot be obtained the court shall set a hearing for five to days after the day on which the petition is filed a if the time and place of birth or death are in question the court shall hear available evidence and determine the time and place of the birth or death b if the time and place of birth or death are not in question the court shall determine the time and place of birth or death to be those alleged in the petition a court order under this section shall be made on a form prescribed and furnished by the department and is effective upon the filing of a certified copy of the order with the state registrar a for purposes of this section the birth certificate of an adopted alien child as defined in section b is considered to be unobtainable if the child was born in a country that is not recognized by department rule as having an established vital records registration system b if the adopted child was born in a country recognized by department rule but a person described in subsection is unable to obtain a certified copy of the birth certificate the state registrar shall authorize the preparation of a birth certificate if the state registrar receives a written statement signed by the registrar of the child s birth country stating a certified copy of the birth certificate is not available section section b which is renumbered from section is renumbered and amended to read b certificate of death duties of a custodial funeral service director an agent of a funeral service director or a dispositioner medical certification records of funeral service director or dispositioner information filed with local registrar unlawful signing of certificate of death the custodial funeral service director or if a funeral service director is not retained a dispositioner shall sign the certificate of death prior to any disposition of a dead body or dead fetus the custodial funeral service director an agent of the custodial funeral service director or if a funeral service director is not retained a dispositioner shall a obtain personal and statistical information regarding the decedent from the available persons best qualified to provide the information b present the certificate of death to the attending health care professional if any or to the medical examiner who shall certify the cause of death and other information required on the certificate of death c provide the address of the custodial funeral service director or if a funeral service director is not retained a dispositioner d certify the date and place of burial and e file the certificate of death with the state or local registrar a funeral service director dispositioner embalmer or other person who removes a dead body or dead fetus from the place of death or transports or is in charge of final disposal of a dead body or dead fetus shall keep a record identifying the dead body or dead fetus and containing information pertaining to receipt removal and delivery of the dead body or dead fetus as prescribed by department rule a not later than the tenth day of each month every licensed funeral service establishment shall send to the local registrar and the department a list of the information required in subsection for each casket furnished and for funerals performed when no casket was furnished during the preceding month b the list described in subsection a shall be in the form prescribed by the state registrar any person who intentionally signs the portion of a certificate of death that is required to be signed by a funeral service director or a dispositioner under subsection is guilty of a class b misdemeanor unless the person a i is a funeral service director and ii is employed by a licensed funeral establishment or b is a dispositioner if a funeral service director is not retained the state registrar shall post information on the state registrar s website providing instructions to a dispositioner for complying with the requirements of law relating to the dispositioner s responsibilities for a completing and filing a certificate of death and b possessing transporting and disposing of a dead body or dead fetus the provisions of this chapter part shall be construed to avoid interference to the fullest extent possible with the ceremonies customs rites or beliefs of the decedent and the decedent s next of kin for disposing of a dead body or dead fetus section section b which is renumbered from section is renumbered and amended to read b certificate of death registration prerequisite to interment burial transit permits procedure where body donated under anatomical gift law permit for disinterment a a dead body or dead fetus may not be interred or otherwise disposed of or removed from the registration district in which death or fetal death occurred or the remains are found until a certificate of death is registered b subsection a does not apply to fetal remains for a fetus that is less than weeks in gestational age a for deaths or fetal deaths which occur in this state no burial transit permit is required for final disposition of the remains if i disposition occurs in the state and is performed by a funeral service director or ii the disposition takes place with authorization of the next of kin and in a a general acute hospital as that term is defined in section b that is licensed by the department or b in a pathology laboratory operated under contract with a general acute hospital licensed by the department b for an abortion or miscarriage that occurs at a health care facility no burial transit permit is required for final disposition of the fetal remains if i disposition occurs in the state and is performed by a funeral service director or ii the disposition takes place a with authorization of the parent of a miscarried fetus or the pregnant woman for an aborted fetus and b in a general acute hospital as that term is defined in section b or a pathology laboratory operated under contract with a general acute hospital a a burial transit permit shall be issued by the local registrar of the district where the certificate of death or fetal death is registered i for a dead body or a dead fetus to be transported out of the state for final disposition or ii when disposition of the dead body or dead fetus is made by a person other than a funeral service director b for fetal remains that are less than weeks in gestational age a burial transit permit shall be issued by the local registrar of the district where the health care facility that is in possession of the fetal remains is located i for the fetal remains to be transported out of the state for final disposition or ii when disposition of the fetal remains is made by a person other than a funeral service director c a local registrar issuing a burial transit permit issued under subsection b i may not require an individual to designate a name for the fetal remains and ii may leave the space for a name on the burial transit permit blank and d shall redact from any public records maintained under this chapter part any information i that is submitted under subsection c and ii that may be used to identify the parent or pregnant woman a burial transit permit issued under the law of another state which accompanies a dead body dead fetus or fetal remains brought into this state is authority for final disposition of the dead body dead fetus or fetal remains in this state when a dead body or dead fetus or any part of the dead body or dead fetus has been donated under the part revised uniform anatomical gift act or similar laws of another state and the preservation of the gift requires the immediate transportation of the dead body dead fetus or any part of the body or fetus outside of the registration district in which death occurs or the remains are found or into this state from another state the dead body or dead fetus or any part of the body or fetus may be transported and the burial transit permit required by this section obtained within a reasonable time after transportation a permit for disinterment and reinterment is required prior to disinterment of a dead body dead fetus or fetal remains except as otherwise provided by statute or department rule section section b which is renumbered from section is renumbered and amended to read b interments duties of sexton or person in charge record of interments information filed with local registrar a a sexton or person in charge of any premises in which interments are made may not inter or permit the interment of any dead body dead fetus or fetal remains unless the interment is made by a funeral service director or by a person holding a burial transit permit b the right and duty to control the disposition of a deceased person shall be governed by sections through a the sexton or the person in charge of any premises where interments are made shall keep a record of all interments made in the premises under their charge stating the name of the decedent place of death date of burial and name and address of the funeral service director or other person making the interment b the record described in this subsection shall be open to public inspection c a city or county clerk may at the clerk s option maintain the interment records described in this subsection on behalf of the sexton or person in charge of any premises in which interments are made a not later than the tenth day of each month the sexton person in charge of the premises or city or county clerk who maintains the interment records shall send to the local registrar and the department a list of all interments made in the premises during the preceding month b the list described in subsection a shall be in the form prescribed by the state registrar section section b which is renumbered from section is renumbered and amended to read b rules of department for transmittal of certificates and keeping of records by local registrar each local registrar shall transmit all records registered by him to the department in accordance with department rules the manner of keeping local copies of vital records and the uses of them shall be prescribed by department rules section section b which is renumbered from section is renumbered and amended to read b local registrars authorized to issue certified copies of records the state registrar may authorize local registrars to issue certified copies of vital records section section b which is renumbered from section is renumbered and amended to read b inspection of vital records as used in this section a designated legal representative means an attorney physician funeral service director genealogist or other agent of the subject or an immediate family member of the subject who has been delegated the authority to access vital records b drug use intervention or suicide prevention effort means a program that studies or promotes the prevention of drug overdose deaths or suicides in the state c immediate family member means a spouse child parent sibling grandparent or grandchild a the vital records shall be open to inspection but only in compliance with the provisions of this chapter part department rules and sections b and b b it is unlawful for any state or local officer or employee to disclose data contained in vital records contrary to this chapter part department rule section b or section b c i an adoption document is open to inspection as provided in section b or section b ii a birth parent may not access an adoption document under subsection b d a custodian of vital records may permit inspection of a vital record or issue a certified copy of a record or a part of a record when the custodian is satisfied that the applicant has demonstrated a direct tangible and legitimate interest except as provided in subsection a direct tangible and legitimate interest in a vital record is present only if a the request is from i the subject ii an immediate family member of the subject iii the guardian of the subject iv a designated legal representative of the subject or v a person including a child placing agency as defined in section b with whom a child has been placed pending finalization of an adoption of the child b the request involves a personal or property right of the subject of the record c the request is for official purposes of a public health authority or a state local or federal governmental agency d the request is for a drug use intervention or suicide prevention effort or a statistical or medical research program and prior consent has been obtained from the state registrar or e the request is a certified copy of an order of a court of record specifying the record to be examined or copied a except as provided in title b chapter part utah adoption act a parent or an immediate family member of a parent who does not have legal or physical custody of or visitation or parent time rights for a child because of the termination of parental rights under title chapter termination and restoration of parental rights or by virtue of consenting to or relinquishing a child for adoption pursuant to title b chapter part utah adoption act may not be considered as having a direct tangible and legitimate interest under this section b except as provided in subsection d a commercial firm or agency requesting names addresses or similar information may not be considered as having a direct tangible and legitimate interest under this section upon payment of a fee established in accordance with section j the office shall make the following records available to the public a except as provided in subsection b b a birth record excluding confidential information collected for medical and health use if years or more have passed since the date of birth b a death record if years or more have passed since the date of death and c a vital record not subject to subsection a or b if years or more have passed since the date of the event upon which the record is based upon payment of a fee established in accordance with section j the office shall make an adoption document available as provided in sections b and b the office shall make rules in accordance with title g chapter utah administrative rulemaking act establishing procedures and the content of forms as follows a for the inspection of adoption documents under subsection b b for a birth parent s election to permit identifying information about the birth parent to be made available under section b c for the release of information by the mutual consent voluntary adoption registry under section b d for collecting fees and donations under section b and e for the review and approval of a request described in subsection d section section b which is renumbered from section is renumbered and amended to read b records required to be kept by health care institutions information filed with local registrar and department a all administrators or other persons in charge of hospitals nursing homes or other institutions public or private to which persons resort for treatment of diseases confinements or are committed by law shall record all the personal and statistical information about patients of their institutions as required in certificates prescribed by this chapter part b the information described in subsection a shall i be recorded for collection at the time of admission of a patient ii be obtained from the patient if possible and iii if the information cannot be obtained from the patient the information shall be secured in as complete a manner as possible from other persons acquainted with the facts a when a dead body or dead fetus is released or disposed of by an institution the person in charge of the institution shall keep a record showing i the name of the deceased ii the date of death of the deceased iii the name and address of the person to whom the dead body or dead fetus is released and iv the date that the dead body or dead fetus is removed from the institution b if final disposal is by the institution the date place manner of disposition and the name of the person authorizing disposition shall be recorded by the person in charge of the institution not later than the tenth day of each month the administrator of each institution shall cause to be sent to the local registrar and the department a list of all births deaths fetal deaths and induced abortions occurring in the institution during the preceding month the list shall be in the form prescribed by the state registrar a person or institution who in good faith releases a dead body or dead fetus under this section to a funeral service director or a dispositioner is immune from civil liability connected directly or indirectly with release of the dead body or dead fetus section section b which is renumbered from section is renumbered and amended to read b marriage licenses execution and filing requirements the state registrar shall supply county clerks with application forms for marriage licenses completed applications shall be transmitted by the clerks to the state registrar monthly the personal identification information contained on each application for a marriage license filed with the county clerk shall be entered on a form supplied by the state registrar the person performing the marriage shall furnish the date and place of marriage and his name and address the form described in subsection shall be completed and certified by the county clerk before it is filed with the state registrar section section b which is renumbered from section is renumbered and amended to read b divorce or adoption duty of court clerk to file certificates or reports for each adoption annulment of adoption divorce and annulment of marriage ordered or decreed in this state the clerk of the court shall prepare a divorce certificate or report of adoption on a form furnished by the state registrar the petitioner shall provide the information necessary to prepare the certificate or report under subsection the clerk shall a prepare the certificate or report under subsection and b complete the remaining entries for the certificate or report immediately after the decree or order becomes final on or before the th day of each month the clerk shall forward the divorce certificates and reports of adoption under subsection completed by the clerk during the preceding month to the state registrar a a report of adoption under subsection may be provided to the attorney who is providing representation of a party to the adoption or the child placing agency as defined in section b that is placing the child b if a report of adoption is provided to the attorney or the child placing agency as defined in section b the attorney or the child placing agency shall immediately provide the report of adoption to the state registrar section section b which is renumbered from section is renumbered and amended to read b certified copies of vital records preparation by state and local registrars evidentiary value the state registrar and local registrars authorized by the department under section b may prepare typewritten photographic electronic or other reproductions of vital records and certify their correctness certified copies of the vital record or authorized reproductions of the original issued by either the state registrar or a designated local registrar are prima facie evidence in all courts of the state with like effect as the vital record section section b which is renumbered from section is renumbered and amended to read b identifying birth certificates of missing persons procedures as used in this section a division means the criminal investigations and technical services division department of public safety in title chapter criminal investigations and technical services act b missing child means a person younger than years of age old who is missing from the person s home environment or a temporary placement facility for any reason and whose whereabouts cannot be determined by the person responsible for the child s care c missing person means a person who i is missing from the person s home environment and ii a has a physical or mental disability b is missing under circumstances that indicate that the person is endangered missing involuntarily or a victim of a catastrophe or c is a missing child a in accordance with section upon the state registrar s notification by the division that a person who was born in this state is missing the state and local registrars shall flag the registered birth certificate of that person so that when a copy of the registered birth certificate or information regarding the birth record is requested the state and local registrars are alerted to the fact the registered birth certificate is that of a missing person b upon notification by the division the missing person has been recovered the state and local registrars shall remove the flag from that person s registered birth certificate the state and local registrars may not provide a copy of a registered birth certificate of any person whose record is flagged under subsection except as approved by the division a when a copy of the registered birth certificate of a person whose record has been flagged is requested in person the state or local registrar shall require that person to complete a form supplying that person s name address telephone number and relationship to the missing person and the name and birth date of the missing person b the state or local registrar shall inform the requester that a copy of the registered birth certificate will be mailed to the requester c the state or local registrar shall note the physical description of the person making the request and shall immediately notify the division of the request and the information obtained pursuant to this subsection when a copy of the registered birth certificate of a person whose record has been flagged is requested in writing the state or local registrar or personnel of the state or local registrar shall immediately notify the division and provide it with a copy of the written request section section b which is renumbered from section is renumbered and amended to read b birth certificate for foreign adoptees upon presentation of a court order of adoption and an order establishing the fact time and place of birth under section b the department shall prepare a birth certificate for an individual who was adopted under the laws of this state and was at the time of adoption as a child or as an adult considered an alien child or adult for whom the court received documentary evidence of lawful admission under section b section section b which is renumbered from section is renumbered and amended to read b determination of death made by registered nurse as used in this section a health care facility means the same as that term is defined in section b physician means a physician licensed under i title chapter utah medical practice act or ii title chapter utah osteopathic medical practice act c registered registered nurse means a registered nurse licensed under title chapter b nurse practice act a an individual is dead if the individual has sustained either i irreversible cessation of circulatory and respiratory functions or ii irreversible cessation of all functions of the entire brain including the brain stem b a determination of death shall be made in accordance with this part and accepted medical standards a registered nurse may make a determination of death of an individual if a an attending physician has i documented in the individual s medical or clinical record that the individual s death is anticipated due to illness infirmity or disease no later than days after the day on which the physician makes the documentation and ii established clear assessment procedures for determining death b the death actually occurs within the day period described in subsection a and c at the time of the documentation described in subsection a the physician authorized the following in writing to make the determination of death i one or more specific registered nurses or ii if the individual is in a health care facility that has complied with subsection all registered nurses that the facility employs a registered nurse who has determined death under this section shall a document the clinical criteria for the determination in the individual s medical or clinical record b notify the physician described in subsection and c ensure that the death certificate includes i the name of the deceased ii the presence of a contagious disease if known and iii the date and time of death except as otherwise provided by law or rule a physician licensed under title chapter utah medical practice act or title chapter utah osteopathic medical practice act shall certify a determination of death described in subsection within hours after the registered nurse makes the determination of death a for a health care facility to be eligible for a general authorization described in subsection c the facility shall adopt written policies and procedures that provide for the determination of death by a registered nurse under this section b a registered nurse that a health care facility employs may not make a determination of death under this section unless the facility has adopted the written policies and procedures described in subsection a the department may make rules in accordance with title g chapter utah administrative rulemaking act to ensure the appropriate determination of death under this section section section b which is renumbered from section is renumbered and amended to read b unlawful acts concerning certificates records and reports unlawful transportation or acceptance of dead human body it is unlawful for any person association or corporation and the officers of any of them to willfully and knowingly make any false statement in a certificate record or report required to be filed with the department or in an application for a certified copy of a vital record or to willfully and knowingly supply false information intending that the information be used in the preparation of any report record or certificate or an amendment to any of these to make counterfeit alter amend or mutilate any certificate record or report required to be filed under this code or a certified copy of the certificate record or report without lawful authority and with the intent to deceive to willfully and knowingly obtain possess use sell furnish or attempt to obtain possess use sell or furnish to another for any purpose of deception any certificate record report or certified copy of any of them including any that are counterfeited altered amended or mutilated without lawful authority to possess any certificate record or report required by the department or a copy or certified copy of the certificate record or report knowing it to have been stolen or otherwise unlawfully obtained or to willfully and knowingly transport or accept for transportation interment or other disposition a dead human body without a permit required by law section section b which is renumbered from section is renumbered and amended to read b illegal use of birth certificate penalties it is a third degree felony for any person to willfully and knowingly a and with the intent to deceive obtain possess use sell furnish or attempt to obtain possess use sell or furnish to another any certificate of birth or certified copy of a certificate of birth knowing that the certificate or certified copy was issued upon information which is false in whole or in part or which relates to the birth of another person whether living or deceased or b furnish or process a certificate of birth or certified copy of a certificate of birth with the knowledge or intention that it be used for the purpose of deception by a person other than the person to whom the certificate of birth relates the specific criminal violations and the criminal penalty under this section take precedence over any more general criminal offense as described in section b section section b which is renumbered from section is renumbered and amended to read part utah medical examiner b definitions as used in this chapter part dead body means the same as that term is defined in section b a death by violence means death that resulted by the decedent s exposure to physical mechanical or chemical forces b death by violence includes death that appears to have been due to homicide death that occurred during or in an attempt to commit rape mayhem kidnapping robbery burglary housebreaking extortion or blackmail accompanied by threats of violence assault with a dangerous weapon assault with intent to commit any offense punishable by imprisonment for more than one year arson punishable by imprisonment for more than one year or any attempt to commit any of the foregoing offenses immediate relative means an individual s spouse child parent sibling grandparent or grandchild health care professional means any of the following while acting in a professional capacity a a physician licensed under title chapter utah medical practice act or title chapter utah osteopathic medical practice act b a physician assistant licensed under title chapter a utah physician assistant act or c an advance practice registered nurse licensed under subsection b e medical examiner means the state medical examiner appointed pursuant to section b or a deputy appointed by the medical examiner medical examiner record means a all information that the medical examiner obtains regarding a decedent and b reports that the medical examiner makes regarding a decedent regional pathologist means a trained pathologist licensed to practice medicine and surgery in the state appointed by the medical examiner pursuant to subsection b sudden death while in apparent good health means apparently instantaneous death without obvious natural cause death during or following an unexplained syncope or coma or death during an acute or unexplained rapidly fatal illness sudden infant death syndrome means the death of a child who was thought to be in good health or whose terminal illness appeared to be so mild that the possibility of a fatal outcome was not anticipated suicide means death caused by an intentional and voluntary act of an individual who understands the physical nature of the act and intends by such act to accomplish self destruction unattended death means a death that occurs more than days after the day on which a health care professional examined or treated the deceased individual for any purpose including writing a prescription a unavailable for postmortem investigation means that a dead body is i transported out of state ii buried at sea iii cremated iv processed by alkaline hydrolysis or v otherwise made unavailable to the medical examiner for postmortem investigation or autopsy b unavailable for postmortem investigation does not include embalming or burial of a dead body pursuant to the requirements of law within the scope of the decedent s employment means all acts reasonably necessary or incident to the performance of work including matters of personal convenience and comfort not in conflict with specific instructions section section b which is renumbered from section is renumbered and amended to read b chief medical examiner appointment qualifications authority the executive director with the advice of an advisory board consisting of the chairman of the department of pathology at the university of utah medical school and the dean of the law school at the university of utah shall appoint a chief medical examiner who shall be licensed to practice medicine in the state and shall meet the qualifications of a forensic pathologist certified by the american board of pathologists pathology a the medical examiner shall serve at the will of the executive director b the medical examiner has authority to i employ medical technical and clerical personnel as may be required to effectively administer this chapter subject to the rules of the department and the state merit system ii conduct investigations and pathological examinations iii perform autopsies authorized in this title iv conduct or authorize necessary examinations on dead bodies and v notwithstanding the provisions of subsection b retain tissues and biological samples a for scientific purposes b where necessary to accurately certify the cause and manner of death or c for tissue from an unclaimed body subject to section b in order to donate the tissue or biological sample to an individual who is affiliated with an established search and rescue dog organization for the purpose of training a dog to search for human remains c in the case of an unidentified body the medical examiner shall authorize or conduct investigations tests and processes in order to determine its identity as well as the cause of death the medical examiner may appoint regional pathologists each of whom shall be approved by the executive director section section b which is renumbered from section is renumbered and amended to read b county medical examiners the county executive with the advice and consent of the county legislative body may appoint medical examiners for their respective counties section section b which is renumbered from section is renumbered and amended to read b investigation of deaths requests for autopsies the following have authority to investigate a death described in section b and any other case which may be within their jurisdiction a the attorney general or an assistant attorney general b the district attorney or county attorney who has criminal jurisdiction over the death or case c a deputy of the district attorney or county attorney described in subsection b or d a peace officer within the jurisdiction described in subsection b if in the opinion of the medical examiner an autopsy should be performed or if an autopsy is requested by the district attorney or county attorney having criminal jurisdiction or by the attorney general the autopsy shall be performed by the medical examiner or a regional pathologist section section b which is renumbered from section is renumbered and amended to read b custody by medical examiner upon notification under section b or investigation by the medical examiner s office the medical examiner shall assume custody of a deceased body if it appears that death was by violence gunshot suicide or accident was sudden death while in apparent good health occurred unattended except that an autopsy may only be performed in accordance with the provisions of subsection b occurred under suspicious or unusual circumstances resulted from poisoning or overdose of drugs resulted from a disease that may constitute a threat to the public health resulted from disease injury toxic effect or unusual exertion incurred within the scope of the decedent s employment was due to sudden infant death syndrome occurred while the decedent was in prison jail police custody the state hospital or in a detention or medical facility operated for the treatment of persons with a mental illness persons who are emotionally disturbed or delinquent persons resulted directly from the actions of a law enforcement officer as defined in section was associated with diagnostic or therapeutic procedures or was described in this section when request is made to assume custody by a county or district attorney or law enforcement agency in connection with a potential homicide investigation or prosecution section section b which is renumbered from section is renumbered and amended to read b discovery of dead body notice requirements procedure when death occurs under circumstances listed in section b the person or persons finding or having custody of the body shall immediately notify the nearest law enforcement agency the law enforcement agency having jurisdiction over the case shall then proceed to the place where the body is and conduct an investigation concerning the cause and circumstances of death for the purpose of determining whether there exists any criminal responsibility for the death on a determination by the law enforcement agency that death may have occurred in any of the ways described in section b the death shall be reported to the district attorney or county attorney having criminal jurisdiction and to the medical examiner by the law enforcement agency having jurisdiction over the investigation the report shall be made by the most expeditious means available failure to give notification or report to the district attorney or county attorney having criminal jurisdiction and medical examiner is a class b misdemeanor section section b which is renumbered from section is renumbered and amended to read b custody of dead body and personal effects examination of scene of death preservation of body autopsies a upon notification of a death under section b the medical examiner shall assume custody of the deceased body clothing on the body biological samples taken and any article on or near the body which may aid the medical examiner in determining the cause of death except those articles which will assist the investigative agency to proceed without delay with the investigation b in all cases the scene of the event may not be disturbed until authorization is given by the senior ranking peace officer from the law enforcement agency having jurisdiction of the case and conducting the investigation c where death appears to have occurred under circumstances listed in section b the person or persons finding or having custody of the body or jurisdiction over the investigation of the death shall take reasonable precautions to preserve the body and body fluids so that minimum deterioration takes place d a person may not move a body in the custody of the medical examiner unless i the medical examiner or district attorney or county attorney that has criminal jurisdiction authorizes the person to move the body ii a designee of an individual listed in this subsection d authorizes the person to move the body iii not moving the body would be an affront to public decency or impractical or iv the medical examiner determines the cause of death is likely due to natural causes e the body can under direction of the medical examiner or the medical examiner s designee be moved to a place specified by the medical examiner or the medical examiner s designee a if the medical examiner has custody of a body a person may not clean or embalm the body without first obtaining the medical examiner s permission b an intentional or knowing violation of subsection a is a class b misdemeanor a when the medical examiner assumes lawful custody of a body under subsection b solely because the death was unattended an autopsy may not be performed unless requested by the district attorney county attorney having criminal jurisdiction or law enforcement agency having jurisdiction of the place where the body is found b the county attorney or district attorney and law enforcement agency having jurisdiction shall consult with the medical examiner to determine the need for an autopsy c if the deceased chose not to be seen or treated by a health care professional for a spiritual or religious reason a district attorney county attorney or law enforcement agency may not request an autopsy or inquest under subsection a solely because of the deceased s choice d the medical examiner or medical examiner s designee may not conduct a requested autopsy described in subsection a if the medical examiner or medical examiner s designee determines i the request violates subsection c or ii the cause of death can be determined without performing an autopsy section section b which is renumbered from section is renumbered and amended to read b rendering a dead body unavailable for postmortem investigation as used in this section a medical examiner means the same as that term is defined in section b b unavailable for postmortem investigation means the same as that term is defined in section b it is unlawful for a person to engage in any conduct that makes a dead body unavailable for postmortem investigation unless before engaging in that conduct the person obtains a permit from the medical examiner to render the dead body unavailable for postmortem investigation under section b if the person intends to make the body unavailable for postmortem investigation a person who violates subsection is guilty of a third degree felony if a person engages in conduct that constitutes both a violation of this section and a violation of section the provisions and penalties of section supersede the provisions and penalties of this section section section b which is renumbered from section is renumbered and amended to read b certification of cause of death a for a death under any of the circumstances described in section b only the medical examiner or the medical examiner s designee may certify the cause of death b an individual who knowingly certifies the cause of death in violation of subsection a is guilty of a class b misdemeanor a for a death described in section b an individual may not knowingly give false information with the intent to mislead to the medical examiner or the medical examiner s designee b a violation of subsection a is a class b misdemeanor section section b which is renumbered from section is renumbered and amended to read b medical examiner to report death caused by prescribed controlled substance poisoning or overdose if a medical examiner determines that the death of a person who is years old or older at the time of death resulted from poisoning or overdose involving a prescribed controlled substance the medical examiner shall within three business days after the day on which the medical examiner determines the cause of death send a written report to the division of professional licensing created in section that includes a the decedent s name b each drug or other substance found in the decedent s system that may have contributed to the poisoning or overdose if known and c the name of each person the medical examiner has reason to believe may have prescribed a controlled substance described in subsection b to the decedent this section does not create a new cause of action section section b which is renumbered from section is renumbered and amended to read b records and reports of investigations a complete copy of all written records and reports of investigations and facts resulting from medical care treatment autopsies conducted by any person on the body of the deceased who died in any manner listed in section b and the written reports of any investigative agency making inquiry into the incident shall be promptly made and filed with the medical examiner the judiciary or a state or local government entity that retains a record other than a document described in subsection of the decedent shall provide a copy of the record to the medical examiner a in accordance with federal law and b upon receipt of the medical examiner s written request for the record failure to submit reports or records described in subsection or other than reports of a county attorney district attorney or law enforcement agency within days after the day on which the person in possession of the report or record receives the medical examiner s written request for the report or record is a class b misdemeanor section section b which is renumbered from section is renumbered and amended to read b order to exhume body procedure in case of any death described in section b when a body is buried without an investigation by the medical examiner as to the cause and manner of death it shall be the duty of the medical examiner upon being advised of the fact to notify the district attorney or county attorney having criminal jurisdiction where the body is buried or death occurred upon notification the district attorney or county attorney having criminal jurisdiction may file an action in the district court to obtain an order to exhume the body a district judge may order the body exhumed upon an ex parte hearing a a body may not be exhumed until notice of the order has been served upon the executor or administrator of the deceased s estate or if no executor or administrator has been appointed upon the nearest heir of the deceased determined as if the deceased had died intestate if the nearest heir of the deceased cannot be located within the jurisdiction then the next heir in succession within the jurisdiction may be served b the executor administrator or heir shall have hours to notify the issuing court of any objection to the order prior to the time the body is exhumed if no heirs can be located within the jurisdiction within hours the facts shall be reported to the issuing court which may order that the body be exhumed forthwith c notification to the executor administrator or heir shall specifically state the nature of the action and the fact that any objection shall be filed with the issuing court within hours of the time of service d in the event an heir files an objection the court shall set hearing on the matter at the earliest possible time and issue an order on the matter immediately at the conclusion of the hearing upon the receipt of notice of objection the court shall immediately notify the county attorney who requested the order so that the interest of the state may be represented at the hearing e when there is reason to believe that death occurred in a manner described in section b the district attorney or county attorney having criminal jurisdiction may make a motion that the court upon ex parte hearing order the body exhumed forthwith and without notice upon a showing of exigent circumstances the court may order the body exhumed forthwith and without notice in any event upon motion of the district attorney or county attorney having criminal jurisdiction and upon the personal appearance of the medical examiner the court for good cause may order the body exhumed forthwith and without notice an order to exhume a body shall be directed to the medical examiner commanding the medical examiner to cause the body to be exhumed perform the required autopsy and properly cause the body to be reburied upon completion of the examination the examination shall be completed and the complete autopsy report shall be made to the district attorney or county attorney having criminal jurisdiction for any action the attorney considers appropriate the district attorney or county attorney shall submit the return of the order to exhume within days in the manner prescribed by the issuing court section section b which is renumbered from section is renumbered and amended to read b autopsies when authorized the medical examiner shall perform an autopsy to a aid in the discovery and prosecution of a crime b protect an innocent person accused of a crime and c disclose hazards to public health the medical examiner may perform an autopsy a to aid in the administration of civil justice in life and accident insurance problems in accordance with title a chapter workers compensation act and b in other cases involving questions of civil liability section section b which is renumbered from section is renumbered and amended to read b certification of death by attending health care professional deaths without medical attendance cause of death uncertain notice requirements a a health care professional who treats or examines an individual within days from the day on which the individual dies shall certify the individual s cause of death to the best of the health care professional s knowledge and belief unless the health care professional determines the individual may have died in a manner described in section b b if a health care professional is unable to determine an individual s cause of death in accordance with subsection a the health care professional shall notify the medical examiner for an unattended death the person with custody of the body shall notify the medical examiner of the death if the medical examiner determines there may be criminal responsibility for a death the medical examiner shall notify a the district attorney or county attorney that has criminal jurisdiction or b the head of the law enforcement agency that has jurisdiction to investigate the death section section b which is renumbered from section is renumbered and amended to read b deaths in medical centers and federal facilities all death certificates of any decedent who died in a teaching medical center or a federal medical facility unattended or in the care of an unlicensed physician or other medical personnel shall be signed by the licensed supervisory physician attending physician or licensed resident physician of the medical center or facility section section b which is renumbered from section is renumbered and amended to read b release of body for funeral preparations a where a body is held for investigation or autopsy under this chapter or for a medical investigation permitted by law the body shall if requested by the person given priority under section be released for funeral preparations no later than hours after the arrival at the office of the medical examiner or regional medical facility b an extension may be ordered only by a district court the right and duty to control the disposition of a deceased person is governed by sections through section section b which is renumbered from section is renumbered and amended to read b records of medical examiner confidentiality the medical examiner shall maintain complete original records for the medical examiner record which shall a be properly indexed giving the name if known or otherwise identifying every individual whose death is investigated b indicate the place where the body was found c indicate the date of death d indicate the cause and manner of death e indicate the occupation of the decedent if available f include all other relevant information concerning the death and g include a full report and detailed findings of the autopsy or report of the investigation a upon written request from an individual described in subsections a i through iv the medical examiner shall provide a copy of the medical examiner s final report of examination for the decedent including the autopsy report toxicology report lab reports and investigative reports to any of the following i a decedent s immediate relative ii a decedent s legal representative iii a physician or physician assistant who attended the decedent during the year before the decedent s death or iv a county attorney a district attorney a criminal defense attorney or other law enforcement official with jurisdiction as necessary for the performance of the attorney or official s professional duties b upon written request from the director or a designee of the director of an entity described in subsections b i through iv the medical examiner may provide a copy of the of the medical examiner s final report of examination for the decedent including any other reports described in subsection a to any of the following entities as necessary for performance of the entity s official purposes i a local health department ii a local mental health authority iii a public health authority or iv another state or federal governmental agency c the medical examiner may provide a copy of the medical examiner s final report of examination including any other reports described in subsection a if the final report relates to an issue of public health or safety as further defined by rule made by the department in accordance with title g chapter utah administrative rulemaking act reports provided under subsection may not include records that the medical examiner obtains from a third party in the course of investigating the decedent s death the medical examiner may provide a medical examiner record to a researcher who a has an advanced degree b i is affiliated with an accredited college or university a hospital or another system of care including an emergency medical response or a local health agency or ii is part of a research firm contracted with an accredited college or university a hospital or another system of care c requests a medical examiner record for a research project or a quality improvement initiative that will have a public health benefit as determined by the department and d provides to the medical examiner an approval from i the researcher s sponsoring organization and ii the utah department of health and human services institutional review board records provided under subsection may not include a third party record unless a a court has ordered disclosure of the third party record and b disclosure is conducted in compliance with state and federal law a person who obtains a medical examiner record under subsection shall a maintain the confidentiality of the medical examiner record by removing personally identifying information about a decedent or the decedent s family and any other information that may be used to identify a decedent before using the medical examiner record in research b conduct any research within and under the supervision of the office of the medical examiner if the medical examiner record contains a third party record with personally identifiable information c limit the use of a medical examiner record to the purpose for which the person requested the medical examiner record d destroy a medical examiner record and the data abstracted from the medical examiner record at the conclusion of the research for which the person requested the medical examiner record e reimburse the medical examiner as provided in section b for any costs incurred by the medical examiner in providing a medical examiner record f allow the medical examiner to review before public release a publication in which data from a medical examiner record is referenced or analyzed and g provide the medical examiner access to the researcher s database containing data from a medical examiner record until the day on which the researcher permanently destroys the medical examiner record and all data obtained from the medical examiner record the department may make rules in accordance with title g chapter utah administrative rulemaking act and in consideration of applicable state and federal law to establish permissible uses and disclosures of a medical examiner record or other record obtained under this section except as provided in this chapter or ordered by a court the medical examiner may not disclose any part of a medical examiner record a person who obtains a medical examiner record under subsection is guilty of a class b misdemeanor if the person fails to comply with the requirements of subsections a through d section section b which is renumbered from section is renumbered and amended to read b records of medical examiner admissibility as evidence subpoena of person who prepared record the records of the medical examiner or transcripts thereof certified by the medical examiner are admissible as evidence in any civil action in any court in this state except that statements by witnesses or other persons unless taken pursuant to section b as conclusions upon extraneous matters are not hereby made admissible the person who prepared a report or record offered in evidence hereunder may be subpoenaed as a witness in the case by any party section section b which is renumbered from section is renumbered and amended to read b personal property of deceased disposition personal property of the deceased not held as evidence shall be turned over to the legal representative of the deceased within days after completion of the investigation of the death of the deceased if no legal representative is known the county attorney district attorney or the medical examiner shall within days after the investigation turn the personal property over to the county treasurer to be handled pursuant to the escheat laws an affidavit shall be filed with the county treasurer by the county attorney district attorney or the medical examiner within days after investigation of the death of the deceased showing the money or other property belonging to the estate of the deceased person which has come into his possession and the disposition made of the property property required to be turned over to the legal representative of the deceased may be held longer than days if in the opinion of the county attorney district attorney or attorney general the property is necessary evidence in a court proceeding upon conclusion of the court proceedings the personal property shall be turned over as described in this section and in accordance with the rules of the court section section b which is renumbered from section is renumbered and amended to read b officials not liable for authorized acts except as provided in this chapter part a criminal or civil action may not arise against the county attorney district attorney or his deputies the medical examiner or his deputies or regional pathologists for authorizing or performing autopsies authorized by this chapter part or for any other act authorized by this chapter part section section b which is renumbered from section is renumbered and amended to read b authority of county attorney or district attorney to subpoena witnesses and compel testimony determination if decedent died by unlawful means the district attorney or county attorney having criminal jurisdiction may subpoena witnesses and compel testimony concerning the death of any person and have such testimony reduced to writing under his direction and may employ a shorthand reporter for that purpose at the same compensation as is allowed to reporters in the district courts when the testimony has been taken down by the shorthand reporter a transcript thereof duly certified shall constitute the deposition of the witness upon review of all facts and testimony taken concerning the death of a person the district attorney or county attorney having criminal jurisdiction shall determine if the decedent died by unlawful means and shall also determine if criminal prosecution shall be instituted section section b which is renumbered from section is renumbered and amended to read b additional powers and duties of department the department may establish rules to carry out the provisions of this chapter part arrange for the state health laboratory to perform toxicologic analysis for public or private institutions and fix fees for the services cooperate and train law enforcement personnel in the techniques of criminal investigation as related to medical and pathological matters and pay to private parties institutions or funeral directors the reasonable value of services performed for the medical examiner s office section section b which is renumbered from section is renumbered and amended to read b authority of examiner to provide organ or other tissue for transplant purposes when requested by the licensed physician of a patient who is in need of an organ or other tissue for transplant purpose by a legally created utah eye bank organ bank or medical facility the medical examiner may provide an organ or other tissue if a a decedent who may provide a suitable organ or other tissue for the transplant is in the custody of the medical examiner b the medical examiner is assured that the requesting party has made reasonable search for and inquiry of next of kin of the decedent and that no objection by the next of kin is known by the requesting party and c the removal of the organ or other tissue will not interfere with the investigation or autopsy or alter the post mortem facial appearance when the medical examiner is in custody of a decedent who may provide a suitable organ or other tissue for transplant purposes he may contact the appropriate eye bank organ bank or medical facility and notify them concerning the suitability of the organ or other tissue in such contact the medical examiner may disclose the name of the decedent so that necessary clearances can be obtained no person shall be held civilly or criminally liable for any acts performed pursuant to this section section section b which is renumbered from section is renumbered and amended to read b autopsies persons eligible to authorize autopsies may be authorized a by the commissioner of the labor commission or the commissioner s designee as provided in section a b by individuals by will or other written document c upon a decedent by the next of kin in the following order and as known surviving spouse child if years old or older otherwise the legal guardian of the child parent sibling uncle or aunt nephew or niece cousin others charged by law with the duty of burial or friend assuming the obligation of burial d by the county attorney district attorney or the district attorney s deputy or a district judge and e by the medical examiner as provided in this chapter part autopsies authorized under subsections a and d shall be performed by a certified pathologist no criminal or civil action arises against a pathologist or a physician who proceeds in good faith and performs an autopsy authorized by this section section section b which is renumbered from section is renumbered and amended to read b burial of an unclaimed body request by the school of medicine at the university of utah medical examiner may retain tissue for dog training except as described in subsection or a county shall provide at the county s expense decent burial for an unclaimed body found in the county a county is not responsible for decent burial of an unclaimed body found in the county if the body is requested by the dean of the school of medicine at the university of utah under section b for an unclaimed body that is temporarily in the medical examiner s custody before burial under subsection the medical examiner may retain tissue from the unclaimed body in order to donate the tissue to an individual who is affiliated with an established search and rescue dog organization for the purpose of training a dog to search for human remains section section b which is renumbered from section is renumbered and amended to read b social security number in certification of death a certification of death shall include if known the social security number of the deceased person and a copy of the certification shall be sent to the office of recovery services within the department of human services department upon request section section b which is renumbered from section is renumbered and amended to read b registry of unidentified deceased persons if the identity of a deceased person over which the medical examiner has jurisdiction under section b is unknown the medical examiner shall do the following before releasing the body to the county in which the body was found as provided in section b a assign a unique identifying number to the body b create and maintain a file under the assigned number c examine the body take samples and perform other related tasks for the purpose of deriving information that may be useful in ascertaining the identity of the deceased person d use the identifying number in all records created by the medical examiner that pertains to the body e record all information pertaining to the body in the file created and maintained under subsection b f communicate the unique identifying number to the county in which the body was found and g access information from available government sources and databases in an attempt to ascertain the identity of the deceased person a county which has received a body to which subsection applies a shall adopt and use the same identifying number assigned by subsection in all records created by the county that pertain to the body b require any funeral director or sexton who is involved in the disposition of the body to adopt and use the same identifying number assigned by subsection in all records created by the funeral director or sexton pertaining to the body and c shall provide a decent burial for the body within days of receiving a body to which subsection applies the county shall inform the medical examiner of the disposition of the body including the burial plot the medical examiner shall record this information in the file created and maintained under subsection b the requirements of subsections and apply to a county examiner appointed under section b with the additional requirements that the county examiner a obtain a unique identifying number from the medical examiner for the body and b send to the medical examiner a copy of the file created and maintained in accordance with subsection b including the disposition of the body and burial plot within days of releasing the body the medical examiner shall maintain a file received under subsection in the same way that it maintains a file created and maintained by the medical examiner in accordance with subsection b the medical examiner shall cooperate and share information generated and maintained under this section with a person who demonstrates a a legitimate personal or governmental interest in determining the identity of a deceased person and b a reasonable belief that the body of that deceased person may have come into the custody of the medical examiner section section b which is renumbered from section is renumbered and amended to read b testing for suspected suicides maintaining information compensation to deputy medical examiners in all cases where it is suspected that a death resulted from suicide including assisted suicide the medical examiner shall endeavor to have the following tests conducted upon samples taken from the body of the deceased a a test that detects all of the substances included in the volatiles panel of the bureau of forensic toxicology within the department of health department b a test that detects all of the substances included in the drugs of abuse panel of the bureau of forensic toxicology within the department of health department and c a test that detects all of the substances included in the prescription drug panel of the bureau of forensic toxicology within the department of health department the medical examiner shall maintain information regarding the types of substances found present in the samples taken from the body of a person who is suspected to have died as a result of suicide or assisted suicide within funds appropriated by the legislature for this purpose the medical examiner shall provide compensation at a standard rate determined by the medical examiner to a deputy medical examiner who collects samples for the purposes described in subsection section section b which is renumbered from section is renumbered and amended to read b psychological autopsy examiner with funds appropriated by the legislature for this purpose the department shall provide compensation at a standard rate determined by the department to a psychological autopsy examiner the psychological autopsy examiner shall a work with the medical examiner to compile data regarding suicide related deaths b as relatives of the deceased are willing gather information from relatives of the deceased regarding the psychological reasons for the decedent s death c maintain a database of information described in subsections a and b d in accordance with all applicable privacy laws subject to approval by the department share the database described in subsection c with the university of utah department of psychiatry or other university based departments conducting research on suicide e coordinate no less than monthly with the suicide prevention coordinator described in subsection a b and f coordinate no less than quarterly with the state suicide prevention coalition section section b which is renumbered from section is renumbered and amended to read b application for permit to render a dead body unavailable for postmortem examination fees upon receiving an application by a person for a permit to render a dead body unavailable for postmortem investigation the medical examiner shall review the application to determine whether a the person is authorized by law to render the dead body unavailable for postmortem investigation in the manner specified in the application and b there is a need to delay any action that will render the dead body unavailable for postmortem investigation until a postmortem investigation or an autopsy of the dead body is performed by the medical examiner except as provided in subsection within three days after receiving an application described in subsection the medical examiner shall a make the determinations described in subsection and b i issue a permit to render the dead body unavailable for postmortem investigation in the manner specified in the application or ii deny the permit the medical examiner may deny a permit to render a dead body unavailable for postmortem investigation only if a the applicant is not authorized by law to render the dead body unavailable for postmortem investigation in the manner specified in the application b the medical examiner determines that there is a need to delay any action that will render the dead body unavailable for postmortem investigation or c the applicant fails to pay the fee described in subsection if the medical examiner cannot in good faith make the determinations described in subsection within three days after receiving an application described in subsection the medical examiner shall notify the applicant a that more time is needed to make the determinations described in subsection and b of the estimated amount of time needed before the determinations described in subsection can be made the medical examiner may charge a fee pursuant to section j to recover the costs of fulfilling the duties of the medical examiner described in this section section section b which is renumbered from section is renumbered and amended to read b overdose fatality examiner within funds appropriated by the legislature the department shall provide compensation at a standard rate determined by the department to an overdose fatality examiner the overdose fatality examiner shall a work with the medical examiner to compile data regarding overdose and opioid related deaths including i toxicology information ii demographics and iii the source of opioids or drugs b as relatives of the deceased are willing gather information from relatives of the deceased regarding the circumstances of the decedent s death c maintain a database of information described in subsections a and b d coordinate no less than monthly with the suicide prevention coordinator described in section a b and e coordinate no less than quarterly with the opioid and overdose fatality review committee created in section b section section b which is renumbered from section a is renumbered and amended to read a b injury reporting requirements by health care provider contents of report penalties as used in this section a health care provider means any person firm corporation or association which furnishes treatment or care to persons who have suffered bodily injury and includes hospitals clinics podiatrists dentists and dental hygienists nurses nurse practitioners physicians and physicians assistants osteopathic physicians naturopathic practitioners chiropractors acupuncturists paramedics and emergency medical technicians b injury does not include any psychological or physical condition brought about solely through the voluntary administration of prescribed controlled substances c law enforcement agency means the municipal or county law enforcement agency i having jurisdiction over the location where the injury occurred or ii if the reporting health care provider is unable to identify or contact the law enforcement agency with jurisdiction over the injury law enforcement agency means the agency nearest to the location of the reporting health care provider d report to a law enforcement agency means to report by telephone or other spoken communication the facts known regarding an injury subject to reporting under section a to the dispatch desk or other staff person designated by the law enforcement agency to receive reports from the public a any health care provider who treats or cares for any person who suffers from any wound or other injury inflicted by the person s own act or by the act of another by means of a knife gun pistol explosive infernal device or deadly weapon or by violation of any criminal statute of this state shall immediately report to a law enforcement agency the facts regarding the injury b the report shall state the name and address of the injured person if known the person s whereabouts the character and extent of the person s injuries and the name address and telephone number of the person making the report a health care provider may not be discharged suspended disciplined or harassed for making a report pursuant to this section a person may not incur any civil or criminal liability as a result of making any report required by this section a health care provider who has personal knowledge that the report of a wound or injury has been made in compliance with this section is under no further obligation to make a report regarding that wound or injury under this section any health care provider who intentionally or knowingly violates any provision of this section is guilty of a class b misdemeanor section section b which is renumbered from section is renumbered and amended to read part revised uniform anatomical gift act b definitions as used in this chapter part adult means an individual who is at least years of age old agent means an individual a authorized to make health care decisions on the principal s behalf by a power of attorney for health care or b expressly authorized to make an anatomical gift on the principal s behalf by any other record signed by the principal anatomical gift means a donation of all or part of a human body to take effect after the donor s death for the purpose of transplantation therapy research or education decedent means a a deceased individual whose body or part is or may be the source of an anatomical gift and b includes i a stillborn infant and ii subject to restrictions imposed by law other than this chapter part a fetus a disinterested witness means i a witness other than the spouse child parent sibling grandchild grandparent or guardian of the individual who makes amends revokes or refuses to make an anatomical gift or ii another adult who exhibited special care and concern for the individual b disinterested witness does not include a person to which an anatomical gift could pass under section b document of gift means a donor card or other record used to make an anatomical gift the term includes a statement or symbol on a driver license identification card or donor registry donor means an individual whose body or part is the subject of an anatomical gift donor registry means a database that contains records of anatomical gifts and amendments to or revocations of anatomical gifts driver license means a license or permit issued by the driver license division of the department of public safety to operate a vehicle whether or not conditions are attached to the license or permit eye bank means a person that is licensed accredited or regulated under federal or state law to engage in the recovery screening testing processing storage or distribution of human eyes or portions of human eyes guardian a means a person appointed by a court to make decisions regarding the support care education health or welfare of an individual and b does not include a guardian ad litem hospital means a facility licensed as a hospital under the law of any state or a facility operated as a hospital by the united states a state or a subdivision of a state identification card means an identification card issued by the driver license division of the department of public safety know means to have actual knowledge minor means an individual who is under years of age organ procurement organization means a person designated by the secretary of the united states department of health and human services as an organ procurement organization parent means a parent whose parental rights have not been terminated part means an organ an eye or tissue of a human being the term does not include the whole body person means an individual corporation business trust estate trust partnership limited liability company association joint venture public corporation government or governmental subdivision agency or instrumentality or any other legal or commercial entity physician means an individual authorized to practice medicine or osteopathy under the law of any state procurement organization means an eye bank organ procurement organization or tissue bank prospective donor a means an individual who is dead or near death and has been determined by a procurement organization to have a part that could be medically suitable for transplantation therapy research or education and b does not include an individual who has made a refusal reasonably available means able to be contacted by a procurement organization without undue effort and willing and able to act in a timely manner consistent with existing medical criteria necessary for the making of an anatomical gift recipient means an individual into whose body a decedent s part has been or is intended to be transplanted record means information that is inscribed on a tangible medium or that is stored in an electronic or other medium and is retrievable in perceivable form refusal means a record created under section b that expressly states an intent to bar other persons from making an anatomical gift of an individual s body or part sign means with the present intent to authenticate or adopt a record a to execute or adopt a tangible symbol or b to attach to or logically associate with the record an electronic symbol sound or process state means a state of the united states the district of columbia puerto rico the united states virgin islands or any territory or insular possession subject to the jurisdiction of the united states technician a means an individual determined to be qualified to remove or process parts by an appropriate organization that is licensed accredited or regulated under federal or state law and b includes an enucleator tissue means a portion of the human body other than an organ or an eye the term does not include blood unless the blood is donated for the purpose of research or education tissue bank means a person that is licensed accredited or regulated under federal or state law to engage in the recovery screening testing processing storage or distribution of tissue transplant hospital means a hospital that furnishes organ transplants and other medical and surgical specialty services required for the care of transplant patients section section b which is renumbered from section is renumbered and amended to read b applicability this chapter part applies to an anatomical gift or amendment to revocation of or refusal to make an anatomical gift whenever made section section b which is renumbered from section is renumbered and amended to read b who may make anatomical gift before donor s death subject to section b an anatomical gift of a donor s body or part may be made during the life of the donor for the purpose of transplantation therapy research or education in the manner provided in section b by the donor if the donor is an adult or if the donor is a minor and is a emancipated or b authorized under state law to apply for a driver license because the donor is at least years of age old an agent of the donor unless the power of attorney for health care or other record prohibits the agent from making an anatomical gift a parent of the donor if the donor is an unemancipated minor or the donor s guardian section section b which is renumbered from section is renumbered and amended to read b manner of making anatomical gift before donor s death a donor may make an anatomical gift a by authorizing a statement or symbol indicating that the donor has made an anatomical gift to be imprinted on the donor s driver license or identification card b in a will c during a terminal illness or injury of the donor by any form of communication addressed to at least two adults at least one of whom is a disinterested witness or d as provided in subsection a donor or other person authorized to make an anatomical gift under section b may make a gift by a donor card or other record signed by the donor or other person making the gift or by authorizing that a statement or symbol indicating that the donor has made an anatomical gift be included on a donor registry if the donor or other person is physically unable to sign a record the record may be signed by another individual at the direction of the donor or other person and shall a be witnessed by at least two adults at least one of whom is a disinterested witness who have signed at the request of the donor or the other person and b state that it has been signed and witnessed as provided in subsection a revocation suspension expiration or cancellation of a driver license or identification card upon which an anatomical gift is indicated does not invalidate the gift an anatomical gift made by will takes effect upon the donor s death whether or not the will is probated invalidation of the will after the donor s death does not invalidate the gift section section b which is renumbered from section is renumbered and amended to read b amending or revoking anatomical gift before donor s death subject to section b a donor or other person authorized to make an anatomical gift under section b may amend or revoke an anatomical gift by a a record signed by i the donor ii the other person or iii subject to subsection another individual acting at the direction of the donor or the other person if the donor or other person is physically unable to sign or b a later executed document of gift that amends or revokes a previous anatomical gift or portion of an anatomical gift either expressly or by inconsistency a record signed pursuant to subsection a iii shall a be witnessed by at least two adults at least one of whom is a disinterested witness who have signed at the request of the donor or the other person and b state that it has been signed and witnessed as provided in subsection a subject to section b a donor or other person authorized to make an anatomical gift under section b may revoke an anatomical gift by the destruction or cancellation of the document of gift or the portion of the document of gift used to make the gift with the intent to revoke the gift a donor may amend or revoke an anatomical gift that was not made in a will by any form of communication during a terminal illness or injury addressed to at least two adults at least one of whom is a disinterested witness a donor who makes an anatomical gift in a will may amend or revoke the gift in the manner provided for amendment or revocation of wills or as provided in subsection section section b which is renumbered from section is renumbered and amended to read b refusal to make anatomical gift effect of refusal an individual may refuse to make an anatomical gift of the individual s body or part by a a record signed by i the individual or ii subject to subsection another individual acting at the direction of the individual if the individual is physically unable to sign b the individual s will whether or not the will is admitted to probate or invalidated after the individual s death or c any form of communication made by the individual during the individual s terminal illness or injury addressed to at least two adults at least one of whom is a disinterested witness a record signed pursuant to subsection a ii shall a be witnessed by at least two adults at least one of whom is a disinterested witness who have signed at the request of the individual and b state that it has been signed and witnessed as provided in subsection a an individual who has made a refusal may amend or revoke the refusal a in the manner provided in subsection for making a refusal b by subsequently making an anatomical gift pursuant to section b that is inconsistent with the refusal or c by destroying or canceling the record evidencing the refusal or the portion of the record used to make the refusal with the intent to revoke the refusal except as otherwise provided in subsection b in the absence of an express contrary indication by the individual set forth in the refusal an individual s unrevoked refusal to make an anatomical gift of the individual s body or part bars all other persons from making an anatomical gift of the individual s body or part section section b which is renumbered from section is renumbered and amended to read b preclusive effect of anatomical gift amendment or revocation except as otherwise provided in subsection and subject to subsection in the absence of an express contrary indication by the donor a person other than the donor is barred from making amending or revoking an anatomical gift of a donor s body or part if the donor made an anatomical gift of the donor s body or part under section b or an amendment to an anatomical gift of the donor s body or part under section b a donor s revocation of an anatomical gift of the donor s body or part under section b is not a refusal and does not bar another person specified in section or b or b from making an anatomical gift of the donor s body or part under section or b or b if a person other than the donor makes an unrevoked anatomical gift of the donor s body or part under section b or an amendment to an anatomical gift of the donor s body or part under section b another person may not make amend or revoke the gift of the donor s body or part under section b a revocation of an anatomical gift of a donor s body or part under section b by a person other than the donor does not bar another person from making an anatomical gift of the body or part under section or b or b in the absence of an express contrary indication by the donor or other person authorized to make an anatomical gift under section b an anatomical gift of a part is neither a refusal to give another part nor a limitation on the making of an anatomical gift of another part at a later time by the donor or another person in the absence of an express contrary indication by the donor or other person authorized to make an anatomical gift under section b an anatomical gift of a part for one or more of the purposes set forth in section b is not a limitation on the making of an anatomical gift of the part for any of the other purposes by the donor or any other person under section or b or b if a donor who is an unemancipated minor dies a parent of the donor who is reasonably available may revoke or amend an anatomical gift of the donor s body or part if an unemancipated minor who signed a refusal dies a parent of the minor who is reasonably available may revoke the minor s refusal section section b which is renumbered from section is renumbered and amended to read b who may make anatomical gift of decedent s body or part subject to subsections and and unless barred by section or b or b an anatomical gift of a decedent s body or part for purpose of transplantation therapy research or education may be made by any member of the following classes of persons who is reasonably available in the order of priority listed a an agent of the decedent at the time of death who could have made an anatomical gift under subsection b immediately before the decedent s death b the spouse of the decedent c adult children of the decedent d parents of the decedent e adult siblings of the decedent f adult grandchildren of the decedent g grandparents of the decedent h the persons who were acting as the guardians of the person of the decedent at the time of death i an adult who exhibited special care and concern for the decedent and j any other person having the authority to dispose of the decedent s body if there is more than one member of a class listed in subsection a c d e f g or j entitled to make an anatomical gift an anatomical gift may be made by a member of the class unless that member or a person to which the gift may pass under section b knows of an objection by another member of the class if an objection is known the gift may be made only by a majority of the members of the class who are reasonably available a person may not make an anatomical gift if at the time of the decedent s death a person in a prior class under subsection is reasonably available to make or to object to the making of an anatomical gift section section b which is renumbered from section is renumbered and amended to read b manner of making amending or revoking anatomical gift of decedent s body or part a person authorized to make an anatomical gift under section b may make an anatomical gift by a document of gift signed by the person making the gift or by that person s oral communication that is electronically recorded or is contemporaneously reduced to a record and signed by the individual receiving the oral communication subject to subsection an anatomical gift by a person authorized under section b may be amended or revoked orally or in a record by any member of a prior class who is reasonably available if more than one member of the prior class is reasonably available the gift made by a person authorized under section b may be a amended only if a majority of the reasonably available members agree to the amending of the gift or b revoked only if a majority of the reasonably available members agree to the revoking of the gift or if they are equally divided as to whether to revoke the gift a revocation under subsection is effective only if before an incision has been made to remove a part from the donor s body or before invasive procedures have begun to prepare the recipient the procurement organization transplant hospital or physician or technician knows of the revocation section section b which is renumbered from section is renumbered and amended to read b persons that may receive anatomical gift purpose of anatomical gift an anatomical gift may be made to the following persons named in the document of gift a a hospital accredited medical school dental school college university organ procurement organization or other appropriate person for research or education b subject to subsection an individual designated by the person making the anatomical gift if the individual is the recipient of the part or c an eye bank or tissue bank if an anatomical gift to an individual under subsection b cannot be transplanted into the individual the part passes in accordance with subsection in the absence of an express contrary indication by the person making the anatomical gift if an anatomical gift of one or more specific parts or of all parts is made in a document of gift that does not name a person described in subsection but identifies the purpose for which an anatomical gift may be used the following rules apply a if the part is an eye and the gift is for the purpose of transplantation or therapy the gift passes to the appropriate eye bank b if the part is tissue and the gift is for the purpose of transplantation or therapy the gift passes to the appropriate tissue bank c if the part is an organ and the gift is for the purpose of transplantation or therapy the gift passes to the appropriate organ procurement organization as custodian of the organ d if the part is an organ an eye or tissue and the gift is for the purpose of research or education the gift passes to the appropriate procurement organization for the purpose of subsection if there is more than one purpose of an anatomical gift set forth in the document of gift but the purposes are not set forth in any priority the gift shall be used for transplantation or therapy if suitable if the gift cannot be used for transplantation or therapy the gift may be used for research or education if an anatomical gift of one or more specific parts is made in a document of gift that does not name a person described in subsection and does not identify the purpose of the gift the gift may be used only for transplantation or therapy and the gift passes in accordance with subsection if a document of gift specifies only a general intent to make an anatomical gift by words such as donor organ donor or body donor or by a symbol or statement of similar import the gift may be used only for transplantation or therapy and the gift passes in accordance with subsection for purposes of subsections and this subsection the following rules apply a if the part is an eye the gift passes to the appropriate eye bank b if the part is tissue the gift passes to the appropriate tissue bank c if the part is an organ the gift passes to the appropriate organ procurement organization as custodian of the organ an anatomical gift of an organ for transplantation or therapy other than an anatomical gift under subsection b passes to the organ procurement organization as custodian of the organ if an anatomical gift does not pass pursuant to subsections through or the decedent s body or part is not used for transplantation therapy research or education custody of the body or part passes to the person under obligation to dispose of the body or part a person may not accept an anatomical gift if the person knows that the gift was not effectively made under section or b or b or if the person knows that the decedent made a refusal under section b that was not revoked for purposes of this subsection if a person knows that an anatomical gift was made on a document of gift the person is considered to know of any amendment or revocation of the gift or any refusal to make an anatomical gift on the same document of gift except as otherwise provided in subsection b nothing in this chapter part affects the allocation of organs for transplantation or therapy section section b which is renumbered from section is renumbered and amended to read b search and notification the following persons shall make a reasonable search of an individual who the person reasonably believes is dead or near death for a document of gift or other information identifying the individual as a donor or as an individual who made a refusal a a law enforcement officer firefighter paramedic or other emergency rescuer finding the individual b if no other source of the information is immediately available a hospital as soon as practical after the individual s arrival at the hospital and c a law enforcement officer firefighter emergency medical services provider or other emergency rescuer who finds an individual who is deceased at the scene of a motor vehicle accident when the deceased individual is transported from the scene of the accident to a funeral establishment licensed under title chapter funeral services licensing act i the law enforcement officer firefighter emergency medical services provider or other emergency rescuer shall as soon as reasonably possible notify the appropriate organ procurement organization tissue bank or eye bank of a the identity of the deceased individual if known b information if known pertaining to the deceased individual s legal next of kin in accordance with section b and c the name and location of the funeral establishment which received custody of and transported the deceased individual and ii the funeral establishment receiving custody of the deceased individual under this subsection c may not embalm the body of the deceased individual until a the funeral establishment receives notice from the organ procurement organization tissue bank or eye bank that the readily available persons listed as having priority in section b have been informed by the organ procurement organization of the option to make or refuse to make an anatomical gift in accordance with section b with reasonable discretion and sensitivity appropriate to the circumstances of the family b in accordance with federal law prior approval for embalming has been obtained from a family member or other authorized person and c the period of time in which embalming is prohibited under subsection c ii may not exceed hours after death if a document of gift or a refusal to make an anatomical gift is located by the search required by subsection a and the individual or deceased individual to whom it relates is taken to a hospital the person responsible for conducting the search shall send the document of gift or refusal to the hospital a person is not subject to criminal or civil liability for failing to discharge the duties imposed by this section but may be subject to administrative sanctions section section b which is renumbered from section is renumbered and amended to read b delivery of document of gift not required right to examine a document of gift need not be delivered during the donor s lifetime to be effective upon or after an individual s death a person in possession of a document of gift or a refusal to make an anatomical gift with respect to the individual shall allow examination and copying of the document of gift or refusal by a person authorized to make or object to the making of an anatomical gift with respect to the individual or by a person to which the gift could pass under section b section section b which is renumbered from section is renumbered and amended to read b rights and duties of procurement organization and others when a hospital refers an individual at or near death to a procurement organization the organization shall make a reasonable search of the records of the department of public safety and any donor registry that it knows exists for the geographical area in which the individual resides to ascertain whether the individual has made an anatomical gift a procurement organization shall be allowed reasonable access to information in the records of the department of public safety to ascertain whether an individual at or near death is a donor when a hospital refers an individual at or near death to a procurement organization the organization may conduct any reasonable examination necessary to ensure the medical suitability of a part that is or could be the subject of an anatomical gift for transplantation therapy research or education from a donor or a prospective donor during the examination period measures necessary to ensure the medical suitability of the part may not be withdrawn unless the hospital or procurement organization knows that the individual expressed a contrary intent unless prohibited by law other than this chapter part at any time after a donor s death the person to which a part passes under section b may conduct any reasonable examination necessary to ensure the medical suitability of the body or part for its intended purpose unless prohibited by law other than this chapter part an examination under subsection or may include an examination of all medical and dental records of the donor or prospective donor upon the death of a minor who was a donor or had signed a refusal unless a procurement organization knows the minor is emancipated the procurement organization shall conduct a reasonable search for the parents of the minor and provide the parents with an opportunity to revoke or amend the anatomical gift or revoke the refusal upon referral by a hospital under subsection a procurement organization shall make a reasonable search for any person listed in section b having priority to make an anatomical gift on behalf of a prospective donor if a procurement organization receives information that an anatomical gift to any other person was made amended or revoked it shall promptly advise the other person of all relevant information subject to subsection b and section b the rights of the person to which a part passes under section b are superior to the rights of all others with respect to the part the person may accept or reject an anatomical gift in whole or in part subject to the terms of the document of gift and this chapter part a person that accepts an anatomical gift of an entire body may allow embalming burial or cremation and use of remains in a funeral service if the gift is of a part the person to which the part passes under section b upon the death of the donor and before embalming burial or cremation shall cause the part to be removed without unnecessary mutilation neither the physician or physician assistant who attends the decedent at death nor the physician or physician assistant who determines the time of the decedent s death may participate in the procedures for removing or transplanting a part from the decedent a physician physician assistant or technician may remove a donated part from the body of a donor that the physician physician assistant or technician is qualified to remove section section b which is renumbered from section is renumbered and amended to read b coordination of procurement and use each hospital in this state shall enter into agreements or affiliations with procurement organizations for coordination of procurement and use of anatomical gifts section section b which is renumbered from section is renumbered and amended to read b sale or purchase of parts prohibited except as otherwise provided in subsection a person that for valuable consideration knowingly purchases or sells a part for transplantation or therapy if removal of a part from an individual is intended to occur after the individual s death commits a third degree felony a person may charge a reasonable amount for the removal processing preservation quality control storage transportation implantation or disposal of a part section section b which is renumbered from section is renumbered and amended to read b other prohibited acts a person that in order to obtain a financial gain intentionally falsifies forges conceals defaces or obliterates a document of gift an amendment or revocation of a document of gift or a refusal commits a third degree felony section section b which is renumbered from section is renumbered and amended to read b immunity a person that acts in accordance with this chapter part or with the applicable anatomical gift law of another state or attempts in good faith to do so is not liable for the act in a civil action criminal prosecution or administrative proceeding neither the person making an anatomical gift nor the donor s estate is liable for any injury or damage that results from the making or use of the gift in determining whether an anatomical gift has been made amended or revoked under this chapter part a person may rely upon representations of an individual listed in subsection b b c d e f g h i or j relating to the individual s relationship to the donor or prospective donor unless the person knows that the representation is untrue section section b which is renumbered from section is renumbered and amended to read b law governing validity choice of law as to execution of document of gift presumption of validity a document of gift is valid if executed in accordance with a this chapter part b the laws of the state or country where it was executed or c the laws of the state or country where the person making the anatomical gift was domiciled has a place of residence or was a national at the time the document of gift was executed if a document of gift is valid under this section the law of this state governs the interpretation of the document of gift a person may presume that a document of gift or amendment of an anatomical gift is valid unless that person knows that it was not validly executed or was revoked section section b which is renumbered from section is renumbered and amended to read b donor registry the department of public safety may establish or contract for the establishment of a donor registry the driver license division of the department of public safety shall cooperate with a person that administers any donor registry that this state establishes contracts for or recognizes for the purpose of transferring to the donor registry all relevant information regarding a donor s making amendment to or revocation of an anatomical gift a donor registry shall a allow a donor or other person authorized under section b to include on the donor registry a statement or symbol that the donor has made amended or revoked an anatomical gift b be accessible to a procurement organization to allow it to obtain relevant information on the donor registry to determine at or near death of the donor or a prospective donor whether the donor or prospective donor has made amended or revoked an anatomical gift and c be accessible for purposes of subsections a and b seven days a week on a hour basis personally identifiable information on a donor registry about a donor or prospective donor may not be used or disclosed without the express consent of the donor prospective donor or person that made the anatomical gift for any purpose other than to determine at or near death of the donor or prospective donor whether the donor or prospective donor has made amended or revoked an anatomical gift this section does not prohibit any person from creating or maintaining a donor registry that is not established by or under contract with the state any such registry shall comply with subsections and section section b which is renumbered from section is renumbered and amended to read b effect of anatomical gift on advance health care directive as used in this section a advance health care directive means a power of attorney for health care or a record signed or authorized by a prospective donor containing the prospective donor s direction concerning a health care decision for the prospective donor b declaration means a record signed by a prospective donor specifying the circumstances under which a life support system may be withheld or withdrawn from the prospective donor c health care decision means any decision regarding the health care of the prospective donor if a prospective donor has a declaration or advance health care directive and the terms of the declaration or directive and the express or implied terms of a potential anatomical gift are in conflict with regard to the administration of measures necessary to ensure the medical suitability of a part for transplantation or therapy the prospective donor s attending physician and prospective donor shall confer to resolve the conflict if the prospective donor is incapable of resolving the conflict an agent acting under the prospective donor s declaration or directive or if no declaration or directive exists or the agent is not reasonably available another person authorized by a law other than this chapter part to make a health care decision on behalf of the prospective donor shall act for the donor to resolve the conflict the conflict shall be resolved as expeditiously as possible information relevant to the resolution of the conflict may be obtained from the appropriate procurement organization and any other person authorized to make an anatomical gift for the prospective donor under section b before resolution of the conflict measures necessary to ensure the medical suitability of the part may not be withheld or withdrawn from the prospective donor if withholding or withdrawing the measures is not contraindicated by appropriate end of life care section section b which is renumbered from section is renumbered and amended to read b cooperation between medical examiner and procurement organization a medical examiner shall cooperate with procurement organizations to maximize the opportunity to recover anatomical gifts for the purpose of transplantation therapy research or education if a medical examiner receives notice from a procurement organization that an anatomical gift might be available or was made with respect to a decedent whose body is under the jurisdiction of the medical examiner and a postmortem examination is going to be performed unless the medical examiner denies recovery in accordance with section b the medical examiner or designee shall conduct a postmortem examination of the body or the part in a manner and within a period compatible with its preservation for the purposes of the gift a part may not be removed from the body of a decedent under the jurisdiction of a medical examiner for transplantation therapy research or education unless the part is the subject of an anatomical gift the body of a decedent under the jurisdiction of the medical examiner may not be delivered to a person for research or education unless the body is the subject of an anatomical gift this subsection does not preclude a medical examiner from performing the medicolegal investigation upon the body or parts of a decedent under the jurisdiction of the medical examiner section section b which is renumbered from section is renumbered and amended to read b facilitation of anatomical gift from decedent whose body is under jurisdiction of medical examiner upon request of a procurement organization a medical examiner shall release to the procurement organization the name contact information and available medical and social history of a decedent whose body is under the jurisdiction of the medical examiner if the decedent s body or part is medically suitable for transplantation therapy research or education the medical examiner shall release postmortem examination results to the procurement organization the procurement organization may make a subsequent disclosure of the postmortem examination results or other information received from the medical examiner only if relevant to transplantation or therapy the medical examiner may conduct a medicolegal examination by reviewing all medical records laboratory test results x rays other diagnostic results and other information that any person possesses about a donor or prospective donor whose body is under the jurisdiction of the medical examiner which the medical examiner determines may be relevant to the investigation a person that has any information requested by a medical examiner pursuant to subsection shall provide that information as expeditiously as possible to allow the medical examiner to conduct the medicolegal investigation within a period compatible with the preservation of parts for the purpose of transplantation therapy research or education if an anatomical gift has been or might be made of a part of a decedent whose body is under the jurisdiction of the medical examiner and a postmortem examination is not required or the medical examiner determines that a postmortem examination is required but that the recovery of the part that is the subject of an anatomical gift will not interfere with the examination the medical examiner and procurement organization shall cooperate in the timely removal of the part from the decedent for the purpose of transplantation therapy research or education if an anatomical gift of a part from the decedent under the jurisdiction of the medical examiner has been or might be made but the medical examiner initially believes that the recovery of the part could interfere with the postmortem investigation into the decedent s cause or manner of death the medical examiner shall consult with the procurement organization or physician or technician designated by the procurement organization about the proposed recovery after consultation the medical examiner may allow the recovery following the consultation under subsection in the absence of mutually agreed upon protocols to resolve conflict between the medical examiner and the procurement organization if the medical examiner intends to deny recovery the medical examiner or designee at the request of the procurement organization may attend the removal procedure for the part before making a final determination not to allow the procurement organization to recover the part during the removal procedure the medical examiner or designee may allow recovery by the procurement organization to proceed or if the medical examiner or designee reasonably believes that the part may be involved in determining the decedent s cause or manner of death deny recovery by the procurement organization if the medical examiner or designee denies recovery under subsection the medical examiner or designee shall a explain in a record the specific reasons for not allowing recovery of the part
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
diff --git a/assets/data-leg/clean_line_0093_df.csv b/assets/data-leg/clean_line_0093_df.csv
new file mode 100644
index 00000000..7b487677
--- /dev/null
+++ b/assets/data-leg/clean_line_0093_df.csv
@@ -0,0 +1,280 @@
+text
+enrolled copy s b
+
+
+birth certificate modifications
+general session
+state of utah
+chief sponsor daniel mccay
+house sponsor brady brammer
+
+long title
+general description
+this bill enacts provisions regarding amending birth certificates
+highlighted provisions
+this bill
+modifies the rulemaking authority of the department of health and human services
+department regarding when an error or omission to a vital record may be
+corrected
+allows the department to amend a birth certificate without a court order under
+certain circumstances
+creates the procedure a court must follow to grant a petition to amend the sex
+designation of a birth certificate
+requires the court to appoint a guardian ad litem before granting a petition to amend
+the sex designation of a birth certificate
+requires the department to issue an amended birth certificate that does not identify
+the fields that were amended and
+requires the department to issue an amendment history with a birth certificate
+money appropriated in this bill
+none
+other special clauses
+this bill provides a special effective date
+this bill provides a coordination clause
+
+utah code sections affected
+amends
+as last amended by laws of utah chapter
+as last amended by laws of utah chapter
+repeals and reenacts
+as last amended by laws of utah chapter
+
+be it enacted by the legislature of the state of utah
+section section is amended to read
+definitions
+as used in this chapter
+adoption document means an adoption related document filed with the office a
+petition for adoption a decree of adoption an original birth certificate or evidence submitted
+in support of a supplementary birth certificate
+biological sex at birth means an individual s sex as being male or female
+according to distinct reproductive roles as manifested by sex and reproductive organ anatomy
+chromosomal makeup and endogenous hormone profiles
+certified nurse midwife means an individual who
+a is licensed to practice as a certified nurse midwife under title chapter a
+nurse midwife practice act and
+b has completed an education program regarding the completion of a certificate of
+death developed by the department by rule made in accordance with title g chapter utah
+administrative rulemaking act
+custodial funeral service director means a funeral service director who
+a is employed by a licensed funeral establishment and
+b has custody of a dead body
+dead body or decedent means a human body or parts of the human body
+
+from the condition of which it reasonably may be concluded that death occurred
+dead fetus means a product of human conception other than those
+circumstances described in subsection
+a of weeks gestation or more calculated from the date the last normal menstrual
+period began to the date of delivery and
+b that was not born alive
+declarant father means a male who claims to be the genetic father of a child
+and along with the biological mother signs a voluntary declaration of paternity to establish the
+child s paternity
+dispositioner means
+a a person designated in a written instrument under subsection as
+having the right and duty to control the disposition of the decedent if the person voluntarily
+acts as the dispositioner or
+b the next of kin of the decedent if
+i a a person has not been designated as described in subsection a or
+b the person described in subsection a is unable or unwilling to exercise
+the right and duty described in subsection a and
+ii the next of kin voluntarily acts as the dispositioner
+fetal remains means
+a an aborted fetus as that term is defined in section or
+b a miscarried fetus as that term is defined in section
+file means the submission of a completed certificate or other similar
+document record or report as provided under this chapter for registration by the state registrar
+or a local registrar
+funeral service director means the same as that term is defined in section
+
+health care facility means the same as that term is defined in section
+
+
+health care professional means a physician physician assistant nurse
+practitioner or certified nurse midwife
+intersex individual means an individual who
+a is born with external biological sex characteristics that are irresolvably ambiguous
+b is born with xx chromosomes with virilization
+c is born with xy chromosomes with undervirilization
+d has both ovarian and testicular tissue or
+e has been diagnosed by a physician based on genetic or biochemical testing with
+abnormal
+i sex chromosome structure
+ii sex steroid hormone production or
+iii sex steroid hormone action for a male or female
+licensed funeral establishment means
+a if located in utah a funeral service establishment as that term is defined in section
+that is licensed under title chapter funeral services licensing act or
+b if located in a state district or territory of the united states other than utah a
+funeral service establishment that complies with the licensing laws of the jurisdiction where the
+establishment is located
+live birth means the birth of a child who shows evidence of life after the
+child is entirely outside of the mother
+local registrar means a person appointed under subsection b
+nurse practitioner means an individual who
+a is licensed to practice as an advanced practice registered nurse under title
+chapter b nurse practice act and
+b has completed an education program regarding the completion of a certificate of
+death developed by the department by administrative rule made in accordance with title g
+
+chapter utah administrative rulemaking act
+office means the office of vital records and statistics within the
+department of health operating under title chapter utah vital statistics act
+physician means a person licensed to practice as a physician or osteopath
+in this state under title chapter utah medical practice act or title chapter
+utah osteopathic medical practice act
+physician assistant means an individual who
+a is licensed to practice as a physician assistant under title chapter a utah
+physician assistant act and
+b has completed an education program regarding the completion of a certificate of
+death developed by the department by administrative rule made in accordance with title g
+chapter utah administrative rulemaking act
+presumed father means the father of a child conceived or born during a
+marriage as defined in section
+registration or register means acceptance by the local or state registrar
+of a certificate and incorporation of the certificate into the permanent records of the state
+state registrar means the state registrar of vital records appointed under
+subsection e
+vital records means
+a registered certificates or reports of birth death fetal death marriage divorce
+dissolution of marriage or annulment
+b amendments to any of the registered certificates or reports described in subsection
+a
+c an adoption document and
+d other similar documents
+vital statistics means the data derived from registered certificates and
+reports of birth death fetal death induced termination of pregnancy marriage divorce
+
+dissolution of marriage or annulment
+section section is amended to read
+correction of errors or omissions in vital records conflicting birth and
+foundling certificates administrative birth certificate amendment rulemaking
+in accordance with title g chapter utah administrative rulemaking
+act the department may make rules
+a governing applications to correct alleged errors or omissions on any vital
+record
+b establishing procedures to resolve conflicting birth and foundling certificates
+and
+c allowing for the correction and reissuance of a vital record that was originally
+created omitting a diacritical mark and
+d notwithstanding any other provision of law allowing for the change of a child s
+name on the child s birth certificate within one year from the day the child is born
+for a birth certificate the department may correct an error or omission under
+subsection a if
+a the error or omission is a result of a scrivener s error or a data entry error and
+b the department receives
+i a an affidavit from the applicant attesting that there is an error on the birth
+certificate
+b supporting documentation from the health care facility or attending health care
+provider and
+c an affidavit from the health care facility or health care provider described in
+subsection b i b attesting to the accuracy of the supporting documentation or
+ii documentation deemed sufficient by the state registrar to establish the facts of the
+error or omission
+the department may amend a birth certificate s sex designation for an intersex
+
+individual at the request of the individual or the guardian of the individual if
+a the sex designation indicating the biological sex at birth of the individual was
+misidentified on the original certificate due to the individual s condition and
+b the department receives
+i a correction affidavit attesting the individual is intersex
+ii chromosomal molecular karyotypic dna or genetic testing results that confirm
+the individual is intersex and
+iii an affidavit from the health care facility health care professional or laboratory
+testing facility that conducted the test or analyzed the test results attesting to the test results
+and accuracy
+section section is repealed and reenacted to read
+birth certificate name or sex designation change registration of court
+order and amendment of birth certificate
+an individual may obtain a court order in accordance with title names to
+change the name on the individual s birth certificate
+a a court may grant a petition ordering a sex designation change on a birth
+certificate if the court determines by clear and convincing evidence that the individual seeking
+the sex designation change
+i is not involved in any kind of lawsuit
+ii is not on probation or parole
+iii is not seeking the amendment
+a to commit a crime
+b to interfere with the rights of others
+c to avoid creditors
+d to influence the sentence fine or conditions of imprisonment in a criminal case
+e to commit fraud on the public or
+f for any other fraudulent purpose
+
+iv has transitioned from the sex designation of the biological sex at birth to the sex
+sought in the petition
+v has outwardly expressed as the sex sought in the petition in a consistent and
+uniform manner for at least six months and
+vi suffers from clinically significant distress or impairment due to the current sex
+designation on the birth certificate
+b the court shall consider the following when making the determination described in
+subsection a iv
+i evidence of medical history care or treatment related to sex transitioning and
+ii evidence that the sex sought in the petition is sincerely held and part of the
+individual s core identity
+a i when determining whether to grant a sex designation change for a child who
+is at least years and six months old unless the child is emancipated the court shall appoint
+notwithstanding subsection a a guardian ad litem for the child
+ii notwithstanding subsection a the child s parent or guardian is
+responsible for the costs of the guardian ad litem s services unless the court determines the
+parent or guardian is indigent in accordance with section a
+
+b the guardian ad litem shall provide the court relevant evidence whether submitted
+by the child or other sources of evidence regarding the following
+i whether the child is capable of making decisions with long term consequences
+independently of the child s parent or guardian
+ii whether the child is mature and capable of appreciating the implications of the
+decision to change the sex designation on the child s birth certificate and
+iii whether the child meets the other requirements of this section
+c the guardian of a child described in subsection a shall
+i give notice of the proceeding to any known parent of the child and
+ii provide the court with a declaration of the status of any divorce or custody matter
+
+pertaining to the child including the case name case number court judge and current status
+of the case
+d the court shall
+i consider any objection given by a parent
+ii close the hearing on a petition for a sex designation change
+iii receive all evidence and
+iv make a determination as to whether
+a all of the requirements of subsection have been met and
+b the evidence supports a finding by clear and convincing evidence that the sex
+designation change is in the best interest of the child and would not create a risk of harm to the
+minor
+a a court may not grant a petition for a sex designation change if
+i the birth certificate is for a child who is younger than years and six months old
+or
+ii the child s parent or guardian with legal custody has not given permission
+b an order granting a sex designation change under this section is not effective until
+the individual is at least years old
+a petition for a sex designation under this section may be combined with a petition
+under title names
+a upon the receipt of a certified order granting a birth certificate amendment any
+required application and an appropriate fee the department shall issue
+i a birth certificate that does not indicate which fields were amended unless requested
+by the individual and
+ii an amendment history of the birth certificate including the fields of the birth
+certificate that have been amended and the date of the amendment
+b the department shall retain a record of all amendments to a birth certificate
+including any amendment history issued by the department
+
+the provisions of this section are severable
+this section only applies to birth certificates issued by the state
+section effective date
+if approved by two thirds of all the members elected to each house this bill takes effect
+upon approval by the governor or the day following the constitutional time limit of utah
+constitution article vii section without the governor s signature or in the case of a veto
+the date of veto override
+section coordinating s b with h b substantive and technical
+amendments
+if this s b and h b participation in extracurricular activities amendments
+both pass and become law it is the intent of the legislature that the office of legislative
+research and general counsel shall prepare the utah code database for publication by
+replacing each reference to birth certificate in section g with birth certificate and
+birth certificate amendment history
+
+
+
+
+
+
+
+
diff --git a/assets/data-leg/clean_line_0132_fail_df.csv b/assets/data-leg/clean_line_0132_fail_df.csv
new file mode 100644
index 00000000..c0dce001
--- /dev/null
+++ b/assets/data-leg/clean_line_0132_fail_df.csv
@@ -0,0 +1,627 @@
+text
+legislative general counsel
+approved for filing c williams
+pm
+
+h b
+st sub buff
+
+
+
+
+
+
+representative rex p shipp proposes the following substitute bill
+
+
+prohibiting sex transitioning procedures on
+minors
+general session
+state of utah
+chief sponsor rex p shipp
+senate sponsor wayne a harper
+
+cosponsors
+nelson t abbott
+cheryl k acton
+carl r albrecht
+bridger bolinder
+walt brooks
+jefferson s burton
+kay j christofferson
+
+joseph elison colin w jack tim jimenez dan n johnson quinn kotter trevor lee steven j lund phil lyman
+
+a cory maloy michael j petersen thomas w peterson keven j stratton mark a strong jordan d teuscher christine f watkins
+
+
+
+long title
+general description
+this bill prohibits a health care provider from performing a medical procedure on a
+minor for the purpose of attempted sex transitioning or attempted sex change
+highlighted provisions
+this bill
+defines terms
+makes it unprofessional conduct for a health care provider to perform a medical
+procedure on a minor for the purpose of attempted sex transitioning or attempted
+
+
+
+hb s
+
+
+sex change under most circumstances and
+makes technical changes
+money appropriated in this bill
+none
+other special clauses
+none
+utah code sections affected
+amends
+b as last amended by laws of utah chapter
+as last amended by laws of utah chapter
+as last amended by laws of utah chapter
+as last amended by laws of utah chapter
+as last amended by laws of utah chapter
+a as last amended by laws of utah chapter
+enacts
+utah code annotated
+
+be it enacted by the legislature of the state of utah
+section section is enacted to read
+prohibition on hormonal transgender procedures on minors
+as used in this section
+a administration of cross sex hormones means administering or supplying
+i to an individual whose biological sex at birth is female a dose of testosterone or
+other androgens at levels above those normally found in an individual whose biological sex at
+birth is female or
+ii to an individual whose biological sex at birth is male a dose of estrogen or a
+synthetic compound with estrogenic activity or effect at levels above those normally found in
+an individual whose biological sex at birth is male
+b health care provider means
+i a physician licensed under
+a chapter utah medical practice act or
+
+
+b chapter utah osteopathic medical practice act
+ii a physician assistant licensed under chapter a utah physician assistant act or
+iii an advanced practice registered nurse licensed under subsection b e
+c hormonal transgender procedure means
+i administration of cross sex hormones or
+ii performing a puberty inhibition procedure
+d minor means an individual who
+i is less than years old and
+ii is not emancipated under title chapter emancipation
+e i puberty inhibition procedure means administering or supplying alone or in
+combination with aromatase inhibitors
+a gonadotropin releasing hormone agonists
+b progestins or
+c androgen receptor inhibitors
+ii puberty inhibition procedure does not include administering or supplying a
+treatment described in subsection e i to an individual if the treatment is medically
+necessary as a treatment for
+a precocious puberty
+b idiopathic short stature
+c endometriosis or
+d a sex hormone stimulated cancer
+except as provided in subsection a health care provider may not perform a
+hormonal transgender procedure on a minor
+a a health care provider may continue to administer cross sex hormones to a
+minor if the minor
+i began receiving cross sex hormones prior to may
+ii has continuously received cross sex hormones for at least two years and
+iii affirmatively elects in writing to continue to receive cross sex hormones
+b for a minor who does not meet the criteria described in subsection a a health
+care provider who provides cross sex hormones to the minor shall
+i unless the minor elects to discontinue receiving cross sex hormones by an earlier
+
+
+date develop and implement a treatment plan to progressively decrease the dosage of cross sex
+hormones so that cross sex hormone treatment is ended by november and
+ii consult with a mental health professional in order to monitor the minor s
+psychological and emotional state until november
+section section b is amended to read
+b unprofessional conduct
+unprofessional conduct includes
+a failure to safeguard a patient s right to privacy as to the patient s person condition
+diagnosis personal effects or any other matter about which the licensee is privileged to know
+because of the licensee s or person with a certification s position or practice as a nurse or
+practice as a medication aide certified
+b failure to provide nursing service or service as a medication aide certified in a
+manner that demonstrates respect for the patient s human dignity and unique personal character
+and needs without regard to the patient s race religion ethnic background socioeconomic
+status age sex or the nature of the patient s health problem
+c engaging in sexual relations with a patient during any
+i period when a generally recognized professional relationship exists between the
+person licensed or certified under this chapter and the patient or
+ii extended period when a patient has reasonable cause to believe a professional
+relationship exists between the person licensed or certified under the provisions of this chapter
+and the patient
+d i as a result of any circumstance under subsection c exploiting or using
+information about a patient or exploiting the licensee s or the person with a certification s
+professional relationship between the licensee or holder of a certification under this chapter and
+the patient or
+ii exploiting the patient by use of the licensee s or person with a certification s
+knowledge of the patient obtained while acting as a nurse or a medication aide certified
+e unlawfully obtaining possessing or using any prescription drug or illicit drug
+f unauthorized taking or personal use of nursing supplies from an employer
+g unauthorized taking or personal use of a patient s personal property
+h unlawful or inappropriate delegation of nursing care
+
+
+i failure to exercise appropriate supervision of persons providing patient care services
+under supervision of the licensed nurse
+j employing or aiding and abetting the employment of an unqualified or unlicensed
+person to practice as a nurse
+k failure to file or record any medical report as required by law impeding or
+obstructing the filing or recording of such a report or inducing another to fail to file or record
+such a report
+l breach of a statutory common law regulatory or ethical requirement of
+confidentiality with respect to a person who is a patient unless ordered by a court
+m failure to pay a penalty imposed by the division
+n prescribing a schedule ii controlled substance without complying with the
+requirements in section b if applicable
+o violating section b
+p violating the dispensing requirements of section b or chapter b part
+dispensing medical practitioner and dispensing medical practitioner clinic pharmacy if
+applicable
+q falsely making an entry in or altering a medical record with the intent to conceal
+i a wrongful or negligent act or omission of an individual licensed under this chapter
+or an individual under the direction or control of an individual licensed under this chapter or
+ii conduct described in subsections a through o or subsection or
+r violating the requirements of title chapter a utah medical cannabis act
+
+or
+s performing or causing to be performed a hormonal transgender procedure in
+violation of section
+
+unprofessional conduct does not include in accordance with title chapter
+a utah medical cannabis act when registered as a qualified medical provider or acting as
+a limited medical provider as those terms are defined in section a recommending
+the use of medical cannabis
+notwithstanding subsection the division in consultation with the board and in
+accordance with title g chapter utah administrative rulemaking act shall define
+unprofessional conduct for an advanced practice registered nurse described in subsection
+
+
+section section is amended to read
+definitions
+in addition to the definitions in section as used in this chapter
+a ablative procedure means a procedure that is expected to excise vaporize
+disintegrate or remove living tissue including the use of carbon dioxide lasers and erbium
+yag lasers
+b ablative procedure does not include hair removal
+acgme means the accreditation council for graduate medical education of the
+american medical association
+administrative penalty means a monetary fine or citation imposed by the division
+for acts or omissions determined to constitute unprofessional or unlawful conduct in
+accordance with a fine schedule established by the division in collaboration with the board as a
+result of an adjudicative proceeding conducted in accordance with title g chapter
+administrative procedures act
+associate physician means an individual licensed under section
+attempted sex change means an attempt or effort to change an individual s body
+to present that individual as being of a sex or gender that is different from the individual s
+biological sex at birth
+biological sex at birth means an individual s sex as being male or female
+according to distinct reproductive roles as manifested by sex and reproductive organ anatomy
+chromosomal makeup and endogenous hormone profiles
+board means the physicians licensing board created in section
+collaborating physician means an individual licensed under section
+who enters into a collaborative practice arrangement with an associate physician
+collaborative practice arrangement means the arrangement described in
+section
+cosmetic breast surgical procedure means a breast reduction surgery or a breast
+augmentation surgery that is performed for a purpose other than
+a medical necessity or
+b to address a musculoskeletal problem
+a cosmetic medical device means tissue altering energy based devices
+
+
+that have the potential for altering living tissue and that are used to perform ablative or
+nonablative procedures such as american national standards institute ansi designated
+class iiib and class iv lasers intense pulsed light radio frequency devices and lipolytic
+devices and excludes ansi designated class iiia and lower powered devices
+b notwithstanding subsection a a if an ansi designated class iiia and
+lower powered device is being used to perform an ablative procedure the device is included in
+the definition of cosmetic medical device under subsection a a
+cosmetic medical procedure
+a includes the use of cosmetic medical devices to perform ablative or nonablative
+procedures and
+b does not include a treatment of the ocular globe such as refractive surgery
+diagnose means
+a to examine in any manner another person parts of a person s body substances
+fluids or materials excreted taken or removed from a person s body or produced by a person s
+body to determine the source nature kind or extent of a disease or other physical or mental
+condition
+b to attempt to conduct an examination or determination described under subsection
+a a
+c to hold oneself out as making or to represent that one is making an examination or
+determination as described in subsection a a or
+d to make an examination or determination as described in subsection a
+a upon or from information supplied directly or indirectly by another person whether or
+not in the presence of the person making or attempting the diagnosis or examination
+lcme means the liaison committee on medical education of the
+american medical association
+medical assistant means an unlicensed individual who may perform tasks
+as described in subsection
+medically underserved area means a geographic area in which there is a
+shortage of primary care health services for residents as determined by the department of
+health
+medically underserved population means a specified group of people
+
+
+living in a defined geographic area with a shortage of primary care health services as
+determined by the department of health
+a i nonablative procedure means a procedure that is expected or
+intended to alter living tissue but is not intended or expected to excise vaporize disintegrate
+or remove living tissue
+ii notwithstanding subsection a i a i nonablative procedure includes
+hair removal
+b nonablative procedure does not include
+i a superficial procedure as defined in section
+ii the application of permanent make up or
+iii the use of photo therapy and lasers for neuromusculoskeletal treatments that are
+performed by an individual licensed under this title who is acting within the individual s scope
+of practice
+physician means both physicians and surgeons licensed under section
+utah medical practice act and osteopathic physicians and surgeons licensed under
+section utah osteopathic medical practice act
+a practice of medicine means
+i to diagnose treat correct administer anesthesia or prescribe for any human
+disease ailment injury infirmity deformity pain or other condition physical or mental real
+or imaginary including to perform cosmetic medical procedures or to attempt to do so by any
+means or instrumentality and by an individual in utah or outside the state upon or for any
+human within the state
+ii when a person not licensed as a physician directs a licensee under this chapter to
+withhold or alter the health care services that the licensee has ordered
+iii to maintain an office or place of business for the purpose of doing any of the acts
+described in subsection a a whether or not for compensation or
+iv to use in the conduct of any occupation or profession pertaining to the diagnosis or
+treatment of human diseases or conditions in any printed material stationery letterhead
+envelopes signs or advertisements the designation doctor doctor of medicine
+physician surgeon physician and surgeon dr m d or any combination of these
+designations in any manner which might cause a reasonable person to believe the individual
+
+
+using the designation is a licensed physician and surgeon and if the party using the designation
+is not a licensed physician and surgeon the designation must additionally contain the
+description of the branch of the healing arts for which the person has a license provided that an
+individual who has received an earned degree of doctor of medicine degree but is not a licensed
+physician and surgeon in utah may use the designation m d if it is followed by not
+licensed or not licensed in utah in the same size and style of lettering
+b the practice of medicine does not include
+i except for an ablative medical procedure as provided in subsection b ii
+b ii the conduct described in subsection a i a i that is performed in
+accordance with a license issued under another chapter of this title
+ii an ablative cosmetic medical procedure if the scope of practice for the person
+performing the ablative cosmetic medical procedure includes the authority to operate or
+perform a surgical procedure or
+iii conduct under subsection
+prescription device means an instrument apparatus implement machine
+contrivance implant in vitro reagent or other similar or related article and any component
+part or accessory which is required under federal or state law to be prescribed by a practitioner
+and dispensed by or through a person or entity licensed under this chapter or exempt from
+licensure under this chapter
+prescription drug means a drug that is required by federal or state law or
+rule to be dispensed only by prescription or is restricted to administration only by practitioners
+a sex characteristic altering surgical procedure means for the purpose of
+effectuating or facilitating an individual s attempted sex change
+i castration orchiectomy penectomy vaginoplasty vulvoplasty breast augmentation
+surgery or facial feminization surgery on an individual whose biological sex at birth is male
+ii mastectomy hysterectomy oophorectomy metoidioplasty phalloplasty or chest or
+facial masculinization procedures on an individual whose biological sex at birth is female
+iii any surgical procedure that is related to or necessary for a procedure described in
+subsection a i or ii that would result in the sterilization of an individual who is
+non sterile or
+iv removing any otherwise healthy or non diseased body part or tissue
+
+
+b sex characteristic altering surgical procedure does not include
+i surgery or other procedures or treatments performed on an individual who
+a is born with external biological sex characteristics that are irresolvably ambiguous
+b is born with xx chromosomes with virilization
+c is born with xy chromosomes with undervirilization
+d has both ovarian and testicular tissue or
+e has been diagnosed by a physician based on genetic or biochemical testing with a
+sex development disorder characterized by abnormal sex chromosome structure sex steroid
+hormone production or sex steroid hormone action for a male or female or
+ii removing a body part
+a because the body part is cancerous or diseased or
+b for a reason that is medically necessary other than to effectuate or facilitate an
+individual s attempted sex change
+spex means the special purpose examination of the federation of state
+medical boards
+unlawful conduct means the same as that term is defined in sections
+and
+unprofessional conduct means the same as that term is defined in
+sections and and as may be further defined by division rule
+section section is amended to read
+unprofessional conduct
+unprofessional conduct includes in addition to the definition in section
+
+a using or employing the services of any individual to assist a licensee in any manner
+not in accordance with the generally recognized practices standards or ethics of the
+profession state law or division rule
+b making a material misrepresentation regarding the qualifications for licensure under
+section or section
+c violating the dispensing requirements of chapter b part dispensing medical
+practitioner and dispensing medical practitioner clinic pharmacy if applicable
+d violating the requirements of title chapter a utah medical cannabis act
+
+
+or
+e falsely making an entry in or altering a medical record with the intent to conceal
+i a wrongful or negligent act or omission of an individual licensed under this chapter
+or an individual under the direction or control of an individual licensed under this chapter or
+ii conduct described in subsections a through d or subsection
+
+or
+f performing or causing to be performed upon a minor as defined in section
+
+
+i a hormonal transgender procedure in violation of section
+
+ii a sex characteristic altering surgical procedure or
+iii a cosmetic breast surgical procedure
+unprofessional conduct does not include
+a in compliance with section
+i obtaining an investigational drug or investigational device
+ii administering the investigational drug to an eligible patient or
+iii treating an eligible patient with the investigational drug or investigational device
+or
+b in accordance with title chapter a utah medical cannabis act
+i when registered as a qualified medical provider or acting as a limited medical
+provider as those terms are defined in section a recommending the use of medical
+cannabis
+ii when registered as a pharmacy medical provider as that term is defined in section
+a providing pharmacy medical provider services in a medical cannabis pharmacy or
+iii when registered as a state central patient portal medical provider as that term is
+defined in section a providing state central patient portal medical provider services
+notwithstanding subsection b the division in consultation with the board and
+in accordance with title g chapter utah administrative rulemaking act shall define
+unprofessional conduct for a physician described in subsection b
+section section is amended to read
+definitions
+in addition to the definitions in section as used in this chapter
+
+
+a ablative procedure means a procedure that is expected to excise vaporize
+disintegrate or remove living tissue including the use of carbon dioxide lasers and erbium
+yag lasers
+b ablative procedure does not include hair removal
+acgme means the accreditation council for graduate medical education of the
+american medical association
+administrative penalty means a monetary fine imposed by the division for acts or
+omissions determined to constitute unprofessional or unlawful conduct as a result of an
+adjudicative proceeding conducted in accordance with title g chapter administrative
+procedures act
+aoa means the american osteopathic association
+associate physician means an individual licensed under section
+attempted sex change means an attempt or effort to change an individual s body
+to present that individual as being of a sex or gender that is different from the individual s
+biological sex at birth
+biological sex at birth means an individual s sex as being male or female
+according to distinct reproductive roles as manifested by sex and reproductive organ anatomy
+chromosomal makeup and endogenous hormone profiles
+board means the osteopathic physician and surgeon s licensing board
+created in section
+collaborating physician means an individual licensed under section
+who enters into a collaborative practice arrangement with an associate physician
+collaborative practice arrangement means the arrangement described in
+section
+cosmetic breast surgical procedure means a breast reduction surgery or a breast
+augmentation surgery for reasons other than
+a medical necessity or
+b to address a musculoskeletal problem
+a cosmetic medical device means tissue altering energy based devices
+that have the potential for altering living tissue and that are used to perform ablative or
+nonablative procedures such as american national standards institute ansi designated
+
+
+class iiib and class iv lasers intense pulsed light radio frequency devices and lipolytic
+devices and excludes ansi designated class iiia and lower powered devices
+b notwithstanding subsection a a if an ansi designated class iiia and
+lower powered device is being used to perform an ablative procedure the device is included in
+the definition of cosmetic medical device under subsection a a
+cosmetic medical procedure
+a includes the use of cosmetic medical devices to perform ablative or nonablative
+procedures and
+b does not include a treatment of the ocular globe such as refractive surgery
+diagnose means
+a to examine in any manner another person parts of a person s body substances
+fluids or materials excreted taken or removed from a person s body or produced by a person s
+body to determine the source nature kind or extent of a disease or other physical or mental
+condition
+b to attempt to conduct an examination or determination described under subsection
+a a
+c to hold oneself out as making or to represent that one is making an examination or
+determination as described in subsection a a or
+d to make an examination or determination as described in subsection a
+a upon or from information supplied directly or indirectly by another person whether or
+not in the presence of the person making or attempting the diagnosis or examination
+medical assistant means an unlicensed individual who may perform tasks
+as described in subsection
+medically underserved area means a geographic area in which there is a
+shortage of primary care health services for residents as determined by the department of
+health
+medically underserved population means a specified group of people
+living in a defined geographic area with a shortage of primary care health services as
+determined by the department of health
+a i nonablative procedure means a procedure that is expected or
+intended to alter living tissue but is not expected or intended to excise vaporize disintegrate
+
+
+or remove living tissue
+ii notwithstanding subsection a i a i nonablative procedure includes
+hair removal
+b nonablative procedure does not include
+i a superficial procedure as defined in section
+ii the application of permanent make up or
+iii the use of photo therapy lasers for neuromusculoskeletal treatments that are
+preformed by an individual licensed under this title who is acting within the individual s scope
+of practice
+physician means both physicians and surgeons licensed under section
+utah medical practice act and osteopathic physicians and surgeons licensed under
+section utah osteopathic medical practice act
+a practice of osteopathic medicine means
+i to diagnose treat correct administer anesthesia or prescribe for any human
+disease ailment injury infirmity deformity pain or other condition physical or mental real
+or imaginary or to attempt to do so by any means or instrumentality which in whole or in part
+is based upon emphasis of the importance of the musculoskeletal system and manipulative
+therapy in the maintenance and restoration of health by an individual in utah or outside of the
+state upon or for any human within the state
+ii when a person not licensed as a physician directs a licensee under this chapter to
+withhold or alter the health care services that the licensee has ordered
+iii to maintain an office or place of business for the purpose of doing any of the acts
+described in subsection a a whether or not for compensation or
+iv to use in the conduct of any occupation or profession pertaining to the diagnosis or
+treatment of human diseases or conditions in any printed material stationery letterhead
+envelopes signs or advertisements the designation doctor doctor of osteopathic medicine
+osteopathic physician osteopathic surgeon osteopathic physician and surgeon dr
+d o or any combination of these designations in any manner which might cause a
+reasonable person to believe the individual using the designation is a licensed osteopathic
+physician and if the party using the designation is not a licensed osteopathic physician the
+designation must additionally contain the description of the branch of the healing arts for which
+
+
+the person has a license provided that an individual who has received an earned degree of
+doctor of osteopathic medicine but is not a licensed osteopathic physician and surgeon in utah
+may use the designation d o if it is followed by not licensed or not licensed in utah
+in the same size and style of lettering
+b the practice of osteopathic medicine does not include
+i except for an ablative medical procedure as provided in subsection b ii
+b ii the conduct described in subsection a i a i that is performed in
+accordance with a license issued under another chapter of this title
+ii an ablative cosmetic medical procedure if the scope of practice for the person
+performing the ablative cosmetic medical procedure includes the authority to operate or
+perform a surgical procedure or
+iii conduct under subsection
+prescription device means an instrument apparatus implement machine
+contrivance implant in vitro reagent or other similar or related article and any component
+part or accessory which is required under federal or state law to be prescribed by a practitioner
+and dispensed by or through a person or entity licensed under this chapter or exempt from
+licensure under this chapter
+prescription drug means a drug that is required by federal or state law or
+rule to be dispensed only by prescription or is restricted to administration only by practitioners
+a sex characteristic altering surgical procedure means for the purpose of
+effectuating or facilitating an individual s attempted sex change
+i castration orchiectomy penectomy vaginoplasty vulvoplasty breast augmentation
+surgery or facial feminization surgery on an individual whose biological sex at birth is male
+ii mastectomy hysterectomy oophorectomy metoidioplasty phalloplasty or chest or
+facial masculinization procedures on an individual whose biological sex at birth is female
+iii any surgical procedure that is related to or necessary for a procedure described in
+subsection a i or ii that would result in the sterilization of an individual who is
+non sterile or
+iv removing any otherwise healthy or non diseased body part or tissue
+b sex characteristic altering surgical procedure does not include
+i surgery or other procedures or treatments performed on an individual who
+
+
+a is born with external biological sex characteristics that are irresolvably ambiguous
+b is born with xx chromosomes with virilization
+c is born with xy chromosomes with undervirilization
+d has both ovarian and testicular tissue or
+e has been diagnosed by a physician based on genetic or biochemical testing with a
+sex development disorder characterized by abnormal sex chromosome structure sex steroid
+hormone production or sex steroid hormone action for a male or female or
+ii removing a body part
+a because the body part is cancerous or diseased or
+b for a reason that is medically necessary other than to effectuate or facilitate an
+individual s attempted sex change
+spex means the special purpose examination of the federation of state
+medical boards
+unlawful conduct means the same as that term is defined in sections
+and
+unprofessional conduct means the same as that term is defined in
+sections and and as may be further defined by division rule
+section section is amended to read
+unprofessional conduct
+unprofessional conduct includes in addition to the definition in section
+
+a using or employing the services of any individual to assist a licensee in any manner
+not in accordance with the generally recognized practices standards or ethics of the
+profession state law or division rule
+b violating the dispensing requirements of chapter b part dispensing medical
+practitioner and dispensing medical practitioner clinic pharmacy if applicable
+c making a material misrepresentation regarding the qualifications for licensure under
+section
+d violating the requirements of title chapter a utah medical cannabis act
+or
+e falsely making an entry in or altering a medical record with the intent to conceal
+
+
+i a wrongful or negligent act or omission of an individual licensed under this chapter
+or an individual under the direction or control of an individual licensed under this chapter or
+ii conduct described in subsections a through d or subsection
+
+or
+f performing or causing to be performed upon a minor as defined in
+
+i a hormonal transgender procedure in violation of section
+
+ii a sex characteristic altering surgical procedure or
+iii a cosmetic breast surgical procedure
+unprofessional conduct does not include
+a in compliance with section
+i obtaining an investigational drug or investigational device
+ii administering the investigational drug to an eligible patient or
+iii treating an eligible patient with the investigational drug or investigational device
+or
+b in accordance with title chapter a utah medical cannabis act
+i when registered as a qualified medical provider or acting as a limited medical
+provider as those terms are defined in section a recommending the use of medical
+cannabis
+ii when registered as a pharmacy medical provider as that term is defined in section
+a providing pharmacy medical provider services in a medical cannabis pharmacy or
+iii when registered as a state central patient portal medical provider as that term is
+defined in section a providing state central patient portal medical provider services
+notwithstanding subsection b the division in consultation with the board and
+in accordance with title g chapter utah administrative rulemaking act shall define
+unprofessional conduct for a physician described in subsection b
+section section a is amended to read
+a unprofessional conduct
+unprofessional conduct includes
+a violation of a patient confidence to any person who does not have a legal right and a
+professional need to know the information concerning the patient
+b knowingly prescribing selling giving away or directly or indirectly administering
+
+
+or offering to prescribe sell furnish give away or administer any prescription drug except for
+a legitimate medical purpose upon a proper diagnosis indicating use of that drug in the amounts
+prescribed or provided
+c prescribing prescription drugs for oneself or administering prescription drugs to
+oneself except those that have been legally prescribed for the physician assistant by a licensed
+practitioner and that are used in accordance with the prescription order for the condition
+diagnosed
+d in a practice that has physician assistant ownership interests failure to allow a
+physician the independent final decision making authority on treatment decisions for the
+physician s patient
+e violating the dispensing requirements of chapter b part dispensing medical
+practitioner and dispensing medical practitioner clinic pharmacy if applicable
+f falsely making an entry in or altering a medical record with the intent to conceal
+i a wrongful or negligent act or omission of an individual licensed under this chapter
+or an individual under the direction or control of an individual licensed under this chapter or
+ii conduct described in subsections a through e or subsection
+and
+g violating the requirements of title chapter a utah medical cannabis act
+
+or
+h performing or causing to be performed a hormonal transgender procedure in
+violation of section
+
+a unprofessional conduct does not include in accordance with title chapter
+a utah medical cannabis act when registered as a qualified medical provider or acting as a
+limited medical provider as those terms are defined in section a recommending the
+use of medical cannabis
+b notwithstanding subsection a the division in consultation with the board and
+in accordance with title g chapter utah administrative rulemaking act shall define
+unprofessional conduct for a physician assistant described in subsection a
+
+
+
+
+
+
+
+
diff --git a/assets/data-leg/clean_line_0209_df.csv b/assets/data-leg/clean_line_0209_df.csv
new file mode 100644
index 00000000..2667525c
--- /dev/null
+++ b/assets/data-leg/clean_line_0209_df.csv
@@ -0,0 +1,413 @@
+text
+enrolled copy h b
+participation in extracurricular activities
+amendments
+general session
+state of utah
+chief sponsor jordan d teuscher
+senate sponsor lincoln fillmore
+
+long title
+general description
+this bill amends provisions amending student participation in extracurricular activities
+highlighted provisions
+this bill
+defines terms
+allows a private school student a home school student a charter school student or
+an online school student to participate in extracurricular activities outside of the
+student s public school of residence under certain circumstances
+prohibits a public school from participation in an athletics association that does not
+collect a birth certificate or other identifying documents during the registration
+process
+allows athletes without access to a birth certificate to provide alternative
+documentation to an athletic association in certain circumstances and
+makes technical and conforming changes
+money appropriated in this bill
+none
+other special clauses
+none
+utah code sections affected
+amends
+g as last amended by laws of utah chapter
+
+g as last amended by laws of utah chapter
+g as last amended by laws of utah chapter
+g as enacted by laws of utah chapter
+g as renumbered and amended by laws of utah chapter
+be it enacted by the legislature of the state of utah
+section section g is amended to read
+g private school and home school students participation in
+extracurricular activities in a public school
+as used in this section
+a academic eligibility requirements means the academic eligibility requirements
+that a home school student is required to meet to participate in an extracurricular activity in a
+public school
+b association means the same as that term is defined in section g
+
+c extracurricular activity means the same as that term is defined in section
+g
+
+d initial establishment of eligibility requirements means an association s eligibility
+requirements policies procedures and transfer rules that a school student in grade or
+must meet and to which the student is bound to participate on a high school sports team when
+the student
+i attends the high school in which the student is selected for membership on a high
+school sports team or
+ii does not attend the high school in which the student tries out for and is selected for
+membership on a high school sports team
+b e minor means the same as that term is defined in section g
+c f parent means the same as that term is defined in section g
+d g principal means the principal of the school in which a home school student
+participates or intends to participate in an extracurricular activity
+
+a a minor who is enrolled in a private school or a home school shall be is
+eligible to participate in an extracurricular activity at a public school as provided in this
+section
+b a private school student may only participate in an extracurricular activity at a
+public school that is not offered by the student s private school
+c i except as provided in subsection d a private school student or a home
+school student may only participate in an extracurricular activity at
+i a the school within whose with attendance boundaries within which the
+student s custodial parent resides or
+ii b the school from which the student withdrew for the purpose of attending a
+private or home school
+ii a private school student or a home school student retains the ability to participate
+in an extracurricular activity at a school described in subsection c i if the student did not
+initially establish the student s eligibility at another school in grade or
+
+d a school other than a school described in subsection c i or ii may allow a
+private school student or a home school student to participate in an extracurricular activity
+other than that the public school sponsors and supports if
+i for an interscholastic competition of athletic teams sponsored and supported by a
+public school or the private school student or the home school student meets the initial
+establishment of eligibility requirements
+ii for an interscholastic contest or competition for music drama or forensic groups or
+teams sponsored and supported by a public school the private school student subject to
+subsection b or the home school student meets the entry requirements for participation
+iii the private school student or the home school student meets the eligibility
+requirements under this section and
+iv the private school student or the home school student meets the enrollment
+requirements for public school in accordance with part school district enrollment
+a except as provided in subsections through a private school student or a
+
+home school student shall be is eligible to participate in an extracurricular activity at a public
+school consistent with eligibility standards
+i applied to a fully enrolled public school student
+ii of the public school where the private school student or the home school student
+participates in an extracurricular activity and
+iii for the extracurricular activity in which the private school or the home school
+student participates
+b a school district or public school may not impose additional requirements on a
+private school student or a home school student to participate in an extracurricular activity that
+are not imposed on a fully enrolled public school student
+c i a private school student or a home school student who participates in an
+extracurricular activity at a public school shall pay the same fees as required of a fully enrolled
+public school student to participate in an extracurricular activity
+ii if a local school board or a charter school governing board imposes a mandatory
+student activity fee for a student enrolled in a public school the fee may be imposed on a
+private school student or a home school student who participates in an extracurricular activity
+at the public school if the same benefits of paying the mandatory student activity fee that are
+available to a fully enrolled public school student are available to a private school student or a
+home school student who participates in an extracurricular activity at the public school
+eligibility requirements based on school attendance are not applicable to a home
+school student
+a home school student meets academic eligibility requirements to participate in an
+extracurricular activity if
+a the student is mastering the material in each course or subject being taught and
+b the student is maintaining satisfactory progress towards achievement or promotion
+a to establish a home school student s academic eligibility a parent teacher or
+organization providing instruction to the student shall submit an affidavit to the principal
+indicating the student meets academic eligibility requirements
+
+b upon submission of an affidavit pursuant to subsection a a home school
+student shall
+i be considered to meet academic eligibility requirements and
+ii retain academic eligibility for all extracurricular activities during the activity season
+for which the affidavit is submitted until
+a a panel established under subsection determines the home school student does
+not meet academic eligibility requirements or
+b the person who submitted the affidavit under subsection a provides written
+notice to the school principal that the student no longer meets academic eligibility
+requirements
+a a home school student who loses academic eligibility pursuant to subsection
+b ii b may not participate in an extracurricular activity until the person who submitted
+the affidavit under subsection a provides written notice to the school principal that the
+home school student has reestablished academic eligibility
+b if a home school student reestablishes academic eligibility pursuant to subsection
+a the home school student may participate in extracurricular activities for the remainder of
+the activity season for which an affidavit was submitted under subsection a
+a person who has probable cause to believe a home school student does not meet
+academic eligibility requirements may submit an affidavit to the principal
+a asserting the home school student does not meet academic eligibility requirements
+and
+b providing information indicating that the home school student does not meet the
+academic eligibility requirements
+a principal shall review the affidavit submitted under subsection and if the
+principal determines it contains information which constitutes probable cause to believe a
+home school student may not meet academic eligibility requirements the principal shall
+request a panel established pursuant to subsection to verify the student s compliance with
+academic eligibility requirements
+
+a a school district superintendent shall
+i appoint a panel of three individuals to verify a home school student s compliance
+with academic eligibility requirements when requested by a principal pursuant to subsection
+and
+ii select the panel members from nominees submitted by national state or regional
+organizations whose members are home school students and parents
+b of the members appointed to a panel under subsection a
+i one member shall have experience teaching in a public school as a licensed teacher
+and in home schooling high school age students
+ii one member shall have experience teaching in a higher education institution and in
+home schooling and
+iii one member shall have experience in home schooling high school age students
+a panel appointed under subsection
+a shall review the affidavit submitted under subsection
+b may confer with the person who submitted the affidavit under subsection
+c shall request the home school student to submit test scores or a portfolio of work
+documenting the student s academic achievement to the panel
+d shall review the test scores or portfolio of work and
+e shall determine whether the home school student meets academic eligibility
+requirements
+a home school student who meets academic eligibility requirements pursuant to
+subsection retains academic eligibility for all extracurricular activities during the activity
+season for which an affidavit is submitted pursuant to subsection
+a a panel s determination that a home school student does not comply with
+academic eligibility requirements is effective for an activity season and all extracurricular
+activities that have academic eligibility requirements
+b a home school student who is not in compliance with academic eligibility
+requirements as determined by a panel appointed under subsection may seek to establish
+
+academic eligibility under this section for the next activity season
+a a public school student who has been declared to be academically ineligible to
+participate in an extracurricular activity and who subsequently enrolls in a home school shall
+lose eligibility for participation in the extracurricular activity until the student
+i demonstrates academic eligibility by providing test results or a portfolio of the
+student s work to the school principal provided that a student may not reestablish academic
+eligibility under this subsection a during the same activity season in which the student
+was declared to be academically ineligible
+ii returns to public school and reestablishes academic eligibility or
+iii enrolls in a private school and establishes academic eligibility
+b a public school student who has been declared to be behaviorally ineligible to
+participate in an extracurricular activity and who subsequently enrolls in a home school shall
+lose eligibility for participation in the extracurricular activity until the student meets eligibility
+standards as provided in subsection
+when selection to participate in an extracurricular activity at a public school is
+made on a competitive basis a private school student and or a home school student shall be
+is eligible to try out for and participate in the activity as provided in this section
+a if a student exits a public school to enroll in a private school or a home school
+mid semester or during an activity season and the student desires to participate in an
+extracurricular activity at the public school the public school shall issue an interim academic
+assessment based on the student s work in each class
+b a student s academic eligibility to participate in an extracurricular activity under
+the circumstances described in subsection a shall be based is dependent on the student
+meeting public school academic eligibility standards at the time of exiting public school
+c a student may appeal an academic eligibility determination made under subsection
+b in accordance with procedures for appealing a public school student s academic
+eligibility
+section section g is amended to read
+
+g charter school students participation in extracurricular activities at
+other public schools
+as used in this section
+a association means the same as that term is defined in section g
+
+b extracurricular activity means the same as that term is defined in section
+g
+
+c initial establishment of eligibility requirements means the same as that term is
+defined in section g
+
+a charter school student is eligible to participate in an extracurricular activity
+not offered by the student s charter school at
+a the school within whose with attendance boundaries within which the student s
+custodial parent resides if for an interscholastic competition of athletic teams the student did
+not initially establish the student s eligibility at another public school in grade or
+b the public school from which the student withdrew for the purpose of attending a
+charter school or
+c a public school that is not a charter school if the student s charter school is located
+on the campus of the public school or has local school board approval to locate on the campus
+of the public school
+in addition to the public schools listed in subsection the state board
+may establish rules to allow a charter school student to participate in an extracurricular activity
+at a public school other than a public school listed in subsection
+a school other than a school described in subsection a b or c
+may allow a charter school student to participate in extracurricular activities other than an
+extracurricular activity a public school sponsors and supports if
+a for interschool competitions of athletic teams sponsored and supported by a public
+school or the charter school student meets the initial establishment of eligibility
+requirements
+b for interschool contests or competitions for music drama or forensic groups or
+
+teams sponsored and supported by a public school the charter school student meets the entry
+requirements for participation
+c the charter school student meets the eligibility requirements under this section and
+d the charter school student meets the enrollment requirements for public school in
+accordance with part school district enrollment
+a charter school student is eligible for an extracurricular activities activity at
+a public school consistent with eligibility standards as applied to full time students of the
+public school
+a school district or a public school may not impose additional requirements
+on a charter school student to participate in an extracurricular activities activity that are not
+imposed on full time students of the public school
+a the state board shall make rules establishing fees for charter school
+students participation in an extracurricular activities activity at school district schools
+b the rules shall provide that
+i charter school students pay the same fees as other students to participate in an
+extracurricular activities activity
+ii charter school students are eligible for fee waivers pursuant to section g
+iii for each charter school student who participates in an extracurricular activity at a
+school district school the charter school shall pay a share of the school district s costs for the
+extracurricular activity and
+iv a charter school s share of the costs of an extracurricular activity shall reflect state
+and local tax revenues expended except capital facilities expenditures for an extracurricular
+activity in a school district or a school divided by total student enrollment of the school district
+or the school
+c in determining a charter school s share of the costs of an extracurricular activity
+under subsections b iii and iv b iii and iv the state board may establish
+uniform fees statewide based on average costs statewide or average costs within a sample of
+school districts
+
+when selection to participate in an extracurricular activity at a public school is
+made on a competitive basis a charter school student is eligible to try out for and participate in
+the activity as provided in this section
+section section g is amended to read
+g online students participation in extracurricular activities
+as used in this section
+a association means the same as that term is defined in section g
+
+b extracurricular activity means the same as that term is defined in section
+g
+
+c initial establishment of eligibility requirements means the same as that term is
+defined in section g
+
+a d online education means the use of information and communication
+technologies to deliver educational opportunities to a student in a location other than a school
+b e online student means a student who
+i participates in an online education program sponsored or supported by the state
+board a school district or a charter school and
+ii generates funding for the school district or the school pursuant to subsection
+f and rules of the state board
+an online student is eligible to participate in an extracurricular activities activity
+at
+a the school within whose with attendance boundaries within which the student s
+custodial parent resides if for an interscholastic competition of athletic teams the student did
+not initially establish the student s eligibility at another public school in grade or or
+b the public school from which the student withdrew for the purpose of participating
+in an online education program
+a public school other than a school described in subsection a or b may
+allow an online student to participate in an extracurricular activities other than activity that
+the public school sponsors and supports if
+
+a for interschool competitions of athletic teams sponsored and supported by a public
+school or the online school student meets the initial establishment of eligibility
+requirements
+b for interschool contests or competitions for music drama or forensic groups or
+teams sponsored and supported by a public school the online school student meets the entry
+requirements for participation
+c the online school student meets the eligibility requirements under this section and
+d the online school student meets the enrollment requirements for public school in
+accordance with part school district enrollment
+an online student is eligible for to participate in an extracurricular activities
+activity at a public school consistent with eligibility standards as applied to full time students
+of the public school
+a school district or public school may not impose additional requirements on an
+online school student to participate in an extracurricular activities activity that are not
+imposed on full time students of the public school
+a the state board shall make rules establishing fees for an online school student s
+participation in an extracurricular activities activity at school district schools
+b the rules shall provide that
+i online school students pay the same fees as other students to participate in an
+extracurricular activities activity
+ii online school students are eligible for fee waivers pursuant to section g
+iii for each online school student who participates in an extracurricular activity at a
+school district school the online school shall pay a share of the school district s costs for the
+extracurricular activity and
+iv an online school s share of the costs of an extracurricular activity shall reflect state
+and local tax revenues expended except capital facilities expenditures for an extracurricular
+activity in a school district or school divided by total student enrollment of the school district
+or school
+
+c in determining an online school s share of the costs of an extracurricular activity
+under subsections b iii and iv the state board may establish uniform fees statewide
+based on average costs statewide or average costs within a sample of school districts
+when selection to participate in an extracurricular activity at a public school is
+made on a competitive basis an online student is eligible to try out for and participate in the
+activity as provided in this section
+section section g is amended to read
+g definitions
+as used in this part
+athletic association means an association as that term is defined in section
+g
+birth certificate means an official record of an individual s date of birth place of
+birth sex and parentage including a supplementary certificate of birth or birth certificate
+amendment and amendment history as provided in sections and
+
+commission means the school activity eligibility commission created in
+section g
+does not correspond with the sex designation means that a student s sex
+designation for an interscholastic activity in which a student seeks participation does not
+correspond with the sex designation on the student s birth certificate or an amendment
+including the amendment history to the student s birth certificate that the division of vital
+records and statistics provides
+female designated means that an interscholastic activity is designated
+specifically for female students
+gender designated means that an interscholastic activity or facility is
+designated specifically for female or male students
+gender identity means the same as that term is defined in section
+a
+interscholastic activity means an activity in which a student represents the
+
+student s school in the activity in competition against another school
+male designated means that an interscholastic activity is designated
+specifically for male students
+student means a student who is enrolled in a public school that participates
+in interscholastic activities
+section section g is amended to read
+g public schools prohibited from membership
+a public school may not be a member of or pay dues to an association that
+
+a is not in compliance on or after july with
+a i this part
+b ii title chapter open and public meetings act
+c iii title g chapter government records access and management act and
+d iv title chapter utah public officers and employees ethics act
+
+b does not collect each student s birth certificate as that term is defined in section
+g or equivalent documentation as described in subsection to determine
+eligibility as a condition of the association s registration process for an athletic team event or
+category or
+c does not require a student to provide the athlete s date of birth and sex as a
+condition of the registration process for an athletic team event or category
+except as provided in subsection for a student who is homeless or not a united
+states citizen and who is unable to provide a birth certificate the association may collect the
+student s
+a state issued identification document including a driver s license or passport or
+b federally recognized identification document including a document that the
+department of homeland security issues
+subsection b or do not apply to an association for a student who is a
+homeless child or youth as defined in the mckinney vento homeless assistance act
+u s c sec et seq
+
+nothing in this section limits or impairs an lea s requirement to verify a student s
+initial review of eligibility to participate in an athletic team event or category under applicable
+state or federal law or state board rule including the student s
+a residency status
+b age
+c sex verified by the student s birth certificate as that term is defined in section
+g
+
+d academic requirements or
+e school enrollment capacity
+unless otherwise specified an association s compliance with or an association
+employee or officer s compliance with the provisions described in subsection does not alter
+a the association s public or private status or
+b the public or private employment status of the employee or officer
+
+
+
+
+
+
+
+
diff --git a/assets/data-leg/clean_line_0257_df.csv b/assets/data-leg/clean_line_0257_df.csv
new file mode 100644
index 00000000..625faef8
--- /dev/null
+++ b/assets/data-leg/clean_line_0257_df.csv
@@ -0,0 +1,3304 @@
+text
+enrolled copy
+h b
+
+sex based designations for privacy
+
+anti bullying and women s opportunities
+
+general session
+
+state of utah
+
+chief sponsor kera birkeland
+
+senate sponsor daniel mccay
+
+
+long title
+
+general description
+
+this bill establishes a standard regarding distinctions on the basis of sex and applies the
+
+standard in certain facilities and opportunities where designations on the basis of sex
+
+address individual privacy bullying and women s opportunities
+
+
+highlighted provisions
+
+this bill
+
+defines terms
+
+defines certain terms for the entire utah code
+
+establishes a legal standard for distinctions on the basis of sex in certain publicly
+
+owned or controlled circumstances
+
+establishes acceptable and prohibited distinctions on the basis of sex
+
+enacts provisions regarding sex designated restroom shower or locker room
+
+
+
+
+
+
+
+
+
+facilities that students use within the public education system
+requires local education agencies to establish a privacy plan with parents and
+students in certain cases to address gender identity and fear of bullying
+enacts provisions regarding sex designated shower or locker room facilities where
+the general public has an expectation of privacy
+establishes components of the crimes of voyeurism and criminal trespass for certain
+actions within a covered sex designated shower or locker room
+requires government entities to
+c
+report allegations of certain criminal offenses to law enforcement
+h b
+enrolled copy
+
+c
+adopt a privacy compliance plan
+
+c
+provide a single occupant facility in new construction and
+
+c
+consider the feasibility of certain retrofit or remodel projects
+
+provides indemnification for government entities for certain claims
+
+requires the state auditor to investigate government entity compliance with certain
+
+
+
+
+
+
+
+
+
+
+
+
+requirements
+requires the attorney general to impose fines on political subdivisions that fail to
+cure noncompliance that the state auditor identifies
+amends certain crimes to establish a reasonable expectation of privacy in public
+restrooms including enhanced penalties for
+c
+committing multiple offenses concurrently within a public restroom shower or
+locker room and
+c
+committing certain offenses within a public restroom shower or locker room
+that is designated for the opposite sex
+enacts a criminal offense for loitering in a restroom shower or locker room where
+the general public has an expectation of privacy
+establishes elements of the crime of emergency reporting abuse for making repeated
+
+false reports alleging a violation of a sex designation in a publicly owned or
+
+controlled shower or locker room facility where the general public has an
+
+expectation of privacy and
+
+
+
+
+
+makes technical and conforming changes
+money appropriated in this bill
+none
+other special clauses
+this bill provides a special effective date
+
+
+utah code sections affected
+
+amends
+
+g as enacted by laws of utah chapter
+
+enrolled copy
+h b
+
+g as last amended by laws of utah chapter
+
+as last amended by laws of utah chapters and
+
+as last amended by laws of utah chapter
+
+as last amended by laws of utah chapter
+
+as last amended by laws of utah chapter
+
+as last amended by laws of utah chapter
+
+as last amended by laws of utah chapter
+
+as last amended by laws of utah chapter
+
+as last amended by laws of utah chapter
+
+enacts
+
+g utah code annotated
+
+g utah code annotated
+
+g utah code annotated
+
+g utah code annotated
+
+g utah code annotated
+
+g utah code annotated
+
+g utah code annotated
+
+g utah code annotated
+
+g utah code annotated
+
+g utah code annotated
+
+g utah code annotated
+
+g utah code annotated
+
+utah code annotated
+
+
+be it enacted by the legislature of the state of utah
+
+section section g is amended to read
+
+g report action plan
+
+
+as used in this section
+
+h b
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+enrolled copy
+a gender designated interscholastic sport means a sport that is specifically
+designated for female or male students
+b interscholastic sport means an activity in which a student represents the student s
+school in the sport in competition against another school
+c school means a public school that sponsors or offers an interscholastic sport in
+which students enrolled at the school may participate
+d title ix means title ix of the education amendments of u s c sec
+et seq
+before the beginning of each academic year the athletic director or another
+administrator of each school shall report to the school s local governing board regarding
+a the number and type of interscholastic sports available at the school categorized by
+gender designation
+b the number of students competing in a gender designated interscholastic sport at the
+school categorized by gender
+c the amount of spending that the school devotes to each gender designated sport
+reported in total amount and on a per student basis
+d a comparison and evaluation of designated practice and game locations in
+gender designated interscholastic sports
+e any information regarding the school s efforts in compliance with title g
+chapter part distinctions on the basis of sex and title ix compliance and
+f if there is a discrepancy between male designated and female designated sports of
+or greater an action plan that the school develops to address the discrepancy
+an lea governing board that receives the report described in subsection shall
+review the report in a public board meeting
+
+
+section section g is amended to read
+
+g responses to school based behavior
+
+
+as used in this section
+
+a evidence based means a program or practice that has
+
+enrolled copy
+
+
+h b
+i had multiple randomized control studies or a meta analysis demonstrating that the
+program or practice is effective for a specific population
+
+ii been rated as effective by a standardized program evaluation tool or
+
+iii been approved by the state board
+
+
+b habitual truant means a school age child who
+
+i is in grade or above unless the school age child is under years old
+
+ii is subject to the requirements of section g and
+
+iii a is truant at least times during one school year or
+
+b fails to cooperate with efforts on the part of school authorities to resolve the
+
+school age child s attendance problem as required under section g
+
+
+c minor means the same as that term is defined in section
+
+
+d mobile crisis outreach team means the same as that term is defined in section
+
+a
+
+
+
+e prosecuting attorney means the same as that term is defined in subsections
+b and c
+
+
+
+f restorative justice program means a school based program or a program used or
+adopted by a local education agency that is designed
+
+
+i to enhance school safety reduce school suspensions and limit referrals to law
+enforcement agencies and courts and
+
+
+ii to help minors take responsibility for and repair harmful behavior that occurs in
+school
+
+
+g school administrator means a principal of a school
+
+
+h school is in session means a day during which the school conducts instruction for
+
+which student attendance is counted toward calculating average daily membership
+
+
+i school resource officer means a law enforcement officer as defined in section
+
+who contracts with is employed by or whose law enforcement agency contracts
+
+with a local education agency to provide law enforcement services for the local education
+
+agency
+
+
+h b
+enrolled copy
+
+j school age child means the same as that term is defined in section g
+
+
+k i school sponsored activity means an activity fundraising event club camp
+
+clinic or other event or activity that is authorized by a specific local education agency or public
+
+school according to lea governing board policy and satisfies at least one of the following
+
+conditions
+
+
+a the activity is managed or supervised by a local education agency or public school
+or local education agency or public school employee
+
+
+b the activity uses the local education agency s or public school s facilities
+equipment or other school resources or
+
+
+c the activity is supported or subsidized more than inconsequentially by public
+funds including the public school s activity funds or minimum school program dollars
+
+
+
+ii school sponsored activity includes preparation for and involvement in a public
+performance contest athletic competition demonstration display or club activity
+
+
+
+l i status offense means an offense that would not be an offense but for the age of
+the offender
+
+
+
+
+
+ii status offense does not mean an offense that by statute is a misdemeanor or
+felony
+this section applies to a minor enrolled in school who is alleged to have committed
+an offense on school property where the student is enrolled
+
+a when school is in session or
+
+b during a school sponsored activity
+
+
+if a minor is alleged to have committed an offense on school property that is a class
+
+c misdemeanor an infraction or a status offense the school administrator the school
+
+administrator s designee or a school resource officer may refer the minor
+
+a to an evidence based alternative intervention including
+
+i a mobile crisis outreach team
+
+ii a youth services center as defined in section
+
+iii a youth court or comparable restorative justice program
+
+enrolled copy
+
+
+h b
+iv an evidence based alternative intervention created and developed by the school or
+school district
+
+v an evidence based alternative intervention that is jointly created and developed by a
+
+local education agency the state board the juvenile court local counties and municipalities
+
+the department of health and human services or
+
+
+vi a tobacco cessation or education program if the offense is a violation of section
+or
+
+b for prevention and early intervention youth services as described in section
+
+by the division of juvenile justice services if the minor refuses to participate in an
+
+evidence based alternative intervention described in subsection a
+
+
+except as provided in subsection if a minor is alleged to have committed an
+
+offense on school property that is a class c misdemeanor an infraction or a status offense a
+
+school administrator the school administrator s designee or a school resource officer may refer
+
+a minor to a law enforcement officer or agency or a court only if
+
+
+a the minor allegedly committed the same offense on school property on two previous
+occasions and
+
+b the minor was referred to an evidence based alternative intervention or to
+
+prevention or early intervention youth services as described in subsection for both of the
+
+two previous offenses
+
+
+if a minor is alleged to have committed a traffic offense that is an infraction a
+
+school administrator the school administrator s designee or a school resource officer may refer
+
+the minor to a law enforcement officer or agency a prosecuting attorney or a court for the
+
+traffic offense
+
+
+notwithstanding subsection a school resource officer may
+
+a investigate possible criminal offenses and conduct including conducting probable
+
+cause searches
+
+
+b consult with school administration about the conduct of a minor enrolled in a
+school
+
+h b
+
+
+enrolled copy
+c transport a minor enrolled in a school to a location if the location is permitted by
+law
+
+d take temporary custody of a minor in accordance with section or
+
+e protect the safety of students and the school community including the use of
+
+reasonable and necessary physical force when appropriate based on the totality of the
+
+circumstances
+
+
+a if a minor is referred to a court or a law enforcement officer or agency under
+
+subsection the school or the school district shall appoint a school representative to
+
+continue to engage with the minor and the minor s family through the court process
+
+
+
+
+
+b a school representative appointed under subsection a may not be a school
+resource officer
+c a school district or school shall include the following in the school district s or
+school s referral to the court or the law enforcement officer or agency
+
+i attendance records for the minor
+
+ii a report of evidence based alternative interventions used by the school before the
+
+
+
+
+referral including outcomes
+iii the name and contact information of the school representative assigned to actively
+participate in the court process with the minor and the minor s family
+iv if the minor was referred to prevention or early intervention youth services under
+
+subsection b a report from the division of juvenile justice services that demonstrates the
+
+minor s failure to complete or participate in prevention and early intervention youth services
+
+under subsection b and
+
+v any other information that the school district or school considers relevant
+
+
+d a minor referred to a court under subsection may not be ordered to or placed in
+
+secure detention including for a contempt charge or violation of a valid court order under
+
+section a when the underlying offense is a status offense or infraction
+
+
+
+e if a minor is referred to a court under subsection the court may use when
+available the resources of the division of juvenile justice services or the division of
+
+enrolled copy
+
+h b
+substance abuse and mental health to address the minor
+
+
+if a minor is alleged to have committed an offense on school property that is a class
+
+b misdemeanor or a class a misdemeanor the school administrator the school administrator s
+
+designee or a school resource officer may refer the minor directly to a court or to the
+
+evidence based alternative interventions in subsection a
+
+
+a school administrator a school administrator s designee and a school resource
+
+officer retain the discretion described under this section in relation to title g chapter
+
+distinctions on the basis of sex
+
+
+section section g is enacted to read
+
+chapter distinctions on the basis of sex
+
+part general provisions
+
+g definitions
+
+
+as used in this chapter
+
+a changing room means a space designated for multiple individuals to dress or
+
+undress within the same space
+
+
+b changing room includes
+
+i a dressing room fitting room locker room or shower room and
+
+ii a restroom when a changing room contains or is attached to the restroom
+
+
+a facility means a publicly owned or controlled building structure or other
+
+
+
+improvement
+b facility includes a subset of a publicly owned or controlled building structure or
+other improvement including a restroom or locker room
+
+
+government entity means
+
+a the state or
+
+b any county municipality special district special service district or other political
+
+subdivision or administrative unit of the state including
+
+i a state institution of higher education as defined in section b or
+
+ii a local education agency as defined in section g
+
+
+h b
+enrolled copy
+
+intersex individual means the same as that term is defined in section b
+
+
+men s restroom means a restroom that is designated for the exclusive use of
+
+males and not females
+
+
+a open to the general public means that a privacy space is
+
+i freely accessible to a member of the general public
+
+ii accessible to an individual who has purchased a ticket paid an entry fee paid a
+
+membership fee or otherwise paid to access the facility containing the relevant privacy space
+
+or
+
+
+iii accessible to a student of an institution of higher education described in section
+b either freely or as described in subsection a ii
+
+
+b open to the general public does not include a privacy space that is
+
+i only accessible to employees of a government entity or
+
+ii any area that is not normally accessible to the public
+
+
+privacy space means a restroom or changing room within a publicly owned or
+
+
+
+controlled facility where an individual has a reasonable expectation of privacy
+publicly owned or controlled means that a government entity has at least a partial
+ownership interest in or has control of a facility program or event
+
+
+a restroom means any space that includes a toilet
+
+
+b restroom includes
+
+i sex designated men s restrooms
+
+ii sex designated women s restrooms
+
+iii unisex restrooms and
+
+iv single occupant restrooms
+
+
+sex designated means that a facility program or event is designated specifically
+
+
+
+
+for males or females and not the opposite sex
+single occupant means in relation to a single occupant facility or privacy space
+that the facility or privacy space
+a has floor to ceiling walls
+
+enrolled copy
+h b
+
+b has an entirely encased and locking door and
+
+c is designated for single occupancy
+
+
+unisex means in relation to a unisex facility or privacy space that the facility or
+
+privacy space
+
+a is designated for the use of both sexes or
+
+b is not sex designated
+
+
+women s restroom means a restroom that is designated for the exclusive use of
+
+females and not males
+
+
+section section g is enacted to read
+
+g severability
+
+
+if any provision of this chapter or the application of any provision of this part to
+
+any person or circumstance is held invalid by a final decision of a court of competent
+
+jurisdiction the remainder of this chapter shall be given effect without the invalidated
+
+provision or application
+
+
+the provisions of this chapter are severable
+
+
+section section g is enacted to read
+
+part distinctions on the basis of sex
+
+g distinctions on the basis of sex
+
+
+a government entity may not on the basis of sex exclude an individual from
+
+participation in deny an individual from the benefits of or subject an individual to a sex based
+
+distinction in or under any government or otherwise publicly owned or controlled facility
+
+program or event unless the distinction is substantially related to an important government
+
+objective
+
+
+
+each government entity shall ensure the preservation of distinctions on the basis of
+sex that protect individual privacy and competitive opportunity as described in this chapter
+
+
+
+
+a as used in this subsection athletic facility does not include a privacy
+space
+b to preserve the individual privacy and competitive opportunity of females an
+
+h b
+enrolled copy
+
+individual is not entitled to and may not access use or benefit from a government entity s
+
+athletic facility program or event if
+
+i the facility program or event is designated for females and
+
+ii the individual is not female
+
+
+c to preserve the individual privacy and competitive opportunity of males an
+
+individual is not entitled to and may not access use or benefit from a government entity s
+
+athletic facility program or event if
+
+i the facility program or event is designated for males and
+
+ii the individual is not male
+
+
+section section g is enacted to read
+
+g sex based distinctions to protect individual privacy
+
+
+a distinction on the basis of sex that provides separate accommodations for the sexes is
+
+substantially related to the important government objective of protecting individual privacy
+
+including in the following contexts
+
+a privacy space and
+
+a correctional facility as defined in section b
+
+
+section section g is enacted to read
+
+g sex based distinctions to protect athletic health and competitive
+
+
+opportunity
+a distinction on the basis of sex to provide separate accommodations for the sexes is
+
+substantially related to the important government objective of protecting health and
+
+competitive opportunity in the availability or quality of an athletic venue event or program
+
+within the public education system
+
+
+section section g is enacted to read
+
+g prohibited sex based distinctions
+
+
+the following actions within the public education system constitute a violation of
+
+
+section g
+providing a sex designated facility program or event of a higher quality to one sex
+
+enrolled copy
+h b
+
+and of a lesser quality to the opposite sex rather than ensuring equivalent quality or rotational
+
+sharing including the use of athletic facilities or venues
+
+providing males or females preferred or more advantageous scheduling of facilities
+
+programs or events in comparison to the opposite sex rather than ensuring equivalent
+
+scheduling practices or rotational sharing including the scheduling of athletic events or
+
+practices
+
+
+
+
+
+providing males or females with more sex designated opportunities than the
+opposite sex in excess of a disparity
+requiring males or females to participate or compete against the opposite sex in any
+sex designated facility program or event or
+requiring giving official authorization for or knowingly allowing males or females
+
+to use a sex designated facility in the presence of the opposite sex
+
+
+section section g is enacted to read
+
+part sex based distinctions in privacy spaces
+
+g sex designated privacy spaces in public schools
+
+
+to preserve the individual privacy of male and female students in the public
+
+education system a student may only access an operational sex designated privacy space
+
+within a public school that is designated for student use if the student s sex corresponds with
+
+the sex designation of the privacy space
+
+
+for a student who makes a request to use a privacy space other than the
+
+sex designated privacy space that corresponds with the student s sex because of the student s
+
+gender identity as defined in section a or reasonable fear of bullying the local
+
+education agency as defined in section e shall coordinate with the student s parent or
+
+legal guardian to develop a privacy plan that provides the student with
+
+a i reasonable access to a unisex or single occupant facility or
+
+ii reasonable access to a faculty or staff restroom or
+
+b if the access described in subsection a is unavailable reasonable access to
+
+private use of an otherwise sex designated privacy space through staggered scheduling or
+
+h b
+
+
+
+enrolled copy
+another policy provision that provides for temporary private access
+an lea satisfies the lea s duties regarding student use of a privacy space under
+this chapter if the lea
+
+a gives notice to students of the provisions of this section
+
+b takes administrative action to address violations of and promote compliance with
+
+this section and
+
+c develops a privacy plan in accordance with subsection
+
+
+an individual may use the following evidence as a defense to an allegation that the
+
+
+student is not eligible to access and use a sex designated privacy space under subsection
+a the student s unamended birth certificate that corresponds with the sex designation
+
+of privacy space which may be supported with a review of any amendment history obtained
+
+under section b or
+
+
+b documentation of a medical treatment or procedure that is consistent only with the
+sex designation of the privacy space
+
+
+subsection does not apply to
+
+a a unisex or single occupant facility or
+
+b an intersex individual
+
+
+section section g is enacted to read
+
+g sex designated changing rooms in publicly owned facilities open to
+
+
+the general public
+a except as provided in subsection b to preserve the individual privacy of
+
+males and females an individual may only access an operational sex designated changing room
+
+in a government entity s facility that is open to the general public if
+
+i the individual s sex corresponds with the sex designation of the changing room or
+
+ii the individual has
+
+a legally amended the individual s birth certificate to correspond with the sex
+
+designation of the changing room which may be supported with a review of any amendment
+
+history obtained under section b and
+
+enrolled copy
+
+
+h b
+b undergone a primary sex characteristic surgical procedure as defined in section
+to correspond with the sex designation of the changing room
+
+
+b subsection a does not apply to
+
+i a minor child who requires assistance to access or use the changing room that
+
+
+corresponds with the sex of the minor s parent guardian or relative
+ii a dependent minor as defined in section or a dependent adult as defined
+
+in section who requires assistance to access or use the changing room that
+
+corresponds with the sex of a caretaker
+
+
+
+
+
+
+
+
+
+iii an individual providing public safety services including law enforcement
+emergency medical services as defined in section b and fire protection
+iv an employee of a health care facility as defined in section b to provide
+health care services to a patient of the health care facility or
+v an individual whose employment duties include the maintenance or cleaning of the
+changing room
+an individual in a changing room has a reasonable expectation of privacy
+satisfying the privacy element of the offense of voyeurism in section
+an individual who knowingly enters a changing room in violation of subsection
+
+commits the offense of criminal trespass under section if the individual enters or
+
+remains in the changing room under circumstances which a reasonable person would expect to
+
+likely cause affront or alarm to on or in the presence of another individual
+
+
+the surgical provision described in subsection a ii does not shield an
+
+individual from the offense of lewdness related to genitalia under subsection or
+
+
+
+
+an individual may use the following evidence as a defense against an allegation
+
+that the individual is not eligible to access and use a sex designated changing room under
+
+subsection
+
+
+a for an individual whose birth sex corresponds with the sex designation of the
+changing room
+
+h b
+enrolled copy
+
+i an individual s unamended birth certificate that corresponds with the sex
+
+designation of the changing room which may be supported with a review of any amendment
+
+history obtained under section b or
+
+
+
+
+
+
+
+
+ii documentation of a medical treatment or procedure that is consistent only with the
+sex designation of the changing room or
+b for an individual whose birth sex does not correspond with the sex designation of
+the changing room
+i the individual s amended birth certificate which may be supported with a review of
+any amendment history obtained under section b and
+ii documentation that demonstrates that the individual has undergone a primary sex
+characteristic surgical procedure as defined in section
+
+
+subsection does not apply to
+
+a a unisex or single occupant facility
+
+b a changing room that is not open to the general public or
+
+c an intersex individual
+
+
+section section g is enacted to read
+
+g unisex or single occupant facilities
+
+
+the availability of a unisex facility or single occupant facility satisfies a government
+
+entity s obligations regarding an individual who because of the individual s gender identity as
+
+defined in section a or reasonable fear of bullying is uncomfortable using
+
+for a student a privacy space in accordance with section g or
+
+a changing room in accordance with section g
+
+
+section section g is enacted to read
+
+g government entity facility compliance
+
+
+except as provided under section g a government entity shall contact law
+
+enforcement if the entity receives a complaint or allegation regarding the following within a
+
+privacy space in a facility that is open to the general public
+
+a an offense of lewdness under section
+
+enrolled copy
+h b
+
+b an offense of lewdness involving a child under section
+
+c voyeurism under section
+
+d loitering in a privacy space under section or
+
+e for a changing room described in section g an offense of criminal
+
+trespass under subsection g
+
+
+to preserve the individual privacy of males and females in privacy spaces
+
+a a government entity shall adopt a privacy compliance plan to address compliance
+
+
+
+with the government entity s duties under this chapter
+b for construction of a new facility a government entity shall ensure that the new
+construction includes a single occupant facility and
+
+c for existing privacy spaces a government entity
+
+i shall consider the feasibility of retrofitting or remodeling to include
+
+a floor to ceiling walls and doors or similar privacy protections
+
+b curtains or
+
+c other methods of improving individual privacy within the facility that are
+
+
+
+
+
+
+comparable to the methods described in subsections a i and ii and
+ii may reduce the number of fixtures that state law requires by up to to provide
+adequate space for the retrofitting or remodeling described in subsection a
+a government entity shall ensure sufficient sex designated privacy spaces through
+compliance with sections a and a regarding unisex facilities
+section section g is enacted to read
+
+part enforcement and indemnification
+
+g government entity noncompliance
+
+
+the state auditor shall
+
+a establish a process to receive and investigate alleged violations of this chapter by a
+
+government entity
+
+b provide notice to the relevant government entity of
+
+i each alleged violation of this chapter by the government entity
+
+h b
+
+
+
+
+
+
+
+
+enrolled copy
+ii each violation that the state auditor determines to be substantiated including an
+opportunity to cure the violation not to exceed calendar days and
+c if a government entity fails to cure a violation in accordance with subsection
+b ii report the government entity s failure to
+i for a political subdivision as defined in section g the attorney general for
+enforcement under subsection and
+ii for a state entity as defined in section the legislative management
+committee
+
+
+a the attorney general shall
+
+i enforce this chapter against a political subdivision upon referral by the state auditor
+
+under subsection c by imposing a fine of up to per violation per day and
+
+ii deposit fines under subsection a into the general fund
+
+
+b a political subdivision may seek judicial review of a fine that the attorney general
+
+
+
+imposes under this section to determine whether the fine is clearly erroneous
+a local education agency is not in violation of this chapter for a lawful application
+of section g
+
+
+section section g is enacted to read
+
+g indemnification
+
+
+the attorney general shall defend indemnify and hold harmless a government entity
+
+acting under color of state law to enforce this chapter for any claims or damages including
+
+court costs and attorney fees that
+
+arise as a result of this chapter and
+
+are not covered by the government entity s insurance policies or any coverage
+
+agreement that the state risk management fund issues
+
+
+section section is amended to read
+
+functions and duties
+
+
+a the state auditor is the auditor of public accounts and is independent of any
+
+executive or administrative officers of the state
+
+
+enrolled copy
+
+
+
+
+h b
+b the state auditor is not limited in the selection of personnel or in the determination
+of the reasonable and necessary expenses of the state auditor s office
+the state auditor shall examine and certify annually in respect to each fiscal year
+financial statements showing
+
+a the condition of the state s finances
+
+b the revenues received or accrued
+
+c expenditures paid or accrued
+
+d the amount of unexpended or unencumbered balances of the appropriations to the
+
+agencies departments divisions commissions and institutions and
+
+e the cash balances of the funds in the custody of the state treasurer
+
+
+a the state auditor shall
+
+i audit each permanent fund each special fund the general fund and the accounts of
+
+any department of state government or any independent agency or public corporation as the law
+
+requires as the auditor determines is necessary or upon request of the governor or the
+
+legislature
+
+
+ii perform the audits in accordance with generally accepted auditing standards and
+other auditing procedures as promulgated by recognized authoritative bodies and
+
+iii as the auditor determines is necessary conduct the audits to determine
+
+a honesty and integrity in fiscal affairs
+
+b accuracy and reliability of financial statements
+
+c effectiveness and adequacy of financial controls and
+
+d compliance with the law
+
+
+b if any state entity receives federal funding the state auditor shall ensure that the
+
+
+
+
+
+audit is performed in accordance with federal audit requirements
+c i the costs of the federal compliance portion of the audit may be paid from an
+appropriation to the state auditor from the general fund
+ii if an appropriation is not provided or if the federal government does not
+specifically provide for payment of audit costs the costs of the federal compliance portions of
+
+h b
+enrolled copy
+
+the audit shall be allocated on the basis of the percentage that each state entity s federal funding
+
+bears to the total federal funds received by the state
+
+
+iii the allocation shall be adjusted to reflect any reduced audit time required to audit
+
+funds passed through the state to local governments and to reflect any reduction in audit time
+
+obtained through the use of internal auditors working under the direction of the state auditor
+
+
+a except as provided in subsection b the state auditor shall in addition to
+
+financial audits and as the auditor determines is necessary conduct performance and special
+
+purpose audits examinations and reviews of any entity that receives public funds including a
+
+determination of any or all of the following
+
+i the honesty and integrity of all the entity s fiscal affairs
+
+ii whether the entity s administrators have faithfully complied with legislative intent
+
+iii whether the entity s operations have been conducted in an efficient effective and
+
+
+
+
+
+
+
+cost efficient manner
+iv whether the entity s programs have been effective in accomplishing the intended
+objectives and
+v whether the entity s management control and information systems are adequate
+effective and secure
+b the auditor may not conduct performance and special purpose audits
+examinations and reviews of any entity that receives public funds if the entity
+
+i has an elected auditor and
+
+ii has within the entity s last budget year had the entity s financial statements or
+
+performance formally reviewed by another outside auditor
+
+
+the state auditor
+
+a shall administer any oath or affirmation necessary to the performance of the duties
+
+of the auditor s office and
+
+b may
+
+i subpoena witnesses and documents whether electronic or otherwise and
+
+ii examine into any matter that the auditor considers necessary
+
+
+enrolled copy
+
+h b
+the state auditor may require all persons who have had the disposition or
+
+management of any property of this state or its political subdivisions to submit statements
+
+regarding the property at the time and in the form that the auditor requires
+
+
+the state auditor shall
+
+a except where otherwise provided by law institute suits in salt lake county in
+
+relation to the assessment collection and payment of revenues against
+
+
+i persons who by any means have become entrusted with public money or property
+and have failed to pay over or deliver the money or property and
+
+ii all debtors of the state
+
+b collect and pay into the state treasury all fees received by the state auditor
+
+c perform the duties of a member of all boards of which the state auditor is a member
+
+by the constitution or laws of the state and any other duties that are prescribed by the
+
+constitution and by law
+
+d stop the payment of the salary of any state official or state employee who
+
+i refuses to settle accounts or provide required statements about the custody and
+
+disposition of public funds or other state property
+
+ii refuses neglects or ignores the instruction of the state auditor or any controlling
+
+board or department head with respect to the manner of keeping prescribed accounts or funds
+
+or
+
+
+
+
+iii fails to correct any delinquencies improper procedures and errors brought to the
+official s or employee s attention
+e establish accounting systems methods and forms for public accounts in all taxing
+or fee assessing units of the state in the interest of uniformity efficiency and economy
+
+f superintend the contractual auditing of all state accounts
+
+g subject to subsection a withhold state allocated funds or the disbursement of
+
+property taxes from a state or local taxing or fee assessing unit if necessary to ensure that
+
+officials and employees in those taxing units comply with state laws and procedures in the
+
+budgeting expenditures and financial reporting of public funds
+
+h b
+
+enrolled copy
+h subject to subsection withhold the disbursement of tax money from any county
+
+if necessary to ensure that officials and employees in the county comply with section
+
+and
+
+i withhold state allocated funds or the disbursement of property taxes from a local
+
+government entity or a limited purpose entity as those terms are defined in section a if
+
+the state auditor finds the withholding necessary to ensure that the entity registers and
+
+maintains the entity s registration with the lieutenant governor in accordance with section
+
+a
+
+
+a except as otherwise provided by law the state auditor may not withhold funds
+
+under subsection g until a state or local taxing or fee assessing unit has received formal
+
+written notice of noncompliance from the auditor and has been given days to make the
+
+specified corrections
+
+
+b if after receiving notice under subsection a a state or independent local
+
+fee assessing unit that exclusively assesses fees has not made corrections to comply with state
+
+laws and procedures in the budgeting expenditures and financial reporting of public funds the
+
+state auditor
+
+i shall provide a recommended timeline for corrective actions
+
+ii may prohibit the state or local fee assessing unit from accessing money held by the
+
+
+state and
+iii may prohibit a state or local fee assessing unit from accessing money held in an
+
+account of a financial institution by filing an action in district court requesting an order of the
+
+court to prohibit a financial institution from providing the fee assessing unit access to an
+
+account
+
+
+c the state auditor shall remove a limitation on accessing funds under subsection
+
+b upon compliance with state laws and procedures in the budgeting expenditures and
+
+financial reporting of public funds
+
+
+
+d if a local taxing or fee assessing unit has not adopted a budget in compliance with
+state law the state auditor
+
+enrolled copy
+
+
+i shall provide notice to the taxing or fee assessing unit of the unit s failure to
+comply
+
+
+ii may prohibit the taxing or fee assessing unit from accessing money held by the
+state and
+
+
+iii may prohibit a taxing or fee assessing unit from accessing money held in an
+account of a financial institution by
+
+
+h b
+a contacting the taxing or fee assessing unit s financial institution and requesting that
+the institution prohibit access to the account or
+
+b filing an action in district court requesting an order of the court to prohibit a
+
+financial institution from providing the taxing or fee assessing unit access to an account
+
+
+e if the local taxing or fee assessing unit adopts a budget in compliance with state
+
+law the state auditor shall eliminate a limitation on accessing funds described in subsection
+
+d
+
+
+the state auditor may not withhold funds under subsection h until a county has
+
+received formal written notice of noncompliance from the auditor and has been given days
+
+to make the specified corrections
+
+
+a the state auditor may not withhold funds under subsection i until the state
+
+auditor receives a notice of non registration as that term is defined in section a
+
+
+b if the state auditor receives a notice of non registration the state auditor may
+
+prohibit the local government entity or limited purpose entity as those terms are defined in
+
+section a from accessing
+
+i money held by the state and
+
+ii money held in an account of a financial institution by
+
+a contacting the entity s financial institution and requesting that the institution
+
+
+
+
+prohibit access to the account or
+b filing an action in district court requesting an order of the court to prohibit a
+financial institution from providing the entity access to an account
+c the state auditor shall remove the prohibition on accessing funds described in
+
+h b
+enrolled copy
+
+subsection b if the state auditor received a notice of registration as that term is defined in
+
+section a from the lieutenant governor
+
+
+
+notwithstanding subsection g h i b d or b the
+state auditor
+
+a shall authorize a disbursement by a local government entity or limited purpose
+
+entity as those terms are defined in section a or a state or local taxing or fee assessing
+
+unit if the disbursement is necessary to
+
+
+i avoid a major disruption in the operations of the local government entity limited
+purpose entity or state or local taxing or fee assessing unit or
+
+ii meet debt service obligations and
+
+b may authorize a disbursement by a local government entity limited purpose entity
+
+or state or local taxing or fee assessing unit as the state auditor determines is appropriate
+
+
+a the state auditor may seek relief under the utah rules of civil procedure to
+
+take temporary custody of public funds if an action is necessary to protect public funds from
+
+being improperly diverted from their intended public purpose
+
+
+b if the state auditor seeks relief under subsection a
+
+i the state auditor is not required to exhaust the procedures in subsection or
+
+
+and
+ii the state treasurer may hold the public funds in accordance with section if a
+
+court orders the public funds to be protected from improper diversion from their public
+
+purpose
+
+
+the state auditor shall
+
+a establish audit guidelines and procedures for audits of local mental health and
+
+substance abuse authorities and their contract providers conducted pursuant to title
+
+chapter part local substance abuse authorities title chapter part local
+
+mental health authorities title b chapter health care substance use and mental
+
+health and title chapter a accounting reports from political subdivisions interlocal
+
+organizations and other local entities act and
+
+enrolled copy
+h b
+
+b ensure that those guidelines and procedures provide assurances to the state that
+
+i state and federal funds appropriated to local mental health authorities are used for
+
+
+mental health purposes
+ii a private provider under an annual or otherwise ongoing contract to provide
+
+comprehensive mental health programs or services for a local mental health authority is in
+
+compliance with state and local contract requirements and state and federal law
+
+
+iii state and federal funds appropriated to local substance abuse authorities are used
+for substance abuse programs and services and
+
+iv a private provider under an annual or otherwise ongoing contract to provide
+
+comprehensive substance abuse programs or services for a local substance abuse authority is in
+
+compliance with state and local contract requirements and state and federal law
+
+
+a the state auditor may in accordance with the auditor s responsibilities for
+
+political subdivisions of the state as provided in title chapter a accounting reports from
+
+political subdivisions interlocal organizations and other local entities act initiate audits or
+
+investigations of any political subdivision that are necessary to determine honesty and integrity
+
+in fiscal affairs accuracy and reliability of financial statements effectiveness and adequacy of
+
+financial controls and compliance with the law
+
+
+b if the state auditor receives notice under subsection from the
+
+governor s office of economic opportunity on or after july the state auditor may
+
+initiate an audit or investigation of the public entity subject to the notice to determine
+
+compliance with section
+
+
+
+
+
+a the state auditor may not audit work that the state auditor performed before
+becoming state auditor
+b if the state auditor has previously been a responsible official in state government
+whose work has not yet been audited the legislature shall
+
+i designate how that work shall be audited and
+
+ii provide additional funding for those audits if necessary
+
+
+the state auditor shall
+
+h b
+
+enrolled copy
+a with the assistance advice and recommendations of an advisory committee
+
+appointed by the state auditor from among special district boards of trustees officers and
+
+employees and special service district boards officers and employees
+
+i prepare a uniform accounting manual for special districts that
+
+a prescribes a uniform system of accounting and uniform budgeting and reporting
+
+procedures for special districts under title b limited purpose local government entities
+
+special districts and special service districts under title d chapter special service
+
+district act
+
+b conforms with generally accepted accounting principles and
+
+c prescribes reasonable exceptions and modifications for smaller districts to the
+
+uniform system of accounting budgeting and reporting
+
+
+ii maintain the manual under this subsection a so that the manual continues to
+reflect generally accepted accounting principles
+
+
+iii conduct a continuing review and modification of procedures in order to improve
+them
+
+iv prepare and supply each district with suitable budget and reporting forms and
+
+v a prepare instructional materials conduct training programs and render other
+
+services considered necessary to assist special districts and special service districts in
+
+implementing the uniform accounting budgeting and reporting procedures and
+
+
+b ensure that any training described in subsection a v a complies with title
+g chapter state training and certification requirements and
+
+b continually analyze and evaluate the accounting budgeting and reporting practices
+
+and experiences of specific special districts and special service districts selected by the state
+
+auditor and make the information available to all districts
+
+
+a the following records in the custody or control of the state auditor are
+
+protected records under title g chapter government records access and management
+
+act
+
+i records that would disclose information relating to allegations of personal
+
+enrolled copy
+h b
+
+misconduct gross mismanagement or illegal activity of a past or present governmental
+
+employee if the information or allegation cannot be corroborated by the state auditor through
+
+other documents or evidence and the records relating to the allegation are not relied upon by
+
+the state auditor in preparing a final audit report
+
+ii records and audit workpapers to the extent the workpapers would disclose the
+
+identity of an individual who during the course of an audit communicated the existence of any
+
+waste of public funds property or manpower or a violation or suspected violation of a law
+
+rule or regulation adopted under the laws of this state a political subdivision of the state or
+
+any recognized entity of the united states if the information was disclosed on the condition
+
+that the identity of the individual be protected
+
+iii before an audit is completed and the final audit report is released records or drafts
+
+circulated to an individual who is not an employee or head of a governmental entity for the
+
+individual s response or information
+
+
+iv records that would disclose an outline or part of any audit survey plans or audit
+program and
+
+v requests for audits if disclosure would risk circumvention of an audit
+
+
+b the provisions of subsections a i ii and iii do not prohibit the disclosure
+
+of records or information that relate to a violation of the law by a governmental entity or
+
+employee to a government prosecutor or peace officer
+
+
+c the provisions of this subsection do not limit the authority otherwise given to
+
+the state auditor to classify a document as public private controlled or protected under title
+
+g chapter government records access and management act
+
+
+d i as used in this subsection d record dispute means a dispute between the
+
+state auditor and the subject of an audit performed by the state auditor as to whether the state
+
+auditor may release a record as defined in section g to the public that the state
+
+auditor gained access to in the course of the state auditor s audit but which the subject of the
+
+audit claims is not subject to disclosure under title g chapter government records
+
+access and management act
+
+
+h b
+
+enrolled copy
+ii the state auditor may submit a record dispute to the state records committee
+
+created in section g for a determination of whether the state auditor may in
+
+conjunction with the state auditor s release of an audit report release to the public the record
+
+that is the subject of the record dispute
+
+
+iii the state auditor or the subject of the audit may seek judicial review of a state
+
+records committee determination under subsection d ii as provided in section
+
+g
+
+
+if the state auditor conducts an audit of an entity that the state auditor has
+
+previously audited and finds that the entity has not implemented a recommendation made by
+
+the state auditor in a previous audit the state auditor shall notify the legislative management
+
+committee through the legislative management committee s audit subcommittee that the
+
+entity has not implemented that recommendation
+
+
+
+the state auditor shall with the advice and consent of the senate appoint the state
+privacy officer described in section
+
+
+except as provided in subsection the state auditor shall report or ensure that
+
+another government entity reports on the financial operational and performance metrics for
+
+the state system of higher education and the state system of public education including metrics
+
+in relation to students programs and schools within those systems
+
+
+
+
+
+
+
+
+
+
+
+a notwithstanding subsection the state auditor shall conduct regular audits
+of
+i the scholarship granting organization for the special needs opportunity scholarship
+program created in section e
+ii the state board of education for the carson smith scholarship program created in
+section f and
+iii the scholarship program manager for the utah fits all scholarship program
+created in section f
+b nothing in this subsection limits or impairs the authority of the state board of
+education to administer the programs described in subsection a
+
+
+enrolled copy
+h b
+
+the state auditor shall based on the information posted by the office of
+
+legislative research and general counsel under subsection for each policy
+
+track and post the following information on the state auditor s website
+
+a the information posted under subsections a through e
+
+b an indication regarding whether the policy is timely adopted adopted late or not
+
+
+adopted
+c an indication regarding whether the policy complies with the requirements
+
+established by law for the policy and
+
+d a link to the policy
+
+
+a a legislator may request that the state auditor conduct an inquiry to determine
+
+whether a government entity government official or government employee has complied with
+
+a legal obligation directly imposed by statute on the government entity government official
+
+or government employee
+
+
+
+
+
+
+
+b the state auditor may upon receiving a request under subsection a conduct
+the inquiry requested
+c if the state auditor conducts the inquiry described in subsection b the state
+auditor shall post the results of the inquiry on the state auditor s website
+d the state auditor may limit the inquiry described in this subsection to a simple
+determination without conducting an audit regarding whether the obligation was fulfilled
+
+
+the state auditor shall
+
+a ensure compliance with title g chapter distinctions on the basis of sex in
+
+
+
+accordance with section g and
+b report to the legislative management committee upon request regarding the state
+auditor s actions under this subsection
+
+
+section section is amended to read
+
+general duties
+
+
+the attorney general shall
+
+a perform all duties in a manner consistent with the attorney client relationship under
+
+h b
+
+
+enrolled copy
+section
+b except as provided in sections and a attend the supreme court
+
+and the court of appeals of this state and all courts of the united states and prosecute or
+
+defend all causes to which the state or any officer board or commission of the state in an
+
+official capacity is a party and take charge as attorney of all civil legal matters in which the
+
+state is interested
+
+
+
+
+c after judgment on any cause referred to in subsection b direct the issuance of
+process as necessary to execute the judgment
+d account for and pay over to the proper officer all money that comes into the
+attorney general s possession that belongs to the state
+
+e keep a file of all cases in which the attorney general is required to appear including
+
+any documents and papers showing the court in which the cases have been instituted and tried
+
+and whether they are civil or criminal and
+
+i if civil the nature of the demand the stage of proceedings and when prosecuted to
+
+judgment a memorandum of the judgment and of any process issued if satisfied and if not
+
+satisfied documentation of the return of the sheriff
+
+ii if criminal the nature of the crime the mode of prosecution the stage of
+
+proceedings and when prosecuted to sentence a memorandum of the sentence and of the
+
+execution if the sentence has been executed and if not executed the reason for the delay or
+
+prevention and
+
+iii deliver this information to the attorney general s successor in office
+
+f exercise supervisory powers over the district and county attorneys of the state in all
+
+matters pertaining to the duties of the district and county attorneys offices including the
+
+authority described in subsection
+
+
+g give the attorney general s opinion in writing and without fee when required upon
+any question of law relating to the office of the requester
+
+i in accordance with section to the legislature or either house
+
+ii to any state officer board or commission and
+
+enrolled copy
+h b
+
+iii to any county attorney or district attorney
+
+h when required by the public service or directed by the governor assist any county
+
+
+district or city attorney in the discharge of county district or city attorney s duties
+i purchase in the name of the state under the direction of the state board of
+
+examiners any property offered for sale under execution issued upon judgments in favor of or
+
+for the use of the state and enter satisfaction in whole or in part of the judgments as the
+
+consideration of the purchases
+
+j when the property of a judgment debtor in any judgment mentioned in subsection
+
+i has been sold under a prior judgment or is subject to any judgment lien or encumbrance
+
+taking precedence of the judgment in favor of the state redeem the property under the
+
+direction of the state board of examiners from the prior judgment lien or encumbrance and
+
+pay all money necessary for the redemption upon the order of the state board of examiners
+
+out of any money appropriated for these purposes
+
+k when in the attorney general s opinion it is necessary for the collection or
+
+enforcement of any judgment institute and prosecute on behalf of the state any action or
+
+proceeding necessary to set aside and annul all conveyances fraudulently made by the judgment
+
+debtors and pay the cost necessary to the prosecution when allowed by the state board of
+
+examiners out of any money not otherwise appropriated
+
+l discharge the duties of a member of all official boards of which the attorney general
+
+is or may be made a member by the utah constitution or by the laws of the state and other
+
+duties prescribed by law
+
+m institute and prosecute proper proceedings in any court of the state or of the united
+
+states to restrain and enjoin corporations organized under the laws of this or any other state or
+
+territory from acting illegally or in excess of their corporate powers or contrary to public
+
+policy and in proper cases forfeit their corporate franchises dissolve the corporations and
+
+wind up their affairs
+
+
+n institute investigations for the recovery of all real or personal property that may
+have escheated or should escheat to the state and for that purpose subpoena any persons
+
+h b
+enrolled copy
+
+before any of the district courts to answer inquiries and render accounts concerning any
+
+property examine all books and papers of any corporations and when any real or personal
+
+property is discovered that should escheat to the state institute suit in the district court of the
+
+county where the property is situated for its recovery and escheat that property to the state
+
+
+
+
+
+
+
+o administer the children s justice center as a program to be implemented in various
+counties pursuant to sections b through b
+p assist the constitutional defense council as provided in title c chapter a
+constitutional and federalism defense act
+q pursue any appropriate legal action to implement the state s public lands policy
+established in section c a
+r investigate and prosecute violations of all applicable state laws relating to fraud in
+
+connection with the state medicaid program and any other medical assistance program
+
+administered by the state including violations of title b chapter part utah false
+
+claims act
+
+s investigate and prosecute complaints of abuse neglect or exploitation of patients
+
+i in health care facilities that receive payments under the state medicaid program
+
+ii in board and care facilities as defined in the federal social security act u s c
+
+
+
+
+
+
+sec b q b regardless of the source of payment to the board and care facility and
+iii who are receiving medical assistance under the medicaid program as defined in
+section b in a noninstitutional or other setting
+t i report at least twice per year to the legislative management committee on any
+pending or anticipated lawsuits other than eminent domain lawsuits that might
+
+a cost the state more than or
+
+b require the state to take legally binding action that would cost more than
+
+
+
+
+to implement and
+ii if the meeting is closed include an estimate of the state s potential financial or
+other legal exposure in that report
+u i submit a written report to the committees described in subsection u ii that
+
+enrolled copy
+h b
+
+summarizes any lawsuit or decision in which a court or the office of the attorney general has
+
+determined that a state statute is unconstitutional or unenforceable since the attorney general s
+
+last report under this subsection u including any
+
+a settlements reached
+
+b consent decrees entered
+
+c judgments issued
+
+d preliminary injunctions issued
+
+e temporary restraining orders issued or
+
+f formal or informal policies of the office of the attorney general to not enforce a
+
+
+law and
+ii at least days before the legislature s may and november interim meetings
+
+submit the report described in subsection u i to
+
+a the legislative management committee
+
+b the judiciary interim committee and
+
+c the law enforcement and criminal justice interim committee
+
+v if the attorney general operates the office of the attorney general or any portion of
+
+the office of the attorney general as an internal service fund agency in accordance with
+
+section submit to the rate committee established in section
+
+i a proposed rate and fee schedule in accordance with subsection and
+
+ii any other information or analysis requested by the rate committee
+
+w before the end of each calendar year create an annual performance report for the
+
+
+
+
+office of the attorney general and post the report on the attorney general s website
+x ensure that any training required under this chapter complies with title g
+chapter state training and certification requirements
+y notify the legislative general counsel in writing within three business days after the
+
+day on which the attorney general is officially notified of a claim regardless of whether the
+
+claim is filed in state or federal court that challenges
+
+i the constitutionality of a state statute
+
+h b
+enrolled copy
+
+ii the validity of legislation or
+
+iii any action of the legislature and
+
+z i notwithstanding title g chapter a utah procurement code provide a
+
+special advisor to the office of the governor and the office of the attorney general in matters
+
+relating to native american and tribal issues to
+
+a establish outreach to the tribes and affected counties and communities and
+
+b foster better relations and a cooperative framework and
+
+ii annually report to the executive offices and criminal justice appropriations
+
+subcommittee regarding
+
+a the status of the work of the special advisor described in subsection z i and
+
+b whether the need remains for the ongoing appropriation to fund the special advisor
+
+
+
+
+
+
+described in subsection z i and
+aa i enforce compliance with title g chapter distinctions on the basis of
+sex in accordance with section g and
+ii report to the legislative management committee upon request regarding the
+attorney general s enforcement under this subsection aa
+a the attorney general may require a district attorney or county attorney of the
+
+state to upon request report on the status of public business entrusted to the district or county
+
+attorney s charge
+
+
+
+
+b the attorney general may review investigation results de novo and file criminal
+charges if warranted in any case involving a first degree felony if
+i a law enforcement agency submits investigation results to the county attorney or
+
+district attorney of the jurisdiction where the incident occurred and the county attorney or
+
+district attorney
+
+a declines to file criminal charges or
+
+b fails to screen the case for criminal charges within six months after the law
+
+
+enforcement agency s submission of the investigation results and
+ii after consultation with the county attorney or district attorney of the jurisdiction
+
+enrolled copy
+h b
+
+where the incident occurred the attorney general reasonably believes action by the attorney
+
+general would not interfere with an ongoing investigation or prosecution by the county attorney
+
+or district attorney of the jurisdiction where the incident occurred
+
+
+c if the attorney general decides to conduct a review under subsection b the
+
+district attorney county attorney and law enforcement agency shall within days after the
+
+day on which the attorney general makes a request provide the attorney general with
+
+
+
+
+i all information relating to the investigation including all reports witness lists
+witness statements and other documents created or collected in relation to the investigation
+ii all recordings photographs and other physical or digital media created or collected
+in relation to the investigation
+
+iii access to all evidence gathered or collected in relation to the investigation and
+
+iv the identification of and access to all officers or other persons who have
+
+
+information relating to the investigation
+d if a district attorney county attorney or law enforcement agency fails to timely
+
+comply with subsection c the attorney general may seek a court order compelling
+
+compliance
+
+
+e if the attorney general seeks a court order under subsection d the court shall
+
+grant the order unless the district attorney county attorney or law enforcement agency shows
+
+good cause and a compelling interest for not complying with subsection c
+
+
+section section is amended to read
+
+definitions for utah code
+
+
+the definitions listed in this section apply to the utah code unless
+
+a the definition is inconsistent with the manifest intent of the legislature or repugnant
+
+
+
+to the context of the statute or
+b a different definition is expressly provided for the respective title chapter part
+section or subsection
+
+
+adjudicative proceeding means
+
+a an action by a board commission department officer or other administrative unit
+
+h b
+enrolled copy
+
+of the state that determines the legal rights duties privileges immunities or other legal
+
+interests of one or more identifiable persons including an action to grant deny revoke
+
+suspend modify annul withdraw or amend an authority right or license and
+
+b judicial review of an action described in subsection a
+
+
+administrator includes executor when the subject matter justifies the use
+
+
+advisory board advisory commission and advisory council mean a board
+
+commission committee or council that
+
+a is created by and whose duties are provided by statute or executive order
+
+b performs its duties only under the supervision of another person as provided by
+
+
+
+
+
+
+
+statute and
+c provides advice and makes recommendations to another person that makes policy
+for the benefit of the general public
+armed forces means the united states army navy air force marine corps
+space force and coast guard
+city includes depending on population a metro township as defined in section
+c
+
+
+county executive means
+
+a the county commission in the county commission or expanded county commission
+
+form of government established under title chapter a changing forms of county
+
+government
+
+
+
+
+b the county executive in the county executive council optional form of government
+authorized by section a or
+c the county manager in the council manager optional form of government
+authorized by section a
+
+
+county legislative body means
+
+a the county commission in the county commission or expanded county commission
+
+form of government established under title chapter a changing forms of county
+
+government
+
+enrolled copy
+
+
+b the county council in the county executive council optional form of government
+authorized by section a and
+
+
+h b
+c the county council in the council manager optional form of government authorized
+by section a
+
+
+depose means to make a written statement made under oath or affirmation
+
+
+a equal means with respect to biological sex of the same value
+
+
+b equal does not mean with respect to biological sex
+
+i a characteristic of being the same or identical or
+
+ii a requirement that biological sexes be ignored or co mingled in every circumstance
+
+
+executor includes administrator when the subject matter justifies the
+
+use
+
+
+father means a parent who is of the male sex
+
+
+female means the characteristic of an individual whose biological reproductive
+
+system is of the general type that functions in a way that could produce ova
+
+
+guardian includes a person who
+
+a qualifies as a guardian of a minor or incapacitated person pursuant to testamentary
+
+or court appointment or
+
+b is appointed by a court to manage the estate of a minor or incapacitated person
+
+
+highway includes
+
+a a public bridge
+
+b a county way
+
+c a county road
+
+d a common road and
+
+e a state road
+
+
+intellectual disability means a significant subaverage general intellectual
+
+functioning that
+
+a exists concurrently with deficits in adaptive behavior and
+
+b is manifested during the developmental period as defined in the current edition of
+
+h b
+enrolled copy
+
+the diagnostic and statistical manual of mental disorders published by the american
+
+psychiatric association
+
+
+intermediate care facility for people with an intellectual disability means
+
+an intermediate care facility for the mentally retarded as defined in title xix of the social
+
+security act
+
+
+land includes
+
+a land
+
+b a tenement
+
+c a hereditament
+
+d a water right
+
+e a possessory right and
+
+f a claim
+
+
+male means the characteristic of an individual whose biological reproductive
+
+system is of the general type that functions to fertilize the ova of a female
+
+
+man means an adult human male
+
+
+month means a calendar month unless otherwise expressed
+
+
+mother means a parent who is of the female sex
+
+
+oath includes affirmation
+
+person means
+
+a an individual
+
+b an association
+
+c an institution
+
+d a corporation
+
+e a company
+
+f a trust
+
+g a limited liability company
+
+h a partnership
+
+i a political subdivision
+
+enrolled copy
+
+
+h b
+j a government office department division bureau or other body of government
+and
+
+k any other organization or entity
+
+
+personal property includes
+
+a money
+
+b goods
+
+c chattels
+
+d effects
+
+e evidences of a right in action
+
+f a written instrument by which a pecuniary obligation right or title to property is
+
+created acknowledged transferred increased defeated discharged or diminished and
+
+g a right or interest in an item described in subsections a a through f
+
+
+personal representative executor and administrator include
+
+a an executor
+
+b an administrator
+
+c a successor personal representative
+
+d a special administrator and
+
+e a person who performs substantially the same function as a person described in
+
+
+
+subsections a a through d under the law governing the person s status
+policy board policy commission or policy council means a board
+commission or council that
+
+a is authorized to make policy for the benefit of the general public
+
+b is created by and whose duties are provided by the constitution or statute and
+
+c performs its duties according to its own rules without supervision other than under
+
+
+
+
+the general control of another person as provided by statute
+population is shown by the most recent state or national census unless
+expressly provided otherwise
+process means a writ or summons issued in the course of a judicial
+
+h b
+
+enrolled copy
+proceeding
+
+
+property includes both real and personal property
+
+
+real estate or real property includes
+
+a land
+
+b a tenement
+
+c a hereditament
+
+d a water right
+
+e a possessory right and
+
+f a claim
+
+
+review board review commission and review council mean a board
+
+
+
+commission committee or council that
+a is authorized to approve policy made for the benefit of the general public by another
+body or person
+
+b is created by and whose duties are provided by statute and
+
+c performs its duties according to its own rules without supervision other than under
+
+the general control of another person as provided by statute
+
+
+road includes
+
+a a public bridge
+
+b a county way
+
+c a county road
+
+d a common road and
+
+e a state road
+
+
+sex means in relation to an individual the individual s biological sex either
+
+male or female at birth according to distinct reproductive roles as manifested by
+
+a sex and reproductive organ anatomy
+
+b chromosomal makeup and
+
+c endogenous hormone profiles
+
+
+signature includes a name mark or sign written with the intent to
+
+enrolled copy
+
+h b
+authenticate an instrument or writing
+
+
+state when applied to the different parts of the united states includes a
+
+state district or territory of the united states
+
+
+swear includes affirm
+
+testify means to make an oral statement under oath or affirmation
+
+
+town includes depending on population a metro township as defined in
+
+section c
+
+
+uniformed services means
+
+a the armed forces
+
+b the commissioned corps of the national oceanic and atmospheric administration
+
+and
+
+c the commissioned corps of the united states public health service
+
+
+united states includes each state district and territory of the united
+
+states of america
+
+
+utah code means the recodification of the utah code as amended
+
+unless the text expressly references a portion of the recodification of the utah code as it
+
+existed
+
+a on the day on which the recodification of the utah code was enacted or
+
+b i after the day described in subsection a a and
+
+ii before the most recent amendment to the referenced portion of the
+
+
+
+recodification of the utah code
+vessel when used with reference to shipping includes a steamboat canal
+boat and every structure adapted to be navigated from place to place
+
+
+a veteran means an individual who
+
+i has served in the united states armed forces for at least days
+
+a on active duty or
+
+b in a reserve component to include the national guard or
+
+ii has incurred an actual service related injury or disability while in the united states
+
+h b
+
+enrolled copy
+armed forces regardless of whether the individual completed days and
+
+iii was separated or retired under conditions characterized as honorable or general
+
+
+b this definition is not intended to confer eligibility for benefits
+
+
+will includes a codicil
+
+
+woman means an adult human female
+
+
+writ means an order or precept in writing issued in the name of
+
+a the state
+
+b a court or
+
+c a judicial officer
+
+
+writing includes
+
+a printing
+
+b handwriting and
+
+c information stored in an electronic or other medium if the information is retrievable
+
+in a perceivable format
+
+
+section section is amended to read
+
+criminal trespass
+
+
+a as used in this section
+
+i enter means intrusion of the entire body or the entire unmanned aircraft
+
+
+ii graffiti means the same as that term is defined in section
+
+
+iii remain unlawfully as that term relates to an unmanned aircraft means
+
+remaining on or over private property when
+
+
+
+
+a the private property or any portion of the private property is not open to the public
+and
+b the person operating the unmanned aircraft is not otherwise authorized to fly the
+unmanned aircraft over the private property or any portion of the private property
+
+
+b terms defined in sections and apply to this section
+
+
+an actor commits criminal trespass if under circumstances not amounting to
+
+burglary as defined in section or or a violation of section
+
+enrolled copy
+
+regarding commercial obstruction
+
+
+a the actor enters or remains unlawfully on or causes an unmanned aircraft to enter
+and remain unlawfully over property and
+
+
+h b
+i intends to cause annoyance or injury to any person or damage to any property
+including the use of graffiti
+
+ii intends to commit any crime other than theft or a felony or
+
+iii is reckless as to whether the actor s or unmanned aircraft s presence will cause fear
+
+for the safety of another
+
+b knowing the actor s or unmanned aircraft s entry or presence is unlawful the actor
+
+enters or remains on or causes an unmanned aircraft to enter or remain unlawfully over
+
+property to which notice against entering is given by
+
+
+i personal communication to the actor by the owner or someone with apparent
+authority to act for the owner
+
+ii fencing or other enclosure obviously designed to exclude intruders or
+
+iii posting of signs reasonably likely to come to the attention of intruders or
+
+c the actor enters a condominium unit in violation of subsection section
+
+or
+
+
+d the actor enters a sex designated changing room in violation of subsection
+g
+
+
+
+a except as provided in subsection b a violation of subsection a or
+b or d is a class b misdemeanor
+
+
+b if the following is a class a misdemeanor
+
+i if a violation of subsection a or b is committed in a dwelling the violation is
+
+a class a misdemeanor
+
+
+ii if a violation of subsection d is committed while also committing the offense
+of
+
+a lewdness under section
+
+b lewdness involving a child under section
+
+h b
+enrolled copy
+
+c voyeurism under section or
+
+d loitering in a privacy space under section or
+
+iii if a violation of subsection d is committed in a sex designated privacy space
+
+as defined in section that is not designated for individuals of the actor s sex
+
+
+c a violation of subsection c is an infraction
+
+
+it is a defense to prosecution under this section that
+
+a the property was at the time open to the public and
+
+b the defendant complied with all lawful conditions imposed on access to or
+
+
+
+
+
+remaining on the property
+in addition to an order for restitution under section b an actor who
+commits a violation of subsection may also be liable for
+a statutory damages in the amount of three times the value of damages resulting from
+the violation of subsection or whichever is greater and
+
+b reasonable attorney fees not to exceed and court costs
+
+
+civil damages under subsection may be collected in a separate action by the
+
+property owner or the owner s assignee
+
+
+section section is amended to read
+
+emergency reporting interference false report
+
+
+as used in this section
+
+a emergency means a situation in which property or human life is in jeopardy and
+
+the prompt summoning of aid is essential to the preservation of human life or property
+
+
+b party line means a subscriber s line or telephone circuit
+
+i that consists of two or more connected main telephone stations and
+
+ii where each telephone station has a distinctive ring or telephone number
+
+
+an actor is guilty of emergency reporting abuse if the actor
+
+a intentionally refuses to yield or surrender the use of a party line or a public pay
+
+telephone to another individual upon being informed that the telephone is needed to report a
+
+fire or summon police medical or other aid in case of emergency unless the telephone is
+
+enrolled copy
+
+
+
+
+h b
+likewise being used for an emergency call
+b asks for or requests the use of a party line or a public pay telephone on the pretext
+that an emergency exists knowing that no emergency exists
+c reports an emergency or causes an emergency to be reported to any public private
+
+or volunteer entity whose purpose is to respond to fire police or medical emergencies when
+
+the actor knows the reported emergency does not exist or
+
+d makes a false report or intentionally aids abets or causes a third party to make a
+
+false report to an emergency response service including a law enforcement dispatcher or a
+
+emergency response service if the false report claims that
+
+i an ongoing emergency exists
+
+ii the emergency described in subsection d i currently involves or involves an
+
+
+
+
+imminent threat of serious bodily injury serious physical injury or death and
+iii the emergency described in subsection d i is occurring at a specified
+location or
+e makes a false report after having previously made a false report or intentionally
+
+aides abets or causes a third party to make a false report to an emergency response service
+
+including a law enforcement dispatcher or a emergency response service alleging a
+
+violation of section g regarding a sex designated changing room
+
+
+a a violation of subsection a or b is a class c misdemeanor
+
+
+b a violation of subsection c is a class b misdemeanor except as provided
+
+
+
+under subsection c
+c a violation of subsection c is a second degree felony if the report is regarding
+a weapon of mass destruction as defined in section
+
+
+d a violation of subsection d
+
+i except as provided in subsection d ii is a third degree felony or
+
+ii is a second degree felony if
+
+a while acting in response to the report the emergency responder causes physical
+
+injury to an individual at the location described in subsection d iii or
+
+h b
+
+enrolled copy
+b the actor makes the false report or aids abets or causes a third party to make the
+
+false report with intent to ambush attack or otherwise harm a responding law enforcement
+
+officer or emergency responder
+
+
+e a violation of subsection e is a class b misdemeanor
+
+
+a in addition to any other penalty authorized by law a court shall order an actor
+
+
+
+
+
+
+convicted of a violation of this section to reimburse
+i any federal state or local unit of government or any private business organization
+individual or entity for all expenses and losses incurred in responding to the violation and
+ii an individual described in subsection d ii for the costs for the treatment of the
+physical injury and any psychological injury caused by the offense
+b the court may order that the defendant pay less than the full amount of the costs
+
+described in subsection a only if the court states on the record the reasons why the
+
+reimbursement would be inappropriate
+
+
+section section is amended to read
+
+lewdness
+
+
+a person is guilty of lewdness if the person under circumstances not amounting to
+
+rape object rape forcible sodomy forcible sexual abuse aggravated sexual assault sexual
+
+abuse of a minor unlawful sexual conduct with a or year old custodial sexual relations
+
+under section custodial sexual misconduct under section custodial
+
+sexual relations with youth receiving state services under section custodial sexual
+
+misconduct with youth receiving state services under section or an attempt to
+
+commit any of these offenses performs any of the following acts in a public place or under
+
+circumstances which the person should know will likely cause affront or alarm to on or in the
+
+presence of another who is years old or older
+
+a an act of sexual intercourse or sodomy
+
+b exposes his or her genitals the female breast below the top of the areola the
+
+
+buttocks the anus or the pubic area
+c masturbates or
+
+enrolled copy
+h b
+
+d any other act of lewdness
+
+
+a a person convicted the first or second time of a violation of subsection is
+
+
+
+guilty of a class b misdemeanor except under subsection b
+b a person convicted of a violation of subsection is guilty of a third degree felony
+if at the time of the violation
+
+i the person is a sex offender as defined in section
+
+ii the person has been previously convicted two or more times of violating subsection
+
+
+
+or
+iii the person has previously been convicted of a violation of subsection and has
+also previously been convicted of a violation of section
+
+iv the person commits the offense of lewdness while also committing the offense of
+
+a criminal trespass in a sex designated changing room under subsection
+
+d
+
+b lewdness involving a child under section
+
+c voyeurism under section or
+
+d loitering in a privacy space under section or
+
+v the person commits the offense of lewdness in a sex designated privacy space as
+
+
+defined in section that is not designated for individuals of the actor s sex
+c i for purposes of this subsection and subsection a plea of
+
+guilty or nolo contendere to a charge under this section that is held in abeyance under title
+
+chapter a pleas in abeyance is the equivalent of a conviction
+
+
+
+ii this subsection c also applies if the charge under this subsection has been
+subsequently reduced or dismissed in accordance with the plea in abeyance agreement
+
+
+a as used in this subsection
+
+i common area of a privacy space means any area of a privacy space other than
+
+a a toilet stall with a closed door
+
+b immediately in front of a urinal during use or
+
+c a shower stall with a closed door or other closed covering
+
+
+h b
+enrolled copy
+
+ii privacy space means the same as that term is defined in section
+
+
+b the common area of a privacy space constitutes a public place or circumstance
+
+described in subsection where an act or an attempted act described in subsection
+
+constitutes lewdness
+
+
+c within the common area of a dressing room fitting room locker room changing
+
+facility or any other space designated for multiple individuals to dress or undress within the
+
+same space exposing displaying or otherwise uncovering genitalia that does not correspond
+
+with the sex designation of the changing room constitutes an act or an attempted act described
+
+in subsection that constitutes lewdness
+
+
+a woman s breast feeding including breast feeding in any location where the
+
+woman otherwise may rightfully be does not under any circumstance constitute a lewd act
+
+irrespective of whether or not the breast is covered during or incidental to feeding
+
+
+section section is amended to read
+
+lewdness involving a child
+
+
+as used in this section
+
+a in in the presence of includes within visual contact through an electronic device
+
+
+b common area of a privacy space means the same as that term is defined in
+
+section
+
+
+c privacy space means the same as that term is defined in section
+
+
+a person is guilty of lewdness involving a child if the person under circumstances
+
+not amounting to rape of a child object rape of a child sodomy upon a child sexual abuse of a
+
+child aggravated sexual abuse of a child or an attempt to commit any of those offenses
+
+intentionally or knowingly
+
+a does any of the following in the presence of a child who is under years of age
+
+i performs an act of sexual intercourse or sodomy
+
+ii exposes his or her genitals the female breast below the top of the areola the
+
+
+buttocks the anus or the pubic area
+a in a public place or
+
+enrolled copy
+
+
+h b
+b in a private place under circumstances the person should know will likely cause
+affront or alarm or with the intent to arouse or gratify the sexual desire of the actor or the child
+
+iii masturbates or
+
+iv performs any other act of lewdness or
+
+b under circumstances not amounting to sexual exploitation of a child under section
+
+b or aggravated sexual exploitation of a child under section b causes a
+
+child under the age of years to expose his or her genitals anus or breast if female to the
+
+actor with the intent to arouse or gratify the sexual desire of the actor or the child
+
+
+
+a lewdness involving a child is a class a misdemeanor except under subsection
+b
+
+
+b lewdness involving a child is a third degree felony if at the time of the violation
+
+i the person is a sex offender as defined in section or
+
+ii the person has previously been convicted of a violation of this section
+
+iii the person commits the offense of lewdness involving a child while also
+
+
+
+committing the offense of
+a criminal trespass in a sex designated changing room under subsection
+d
+
+b lewdness under section
+
+c voyeurism under section or
+
+d loitering in a privacy space under section or
+
+iv the person commits the offense of lewdness involving a child in a sex designated
+
+privacy space as defined in section that is not designated for individuals of the
+
+actor s sex
+
+
+a the common area of a privacy space constitutes a public place or circumstance
+
+described in subsection where an act or an attempted act described in subsection
+
+constitutes lewdness involving a child
+
+
+
+b within the common area of a government entity s dressing room fitting room
+locker room changing facility or any other space designated for multiple individuals to dress
+
+h b
+enrolled copy
+
+or undress within the same space exposing displaying or otherwise uncovering genitalia that
+
+does not correspond with the sex designation of the changing room constitutes an act or an
+
+attempted act described in subsection that constitutes lewdness involving a child
+
+
+section section is amended to read
+
+voyeurism offenses penalties
+
+
+a person is guilty of voyeurism who intentionally uses any type of technology to
+
+
+secretly or surreptitiously record by video photograph or other means an individual
+a for the purpose of viewing any portion of the individual s body regarding which the
+
+individual has a reasonable expectation of privacy whether or not that portion of the body is
+
+covered with clothing
+
+b without the knowledge or consent of the individual and
+
+c under circumstances in which the individual has a reasonable expectation of
+
+
+
+privacy
+a a except as provided in subsection b a violation of subsection is a
+class a misdemeanor except that
+
+
+b the following is a third degree felony
+
+i a violation of subsection committed against a child under years of age is a
+
+third degree felony
+
+ii a violation of subsection committed while also committing the offense of
+
+a criminal trespass in a sex designated changing room under subsection
+
+d
+
+b lewdness under section
+
+c lewdness involving a child under section or
+
+d loitering in a privacy space under section or
+
+iii a violation of subsection in a sex designated privacy space as defined in
+
+
+
+section that is not designated for individuals of the actor s sex
+distribution or sale of any images including in print electronic magnetic or
+digital format obtained under subsection by transmission display or dissemination is a
+
+enrolled copy
+h b
+
+third degree felony except that if the violation of this subsection includes images of a child
+
+under years of age the violation is a second degree felony
+
+
+a person is guilty of voyeurism who under circumstances not amounting to a
+
+violation of subsection views or attempts to view an individual with or without the use of
+
+any instrumentality
+
+a with the intent of viewing any portion of the individual s body regarding which the
+
+individual has a reasonable expectation of privacy whether or not that portion of the body is
+
+covered with clothing
+
+b without the knowledge or consent of the individual and
+
+c under circumstances in which the individual has a reasonable expectation of
+
+
+
+privacy
+a a except as provided in subsection b a violation of subsection is a
+class b misdemeanor except that
+
+
+b the following is a class a misdemeanor
+
+i a violation of subsection committed against a child under years of age is a
+
+class a misdemeanor
+
+ii a violation of subsection committed while also committing the offense of
+
+a criminal trespass in a sex designated changing room under subsection
+
+d
+
+b lewdness under section
+
+c lewdness involving a child under section or
+
+d loitering in a privacy space under section or
+
+iii a violation of subsection committed in a sex designated privacy space as
+
+
+
+defined in section that is not designated for individuals of the actor s sex
+for purposes of this section an individual has a reasonable expectation of privacy
+within a public restroom
+
+
+section section is enacted to read
+
+loitering in a privacy space
+
+
+h b
+enrolled copy
+
+as used in this section
+
+a privacy space means the following in which an individual has a reasonable
+
+expectation of privacy
+
+i a restroom or any other space that includes a toilet
+
+ii a dressing room fitting room locker room changing facility or any other space
+
+designated for multiple individuals to dress or undress within the same space or
+
+iii any room or space that includes a shower
+
+
+b sex designated means that a facility program or event is designated specifically
+
+for males or females and not the opposite sex
+
+
+
+an actor commits the offense of unlawfully loitering in a privacy space if the actor
+intentionally or knowingly remains unlawfully in a privacy space
+
+
+
+a except as provided in subsection b a violation of subsection is a class
+b misdemeanor
+
+
+
+b a violation of subsection is a class a misdemeanor if the actor commits the
+offense
+
+i while also committing the offense of
+
+a criminal trespass in a sex designated changing room under subsection
+
+d
+
+b lewdness under section
+
+c lewdness involving a child under section or
+
+d voyeurism under section or
+
+ii in a sex designated privacy space that is not designated for individuals of the actor s
+
+sex
+
+
+section effective date
+
+
+except as provided in subsection if approved by two thirds of all the members
+
+elected to each house this bill takes effect upon approval by the governor or the day following
+
+the constitutional time limit of utah constitution article vii section without the governor s
+
+signature or in the case of a veto the date of veto override
+
+
+enrolled copy
+h b
+
+the actions affecting the following sections take effect on may
+
+a section g
+
+b section and
+
+c section
+
+
+