Text of UT SB 39 (2023)

S.B. 39 LEGISLATIVE GENERAL COUNSEL 6 Approved for Filing: D.M. Cheung 6 6 02-10-23 5:41 PM 6 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 Committee Note: 10 The Health and Human Services Interim Committee recommended this bill. 11 Legislative Vote: 14 voting for 0 voting against 4 absent 12 General Description: 13 This bill recodifies portions of the Utah Health Code and Utah Human Services Code. 14 Highlighted Provisions: 15 This bill: 16 < recodifies provisions regarding: 17 C health care administration and assistance; and 18 C vital statistics, health data, and the Utah Medical Examiner; and 19 < makes technical and corresponding changes. 20 Money Appropriated in this Bill: 21 None 22 Other Special Clauses: 23 This bill provides revisor instructions. 24 Utah Code Sections Affected: 25 AMENDS: 26 26B-3-101, as enacted by Laws of Utah 2022, Chapter 255 27 26B-8-101, as enacted by Laws of Utah 2022, Chapter 255 *SB0039* S.B. 39 02-10-23 5:41 PM - 2 - 28 RENUMBERS AND AMENDS: 29 26B-3-102, (Renumbered from 26-18-2.1, as last amended by Laws of Utah 2019, 30 Chapter 393) 31 26B-3-103, (Renumbered from 26-18-2.2, as last amended by Laws of Utah 2019, 32 Chapter 393) 33 26B-3-104, (Renumbered from 26-18-2.3, as last amended by Laws of Utah 2020, 34 Chapter 225) 35 26B-3-105, (Renumbered from 26-18-2.4, as last amended by Laws of Utah 2022, 36 Chapter 255) 37 26B-3-106, (Renumbered from 26-18-2.5, as last amended by Laws of Utah 2019, 38 Chapter 393) 39 26B-3-107, (Renumbered from 26-18-2.6, as last amended by Laws of Utah 2021, 40 Chapter 234) 41 26B-3-108, (Renumbered from 26-18-3, as last amended by Laws of Utah 2021, 42 Chapter 422) 43 26B-3-109, (Renumbered from 26-18-3.1, as last amended by Laws of Utah 2020, 44 Chapter 225) 45 26B-3-110, (Renumbered from 26-18-3.5, as last amended by Laws of Utah 2019, 46 Chapter 393) 47 26B-3-111, (Renumbered from 26-18-3.6, as last amended by Laws of Utah 2019, 48 Chapter 393) 49 26B-3-112, (Renumbered from 26-18-3.8, as last amended by Laws of Utah 2020, Sixth 50 Special Session, Chapter 3) 51 26B-3-113, (Renumbered from 26-18-3.9, as last amended by Laws of Utah 2020, Fifth 52 Special Session, Chapter 4) 53 26B-3-114, (Renumbered from 26-18-4, as last amended by Laws of Utah 2013, 54 Chapter 167) 55 26B-3-115, (Renumbered from 26-18-5, as last amended by Laws of Utah 2020, 56 Chapter 225) 57 26B-3-116, (Renumbered from 26-18-5.5, as enacted by Laws of Utah 2022, Chapter 58 469) 02-10-23 5:41 PM S.B. 39 - 3 - 59 26B-3-117, (Renumbered from 26-18-6, as enacted by Laws of Utah 1981, Chapter 60 126) 61 26B-3-118, (Renumbered from 26-18-7, as last amended by Laws of Utah 1988, 62 Chapter 21) 63 26B-3-119, (Renumbered from 26-18-8, as last amended by Laws of Utah 2020, 64 Chapter 225) 65 26B-3-120, (Renumbered from 26-18-9, as enacted by Laws of Utah 1981, Chapter 66 126) 67 26B-3-121, (Renumbered from 26-18-11, as last amended by Laws of Utah 2019, 68 Chapter 393) 69 26B-3-122, (Renumbered from 26-18-13, as last amended by Laws of Utah 2017, 70 Chapter 241) 71 26B-3-123, (Renumbered from 26-18-13.5, as last amended by Laws of Utah 2019, 72 Chapter 249) 73 26B-3-124, (Renumbered from 26-18-15, as last amended by Laws of Utah 2021, 74 Chapter 163) 75 26B-3-125, (Renumbered from 26-18-16, as enacted by Laws of Utah 2012, Chapter 76 155) 77 26B-3-126, (Renumbered from 26-18-17, as enacted by Laws of Utah 2013, Chapter 78 53) 79 26B-3-127, (Renumbered from 26-18-18, as last amended by Laws of Utah 2019, 80 Chapter 393) 81 26B-3-128, (Renumbered from 26-18-19, as last amended by Laws of Utah 2016, 82 Chapter 114) 83 26B-3-129, (Renumbered from 26-18-20, as last amended by Laws of Utah 2022, 84 Chapter 443) 85 26B-3-130, (Renumbered from 26-18-21, as last amended by Laws of Utah 2019, 86 Chapter 393) 87 26B-3-131, (Renumbered from 26-18-22, as enacted by Laws of Utah 2017, Chapter 88 180) 89 26B-3-132, (Renumbered from 26-18-23, as enacted by Laws of Utah 2017, Chapter S.B. 39 02-10-23 5:41 PM - 4 - 90 53) 91 26B-3-133, (Renumbered from 26-18-24, as enacted by Laws of Utah 2018, Chapter 92 180) 93 26B-3-134, (Renumbered from 26-18-25, as enacted by Laws of Utah 2019, Chapter 94 320) 95 26B-3-135, (Renumbered from 26-18-26, as enacted by Laws of Utah 2019, Chapter 96 265) 97 26B-3-136, (Renumbered from 26-18-27, as enacted by Laws of Utah 2021, Chapter 98 163) 99 26B-3-137, (Renumbered from 26-18-28, as enacted by Laws of Utah 2022, Chapter 100 206) 101 26B-3-138, (Renumbered from 26-18-427, as enacted by Laws of Utah 2022, Chapter 102 394) 103 26B-3-139, (Renumbered from 26-18-603, as last amended by Laws of Utah 2015, 104 Chapter 135) 105 26B-3-140, (Renumbered from 26-18-604, as last amended by Laws of Utah 2015, 106 Chapter 135) 107 26B-3-141, (Renumbered from 26-18-703, as renumbered and amended by Laws of 108 Utah 2022, Chapter 334) 109 26B-3-201, (Renumbered from 26-18-403, as enacted by Laws of Utah 2006, Chapter 110 110) 111 26B-3-202, (Renumbered from 26-18-405, as last amended by Laws of Utah 2020, 112 Chapter 275) 113 26B-3-203, (Renumbered from 26-18-405.5, as last amended by Laws of Utah 2022, 114 Chapter 149) 115 26B-3-204, (Renumbered from 26-18-408, as last amended by Laws of Utah 2020, 116 Fifth Special Session, Chapter 4) 117 26B-3-205, (Renumbered from 26-18-409, as enacted by Laws of Utah 2014, Chapter 118 174) 119 26B-3-206, (Renumbered from 26-18-410, as last amended by Laws of Utah 2022, 120 Chapter 226) 02-10-23 5:41 PM S.B. 39 - 5 - 121 26B-3-207, (Renumbered from 26-18-411, as last amended by Laws of Utah 2022, 122 Chapter 394) 123 26B-3-208, (Renumbered from 26-18-413, as last amended by Laws of Utah 2020, 124 Chapter 225) 125 26B-3-209, (Renumbered from 26-18-414, as enacted by Laws of Utah 2017, Chapter 126 307) 127 26B-3-210, (Renumbered from 26-18-415, as last amended by Laws of Utah 2019, 128 Chapters 1 and 393) 129 26B-3-211, (Renumbered from 26-18-416, as last amended by Laws of Utah 2020, 130 Chapter 354) 131 26B-3-212, (Renumbered from 26-18-417, as last amended by Laws of Utah 2019, 132 Chapter 393) 133 26B-3-213, (Renumbered from 26-18-418, as last amended by Laws of Utah 2020, 134 Chapter 303) 135 26B-3-214, (Renumbered from 26-18-419, as enacted by Laws of Utah 2019, Chapter 136 172) 137 26B-3-215, (Renumbered from 26-18-420, as enacted by Laws of Utah 2020, Chapter 138 187) 139 26B-3-216, (Renumbered from 26-18-420.1, as enacted by Laws of Utah 2021, Chapter 140 133) 141 26B-3-217, (Renumbered from 26-18-421, as enacted by Laws of Utah 2020, Chapter 142 159) 143 26B-3-218, (Renumbered from 26-18-422, as enacted by Laws of Utah 2020, Chapter 144 188) 145 26B-3-219, (Renumbered from 26-18-423, as enacted by Laws of Utah 2020, Chapter 146 303) 147 26B-3-220, (Renumbered from 26-18-424, as enacted by Laws of Utah 2021, Chapter 148 76) 149 26B-3-221, (Renumbered from 26-18-425, as enacted by Laws of Utah 2021, Chapter 150 27) 151 26B-3-222, (Renumbered from 26-18-426, as enacted by Laws of Utah 2021, Chapter S.B. 39 02-10-23 5:41 PM - 6 - 152 212) 153 26B-3-223, (Renumbered from 26-18-428, as enacted by Laws of Utah 2022, Chapter 154 394) 155 26B-3-224, (Renumbered from 26-18-429, as enacted by Laws of Utah 2022, Chapter 156 253) 157 26B-3-301, (Renumbered from 26-18-101, as last amended by Laws of Utah 2004, 158 Chapter 280) 159 26B-3-302, (Renumbered from 26-18-102, as last amended by Laws of Utah 2010, 160 Chapters 286 and 324) 161 26B-3-303, (Renumbered from 26-18-103, as last amended by Laws of Utah 2020, 162 Chapter 225) 163 26B-3-304, (Renumbered from 26-18-104, as last amended by Laws of Utah 2008, 164 Chapter 382) 165 26B-3-305, (Renumbered from 26-18-105, as last amended by Laws of Utah 2010, 166 Chapter 205) 167 26B-3-306, (Renumbered from 26-18-106, as enacted by Laws of Utah 1992, Chapter 168 273) 169 26B-3-307, (Renumbered from 26-18-107, as last amended by Laws of Utah 2019, 170 Chapter 349) 171 26B-3-308, (Renumbered from 26-18-108, as enacted by Laws of Utah 1992, Chapter 172 273) 173 26B-3-309, (Renumbered from 26-18-109, as enacted by Laws of Utah 1992, Chapter 174 273) 175 26B-3-310, (Renumbered from 26-18-502, as last amended by Laws of Utah 2021, 176 Chapter 274) 177 26B-3-311, (Renumbered from 26-18-503, as last amended by Laws of Utah 2022, 178 Chapter 274) 179 26B-3-312, (Renumbered from 26-18-504, as last amended by Laws of Utah 2017, 180 Chapter 443) 181 26B-3-313, (Renumbered from 26-18-505, as last amended by Laws of Utah 2017, 182 Chapter 443) 02-10-23 5:41 PM S.B. 39 - 7 - 183 26B-3-401, (Renumbered from 26-35a-103, as last amended by Laws of Utah 2018, 184 Chapter 39) 185 26B-3-402, (Renumbered from 26-35a-102, as last amended by Laws of Utah 2011, 186 Chapter 366) 187 26B-3-403, (Renumbered from 26-35a-104, as last amended by Laws of Utah 2017, 188 Chapter 443) 189 26B-3-404, (Renumbered from 26-35a-105, as enacted by Laws of Utah 2004, Chapter 190 284) 191 26B-3-405, (Renumbered from 26-35a-107, as last amended by Laws of Utah 2017, 192 Chapter 443) 193 26B-3-406, (Renumbered from 26-35a-108, as last amended by Laws of Utah 2011, 194 Chapter 366) 195 26B-3-501, (Renumbered from 26-36b-103, as last amended by Laws of Utah 2019, 196 Chapter 1) 197 26B-3-502, (Renumbered from 26-36b-102, as last amended by Laws of Utah 2018, 198 Chapter 384) 199 26B-3-503, (Renumbered from 26-36b-201, as last amended by Laws of Utah 2018, 200 Chapters 384 and 468) 201 26B-3-504, (Renumbered from 26-36b-202, as last amended by Laws of Utah 2019, 202 Chapter 393) 203 26B-3-505, (Renumbered from 26-36b-203, as last amended by Laws of Utah 2018, 204 Chapters 384 and 468) 205 26B-3-506, (Renumbered from 26-36b-204, as last amended by Laws of Utah 2020, 206 Chapter 225) 207 26B-3-507, (Renumbered from 26-36b-205, as last amended by Laws of Utah 2020, 208 Chapter 225) 209 26B-3-508, (Renumbered from 26-36b-206, as last amended by Laws of Utah 2018, 210 Chapters 384 and 468) 211 26B-3-509, (Renumbered from 26-36b-207, as last amended by Laws of Utah 2018, 212 Chapters 384 and 468) 213 26B-3-510, (Renumbered from 26-36b-209, as last amended by Laws of Utah 2018, S.B. 39 02-10-23 5:41 PM - 8 - 214 Chapters 384 and 468) 215 26B-3-511, (Renumbered from 26-36b-210, as last amended by Laws of Utah 2018, 216 Chapters 384 and 468) 217 26B-3-512, (Renumbered from 26-36b-211, as last amended by Laws of Utah 2018, 218 Chapters 384 and 468) 219 26B-3-601, (Renumbered from 26-36c-102, as last amended by Laws of Utah 2019, 220 Chapter 1) 221 26B-3-602, (Renumbered from 26-36c-103, as enacted by Laws of Utah 2018, Chapter 222 468) 223 26B-3-603, (Renumbered from 26-36c-201, as last amended by Laws of Utah 2019, 224 Chapter 1) 225 26B-3-604, (Renumbered from 26-36c-202, as last amended by Laws of Utah 2019, 226 Chapter 393) 227 26B-3-605, (Renumbered from 26-36c-203, as last amended by Laws of Utah 2019, 228 Chapter 1) 229 26B-3-606, (Renumbered from 26-36c-204, as last amended by Laws of Utah 2020, 230 Chapter 225) 231 26B-3-607, (Renumbered from 26-36c-205, as last amended by Laws of Utah 2019, 232 Chapter 136) 233 26B-3-608, (Renumbered from 26-36c-206, as last amended by Laws of Utah 2019, 234 Chapter 1) 235 26B-3-609, (Renumbered from 26-36c-207, as enacted by Laws of Utah 2018, Chapter 236 468) 237 26B-3-610, (Renumbered from 26-36c-208, as last amended by Laws of Utah 2019, 238 Chapter 1) 239 26B-3-611, (Renumbered from 26-36c-209, as last amended by Laws of Utah 2019, 240 Chapter 1) 241 26B-3-612, (Renumbered from 26-36c-210, as last amended by Laws of Utah 2019, 242 Chapter 136) 243 26B-3-701, (Renumbered from 26-36d-103, as repealed and reenacted by Laws of Utah 244 2019, Chapter 455) 02-10-23 5:41 PM S.B. 39 - 9 - 245 26B-3-702, (Renumbered from 26-36d-102, as repealed and reenacted by Laws of Utah 246 2019, Chapter 455) 247 26B-3-703, (Renumbered from 26-36d-201, as repealed and reenacted by Laws of Utah 248 2019, Chapter 455) 249 26B-3-704, (Renumbered from 26-36d-202, as repealed and reenacted by Laws of Utah 250 2019, Chapter 455) 251 26B-3-705, (Renumbered from 26-36d-203, as repealed and reenacted by Laws of Utah 252 2019, Chapter 455) 253 26B-3-706, (Renumbered from 26-36d-204, as repealed and reenacted by Laws of Utah 254 2019, Chapter 455) 255 26B-3-707, (Renumbered from 26-36d-205, as repealed and reenacted by Laws of Utah 256 2019, Chapter 455) 257 26B-3-708, (Renumbered from 26-36d-206, as repealed and reenacted by Laws of Utah 258 2019, Chapter 455) 259 26B-3-709, (Renumbered from 26-36d-208, as repealed and reenacted by Laws of Utah 260 2019, Chapter 455) 261 26B-3-801, (Renumbered from 26-37a-102, as last amended by Laws of Utah 2016, 262 Chapter 348) 263 26B-3-802, (Renumbered from 26-37a-103, as enacted by Laws of Utah 2015, Chapter 264 440) 265 26B-3-803, (Renumbered from 26-37a-104, as enacted by Laws of Utah 2015, Chapter 266 440) 267 26B-3-804, (Renumbered from 26-37a-105, as enacted by Laws of Utah 2015, Chapter 268 440) 269 26B-3-805, (Renumbered from 26-37a-106, as enacted by Laws of Utah 2015, Chapter 270 440) 271 26B-3-806, (Renumbered from 26-37a-108, as enacted by Laws of Utah 2015, Chapter 272 440) 273 26B-3-901, (Renumbered from 26-40-102, as last amended by Laws of Utah 2019, 274 Chapter 393) 275 26B-3-902, (Renumbered from 26-40-103, as last amended by Laws of Utah 2019, S.B. 39 02-10-23 5:41 PM - 10 - 276 Chapter 393) 277 26B-3-903, (Renumbered from 26-40-105, as last amended by Laws of Utah 2019, 278 Chapter 393) 279 26B-3-904, (Renumbered from 26-40-106, as last amended by Laws of Utah 2021, 280 Chapter 175) 281 26B-3-905, (Renumbered from 26-40-107, as enacted by Laws of Utah 1998, Chapter 282 360) 283 26B-3-906, (Renumbered from 26-40-108, as last amended by Laws of Utah 2010, 284 Chapter 391) 285 26B-3-907, (Renumbered from 26-40-109, as last amended by Laws of Utah 2013, 286 Chapter 167) 287 26B-3-908, (Renumbered from 26-40-110, as last amended by Laws of Utah 2019, 288 Chapter 393) 289 26B-3-909, (Renumbered from 26-40-115, as last amended by Laws of Utah 2020, 290 Chapters 32 and 152) 291 26B-3-1001, (Renumbered from 26-19-102, as renumbered and amended by Laws of 292 Utah 2018, Chapter 443) 293 26B-3-1002, (Renumbered from 26-19-103, as renumbered and amended by Laws of 294 Utah 2018, Chapter 443) 295 26B-3-1003, (Renumbered from 26-19-201, as last amended by Laws of Utah 2021, 296 Chapter 300) 297 26B-3-1004, (Renumbered from 26-19-301, as renumbered and amended by Laws of 298 Utah 2018, Chapter 443) 299 26B-3-1005, (Renumbered from 26-19-302, as last amended by Laws of Utah 2020, 300 Chapter 354) 301 26B-3-1006, (Renumbered from 26-19-303, as renumbered and amended by Laws of 302 Utah 2018, Chapter 443) 303 26B-3-1007, (Renumbered from 26-19-304, as renumbered and amended by Laws of 304 Utah 2018, Chapter 443) 305 26B-3-1008, (Renumbered from 26-19-305, as renumbered and amended by Laws of 306 Utah 2018, Chapter 443) 02-10-23 5:41 PM S.B. 39 - 11 - 307 26B-3-1009, (Renumbered from 26-19-401, as last amended by Laws of Utah 2021, 308 Chapter 300) 309 26B-3-1010, (Renumbered from 26-19-402, as renumbered and amended by Laws of 310 Utah 2018, Chapter 443) 311 26B-3-1011, (Renumbered from 26-19-403, as renumbered and amended by Laws of 312 Utah 2018, Chapter 443) 313 26B-3-1012, (Renumbered from 26-19-404, as enacted by Laws of Utah 2018, Chapter 314 443) 315 26B-3-1013, (Renumbered from 26-19-405, as renumbered and amended by Laws of 316 Utah 2018, Chapter 443) 317 26B-3-1014, (Renumbered from 26-19-406, as renumbered and amended by Laws of 318 Utah 2018, Chapter 443) 319 26B-3-1015, (Renumbered from 26-19-501, as enacted by Laws of Utah 2018, Chapter 320 443) 321 26B-3-1016, (Renumbered from 26-19-502, as enacted by Laws of Utah 2018, Chapter 322 443) 323 26B-3-1017, (Renumbered from 26-19-503, as enacted by Laws of Utah 2018, Chapter 324 443) 325 26B-3-1018, (Renumbered from 26-19-504, as enacted by Laws of Utah 2018, Chapter 326 443) 327 26B-3-1019, (Renumbered from 26-19-505, as enacted by Laws of Utah 2018, Chapter 328 443) 329 26B-3-1020, (Renumbered from 26-19-506, as enacted by Laws of Utah 2018, Chapter 330 443) 331 26B-3-1021, (Renumbered from 26-19-507, as enacted by Laws of Utah 2018, Chapter 332 443) 333 26B-3-1022, (Renumbered from 26-19-508, as enacted by Laws of Utah 2018, Chapter 334 443) 335 26B-3-1023, (Renumbered from 26-19-509, as enacted by Laws of Utah 2018, Chapter 336 443) 337 26B-3-1024, (Renumbered from 26-19-601, as renumbered and amended by Laws of S.B. 39 02-10-23 5:41 PM - 12 - 338 Utah 2018, Chapter 443) 339 26B-3-1025, (Renumbered from 26-19-602, as renumbered and amended by Laws of 340 Utah 2018, Chapter 443) 341 26B-3-1026, (Renumbered from 26-19-603, as renumbered and amended by Laws of 342 Utah 2018, Chapter 443) 343 26B-3-1027, (Renumbered from 26-19-604, as renumbered and amended by Laws of 344 Utah 2018, Chapter 443) 345 26B-3-1028, (Renumbered from 26-19-605, as renumbered and amended by Laws of 346 Utah 2018, Chapter 443) 347 26B-3-1101, (Renumbered from 26-20-2, as last amended by Laws of Utah 2007, 348 Chapter 48) 349 26B-3-1102, (Renumbered from 26-20-3, as last amended by Laws of Utah 2011, 350 Chapter 297) 351 26B-3-1103, (Renumbered from 26-20-4, as repealed and reenacted by Laws of Utah 352 2007, Chapter 48) 353 26B-3-1104, (Renumbered from 26-20-5, as last amended by Laws of Utah 2007, 354 Chapter 48) 355 26B-3-1105, (Renumbered from 26-20-6, as last amended by Laws of Utah 2011, 356 Chapter 297) 357 26B-3-1106, (Renumbered from 26-20-7, as last amended by Laws of Utah 2007, 358 Chapter 48) 359 26B-3-1107, (Renumbered from 26-20-8, as last amended by Laws of Utah 2011, 360 Chapter 297) 361 26B-3-1108, (Renumbered from 26-20-9, as last amended by Laws of Utah 2007, 362 Chapter 48) 363 26B-3-1109, (Renumbered from 26-20-9.5, as last amended by Laws of Utah 2011, 364 Chapter 297) 365 26B-3-1110, (Renumbered from 26-20-10, as last amended by Laws of Utah 1998, 366 Chapter 192) 367 26B-3-1111, (Renumbered from 26-20-11, as enacted by Laws of Utah 1986, Chapter 368 46) 02-10-23 5:41 PM S.B. 39 - 13 - 369 26B-3-1112, (Renumbered from 26-20-12, as last amended by Laws of Utah 2011, 370 Chapter 297) 371 26B-3-1113, (Renumbered from 26-20-13, as last amended by Laws of Utah 2007, 372 Chapter 48) 373 26B-3-1114, (Renumbered from 26-20-14, as last amended by Laws of Utah 2011, 374 Chapter 297) 375 26B-3-1115, (Renumbered from 26-20-15, as enacted by Laws of Utah 2007, Chapter 376 48) 377 26B-8-102, (Renumbered from 26-2-3, as last amended by Laws of Utah 2017, Chapter 378 22) 379 26B-8-103, (Renumbered from 26-2-4, as last amended by Laws of Utah 2022, 380 Chapters 231 and 365) 381 26B-8-104, (Renumbered from 26-2-5, as last amended by Laws of Utah 2019, Chapter 382 349) 383 26B-8-105, (Renumbered from 26-2-5.5, as last amended by Laws of Utah 1995, 384 Chapter 202) 385 26B-8-106, (Renumbered from 26-2-6, as last amended by Laws of Utah 1995, Chapter 386 202) 387 26B-8-107, (Renumbered from 26-2-7, as last amended by Laws of Utah 2022, Chapter 388 231) 389 26B-8-108, (Renumbered from 26-2-8, as last amended by Laws of Utah 1995, Chapter 390 202) 391 26B-8-109, (Renumbered from 26-2-9, as last amended by Laws of Utah 1995, Chapter 392 202) 393 26B-8-110, (Renumbered from 26-2-10, as last amended by Laws of Utah 2021, 394 Chapter 65) 395 26B-8-111, (Renumbered from 26-2-11, as last amended by Laws of Utah 1995, 396 Chapter 202) 397 26B-8-112, (Renumbered from 26-2-12.5, as last amended by Laws of Utah 2022, 398 Chapters 255 and 335) 399 26B-8-113, (Renumbered from 26-2-12.6, as last amended by Laws of Utah 2022, S.B. 39 02-10-23 5:41 PM - 14 - 400 Chapters 255 and 365) 401 26B-8-114, (Renumbered from 26-2-13, as last amended by Laws of Utah 2021, 402 Chapters 11 and 297) 403 26B-8-115, (Renumbered from 26-2-14, as last amended by Laws of Utah 1995, 404 Chapter 202) 405 26B-8-116, (Renumbered from 26-2-14.1, as enacted by Laws of Utah 2002, Chapter 406 69) 407 26B-8-117, (Renumbered from 26-2-14.2, as enacted by Laws of Utah 2002, Chapter 408 69) 409 26B-8-118, (Renumbered from 26-2-14.3, as enacted by Laws of Utah 2015, Chapter 410 184) 411 26B-8-119, (Renumbered from 26-2-15, as last amended by Laws of Utah 2020, 412 Chapter 201) 413 26B-8-120, (Renumbered from 26-2-16, as last amended by Laws of Utah 2009, 414 Chapters 66 and 68) 415 26B-8-121, (Renumbered from 26-2-17, as last amended by Laws of Utah 2020, 416 Chapter 251) 417 26B-8-122, (Renumbered from 26-2-18, as last amended by Laws of Utah 2020, 418 Chapter 251) 419 26B-8-123, (Renumbered from 26-2-19, as last amended by Laws of Utah 1995, 420 Chapter 202) 421 26B-8-124, (Renumbered from 26-2-21, as last amended by Laws of Utah 1995, 422 Chapter 202) 423 26B-8-125, (Renumbered from 26-2-22, as last amended by Laws of Utah 2021, 424 Chapter 262) 425 26B-8-126, (Renumbered from 26-2-23, as last amended by Laws of Utah 2009, 426 Chapter 68) 427 26B-8-127, (Renumbered from 26-2-24, as last amended by Laws of Utah 1995, 428 Chapter 202) 429 26B-8-128, (Renumbered from 26-2-25, as last amended by Laws of Utah 2021, 430 Chapter 65) 02-10-23 5:41 PM S.B. 39 - 15 - 431 26B-8-129, (Renumbered from 26-2-26, as last amended by Laws of Utah 1995, 432 Chapter 202) 433 26B-8-130, (Renumbered from 26-2-27, as last amended by Laws of Utah 2011, 434 Chapter 366) 435 26B-8-131, (Renumbered from 26-2-28, as last amended by Laws of Utah 2021, 436 Chapter 65) 437 26B-8-132, (Renumbered from 26-34-4, as enacted by Laws of Utah 2020, Chapter 438 353) 439 26B-8-133, (Renumbered from 26-23-5, as last amended by Laws of Utah 1995, 440 Chapter 202) 441 26B-8-134, (Renumbered from 26-23-5.5, as enacted by Laws of Utah 1995, Chapter 442 202) 443 26B-8-201, (Renumbered from 26-4-2, as last amended by Laws of Utah 2022, Chapter 444 277) 445 26B-8-202, (Renumbered from 26-4-4, as last amended by Laws of Utah 2015, Chapter 446 72) 447 26B-8-203, (Renumbered from 26-4-5, as last amended by Laws of Utah 1993, Chapter 448 227) 449 26B-8-204, (Renumbered from 26-4-6, as last amended by Laws of Utah 2009, Chapter 450 63) 451 26B-8-205, (Renumbered from 26-4-7, as last amended by Laws of Utah 2021, Chapter 452 25) 453 26B-8-206, (Renumbered from 26-4-8, as last amended by Laws of Utah 1993, Chapter 454 38) 455 26B-8-207, (Renumbered from 26-4-9, as last amended by Laws of Utah 2021, Chapter 456 297) 457 26B-8-208, (Renumbered from 26-2-18.5, as last amended by Laws of Utah 2019, 458 Chapter 189) 459 26B-8-209, (Renumbered from 26-4-10, as last amended by Laws of Utah 2021, 460 Chapter 25) 461 26B-8-210, (Renumbered from 26-4-10.5, as last amended by Laws of Utah 2022, S.B. 39 02-10-23 5:41 PM - 16 - 462 Chapter 415) 463 26B-8-211, (Renumbered from 26-4-11, as last amended by Laws of Utah 2018, 464 Chapter 414) 465 26B-8-212, (Renumbered from 26-4-12, as last amended by Laws of Utah 2011, 466 Chapter 297) 467 26B-8-213, (Renumbered from 26-4-13, as last amended by Laws of Utah 2001, 468 Chapter 278) 469 26B-8-214, (Renumbered from 26-4-14, as last amended by Laws of Utah 2021, 470 Chapter 297) 471 26B-8-215, (Renumbered from 26-4-15, as enacted by Laws of Utah 1981, Chapter 472 126) 473 26B-8-216, (Renumbered from 26-4-16, as last amended by Laws of Utah 2007, 474 Chapter 144) 475 26B-8-217, (Renumbered from 26-4-17, as last amended by Laws of Utah 2022, 476 Chapter 255) 477 26B-8-218, (Renumbered from 26-4-18, as enacted by Laws of Utah 1981, Chapter 478 126) 479 26B-8-219, (Renumbered from 26-4-19, as last amended by Laws of Utah 1993, 480 Chapter 38) 481 26B-8-220, (Renumbered from 26-4-20, as last amended by Laws of Utah 2011, 482 Chapter 297) 483 26B-8-221, (Renumbered from 26-4-21, as last amended by Laws of Utah 1997, 484 Chapter 372) 485 26B-8-222, (Renumbered from 26-4-22, as enacted by Laws of Utah 1981, Chapter 486 126) 487 26B-8-223, (Renumbered from 26-4-23, as enacted by Laws of Utah 1981, Chapter 488 126) 489 26B-8-224, (Renumbered from 26-4-24, as last amended by Laws of Utah 1997, 490 Chapter 375) 491 26B-8-225, (Renumbered from 26-4-25, as repealed and reenacted by Laws of Utah 492 2015, Chapter 72) 02-10-23 5:41 PM S.B. 39 - 17 - 493 26B-8-226, (Renumbered from 26-4-26, as enacted by Laws of Utah 1997, Chapter 494 232) 495 26B-8-227, (Renumbered from 26-4-27, as enacted by Laws of Utah 1998, Chapter 496 153) 497 26B-8-228, (Renumbered from 26-4-28, as last amended by Laws of Utah 2013, 498 Chapter 167) 499 26B-8-229, (Renumbered from 26-4-28.5, as enacted by Laws of Utah 2017, Chapter 500 346) 501 26B-8-230, (Renumbered from 26-4-29, as last amended by Laws of Utah 2010, 502 Chapter 218) 503 26B-8-231, (Renumbered from 26-4-30, as enacted by Laws of Utah 2020, Chapter 504 201) 505 26B-8-301, (Renumbered from 26-28-102, as enacted by Laws of Utah 2007, Chapter 506 60) 507 26B-8-302, (Renumbered from 26-28-103, as enacted by Laws of Utah 2007, Chapter 508 60) 509 26B-8-303, (Renumbered from 26-28-104, as enacted by Laws of Utah 2007, Chapter 510 60) 511 26B-8-304, (Renumbered from 26-28-105, as last amended by Laws of Utah 2011, 512 Chapter 297) 513 26B-8-305, (Renumbered from 26-28-106, as last amended by Laws of Utah 2011, 514 Chapter 297) 515 26B-8-306, (Renumbered from 26-28-107, as last amended by Laws of Utah 2011, 516 Chapter 297) 517 26B-8-307, (Renumbered from 26-28-108, as enacted by Laws of Utah 2007, Chapter 518 60) 519 26B-8-308, (Renumbered from 26-28-109, as last amended by Laws of Utah 2018, 520 Chapter 48) 521 26B-8-309, (Renumbered from 26-28-110, as enacted by Laws of Utah 2007, Chapter 522 60) 523 26B-8-310, (Renumbered from 26-28-111, as last amended by Laws of Utah 2011, S.B. 39 02-10-23 5:41 PM - 18 - 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) 02-10-23 5:41 PM S.B. 39 - 19 - 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, S.B. 39 02-10-23 5:41 PM - 20 - 586 Chapter 201) 587 26B-8-508, (Renumbered from 26-33a-109, as last amended by Laws of Utah 2021, 588 Chapter 277) 589 26B-8-509, (Renumbered from 26-33a-110, as enacted by Laws of Utah 1990, Chapter 590 305) 591 26B-8-510, (Renumbered from 26-33a-111, as last amended by Laws of Utah 2011, 592 Chapter 297) 593 26B-8-511, (Renumbered from 26-33a-115, as enacted by Laws of Utah 2013, Chapter 594 102) 595 26B-8-512, (Renumbered from 26-33a-116, as enacted by Laws of Utah 2019, Chapter 596 287) 597 26B-8-513, (Renumbered from 26-33a-117, as enacted by Laws of Utah 2020, Chapter 598 181) 599 26B-8-514, (Renumbered from 26-70-102, as enacted by Laws of Utah 2022, Chapter 600 327) 601 602 Be it enacted by the Legislature of the state of Utah: 603 Section 1. Section 26B-3-101 is amended to read: 604 CHAPTER 3. HEALTH CARE - DELIVERY AND ASSISTANCE 605 Part 1. Health Care Assistance 606 26B-3-101. Definitions. 607 [Reserved] 608 As used in this chapter: 609 (1) "Applicant" means any person who requests assistance under the medical programs 610 of the state. 611 (2) "CMS" means the Centers for Medicare and Medicaid Services within the United 612 States Department of Health and Human Services. 613 (3) "Division" means the Division of Integrated Healthcare within the department, 614 established under Section 26B-3-102. 615 (4) "Enrollee" or "member" means an individual whom the department has determined 616 to be eligible for assistance under the Medicaid program. 02-10-23 5:41 PM S.B. 39 - 21 - 617 (5) "Medicaid program" means the state program for medical assistance for persons 618 who are eligible under the state plan adopted pursuant to Title XIX of the federal Social 619 Security Act. 620 (6) "Medical assistance" means services furnished or payments made to or on behalf of 621 a member. 622 (7) (a) "Passenger vehicle" means a self-propelled, two-axle vehicle intended primarily 623 for operation on highways and used by an applicant or recipient to meet basic transportation 624 needs and has a fair market value below 40% of the applicable amount of the federal luxury 625 passenger automobile tax established in 26 U.S.C. Sec. 4001 and adjusted annually for 626 inflation. 627 (b) "Passenger vehicle" does not include: 628 (i) a commercial vehicle, as defined in Section 41-1a-102; 629 (ii) an off-highway vehicle, as defined in Section 41-1a-102; or 630 (iii) a motor home, as defined in Section 13-14-102. 631 (8) "PPACA" means the same as that term is defined in Section 31A-1-301. 632 (9) "Recipient" means a person who has received medical assistance under the 633 Medicaid program. 634 Section 2. Section 26B-3-102, which is renumbered from Section 26-18-2.1 is 635 renumbered and amended to read: 636 [26-18-2.1]. 26B-3-102. Division -- Creation. 637 There is created, within the department, the Division of [Medicaid and Health 638 Financing] Integrated Healthcare which shall be responsible for implementing, organizing, and 639 maintaining the Medicaid program and the Children's Health Insurance Program established in 640 Section [26-40-103] 26B-3-902, in accordance with the provisions of this chapter and 641 applicable federal law. 642 Section 3. Section 26B-3-103, which is renumbered from Section 26-18-2.2 is 643 renumbered and amended to read: 644 [26-18-2.2]. 26B-3-103. State Medicaid director -- Appointment -- 645 Responsibilities. 646 (1) The state Medicaid director shall be appointed by the governor, after consultation 647 with the executive director, with the advice and consent of the Senate. S.B. 39 02-10-23 5:41 PM - 22 - 648 (2) The state Medicaid director may employ other employees as necessary to 649 implement the provisions of this chapter, and shall: 650 [(1)] (a) administer the responsibilities of the division as set forth in this chapter; 651 [(2)] (b) administer the division's budget; and 652 [(3)] (c) establish and maintain a state plan for the Medicaid program in compliance 653 with federal law and regulations. 654 Section 4. Section 26B-3-104, which is renumbered from Section 26-18-2.3 is 655 renumbered and amended to read: 656 [26-18-2.3]. 26B-3-104. Division responsibilities -- Emphasis -- Periodic 657 assessment. 658 (1) In accordance with the requirements of Title XIX of the Social Security Act and 659 applicable federal regulations, the division is responsible for the effective and impartial 660 administration of this chapter in an efficient, economical manner. The division shall: 661 (a) establish, on a statewide basis, a program to safeguard against unnecessary or 662 inappropriate use of Medicaid services, excessive payments, and unnecessary or inappropriate 663 hospital admissions or lengths of stay; 664 (b) deny any provider claim for services that fail to meet criteria established by the 665 division concerning medical necessity or appropriateness; and 666 (c) place its emphasis on high quality care to recipients in the most economical and 667 cost-effective manner possible, with regard to both publicly and privately provided services. 668 (2) The division shall implement and utilize cost-containment methods, where 669 possible, which may include: 670 (a) prepayment and postpayment review systems to determine if utilization is 671 reasonable and necessary; 672 (b) preadmission certification of nonemergency admissions; 673 (c) mandatory outpatient, rather than inpatient, surgery in appropriate cases; 674 (d) second surgical opinions; 675 (e) procedures for encouraging the use of outpatient services; 676 (f) consistent with Sections [26-18-2.4] 26B-3-105 and 58-17b-606, a Medicaid drug 677 program; 678 (g) coordination of benefits; and 02-10-23 5:41 PM S.B. 39 - 23 - 679 (h) review and exclusion of providers who are not cost effective or who have abused 680 the Medicaid program, in accordance with the procedures and provisions of federal law and 681 regulation. 682 (3) The state Medicaid director shall periodically assess the cost effectiveness and 683 health implications of the existing Medicaid program, and consider alternative approaches to 684 the provision of covered health and medical services through the Medicaid program, in order to 685 reduce unnecessary or unreasonable utilization. 686 (4) (a) The department shall ensure Medicaid program integrity by conducting internal 687 audits of the Medicaid program for efficiencies, best practices, and cost avoidance. 688 (b) The department shall coordinate with the Office of the Inspector General for 689 Medicaid Services created in Section 63A-13-201 to implement Subsection (2) and to address 690 Medicaid fraud, waste, or abuse as described in Section 63A-13-202. 691 Section 5. Section 26B-3-105, which is renumbered from Section 26-18-2.4 is 692 renumbered and amended to read: 693 [26-18-2.4]. 26B-3-105. Medicaid drug program -- Preferred drug list. 694 (1) A Medicaid drug program developed by the department under Subsection 695 [26-18-2.3] 26B-3-104(2)(f): 696 (a) shall, notwithstanding Subsection [26-18-2.3] 26B-3-104(1)(b), be based on clinical 697 and cost-related factors which include medical necessity as determined by a provider in 698 accordance with administrative rules established by the Drug Utilization Review Board; 699 (b) may include therapeutic categories of drugs that may be exempted from the drug 700 program; 701 (c) may include placing some drugs, except the drugs described in Subsection (2), on a 702 preferred drug list: 703 (i) to the extent determined appropriate by the department; and 704 (ii) in the manner described in Subsection (3) for psychotropic drugs; 705 (d) notwithstanding the requirements of [Part 2] Sections 26B-3-302 through 706 26B-3-309 regarding the, Drug Utilization Review Board, and except as provided in 707 Subsection (3), shall immediately implement the prior authorization requirements for a 708 nonpreferred drug that is in the same therapeutic class as a drug that is: 709 (i) on the preferred drug list on the date that this act takes effect; or S.B. 39 02-10-23 5:41 PM - 24 - 710 (ii) added to the preferred drug list after this act takes effect; and 711 (e) except as prohibited by Subsections 58-17b-606(4) and (5), shall establish the prior 712 authorization requirements established under Subsections (1)(c) and (d) which shall permit a 713 health care provider or the health care provider's agent to obtain a prior authorization override 714 of the preferred drug list through the department's pharmacy prior authorization review process, 715 and which shall: 716 (i) provide either telephone or fax approval or denial of the request within 24 hours of 717 the receipt of a request that is submitted during normal business hours of Monday through 718 Friday from 8 a.m. to 5 p.m.; 719 (ii) provide for the dispensing of a limited supply of a requested drug as determined 720 appropriate by the department in an emergency situation, if the request for an override is 721 received outside of the department's normal business hours; and 722 (iii) require the health care provider to provide the department with documentation of 723 the medical need for the preferred drug list override in accordance with criteria established by 724 the department in consultation with the Pharmacy and Therapeutics Committee. 725 (2) (a) [For purposes of] As used in this Subsection (2): 726 (i) "Immunosuppressive drug": 727 (A) means a drug that is used in immunosuppressive therapy to inhibit or prevent 728 activity of the immune system to aid the body in preventing the rejection of transplanted organs 729 and tissue; and 730 (B) does not include drugs used for the treatment of autoimmune disease or diseases 731 that are most likely of autoimmune origin. 732 (ii) "Stabilized" means a health care provider has documented in the patient's medical 733 chart that a patient has achieved a stable or steadfast medical state within the past 90 days using 734 a particular psychotropic drug. 735 (b) A preferred drug list developed under the provisions of this section may not include 736 an immunosuppressive drug. 737 (c) (i) The state Medicaid program shall reimburse for a prescription for an 738 immunosuppressive drug as written by the health care provider for a patient who has undergone 739 an organ transplant. 740 (ii) For purposes of Subsection 58-17b-606(4), and with respect to patients who have 02-10-23 5:41 PM S.B. 39 - 25 - 741 undergone an organ transplant, the prescription for a particular immunosuppressive drug as 742 written by a health care provider meets the criteria of demonstrating to the department a 743 medical necessity for dispensing the prescribed immunosuppressive drug. 744 (d) Notwithstanding the requirements of [Part 2] Sections 26B-3-302 through 745 26B-3-309 regarding the, Drug Utilization Review Board, the state Medicaid drug program 746 may not require the use of step therapy for immunosuppressive drugs without the written or 747 oral consent of the health care provider and the patient. 748 (e) The department may include a sedative hypnotic on a preferred drug list in 749 accordance with Subsection (2)(f). 750 (f) The department shall grant a prior authorization for a sedative hypnotic that is not 751 on the preferred drug list under Subsection (2)(e), if the health care provider has documentation 752 related to one of the following conditions for the Medicaid client: 753 (i) a trial and failure of at least one preferred agent in the drug class, including the 754 name of the preferred drug that was tried, the length of therapy, and the reason for the 755 discontinuation; 756 (ii) detailed evidence of a potential drug interaction between current medication and 757 the preferred drug; 758 (iii) detailed evidence of a condition or contraindication that prevents the use of the 759 preferred drug; 760 (iv) objective clinical evidence that a patient is at high risk of adverse events due to a 761 therapeutic interchange with a preferred drug; 762 (v) the patient is a new or previous Medicaid client with an existing diagnosis 763 previously stabilized with a nonpreferred drug; or 764 (vi) other valid reasons as determined by the department. 765 (g) A prior authorization granted under Subsection (2)(f) is valid for one year from the 766 date the department grants the prior authorization and shall be renewed in accordance with 767 Subsection (2)(f). 768 (3) (a) [For purposes of] As used in this Subsection (3), "psychotropic drug" means the 769 following classes of drugs: 770 (i) atypical anti-psychotic; 771 (ii) anti-depressant; S.B. 39 02-10-23 5:41 PM - 26 - 772 (iii) anti-convulsant/mood stabilizer; 773 (iv) anti-anxiety; and 774 (v) attention deficit hyperactivity disorder stimulant. 775 (b) (i) The department shall develop a preferred drug list for psychotropic drugs. 776 (ii) Except as provided in Subsection (3)(d), a preferred drug list for psychotropic 777 drugs developed under this section shall allow a health care provider to override the preferred 778 drug list by writing "dispense as written" on the prescription for the psychotropic drug. 779 (iii) A health care provider may not override Section 58-17b-606 by writing "dispense 780 as written" on a prescription. 781 (c) The department, and a Medicaid accountable care organization that is responsible 782 for providing behavioral health, shall: 783 (i) establish a system to: 784 (A) track health care provider prescribing patterns for psychotropic drugs; 785 (B) educate health care providers who are not complying with the preferred drug list; 786 and 787 (C) implement peer to peer education for health care providers whose prescribing 788 practices continue to not comply with the preferred drug list; and 789 (ii) determine whether health care provider compliance with the preferred drug list is at 790 least: 791 (A) 55% of prescriptions by July 1, 2017; 792 (B) 65% of prescriptions by July 1, 2018; and 793 (C) 75% of prescriptions by July 1, 2019. 794 (d) Beginning October 1, 2019, the department shall eliminate the dispense as written 795 override for the preferred drug list, and shall implement a prior authorization system for 796 psychotropic drugs, in accordance with Subsection (2)(f), if by July 1, 2019, the department has 797 not realized annual savings from implementing the preferred drug list for psychotropic drugs of 798 at least $750,000 General Fund savings. 799 Section 6. Section 26B-3-106, which is renumbered from Section 26-18-2.5 is 800 renumbered and amended to read: 801 [26-18-2.5]. 26B-3-106. Simplified enrollment and renewal process for Medicaid 802 and other state medical programs -- Financial institutions. 02-10-23 5:41 PM S.B. 39 - 27 - 803 (1) The department may apply for grants and accept donations to make technology 804 system improvements necessary to implement a simplified enrollment and renewal process for 805 the Medicaid program, Utah Premium Partnership, and Primary Care Network Demonstration 806 Project programs. 807 (2) (a) The department may enter into an agreement with a financial institution doing 808 business in the state to develop and operate a data match system to identify an applicant's or 809 enrollee's assets that: 810 (i) uses automated data exchanges to the maximum extent feasible; and 811 (ii) requires a financial institution each month to provide the name, record address, 812 Social Security number, other taxpayer identification number, or other identifying information 813 for each applicant or enrollee who maintains an account at the financial institution. 814 (b) The department may pay a reasonable fee to a financial institution for compliance 815 with this Subsection (2), as provided in Section 7-1-1006. 816 (c) A financial institution may not be liable under any federal or state law to any person 817 for any disclosure of information or action taken in good faith under this Subsection (2). 818 (d) The department may disclose a financial record obtained from a financial institution 819 under this section only for the purpose of, and to the extent necessary in, verifying eligibility as 820 provided in this section and Section [26-40-105] 26B-3-903. 821 Section 7. Section 26B-3-107, which is renumbered from Section 26-18-2.6 is 822 renumbered and amended to read: 823 [26-18-2.6]. 26B-3-107. Dental benefits. 824 (1) (a) Except as provided in Subsection (8), the division may establish a competitive 825 bid process to bid out Medicaid dental benefits under this chapter. 826 (b) The division may bid out the Medicaid dental benefits separately from other 827 program benefits. 828 (2) The division shall use the following criteria to evaluate dental bids: 829 (a) ability to manage dental expenses; 830 (b) proven ability to handle dental insurance; 831 (c) efficiency of claim paying procedures; 832 (d) provider contracting, discounts, and adequacy of network; and 833 (e) other criteria established by the department. S.B. 39 02-10-23 5:41 PM - 28 - 834 (3) The division shall request bids for the program's benefits at least once every five 835 years. 836 (4) The division's contract with dental plans for the program's benefits shall include 837 risk sharing provisions in which the dental plan must accept 100% of the risk for any difference 838 between the division's premium payments per client and actual dental expenditures. 839 (5) The division may not award contracts to: 840 (a) more than three responsive bidders under this section; or 841 (b) an insurer that does not have a current license in the state. 842 (6) (a) The division may cancel the request for proposals if: 843 (i) there are no responsive bidders; or 844 (ii) the division determines that accepting the bids would increase the program's costs. 845 (b) If the division cancels a request for proposal or a contract that results from a request 846 for proposal described in Subsection (6)(a), the division shall report to the Health and Human 847 Services Interim Committee regarding the reasons for the decision. 848 (7) Title 63G, Chapter 6a, Utah Procurement Code, shall apply to this section. 849 (8) (a) The division may: 850 (i) establish a dental health care delivery system and payment reform pilot program for 851 Medicaid dental benefits to increase access to cost effective and quality dental health care by 852 increasing the number of dentists available for Medicaid dental services; and 853 (ii) target specific Medicaid populations or geographic areas in the state. 854 (b) The pilot program shall establish compensation models for dentists and dental 855 hygienists that: 856 (i) increase access to quality, cost effective dental care; and 857 (ii) use funds from the Division of Family Health and Preparedness that are available to 858 reimburse dentists for educational loans in exchange for the dentist agreeing to serve Medicaid 859 and under-served populations. 860 (c) The division may amend the state plan and apply to the Secretary of the United 861 States Department of Health and Human Services for waivers or pilot programs if necessary to 862 establish the new dental care delivery and payment reform model. 863 (d) The division shall evaluate the pilot program's effect on the cost of dental care and 864 access to dental care for the targeted Medicaid populations. 02-10-23 5:41 PM S.B. 39 - 29 - 865 (9) (a) As used in this Subsection (9), "dental hygienist" means an individual who is 866 licensed as a dental hygienist under Section 58-69-301. 867 (b) The department shall reimburse a dental hygienist for dental services performed in 868 a public health setting and in accordance with Subsection (9)(c) beginning on the earlier of: 869 (i) January 1, 2023; or 870 (ii) 30 days after the date on which the replacement of the department's Medicaid 871 Management Information System software is complete. 872 (c) The department shall reimburse a dental hygienist directly for a service provided 873 through the Medicaid program if: 874 (i) the dental hygienist requests to be reimbursed directly; and 875 (ii) the dental hygienist provides the service within the scope of practice described in 876 Section 58-69-801. 877 (d) Before November 30 of each year in which the department reimburses dental 878 hygienists in accordance with Subsection (9)(c), the department shall report to the Health and 879 Human Services Interim Committee, for the previous fiscal year: 880 (i) the number and geographic distribution of dental hygienists who requested to be 881 reimbursed directly; 882 (ii) the total number of Medicaid enrollees who were served by a dental hygienist who 883 were reimbursed under this Subsection (9); 884 (iii) the total amount reimbursed directly to dental hygienists under this Subsection (9); 885 (iv) the specific services and billing codes that are reimbursed under this Subsection 886 (9); and 887 (v) the aggregate amount reimbursed for each service and billing code described in 888 Subsection (9)(d)(iv). 889 (e) (i) Except as provided in this Subsection (9), nothing in this Subsection (9) shall be 890 interpreted as expanding or otherwise altering the limitations and scope of practice for a dental 891 hygienist. 892 (ii) A dental hygienist may only directly bill and receive compensation for billing codes 893 that fall within the scope of practice of a dental hygienist. 894 Section 8. Section 26B-3-108, which is renumbered from Section 26-18-3 is 895 renumbered and amended to read: S.B. 39 02-10-23 5:41 PM - 30 - 896 [26-18-3]. 26B-3-108. Administration of Medicaid program by department -- 897 Reporting to the Legislature -- Disciplinary measures and sanctions -- Funds collected -- 898 Eligibility standards -- Internal audits -- Health opportunity accounts. 899 (1) The department shall be the single state agency responsible for the administration 900 of the Medicaid program in connection with the United States Department of Health and 901 Human Services pursuant to Title XIX of the Social Security Act. 902 (2) (a) The department shall implement the Medicaid program through administrative 903 rules in conformity with this chapter, Title 63G, Chapter 3, Utah Administrative Rulemaking 904 Act, the requirements of Title XIX, and applicable federal regulations. 905 (b) The rules adopted under Subsection (2)(a) shall include, in addition to other rules 906 necessary to implement the program: 907 (i) the standards used by the department for determining eligibility for Medicaid 908 services; 909 (ii) the services and benefits to be covered by the Medicaid program; 910 (iii) reimbursement methodologies for providers under the Medicaid program; and 911 (iv) a requirement that: 912 (A) a person receiving Medicaid services shall participate in the electronic exchange of 913 clinical health records established in accordance with Section [26-1-37] 26B-8-411 unless the 914 individual opts out of participation; 915 (B) prior to enrollment in the electronic exchange of clinical health records the enrollee 916 shall receive notice of enrollment in the electronic exchange of clinical health records and the 917 right to opt out of participation at any time; and 918 (C) beginning July 1, 2012, when the program sends enrollment or renewal information 919 to the enrollee and when the enrollee logs onto the program's website, the enrollee shall receive 920 notice of the right to opt out of the electronic exchange of clinical health records. 921 (3) (a) The department shall, in accordance with Subsection (3)(b), report to the Social 922 Services Appropriations Subcommittee when the department: 923 (i) implements a change in the Medicaid State Plan; 924 (ii) initiates a new Medicaid waiver; 925 (iii) initiates an amendment to an existing Medicaid waiver; 926 (iv) applies for an extension of an application for a waiver or an existing Medicaid 02-10-23 5:41 PM S.B. 39 - 31 - 927 waiver; 928 (v) applies for or receives approval for a change in any capitation rate within the 929 Medicaid program; or 930 (vi) initiates a rate change that requires public notice under state or federal law. 931 (b) The report required by Subsection (3)(a) shall: 932 (i) be submitted to the Social Services Appropriations Subcommittee prior to the 933 department implementing the proposed change; and 934 (ii) include: 935 (A) a description of the department's current practice or policy that the department is 936 proposing to change; 937 (B) an explanation of why the department is proposing the change; 938 (C) the proposed change in services or reimbursement, including a description of the 939 effect of the change; 940 (D) the effect of an increase or decrease in services or benefits on individuals and 941 families; 942 (E) the degree to which any proposed cut may result in cost-shifting to more expensive 943 services in health or human service programs; and 944 (F) the fiscal impact of the proposed change, including: 945 (I) the effect of the proposed change on current or future appropriations from the 946 Legislature to the department; 947 (II) the effect the proposed change may have on federal matching dollars received by 948 the state Medicaid program; 949 (III) any cost shifting or cost savings within the department's budget that may result 950 from the proposed change; and 951 (IV) identification of the funds that will be used for the proposed change, including any 952 transfer of funds within the department's budget. 953 (4) Any rules adopted by the department under Subsection (2) are subject to review and 954 reauthorization by the Legislature in accordance with Section 63G-3-502. 955 (5) The department may, in its discretion, contract with [the Department of Human 956 Services or] other qualified agencies for services in connection with the administration of the 957 Medicaid program, including: S.B. 39 02-10-23 5:41 PM - 32 - 958 (a) the determination of the eligibility of individuals for the program; 959 (b) recovery of overpayments; and 960 (c) consistent with Section [26-20-13] 26B-3-1113, and to the extent permitted by law 961 and quality control services, enforcement of fraud and abuse laws. 962 (6) The department shall provide, by rule, disciplinary measures and sanctions for 963 Medicaid providers who fail to comply with the rules and procedures of the program, provided 964 that sanctions imposed administratively may not extend beyond: 965 (a) termination from the program; 966 (b) recovery of claim reimbursements incorrectly paid; and 967 (c) those specified in Section 1919 of Title XIX of the federal Social Security Act. 968 (7) (a) Funds collected as a result of a sanction imposed under Section 1919 of Title 969 XIX of the federal Social Security Act shall be deposited in the General Fund as dedicated 970 credits to be used by the division in accordance with the requirements of Section 1919 of Title 971 XIX of the federal Social Security Act. 972 (b) In accordance with Section 63J-1-602.2, sanctions collected under this Subsection 973 (7) are nonlapsing. 974 (8) (a) In determining whether an applicant or recipient is eligible for a service or 975 benefit under this part or [Chapter 40] Part 9, Utah Children's Health Insurance [Act] Program, 976 the department shall, if Subsection (8)(b) is satisfied, exclude from consideration one passenger 977 vehicle designated by the applicant or recipient. 978 (b) Before Subsection (8)(a) may be applied: 979 (i) the federal government shall: 980 (A) determine that Subsection (8)(a) may be implemented within the state's existing 981 public assistance-related waivers as of January 1, 1999; 982 (B) extend a waiver to the state permitting the implementation of Subsection (8)(a); or 983 (C) determine that the state's waivers that permit dual eligibility determinations for 984 cash assistance and Medicaid are no longer valid; and 985 (ii) the department shall determine that Subsection (8)(a) can be implemented within 986 existing funding. 987 (9) (a) [For purposes of] As used in this Subsection (9): 988 (i) "aged, blind, or has a disability" means an aged, blind, or disabled individual, as 02-10-23 5:41 PM S.B. 39 - 33 - 989 defined in 42 U.S.C. Sec. 1382c(a)(1); and 990 (ii) "spend down" means an amount of income in excess of the allowable income 991 standard that shall be paid in cash to the department or incurred through the medical services 992 not paid by Medicaid. 993 (b) In determining whether an applicant or recipient who is aged, blind, or has a 994 disability is eligible for a service or benefit under this chapter, the department shall use 100% 995 of the federal poverty level as: 996 (i) the allowable income standard for eligibility for services or benefits; and 997 (ii) the allowable income standard for eligibility as a result of spend down. 998 (10) The department shall conduct internal audits of the Medicaid program. 999 (11) (a) The department may apply for and, if approved, implement a demonstration 1000 program for health opportunity accounts, as provided for in 42 U.S.C. Sec. 1396u-8. 1001 (b) A health opportunity account established under Subsection (11)(a) shall be an 1002 alternative to the existing benefits received by an individual eligible to receive Medicaid under 1003 this chapter. 1004 (c) Subsection (11)(a) is not intended to expand the coverage of the Medicaid program. 1005 (12) (a) (i) The department shall apply for, and if approved, implement an amendment 1006 to the state plan under this Subsection (12) for benefits for: 1007 (A) medically needy pregnant women; 1008 (B) medically needy children; and 1009 (C) medically needy parents and caretaker relatives. 1010 (ii) The department may implement the eligibility standards of Subsection (12)(b) for 1011 eligibility determinations made on or after the date of the approval of the amendment to the 1012 state plan. 1013 (b) In determining whether an applicant is eligible for benefits described in Subsection 1014 (12)(a)(i), the department shall: 1015 (i) disregard resources held in an account in the savings plan created under Title 53B, 1016 Chapter 8a, Utah Educational Savings Plan, if the beneficiary of the account is: 1017 (A) under the age of 26; and 1018 (B) living with the account owner, as that term is defined in Section 53B-8a-102, or 1019 temporarily absent from the residence of the account owner; and S.B. 39 02-10-23 5:41 PM - 34 - 1020 (ii) include the withdrawals from an account in the Utah Educational Savings Plan as 1021 resources for a benefit determination, if the withdrawal was not used for qualified higher 1022 education costs as that term is defined in Section 53B-8a-102.5. 1023 (13) (a) The department may not deny or terminate eligibility for Medicaid solely 1024 because an individual is: 1025 (i) incarcerated; and 1026 (ii) not an inmate as defined in Section 64-13-1. 1027 (b) Subsection (13)(a) does not require the Medicaid program to provide coverage for 1028 any services for an individual while the individual is incarcerated. 1029 (14) The department is a party to, and may intervene at any time in, any judicial or 1030 administrative action: 1031 (a) to which the Department of Workforce Services is a party; and 1032 (b) that involves medical assistance under[:] this chapter. 1033 [(i) Title 26, Chapter 18, Medical Assistance Act; or] 1034 [(ii) Title 26, Chapter 40, Utah Children's Health Insurance Act.] 1035 Section 9. Section 26B-3-109, which is renumbered from Section 26-18-3.1 is 1036 renumbered and amended to read: 1037 [26-18-3.1]. 26B-3-109. Medicaid expansion. 1038 (1) The purpose of this section is to expand the coverage of the Medicaid program to 1039 persons who are in categories traditionally not served by that program. 1040 (2) Within appropriations from the Legislature, the department may amend the state 1041 plan for medical assistance to provide for eligibility for Medicaid: 1042 (a) on or after July 1, 1994, for children 12 to 17 years old who live in households 1043 below the federal poverty income guideline; and 1044 (b) on or after July 1, 1995, for persons who have incomes below the federal poverty 1045 income guideline and who are aged, blind, or have a disability. 1046 (3) (a) Within appropriations from the Legislature, on or after July 1, 1996, the 1047 Medicaid program may provide for eligibility for persons who have incomes below the federal 1048 poverty income guideline. 1049 (b) In order to meet the provisions of this subsection, the department may seek 1050 approval for a demonstration project under 42 U.S.C. Sec. 1315 from the secretary of the 02-10-23 5:41 PM S.B. 39 - 35 - 1051 United States Department of Health and Human Services. 1052 (4) The Medicaid program shall provide for eligibility for persons as required by 1053 Subsection [26-18-3.9] 26B-3-113(2). 1054 (5) Services available for persons described in this section shall include required 1055 Medicaid services and may include one or more optional Medicaid services if those services 1056 are funded by the Legislature. The department may also require persons described in 1057 Subsections (1) through (3) to meet an asset test. 1058 Section 10. Section 26B-3-110, which is renumbered from Section 26-18-3.5 is 1059 renumbered and amended to read: 1060 [26-18-3.5]. 26B-3-110. Copayments by recipients -- Employer sponsored plans. 1061 (1) The department shall selectively provide for enrollment fees, premiums, 1062 deductions, cost sharing or other similar charges to be paid by recipients, their spouses, and 1063 parents, within the limitations of federal law and regulation. 1064 (2) Beginning May 1, 2006, within appropriations by the Legislature and as a means to 1065 increase health care coverage among the uninsured, the department shall take steps to promote 1066 increased participation in employer sponsored health insurance, including: 1067 (a) maximizing the health insurance premium subsidy provided under the state's 1115 1068 demonstration waiver by: 1069 (i) ensuring that state funds are matched by federal funds to the greatest extent 1070 allowable; and 1071 (ii) as the department determines appropriate, seeking federal approval to do one or 1072 more of the following: 1073 (A) eliminate or otherwise modify the annual enrollment fee; 1074 (B) eliminate or otherwise modify the schedule used to determine the level of subsidy 1075 provided to an enrollee each year; 1076 (C) reduce the maximum number of participants allowable under the subsidy program; 1077 or 1078 (D) otherwise modify the program in a manner that promotes enrollment in employer 1079 sponsored health insurance; and 1080 (b) exploring the use of other options, including the development of a waiver under the 1081 Medicaid Health Insurance Flexibility Demonstration Initiative or other federal authority. S.B. 39 02-10-23 5:41 PM - 36 - 1082 Section 11. Section 26B-3-111, which is renumbered from Section 26-18-3.6 is 1083 renumbered and amended to read: 1084 [26-18-3.6]. 26B-3-111. Income and resources from institutionalized spouses. 1085 (1) As used in this section: 1086 (a) "Community spouse" means the spouse of an institutionalized spouse. 1087 (b) (i) "Community spouse monthly income allowance" means an amount by which the 1088 minimum monthly maintenance needs allowance for the spouse exceeds the amount of monthly 1089 income otherwise available to the community spouse, determined without regard to the 1090 allowance, except as provided in Subsection (1)(b)(ii). 1091 (ii) If a court has entered an order against an institutionalized spouse for monthly 1092 income for the support of the community spouse, the community spouse monthly income 1093 allowance for the spouse may not be less than the amount of the monthly income so ordered. 1094 (c) "Community spouse resource allowance" is the amount of combined resources that 1095 are protected for a community spouse living in the community, which the division shall 1096 establish by rule made in accordance with Title 63G, Chapter 3, Utah Administrative 1097 Rulemaking Act, based on the amounts established by the United States Department of Health 1098 and Human Services. 1099 (d) "Excess shelter allowance" for a community spouse means the amount by which the 1100 sum of the spouse's expense for rent or mortgage payment, taxes, and insurance, and in the case 1101 of condominium or cooperative, required maintenance charge, for the community spouse's 1102 principal residence and the spouse's actual expenses for electricity, natural gas, and water 1103 utilities or, at the discretion of the department, the federal standard utility allowance under 1104 SNAP as defined in Section 35A-1-102, exceeds 30% of the amount described in Subsection 1105 (9). 1106 (e) "Family member" means a minor dependent child, dependent parents, or dependent 1107 sibling of the institutionalized spouse or community spouse who are residing with the 1108 community spouse. 1109 (f) (i) "Institutionalized spouse" means a person who is residing in a nursing facility 1110 and is married to a spouse who is not in a nursing facility. 1111 (ii) An "institutionalized spouse" does not include a person who is not likely to reside 1112 in a nursing facility for at least 30 consecutive days. 02-10-23 5:41 PM S.B. 39 - 37 - 1113 (g) "Nursing care facility" means the same as that term is defined in Section [26-21-2] 1114 26B-2-201. 1115 (2) The division shall comply with this section when determining eligibility for 1116 medical assistance for an institutionalized spouse. 1117 (3) For services furnished during a calendar year beginning on or after January 1, 1999, 1118 the community spouse resource allowance shall be increased by the division by an amount as 1119 determined annually by CMS. 1120 (4) The division shall compute, as of the beginning of the first continuous period of 1121 institutionalization of the institutionalized spouse: 1122 (a) the total value of the resources to the extent either the institutionalized spouse or 1123 the community spouse has an ownership interest; and 1124 (b) a spousal share, which is 1/2 of the resources described in Subsection (4)(a). 1125 (5) At the request of an institutionalized spouse or a community spouse, at the 1126 beginning of the first continuous period of institutionalization of the institutionalized spouse 1127 and upon the receipt of relevant documentation of resources, the division shall promptly assess 1128 and document the total value described in Subsection (4)(a) and shall provide a copy of that 1129 assessment and documentation to each spouse and shall retain a copy of the assessment. When 1130 the division provides a copy of the assessment, it shall include a notice stating that the spouse 1131 may request a hearing under Subsection (11). 1132 (6) When determining eligibility for medical assistance under this chapter: 1133 (a) Except as provided in Subsection (6)(b), all resources held by either the 1134 institutionalized spouse, community spouse, or both, are considered to be available to the 1135 institutionalized spouse. 1136 (b) Resources are considered to be available to the institutionalized spouse only to the 1137 extent that the amount of those resources exceeds the community spouse resource allowance at 1138 the time of application for medical assistance under this chapter. 1139 (7) (a) The division may not find an institutionalized spouse to be ineligible for 1140 medical assistance by reason of resources determined under Subsection (5) to be available for 1141 the cost of care when: 1142 (i) the institutionalized spouse has assigned to the state any rights to support from the 1143 community spouse; S.B. 39 02-10-23 5:41 PM - 38 - 1144 (ii) except as provided in Subsection (7)(b), the institutionalized spouse lacks the 1145 ability to execute an assignment due to physical or mental impairment; or 1146 (iii) the division determines that denial of medical assistance would cause an undue 1147 burden. 1148 (b) Subsection (7)(a)(ii) does not prevent the division from seeking a court order for an 1149 assignment of support. 1150 (8) During the continuous period in which an institutionalized spouse is in an 1151 institution and after the month in which an institutionalized spouse is eligible for medical 1152 assistance, the resources of the community spouse may not be considered to be available to the 1153 institutionalized spouse. 1154 (9) When an institutionalized spouse is determined to be eligible for medical 1155 assistance, in determining the amount of the spouse's income that is to be applied monthly for 1156 the cost of care in the nursing care facility, the division shall deduct from the spouse's monthly 1157 income the following amounts in the following order: 1158 (a) a personal needs allowance, the amount of which is determined by the division; 1159 (b) a community spouse monthly income allowance, but only to the extent that the 1160 income of the institutionalized spouse is made available to, or for the benefit of, the community 1161 spouse; 1162 (c) a family allowance for each family member, equal to at least 1/3 of the amount that 1163 the amount described in Subsection (10)(a) exceeds the amount of the family member's 1164 monthly income; and 1165 (d) amounts for incurred expenses for the medical or remedial care for the 1166 institutionalized spouse. 1167 (10) The division shall establish a minimum monthly maintenance needs allowance for 1168 each community spouse that includes: 1169 (a) an amount established by the division by rule made in accordance with Title 63G, 1170 Chapter 3, Utah Administrative Rulemaking Act, based on the amounts established by the 1171 United States Department of Health and Human Services; and 1172 (b) an excess shelter allowance. 1173 (11) (a) An institutionalized spouse or a community spouse may request a hearing with 1174 respect to the determinations described in Subsections (11)(e)(i) through (v) if an application 02-10-23 5:41 PM S.B. 39 - 39 - 1175 for medical assistance has been made on behalf of the institutionalized spouse. 1176 (b) A hearing under this subsection regarding the community spouse resource 1177 allowance shall be held by the division within 90 days from the date of the request for the 1178 hearing. 1179 (c) If either spouse establishes that the community spouse needs income, above the 1180 level otherwise provided by the minimum monthly maintenance needs allowance, due to 1181 exceptional circumstances resulting in significant financial duress, there shall be substituted, 1182 for the minimum monthly maintenance needs allowance provided under Subsection (10), an 1183 amount adequate to provide additional income as is necessary. 1184 (d) If either spouse establishes that the community spouse resource allowance, in 1185 relation to the amount of income generated by the allowance is inadequate to raise the 1186 community spouse's income to the minimum monthly maintenance needs allowance, there shall 1187 be substituted, for the community spouse resource allowance, an amount adequate to provide a 1188 minimum monthly maintenance needs allowance. 1189 (e) A hearing may be held under this subsection if either the institutionalized spouse or 1190 community spouse is dissatisfied with a determination of: 1191 (i) the community spouse monthly income allowance; 1192 (ii) the amount of monthly income otherwise available to the community spouse; 1193 (iii) the computation of the spousal share of resources under Subsection (4); 1194 (iv) the attribution of resources under Subsection (6); or 1195 (v) the determination of the community spouse resource allocation. 1196 (12) (a) An institutionalized spouse may transfer an amount equal to the community 1197 spouse resource allowance, but only to the extent the resources of the institutionalized spouse 1198 are transferred to or for the sole benefit of the community spouse. 1199 (b) The transfer under Subsection (12)(a) shall be made as soon as practicable after the 1200 date of the initial determination of eligibility, taking into account the time necessary to obtain a 1201 court order under Subsection (12)(c). 1202 (c) [Chapter 19, Medical Benefits Recovery Act] Part 10, Medical Benefits Recovery, 1203 does not apply if a court has entered an order against an institutionalized spouse for the support 1204 of the community spouse. 1205 Section 12. Section 26B-3-112, which is renumbered from Section 26-18-3.8 is S.B. 39 02-10-23 5:41 PM - 40 - 1206 renumbered and amended to read: 1207 [26-18-3.8]. 26B-3-112. Maximizing use of premium assistance programs -- 1208 Utah's Premium Partnership for Health Insurance. 1209 (1) (a) The department shall seek to maximize the use of Medicaid and Children's 1210 Health Insurance Program funds for assistance in the purchase of private health insurance 1211 coverage for Medicaid-eligible and non-Medicaid-eligible individuals. 1212 (b) The department's efforts to expand the use of premium assistance shall: 1213 (i) include, as necessary, seeking federal approval under all Medicaid and Children's 1214 Health Insurance Program premium assistance provisions of federal law, including provisions 1215 of [the Patient Protection and Affordable Care Act, Public Law 111-148] PPACA; 1216 (ii) give priority to, but not be limited to, expanding the state's Utah Premium 1217 Partnership for Health Insurance Program, including as required under Subsection (2); and 1218 (iii) encourage the enrollment of all individuals within a household in the same plan, 1219 where possible, including enrollment in a plan that allows individuals within the household 1220 transitioning out of Medicaid to retain the same network and benefits they had while enrolled 1221 in Medicaid. 1222 (2) The department shall seek federal approval of an amendment to the state's Utah 1223 Premium Partnership for Health Insurance program to adjust the eligibility determination for 1224 single adults and parents who have an offer of employer sponsored insurance. The amendment 1225 shall: 1226 (a) be within existing appropriations for the Utah Premium Partnership for Health 1227 Insurance program; and 1228 (b) provide that adults who are up to 200% of the federal poverty level are eligible for 1229 premium subsidies in the Utah Premium Partnership for Health Insurance program. 1230 (3) For the fiscal year 2020-21, the department shall seek authority to increase the 1231 maximum premium subsidy per month for adults under the Utah Premium Partnership for 1232 Health Insurance program to $300. 1233 (4) Beginning with the fiscal year 2021-22, and in each subsequent fiscal year, the 1234 department may increase premium subsidies for single adults and parents who have an offer of 1235 employer-sponsored insurance to keep pace with the increase in insurance premium costs, 1236 subject to appropriation of additional funding. 02-10-23 5:41 PM S.B. 39 - 41 - 1237 Section 13. Section 26B-3-113, which is renumbered from Section 26-18-3.9 is 1238 renumbered and amended to read: 1239 [26-18-3.9]. 26B-3-113. Expanding the Medicaid program. 1240 (1) As used in this section: 1241 [(a) "CMS" means the Centers for Medicare and Medicaid Services in the United 1242 States Department of Health and Human Services.] 1243 [(b)] (a) "Federal poverty level" means the same as that term is defined in Section 1244 [26-18-411] 26B-3-207. 1245 [(c)] (b) "Medicaid expansion" means an expansion of the Medicaid program in 1246 accordance with this section. 1247 [(d)] (c) "Medicaid Expansion Fund" means the Medicaid Expansion Fund created in 1248 Section [26-36b-208] 26B-1-315. 1249 (2) (a) As set forth in Subsections (2) through (5), eligibility criteria for the Medicaid 1250 program shall be expanded to cover additional low-income individuals. 1251 (b) The department shall continue to seek approval from CMS to implement the 1252 Medicaid waiver expansion as defined in Section [26-18-415] 26B-1-112. 1253 (c) The department may implement any provision described in Subsections 1254 [26-18-415] 26B-3-112(2)(b)(iii) through (viii) in a Medicaid expansion if the department 1255 receives approval from CMS to implement that provision. 1256 (3) The department shall expand the Medicaid program in accordance with this 1257 Subsection (3) if the department: 1258 (a) receives approval from CMS to: 1259 (i) expand Medicaid coverage to eligible individuals whose income is below 95% of 1260 the federal poverty level; 1261 (ii) obtain maximum federal financial participation under 42 U.S.C. Sec. 1396d(b) for 1262 enrolling an individual in the Medicaid expansion under this Subsection (3); and 1263 (iii) permit the state to close enrollment in the Medicaid expansion under this 1264 Subsection (3) if the department has insufficient funds to provide services to new enrollment 1265 under the Medicaid expansion under this Subsection (3); 1266 (b) pays the state portion of costs for the Medicaid expansion under this Subsection (3) 1267 with funds from: S.B. 39 02-10-23 5:41 PM - 42 - 1268 (i) the Medicaid Expansion Fund; 1269 (ii) county contributions to the nonfederal share of Medicaid expenditures; or 1270 (iii) any other contributions, funds, or transfers from a nonstate agency for Medicaid 1271 expenditures; and 1272 (c) closes the Medicaid program to new enrollment under the Medicaid expansion 1273 under this Subsection (3) if the department projects that the cost of the Medicaid expansion 1274 under this Subsection (3) will exceed the appropriations for the fiscal year that are authorized 1275 by the Legislature through an appropriations act adopted in accordance with Title 63J, Chapter 1276 1, Budgetary Procedures Act. 1277 (4) (a) The department shall expand the Medicaid program in accordance with this 1278 Subsection (4) if the department: 1279 (i) receives approval from CMS to: 1280 (A) expand Medicaid coverage to eligible individuals whose income is below 95% of 1281 the federal poverty level; 1282 (B) obtain maximum federal financial participation under 42 U.S.C. Sec. 1396d(y) for 1283 enrolling an individual in the Medicaid expansion under this Subsection (4); and 1284 (C) permit the state to close enrollment in the Medicaid expansion under this 1285 Subsection (4) if the department has insufficient funds to provide services to new enrollment 1286 under the Medicaid expansion under this Subsection (4); 1287 (ii) pays the state portion of costs for the Medicaid expansion under this Subsection (4) 1288 with funds from: 1289 (A) the Medicaid Expansion Fund; 1290 (B) county contributions to the nonfederal share of Medicaid expenditures; or 1291 (C) any other contributions, funds, or transfers from a nonstate agency for Medicaid 1292 expenditures; and 1293 (iii) closes the Medicaid program to new enrollment under the Medicaid expansion 1294 under this Subsection (4) if the department projects that the cost of the Medicaid expansion 1295 under this Subsection (4) will exceed the appropriations for the fiscal year that are authorized 1296 by the Legislature through an appropriations act adopted in accordance with Title 63J, Chapter 1297 1, Budgetary Procedures Act. 1298 (b) The department shall submit a waiver, an amendment to an existing waiver, or a 02-10-23 5:41 PM S.B. 39 - 43 - 1299 state plan amendment to CMS to: 1300 (i) administer federal funds for the Medicaid expansion under this Subsection (4) 1301 according to a per capita cap developed by the department that includes an annual inflationary 1302 adjustment, accounts for differences in cost among categories of Medicaid expansion enrollees, 1303 and provides greater flexibility to the state than the current Medicaid payment model; 1304 (ii) limit, in certain circumstances as defined by the department, the ability of a 1305 qualified entity to determine presumptive eligibility for Medicaid coverage for an individual 1306 enrolled in a Medicaid expansion under this Subsection (4); 1307 (iii) impose a lock-out period if an individual enrolled in a Medicaid expansion under 1308 this Subsection (4) violates certain program requirements as defined by the department; 1309 (iv) allow an individual enrolled in a Medicaid expansion under this Subsection (4) to 1310 remain in the Medicaid program for up to a 12-month certification period as defined by the 1311 department; and 1312 (v) allow federal Medicaid funds to be used for housing support for eligible enrollees 1313 in the Medicaid expansion under this Subsection (4). 1314 (5) (a) (i) If CMS does not approve a waiver to expand the Medicaid program in 1315 accordance with Subsection (4)(a) on or before January 1, 2020, the department shall develop 1316 proposals to implement additional flexibilities and cost controls, including cost sharing tools, 1317 within a Medicaid expansion under this Subsection (5) through a request to CMS for a waiver 1318 or state plan amendment. 1319 (ii) The request for a waiver or state plan amendment described in Subsection (5)(a)(i) 1320 shall include: 1321 (A) a path to self-sufficiency for qualified adults in the Medicaid expansion that 1322 includes employment and training as defined in 7 U.S.C. Sec. 2015(d)(4); and 1323 (B) a requirement that an individual who is offered a private health benefit plan by an 1324 employer to enroll in the employer's health plan. 1325 (iii) The department shall submit the request for a waiver or state plan amendment 1326 developed under Subsection (5)(a)(i) on or before March 15, 2020. 1327 (b) Notwithstanding Sections [26-18-18] 26B-3-127 and 63J-5-204, and in accordance 1328 with this Subsection (5), eligibility for the Medicaid program shall be expanded to include all 1329 persons in the optional Medicaid expansion population under [the Patient Protection and S.B. 39 02-10-23 5:41 PM - 44 - 1330 Affordable Care Act, Pub. L. No. 111-148] PPACA and the Health Care Education 1331 Reconciliation Act of 2010, Pub. L. No. 111-152, and related federal regulations and guidance, 1332 on the earlier of: 1333 (i) the day on which CMS approves a waiver to implement the provisions described in 1334 Subsections (5)(a)(ii)(A) and (B); or 1335 (ii) July 1, 2020. 1336 (c) The department shall seek a waiver, or an amendment to an existing waiver, from 1337 federal law to: 1338 (i) implement each provision described in Subsections [26-18-415] 1339 26B-3-210(2)(b)(iii) through (viii) in a Medicaid expansion under this Subsection (5); 1340 (ii) limit, in certain circumstances as defined by the department, the ability of a 1341 qualified entity to determine presumptive eligibility for Medicaid coverage for an individual 1342 enrolled in a Medicaid expansion under this Subsection (5); and 1343 (iii) impose a lock-out period if an individual enrolled in a Medicaid expansion under 1344 this Subsection (5) violates certain program requirements as defined by the department. 1345 (d) The eligibility criteria in this Subsection (5) shall be construed to include all 1346 individuals eligible for the health coverage improvement program under Section [26-18-411] 1347 26B-3-207. 1348 (e) The department shall pay the state portion of costs for a Medicaid expansion under 1349 this Subsection (5) entirely from: 1350 (i) the Medicaid Expansion Fund; 1351 (ii) county contributions to the nonfederal share of Medicaid expenditures; or 1352 (iii) any other contributions, funds, or transfers from a nonstate agency for Medicaid 1353 expenditures. 1354 (f) If the costs of the Medicaid expansion under this Subsection (5) exceed the funds 1355 available under Subsection (5)(e): 1356 (i) the department may reduce or eliminate optional Medicaid services under this 1357 chapter; and 1358 (ii) savings, as determined by the department, from the reduction or elimination of 1359 optional Medicaid services under Subsection (5)(f)(i) shall be deposited into the Medicaid 1360 Expansion Fund; and 02-10-23 5:41 PM S.B. 39 - 45 - 1361 (iii) the department may submit to CMS a request for waivers, or an amendment of 1362 existing waivers, from federal law necessary to implement budget controls within the Medicaid 1363 program to address the deficiency. 1364 (g) If the costs of the Medicaid expansion under this Subsection (5) are projected by 1365 the department to exceed the funds available in the current fiscal year under Subsection (5)(e), 1366 including savings resulting from any action taken under Subsection (5)(f): 1367 (i) the governor shall direct the [Department of Health, Department of Human 1368 Services,] department and Department of Workforce Services to reduce commitments and 1369 expenditures by an amount sufficient to offset the deficiency: 1370 (A) proportionate to the share of total current fiscal year General Fund appropriations 1371 for each of those agencies; and 1372 (B) up to 10% of each agency's total current fiscal year General Fund appropriations; 1373 (ii) the Division of Finance shall reduce allotments to the [Department of Health, 1374 Department of Human Services,] department and Department of Workforce Services by a 1375 percentage: 1376 (A) proportionate to the amount of the deficiency; and 1377 (B) up to 10% of each agency's total current fiscal year General Fund appropriations; 1378 and 1379 (iii) the Division of Finance shall deposit the total amount from the reduced allotments 1380 described in Subsection (5)(g)(ii) into the Medicaid Expansion Fund. 1381 (6) The department shall maximize federal financial participation in implementing this 1382 section, including by seeking to obtain any necessary federal approvals or waivers. 1383 (7) Notwithstanding Sections 17-43-201 and 17-43-301, a county does not have to 1384 provide matching funds to the state for the cost of providing Medicaid services to newly 1385 enrolled individuals who qualify for Medicaid coverage under a Medicaid expansion. 1386 (8) The department shall report to the Social Services Appropriations Subcommittee on 1387 or before November 1 of each year that a Medicaid expansion is operational: 1388 (a) the number of individuals who enrolled in the Medicaid expansion; 1389 (b) costs to the state for the Medicaid expansion; 1390 (c) estimated costs to the state for the Medicaid expansion for the current and 1391 following fiscal years; S.B. 39 02-10-23 5:41 PM - 46 - 1392 (d) recommendations to control costs of the Medicaid expansion; and 1393 (e) as calculated in accordance with Subsections [26-36b-204] 26B-3-506(4) and 1394 [26-36c-204] 26B-3-606(2), the state's net cost of the qualified Medicaid expansion. 1395 Section 14. Section 26B-3-114, which is renumbered from Section 26-18-4 is 1396 renumbered and amended to read: 1397 [26-18-4]. 26B-3-114. Department standards for eligibility under Medicaid -- 1398 Funds for abortions. 1399 (1) (a) The department may develop standards and administer policies relating to 1400 eligibility under the Medicaid program as long as they are consistent with Subsection [26-18-3] 1401 26B-4-704(8). 1402 (b) An applicant receiving Medicaid assistance may be limited to particular types of 1403 care or services or to payment of part or all costs of care determined to be medically necessary. 1404 (2) The department may not provide any funds for medical, hospital, or other medical 1405 expenditures or medical services to otherwise eligible persons where the purpose of the 1406 assistance is to perform an abortion, unless the life of the mother would be endangered if an 1407 abortion were not performed. 1408 (3) Any employee of the department who authorizes payment for an abortion contrary 1409 to the provisions of this section is guilty of a class B misdemeanor and subject to forfeiture of 1410 office. 1411 (4) Any person or organization that, under the guise of other medical treatment, 1412 provides an abortion under auspices of the Medicaid program is guilty of a third degree felony 1413 and subject to forfeiture of license to practice medicine or authority to provide medical services 1414 and treatment. 1415 Section 15. Section 26B-3-115, which is renumbered from Section 26-18-5 is 1416 renumbered and amended to read: 1417 [26-18-5]. 26B-3-115. Contracts for provision of medical services -- Federal 1418 provisions modifying department rules -- Compliance with Social Security Act. 1419 (1) The department may contract with other public or private agencies to purchase or 1420 provide medical services in connection with the programs of the division. Where these 1421 programs are used by other government entities, contracts shall provide that other government 1422 entities, in compliance with state and federal law regarding intergovernmental transfers, 02-10-23 5:41 PM S.B. 39 - 47 - 1423 transfer the state matching funds to the department in amounts sufficient to satisfy needs of the 1424 specified program. 1425 (2) Contract terms shall include provisions for maintenance, administration, and 1426 service costs. 1427 (3) If a federal legislative or executive provision requires modifications or revisions in 1428 an eligibility factor established under this chapter as a condition for participation in medical 1429 assistance, the department may modify or change its rules as necessary to qualify for 1430 participation. 1431 (4) The provisions of this section do not apply to department rules governing abortion. 1432 (5) The department shall comply with all pertinent requirements of the Social Security 1433 Act and all orders, rules, and regulations adopted thereunder when required as a condition of 1434 participation in benefits under the Social Security Act. 1435 Section 16. Section 26B-3-116, which is renumbered from Section 26-18-5.5 is 1436 renumbered and amended to read: 1437 [26-18-5.5]. 26B-3-116. Liability insurance required. 1438 The Medicaid program may not reimburse a home health agency, as defined in Section 1439 [26-21-2] 26B-2-201, for home health services provided to an enrollee unless the home health 1440 agency has liability coverage of: 1441 (1) at least $500,000 per incident; or 1442 (2) an amount established by department rule made in accordance with Title 63G, 1443 Chapter 3, Utah Administrative Rulemaking Act. 1444 Section 17. Section 26B-3-117, which is renumbered from Section 26-18-6 is 1445 renumbered and amended to read: 1446 [26-18-6]. 26B-3-117. Federal aid -- Authority of executive director. 1447 (1) The executive director, with the approval of the governor, may bind the state to any 1448 executive or legislative provisions promulgated or enacted by the federal government which 1449 invite the state to participate in the distribution, disbursement or administration of any fund or 1450 service advanced, offered or contributed in whole or in part by the federal government for 1451 purposes consistent with the powers and duties of the department. 1452 (2) Such funds shall be used as provided in this chapter and be administered by the 1453 department for purposes related to medical assistance programs. S.B. 39 02-10-23 5:41 PM - 48 - 1454 Section 18. Section 26B-3-118, which is renumbered from Section 26-18-7 is 1455 renumbered and amended to read: 1456 [26-18-7]. 26B-3-118. Medical vendor rates. 1457 (1) Medical vendor payments made to providers of services for and in behalf of 1458 recipient households shall be based upon predetermined rates from standards developed by the 1459 division in cooperation with providers of services for each type of service purchased by the 1460 division. 1461 (2) As far as possible, the rates paid for services shall be established in advance of the 1462 fiscal year for which funds are to be requested. 1463 Section 19. Section 26B-3-119, which is renumbered from Section 26-18-8 is 1464 renumbered and amended to read: 1465 [26-18-8]. 26B-3-119. Enforcement of public assistance statutes. 1466 (1) The department shall enforce or contract for the enforcement of Sections 1467 35A-1-503, 35A-3-108, 35A-3-110, 35A-3-111, 35A-3-112, and 35A-3-603 to the extent that 1468 these sections pertain to benefits conferred or administered by the division under this chapter, 1469 to the extent allowed under federal law or regulation. 1470 (2) The department may contract for services covered in Section 35A-3-111 insofar as 1471 that section pertains to benefits conferred or administered by the division under this chapter. 1472 Section 20. Section 26B-3-120, which is renumbered from Section 26-18-9 is 1473 renumbered and amended to read: 1474 [26-18-9]. 26B-3-120. Prohibited acts of state or local employees of Medicaid 1475 program -- Violation a misdemeanor. 1476 (1) Each state or local employee responsible for the expenditure of funds under the 1477 state Medicaid program, each individual who formerly was such an officer or employee, and 1478 each partner of such an officer or employee is prohibited for a period of one year after 1479 termination of such responsibility from committing any act, the commission of which by an 1480 officer or employee of the United States Government, an individual who was such an officer or 1481 employee, or a partner of such an officer or employee is prohibited by Section 207 or Section 1482 208 of Title 18, United States Code. 1483 (2) Violation of this section is a class A misdemeanor. 1484 Section 21. Section 26B-3-121, which is renumbered from Section 26-18-11 is 02-10-23 5:41 PM S.B. 39 - 49 - 1485 renumbered and amended to read: 1486 [26-18-11]. 26B-3-121. Rural hospitals. 1487 (1) [For purposes of] As used in this section "rural hospital" means a hospital located 1488 outside of a standard metropolitan statistical area, as designated by the United States Bureau of 1489 the Census. 1490 (2) For purposes of the Medicaid program, the [Division of Medicaid and Health 1491 Financing] division may not discriminate among rural hospitals on the basis of size. 1492 Section 22. Section 26B-3-122, which is renumbered from Section 26-18-13 is 1493 renumbered and amended to read: 1494 [26-18-13]. 26B-3-122. Telemedicine -- Reimbursement -- Rulemaking. 1495 (1) (a) As used in this section, communication by telemedicine is considered 1496 face-to-face contact between a health care provider and a patient under the state's medical 1497 assistance program if: 1498 (i) the communication by telemedicine meets the requirements of administrative rules 1499 adopted in accordance with Subsection (3); and 1500 (ii) the health care services are eligible for reimbursement under the state's medical 1501 assistance program. 1502 (b) This Subsection (1) applies to any managed care organization that contracts with 1503 the state's medical assistance program. 1504 (2) The reimbursement rate for telemedicine services approved under this section: 1505 (a) shall be subject to reimbursement policies set by the state plan; and 1506 (b) may be based on: 1507 (i) a monthly reimbursement rate; 1508 (ii) a daily reimbursement rate; or 1509 (iii) an encounter rate. 1510 (3) The department shall adopt administrative rules in accordance with Title 63G, 1511 Chapter 3, Utah Administrative Rulemaking Act, which establish: 1512 (a) the particular telemedicine services that are considered face-to-face encounters for 1513 reimbursement purposes under the state's medical assistance program; and 1514 (b) the reimbursement methodology for the telemedicine services designated under 1515 Subsection (3)(a). S.B. 39 02-10-23 5:41 PM - 50 - 1516 Section 23. Section 26B-3-123, which is renumbered from Section 26-18-13.5 is 1517 renumbered and amended to read: 1518 [26-18-13.5]. 26B-3-123. Reimbursement of telemedicine services and 1519 telepsychiatric consultations. 1520 (1) As used in this section: 1521 (a) "Telehealth services" means the same as that term is defined in Section [26-60-102] 1522 26B-4-704. 1523 (b) "Telemedicine services" means the same as that term is defined in Section 1524 [26-60-102] 26B-4-704. 1525 (c) "Telepsychiatric consultation" means a consultation between a physician and a 1526 board certified psychiatrist, both of whom are licensed to engage in the practice of medicine in 1527 the state, that utilizes: 1528 (i) the health records of the patient, provided from the patient or the referring 1529 physician; 1530 (ii) a written, evidence-based patient questionnaire; and 1531 (iii) telehealth services that meet industry security and privacy standards, including 1532 compliance with the: 1533 (A) Health Insurance Portability and Accountability Act; and 1534 (B) Health Information Technology for Economic and Clinical Health Act, Pub. L. No. 1535 111-5, 123 Stat. 226, 467, as amended. 1536 (2) This section applies to: 1537 (a) a managed care organization that contracts with the Medicaid program; and 1538 (b) a provider who is reimbursed for health care services under the Medicaid program. 1539 (3) The Medicaid program shall reimburse for telemedicine services at the same rate 1540 that the Medicaid program reimburses for other health care services. 1541 (4) The Medicaid program shall reimburse for telepsychiatric consultations at a rate set 1542 by the Medicaid program. 1543 Section 24. Section 26B-3-124, which is renumbered from Section 26-18-15 is 1544 renumbered and amended to read: 1545 [26-18-15]. 26B-3-124. Process to promote health insurance coverage for 1546 children. 02-10-23 5:41 PM S.B. 39 - 51 - 1547 (1) The department, in collaboration with the Department of Workforce Services and 1548 the State Board of Education, shall develop a process to promote health insurance coverage for 1549 a child in school when: 1550 (a) the child applies for free or reduced price school lunch; 1551 (b) a child enrolls in or registers in school; and 1552 (c) other appropriate school related opportunities. 1553 (2) The department, in collaboration with the Department of Workforce Services, shall 1554 promote and facilitate the enrollment of children identified under Subsection (1) without health 1555 insurance in the Utah Children's Health Insurance Program, the Medicaid program, or the Utah 1556 Premium Partnership for Health Insurance Program. 1557 Section 25. Section 26B-3-125, which is renumbered from Section 26-18-16 is 1558 renumbered and amended to read: 1559 [26-18-16]. 26B-3-125. Medicaid -- Continuous eligibility -- Promoting payment 1560 and delivery reform. 1561 (1) In accordance with Subsection (2), and within appropriations from the Legislature, 1562 the department may amend the state Medicaid plan to: 1563 (a) create continuous eligibility for up to 12 months for an individual who has qualified 1564 for the state Medicaid program; 1565 (b) provide incentives in managed care contracts for an individual to obtain appropriate 1566 care in appropriate settings; and 1567 (c) require the managed care system to accept the risk of managing the Medicaid 1568 population assigned to the plan amendment in return for receiving the benefits of providing 1569 quality and cost effective care. 1570 (2) If the department amends the state Medicaid plan under Subsection (1)(a) or (b), 1571 the department: 1572 (a) shall ensure that the plan amendment: 1573 (i) is cost effective for the state Medicaid program; 1574 (ii) increases the quality and continuity of care for recipients; and 1575 (iii) calculates and transfers administrative savings from continuous enrollment from 1576 the Department of Workforce Services to the [Department of Health] department; and 1577 (b) may limit the plan amendment under Subsection (1)(a) or (b) to select geographic S.B. 39 02-10-23 5:41 PM - 52 - 1578 areas or specific Medicaid populations. 1579 (3) The department may seek approval for a state plan amendment, waiver, or a 1580 demonstration project from the Secretary of the United States Department of Health and 1581 Human Services if necessary to implement a plan amendment under Subsection (1)(a) or (b). 1582 Section 26. Section 26B-3-126, which is renumbered from Section 26-18-17 is 1583 renumbered and amended to read: 1584 [26-18-17]. 26B-3-126. Patient notice of health care provider privacy practices. 1585 (1) (a) For purposes of this section: 1586 (i) "Health care provider" means a health care provider as defined in Section 1587 78B-3-403 who: 1588 (A) receives payment for medical services from the Medicaid program established in 1589 this chapter, or the Children's Health Insurance Program established in [Chapter 40, Utah 1590 Children's Health Insurance Act] Section 26B-3-902; and 1591 (B) submits a patient's personally identifiable information to the Medicaid eligibility 1592 database or the Children's Health Insurance Program eligibility database. 1593 (ii) "HIPAA" means 45 C.F.R. Parts 160, 162, and 164, Health Insurance Portability 1594 and Accountability Act of 1996, as amended. 1595 (b) Beginning July 1, 2013, this section applies to the Medicaid program, the 1596 Children's Health Insurance Program created in [Chapter 40, Utah Children's Health Insurance 1597 Act] Section 26B-3-902, and a health care provider. 1598 (2) A health care provider shall, as part of the notice of privacy practices required by 1599 HIPAA, provide notice to the patient or the patient's personal representative that the health care 1600 provider either has, or may submit, personally identifiable information about the patient to the 1601 Medicaid eligibility database and the Children's Health Insurance Program eligibility database. 1602 (3) The Medicaid program and the Children's Health Insurance Program may not give a 1603 health care provider access to the Medicaid eligibility database or the Children's Health 1604 Insurance Program eligibility database unless the health care provider's notice of privacy 1605 practices complies with Subsection (2). 1606 (4) The department may adopt an administrative rule to establish uniform language for 1607 the state requirement regarding notice of privacy practices to patients required under 1608 Subsection (2). 02-10-23 5:41 PM S.B. 39 - 53 - 1609 Section 27. Section 26B-3-127, which is renumbered from Section 26-18-18 is 1610 renumbered and amended to read: 1611 [26-18-18]. 26B-3-127. Optional Medicaid expansion. 1612 (1) The department and the governor may not expand the state's Medicaid program 1613 under PPACA unless: 1614 (a) the department expands Medicaid in accordance with Section [26-18-415] 1615 26B-3-210; or 1616 (b) (i) the governor or the governor's designee has reported the intention to expand the 1617 state Medicaid program under PPACA to the Legislature in compliance with the legislative 1618 review process in Section [26-18-3] 26B-3-108; and 1619 (ii) the governor submits the request for expansion of the Medicaid program for 1620 optional populations to the Legislature under the high impact federal funds request process 1621 required by Section 63J-5-204. 1622 (2) (a) The department shall request approval from CMS for waivers from federal 1623 statutory and regulatory law necessary to implement the health coverage improvement program 1624 under Section [26-18-411] 26B-3-207. 1625 (b) The health coverage improvement program under Section [26-18-411] 26B-3-207 1626 is not subject to the requirements in Subsection (1). 1627 Section 28. Section 26B-3-128, which is renumbered from Section 26-18-19 is 1628 renumbered and amended to read: 1629 [26-18-19]. 26B-3-128. Medicaid vision services -- Request for proposals. 1630 The department may select one or more contractors, in accordance with Title 63G, 1631 Chapter 6a, Utah Procurement Code, to provide vision services to the Medicaid populations 1632 that are eligible for vision services, as described in department rules, without restricting 1633 provider participation, and within existing appropriations from the Legislature. 1634 Section 29. Section 26B-3-129, which is renumbered from Section 26-18-20 is 1635 renumbered and amended to read: 1636 [26-18-20]. 26B-3-129. Review of claims -- Audit and investigation procedures. 1637 (1) (a) The department shall adopt administrative rules in accordance with Title 63G, 1638 Chapter 3, Utah Administrative Rulemaking Act, and in consultation with providers and health 1639 care professionals subject to audit and investigation under the state Medicaid program, to S.B. 39 02-10-23 5:41 PM - 54 - 1640 establish procedures for audits and investigations that are fair and consistent with the duties of 1641 the department as the single state agency responsible for the administration of the Medicaid 1642 program under Section [26-18-3] 26B-3-108 and Title XIX of the Social Security Act. 1643 (b) If the providers and health care professionals do not agree with the rules proposed 1644 or adopted by the department under Subsection (1)(a), the providers or health care 1645 professionals may: 1646 (i) request a hearing for the proposed administrative rule or seek any other remedies 1647 under the provisions of Title 63G, Chapter 3, Utah Administrative Rulemaking Act; and 1648 (ii) request a review of the rule by the Legislature's Administrative Rules Review and 1649 General Oversight Committee created in Section 63G-3-501. 1650 (2) The department shall: 1651 (a) notify and educate providers and health care professionals subject to audit and 1652 investigation under the Medicaid program of the providers' and health care professionals' 1653 responsibilities and rights under the administrative rules adopted by the department under the 1654 provisions of this section; 1655 (b) ensure that the department, or any entity that contracts with the department to 1656 conduct audits: 1657 (i) has on staff or contracts with a medical or dental professional who is experienced in 1658 the treatment, billing, and coding procedures used by the type of provider being audited; and 1659 (ii) uses the services of the appropriate professional described in Subsection (3)(b)(i) if 1660 the provider who is the subject of the audit disputes the findings of the audit; 1661 (c) ensure that a finding of overpayment or underpayment to a provider is not based on 1662 extrapolation, as defined in Section 63A-13-102, unless: 1663 (i) there is a determination that the level of payment error involving the provider 1664 exceeds a 10% error rate: 1665 (A) for a sample of claims for a particular service code; and 1666 (B) over a three year period of time; 1667 (ii) documented education intervention has failed to correct the level of payment error; 1668 and 1669 (iii) the value of the claims for the provider, in aggregate, exceeds $200,000 in 1670 reimbursement for a particular service code on an annual basis; and 02-10-23 5:41 PM S.B. 39 - 55 - 1671 (d) require that any entity with which the office contracts, for the purpose of 1672 conducting an audit of a service provider, shall be paid on a flat fee basis for identifying both 1673 overpayments and underpayments. 1674 (3) (a) If the department, or a contractor on behalf of the department: 1675 (i) intends to implement the use of extrapolation as a method of auditing claims, the 1676 department shall, prior to adopting the extrapolation method of auditing, report its intent to use 1677 extrapolation to the Social Services Appropriations Subcommittee; and 1678 (ii) determines Subsections (2)(c)(i) through (iii) are applicable to a provider, the 1679 department or the contractor may use extrapolation only for the service code associated with 1680 the findings under Subsections (2)(c)(i) through (iii). 1681 (b) (i) If extrapolation is used under this section, a provider may, at the provider's 1682 option, appeal the results of the audit based on: 1683 (A) each individual claim; or 1684 (B) the extrapolation sample. 1685 (ii) Nothing in this section limits a provider's right to appeal the audit under Title 63G, 1686 General Government, Title 63G, Chapter 4, Administrative Procedures Act, the Medicaid 1687 program and its manual or rules, or other laws or rules that may provide remedies to providers. 1688 Section 30. Section 26B-3-130, which is renumbered from Section 26-18-21 is 1689 renumbered and amended to read: 1690 [26-18-21]. 26B-3-130. Medicaid intergovernmental transfer report -- Approval 1691 requirements. 1692 (1) As used in this section: 1693 (a) (i) "Intergovernmental transfer" means the transfer of public funds from: 1694 (A) a local government entity to another nonfederal governmental entity; or 1695 (B) from a nonfederal, government owned health care facility regulated under [Chapter 1696 21, Health Care Facility Licensing and Inspection Act] Chapter 2, Part 2, Health Care Facility 1697 Licensing and Inspection, to another nonfederal governmental entity. 1698 (ii) "Intergovernmental transfer" does not include: 1699 (A) the transfer of public funds from one state agency to another state agency; or 1700 (B) a transfer of funds from the University of Utah Hospitals and Clinics. 1701 (b) (i) "Intergovernmental transfer program" means a federally approved S.B. 39 02-10-23 5:41 PM - 56 - 1702 reimbursement program or category that is authorized by the Medicaid state plan or waiver 1703 authority for intergovernmental transfers. 1704 (ii) "Intergovernmental transfer program" does not include the addition of a provider to 1705 an existing intergovernmental transfer program. 1706 (c) "Local government entity" means a county, city, town, special service district, local 1707 district, or local education agency as that term is defined in Section 63J-5-102. 1708 (d) "Non-state government entity" means a hospital authority, hospital district, health 1709 care district, special service district, county, or city. 1710 (2) (a) An entity that receives federal Medicaid dollars from the department as a result 1711 of an intergovernmental transfer shall, on or before August 1, 2017, and on or before August 1 1712 each year thereafter, provide the department with: 1713 (i) information regarding the payments funded with the intergovernmental transfer as 1714 authorized by and consistent with state and federal law; 1715 (ii) information regarding the entity's ability to repay federal funds, to the extent 1716 required by the department in the contract for the intergovernmental transfer; and 1717 (iii) other information reasonably related to the intergovernmental transfer that may be 1718 required by the department in the contract for the intergovernmental transfer. 1719 (b) On or before October 15, 2017, and on or before October 15 each subsequent year, 1720 the department shall prepare a report for the Executive Appropriations Committee that 1721 includes: 1722 (i) the amount of each intergovernmental transfer under Subsection (2)(a); 1723 (ii) a summary of changes to CMS regulations and practices that are known by the 1724 department regarding federal funds related to an intergovernmental transfer program; and 1725 (iii) other information the department gathers about the intergovernmental transfer 1726 under Subsection (2)(a). 1727 (3) The department shall not create a new intergovernmental transfer program after 1728 July 1, 2017, unless the department reports to the Executive Appropriations Committee, in 1729 accordance with Section 63J-5-206, before submitting the new intergovernmental transfer 1730 program for federal approval. The report shall include information required by Subsection 1731 63J-5-102(1)(d) and the analysis required in Subsections (2)(a) and (b). 1732 (4) (a) The department shall enter into new Nursing Care Facility Non-State 02-10-23 5:41 PM S.B. 39 - 57 - 1733 Government-Owned Upper Payment Limit program contracts and contract amendments adding 1734 new nursing care facilities and new non-state government entity operators in accordance with 1735 this Subsection (4). 1736 (b) (i) If the nursing care facility expects to receive less than $1,000,000 in federal 1737 funds each year from the Nursing Care Facility Non-State Government-Owned Upper Payment 1738 Limit program, excluding seed funding and administrative fees paid by the non-state 1739 government entity, the department shall enter into a Nursing Care Facility Non-State 1740 Government-Owned Upper Payment Limit program contract with the non-state government 1741 entity operator of the nursing care facility. 1742 (ii) If the nursing care facility expects to receive between $1,000,000 and $10,000,000 1743 in federal funds each year from the Nursing Care Facility Non-State Government-Owned 1744 Upper Payment Limit program, excluding seed funding and administrative fees paid by the 1745 non-state government entity, the department shall enter into a Nursing Care Facility Non-State 1746 Government-Owned Upper Payment Limit program contract with the non-state government 1747 entity operator of the nursing care facility after receiving the approval of the Executive 1748 Appropriations Committee. 1749 (iii) If the nursing care facility expects to receive more than $10,000,000 in federal 1750 funds each year from the Nursing Care Facility Non-State Government-Owned Upper Payment 1751 Limit program, excluding seed funding and administrative fees paid by the non-state 1752 government entity, the department may not approve the application without obtaining approval 1753 from the Legislature and the governor. 1754 (c) A non-state government entity may not participate in the Nursing Care Facility 1755 Non-State Government-Owned Upper Payment Limit program unless the non-state government 1756 entity is a special service district, county, or city that operates a hospital or holds a license 1757 under [Chapter 21, Health Care Facility Licensing and Inspection Act] Chapter 2, Part 2, 1758 Health Care Facility Licensing and Inspection. 1759 (d) Each non-state government entity that participates in the Nursing Care Facility 1760 Non-State Government-Owned Upper Payment Limit program shall certify to the department 1761 that: 1762 (i) the non-state government entity is a local government entity that is able to make an 1763 intergovernmental transfer under applicable state and federal law; S.B. 39 02-10-23 5:41 PM - 58 - 1764 (ii) the non-state government entity has sufficient public funds or other permissible 1765 sources of seed funding that comply with the requirements in 42 C.F.R. Part 433, Subpart B; 1766 (iii) the funds received from the Nursing Care Facility Non-State Government-Owned 1767 Upper Payment Limit program are: 1768 (A) for each nursing care facility, available for patient care until the end of the 1769 non-state government entity's fiscal year; and 1770 (B) used exclusively for operating expenses for nursing care facility operations, patient 1771 care, capital expenses, rent, royalties, and other operating expenses; and 1772 (iv) the non-state government entity has completed all licensing, enrollment, and other 1773 forms and documents required by federal and state law to register a change of ownership with 1774 the department and with CMS. 1775 (5) The department shall add a nursing care facility to an existing Nursing Care Facility 1776 Non-State Government-Owned Upper Payment Limit program contract if: 1777 (a) the nursing care facility is managed by or affiliated with the same non-state 1778 government entity that also manages one or more nursing care facilities that are included in an 1779 existing Nursing Care Facility Non-State Government-Owned Upper Payment Limit program 1780 contract; and 1781 (b) the non-state government entity makes the certification described in Subsection 1782 (4)(d)(ii). 1783 (6) The department may not increase the percentage of the administrative fee paid by a 1784 non-state government entity to the department under the Nursing Care Facility Non-State 1785 Government-Owned Upper Payment Limit program. 1786 (7) The department may not condition participation in the Nursing Care Facility 1787 Non-State Government-Owned Upper Payment Limit program on: 1788 (a) a requirement that the department be allowed to direct or determine the types of 1789 patients that a non-state government entity will treat or the course of treatment for a patient in a 1790 non-state government nursing care facility; or 1791 (b) a requirement that a non-state government entity or nursing care facility post a 1792 bond, purchase insurance, or create a reserve account of any kind. 1793 (8) The non-state government entity shall have the primary responsibility for ensuring 1794 compliance with Subsection (4)(d)(ii). 02-10-23 5:41 PM S.B. 39 - 59 - 1795 (9) (a) The department may not enter into a new Nursing Care Facility Non-State 1796 Government-Owned Upper Payment Limit program contract before January 1, 2019. 1797 (b) Subsection (9)(a) does not apply to: 1798 (i) a new Nursing Care Facility Non-State Government-Owned Upper Payment Limit 1799 program contract that was included in the federal funds request summary under Section 1800 63J-5-201 for fiscal year 2018; or 1801 (ii) a nursing care facility that is operated or managed by the same company as a 1802 nursing care facility that was included in the federal funds request summary under Section 1803 63J-5-201 for fiscal year 2018. 1804 Section 31. Section 26B-3-131, which is renumbered from Section 26-18-22 is 1805 renumbered and amended to read: 1806 [26-18-22]. 26B-3-131. Screening, Brief Intervention, and Referral to 1807 Treatment Medicaid reimbursement. 1808 (1) As used in this section: 1809 (a) "Controlled substance prescriber" means a controlled substance prescriber, as that 1810 term is defined in Section 58-37-6.5, who: 1811 (i) has a record of having completed SBIRT training, in accordance with Subsection 1812 58-37-6.5(2), before providing the SBIRT services; and 1813 (ii) is a Medicaid enrolled health care provider. 1814 (b) "SBIRT" means the same as that term is defined in Section 58-37-6.5. 1815 (2) The department shall reimburse a controlled substance prescriber who provides 1816 SBIRT services to a Medicaid enrollee who is 13 years of age or older for the SBIRT services. 1817 Section 32. Section 26B-3-132, which is renumbered from Section 26-18-23 is 1818 renumbered and amended to read: 1819 [26-18-23]. 26B-3-132. Prescribing policies for opioid prescriptions. 1820 (1) The department may implement a prescribing policy for certain opioid prescriptions 1821 that is substantially similar to the prescribing policies required in Section 31A-22-615.5. 1822 (2) The department may amend the state program and apply for waivers for the state 1823 program, if necessary, to implement Subsection (1). 1824 Section 33. Section 26B-3-133, which is renumbered from Section 26-18-24 is 1825 renumbered and amended to read: S.B. 39 02-10-23 5:41 PM - 60 - 1826 [26-18-24]. 26B-3-133. Reimbursement for long-acting reversible contraception 1827 immediately following childbirth. 1828 (1) As used in this section, "long-acting reversible contraception" means a 1829 contraception method that requires administration less than once per month, including: 1830 (a) an intrauterine device; and 1831 (b) a contraceptive implant. 1832 (2) The division shall separately identify and reimburse, from other labor and delivery 1833 services within the Medicaid program, the provision and insertion of long-acting reversible 1834 contraception immediately after childbirth. 1835 Section 34. Section 26B-3-134, which is renumbered from Section 26-18-25 is 1836 renumbered and amended to read: 1837 [26-18-25]. 26B-3-134. Coverage of exome sequence testing. 1838 (1) As used in this section, "exome sequence testing" means a genomic technique for 1839 sequencing the genome of an individual for diagnostic purposes. 1840 (2) The Medicaid program shall reimburse for exome sequence testing: 1841 (a) for an enrollee who: 1842 (i) is younger than 21 years of age; and 1843 (ii) who remains undiagnosed after exhausting all other appropriate diagnostic-related 1844 tests; 1845 (b) performed by a nationally recognized provider with significant experience in exome 1846 sequence testing; 1847 (c) that is medically necessary; and 1848 (d) at a rate set by the Medicaid program. 1849 Section 35. Section 26B-3-135, which is renumbered from Section 26-18-26 is 1850 renumbered and amended to read: 1851 [26-18-26]. 26B-3-135. Reimbursement for nonemergency secured behavioral 1852 health transport providers. 1853 The department may not reimburse a nonemergency secured behavioral health transport 1854 provider that is designated under Section [26-8a-303] 26B-4-117. 1855 Section 36. Section 26B-3-136, which is renumbered from Section 26-18-27 is 1856 renumbered and amended to read: 02-10-23 5:41 PM S.B. 39 - 61 - 1857 [26-18-27]. 26B-3-136. Children's Health Care Coverage Program. 1858 (1) As used in this section: 1859 (a) "CHIP" means the Children's Health Insurance Program created in Section 1860 [26-40-103] 26B-3-902. 1861 (b) "Program" means the Children's Health Care Coverage Program created in 1862 Subsection (2). 1863 (2) (a) There is created the Children's Health Care Coverage Program within the 1864 department. 1865 (b) The purpose of the program is to: 1866 (i) promote health insurance coverage for children in accordance with Section 1867 [26-18-15] 26B-3-124; 1868 (ii) conduct research regarding families who are eligible for Medicaid and CHIP to 1869 determine awareness and understanding of available coverage; 1870 (iii) analyze trends in disenrollment and identify reasons that families may not be 1871 renewing enrollment, including any barriers in the process of renewing enrollment; 1872 (iv) administer surveys to recently enrolled CHIP and children's Medicaid enrollees to 1873 identify: 1874 (A) how the enrollees learned about coverage; and 1875 (B) any barriers during the application process; 1876 (v) develop promotional material regarding CHIP and children's Medicaid eligibility, 1877 including outreach through social media, video production, and other media platforms; 1878 (vi) identify ways that the eligibility website for enrollment in CHIP and children's 1879 Medicaid can be redesigned to increase accessibility and enhance the user experience; 1880 (vii) identify outreach opportunities, including partnerships with community 1881 organizations including: 1882 (A) schools; 1883 (B) small businesses; 1884 (C) unemployment centers; 1885 (D) parent-teacher associations; and 1886 (E) youth athlete clubs and associations; and 1887 (viii) develop messaging to increase awareness of coverage options that are available S.B. 39 02-10-23 5:41 PM - 62 - 1888 through the department. 1889 (3) (a) The department may not delegate implementation of the program to a private 1890 entity. 1891 (b) Notwithstanding Subsection (3)(a), the department may contract with a media 1892 agency to conduct the activities described in Subsection (2)(b)(iv) and (vii). 1893 Section 37. Section 26B-3-137, which is renumbered from Section 26-18-28 is 1894 renumbered and amended to read: 1895 [26-18-28]. 26B-3-137. Reimbursement for diabetes prevention program. 1896 (1) As used in this section, "DPP" means the National Diabetes Prevention Program 1897 developed by the United States Centers for Disease Control and Prevention. 1898 (2) Beginning July 1, 2022, the Medicaid program shall reimburse a provider for an 1899 enrollee's participation in the DPP if the enrollee: 1900 (a) meets the DPP's eligibility requirements; and 1901 (b) has not previously participated in the DPP after July 1, 2022, while enrolled in the 1902 Medicaid program. 1903 (3) Subject to appropriation, the Medicaid program may set the rate for reimbursement. 1904 (4) The department may apply for a state plan amendment if necessary to implement 1905 this section. 1906 (5) (a) On or after July 1, 2025, but before October 1, 2025, the department shall 1907 provide a written report regarding the efficacy of the DPP and reimbursement under this 1908 section to the Health and Human Services Interim Committee. 1909 (b) The report described in Subsection (5)(a) shall include: 1910 (i) the total number of enrollees with a prediabetic condition as of July 1, 2022; 1911 (ii) the total number of enrollees as of July 1, 2022, with a diagnosis of type 2 diabetes; 1912 (iii) the total number of enrollees who participated in the DPP; 1913 (iv) the total cost incurred by the state to implement this section; and 1914 (v) any conclusions that can be drawn regarding the impact of the DPP on the rate of 1915 type 2 diabetes for enrollees. 1916 Section 38. Section 26B-3-138, which is renumbered from Section 26-18-427 is 1917 renumbered and amended to read: 1918 [26-18-427]. 26B-3-138. Behavioral health delivery working group. 02-10-23 5:41 PM S.B. 39 - 63 - 1919 (1) As used in this section, "targeted adult Medicaid program" means the same as that 1920 term is defined in Section [26-18-411] 26B-3-207. 1921 (2) On or before May 31, 2022, the department shall convene a working group to 1922 collaborate with the department on: 1923 (a) establishing specific and measurable metrics regarding: 1924 (i) compliance of managed care organizations in the state with federal Medicaid 1925 managed care requirements; 1926 (ii) timeliness and accuracy of authorization and claims processing in accordance with 1927 Medicaid policy and contract requirements; 1928 (iii) reimbursement by managed care organizations in the state to providers to maintain 1929 adequacy of access to care; 1930 (iv) availability of care management services to meet the needs of Medicaid-eligible 1931 individuals enrolled in the plans of managed care organizations in the state; and 1932 (v) timeliness of resolution for disputes between a managed care organization and the 1933 managed care organization's providers and enrollees; 1934 (b) improving the delivery of behavioral health services in the Medicaid program; 1935 (c) proposals to implement the delivery system adjustments authorized under 1936 Subsection [26-18-428] 26B-3-223(3); and 1937 (d) issues that are identified by managed care organizations, behavioral health service 1938 providers, and the department. 1939 (3) The working group convened under Subsection (2) shall: 1940 (a) meet quarterly; and 1941 (b) consist of at least the following individuals: 1942 (i) the executive director or the executive director's designee; 1943 (ii) for each Medicaid accountable care organization with which the department 1944 contracts, an individual selected by the accountable care organization; 1945 (iii) five individuals selected by the department to represent various types of behavioral 1946 health services providers, including, at a minimum, individuals who represent providers who 1947 provide the following types of services: 1948 (A) acute inpatient behavioral health treatment; 1949 (B) residential treatment; S.B. 39 02-10-23 5:41 PM - 64 - 1950 (C) intensive outpatient or partial hospitalization treatment; and 1951 (D) general outpatient treatment; 1952 (iv) a representative of an association that represents behavioral health treatment 1953 providers in the state, designated by the Utah Behavioral Healthcare Council convened by the 1954 Utah Association of Counties; 1955 (v) a representative of an organization representing behavioral health organizations; 1956 (vi) the chair of the Utah Substance Use and Mental Health Advisory Council created 1957 in Section 63M-7-301; 1958 (vii) a representative of an association that represents local authorities who provide 1959 public behavioral health care, designated by the department; 1960 (viii) one member of the Senate, appointed by the president of the Senate; and 1961 (ix) one member of the House of Representatives, appointed by the speaker of the 1962 House of Representatives. 1963 (4) The working group convened under this section shall recommend to the 1964 department: 1965 (a) specific and measurable metrics under Subsection (2)(a); 1966 (b) how physical and behavioral health services may be integrated for the targeted adult 1967 Medicaid program, including ways the department may address issues regarding: 1968 (i) filing of claims; 1969 (ii) authorization and reauthorization for treatment services; 1970 (iii) reimbursement rates; and 1971 (iv) other issues identified by the department, behavioral health services providers, or 1972 Medicaid managed care organizations; 1973 (c) ways to improve delivery of behavioral health services to enrollees, including 1974 changes to statute or administrative rule; and 1975 (d) wraparound service coverage for enrollees who need specific, nonclinical services 1976 to ensure a path to success. 1977 Section 39. Section 26B-3-139, which is renumbered from Section 26-18-603 is 1978 renumbered and amended to read: 1979 [26-18-603]. 26B-3-139. Adjudicative proceedings related to Medicaid 1980 funds. 02-10-23 5:41 PM S.B. 39 - 65 - 1981 (1) If a proceeding of the department, under Title 63G, Chapter 4, Administrative 1982 Procedures Act, relates in any way to recovery of Medicaid funds: 1983 (a) the presiding officer shall be designated by the executive director of the department 1984 and report directly to the executive director or, in the discretion of the executive director, report 1985 directly to the director of the Office of Internal Audit; and 1986 (b) the decision of the presiding officer is the recommended decision to the executive 1987 director of the department or a designee of the executive director who is not in the division. 1988 (2) Subsection (1) does not apply to hearings conducted by the Department of 1989 Workforce Services relating to medical assistance eligibility determinations. 1990 (3) If a proceeding of the department, under Title 63G, Chapter 4, Administrative 1991 Procedures Act, relates in any way to Medicaid or Medicaid funds, the following may attend 1992 and present evidence or testimony at the proceeding: 1993 (a) the director of the Office of Internal Audit, or the director's designee; and 1994 (b) the inspector general of Medicaid services or the inspector general's designee. 1995 (4) In relation to a proceeding of the department under Title 63G, Chapter 4, 1996 Administrative Procedures Act, a person may not, outside of the actual proceeding, attempt to 1997 influence the decision of the presiding officer. 1998 Section 40. Section 26B-3-140, which is renumbered from Section 26-18-604 is 1999 renumbered and amended to read: 2000 [26-18-604]. 26B-3-140. Medical assistance accountability -- Division 2001 duties -- Reporting. 2002 (1) As used in this section: 2003 (a) "Abuse" means: 2004 (i) an action or practice that: 2005 (A) is inconsistent with sound fiscal, business, or medical practices; and 2006 (B) results, or may result, in unnecessary Medicaid related costs or other medical or 2007 hospital assistance costs; or 2008 (ii) reckless or negligent upcoding. 2009 (b) "Fraud" means intentional or knowing: 2010 (i) deception, misrepresentation, or upcoding in relation to Medicaid funds, costs, 2011 claims, reimbursement, or practice; or S.B. 39 02-10-23 5:41 PM - 66 - 2012 (ii) deception or misrepresentation in relation to medical or hospital assistance funds, 2013 costs, claims, reimbursement, or practice. 2014 (c) "Upcoding" means assigning an inaccurate billing code for a service that is payable 2015 or reimbursable by Medicaid funds, if the correct billing code for the service, taking into 2016 account reasonable opinions derived from official published coding definitions, would result in 2017 a lower Medicaid payment or reimbursement. 2018 (d) "Waste" means overutilization of resources or inappropriate payment. 2019 (2) The division shall: 2020 [(1)] (a) develop and implement procedures relating to Medicaid funds and medical or 2021 hospital assistance funds to ensure that providers do not receive: 2022 [(a)] (i) duplicate payments for the same goods or services; 2023 [(b)] (ii) payment for goods or services by resubmitting a claim for which: 2024 [(i)] (A) payment has been disallowed on the grounds that payment would be a 2025 violation of federal or state law, administrative rule, or the state plan; and 2026 [(ii)] (B) the decision to disallow the payment has become final; 2027 [(c)] (iii) payment for goods or services provided after a recipient's death, including 2028 payment for pharmaceuticals or long-term care; or 2029 [(d)] (iv) payment for transporting an unborn infant; 2030 [(2)] (b) consult with [the Centers for Medicaid and Medicare Services] CMS, other 2031 states, and the Office of Inspector General of Medicaid Services to determine and implement 2032 best practices for discovering and eliminating fraud, waste, and abuse of Medicaid funds and 2033 medical or hospital assistance funds; 2034 [(3)] (c) actively seek repayment from providers for improperly used or paid: 2035 [(a)] (i) Medicaid funds; and 2036 [(b)] (ii) medical or hospital assistance funds; 2037 [(4)] (d) coordinate, track, and keep records of all division efforts to obtain repayment 2038 of the funds described in Subsection [(3)] (2)(c), and the results of those efforts; 2039 [(5)] (e) keep Medicaid pharmaceutical costs as low as possible by actively seeking to 2040 obtain pharmaceuticals at the lowest price possible, including, on a quarterly basis for the 2041 pharmaceuticals that represent the highest 45% of state Medicaid expenditures for 2042 pharmaceuticals and on an annual basis for the remaining pharmaceuticals: 02-10-23 5:41 PM S.B. 39 - 67 - 2043 [(a)] (i) tracking changes in the price of pharmaceuticals; 2044 [(b)] (ii) checking the availability and price of generic drugs; 2045 [(c)] (iii) reviewing and updating the state's maximum allowable cost list; and 2046 [(d)] (iv) comparing pharmaceutical costs of the state Medicaid program to available 2047 pharmacy price lists; and 2048 [(6)] (f) provide training, on an annual basis, to the employees of the division who 2049 make decisions on billing codes, or who are in the best position to observe and identify 2050 upcoding, in order to avoid and detect upcoding. 2051 Section 41. Section 26B-3-141, which is renumbered from Section 26-18-703 is 2052 renumbered and amended to read: 2053 [26-18-703]. 26B-3-141. Medical assistance from division or Department 2054 of Workforce Services and compliance under adoption assistance interstate compact -- 2055 Penalty for fraudulent claim. 2056 (1) As used in this section: 2057 (a) "Adoption assistance" means the same as that term is defined in Section 80-2-809. 2058 (b) "Adoption assistance agreement" means the same as that term is defined in Section 2059 80-2-809. 2060 (c) "Adoption assistance interstate compact" means an agreement executed by the 2061 Division of Child and Family Services with any other state in accordance with Section 2062 80-2-809. 2063 [(1)] (2) (a) A child who is a resident of this state and is the subject of an adoption 2064 assistance interstate compact is entitled to receive medical assistance from the division and the 2065 Department of Workforce Services by filing a certified copy of the child's adoption assistance 2066 agreement with the division or the Department of Workforce Services. 2067 (b) The adoptive parent of the child described in Subsection [(1)] (2)(a) shall annually 2068 provide the division or the Department of Workforce Services with evidence verifying that the 2069 adoption assistance agreement is still effective. 2070 [(2)] (3) The Department of Workforce Services shall consider the recipient of medical 2071 assistance under this section as the Department of Workforce Services does any other recipient 2072 of medical assistance under an adoption assistance agreement executed by the Division of 2073 Child and Family Services. S.B. 39 02-10-23 5:41 PM - 68 - 2074 [(3)] (4) (a) A person may not submit a claim for payment or reimbursement under this 2075 section that the person knows is false, misleading, or fraudulent. 2076 (b) A violation of Subsection [(3)] (4)(a) is a third degree felony. 2077 (5) The division and the Department of Workforce Services shall: 2078 (a) cooperate with the Division of Child and Family Services in regards to an adoption 2079 assistance interstate compact; and 2080 (b) comply with an adoption assistance interstate compact. 2081 Section 42. Section 26B-3-201, which is renumbered from Section 26-18-403 is 2082 renumbered and amended to read: 2083 Part 2. Medicaid Waivers 2084 [26-18-403]. 26B-3-201. Medicaid waiver for independent foster care 2085 adolescents. 2086 (1) [For purposes of] As used in this section, an "independent foster care adolescent" 2087 includes any individual who reached 18 years of age while in the custody of the[ Division of 2088 Child and Family Services, or the Department of Human Services] department if the [Division 2089 of Child and Family Services] department was the primary case manager, or a federally 2090 recognized Indian tribe. 2091 (2) An independent foster care adolescent is eligible, when funds are available, for 2092 Medicaid coverage until the individual reaches 21 years of age. 2093 (3) Before July 1, 2006, the division shall submit a state Medicaid Plan amendment to 2094 [the Center For Medicaid Services] CMS to provide medical coverage for independent foster 2095 care adolescents effective fiscal year 2006-07. 2096 Section 43. Section 26B-3-202, which is renumbered from Section 26-18-405 is 2097 renumbered and amended to read: 2098 [26-18-405]. 26B-3-202. Waivers to maximize replacement of 2099 fee-for-service delivery model -- Cost of mandated program changes. 2100 (1) The department shall develop a waiver program in the Medicaid program to replace 2101 the fee-for-service delivery model with one or more risk-based delivery models. 2102 (2) The waiver program shall: 2103 (a) restructure the program's provider payment provisions to reward health care 2104 providers for delivering the most appropriate services at the lowest cost and in ways that, 02-10-23 5:41 PM S.B. 39 - 69 - 2105 compared to services delivered before implementation of the waiver program, maintain or 2106 improve recipient health status; 2107 (b) restructure the program's cost sharing provisions and other incentives to reward 2108 recipients for personal efforts to: 2109 (i) maintain or improve their health status; and 2110 (ii) use providers that deliver the most appropriate services at the lowest cost; 2111 (c) identify the evidence-based practices and measures, risk adjustment methodologies, 2112 payment systems, funding sources, and other mechanisms necessary to reward providers for 2113 delivering the most appropriate services at the lowest cost, including mechanisms that: 2114 (i) pay providers for packages of services delivered over entire episodes of illness 2115 rather than for individual services delivered during each patient encounter; and 2116 (ii) reward providers for delivering services that make the most positive contribution to 2117 a recipient's health status; 2118 (d) limit total annual per-patient-per-month expenditures for services delivered through 2119 fee-for-service arrangements to total annual per-patient-per-month expenditures for services 2120 delivered through risk-based arrangements covering similar recipient populations and services; 2121 and 2122 (e) except as provided in Subsection (4), limit the rate of growth in 2123 per-patient-per-month General Fund expenditures for the program to the rate of growth in 2124 General Fund expenditures for all other programs, when the rate of growth in the General Fund 2125 expenditures for all other programs is greater than zero. 2126 (3) To the extent possible, the department shall operate the waiver program with the 2127 input of stakeholder groups representing those who will be affected by the waiver program. 2128 (4) (a) For purposes of this Subsection (4), "mandated program change" shall be 2129 determined by the department in consultation with the Medicaid accountable care 2130 organizations, and may include a change to the state Medicaid program that is required by state 2131 or federal law, state or federal guidance, policy, or the state Medicaid plan. 2132 (b) A mandated program change shall be included in the base budget for the Medicaid 2133 program for the fiscal year in which the Medicaid program adopted the mandated program 2134 change. 2135 (c) The mandated program change is not subject to the limit on the rate of growth in S.B. 39 02-10-23 5:41 PM - 70 - 2136 per-patient-per-month General Fund expenditures for the program established in Subsection 2137 (2)(e), until the fiscal year following the fiscal year in which the Medicaid program adopted the 2138 mandated program change. 2139 (5) A managed care organization or a pharmacy benefit manager that provides a 2140 pharmacy benefit to an enrollee shall establish a unique group number, payment classification 2141 number, or bank identification number for each Medicaid managed care organization plan for 2142 which the managed care organization or pharmacy benefit manager provides a pharmacy 2143 benefit. 2144 Section 44. Section 26B-3-203, which is renumbered from Section 26-18-405.5 is 2145 renumbered and amended to read: 2146 [26-18-405.5]. 26B-3-203. Base budget appropriations for Medicaid 2147 accountable care organizations and behavioral health plans -- Forecast of behavioral 2148 health services cost. 2149 (1) As used in this section: 2150 (a) "ACO" means an accountable care organization that contracts with the state's 2151 Medicaid program for: 2152 (i) physical health services; or 2153 (ii) integrated physical and behavioral health services. 2154 (b) "Base budget" means the same as that term is defined in legislative rule. 2155 (c) "Behavioral health plan" means a managed care or fee for service delivery system 2156 that contracts with or is operated by the department to provide behavioral health services to 2157 Medicaid eligible individuals. 2158 (d) "Behavioral health services" means mental health or substance use treatment or 2159 services. 2160 (e) "General Fund growth factor" means the amount determined by dividing the next 2161 fiscal year ongoing General Fund revenue estimate by current fiscal year ongoing 2162 appropriations from the General Fund. 2163 (f) "Next fiscal year ongoing General Fund revenue estimate" means the next fiscal 2164 year ongoing General Fund revenue estimate identified by the Executive Appropriations 2165 Committee, in accordance with legislative rule, for use by the Office of the Legislative Fiscal 2166 Analyst in preparing budget recommendations. 02-10-23 5:41 PM S.B. 39 - 71 - 2167 (g) "PMPM" means per-member-per-month funding. 2168 (2) If the General Fund growth factor is less than 100%, the next fiscal year base 2169 budget shall, subject to Subsection (5), include an appropriation to the department in an 2170 amount necessary to ensure that the next fiscal year PMPM for ACOs and behavioral health 2171 plans equals the current fiscal year PMPM for the ACOs and behavioral health plans multiplied 2172 by 100%. 2173 (3) If the General Fund growth factor is greater than or equal to 100%, but less than 2174 102%, the next fiscal year base budget shall, subject to Subsection (5), include an appropriation 2175 to the department in an amount necessary to ensure that the next fiscal year PMPM for ACOs 2176 and behavioral health plans equals the current fiscal year PMPM for the ACOs and behavioral 2177 health plans multiplied by the General Fund growth factor. 2178 (4) If the General Fund growth factor is greater than or equal to 102%, the next fiscal 2179 year base budget shall, subject to Subsection (5), include an appropriation to the department in 2180 an amount necessary to ensure that the next fiscal year PMPM for ACOs and behavioral health 2181 plans is greater than or equal to the current fiscal year PMPM for the ACOs and behavioral 2182 health plans multiplied by 102% and less than or equal to the current fiscal year PMPM for the 2183 ACOs and behavioral health plans multiplied by the General Fund growth factor. 2184 (5) The appropriations provided to the department for behavioral health plans under 2185 this section shall be reduced by the amount contributed by counties in the current fiscal year for 2186 behavioral health plans in accordance with Subsections 17-43-201(5)(k) and 2187 17-43-301(6)(a)(x). 2188 (6) In order for the department to estimate the impact of Subsections (2) through (4) 2189 before identification of the next fiscal year ongoing General Fund revenue estimate, the 2190 Governor's Office of Planning and Budget shall, in cooperation with the Office of the 2191 Legislative Fiscal Analyst, develop an estimate of ongoing General Fund revenue for the next 2192 fiscal year and provide the estimate to the department no later than November 1 of each year. 2193 (7) The Office of the Legislative Fiscal Analyst shall include an estimate of the cost of 2194 behavioral health services in any state Medicaid funding or savings forecast that is completed 2195 in coordination with the department and the Governor's Office of Planning and Budget. 2196 Section 45. Section 26B-3-204, which is renumbered from Section 26-18-408 is 2197 renumbered and amended to read: S.B. 39 02-10-23 5:41 PM - 72 - 2198 [26-18-408]. 26B-3-204. Incentives to appropriately use emergency 2199 department services. 2200 (1) (a) This section applies to the Medicaid program and to the Utah Children's Health 2201 Insurance Program created in [Chapter 40, Utah Children's Health Insurance Act] Section 2202 26B-3-902. 2203 (b) As used in this section: 2204 (i) "Managed care organization" means a comprehensive full risk managed care 2205 delivery system that contracts with the Medicaid program or the Children's Health Insurance 2206 Program to deliver health care through a managed care plan. 2207 (ii) "Managed care plan" means a risk-based delivery service model authorized by 2208 Section [26-18-405] 26B-3-202 and administered by a managed care organization. 2209 (iii) "Non-emergent care": 2210 (A) means use of the emergency department to receive health care that is non-emergent 2211 as defined by the department by administrative rule adopted in accordance with Title 63G, 2212 Chapter 3, Utah Administrative Rulemaking Act, and the Emergency Medical Treatment and 2213 Active Labor Act; and 2214 (B) does not mean the medical services provided to an individual required by the 2215 Emergency Medical Treatment and Active Labor Act, including services to conduct a medical 2216 screening examination to determine if the recipient has an emergent or non-emergent condition. 2217 (iv) "Professional compensation" means payment made for services rendered to a 2218 Medicaid recipient by an individual licensed to provide health care services. 2219 (v) "Super-utilizer" means a Medicaid recipient who has been identified by the 2220 recipient's managed care organization as a person who uses the emergency department 2221 excessively, as defined by the managed care organization. 2222 (2) (a) A managed care organization may, in accordance with Subsections (2)(b) and 2223 (c): 2224 (i) audit emergency department services provided to a recipient enrolled in the 2225 managed care plan to determine if non-emergent care was provided to the recipient; and 2226 (ii) establish differential payment for emergent and non-emergent care provided in an 2227 emergency department. 2228 (b) (i) The differential payments under Subsection (2)(a)(ii) do not apply to 02-10-23 5:41 PM S.B. 39 - 73 - 2229 professional compensation for services rendered in an emergency department. 2230 (ii) Except in cases of suspected fraud, waste, and abuse, a managed care organization's 2231 audit of payment under Subsection (2)(a)(i) is limited to the 18-month period of time after the 2232 date on which the medical services were provided to the recipient. If fraud, waste, or abuse is 2233 alleged, the managed care organization's audit of payment under Subsection (2)(a)(i) is limited 2234 to three years after the date on which the medical services were provided to the recipient. 2235 (c) The audits and differential payments under Subsections (2)(a) and (b) apply to 2236 services provided to a recipient on or after July 1, 2015. 2237 (3) A managed care organization shall: 2238 (a) use the savings under Subsection (2) to maintain and improve access to primary 2239 care and urgent care services for all Medicaid or CHIP recipients enrolled in the managed care 2240 plan; 2241 (b) provide viable alternatives for increasing primary care provider reimbursement 2242 rates to incentivize after hours primary care access for recipients; and 2243 (c) report to the department on how the managed care organization complied with this 2244 Subsection (3). 2245 (4) The department may: 2246 (a) through administrative rule adopted by the department, develop quality 2247 measurements that evaluate a managed care organization's delivery of: 2248 (i) appropriate emergency department services to recipients enrolled in the managed 2249 care plan; 2250 (ii) expanded primary care and urgent care for recipients enrolled in the managed care 2251 plan, with consideration of the managed care organization's: 2252 (A) delivery of primary care, urgent care, and after hours care through means other than 2253 the emergency department; 2254 (B) recipient access to primary care providers and community health centers including 2255 evening and weekend access; and 2256 (C) other innovations for expanding access to primary care; and 2257 (iii) quality of care for the managed care plan members; 2258 (b) compare the quality measures developed under Subsection (4)(a) for each managed 2259 care organization; and S.B. 39 02-10-23 5:41 PM - 74 - 2260 (c) develop, by administrative rule, an algorithm to determine assignment of new, 2261 unassigned recipients to specific managed care plans based on the plan's performance in 2262 relation to the quality measures developed pursuant to Subsection (4)(a). 2263 Section 46. Section 26B-3-205, which is renumbered from Section 26-18-409 is 2264 renumbered and amended to read: 2265 [26-18-409]. 26B-3-205. Long-term care insurance partnership. 2266 (1) As used in this section: 2267 (a) "Qualified long-term care insurance contract" is as defined in 26 U.S.C. Sec. 2268 7702B(b). 2269 (b) "Qualified long-term care insurance partnership" is as defined in 42 U.S.C. Sec. 2270 1396p(b)(1)(C)(iii). 2271 (c) "State plan amendment" means an amendment to the state Medicaid plan drafted by 2272 the department in compliance with this section. 2273 (2) No later than July 1, 2014, the department shall seek federal approval of a state plan 2274 amendment that creates a qualified long-term care insurance partnership. 2275 (3) The department may make rules to comply with federal laws and regulations 2276 relating to qualified long-term care insurance partnerships and qualified long-term care 2277 insurance contracts. 2278 Section 47. Section 26B-3-206, which is renumbered from Section 26-18-410 is 2279 renumbered and amended to read: 2280 [26-18-410]. 26B-3-206. Medicaid waiver for children with disabilities 2281 and complex medical needs. 2282 (1) As used in this section: 2283 (a) "Additional eligibility criteria" means the additional eligibility criteria set by the 2284 department under Subsection (4)(e). 2285 (b) "Complex medical condition" means a physical condition of an individual that: 2286 (i) results in severe functional limitations for the individual; and 2287 (ii) is likely to: 2288 (A) last at least 12 months; or 2289 (B) result in death. 2290 (c) "Program" means the program for children with complex medical conditions 02-10-23 5:41 PM S.B. 39 - 75 - 2291 created in Subsection (3). 2292 (d) "Qualified child" means a child who: 2293 (i) is less than 19 years old; 2294 (ii) is diagnosed with a complex medical condition; 2295 (iii) has a condition that meets the definition of disability in 42 U.S.C. Sec. 12102; and 2296 (iv) meets the additional eligibility criteria. 2297 (2) The department shall apply for a Medicaid home and community-based waiver with 2298 CMS to implement, within the state Medicaid program, the program described in Subsection 2299 (3). 2300 (3) If the waiver described in Subsection (2) is approved, the department shall offer a 2301 program that: 2302 (a) as funding permits, provides treatment for qualified children; 2303 (b) if approved by CMS and as funding permits, beginning in fiscal year 2023 provides 2304 on an ongoing basis treatment for 130 more qualified children than the program provided 2305 treatment for during fiscal year 2022; and 2306 (c) accepts applications for the program on an ongoing basis. 2307 (i) requires periodic reevaluations of an enrolled child's eligibility and other applicants 2308 or eligible children waiting for services in the program based on the additional eligibility 2309 criteria; and 2310 (ii) at the time of reevaluation, allows the department to disenroll a child based on the 2311 prioritization described in Subsection (4)(a) and additional eligibility criteria. 2312 (4) The department shall: 2313 (a) establish by rule made in accordance with Title 63G, Chapter 3, Utah 2314 Administrative Rulemaking Act, criteria to prioritize qualified children's participation in the 2315 program based on the following factors, in the following priority order: 2316 (i) the complexity of a qualified child's medical condition; and 2317 (ii) the financial needs of the qualified child and the qualified child's family; 2318 (b) convene a public process to determine the benefits and services to offer a qualified 2319 child under the program; 2320 (c) evaluate, on an ongoing basis, the cost and effectiveness of the program; 2321 (d) if funding for the program is reduced, develop an evaluation process to reduce the S.B. 39 02-10-23 5:41 PM - 76 - 2322 number of children served based on the participation criteria established under Subsection 2323 (4)(a); and 2324 (e) establish, by rule made in accordance with Title 63G, Chapter 3, Utah 2325 Administrative Rulemaking Act, additional eligibility criteria based on the factors described in 2326 Subsections (4)(a)(i) and (ii). 2327 Section 48. Section 26B-3-207, which is renumbered from Section 26-18-411 is 2328 renumbered and amended to read: 2329 [26-18-411]. 26B-3-207. Health coverage improvement program -- 2330 Eligibility -- Annual report -- Expansion of eligibility for adults with dependent children. 2331 (1) As used in this section: 2332 (a) "Adult in the expansion population" means an individual who: 2333 (i) is described in 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII); and 2334 (ii) is not otherwise eligible for Medicaid as a mandatory categorically needy 2335 individual. 2336 (b) "Enhancement waiver program" means the Primary Care Network enhancement 2337 waiver program described in Section [26-18-416] 26B-3-211. 2338 (c) "Federal poverty level" means the poverty guidelines established by the Secretary of 2339 the United States Department of Health and Human Services under 42 U.S.C. Sec. 9909(2). 2340 (d) "Health coverage improvement program" means the health coverage improvement 2341 program described in Subsections (3) through [(10)] (9). 2342 (e) "Homeless": 2343 (i) means an individual who is chronically homeless, as determined by the department; 2344 and 2345 (ii) includes someone who was chronically homeless and is currently living in 2346 supported housing for the chronically homeless. 2347 (f) "Income eligibility ceiling" means the percent of federal poverty level: 2348 (i) established by the state in an appropriations act adopted pursuant to Title 63J, 2349 Chapter 1, Budgetary Procedures Act; and 2350 (ii) under which an individual may qualify for Medicaid coverage in accordance with 2351 this section. 2352 (g) "Targeted adult Medicaid program" means the program implemented by the 02-10-23 5:41 PM S.B. 39 - 77 - 2353 department under Subsections (5) through (7). 2354 (2) Beginning July 1, 2016, the department shall amend the state Medicaid plan to 2355 allow temporary residential treatment for substance abuse, for the traditional Medicaid 2356 population, in a short term, non-institutional, 24-hour facility, without a bed capacity limit that 2357 provides rehabilitation services that are medically necessary and in accordance with an 2358 individualized treatment plan, as approved by CMS and as long as the county makes the 2359 required match under Section 17-43-201. 2360 (3) Beginning July 1, 2016, the department shall amend the state Medicaid plan to 2361 increase the income eligibility ceiling to a percentage of the federal poverty level designated by 2362 the department, based on appropriations for the program, for an individual with a dependent 2363 child. 2364 (4) Before July 1, 2016, the division shall submit to CMS a request for waivers, or an 2365 amendment of existing waivers, from federal statutory and regulatory law necessary for the 2366 state to implement the health coverage improvement program in the Medicaid program in 2367 accordance with this section. 2368 (5) (a) An adult in the expansion population is eligible for Medicaid if the adult meets 2369 the income eligibility and other criteria established under Subsection (6). 2370 (b) An adult who qualifies under Subsection (6) shall receive Medicaid coverage: 2371 (i) through the traditional fee for service Medicaid model in counties without Medicaid 2372 accountable care organizations or the state's Medicaid accountable care organization delivery 2373 system, where implemented and subject to Section [26-18-428] 26B-3-223; 2374 (ii) except as provided in Subsection (5)(b)(iii), for behavioral health, through the 2375 counties in accordance with Sections 17-43-201 and 17-43-301; 2376 (iii) that, subject to Section [26-18-428] 26B-3-223, integrates behavioral health 2377 services and physical health services with Medicaid accountable care organizations in select 2378 geographic areas of the state that choose an integrated model; and 2379 (iv) that permits temporary residential treatment for substance abuse in a short term, 2380 non-institutional, 24-hour facility, without a bed capacity limit, as approved by CMS, that 2381 provides rehabilitation services that are medically necessary and in accordance with an 2382 individualized treatment plan. 2383 (6) (a) An individual is eligible for the health coverage improvement program under S.B. 39 02-10-23 5:41 PM - 78 - 2384 Subsection (5) if: 2385 (i) at the time of enrollment, the individual's annual income is below the income 2386 eligibility ceiling established by the state under Subsection (1)(f); and 2387 (ii) the individual meets the eligibility criteria established by the department under 2388 Subsection (6)(b). 2389 (b) Based on available funding and approval from CMS, the department shall select the 2390 criteria for an individual to qualify for the Medicaid program under Subsection (6)(a)(ii), based 2391 on the following priority: 2392 (i) a chronically homeless individual; 2393 (ii) if funding is available, an individual: 2394 (A) involved in the justice system through probation, parole, or court ordered 2395 treatment; and 2396 (B) in need of substance abuse treatment or mental health treatment, as determined by 2397 the department; or 2398 (iii) if funding is available, an individual in need of substance abuse treatment or 2399 mental health treatment, as determined by the department. 2400 (c) An individual who qualifies for Medicaid coverage under Subsections (6)(a) and (b) 2401 may remain on the Medicaid program for a 12-month certification period as defined by the 2402 department. Eligibility changes made by the department under Subsection (1)(f) or (6)(b) shall 2403 not apply to an individual during the 12-month certification period. 2404 (7) The state may request a modification of the income eligibility ceiling and other 2405 eligibility criteria under Subsection (6) each fiscal year based on projected enrollment, costs to 2406 the state, and the state budget. 2407 (8) The current Medicaid program and the health coverage improvement program, 2408 when implemented, shall coordinate with a state prison or county jail to expedite Medicaid 2409 enrollment for an individual who is released from custody and was eligible for or enrolled in 2410 Medicaid before incarceration. 2411 (9) Notwithstanding Sections 17-43-201 and 17-43-301, a county does not have to 2412 provide matching funds to the state for the cost of providing Medicaid services to newly 2413 enrolled individuals who qualify for Medicaid coverage under the health coverage 2414 improvement program under Subsection (6). 02-10-23 5:41 PM S.B. 39 - 79 - 2415 (10) If the enhancement waiver program is implemented, the department: 2416 (a) may not accept any new enrollees into the health coverage improvement program 2417 after the day on which the enhancement waiver program is implemented; 2418 (b) shall transition all individuals who are enrolled in the health coverage improvement 2419 program into the enhancement waiver program; 2420 (c) shall suspend the health coverage improvement program within one year after the 2421 day on which the enhancement waiver program is implemented; 2422 (d) shall, within one year after the day on which the enhancement waiver program is 2423 implemented, use all appropriations for the health coverage improvement program to 2424 implement the enhancement waiver program; and 2425 (e) shall work with CMS to maintain any waiver for the health coverage improvement 2426 program while the health coverage improvement program is suspended under Subsection [(11)] 2427 (10)(c). 2428 (11) If, after the enhancement waiver program takes effect, the enhancement waiver 2429 program is repealed or suspended by either the state or federal government, the department 2430 shall reinstate the health coverage improvement program and continue to accept new enrollees 2431 into the health coverage improvement program in accordance with the provisions of this 2432 section. 2433 Section 49. Section 26B-3-208, which is renumbered from Section 26-18-413 is 2434 renumbered and amended to read: 2435 [26-18-413]. 26B-3-208. Medicaid waiver for delivery of adult dental 2436 services. 2437 (1) (a) Before June 30, 2016, the department shall ask CMS to grant waivers from 2438 federal statutory and regulatory law necessary for the Medicaid program to provide dental 2439 services in the manner described in Subsection (2)(a). 2440 (b) Before June 30, 2018, the department shall submit to CMS a request for waivers, or 2441 an amendment of existing waivers, from federal law necessary for the state to provide dental 2442 services, in accordance with Subsections (2)(b)(i) and (d) through (g), to an individual 2443 described in Subsection (2)(b)(i). 2444 (c) Before June 30, 2019, the department shall submit to the Centers for Medicare and 2445 Medicaid Services a request for waivers, or an amendment to existing waivers, from federal S.B. 39 02-10-23 5:41 PM - 80 - 2446 law necessary for the state to: 2447 (i) provide dental services, in accordance with Subsections (2)(b)(ii) and (d) through 2448 (g) to an individual described in Subsection (2)(b)(ii); and 2449 (ii) provide the services described in Subsection (2)(h). 2450 (2) (a) To the extent funded, the department shall provide services to only blind or 2451 disabled individuals, as defined in 42 U.S.C. Sec. 1382c(a)(1), who are 18 years old or older 2452 and eligible for the program. 2453 (b) Notwithstanding Subsection (2)(a): 2454 (i) if a waiver is approved under Subsection (1)(b), the department shall provide dental 2455 services to an individual who: 2456 (A) qualifies for the health coverage improvement program described in Section 2457 26-18-411; and 2458 (B) is receiving treatment in a substance abuse treatment program, as defined in 2459 Section [62A-2-101] 26B-2-101, licensed under [Title 62A, Chapter 2, Licensure of Programs 2460 and Facilities] Chapter 2, Part 1, Human Services Programs and Facilities; and 2461 (ii) if a waiver is approved under Subsection (1)(c)(i), the department shall provide 2462 dental services to an individual who is an aged individual as defined in 42 U.S.C. Sec. 2463 1382c(a)(1). 2464 (c) To the extent possible, services to individuals described in Subsection (2)(a) shall 2465 be provided through the University of Utah School of Dentistry and the University of Utah 2466 School of Dentistry's associated statewide network. 2467 (d) The department shall provide the services to individuals described in Subsection 2468 (2)(b): 2469 (i) by contracting with an entity that: 2470 (A) has demonstrated experience working with individuals who are being treated for 2471 both a substance use disorder and a major oral health disease; 2472 (B) operates a program, targeted at the individuals described in Subsection (2)(b), that 2473 has demonstrated, through a peer-reviewed evaluation, the effectiveness of providing dental 2474 treatment to those individuals described in Subsection (2)(b); 2475 (C) is willing to pay for an amount equal to the program's non-federal share of the cost 2476 of providing dental services to the population described in Subsection (2)(b); and 02-10-23 5:41 PM S.B. 39 - 81 - 2477 (D) is willing to pay all state costs associated with applying for the waiver described in 2478 Subsection (1)(b) and administering the program described in Subsection (2)(b); and 2479 (ii) through a fee-for-service payment model. 2480 (e) The entity that receives the contract under Subsection (2)(d)(i) shall cover all state 2481 costs of the program described in Subsection (2)(b). 2482 (f) Each fiscal year, the University of Utah School of Dentistry shall, in compliance 2483 with state and federal regulations regarding intergovernmental transfers, transfer funds to the 2484 program in an amount equal to the program's non-federal share of the cost of providing services 2485 under this section through the school during the fiscal year. 2486 (g) If a waiver is approved under Subsection (1)(c)(ii), the department shall provide 2487 coverage for porcelain and porcelain-to-metal crowns if the services are provided: 2488 (i) to an individual who qualifies for dental services under Subsection (2)(b); and 2489 (ii) by an entity that covers all state costs of: 2490 (A) providing the coverage described in this Subsection (2)(h); and 2491 (B) applying for the waiver described in Subsection (1)(c). 2492 (h) Where possible, the department shall ensure that services described in Subsection 2493 (2)(a) that are not provided by the University of Utah School of Dentistry or the University of 2494 Utah School of Dentistry's associated network are provided: 2495 (i) through fee for service reimbursement until July 1, 2018; and 2496 (ii) after July 1, 2018, through the method of reimbursement used by the division for 2497 Medicaid dental benefits. 2498 (i) Subject to appropriations by the Legislature, and as determined by the department, 2499 the scope, amount, duration, and frequency of services may be limited. 2500 (3) (a) If the waivers requested under Subsection (1)(a) are granted, the Medicaid 2501 program shall begin providing dental services in the manner described in Subsection (2) no 2502 later than July 1, 2017. 2503 (b) If the waivers requested under Subsection (1)(b) are granted, the Medicaid program 2504 shall begin providing dental services to the population described in Subsection (2)(b) within 90 2505 days from the day on which the waivers are granted. 2506 (c) If the waivers requested under Subsection (1)(c)(i) are granted, the Medicaid 2507 program shall begin providing dental services to the population described in Subsection S.B. 39 02-10-23 5:41 PM - 82 - 2508 (2)(b)(ii) within 90 days after the day on which the waivers are granted. 2509 (4) If the federal share of the cost of providing dental services under this section will be 2510 less than 65% during any portion of the next fiscal year, the Medicaid program shall cease 2511 providing dental services under this section no later than the end of the current fiscal year. 2512 Section 50. Section 26B-3-209, which is renumbered from Section 26-18-414 is 2513 renumbered and amended to read: 2514 [26-18-414]. 26B-3-209. Medicaid long-term support services housing 2515 coordinator. 2516 (1) There is created within the Medicaid program a full-time-equivalent position of 2517 Medicaid long-term support services housing coordinator. 2518 (2) The coordinator shall help Medicaid recipients receive long-term support services 2519 in a home or other community-based setting rather than in a nursing home or other institutional 2520 setting by: 2521 (a) working with municipalities, counties, the Housing and Community Development 2522 Division within the Department of Workforce Services, and others to identify 2523 community-based settings available to recipients; 2524 (b) working with the same entities to promote the development, construction, and 2525 availability of additional community-based settings; 2526 (c) training Medicaid case managers and support coordinators on how to help Medicaid 2527 recipients move from an institutional setting to a community-based setting; and 2528 (d) performing other related duties. 2529 Section 51. Section 26B-3-210, which is renumbered from Section 26-18-415 is 2530 renumbered and amended to read: 2531 [26-18-415]. 26B-3-210. Medicaid waiver expansion. 2532 (1) As used in this section: 2533 (a) "Federal poverty level" means the same as that term is defined in Section 2534 [26-18-411] 26B-3-207. 2535 (b) "Medicaid waiver expansion" means an expansion of the Medicaid program in 2536 accordance with this section. 2537 (2) (a) Before January 1, 2019, the department shall apply to CMS for approval of a 2538 waiver or state plan amendment to implement the Medicaid waiver expansion. 02-10-23 5:41 PM S.B. 39 - 83 - 2539 (b) The Medicaid waiver expansion shall: 2540 (i) expand Medicaid coverage to eligible individuals whose income is below 95% of 2541 the federal poverty level; 2542 (ii) obtain maximum federal financial participation under 42 U.S.C. Sec. 1396d(y) for 2543 enrolling an individual in the Medicaid program; 2544 (iii) provide Medicaid benefits through the state's Medicaid accountable care 2545 organizations in areas where a Medicaid accountable care organization is implemented; 2546 (iv) integrate the delivery of behavioral health services and physical health services 2547 with Medicaid accountable care organizations in select geographic areas of the state that 2548 choose an integrated model; 2549 (v) include a path to self-sufficiency, including work activities as defined in 42 U.S.C. 2550 Sec. 607(d), for qualified adults; 2551 (vi) require an individual who is offered a private health benefit plan by an employer to 2552 enroll in the employer's health plan; 2553 (vii) sunset in accordance with Subsection (5)(a); and 2554 (viii) permit the state to close enrollment in the Medicaid waiver expansion if the 2555 department has insufficient funding to provide services to additional eligible individuals. 2556 (3) If the Medicaid waiver described in Subsection (2)(a) is approved, the department 2557 may only pay the state portion of costs for the Medicaid waiver expansion with appropriations 2558 from: 2559 (a) the Medicaid Expansion Fund, created in Section [26-36b-208] 26B-1-315; 2560 (b) county contributions to the non-federal share of Medicaid expenditures; and 2561 (c) any other contributions, funds, or transfers from a non-state agency for Medicaid 2562 expenditures. 2563 (4) (a) In consultation with the department, Medicaid accountable care organizations 2564 and counties that elect to integrate care under Subsection (2)(b)(iv) shall collaborate on 2565 enrollment, engagement of patients, and coordination of services. 2566 (b) As part of the provision described in Subsection (2)(b)(iv), the department shall 2567 apply for a waiver to permit the creation of an integrated delivery system: 2568 (i) for any geographic area that expresses interest in integrating the delivery of services 2569 under Subsection (2)(b)(iv); and S.B. 39 02-10-23 5:41 PM - 84 - 2570 (ii) in which the department: 2571 (A) may permit a local mental health authority to integrate the delivery of behavioral 2572 health services and physical health services; 2573 (B) may permit a county, local mental health authority, or Medicaid accountable care 2574 organization to integrate the delivery of behavioral health services and physical health services 2575 to select groups within the population that are newly eligible under the Medicaid waiver 2576 expansion; and 2577 (C) may make rules in accordance with Title 63G, Chapter 3, Utah Administrative 2578 Rulemaking Act, to integrate payments for behavioral health services and physical health 2579 services to plans or providers. 2580 (5) (a) If federal financial participation for the Medicaid waiver expansion is reduced 2581 below 90%, the authority of the department to implement the Medicaid waiver expansion shall 2582 sunset no later than the next July 1 after the date on which the federal financial participation is 2583 reduced. 2584 (b) The department shall close the program to new enrollment if the cost of the 2585 Medicaid waiver expansion is projected to exceed the appropriations for the fiscal year that are 2586 authorized by the Legislature through an appropriations act adopted in accordance with Title 2587 63J, Chapter 1, Budgetary Procedures Act. 2588 (6) If the Medicaid waiver expansion is approved by CMS, the department shall report 2589 to the Social Services Appropriations Subcommittee on or before November 1 of each year that 2590 the Medicaid waiver expansion is operational: 2591 (a) the number of individuals who enrolled in the Medicaid waiver program; 2592 (b) costs to the state for the Medicaid waiver program; 2593 (c) estimated costs for the current and following state fiscal year; and 2594 (d) recommendations to control costs of the Medicaid waiver expansion. 2595 Section 52. Section 26B-3-211, which is renumbered from Section 26-18-416 is 2596 renumbered and amended to read: 2597 [26-18-416]. 26B-3-211. Primary Care Network enhancement waiver 2598 program. 2599 (1) As used in this section: 2600 (a) "Enhancement waiver program" means the Primary Care Network enhancement 02-10-23 5:41 PM S.B. 39 - 85 - 2601 waiver program described in this section. 2602 (b) "Federal poverty level" means the poverty guidelines established by the secretary of 2603 the United States Department of Health and Human Services under 42 U.S.C. Sec. 9902(2). 2604 (c) "Health coverage improvement program" means the same as that term is defined in 2605 Section [26-18-411] 26B-3-207. 2606 (d) "Income eligibility ceiling" means the percentage of federal poverty level: 2607 (i) established by the Legislature in an appropriations act adopted pursuant to Title 63J, 2608 Chapter 1, Budgetary Procedures Act; and 2609 (ii) under which an individual may qualify for coverage in the enhancement waiver 2610 program in accordance with this section. 2611 (e) "Optional population" means the optional expansion population under PPACA if 2612 the expansion provides coverage for individuals at or above 95% of the federal poverty level. 2613 (f) "Primary Care Network" means the state Primary Care Network program created by 2614 the Medicaid primary care network demonstration waiver obtained under Section [26-18-3] 2615 26B-3-108. 2616 (2) The department shall continue to implement the Primary Care Network program for 2617 qualified individuals under the Primary Care Network program. 2618 (3) (a) The division shall apply for a Medicaid waiver or a state plan amendment with 2619 CMS to implement, within the state Medicaid program, the enhancement waiver program 2620 described in this section within six months after the day on which: 2621 (i) the division receives a notice from CMS that the waiver for the Medicaid waiver 2622 expansion submitted under Section [26-18-415] 26B-3-210, Medicaid waiver expansion, will 2623 not be approved; or 2624 (ii) the division withdraws the waiver for the Medicaid waiver expansion submitted 2625 under Section [26-18-415] 26B-3-210, Medicaid waiver expansion. 2626 (b) The division may not apply for a waiver under Subsection (3)(a) while a waiver 2627 request under Section [26-18-415] 26B-3-210, Medicaid waiver expansion, is pending with 2628 CMS. 2629 (4) An individual who is eligible for the enhancement waiver program may receive the 2630 following benefits under the enhancement waiver program: 2631 (a) the benefits offered under the Primary Care Network program; S.B. 39 02-10-23 5:41 PM - 86 - 2632 (b) diagnostic testing and procedures; 2633 (c) medical specialty care; 2634 (d) inpatient hospital services; 2635 (e) outpatient hospital services; 2636 (f) outpatient behavioral health care, including outpatient substance abuse care; and 2637 (g) for an individual who qualifies for the health coverage improvement program, as 2638 approved by CMS, temporary residential treatment for substance abuse in a short term, 2639 non-institutional, 24-hour facility, without a bed capacity limit, that provides rehabilitation 2640 services that are medically necessary and in accordance with an individualized treatment plan. 2641 (5) An individual is eligible for the enhancement waiver program if, at the time of 2642 enrollment: 2643 (a) the individual is qualified to enroll in the Primary Care Network or the health 2644 coverage improvement program; 2645 (b) the individual's annual income is below the income eligibility ceiling established by 2646 the Legislature under Subsection (1)(d); and 2647 (c) the individual meets the eligibility criteria established by the department under 2648 Subsection (6). 2649 (6) (a) Based on available funding and approval from CMS, the department shall 2650 determine the criteria for an individual to qualify for the enhancement waiver program, based 2651 on the following priority: 2652 (i) adults in the expansion population, as defined in Section [26-18-411] 26B-3-207, 2653 who qualify for the health coverage improvement program; 2654 (ii) adults with dependent children who qualify for the health coverage improvement 2655 program under Subsection [26-18-411] 26B-3-207(3); 2656 (iii) adults with dependent children who do not qualify for the health coverage 2657 improvement program; and 2658 (iv) if funding is available, adults without dependent children. 2659 (b) The number of individuals enrolled in the enhancement waiver program may not 2660 exceed 105% of the number of individuals who were enrolled in the Primary Care Network on 2661 December 31, 2017. 2662 (c) The department may only use appropriations from the Medicaid Expansion Fund 02-10-23 5:41 PM S.B. 39 - 87 - 2663 created in Section [26-36b-208] 26B-1-315 to fund the state portion of the enhancement waiver 2664 program. 2665 (7) The department may request a modification of the income eligibility ceiling and the 2666 eligibility criteria under Subsection (6) from CMS each fiscal year based on enrollment in the 2667 enhancement waiver program, projected enrollment in the enhancement waiver program, costs 2668 to the state, and the state budget. 2669 (8) The department may implement the enhancement waiver program by contracting 2670 with Medicaid accountable care organizations to administer the enhancement waiver program. 2671 (9) In accordance with Subsections [26-18-411(11) and (12)] 26B-3-207(10) and (11), 2672 the department may use funds that have been appropriated for the health coverage 2673 improvement program to implement the enhancement waiver program. 2674 (10) If the department expands the state Medicaid program to the optional population, 2675 the department: 2676 (a) except as provided in Subsection (11), may not accept any new enrollees into the 2677 enhancement waiver program after the day on which the expansion to the optional population 2678 is effective; 2679 (b) shall suspend the enhancement waiver program within one year after the day on 2680 which the expansion to the optional population is effective; and 2681 (c) shall work with CMS to maintain the waiver for the enhancement waiver program 2682 submitted under Subsection (3) while the enhancement waiver program is suspended under 2683 Subsection (10)(b). 2684 (11) If, after the expansion to the optional population described in Subsection (10) 2685 takes effect, the expansion to the optional population is repealed by either the state or the 2686 federal government, the department shall reinstate the enhancement waiver program and 2687 continue to accept new enrollees into the enhancement waiver program in accordance with the 2688 provisions of this section. 2689 Section 53. Section 26B-3-212, which is renumbered from Section 26-18-417 is 2690 renumbered and amended to read: 2691 [26-18-417]. 26B-3-212. Limited family planning services for low-income 2692 individuals. 2693 (1) As used in this section: S.B. 39 02-10-23 5:41 PM - 88 - 2694 (a) (i) "Family planning services" means family planning services that are provided 2695 under the state Medicaid program, including: 2696 (A) sexual health education and family planning counseling; and 2697 (B) other medical diagnosis, treatment, or preventative care routinely provided as part 2698 of a family planning service visit. 2699 (ii) "Family planning services" do not include an abortion, as that term is defined in 2700 Section 76-7-301. 2701 (b) "Low-income individual" means an individual who: 2702 (i) has an income level that is equal to or below 95% of the federal poverty level; and 2703 (ii) does not qualify for full coverage under the Medicaid program. 2704 (2) Before July 1, 2018, the division shall apply for a Medicaid waiver or a state plan 2705 amendment with CMS to: 2706 (a) offer a program that provides family planning services to low-income individuals; 2707 and 2708 (b) receive a federal match rate of 90% of state expenditures for family planning 2709 services provided under the waiver or state plan amendment. 2710 Section 54. Section 26B-3-213, which is renumbered from Section 26-18-418 is 2711 renumbered and amended to read: 2712 [26-18-418]. 26B-3-213. Medicaid waiver for mental health crisis lines 2713 and mobile crisis outreach teams. 2714 (1) As used in this section: 2715 (a) "Local mental health crisis line" means the same as that term is defined in Section 2716 [62A-15-1301] 26B-5-610. 2717 (b) "Mental health crisis" means: 2718 (i) a mental health condition that manifests itself in an individual by symptoms of 2719 sufficient severity that a prudent layperson who possesses an average knowledge of mental 2720 health issues could reasonably expect the absence of immediate attention or intervention to 2721 result in: 2722 (A) serious danger to the individual's health or well-being; or 2723 (B) a danger to the health or well-being of others; or 2724 (ii) a mental health condition that, in the opinion of a mental health therapist or the 02-10-23 5:41 PM S.B. 39 - 89 - 2725 therapist's designee, requires direct professional observation or the intervention of a mental 2726 health therapist. 2727 (c) (i) "Mental health crisis services" means direct mental health services and on-site 2728 intervention that a mobile crisis outreach team provides to an individual suffering from a 2729 mental health crisis, including the provision of safety and care plans, prolonged mental health 2730 services for up to 90 days, and referrals to other community resources. 2731 (ii) "Mental health crisis services" includes: 2732 (A) local mental health crisis lines; and 2733 (B) the statewide mental health crisis line. 2734 (d) "Mental health therapist" means the same as that term is defined in Section 2735 58-60-102. 2736 (e) "Mobile crisis outreach team" or "MCOT" means a mobile team of medical and 2737 mental health professionals that, in coordination with local law enforcement and emergency 2738 medical service personnel, provides mental health crisis services. 2739 (f) "Statewide mental health crisis line" means the same as that term is defined in 2740 Section [62A-15-1301] 26B-5-610. 2741 (2) In consultation with the Department of Human Services and the Behavioral Health 2742 Crisis Response Commission created in Section 63C-18-202, the department shall develop a 2743 proposal to amend the state Medicaid plan to include mental health crisis services, including 2744 the statewide mental health crisis line, local mental health crisis lines, and mobile crisis 2745 outreach teams. 2746 (3) By January 1, 2019, the department shall apply for a Medicaid waiver with CMS, if 2747 necessary to implement, within the state Medicaid program, the mental health crisis services 2748 described in Subsection (2). 2749 Section 55. Section 26B-3-214, which is renumbered from Section 26-18-419 is 2750 renumbered and amended to read: 2751 [26-18-419]. 26B-3-214. Medicaid waiver for coverage of mental health 2752 services in schools. 2753 (1) As used in this section, "local education agency" means: 2754 (a) a school district; 2755 (b) a charter school; or S.B. 39 02-10-23 5:41 PM - 90 - 2756 (c) the Utah Schools for the Deaf and the Blind. 2757 (2) In consultation with [the Department of Human Services and] the State Board of 2758 Education, the department shall develop a proposal to allow the state Medicaid program to 2759 reimburse a local education agency, a local mental health authority, or a private provider for 2760 covered mental health services provided: 2761 (a) in accordance with Section 53E-9-203; and 2762 (b) (i) at a local education agency building or facility; or 2763 (ii) by an employee or contractor of a local education agency. 2764 (3) Before January 1, 2020, the department shall apply to CMS for a state plan 2765 amendment to implement the coverage described in Subsection (2). 2766 Section 56. Section 26B-3-215, which is renumbered from Section 26-18-420 is 2767 renumbered and amended to read: 2768 [26-18-420]. 26B-3-215. Coverage for in vitro fertilization and genetic 2769 testing. 2770 (1) As used in this section: 2771 (a) "Qualified condition" means: 2772 (i) cystic fibrosis; 2773 (ii) spinal muscular atrophy; 2774 (iii) Morquio Syndrome; 2775 (iv) myotonic dystrophy; or 2776 (v) sickle cell anemia. 2777 (b) "Qualified enrollee" means an individual who: 2778 (i) is enrolled in the Medicaid program; 2779 (ii) has been diagnosed by a physician as having a genetic trait associated with a 2780 qualified condition; and 2781 (iii) intends to get pregnant with a partner who is diagnosed by a physician as having a 2782 genetic trait associated with the same qualified condition as the individual. 2783 (2) Before January 1, 2021, the department shall apply for a Medicaid waiver or a state 2784 plan amendment with the Centers for Medicare and Medicaid Services within the United States 2785 Department of Health and Human Services to implement the coverage described in Subsection 2786 (3). 02-10-23 5:41 PM S.B. 39 - 91 - 2787 (3) If the waiver described in Subsection (2) is approved, the Medicaid program shall 2788 provide coverage to a qualified enrollee for: 2789 (a) in vitro fertilization services; and 2790 (b) genetic testing of a qualified enrollee who receives in vitro fertilization services 2791 under Subsection (3)(a). 2792 (4) The Medicaid program may not provide the coverage described in Subsection (3) 2793 before the later of: 2794 (a) the day on which the waiver described in Subsection (2) is approved; and 2795 (b) January 1, 2021. 2796 (5) Before November 1, 2022, and before November 1 of every third year thereafter, 2797 the department shall: 2798 (a) calculate the change in state spending attributable to the coverage under this 2799 section; and 2800 (b) report the amount described in Subsection (4)(a) to the Health and Human Services 2801 Interim Committee and the Social Services Appropriations Subcommittee. 2802 Section 57. Section 26B-3-216, which is renumbered from Section 26-18-420.1 is 2803 renumbered and amended to read: 2804 [26-18-420.1]. 26B-3-216. Medicaid waiver for fertility preservation 2805 services. 2806 (1) As used in this section: 2807 (a) "Iatrogenic infertility" means an impairment of fertility or reproductive functioning 2808 caused by surgery, chemotherapy, radiation, or other medical treatment. 2809 (b) "Physician" means an individual licensed to practice under Title 58, Chapter 67, 2810 Utah Medical Practice Act, or Title 58, Chapter 68, Utah Osteopathic Medical Practice Act. 2811 (c) "Qualified enrollee" means an individual who: 2812 (i) is enrolled in the Medicaid program; 2813 (ii) has been diagnosed with a form of cancer by a physician; and 2814 (iii) needs treatment for that cancer that may cause a substantial risk of sterility or 2815 iatrogenic infertility, including surgery, radiation, or chemotherapy. 2816 (d) "Standard fertility preservation service" means a fertility preservation procedure 2817 and service that: S.B. 39 02-10-23 5:41 PM - 92 - 2818 (i) is not considered experimental or investigational by the American Society for 2819 Reproductive Medicine or the American Society of Clinical Oncology; and 2820 (ii) is consistent with established medical practices or professional guidelines 2821 published by the American Society for Reproductive Medicine or the American Society of 2822 Clinical Oncology, including: 2823 (A) sperm banking; 2824 (B) oocyte banking; 2825 (C) embryo banking; 2826 (D) banking of reproductive tissues; and 2827 (E) storage of reproductive cells and tissues. 2828 (2) Before January 1, 2022, the department shall apply for a Medicaid waiver or a state 2829 plan amendment with CMS to implement the coverage described in Subsection (3). 2830 (3) If the waiver or state plan amendment described in Subsection (2) is approved, the 2831 Medicaid program shall provide coverage to a qualified enrollee for standard fertility 2832 preservation services. 2833 (4) The Medicaid program may not provide the coverage described in Subsection (3) 2834 before the later of: 2835 (a) the day on which the waiver described in Subsection (2) is approved; and 2836 (b) January 1, 2023. 2837 (5) Before November 1, 2023, and before November 1 of each third year after 2023, 2838 the department shall: 2839 (a) calculate the change in state spending attributable to the coverage described in this 2840 section; and 2841 (b) report the amount described in Subsection (5)(a) to the Health and Human Services 2842 Interim Committee and the Social Services Appropriations Subcommittee. 2843 Section 58. Section 26B-3-217, which is renumbered from Section 26-18-421 is 2844 renumbered and amended to read: 2845 [26-18-421]. 26B-3-217. Medicaid waiver for coverage of qualified 2846 inmates leaving prison or jail. 2847 (1) As used in this section: 2848 (a) "Correctional facility" means: 02-10-23 5:41 PM S.B. 39 - 93 - 2849 (i) a county jail; 2850 (ii) the Department of Corrections, created in Section 64-13-2; or 2851 (iii) a prison, penitentiary, or other institution operated by or under contract with the 2852 Department of Corrections for the confinement of an offender, as defined in Section 64-13-1. 2853 (b) "Qualified inmate" means an individual who: 2854 (i) is incarcerated in a correctional facility; and 2855 (ii) has: 2856 (A) a chronic physical or behavioral health condition; 2857 (B) a mental illness, as defined in Section [62A-15-602] 26B-5-301; or 2858 (C) an opioid use disorder. 2859 (2) Before July 1, 2020, the division shall apply for a Medicaid waiver or a state plan 2860 amendment with CMS to offer a program to provide Medicaid coverage to a qualified inmate 2861 for up to 30 days immediately before the day on which the qualified inmate is released from a 2862 correctional facility. 2863 (3) If the waiver or state plan amendment described in Subsection (2) is approved, the 2864 department shall report to the Health and Human Services Interim Committee each year before 2865 November 30 while the waiver or state plan amendment is in effect regarding: 2866 (a) the number of qualified inmates served under the program; 2867 (b) the cost of the program; and 2868 (c) the effectiveness of the program, including: 2869 (i) any reduction in the number of emergency room visits or hospitalizations by 2870 inmates after release from a correctional facility; 2871 (ii) any reduction in the number of inmates undergoing inpatient treatment after release 2872 from a correctional facility; 2873 (iii) any reduction in overdose rates and deaths of inmates after release from a 2874 correctional facility; and 2875 (iv) any other costs or benefits as a result of the program. 2876 (4) If the waiver or state plan amendment described in Subsection (2) is approved, a 2877 county that is responsible for the cost of a qualified inmate's medical care shall provide the 2878 required matching funds to the state for: 2879 (a) any costs to enroll the qualified inmate for the Medicaid coverage described in S.B. 39 02-10-23 5:41 PM - 94 - 2880 Subsection (2); 2881 (b) any administrative fees for the Medicaid coverage described in Subsection (2); and 2882 (c) the Medicaid coverage that is provided to the qualified inmate under Subsection 2883 (2). 2884 Section 59. Section 26B-3-218, which is renumbered from Section 26-18-422 is 2885 renumbered and amended to read: 2886 [26-18-422]. 26B-3-218. Medicaid waiver for inpatient care in an 2887 institution for mental diseases. 2888 (1) As used in this section, "institution for mental diseases" means the same as that 2889 term is defined in 42 C.F.R. Sec. 435.1010. 2890 (2) Before August 1, 2020, the division shall apply for a Medicaid waiver or a state 2891 plan amendment with CMS to offer a program that provides reimbursement for mental health 2892 services that are provided: 2893 (a) in an institution for mental diseases that includes more than 16 beds; and 2894 (b) to an individual who receives mental health services in an institution for mental 2895 diseases for a period of more than 15 days in a calendar month. 2896 (3) If the waiver or state plan amendment described in Subsection (2) is approved, the 2897 department shall: 2898 (a) [coordinate with the Department of Human Services to] develop and offer the 2899 program described in Subsection (2); and 2900 (b) submit to the Health and Human Services Interim Committee and the Social 2901 Services Appropriations Subcommittee any report that the department submits to CMS that 2902 relates to the budget neutrality, independent waiver evaluation, or performance metrics of the 2903 program described in Subsection (2), within 15 days after the day on which the report is 2904 submitted to CMS. 2905 (4) Notwithstanding Sections 17-43-201 and 17-43-301, if the waiver or state plan 2906 amendment described in Subsection (2) is approved, a county does not have to provide 2907 matching funds to the state for the mental health services described in Subsection (2) that are 2908 provided to an individual who qualifies for Medicaid coverage under Section [26-18-3.9 or 2909 Section 26-18-411] 26B-3-113 or 26B-3-207. 2910 Section 60. Section 26B-3-219, which is renumbered from Section 26-18-423 is 02-10-23 5:41 PM S.B. 39 - 95 - 2911 renumbered and amended to read: 2912 [26-18-423]. 26B-3-219. Reimbursement for crisis management services 2913 provided in a behavioral health receiving center -- Integration of payment for physical 2914 health services. 2915 (1) As used in this section: 2916 (a) "Accountable care organization" means the same as that term is defined in Section 2917 [26-18-408] 26B-3-204. 2918 (b) "Behavioral health receiving center" means the same as that term is defined in 2919 Section [62A-15-118] 26B-4-114. 2920 (c) "Crisis management services" means behavioral health services provided to an 2921 individual who is experiencing a mental health crisis. 2922 (d) "Managed care organization" means the same as that term is defined in 42 C.F.R. 2923 Sec. 438.2. 2924 (2) Before July 1, 2020, the division shall apply for a Medicaid waiver or state plan 2925 amendment with CMS to offer a program that provides reimbursement through a bundled daily 2926 rate for crisis management services that are delivered to an individual during the individual's 2927 stay at a behavioral health receiving center. 2928 (3) If the waiver or state plan amendment described in Subsection (2) is approved, the 2929 department shall: 2930 (a) implement the program described in Subsection (2); and 2931 (b) require a managed care organization that contracts with the state's Medicaid 2932 program for behavioral health services or integrated health services to provide coverage for 2933 crisis management services that are delivered to an individual during the individual's stay at a 2934 behavioral health receiving center. 2935 (4) (a) The department may elect to integrate payment for physical health services 2936 provided in a behavioral health receiving center. 2937 (b) In determining whether to integrate payment under Subsection (4)(a), the 2938 department shall consult with accountable care organizations and counties in the state. 2939 Section 61. Section 26B-3-220, which is renumbered from Section 26-18-424 is 2940 renumbered and amended to read: 2941 [26-18-424]. 26B-3-220. Crisis services -- Reimbursement. S.B. 39 02-10-23 5:41 PM - 96 - 2942 The Department shall submit a waiver or state plan amendment to allow for 2943 reimbursement for 988 services provided to an individual who is eligible and enrolled in 2944 Medicaid at the time this service is provided. 2945 Section 62. Section 26B-3-221, which is renumbered from Section 26-18-425 is 2946 renumbered and amended to read: 2947 [26-18-425]. 26B-3-221. Medicaid waiver for respite care facility that 2948 provides services to homeless individuals. 2949 (1) As used in this section: 2950 (a) "Adult in the expansion population" means an adult: 2951 (i) described in 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII); and 2952 (ii) not otherwise eligible for Medicaid as a mandatory categorically needy individual. 2953 (b) "Homeless" means the same as that term is defined in Section [26-18-411] 2954 26B-3-207. 2955 (c) "Medical respite care" means short-term housing with supportive medical services. 2956 (d) "Medical respite facility" means a residential facility that provides medical respite 2957 care to homeless individuals. 2958 (2) Before January 1, 2022, the department shall apply for a Medicaid waiver or state 2959 plan amendment with CMS to choose a single medical respite facility to reimburse for services 2960 provided to an individual who is: 2961 (a) homeless; and 2962 (b) an adult in the expansion population. 2963 (3) The department shall choose a medical respite facility best able to serve homeless 2964 individuals who are adults in the expansion population. 2965 (4) If the waiver or state plan amendment described in Subsection (2) is approved, 2966 while the waiver or state plan amendment is in effect, the department shall submit a report to 2967 the Health and Human Services Interim Committee each year before November 30 detailing: 2968 (a) the number of homeless individuals served at the facility; 2969 (b) the cost of the program; and 2970 (c) the reduction of health care costs due to the program's implementation. 2971 (5) Through administrative rule made in accordance with Title 63G, Chapter 3, Utah 2972 Administrative Rulemaking Act, the department shall further define and limit the services, 02-10-23 5:41 PM S.B. 39 - 97 - 2973 described in this section, provided to a homeless individual. 2974 Section 63. Section 26B-3-222, which is renumbered from Section 26-18-426 is 2975 renumbered and amended to read: 2976 [26-18-426]. 26B-3-222. Medicaid waiver expansion for extraordinary 2977 care reimbursement. 2978 (1) As used in this section: 2979 (a) "Existing home and community-based services waiver" means an existing home 2980 and community-based services waiver in the state that serves an individual: 2981 (i) with an acquired brain injury; 2982 (ii) with an intellectual or physical disability; or 2983 (iii) who is 65 years old or older. 2984 (b) "Personal care services" means a service that: 2985 (i) is furnished to an individual who is not an inpatient nor a resident of a hospital, 2986 nursing facility, intermediate care facility, or institution for mental diseases; 2987 (ii) is authorized for an individual described in Subsection (1)(b)(i) in accordance with 2988 a plan of treatment; 2989 (iii) is provided by an individual who is qualified to provide the services; and 2990 (iv) is furnished in a home or another community-based setting. 2991 (c) "Waiver enrollee" means an individual who is enrolled in an existing home and 2992 community-based services waiver. 2993 (2) Before July 1, 2021, the department shall apply with CMS for an amendment to an 2994 existing home and community-based services waiver to implement a program to offer 2995 reimbursement to an individual who provides personal care services that constitute 2996 extraordinary care to a waiver enrollee who is the individual's spouse. 2997 (3) If CMS approves the amendment described in Subsection (2), the department shall 2998 implement the program described in Subsection (2). 2999 (4) The department shall by rule, made in accordance with Title 63G, Chapter 3, Utah 3000 Administrative Rulemaking Act, define "extraordinary care" for purposes of Subsection (2). 3001 Section 64. Section 26B-3-223, which is renumbered from Section 26-18-428 is 3002 renumbered and amended to read: 3003 [26-18-428]. 26B-3-223. Delivery system adjustments for the targeted S.B. 39 02-10-23 5:41 PM - 98 - 3004 adult Medicaid program. 3005 (1) As used in this section, "targeted adult Medicaid program" means the same as that 3006 term is defined in Section [26-18-411] 26B-3-207. 3007 (2) The department may implement the delivery system adjustments authorized under 3008 Subsection (3) only on the later of: 3009 (a) July 1, 2023; and 3010 (b) the department determining that the Medicaid program, including providers and 3011 managed care organizations, are satisfying the metrics established in collaboration with the 3012 working group convened under Subsection [26-18-427] 26B-3-138(2). 3013 (3) The department may, for individuals who are enrolled in the targeted adult 3014 Medicaid program: 3015 (a) integrate the delivery of behavioral and physical health in certain counties; and 3016 (b) deliver behavioral health services through an accountable care organization where 3017 implemented. 3018 (4) Before implementing the delivery system adjustments described in Subsection (3) 3019 in a county, the department shall, at a minimum, seek input from: 3020 (a) individuals who qualify for the targeted adult Medicaid program who reside in the 3021 county; 3022 (b) the county's executive officer, legislative body, and other county officials who are 3023 involved in the delivery of behavioral health services; 3024 (c) the local mental health authority and substance use authority that serves the county; 3025 (d) Medicaid managed care organizations operating in the state, including Medicaid 3026 accountable care organizations; 3027 (e) providers of physical or behavioral health services in the county who provide 3028 services to enrollees in the targeted adult Medicaid program in the county; and 3029 (f) other individuals that the department deems necessary. 3030 (5) If the department provides Medicaid coverage through a managed care delivery 3031 system under this section, the department shall include language in the department's managed 3032 care contracts that require the managed care plan to: 3033 (a) be in compliance with federal Medicaid managed care requirements; 3034 (b) timely and accurately process authorizations and claims in accordance with 02-10-23 5:41 PM S.B. 39 - 99 - 3035 Medicaid policy and contract requirements; 3036 (c) adequately reimburse providers to maintain adequacy of access to care; 3037 (d) provide care management services sufficient to meet the needs of Medicaid eligible 3038 individuals enrolled in the managed care plan's plan; and 3039 (e) timely resolve any disputes between a provider or enrollee with the managed care 3040 plan. 3041 (6) The department may take corrective action if the managed care organization fails to 3042 comply with the terms of the managed care organization's contract. 3043 Section 65. Section 26B-3-224, which is renumbered from Section 26-18-429 is 3044 renumbered and amended to read: 3045 [26-18-429]. 26B-3-224. Medicaid waiver for increased integrated health 3046 care reimbursement. 3047 (1) As used in this section: 3048 (a) "Integrated health care setting" means a health care or behavioral health care setting 3049 that provides integrated physical and behavioral health care services. 3050 (b) "Local mental health authority" means a local mental health authority described in 3051 Section 17-43-301. 3052 (2) The department shall develop a proposal to allow the state Medicaid program to 3053 reimburse a local mental health authority for covered physical health care services provided in 3054 an integrated health care setting to Medicaid eligible individuals. 3055 (3) Before December 31, 2022, the department shall apply for a Medicaid waiver or a 3056 state plan amendment with CMS to implement the proposal described in Subsection (2). 3057 (4) If the waiver or state plan amendment described in Subsection (3) is approved, the 3058 department shall: 3059 (a) implement the proposal described in Subsection (2); and 3060 (b) while the waiver or state plan amendment is in effect, submit a report to the Health 3061 and Human Services Interim Committee each year before November 30 detailing: 3062 (i) the number of patients served under the waiver or state plan amendment; 3063 (ii) the cost of the waiver or state plan amendment; and 3064 (iii) any benefits of the waiver or state plan amendment. 3065 Section 66. Section 26B-3-301, which is renumbered from Section 26-18-101 is S.B. 39 02-10-23 5:41 PM - 100 - 3066 renumbered and amended to read: 3067 Part 3. Administration of Medicaid Programs: Drug Utilization Review and 3068 Long Term Care Facility Certification 3069 [26-18-101]. 26B-3-301. Definitions. 3070 As used in this part: 3071 (1) "Appropriate and medically necessary" means, regarding drug prescribing, 3072 dispensing, and patient usage, that it is in conformity with the criteria and standards developed 3073 in accordance with this part. 3074 (2) "Board" means the Drug Utilization Review Board created in Section [26-18-102] 3075 26B-3-302. 3076 (3) "Certified program" means a nursing care facility program with Medicaid 3077 certification. 3078 [(3)] (4) "Compendia" means resources widely accepted by the medical profession in 3079 the efficacious use of drugs, including "American Hospital Formulary Services Drug 3080 Information," "U.S. Pharmacopeia - Drug Information," "A.M.A. Drug Evaluations," 3081 peer-reviewed medical literature, and information provided by manufacturers of drug products. 3082 [(4)] (5) "Counseling" means the activities conducted by a pharmacist to inform 3083 Medicaid recipients about the proper use of drugs, as required by the board under this part. 3084 [(5)] (6) "Criteria" means those predetermined and explicitly accepted elements used to 3085 measure drug use on an ongoing basis in order to determine if the use is appropriate, medically 3086 necessary, and not likely to result in adverse medical outcomes. 3087 [(6)] (7) "Drug-disease contraindications" means that the therapeutic effect of a drug is 3088 adversely altered by the presence of another disease condition. 3089 [(7)] (8) "Drug-interactions" means that two or more drugs taken by a recipient lead to 3090 clinically significant toxicity that is characteristic of one or any of the drugs present, or that 3091 leads to interference with the effectiveness of one or any of the drugs. 3092 [(8)] (9) "Drug Utilization Review" or "DUR" means the program designed to measure 3093 and assess, on a retrospective and prospective basis, the proper use of outpatient drugs in the 3094 Medicaid program. 3095 [(9)] (10) "Intervention" means a form of communication utilized by the board with a 3096 prescriber or pharmacist to inform about or influence prescribing or dispensing practices. 02-10-23 5:41 PM S.B. 39 - 101 - 3097 (11) "Medicaid certification" means the right of a nursing care facility, as a provider of 3098 a nursing care facility program, to receive Medicaid reimbursement for a specified number of 3099 beds within the facility. 3100 (12) (a) "Nursing care facility" means the following facilities licensed by the 3101 department under Chapter 2, Part 2, Health Care Facility Licensing and Inspection: 3102 (i) skilled nursing facilities; 3103 (ii) intermediate care facilities; and 3104 (iii) an intermediate care facility for people with an intellectual disability. 3105 (b) "Nursing care facility" does not mean a critical access hospital that meets the 3106 criteria of 42 U.S.C. 1395i-4(c)(2) (1998). 3107 (13) "Nursing care facility program" means the personnel, licenses, services, contracts 3108 and all other requirements that shall be met for a nursing care facility to be eligible for 3109 Medicaid certification under this part and division rule. 3110 [(10)] (14) "Overutilization" or "underutilization" means the use of a drug in such 3111 quantities that the desired therapeutic goal is not achieved. 3112 [(11)] (15) "Pharmacist" means a person licensed in this state to engage in the practice 3113 of pharmacy under Title 58, Chapter 17b, Pharmacy Practice Act. 3114 (16) "Physical facility" means the buildings or other physical structures where a 3115 nursing care facility program is operated. 3116 [(12)] (17) "Physician" means a person licensed in this state to practice medicine and 3117 surgery under Section 58-67-301 or osteopathic medicine under Section 58-68-301. 3118 [(13)] (18) "Prospective DUR" means that part of the drug utilization review program 3119 that occurs before a drug is dispensed, and that is designed to screen for potential drug therapy 3120 problems based on explicit and predetermined criteria and standards. 3121 [(14)] (19) "Retrospective DUR" means that part of the drug utilization review 3122 program that assesses or measures drug use based on an historical review of drug use data 3123 against predetermined and explicit criteria and standards, on an ongoing basis with professional 3124 input. 3125 (20) "Rural county" means a county with a population of less than 50,000, as 3126 determined by: 3127 (a) the most recent official census or census estimate of the United States Bureau of the S.B. 39 02-10-23 5:41 PM - 102 - 3128 Census; or 3129 (b) the most recent population estimate for the county from the Utah Population 3130 Committee, if a population figure for the county is not available under Subsection (7)(a). 3131 (21) "Service area" means the boundaries of the distinct geographic area served by a 3132 certified program as determined by the division in accordance with this part and division rule. 3133 [(15)] (22) "Standards" means the acceptable range of deviation from the criteria that 3134 reflects local medical practice and that is tested on the Medicaid recipient database. 3135 [(16)] (23) "SURS" means the Surveillance Utilization Review System of the Medicaid 3136 program. 3137 [(17)] (24) "Therapeutic appropriateness" means drug prescribing and dispensing based 3138 on rational drug therapy that is consistent with criteria and standards. 3139 [(18)] (25) "Therapeutic duplication" means prescribing and dispensing the same drug 3140 or two or more drugs from the same therapeutic class where periods of drug administration 3141 overlap and where that practice is not medically indicated. 3142 (26) "Urban county" means a county that is not a rural county. 3143 Section 67. Section 26B-3-302, which is renumbered from Section 26-18-102 is 3144 renumbered and amended to read: 3145 [26-18-102]. 26B-3-302. DUR Board -- Creation and membership -- 3146 Expenses. 3147 (1) There is created a 12-member Drug Utilization Review Board responsible for 3148 implementation of a retrospective and prospective DUR program. 3149 (2) (a) Except as required by Subsection (2)(b), as terms of current board members 3150 expire, the executive director shall appoint each new member or reappointed member to a 3151 four-year term. 3152 (b) Notwithstanding the requirements of Subsection (2)(a), the executive director shall, 3153 at the time of appointment or reappointment, adjust the length of terms to ensure that the terms 3154 of board members are staggered so that approximately half of the board is appointed every two 3155 years. 3156 (c) Persons appointed to the board may be reappointed upon completion of their terms, 3157 but may not serve more than two consecutive terms. 3158 (d) The executive director shall provide for geographic balance in representation on the 02-10-23 5:41 PM S.B. 39 - 103 - 3159 board. 3160 (3) When a vacancy occurs in the membership for any reason, the replacement shall be 3161 appointed for the unexpired term. 3162 (4) The membership shall be comprised of the following: 3163 (a) four physicians who are actively engaged in the practice of medicine or osteopathic 3164 medicine in this state, to be selected from a list of nominees provided by the Utah Medical 3165 Association; 3166 (b) one physician in this state who is actively engaged in academic medicine; 3167 (c) three pharmacists who are actively practicing in retail pharmacy in this state, to be 3168 selected from a list of nominees provided by the Utah Pharmaceutical Association; 3169 (d) one pharmacist who is actively engaged in academic pharmacy; 3170 (e) one person who shall represent consumers; 3171 (f) one person who shall represent pharmaceutical manufacturers, to be recommended 3172 by the Pharmaceutical Manufacturers Association; and 3173 (g) one dentist licensed to practice in this state under Title 58, Chapter 69, Dentist and 3174 Dental Hygienist Practice Act, who is actively engaged in the practice of dentistry, nominated 3175 by the Utah Dental Association. 3176 (5) Physician and pharmacist members of the board shall have expertise in clinically 3177 appropriate prescribing and dispensing of outpatient drugs. 3178 (6) The board shall elect a chair from among its members who shall serve a one-year 3179 term, and may serve consecutive terms. 3180 (7) A member may not receive compensation or benefits for the member's service, but 3181 may receive per diem and travel expenses in accordance with: 3182 (a) Section 63A-3-106; 3183 (b) Section 63A-3-107; and 3184 (c) rules made by the Division of Finance pursuant to Sections 63A-3-106 and 3185 63A-3-107. 3186 Section 68. Section 26B-3-303, which is renumbered from Section 26-18-103 is 3187 renumbered and amended to read: 3188 [26-18-103]. 26B-3-303. DUR Board -- Responsibilities. 3189 The board shall: S.B. 39 02-10-23 5:41 PM - 104 - 3190 (1) develop rules necessary to carry out its responsibilities as defined in this part; 3191 (2) oversee the implementation of a Medicaid retrospective and prospective DUR 3192 program in accordance with this part, including responsibility for approving provisions of 3193 contractual agreements between the Medicaid program and any other entity that will process 3194 and review Medicaid drug claims and profiles for the DUR program in accordance with this 3195 part; 3196 (3) develop and apply predetermined criteria and standards to be used in retrospective 3197 and prospective DUR, ensuring that the criteria and standards are based on the compendia, and 3198 that they are developed with professional input, in a consensus fashion, with provisions for 3199 timely revision and assessment as necessary. The DUR standards developed by the board shall 3200 reflect the local practices of physicians in order to monitor: 3201 (a) therapeutic appropriateness; 3202 (b) overutilization or underutilization; 3203 (c) therapeutic duplication; 3204 (d) drug-disease contraindications; 3205 (e) drug-drug interactions; 3206 (f) incorrect drug dosage or duration of drug treatment; and 3207 (g) clinical abuse and misuse; 3208 (4) develop, select, apply, and assess interventions and remedial strategies for 3209 physicians, pharmacists, and recipients that are educational and not punitive in nature, in order 3210 to improve the quality of care; 3211 (5) disseminate information to physicians and pharmacists to ensure that they are aware 3212 of the board's duties and powers; 3213 (6) provide written, oral, or electronic reminders of patient-specific or drug-specific 3214 information, designed to ensure recipient, physician, and pharmacist confidentiality, and 3215 suggest changes in prescribing or dispensing practices designed to improve the quality of care; 3216 (7) utilize face-to-face discussions between experts in drug therapy and the prescriber 3217 or pharmacist who has been targeted for educational intervention; 3218 (8) conduct intensified reviews or monitoring of selected prescribers or pharmacists; 3219 (9) create an educational program using data provided through DUR to provide active 3220 and ongoing educational outreach programs to improve prescribing and dispensing practices, 02-10-23 5:41 PM S.B. 39 - 105 - 3221 either directly or by contract with other governmental or private entities; 3222 (10) provide a timely evaluation of intervention to determine if those interventions 3223 have improved the quality of care; 3224 (11) publish the annual Drug Utilization Review report required under 42 C.F.R. Sec. 3225 712; 3226 (12) develop a working agreement with related boards or agencies, including the State 3227 Board of Pharmacy, Physicians' Licensing Board, and SURS staff within the division, in order 3228 to clarify areas of responsibility for each, where those areas may overlap; 3229 (13) establish a grievance process for physicians and pharmacists under this part, in 3230 accordance with Title 63G, Chapter 4, Administrative Procedures Act; 3231 (14) publish and disseminate educational information to physicians and pharmacists 3232 concerning the board and the DUR program, including information regarding: 3233 (a) identification and reduction of the frequency of patterns of fraud, abuse, gross 3234 overuse, inappropriate, or medically unnecessary care among physicians, pharmacists, and 3235 recipients; 3236 (b) potential or actual severe or adverse reactions to drugs; 3237 (c) therapeutic appropriateness; 3238 (d) overutilization or underutilization; 3239 (e) appropriate use of generics; 3240 (f) therapeutic duplication; 3241 (g) drug-disease contraindications; 3242 (h) drug-drug interactions; 3243 (i) incorrect drug dosage and duration of drug treatment; 3244 (j) drug allergy interactions; and 3245 (k) clinical abuse and misuse; 3246 (15) develop and publish, with the input of the State Board of Pharmacy, guidelines 3247 and standards to be used by pharmacists in counseling Medicaid recipients in accordance with 3248 this part. The guidelines shall ensure that the recipient may refuse counseling and that the 3249 refusal is to be documented by the pharmacist. Items to be discussed as part of that counseling 3250 include: 3251 (a) the name and description of the medication; S.B. 39 02-10-23 5:41 PM - 106 - 3252 (b) administration, form, and duration of therapy; 3253 (c) special directions and precautions for use; 3254 (d) common severe side effects or interactions, and therapeutic interactions, and how to 3255 avoid those occurrences; 3256 (e) techniques for self-monitoring drug therapy; 3257 (f) proper storage; 3258 (g) prescription refill information; and 3259 (h) action to be taken in the event of a missed dose; and 3260 (16) establish procedures in cooperation with the State Board of Pharmacy for 3261 pharmacists to record information to be collected under this part. The recorded information 3262 shall include: 3263 (a) the name, address, age, and gender of the recipient; 3264 (b) individual history of the recipient where significant, including disease state, known 3265 allergies and drug reactions, and a comprehensive list of medications and relevant devices; 3266 (c) the pharmacist's comments on the individual's drug therapy; 3267 (d) name of prescriber; and 3268 (e) name of drug, dose, duration of therapy, and directions for use. 3269 Section 69. Section 26B-3-304, which is renumbered from Section 26-18-104 is 3270 renumbered and amended to read: 3271 [26-18-104]. 26B-3-304. Confidentiality of records. 3272 (1) Information obtained under this part shall be treated as confidential or controlled 3273 information under Title 63G, Chapter 2, Government Records Access and Management Act. 3274 (2) The board shall establish procedures insuring that the information described in 3275 Subsection [26-18-103] 26B-3-304(16) is held confidential by the pharmacist, being provided 3276 to the physician only upon request. 3277 (3) The board shall adopt and implement procedures designed to ensure the 3278 confidentiality of all information collected, stored, retrieved, assessed, or analyzed by the 3279 board, staff to the board, or contractors to the DUR program, that identifies individual 3280 physicians, pharmacists, or recipients. The board may have access to identifying information 3281 for purposes of carrying out intervention activities, but that identifying information may not be 3282 released to anyone other than a member of the board. The board may release cumulative 02-10-23 5:41 PM S.B. 39 - 107 - 3283 nonidentifying information for research purposes. 3284 Section 70. Section 26B-3-305, which is renumbered from Section 26-18-105 is 3285 renumbered and amended to read: 3286 [26-18-105]. 26B-3-305. Drug prior approval program. 3287 (1) A drug prior approval program approved or implemented by the board shall meet 3288 the following conditions: 3289 (a) except as provided in Subsection (2), a drug may not be placed on prior approval 3290 for other than medical reasons; 3291 (b) the board shall hold a public hearing at least 30 days prior to placing a drug on prior 3292 approval; 3293 (c) notwithstanding the provisions of Section 52-4-202, the board shall provide not less 3294 than 14 days' notice to the public before holding a public hearing under Subsection (1)(b); 3295 (d) the board shall consider written and oral comments submitted by interested parties 3296 prior to or during the hearing held in accordance with Subsection (1)(b); 3297 (e) the board shall provide evidence that placing a drug class on prior approval: 3298 (i) will not impede quality of recipient care; and 3299 (ii) that the drug class is subject to clinical abuse or misuse; 3300 (f) the board shall reconsider its decision to place a drug on prior approval: 3301 (i) no later than nine months after any drug class is placed on prior approval; and 3302 (ii) at a public hearing with notice as provided in Subsection (1)(b); 3303 (g) the program shall provide an approval or denial of a request for prior approval: 3304 (i) by either: 3305 (A) fax; 3306 (B) telephone; or 3307 (C) electronic transmission; 3308 (ii) at least Monday through Friday, except for state holidays; and 3309 (iii) within 24 hours after receipt of the prior approval request; 3310 (h) the program shall provide for the dispensing of at least a 72-hour supply of the drug 3311 on the prior approval program: 3312 (i) in an emergency situation; or 3313 (ii) on weekends or state holidays; S.B. 39 02-10-23 5:41 PM - 108 - 3314 (i) the program may be applied to allow acceptable medical use of a drug on prior 3315 approval for appropriate off-label indications; and 3316 (j) before placing a drug class on the prior approval program, the board shall: 3317 (i) determine that the requirements of Subsections (1)(a) through (i) have been met; 3318 and 3319 (ii) by majority vote, place the drug class on prior approval. 3320 (2) The board may, only after complying with Subsections (1)(b) through (j), consider 3321 the cost: 3322 (a) of a drug when placing a drug on the prior approval program; and 3323 (b) associated with including, or excluding a drug from the prior approval process, 3324 including: 3325 (i) potential side effects associated with a drug; or 3326 (ii) potential hospitalizations or other complications that may occur as a result of a 3327 drug's inclusion on the prior approval process. 3328 Section 71. Section 26B-3-306, which is renumbered from Section 26-18-106 is 3329 renumbered and amended to read: 3330 [26-18-106]. 26B-3-306. Advisory committees. 3331 The board may establish advisory committees to assist it in carrying out its duties under 3332 [this part] Sections 26B-3-302 through 26B-3-309. 3333 Section 72. Section 26B-3-307, which is renumbered from Section 26-18-107 is 3334 renumbered and amended to read: 3335 [26-18-107]. 26B-3-307. Retrospective and prospective DUR. 3336 (1) The board, in cooperation with the division, shall include in its state plan the 3337 creation and implementation of a retrospective and prospective DUR program for Medicaid 3338 outpatient drugs to ensure that prescriptions are appropriate, medically necessary, and not likely 3339 to result in adverse medical outcomes. 3340 (2) The retrospective and prospective DUR program shall be operated under guidelines 3341 established by the board under Subsections (3) and (4). 3342 (3) The retrospective DUR program shall be based on guidelines established by the 3343 board, using the mechanized drug claims processing and information retrieval system to 3344 analyze claims data in order to: 02-10-23 5:41 PM S.B. 39 - 109 - 3345 (a) identify patterns of fraud, abuse, gross overuse, and inappropriate or medically 3346 unnecessary care; and 3347 (b) assess data on drug use against explicit predetermined standards that are based on 3348 the compendia and other sources for the purpose of monitoring: 3349 (i) therapeutic appropriateness; 3350 (ii) overutilization or underutilization; 3351 (iii) therapeutic duplication; 3352 (iv) drug-disease contraindications; 3353 (v) drug-drug interactions; 3354 (vi) incorrect drug dosage or duration of drug treatment; and 3355 (vii) clinical abuse and misuse. 3356 (4) The prospective DUR program shall be based on guidelines established by the 3357 board and shall provide that, before a prescription is filled or delivered, a review will be 3358 conducted by the pharmacist at the point of sale to screen for potential drug therapy problems 3359 resulting from: 3360 (a) therapeutic duplication; 3361 (b) drug-drug interactions; 3362 (c) incorrect dosage or duration of treatment; 3363 (d) drug-allergy interactions; and 3364 (e) clinical abuse or misuse. 3365 (5) In conducting the prospective DUR, a pharmacist may not alter the prescribed 3366 outpatient drug therapy without the consent of the prescribing physician or physician assistant. 3367 This section does not effect the ability of a pharmacist to substitute a generic equivalent. 3368 Section 73. Section 26B-3-308, which is renumbered from Section 26-18-108 is 3369 renumbered and amended to read: 3370 [26-18-108]. 26B-3-308. Penalties. 3371 Any person who violates the confidentiality provisions of [this part] Sections 3372 26B-3-302 through 26B-3-307 is guilty of a class B misdemeanor. 3373 Section 74. Section 26B-3-309, which is renumbered from Section 26-18-109 is 3374 renumbered and amended to read: 3375 [26-18-109]. 26B-3-309. Immunity. S.B. 39 02-10-23 5:41 PM - 110 - 3376 There is no liability on the part of, and no cause of action of any nature arises against 3377 any member of the board, its agents, or employees for any action or omission by them in 3378 effecting the provisions of [this part] Sections 26B-3-302 through 26B-3-307. 3379 Section 75. Section 26B-3-310, which is renumbered from Section 26-18-502 is 3380 renumbered and amended to read: 3381 [26-18-502]. 26B-3-310. Purpose -- Medicaid certification of nursing care 3382 facilities. 3383 (1) The Legislature finds: 3384 (a) that an oversupply of nursing care facilities in the state adversely affects the state 3385 Medicaid program and the health of the people in the state; 3386 (b) it is in the best interest of the state to prohibit nursing care facilities from receiving 3387 Medicaid certification, except as provided by [this part] Sections 26B-3-311 through 3388 26B-3-313; and 3389 (c) it is in the best interest of the state to encourage aging nursing care facilities with 3390 Medicaid certification to renovate the nursing care facilities' physical facilities so that the 3391 quality of life and clinical services for Medicaid residents are preserved. 3392 (2) Medicaid reimbursement of nursing care facility programs is limited to: 3393 (a) the number of nursing care facility programs with Medicaid certification as of May 3394 9, 2016; and 3395 (b) additional nursing care facility programs approved for Medicaid certification under 3396 the provisions of Subsections [26-18-503] 26B-3-311(5) and (7). 3397 (3) The division may not: 3398 (a) except as authorized by Section [26-18-503] 26B-3-311: 3399 (i) process initial applications for Medicaid certification or execute provider 3400 agreements with nursing care facility programs; or 3401 (ii) reinstate Medicaid certification for a nursing care facility whose certification 3402 expired or was terminated by action of the federal or state government; or 3403 (b) execute a Medicaid provider agreement with a certified program that moves to a 3404 different physical facility, except as authorized by Subsection [26-18-503] 26B-3-311(3). 3405 (4) Notwithstanding Section [26-18-503] 26B-3-311, beginning May 4, 2021, the 3406 division may not approve a new or additional bed in an intermediate care facility for 02-10-23 5:41 PM S.B. 39 - 111 - 3407 individuals with an intellectual disability for Medicaid certification, unless certification of the 3408 bed by the division does not increase the total number in the state of Medicaid-certified beds in 3409 intermediate care facilities for individuals with an intellectual disability. 3410 Section 76. Section 26B-3-311, which is renumbered from Section 26-18-503 is 3411 renumbered and amended to read: 3412 [26-18-503]. 26B-3-311. Authorization to renew, transfer, or increase 3413 Medicaid certified programs -- Reimbursement methodology. 3414 (1) (a) The division may renew Medicaid certification of a certified program if the 3415 program, without lapse in service to Medicaid recipients, has its nursing care facility program 3416 certified by the division at the same physical facility as long as the licensed and certified bed 3417 capacity at the facility has not been expanded, unless the director has approved additional beds 3418 in accordance with Subsection (5). 3419 (b) The division may renew Medicaid certification of a nursing care facility program 3420 that is not currently certified if: 3421 (i) since the day on which the program last operated with Medicaid certification: 3422 (A) the physical facility where the program operated has functioned solely and 3423 continuously as a nursing care facility; and 3424 (B) the owner of the program has not, under this section or Section [26-18-505] 3425 26B-3-313, transferred to another nursing care facility program the license for any of the 3426 Medicaid beds in the program; and 3427 (ii) except as provided in Subsection [26-18-502] 26B-3-310(4), the number of beds 3428 granted renewed Medicaid certification does not exceed the number of beds certified at the 3429 time the program last operated with Medicaid certification, excluding a period of time where 3430 the program operated with temporary certification under Subsection [26-18-504] 26B-3-312(3). 3431 (2) (a) The division may issue a Medicaid certification for a new nursing care facility 3432 program if a current owner of the Medicaid certified program transfers its ownership of the 3433 Medicaid certification to the new nursing care facility program and the new nursing care 3434 facility program meets all of the following conditions: 3435 (i) the new nursing care facility program operates at the same physical facility as the 3436 previous Medicaid certified program; 3437 (ii) the new nursing care facility program gives a written assurance to the director in S.B. 39 02-10-23 5:41 PM - 112 - 3438 accordance with Subsection (4); 3439 (iii) the new nursing care facility program receives the Medicaid certification within 3440 one year of the date the previously certified program ceased to provide medical assistance to a 3441 Medicaid recipient; and 3442 (iv) the licensed and certified bed capacity at the facility has not been expanded, unless 3443 the director has approved additional beds in accordance with Subsection (5). 3444 (b) A nursing care facility program that receives Medicaid certification under the 3445 provisions of Subsection (2)(a) does not assume the Medicaid liabilities of the previous nursing 3446 care facility program if the new nursing care facility program: 3447 (i) is not owned in whole or in part by the previous nursing care facility program; or 3448 (ii) is not a successor in interest of the previous nursing care facility program. 3449 (3) The division may issue a Medicaid certification to a nursing care facility program 3450 that was previously a certified program but now resides in a new or renovated physical facility 3451 if the nursing care facility program meets all of the following: 3452 (a) the nursing care facility program met all applicable requirements for Medicaid 3453 certification at the time of closure; 3454 (b) the new or renovated physical facility is in the same county or within a five-mile 3455 radius of the original physical facility; 3456 (c) the time between which the certified program ceased to operate in the original 3457 facility and will begin to operate in the new physical facility is not more than three years, 3458 unless: 3459 (i) an emergency is declared by the president of the United States or the governor, 3460 affecting the building or renovation of the physical facility; 3461 (ii) the director approves an exception to the three-year requirement for any nursing 3462 care facility program within the three-year requirement; 3463 (iii) the provider submits documentation supporting a request for an extension to the 3464 director that demonstrates a need for an extension; and 3465 (iv) the exception does not extend for more than two years beyond the three-year 3466 requirement; 3467 (d) if Subsection (3)(c) applies, the certified program notifies the department within 90 3468 days after ceasing operations in its original facility, of its intent to retain its Medicaid 02-10-23 5:41 PM S.B. 39 - 113 - 3469 certification; 3470 (e) the provider gives written assurance to the director in accordance with Subsection 3471 (4) that no third party has a legitimate claim to operate a certified program at the previous 3472 physical facility; and 3473 (f) the bed capacity in the physical facility has not been expanded unless the director 3474 has approved additional beds in accordance with Subsection (5). 3475 (4) (a) The entity requesting Medicaid certification under Subsections (2) and (3) shall 3476 give written assurances satisfactory to the director or the director's designee that: 3477 (i) no third party has a legitimate claim to operate the certified program; 3478 (ii) the requesting entity agrees to defend and indemnify the department against any 3479 claims by a third party who may assert a right to operate the certified program; and 3480 (iii) if a third party is found, by final agency action of the department after exhaustion 3481 of all administrative and judicial appeal rights, to be entitled to operate a certified program at 3482 the physical facility the certified program shall voluntarily comply with Subsection (4)(b). 3483 (b) If a finding is made under the provisions of Subsection (4)(a)(iii): 3484 (i) the certified program shall immediately surrender its Medicaid certification and 3485 comply with division rules regarding billing for Medicaid and the provision of services to 3486 Medicaid patients; and 3487 (ii) the department shall transfer the surrendered Medicaid certification to the third 3488 party who prevailed under Subsection (4)(a)(iii). 3489 (5) (a) The director may approve additional nursing care facility programs for Medicaid 3490 certification, or additional beds for Medicaid certification within an existing nursing care 3491 facility program, if a nursing care facility or other interested party requests Medicaid 3492 certification for a nursing care facility program or additional beds within an existing nursing 3493 care facility program, and the nursing care facility program or other interested party complies 3494 with this section. 3495 (b) The nursing care facility or other interested party requesting Medicaid certification 3496 for a nursing care facility program or additional beds within an existing nursing care facility 3497 program under Subsection (5)(a) shall submit to the director: 3498 (i) proof of the following as reasonable evidence that bed capacity provided by 3499 Medicaid certified programs within the county or group of counties impacted by the requested S.B. 39 02-10-23 5:41 PM - 114 - 3500 additional Medicaid certification is insufficient: 3501 (A) nursing care facility occupancy levels for all existing and proposed facilities will 3502 be at least 90% for the next three years; 3503 (B) current nursing care facility occupancy is 90% or more; or 3504 (C) there is no other nursing care facility within a 35-mile radius of the nursing care 3505 facility requesting the additional certification; and 3506 (ii) an independent analysis demonstrating that at projected occupancy rates the nursing 3507 care facility's after-tax net income is sufficient for the facility to be financially viable. 3508 (c) Any request for additional beds as part of a renovation project are limited to the 3509 maximum number of beds allowed in Subsection (7). 3510 (d) The director shall determine whether to issue additional Medicaid certification by 3511 considering: 3512 (i) whether bed capacity provided by certified programs within the county or group of 3513 counties impacted by the requested additional Medicaid certification is insufficient, based on 3514 the information submitted to the director under Subsection (5)(b); 3515 (ii) whether the county or group of counties impacted by the requested additional 3516 Medicaid certification is underserved by specialized or unique services that would be provided 3517 by the nursing care facility; 3518 (iii) whether any Medicaid certified beds are subject to a claim by a previous certified 3519 program that may reopen under the provisions of Subsections (2) and (3); 3520 (iv) how additional bed capacity should be added to the long-term care delivery system 3521 to best meet the needs of Medicaid recipients; and 3522 (v) (A) whether the existing certified programs within the county or group of counties 3523 have provided services of sufficient quality to merit at least a two-star rating in the Medicare 3524 Five-Star Quality Rating System over the previous three-year period; and 3525 (B) information obtained under Subsection (9). 3526 (6) The department shall adopt administrative rules in accordance with Title 63G, 3527 Chapter 3, Utah Administrative Rulemaking Act, to adjust the Medicaid nursing care facility 3528 property reimbursement methodology to: 3529 (a) only pay that portion of the property component of rates, representing actual bed 3530 usage by Medicaid clients as a percentage of the greater of: 02-10-23 5:41 PM S.B. 39 - 115 - 3531 (i) actual occupancy; or 3532 (ii) (A) for a nursing care facility other than a facility described in Subsection 3533 (6)(a)(ii)(B), 85% of total bed capacity; or 3534 (B) for a rural nursing care facility, 65% of total bed capacity; and 3535 (b) not allow for increases in reimbursement for property values without major 3536 renovation or replacement projects as defined by the department by rule. 3537 (7) (a) Except as provided in Subsection 26-18-502(3), if a nursing care facility does 3538 not seek Medicaid certification for a bed under Subsections (1) through (6), the department 3539 shall, notwithstanding Subsections [26-18-504] 26B-3-312(3)(a) and (b), grant Medicaid 3540 certification for additional beds in an existing Medicaid certified nursing care facility that has 3541 90 or fewer licensed beds, including Medicaid certified beds, in the facility if: 3542 (i) the nursing care facility program was previously a certified program for all beds but 3543 now resides in a new facility or in a facility that underwent major renovations involving major 3544 structural changes, with 50% or greater facility square footage design changes, requiring review 3545 and approval by the department; 3546 (ii) the nursing care facility meets the quality of care regulations issued by CMS; and 3547 (iii) the total number of additional beds in the facility granted Medicaid certification 3548 under this section does not exceed 10% of the number of licensed beds in the facility. 3549 (b) The department may not revoke the Medicaid certification of a bed under this 3550 Subsection (7) as long as the provisions of Subsection (7)(a)(ii) are met. 3551 (8) (a) If a nursing care facility or other interested party indicates in its request for 3552 additional Medicaid certification under Subsection (5)(a) that the facility will offer specialized 3553 or unique services, but the facility does not offer those services after receiving additional 3554 Medicaid certification, the director shall revoke the additional Medicaid certification. 3555 (b) The nursing care facility program shall obtain Medicaid certification for any 3556 additional Medicaid beds approved under Subsection (5) or (7) within three years of the date of 3557 the director's approval, or the approval is void. 3558 (9) (a) If the director makes an initial determination that quality standards under 3559 Subsection (5)(d)(v) have not been met in a rural county or group of rural counties over the 3560 previous three-year period, the director shall, before approving certification of additional 3561 Medicaid beds in the rural county or group of counties: S.B. 39 02-10-23 5:41 PM - 116 - 3562 (i) notify the certified program that has not met the quality standards in Subsection 3563 (5)(d)(v) that the director intends to certify additional Medicaid beds under the provisions of 3564 Subsection (5)(d)(v); and 3565 (ii) consider additional information submitted to the director by the certified program 3566 in a rural county that has not met the quality standards under Subsection (5)(d)(v). 3567 (b) The notice under Subsection (9)(a) does not give the certified program that has not 3568 met the quality standards under Subsection (5)(d)(v), the right to legally challenge or appeal the 3569 director's decision to certify additional Medicaid beds under Subsection (5)(d)(v). 3570 Section 77. Section 26B-3-312, which is renumbered from Section 26-18-504 is 3571 renumbered and amended to read: 3572 [26-18-504]. 26B-3-312. Appeals of division decision -- Rulemaking 3573 authority -- Application of act. 3574 (1) A decision by the director under this part to deny Medicaid certification for a 3575 nursing care facility program or to deny additional bed capacity for an existing certified 3576 program is subject to review under the procedures and requirements of Title 63G, Chapter 4, 3577 Administrative Procedures Act. 3578 (2) The department shall make rules to administer and enforce [this part] Sections 3579 26B-3-310 through 26B-3-313 in accordance with Title 63G, Chapter 3, Utah Administrative 3580 Rulemaking Act. 3581 (3) (a) In the event the department is at risk for a federal disallowance with regard to a 3582 Medicaid recipient being served in a nursing care facility program that is not Medicaid 3583 certified, the department may grant temporary Medicaid certification to that facility for up to 24 3584 months. 3585 (b) (i) The department may extend a temporary Medicaid certification granted to a 3586 facility under Subsection (3)(a): 3587 (A) for the number of beds in the nursing care facility occupied by a Medicaid 3588 recipient; and 3589 (B) for the period of time during which the Medicaid recipient resides at the facility. 3590 (ii) A temporary Medicaid certification granted under this Subsection (3) is revoked 3591 upon: 3592 (A) the discharge of the patient from the facility; or 02-10-23 5:41 PM S.B. 39 - 117 - 3593 (B) the patient no longer residing at the facility for any reason. 3594 (c) The department may place conditions on the temporary certification granted under 3595 Subsections (3)(a) and (b), such as: 3596 (i) not allowing additional admissions of Medicaid recipients to the program; and 3597 (ii) not paying for the care of the patient after October 1, 2008, with state only dollars. 3598 Section 78. Section 26B-3-313, which is renumbered from Section 26-18-505 is 3599 renumbered and amended to read: 3600 [26-18-505]. 26B-3-313. Authorization to sell or transfer licensed 3601 Medicaid beds -- Duties of transferor -- Duties of transferee -- Duties of division. 3602 (1) This section provides a method to transfer or sell the license for a Medicaid bed 3603 from a nursing care facility program to another entity that is in addition to the authorization to 3604 transfer under Section [26-18-503] 26B-3-311. 3605 (2) (a) A nursing care facility program may transfer or sell one or more of its licenses 3606 for Medicaid beds in accordance with Subsection (2)(b) if: 3607 (i) at the time of the transfer, and with respect to the license for the Medicaid bed that 3608 will be transferred, the nursing care facility program that will transfer the Medicaid license 3609 meets all applicable regulations for Medicaid certification; 3610 (ii) the nursing care facility program gives a written assurance, which is postmarked or 3611 has proof of delivery 30 days before the transfer, to the director and to the transferee in 3612 accordance with Subsection [26-18-503] 26B-3-311(4); 3613 (iii) the nursing care facility program that will transfer the license for a Medicaid bed 3614 notifies the division in writing, which is postmarked or has proof of delivery 30 days before the 3615 transfer, of: 3616 (A) the number of bed licenses that will be transferred; 3617 (B) the date of the transfer; and 3618 (C) the identity and location of the entity receiving the transferred licenses; and 3619 (iv) if the nursing care facility program for which the license will be transferred or 3620 purchased is located in an urban county with a nursing care facility average annual occupancy 3621 rate over the previous two years less than or equal to 75%, the nursing care facility program 3622 transferring or selling the license demonstrates to the satisfaction of the director that the sale or 3623 transfer: S.B. 39 02-10-23 5:41 PM - 118 - 3624 (A) will not result in an excessive number of Medicaid certified beds within the county 3625 or group of counties that would be impacted by the transfer or sale; and 3626 (B) best meets the needs of Medicaid recipients. 3627 (b) Except as provided in Subsection (2)(c), a nursing care facility program may 3628 transfer or sell one or more of its licenses for Medicaid beds to: 3629 (i) a nursing care facility program that has the same owner or successor in interest of 3630 the same owner; 3631 (ii) a nursing care facility program that has a different owner; or 3632 (iii) a related-party nonnursing-care-facility entity that wants to hold one or more of the 3633 licenses for a nursing care facility program not yet identified, as long as: 3634 (A) the licenses are subsequently transferred or sold to a nursing care facility program 3635 within three years; and 3636 (B) the nursing care facility program notifies the director of the transfer or sale in 3637 accordance with Subsection (2)(a)(iii). 3638 (c) A nursing care facility program may not transfer or sell one or more of its licenses 3639 for Medicaid beds to an entity under Subsection (2)(b)(i), (ii), or (iii) that is located in a rural 3640 county unless the entity requests, and the director issues, Medicaid certification for the beds 3641 under Subsection [26-18-503] 26B-3-311(5). 3642 (3) A nursing care facility program or entity under Subsection (2)(b)(i), (ii), or (iii) that 3643 receives or purchases a license for a Medicaid bed under Subsection (2)(b): 3644 (a) may receive a license for a Medicaid bed from more than one nursing care facility 3645 program; 3646 (b) shall give the division notice, which is postmarked or has proof of delivery within 3647 14 days of the nursing care facility program or entity seeking Medicaid certification of beds in 3648 the nursing care facility program or entity, of the total number of licenses for Medicaid beds 3649 that the entity received and who it received the licenses from; 3650 (c) may only seek Medicaid certification for the number of licensed beds in the nursing 3651 care facility program equal to the total number of licenses for Medicaid beds received by the 3652 entity; 3653 (d) does not have to demonstrate need or seek approval for the Medicaid licensed bed 3654 under Subsection [26-18-503] 26B-3-311(5), except as provided in Subsections (2)(a)(iv) and 02-10-23 5:41 PM S.B. 39 - 119 - 3655 (2)(c); 3656 (e) shall meet the standards for Medicaid certification other than those in Subsection 3657 [26-18-503] 26B-3-311(5), including personnel, services, contracts, and licensing of facilities 3658 under [Chapter 21, Health Care Facility Licensing and Inspection Act] Chapter 2, Part 2, 3659 Health Care Facility Licensing and Inspection; and 3660 (f) shall obtain Medicaid certification for the licensed Medicaid beds within three years 3661 of the date of transfer as documented under Subsection (2)(a)(iii)(B). 3662 (4) (a) When the division receives notice of a transfer of a license for a Medicaid bed 3663 under Subsection (2)(a)(iii)(A), the department shall reduce the number of licenses for 3664 Medicaid beds at the transferring nursing care facility: 3665 (i) equal to the number of licenses transferred; and 3666 (ii) effective on the date of the transfer as reported under Subsection (2)(a)(iii)(B). 3667 (b) For purposes of Section [26-18-502] 26B-3-310, the division shall approve 3668 Medicaid certification for the receiving nursing care facility program or entity: 3669 (i) in accordance with the formula established in Subsection (3)(c); and 3670 (ii) if: 3671 (A) the nursing care facility seeks Medicaid certification for the transferred licenses 3672 within the time limit required by Subsection (3)(f); and 3673 (B) the nursing care facility program meets other requirements for Medicaid 3674 certification under Subsection (3)(e). 3675 (c) A license for a Medicaid bed may not be approved for Medicaid certification 3676 without meeting the requirements of Sections [26-18-502 and 26-18-503] 26B-3-310 and 3677 26B-3-311 if: 3678 (i) the license for a Medicaid bed is transferred under this section but the receiving 3679 entity does not obtain Medicaid certification for the licensed bed within the time required by 3680 Subsection (3)(f); or 3681 (ii) the license for a Medicaid bed is transferred under this section but the license is no 3682 longer eligible for Medicaid certification. 3683 Section 79. Section 26B-3-401, which is renumbered from Section 26-35a-103 is 3684 renumbered and amended to read: 3685 Part 4. Nursing Care Facility Assessment S.B. 39 02-10-23 5:41 PM - 120 - 3686 [26-35a-103]. 26B-3-401. Definitions. 3687 As used in this [chapter] part: 3688 (1) (a) "Nursing care facility" means: 3689 (i) a nursing care facility [described in Subsection 26-21-2(17)] as defined in Section 3690 26B-2-201; 3691 (ii) beginning January 1, 2006, a designated swing bed in: 3692 (A) a general acute hospital as defined in [Subsection 26-21-2(11)] Section 26B-2-201; 3693 and 3694 (B) a critical access hospital which meets the criteria of 42 U.S.C. Sec. 1395i-4(c)(2) 3695 (1998); and 3696 (iii) an intermediate care facility for people with an intellectual disability that is 3697 licensed under Section [26-21-13.5] 26B-2-212. 3698 (b) "Nursing care facility" does not include: 3699 (i) the Utah State Developmental Center; 3700 (ii) the Utah State Hospital; 3701 (iii) a general acute hospital, specialty hospital, or small health care facility as those 3702 terms are defined in Section [26-21-2] 26B-2-201; or 3703 (iv) a Utah State Veterans Home. 3704 (2) "Patient day" means each calendar day in which an individual patient is admitted to 3705 the nursing care facility during a calendar month, even if on a temporary leave of absence from 3706 the facility. 3707 Section 80. Section 26B-3-402, which is renumbered from Section 26-35a-102 is 3708 renumbered and amended to read: 3709 [26-35a-102]. 26B-3-402. Legislative findings. 3710 (1) The Legislature finds that there is an important state purpose to improve the quality 3711 of care given to persons who are elderly and to people who have a disability, in long-term care 3712 nursing facilities. 3713 (2) The Legislature finds that in order to improve the quality of care to those persons 3714 described in Subsection (1), the rates paid to the nursing care facilities by the Medicaid 3715 program must be adequate to encourage and support quality care. 3716 (3) The Legislature finds that in order to meet the objectives in Subsections (1) and (2), 02-10-23 5:41 PM S.B. 39 - 121 - 3717 adequate funding must be provided to increase the rates paid to nursing care facilities providing 3718 services pursuant to the Medicaid program. 3719 Section 81. Section 26B-3-403, which is renumbered from Section 26-35a-104 is 3720 renumbered and amended to read: 3721 [26-35a-104]. 26B-3-403. Collection, remittance, and payment of nursing 3722 care facilities assessment. 3723 (1) (a) Beginning July 1, 2004, an assessment is imposed upon each nursing care 3724 facility in the amount designated in Subsection (1)(c). 3725 (b) (i) The department shall establish by rule, a uniform rate per non-Medicare patient 3726 day that may not exceed 6% of the total gross revenue for services provided to patients of all 3727 nursing care facilities licensed in this state. 3728 (ii) For purposes of Subsection (1)(b)(i), total revenue does not include charitable 3729 contribution received by a nursing care facility. 3730 (c) The department shall calculate the assessment imposed under Subsection (1)(a) by 3731 multiplying the total number of patient days of care provided to non-Medicare patients by the 3732 nursing care facility, as provided to the department pursuant to Subsection (3)(a), by the 3733 uniform rate established by the department pursuant to Subsection (1)(b). 3734 (2) (a) The assessment imposed by this [chapter] part is due and payable on a monthly 3735 basis on or before the last day of the month next succeeding each monthly period. 3736 (b) The collecting agent for this assessment shall be the department which is vested 3737 with the administration and enforcement of this [chapter] part, including the right to audit 3738 records of a nursing care facility related to patient days of care for the facility. 3739 (c) The department shall forward proceeds from the assessment imposed by this 3740 [chapter] part to the state treasurer for deposit in the expendable special revenue fund as 3741 specified in Section [26-35a-106] 26B-1-332. 3742 (3) Each nursing care facility shall, on or before the end of the month next succeeding 3743 each calendar monthly period, file with the department: 3744 (a) a report which includes: 3745 (i) the total number of patient days of care the facility provided to non-Medicare 3746 patients during the preceding month; 3747 (ii) the total gross revenue the facility earned as compensation for services provided to S.B. 39 02-10-23 5:41 PM - 122 - 3748 patients during the preceding month; and 3749 (iii) any other information required by the department; and 3750 (b) a return for the monthly period, and shall remit with the return the assessment 3751 required by this [chapter] part to be paid for the period covered by the return. 3752 (4) Each return shall contain information and be in the form the department prescribes 3753 by rule. 3754 (5) The assessment as computed in the return is an allowable cost for Medicaid 3755 reimbursement purposes. 3756 (6) The department may by rule, extend the time for making returns and paying the 3757 assessment. 3758 (7) Each nursing care facility that fails to pay any assessment required to be paid to the 3759 state, within the time required by this [chapter] part, or that fails to file a return as required by 3760 this [chapter] part, shall pay, in addition to the assessment, penalties and interest as provided in 3761 Section [26-35a-105] 26B-3-404. 3762 Section 82. Section 26B-3-404, which is renumbered from Section 26-35a-105 is 3763 renumbered and amended to read: 3764 [26-35a-105]. 26B-3-404. Penalties and interest. 3765 (1) The penalty for failure to file a return or pay the assessment due within the time 3766 prescribed by this [chapter] part is the greater of $50, or 1% of the assessment due on the 3767 return. 3768 (2) For failure to pay within 30 days of a notice of deficiency of assessment required to 3769 be paid, the penalty is the greater of $50 or 5% of the assessment due. 3770 (3) The penalty for underpayment of the assessment is as follows: 3771 (a) If any underpayment of assessment is due to negligence, the penalty is 25% of the 3772 underpayment. 3773 (b) If the underpayment of the assessment is due to intentional disregard of law or rule, 3774 the penalty is 50% of the underpayment. 3775 (4) For intent to evade the assessment, the penalty is 100% of the underpayment. 3776 (5) The rate of interest applicable to an underpayment of an assessment under this 3777 [chapter] part or an unpaid penalty under this [chapter] part is 12% annually. 3778 (6) The department may waive the imposition of a penalty for good cause. 02-10-23 5:41 PM S.B. 39 - 123 - 3779 Section 83. Section 26B-3-405, which is renumbered from Section 26-35a-107 is 3780 renumbered and amended to read: 3781 [26-35a-107]. 26B-3-405. Adjustment to nursing care facility Medicaid 3782 reimbursement rates. 3783 If federal law or regulation prohibits the money in the Nursing Care Facilities Provider 3784 Assessment Fund from being used in the manner set forth in Subsection [26-35a-106] 3785 26B-1-332(1)(b), the rates paid to nursing care facilities for providing services pursuant to the 3786 Medicaid program shall be changed: 3787 (1) except as otherwise provided in Subsection (2), to the rates paid to nursing care 3788 facilities on June 30, 2004; or 3789 (2) if the Legislature or the department has on or after July 1, 2004, changed the rates 3790 paid to facilities through a manner other than the use of expenditures from the Nursing Care 3791 Facilities Provider Assessment Fund, to the rates provided for by the Legislature or the 3792 department. 3793 Section 84. Section 26B-3-406, which is renumbered from Section 26-35a-108 is 3794 renumbered and amended to read: 3795 [26-35a-108]. 26B-3-406. Intermediate care facility for people with an 3796 intellectual disability -- Uniform rate. 3797 An intermediate care facility for people with an intellectual disability is subject to all 3798 the provisions of this [chapter] part, except that the department shall establish a uniform rate 3799 for an intermediate care facility for people with an intellectual disability that: 3800 (1) is based on the same formula specified for nursing care facilities under the 3801 provisions of Subsection [26-35a-104] 26B-3-403(1)(b); and 3802 (2) may be different than the uniform rate established for other nursing care facilities. 3803 Section 85. Section 26B-3-501, which is renumbered from Section 26-36b-103 is 3804 renumbered and amended to read: 3805 Part 5. Inpatient Hospital Assessment 3806 [26-36b-103]. 26B-3-501. Definitions. 3807 As used in this [chapter] part: 3808 (1) "Assessment" means the inpatient hospital assessment established by this [chapter] 3809 part. S.B. 39 02-10-23 5:41 PM - 124 - 3810 (2) "CMS" means the Centers for Medicare and Medicaid Services within the United 3811 States Department of Health and Human Services. 3812 (3) "Discharges" means the number of total hospital discharges reported on: 3813 (a) Worksheet S-3 Part I, column 15, lines 14, 16, and 17 of the 2552-10 Medicare cost 3814 report for the applicable assessment year; or 3815 (b) a similar report adopted by the department by administrative rule, if the report 3816 under Subsection (3)(a) is no longer available. 3817 (4) "Division" means the Division of Health Care Financing within the department. 3818 (5) "Enhancement waiver program" means the program established by the Primary 3819 Care Network enhancement waiver program described in Section [26-18-416] 26B-3-211. 3820 (6) "Health coverage improvement program" means the health coverage improvement 3821 program described in Section [26-18-411] 26B-3-207. 3822 (7) "Hospital share" means the hospital share described in Section [26-36b-203] 3823 26B-3-505. 3824 (8) "Medicaid accountable care organization" means a managed care organization, as 3825 defined in 42 C.F.R. Sec. 438, that contracts with the department under the provisions of 3826 Section [26-18-405] 26B-3-202. 3827 (9) "Medicaid waiver expansion" means a Medicaid expansion in accordance with 3828 Section [26-18-3.9 or 26-18-415] 26B-3-113 or 26B-3-210. 3829 (10) "Medicare cost report" means CMS-2552-10, the cost report for electronic filing 3830 of hospitals. 3831 (11) (a) "Non-state government hospital" means a hospital owned by a non-state 3832 government entity. 3833 (b) "Non-state government hospital" does not include: 3834 (i) the Utah State Hospital; or 3835 (ii) a hospital owned by the federal government, including the Veterans Administration 3836 Hospital. 3837 (12) (a) "Private hospital" means: 3838 (i) a general acute hospital, as defined in Section [26-21-2] 26B-2-201, that is privately 3839 owned and operating in the state; and 3840 (ii) a privately owned specialty hospital operating in the state, including a privately 02-10-23 5:41 PM S.B. 39 - 125 - 3841 owned hospital whose inpatient admissions are predominantly for: 3842 (A) rehabilitation; 3843 (B) psychiatric care; 3844 (C) chemical dependency services; or 3845 (D) long-term acute care services. 3846 (b) "Private hospital" does not include a facility for residential treatment as defined in 3847 Section [62A-2-101] 26B-2-101. 3848 (13) "State teaching hospital" means a state owned teaching hospital that is part of an 3849 institution of higher education. 3850 (14) "Upper payment limit gap" means the difference between the private hospital 3851 outpatient upper payment limit and the private hospital Medicaid outpatient payments, as 3852 determined in accordance with 42 C.F.R. Sec. 447.321. 3853 Section 86. Section 26B-3-502, which is renumbered from Section 26-36b-102 is 3854 renumbered and amended to read: 3855 [26-36b-102]. 26B-3-502. Application. 3856 (1) Other than for the imposition of the assessment described in this [chapter] part, 3857 nothing in this [chapter] part shall affect the nonprofit or tax exempt status of any nonprofit 3858 charitable, religious, or educational health care provider under any: 3859 (a) state law; 3860 (b) ad valorem property taxes; 3861 (c) sales or use taxes; or 3862 (d) other taxes, fees, or assessments, whether imposed or sought to be imposed, by the 3863 state or any political subdivision of the state. 3864 (2) All assessments paid under this [chapter] part may be included as an allowable cost 3865 of a hospital for purposes of any applicable Medicaid reimbursement formula. 3866 (3) This [chapter] part does not authorize a political subdivision of the state to: 3867 (a) license a hospital for revenue; 3868 (b) impose a tax or assessment upon a hospital; or 3869 (c) impose a tax or assessment measured by the income or earnings of a hospital. 3870 Section 87. Section 26B-3-503, which is renumbered from Section 26-36b-201 is 3871 renumbered and amended to read: S.B. 39 02-10-23 5:41 PM - 126 - 3872 [26-36b-201]. 26B-3-503. Assessment. 3873 (1) An assessment is imposed on each private hospital: 3874 (a) beginning upon the later of CMS approval of: 3875 (i) the health coverage improvement program waiver under Section [26-18-411] 3876 26B-3-207; and 3877 (ii) the assessment under this [chapter] part; 3878 (b) in the amount designated in Sections [26-36b-204 and 26-36b-205] 26B-3-506 and 3879 26B-3-507; and 3880 (c) in accordance with Section [26-36b-202] 26B-3-504. 3881 (2) Subject to Section [26-36b-203] 26B-3-505, the assessment imposed by this 3882 [chapter] part is due and payable on a quarterly basis, after payment of the outpatient upper 3883 payment limit supplemental payments under Section [26-36b-210] 26B-3-511 have been paid. 3884 (3) The first quarterly payment is not due until at least three months after the earlier of 3885 the effective dates of the coverage provided through: 3886 (a) the health coverage improvement program; 3887 (b) the enhancement waiver program; or 3888 (c) the Medicaid waiver expansion. 3889 Section 88. Section 26B-3-504, which is renumbered from Section 26-36b-202 is 3890 renumbered and amended to read: 3891 [26-36b-202]. 26B-3-504. Collection of assessment -- Deposit of revenue -- 3892 Rulemaking. 3893 (1) The collecting agent for the assessment imposed under Section [26-36b-201] 3894 26B-3-503 is the department. 3895 (2) The department is vested with the administration and enforcement of this [chapter] 3896 part, and may make rules in accordance with Title 63G, Chapter 3, Utah Administrative 3897 Rulemaking Act, necessary to: 3898 (a) collect the assessment, intergovernmental transfers, and penalties imposed under 3899 this [chapter] part; 3900 (b) audit records of a facility that: 3901 (i) is subject to the assessment imposed by this [chapter] part; and 3902 (ii) does not file a Medicare cost report; and 02-10-23 5:41 PM S.B. 39 - 127 - 3903 (c) select a report similar to the Medicare cost report if Medicare no longer uses a 3904 Medicare cost report. 3905 (3) The department shall: 3906 (a) administer the assessment in this [chapter] part separately from the assessment in 3907 [Chapter 36d] Part 7, Hospital Provider Assessment Act; and 3908 (b) deposit assessments collected under this [chapter] part into the Medicaid Expansion 3909 Fund created by Section [26-36b-208] 26B-1-315. 3910 Section 89. Section 26B-3-505, which is renumbered from Section 26-36b-203 is 3911 renumbered and amended to read: 3912 [26-36b-203]. 26B-3-505. Quarterly notice. 3913 (1) Quarterly assessments imposed by this [chapter] part shall be paid to the division 3914 within 15 business days after the original invoice date that appears on the invoice issued by the 3915 division. 3916 (2) The department may, by rule, extend the time for paying the assessment. 3917 Section 90. Section 26B-3-506, which is renumbered from Section 26-36b-204 is 3918 renumbered and amended to read: 3919 [26-36b-204]. 26B-3-506. Hospital financing of health coverage 3920 improvement program Medicaid waiver expansion -- Hospital share. 3921 (1) The hospital share is: 3922 (a) 45% of the state's net cost of the health coverage improvement program, including 3923 Medicaid coverage for individuals with dependent children up to the federal poverty level 3924 designated under Section [26-18-411] 26B-3-207; 3925 (b) 45% of the state's net cost of the enhancement waiver program; 3926 (c) if the waiver for the Medicaid waiver expansion is approved, $11,900,000; and 3927 (d) 45% of the state's net cost of the upper payment limit gap. 3928 (2) (a) The hospital share is capped at no more than $13,600,000 annually, consisting 3929 of: 3930 (i) an $11,900,000 cap for the programs specified in Subsections (1)(a) through (c); 3931 and 3932 (ii) a $1,700,000 cap for the program specified in Subsection (1)(d). 3933 (b) The department shall prorate the cap described in Subsection (2)(a) in any year in S.B. 39 02-10-23 5:41 PM - 128 - 3934 which the programs specified in Subsections (1)(a) and (d) are not in effect for the full fiscal 3935 year. 3936 (3) Private hospitals shall be assessed under this [chapter] part for: 3937 (a) 69% of the portion of the hospital share for the programs specified in Subsections 3938 (1)(a) through (c); and 3939 (b) 100% of the portion of the hospital share specified in Subsection (1)(d). 3940 (4) (a) In the report described in Subsection [26-18-3.9] 26B-3-113(8), the department 3941 shall calculate the state's net cost of each of the programs described in Subsections (1)(a) 3942 through (c) that are in effect for that year. 3943 (b) If the assessment collected in the previous fiscal year is above or below the hospital 3944 share for private hospitals for the previous fiscal year, the underpayment or overpayment of the 3945 assessment by the private hospitals shall be applied to the fiscal year in which the report is 3946 issued. 3947 (5) A Medicaid accountable care organization shall, on or before October 15 of each 3948 year, report to the department the following data from the prior state fiscal year for each private 3949 hospital, state teaching hospital, and non-state government hospital provider that the Medicaid 3950 accountable care organization contracts with: 3951 (a) for the traditional Medicaid population: 3952 (i) hospital inpatient payments; 3953 (ii) hospital inpatient discharges; 3954 (iii) hospital inpatient days; and 3955 (iv) hospital outpatient payments; and 3956 (b) if the Medicaid accountable care organization enrolls any individuals in the health 3957 coverage improvement program, the enhancement waiver program, or the Medicaid waiver 3958 expansion, for the population newly eligible for any of those programs: 3959 (i) hospital inpatient payments; 3960 (ii) hospital inpatient discharges; 3961 (iii) hospital inpatient days; and 3962 (iv) hospital outpatient payments. 3963 (6) The department shall, by rule made in accordance with Title 63G, Chapter 3, Utah 3964 Administrative Rulemaking Act, provide details surrounding specific content and format for 02-10-23 5:41 PM S.B. 39 - 129 - 3965 the reporting by the Medicaid accountable care organization. 3966 Section 91. Section 26B-3-507, which is renumbered from Section 26-36b-205 is 3967 renumbered and amended to read: 3968 [26-36b-205]. 26B-3-507. Calculation of assessment. 3969 (1) (a) Except as provided in Subsection (1)(b), an annual assessment is payable on a 3970 quarterly basis for each private hospital in an amount calculated by the division at a uniform 3971 assessment rate for each hospital discharge, in accordance with this section. 3972 (b) A private teaching hospital with more than 425 beds and 60 residents shall pay an 3973 assessment rate 2.5 times the uniform rate established under Subsection (1)(c). 3974 (c) The division shall calculate the uniform assessment rate described in Subsection 3975 (1)(a) by dividing the hospital share for assessed private hospitals, described in Subsections 3976 [26-36b-204(1) and 26-36b-204(3)] 26B-3-506(1) and (3), by the sum of: 3977 (i) the total number of discharges for assessed private hospitals that are not a private 3978 teaching hospital; and 3979 (ii) 2.5 times the number of discharges for a private teaching hospital, described in 3980 Subsection (1)(b). 3981 (d) The division may, by rule made in accordance with Title 63G, Chapter 3, Utah 3982 Administrative Rulemaking Act, adjust the formula described in Subsection (1)(c) to address 3983 unforeseen circumstances in the administration of the assessment under this [chapter] part. 3984 (e) Any quarterly changes to the uniform assessment rate shall be applied uniformly to 3985 all assessed private hospitals. 3986 (2) Except as provided in Subsection (3), for each state fiscal year, the division shall 3987 determine a hospital's discharges as follows: 3988 (a) for state fiscal year 2017, the hospital's cost report data for the hospital's fiscal year 3989 ending between July 1, 2013, and June 30, 2014; and 3990 (b) for each subsequent state fiscal year, the hospital's cost report data for the hospital's 3991 fiscal year that ended in the state fiscal year two years before the assessment fiscal year. 3992 (3) (a) If a hospital's fiscal year Medicare cost report is not contained in the CMS 3993 Healthcare Cost Report Information System file: 3994 (i) the hospital shall submit to the division a copy of the hospital's Medicare cost report 3995 applicable to the assessment year; and S.B. 39 02-10-23 5:41 PM - 130 - 3996 (ii) the division shall determine the hospital's discharges. 3997 (b) If a hospital is not certified by the Medicare program and is not required to file a 3998 Medicare cost report: 3999 (i) the hospital shall submit to the division the hospital's applicable fiscal year 4000 discharges with supporting documentation; 4001 (ii) the division shall determine the hospital's discharges from the information 4002 submitted under Subsection (3)(b)(i); and 4003 (iii) failure to submit discharge information shall result in an audit of the hospital's 4004 records and a penalty equal to 5% of the calculated assessment. 4005 (4) Except as provided in Subsection (5), if a hospital is owned by an organization that 4006 owns more than one hospital in the state: 4007 (a) the assessment for each hospital shall be separately calculated by the department; 4008 and 4009 (b) each separate hospital shall pay the assessment imposed by this [chapter] part. 4010 (5) If multiple hospitals use the same Medicaid provider number: 4011 (a) the department shall calculate the assessment in the aggregate for the hospitals 4012 using the same Medicaid provider number; and 4013 (b) the hospitals may pay the assessment in the aggregate. 4014 Section 92. Section 26B-3-508, which is renumbered from Section 26-36b-206 is 4015 renumbered and amended to read: 4016 [26-36b-206]. 26B-3-508. State teaching hospital and non-state government 4017 hospital mandatory intergovernmental transfer. 4018 (1) The state teaching hospital and a non-state government hospital shall make an 4019 intergovernmental transfer to the Medicaid Expansion Fund created in Section [26-36b-208] 4020 26B-1-315, in accordance with this section. 4021 (2) The hospitals described in Subsection (1) shall pay the intergovernmental transfer 4022 beginning on the later of CMS approval of: 4023 (a) the health improvement program waiver under Section [26-18-411] 26B-3-207; or 4024 (b) the assessment for private hospitals in this [chapter] part. 4025 (3) The intergovernmental transfer is apportioned as follows: 4026 (a) the state teaching hospital is responsible for: 02-10-23 5:41 PM S.B. 39 - 131 - 4027 (i) 30% of the portion of the hospital share specified in Subsections [26-36b-204] 4028 26B-3-506(1)(a) through (c); and 4029 (ii) 0% of the hospital share specified in Subsection [26-36b-204] 26B-3-506(1)(d); 4030 and 4031 (b) non-state government hospitals are responsible for: 4032 (i) 1% of the portion of the hospital share specified in Subsections [26-36b-204] 4033 26B-3-506(1)(a) through (c); and 4034 (ii) 0% of the hospital share specified in Subsection [26-36b-204] 26B-3-506(1)(d). 4035 (4) The department shall, by rule made in accordance with Title 63G, Chapter 3, Utah 4036 Administrative Rulemaking Act, designate: 4037 (a) the method of calculating the amounts designated in Subsection (3); and 4038 (b) the schedule for the intergovernmental transfers. 4039 Section 93. Section 26B-3-509, which is renumbered from Section 26-36b-207 is 4040 renumbered and amended to read: 4041 [26-36b-207]. 26B-3-509. Penalties and interest. 4042 (1) A hospital that fails to pay a quarterly assessment, make the mandated 4043 intergovernmental transfer, or file a return as required under this [chapter] part, within the time 4044 required by this [chapter] part, shall pay penalties described in this section, in addition to the 4045 assessment or intergovernmental transfer. 4046 (2) If a hospital fails to timely pay the full amount of a quarterly assessment or the 4047 mandated intergovernmental transfer, the department shall add to the assessment or 4048 intergovernmental transfer: 4049 (a) a penalty equal to 5% of the quarterly amount not paid on or before the due date; 4050 and 4051 (b) on the last day of each quarter after the due date until the assessed amount and the 4052 penalty imposed under Subsection (2)(a) are paid in full, an additional 5% penalty on: 4053 (i) any unpaid quarterly assessment or intergovernmental transfer; and 4054 (ii) any unpaid penalty assessment. 4055 (3) Upon making a record of the division's actions, and upon reasonable cause shown, 4056 the division may waive, reduce, or compromise any of the penalties imposed under this 4057 [chapter] part. S.B. 39 02-10-23 5:41 PM - 132 - 4058 Section 94. Section 26B-3-510, which is renumbered from Section 26-36b-209 is 4059 renumbered and amended to read: 4060 [26-36b-209]. 26B-3-510. Hospital reimbursement. 4061 (1) If the health coverage improvement program, the enhancement waiver program, or 4062 the Medicaid waiver expansion is implemented by contracting with a Medicaid accountable 4063 care organization, the department shall, to the extent allowed by law, include, in a contract to 4064 provide benefits under the health coverage improvement program, the enhancement waiver 4065 program, or the Medicaid waiver expansion, a requirement that the Medicaid accountable care 4066 organization reimburse hospitals in the accountable care organization's provider network at no 4067 less than the Medicaid fee-for-service rate. 4068 (2) If the health coverage improvement program, the enhancement waiver program, or 4069 the Medicaid waiver expansion is implemented by the department as a fee-for-service program, 4070 the department shall reimburse hospitals at no less than the Medicaid fee-for-service rate. 4071 (3) Nothing in this section prohibits a Medicaid accountable care organization from 4072 paying a rate that exceeds the Medicaid fee-for-service rate. 4073 Section 95. Section 26B-3-511, which is renumbered from Section 26-36b-210 is 4074 renumbered and amended to read: 4075 [26-36b-210]. 26B-3-511. Outpatient upper payment limit supplemental 4076 payments. 4077 (1) Beginning on the effective date of the assessment imposed under this [chapter] part, 4078 and for each subsequent fiscal year, the department shall implement an outpatient upper 4079 payment limit program for private hospitals that shall supplement the reimbursement to private 4080 hospitals in accordance with Subsection (2). 4081 (2) The division shall ensure that supplemental payment to Utah private hospitals 4082 under Subsection (1): 4083 (a) does not exceed the positive upper payment limit gap; and 4084 (b) is allocated based on the Medicaid state plan. 4085 (3) The department shall use the same outpatient data to allocate the payments under 4086 Subsection (2) and to calculate the upper payment limit gap. 4087 (4) The supplemental payments to private hospitals under Subsection (1) are payable 4088 for outpatient hospital services provided on or after the later of: 02-10-23 5:41 PM S.B. 39 - 133 - 4089 (a) July 1, 2016; 4090 (b) the effective date of the Medicaid state plan amendment necessary to implement the 4091 payments under this section; or 4092 (c) the effective date of the coverage provided through the health coverage 4093 improvement program waiver. 4094 Section 96. Section 26B-3-512, which is renumbered from Section 26-36b-211 is 4095 renumbered and amended to read: 4096 [26-36b-211]. 26B-3-512. Repeal of assessment. 4097 (1) The assessment imposed by this [chapter] part shall be repealed when: 4098 (a) the executive director certifies that: 4099 (i) action by Congress is in effect that disqualifies the assessment imposed by this 4100 [chapter] part from counting toward state Medicaid funds available to be used to determine the 4101 amount of federal financial participation; 4102 (ii) a decision, enactment, or other determination by the Legislature or by any court, 4103 officer, department, or agency of the state, or of the federal government, is in effect that: 4104 (A) disqualifies the assessment from counting toward state Medicaid funds available to 4105 be used to determine federal financial participation for Medicaid matching funds; or 4106 (B) creates for any reason a failure of the state to use the assessments for at least one of 4107 the Medicaid programs described in this [chapter] part; or 4108 (iii) a change is in effect that reduces the aggregate hospital inpatient and outpatient 4109 payment rate below the aggregate hospital inpatient and outpatient payment rate for July 1, 4110 2015; or 4111 (b) this [chapter] part is repealed in accordance with Section 63I-1-226. 4112 (2) If the assessment is repealed under Subsection (1): 4113 (a) the division may not collect any assessment or intergovernmental transfer under this 4114 [chapter] part; 4115 (b) the department shall disburse money in the special Medicaid Expansion Fund in 4116 accordance with the requirements in Subsection [26-36b-208] 26B-1-315(4), to the extent 4117 federal matching is not reduced by CMS due to the repeal of the assessment; 4118 (c) any money remaining in the Medicaid Expansion Fund after the disbursement 4119 described in Subsection (2)(b) that was derived from assessments imposed by this [chapter] S.B. 39 02-10-23 5:41 PM - 134 - 4120 part shall be refunded to the hospitals in proportion to the amount paid by each hospital for the 4121 last three fiscal years; and 4122 (d) any money remaining in the Medicaid Expansion Fund after the disbursements 4123 described in Subsections (2)(b) and (c) shall be deposited into the General Fund by the end of 4124 the fiscal year that the assessment is suspended. 4125 Section 97. Section 26B-3-601, which is renumbered from Section 26-36c-102 is 4126 renumbered and amended to read: 4127 Part 6. Medicaid Expansion Hospital Assessment 4128 [26-36c-102]. 26B-3-601. Definitions. 4129 As used in this [chapter] part: 4130 (1) "Assessment" means the Medicaid expansion hospital assessment established by 4131 this [chapter] part. 4132 (2) "CMS" means the Centers for Medicare and Medicaid Services within the United 4133 States Department of Health and Human Services. 4134 (3) "Discharges" means the number of total hospital discharges reported on: 4135 (a) Worksheet S-3 Part I, column 15, lines 14, 16, and 17 of the 2552-10 Medicare cost 4136 report for the applicable assessment year; or 4137 (b) a similar report adopted by the department by administrative rule, if the report 4138 under Subsection (3)(a) is no longer available. 4139 (4) "Division" means the Division of Health Care Financing within the department. 4140 (5) "Hospital share" means the hospital share described in Section [26-36c-203] 4141 26B-3-605. 4142 (6) "Medicaid accountable care organization" means a managed care organization, as 4143 defined in 42 C.F.R. Sec. 438, that contracts with the department under the provisions of 4144 Section [26-18-405] 26B-3-202. 4145 (7) "Medicaid Expansion Fund" means the Medicaid Expansion Fund created in 4146 Section [26-36b-208] 26B-1-315. 4147 (8) "Medicaid waiver expansion" means the same as that term is defined in Section 4148 [26-18-415] 26B-3-210. 4149 (9) "Medicare cost report" means CMS-2552-10, the cost report for electronic filing of 4150 hospitals. 02-10-23 5:41 PM S.B. 39 - 135 - 4151 (10) (a) "Non-state government hospital" means a hospital owned by a non-state 4152 government entity. 4153 (b) "Non-state government hospital" does not include: 4154 (i) the Utah State Hospital; or 4155 (ii) a hospital owned by the federal government, including the Veterans Administration 4156 Hospital. 4157 (11) (a) "Private hospital" means: 4158 (i) a privately owned general acute hospital operating in the state as defined in Section 4159 [26-21-2] 26B-2-201; or 4160 (ii) a privately owned specialty hospital operating in the state, including a privately 4161 owned hospital for which inpatient admissions are predominantly: 4162 (A) rehabilitation; 4163 (B) psychiatric; 4164 (C) chemical dependency; or 4165 (D) long-term acute care services. 4166 (b) "Private hospital" does not include a facility for residential treatment as defined in 4167 Section [62A-2-101] 26B-2-101. 4168 (12) "Qualified Medicaid expansion" means an expansion of the Medicaid program in 4169 accordance with Subsection [26-18-3.9] 26B-3-113(5). 4170 (13) "State teaching hospital" means a state owned teaching hospital that is part of an 4171 institution of higher education. 4172 Section 98. Section 26B-3-602, which is renumbered from Section 26-36c-103 is 4173 renumbered and amended to read: 4174 [26-36c-103]. 26B-3-602. Application. 4175 (1) Other than for the imposition of the assessment described in this [chapter] part, 4176 nothing in this [chapter] part shall affect the nonprofit or tax exempt status of any nonprofit 4177 charitable, religious, or educational health care provider under any: 4178 (a) state law; 4179 (b) ad valorem property tax requirement; 4180 (c) sales or use tax requirement; or 4181 (d) other requirements imposed by taxes, fees, or assessments, whether imposed or S.B. 39 02-10-23 5:41 PM - 136 - 4182 sought to be imposed, by the state or any political subdivision of the state. 4183 (2) A hospital paying an assessment under this [chapter] part may include the 4184 assessment as an allowable cost of a hospital for purposes of any applicable Medicaid 4185 reimbursement formula. 4186 (3) This [chapter] part does not authorize a political subdivision of the state to: 4187 (a) license a hospital for revenue; 4188 (b) impose a tax or assessment upon a hospital; or 4189 (c) impose a tax or assessment measured by the income or earnings of a hospital. 4190 Section 99. Section 26B-3-603, which is renumbered from Section 26-36c-201 is 4191 renumbered and amended to read: 4192 [26-36c-201]. 26B-3-603. Assessment. 4193 (1) An assessment is imposed on each private hospital: 4194 (a) beginning upon the later of: 4195 (i) April 1, 2019; and 4196 (ii) CMS approval of the assessment under this [chapter] part; 4197 (b) in the amount designated in Sections [26-36c-204 and 26-36c-205] 26B-3-606 and 4198 26B-3-607; and 4199 (c) in accordance with Section [26-36c-202] 26B-3-604. 4200 (2) The assessment imposed by this [chapter] part is due and payable in accordance 4201 with Subsection [26-36c-202] 26B-3-604(4). 4202 Section 100. Section 26B-3-604, which is renumbered from Section 26-36c-202 is 4203 renumbered and amended to read: 4204 [26-36c-202]. 26B-3-604. Collection of assessment -- Deposit of revenue -- 4205 Rulemaking. 4206 (1) The department shall act as the collecting agent for the assessment imposed under 4207 Section [26-36c-201] 26B-3-603. 4208 (2) The department shall administer and enforce the provisions of this [chapter] part, 4209 and may make rules, in accordance with Title 63G, Chapter 3, Utah Administrative 4210 Rulemaking Act, necessary to: 4211 (a) collect the assessment, intergovernmental transfers, and penalties imposed under 4212 this [chapter] part; 02-10-23 5:41 PM S.B. 39 - 137 - 4213 (b) audit records of a facility that: 4214 (i) is subject to the assessment imposed under this [chapter] part; and 4215 (ii) does not file a Medicare cost report; and 4216 (c) select a report similar to the Medicare cost report if Medicare no longer uses a 4217 Medicare cost report. 4218 (3) The department shall: 4219 (a) administer the assessment in this part separately from the assessments in [Chapter 4220 36d] Part 7, Hospital Provider Assessment [Act, and Chapter 36b] Part 5, Inpatient Hospital 4221 Assessment [Act]; and 4222 (b) deposit assessments collected under this [chapter] part into the Medicaid Expansion 4223 Fund. 4224 (4) (a) Hospitals shall pay the quarterly assessments imposed by this [chapter] part to 4225 the division within 15 business days after the original invoice date that appears on the invoice 4226 issued by the division. 4227 (b) The department may make rules creating requirements to allow the time for paying 4228 the assessment to be extended. 4229 Section 101. Section 26B-3-605, which is renumbered from Section 26-36c-203 is 4230 renumbered and amended to read: 4231 [26-36c-203]. 26B-3-605. Hospital share. 4232 (1) The hospital share is: 4233 (a) for the period from April 1, 2019, through June 30, 2020, $15,000,000; and 4234 (b) beginning July 1, 2020, 100% of the state's net cost of the qualified Medicaid 4235 expansion, after deducting appropriate offsets and savings expected as a result of implementing 4236 the qualified Medicaid expansion, including: 4237 (i) savings from: 4238 (A) the Primary Care Network program; 4239 (B) the health coverage improvement program, as defined in Section [26-18-411] 4240 26B-3-207; 4241 (C) the state portion of inpatient prison medical coverage; 4242 (D) behavioral health coverage; and 4243 (E) county contributions to the non-federal share of Medicaid expenditures; and S.B. 39 02-10-23 5:41 PM - 138 - 4244 (ii) any funds appropriated to the Medicaid Expansion Fund. 4245 (2) (a) Beginning July 1, 2020, the hospital share is capped at no more than 4246 $15,000,000 annually. 4247 (b) Beginning July 1, 2020, the division shall prorate the cap specified in Subsection 4248 (2)(a) in any year in which the qualified Medicaid expansion is not in effect for the full fiscal 4249 year. 4250 Section 102. Section 26B-3-606, which is renumbered from Section 26-36c-204 is 4251 renumbered and amended to read: 4252 [26-36c-204]. 26B-3-606. Hospital financing. 4253 (1) Private hospitals shall be assessed under this [chapter] part for the portion of the 4254 hospital share described in Section [26-36c-209] 26B-3-611. 4255 (2) In the report described in Subsection [26-18-3.9] 26B-3-113(8), the department 4256 shall calculate the state's net cost of the qualified Medicaid expansion. 4257 (3) If the assessment collected in the previous fiscal year is above or below the hospital 4258 share for private hospitals for the previous fiscal year, the division shall apply the 4259 underpayment or overpayment of the assessment by the private hospitals to the fiscal year in 4260 which the report is issued. 4261 Section 103. Section 26B-3-607, which is renumbered from Section 26-36c-205 is 4262 renumbered and amended to read: 4263 [26-36c-205]. 26B-3-607. Calculation of assessment. 4264 (1) (a) Except as provided in Subsection (1)(b), each private hospital shall pay an 4265 annual assessment due on the last day of each quarter in an amount calculated by the division at 4266 a uniform assessment rate for each hospital discharge, in accordance with this section. 4267 (b) A private teaching hospital with more than 425 beds and more than 60 residents 4268 shall pay an assessment rate 2.5 times the uniform rate established under Subsection (1)(c). 4269 (c) The division shall calculate the uniform assessment rate described in Subsection 4270 (1)(a) by dividing the hospital share for assessed private hospitals, as described in Subsection 4271 [26-36c-204] 26B-3-606(1), by the sum of: 4272 (i) the total number of discharges for assessed private hospitals that are not a private 4273 teaching hospital; and 4274 (ii) 2.5 times the number of discharges for a private teaching hospital, described in 02-10-23 5:41 PM S.B. 39 - 139 - 4275 Subsection (1)(b). 4276 (d) The division may make rules in accordance with Title 63G, Chapter 3, Utah 4277 Administrative Rulemaking Act, to adjust the formula described in Subsection (1)(c) to address 4278 unforeseen circumstances in the administration of the assessment under this [chapter] part. 4279 (e) The division shall apply any quarterly changes to the uniform assessment rate 4280 uniformly to all assessed private hospitals. 4281 (2) Except as provided in Subsection (3), for each state fiscal year, the division shall 4282 determine a hospital's discharges as follows: 4283 (a) for state fiscal year 2019, the hospital's cost report data for the hospital's fiscal year 4284 ending between July 1, 2015, and June 30, 2016; and 4285 (b) for each subsequent state fiscal year, the hospital's cost report data for the hospital's 4286 fiscal year that ended in the state fiscal year two years before the assessment fiscal year. 4287 (3) (a) If a hospital's fiscal year Medicare cost report is not contained in the Centers for 4288 Medicare and Medicaid Services' Healthcare Cost Report Information System file: 4289 (i) the hospital shall submit to the division a copy of the hospital's Medicare cost report 4290 applicable to the assessment year; and 4291 (ii) the division shall determine the hospital's discharges. 4292 (b) If a hospital is not certified by the Medicare program and is not required to file a 4293 Medicare cost report: 4294 (i) the hospital shall submit to the division the hospital's applicable fiscal year 4295 discharges with supporting documentation; 4296 (ii) the division shall determine the hospital's discharges from the information 4297 submitted under Subsection (3)(b)(i); and 4298 (iii) if the hospital fails to submit discharge information, the division shall audit the 4299 hospital's records and may impose a penalty equal to 5% of the calculated assessment. 4300 (4) Except as provided in Subsection (5), if a hospital is owned by an organization that 4301 owns more than one hospital in the state: 4302 (a) the division shall calculate the assessment for each hospital separately; and 4303 (b) each separate hospital shall pay the assessment imposed by this [chapter] part. 4304 (5) If multiple hospitals use the same Medicaid provider number: 4305 (a) the department shall calculate the assessment in the aggregate for the hospitals S.B. 39 02-10-23 5:41 PM - 140 - 4306 using the same Medicaid provider number; and 4307 (b) the hospitals may pay the assessment in the aggregate. 4308 Section 104. Section 26B-3-608, which is renumbered from Section 26-36c-206 is 4309 renumbered and amended to read: 4310 [26-36c-206]. 26B-3-608. State teaching hospital and non-state government 4311 hospital mandatory intergovernmental transfer. 4312 (1) A state teaching hospital and a non-state government hospital shall make an 4313 intergovernmental transfer to the Medicaid Expansion Fund, in accordance with this section. 4314 (2) The hospitals described in Subsection (1) shall pay the intergovernmental transfer 4315 beginning on the later of: 4316 (a) April 1, 2019; or 4317 (b) CMS approval of the assessment for private hospitals in this [chapter] part. 4318 (3) The intergovernmental transfer is apportioned between the non-state government 4319 hospitals as follows: 4320 (a) the state teaching hospital shall pay for the portion of the hospital share described in 4321 Section [26-36c-209] 26B-3-611; and 4322 (b) non-state government hospitals shall pay for the portion of the hospital share 4323 described in Section [26-36c-209] 26B-3-611. 4324 (4) The department shall, by rule made in accordance with Title 63G, Chapter 3, Utah 4325 Administrative Rulemaking Act, designate: 4326 (a) the method of calculating the amounts designated in Subsection (3); and 4327 (b) the schedule for the intergovernmental transfers. 4328 Section 105. Section 26B-3-609, which is renumbered from Section 26-36c-207 is 4329 renumbered and amended to read: 4330 [26-36c-207]. 26B-3-609. Penalties. 4331 (1) A hospital that fails to pay a quarterly assessment, make the mandated 4332 intergovernmental transfer, or file a return as required under this [chapter] part, within the time 4333 required by this [chapter] part, shall pay penalties described in this section, in addition to the 4334 assessment or intergovernmental transfer. 4335 (2) If a hospital fails to timely pay the full amount of a quarterly assessment or the 4336 mandated intergovernmental transfer, the department shall add to the assessment or 02-10-23 5:41 PM S.B. 39 - 141 - 4337 intergovernmental transfer: 4338 (a) a penalty equal to 5% of the quarterly amount not paid on or before the due date; 4339 and 4340 (b) on the last day of each quarter after the due date until the assessed amount and the 4341 penalty imposed under Subsection (2)(a) are paid in full, an additional 5% penalty on: 4342 (i) any unpaid quarterly assessment or intergovernmental transfer; and 4343 (ii) any unpaid penalty assessment. 4344 (3) Upon making a record of the division's actions, and upon reasonable cause shown, 4345 the division may waive or reduce any of the penalties imposed under this [chapter] part. 4346 Section 106. Section 26B-3-610, which is renumbered from Section 26-36c-208 is 4347 renumbered and amended to read: 4348 [26-36c-208]. 26B-3-610. Hospital reimbursement. 4349 (1) If the qualified Medicaid expansion is implemented by contracting with a Medicaid 4350 accountable care organization, the department shall, to the extent allowed by law, include in a 4351 contract to provide benefits under the qualified Medicaid expansion a requirement that the 4352 accountable care organization reimburse hospitals in the accountable care organization's 4353 provider network at no less than the Medicaid fee-for-service rate. 4354 (2) If the qualified Medicaid expansion is implemented by the department as a 4355 fee-for-service program, the department shall reimburse hospitals at no less than the Medicaid 4356 fee-for-service rate. 4357 (3) Nothing in this section prohibits the department or a Medicaid accountable care 4358 organization from paying a rate that exceeds the Medicaid fee-for-service rate. 4359 Section 107. Section 26B-3-611, which is renumbered from Section 26-36c-209 is 4360 renumbered and amended to read: 4361 [26-36c-209]. 26B-3-611. Hospital financing of the hospital share. 4362 (1) For the first two full fiscal years that the assessment is in effect, the department 4363 shall: 4364 (a) assess private hospitals under this [chapter] part for 69% of the hospital share; 4365 (b) require the state teaching hospital to make an intergovernmental transfer under this 4366 [chapter] part for 30% of the hospital share; and 4367 (c) require non-state government hospitals to make an intergovernmental transfer under S.B. 39 02-10-23 5:41 PM - 142 - 4368 this [chapter] part for 1% of the hospital share. 4369 (2) (a) At the beginning of the third full fiscal year that the assessment is in effect, and 4370 at the beginning of each subsequent fiscal year, the department may set a different percentage 4371 share for private hospitals, the state teaching hospital, and non-state government hospitals by 4372 rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, with 4373 input from private hospitals and private teaching hospitals. 4374 (b) If the department does not set a different percentage share under Subsection (2)(a), 4375 the percentage shares in Subsection (1) shall apply. 4376 Section 108. Section 26B-3-612, which is renumbered from Section 26-36c-210 is 4377 renumbered and amended to read: 4378 [26-36c-210]. 26B-3-612. Suspension of assessment. 4379 (1) The department shall suspend the assessment imposed by this [chapter] part when 4380 the executive director certifies that: 4381 (a) action by Congress is in effect that disqualifies the assessment imposed by this 4382 [chapter] part from counting toward state Medicaid funds available to be used to determine the 4383 amount of federal financial participation; 4384 (b) a decision, enactment, or other determination by the Legislature or by any court, 4385 officer, department, or agency of the state, or of the federal government, is in effect that: 4386 (i) disqualifies the assessment from counting toward state Medicaid funds available to 4387 be used to determine federal financial participation for Medicaid matching funds; or 4388 (ii) creates for any reason a failure of the state to use the assessments for at least one of 4389 the Medicaid programs described in this [chapter] part; or 4390 (c) a change is in effect that reduces the aggregate hospital inpatient and outpatient 4391 payment rate below the aggregate hospital inpatient and outpatient payment rate for July 1, 4392 2015. 4393 (2) If the assessment is suspended under Subsection (1): 4394 (a) the division may not collect any assessment or intergovernmental transfer under this 4395 [chapter] part; 4396 (b) the division shall disburse money in the Medicaid Expansion Fund that was derived 4397 from assessments imposed by this [chapter] part in accordance with the requirements in 4398 Subsection [26-36b-208] 26B-1-315(4), to the extent federal matching is not reduced by CMS 02-10-23 5:41 PM S.B. 39 - 143 - 4399 due to the repeal of the assessment; and 4400 (c) the division shall refund any money remaining in the Medicaid Expansion Fund 4401 after the disbursement described in Subsection (2)(b) that was derived from assessments 4402 imposed by this [chapter] part to the hospitals in proportion to the amount paid by each hospital 4403 for the last three fiscal years. 4404 Section 109. Section 26B-3-701, which is renumbered from Section 26-36d-103 is 4405 renumbered and amended to read: 4406 Part 7. Hospital Provider Assessment 4407 [26-36d-103]. 26B-3-701. Definitions. 4408 As used in this [chapter] part: 4409 (1) "Accountable care organization" means a managed care organization, as defined in 4410 42 C.F.R. Sec. 438, that contracts with the department under the provisions of Section 4411 [26-18-405] 26B-3-202. 4412 (2) "Assessment" means the Medicaid hospital provider assessment established by this 4413 [chapter] part. 4414 (3) "Discharges" means the number of total hospital discharges reported on Worksheet 4415 S-3 Part I, column 15, lines 12, 14, and 14.01 of the 2552-96 Medicare Cost Report or on 4416 Worksheet S-3 Part I, column 15, lines 14, 16, and 17 of the 2552-10 Medicare Cost Report for 4417 the applicable assessment year. 4418 (4) "Division" means the Division of Health Care Financing of the department. 4419 (5) "Hospital": 4420 (a) means a privately owned: 4421 (i) general acute hospital operating in the state as defined in Section [26-21-2] 4422 26B-2-201; and 4423 (ii) specialty hospital operating in the state, which shall include a privately owned 4424 hospital whose inpatient admissions are predominantly: 4425 (A) rehabilitation; 4426 (B) psychiatric; 4427 (C) chemical dependency; or 4428 (D) long-term acute care services; and 4429 (b) does not include: S.B. 39 02-10-23 5:41 PM - 144 - 4430 (i) a human services program, as defined in Section [62A-2-101] 26B-2-101; 4431 (ii) a hospital owned by the federal government, including the Veterans Administration 4432 Hospital; or 4433 (iii) a hospital that is owned by the state government, a state agency, or a political 4434 subdivision of the state, including: 4435 (A) a state-owned teaching hospital; and 4436 (B) the Utah State Hospital. 4437 (6) "Medicare Cost Report" means CMS-2552-96 or CMS-2552-10, the cost report for 4438 electronic filing of hospitals. 4439 (7) "State plan amendment" means a change or update to the state Medicaid plan. 4440 Section 110. Section 26B-3-702, which is renumbered from Section 26-36d-102 is 4441 renumbered and amended to read: 4442 [26-36d-102]. 26B-3-702. Legislative findings. 4443 (1) The Legislature finds that there is an important state purpose to improve the access 4444 of Medicaid patients to quality care in Utah hospitals because of continuous decreases in state 4445 revenues and increases in enrollment under the Utah Medicaid program. 4446 (2) The Legislature finds that in order to improve this access to those persons described 4447 in Subsection (1): 4448 (a) the rates paid to Utah hospitals shall be adequate to encourage and support 4449 improved access; and 4450 (b) adequate funding shall be provided to increase the rates paid to Utah hospitals 4451 providing services pursuant to the Utah Medicaid program. 4452 Section 111. Section 26B-3-703, which is renumbered from Section 26-36d-201 is 4453 renumbered and amended to read: 4454 [26-36d-201]. 26B-3-703. Application of part. 4455 (1) Other than for the imposition of the assessment described in this [chapter] part, 4456 nothing in this [chapter] part shall affect the nonprofit or tax exempt status of any nonprofit 4457 charitable, religious, or educational health care provider under: 4458 (a) Section 501(c), as amended, of the Internal Revenue Code; 4459 (b) other applicable federal law; 4460 (c) any state law; 02-10-23 5:41 PM S.B. 39 - 145 - 4461 (d) any ad valorem property taxes; 4462 (e) any sales or use taxes; or 4463 (f) any other taxes, fees, or assessments, whether imposed or sought to be imposed by 4464 the state or any political subdivision, county, municipality, district, authority, or any agency or 4465 department thereof. 4466 (2) All assessments paid under this [chapter] part may be included as an allowable cost 4467 of a hospital for purposes of any applicable Medicaid reimbursement formula. 4468 (3) This [chapter] part does not authorize a political subdivision of the state to: 4469 (a) license a hospital for revenue; 4470 (b) impose a tax or assessment upon hospitals; or 4471 (c) impose a tax or assessment measured by the income or earnings of a hospital. 4472 Section 112. Section 26B-3-704, which is renumbered from Section 26-36d-202 is 4473 renumbered and amended to read: 4474 [26-36d-202]. 26B-3-704. Assessment, collection, and payment of hospital 4475 provider assessment. 4476 (1) A uniform, broad based, assessment is imposed on each hospital as defined in 4477 Subsection [26-36d-103] 26B-3-701(5)(a): 4478 (a) in the amount designated in Section [26-36d-203] 26B-3-705; and 4479 (b) in accordance with Section [26-36d-204] 26B-3-706. 4480 (2) (a) The assessment imposed by this [chapter] part is due and payable on a quarterly 4481 basis in accordance with Section [26-36d-204] 26B-3-706. 4482 (b) The collecting agent for this assessment is the department which is vested with the 4483 administration and enforcement of this [chapter] part, including the right to adopt 4484 administrative rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking 4485 Act, necessary to: 4486 (i) implement and enforce the provisions of this act; and 4487 (ii) audit records of a facility: 4488 (A) that is subject to the assessment imposed by this [chapter] part; and 4489 (B) does not file a Medicare Cost Report. 4490 (c) The department shall forward proceeds from the assessment imposed by this 4491 [chapter] part to the state treasurer for deposit in the expendable special revenue fund as S.B. 39 02-10-23 5:41 PM - 146 - 4492 specified in Section [26-36d-207] 26B-1-316. 4493 (3) The department may, by rule, extend the time for paying the assessment. 4494 Section 113. Section 26B-3-705, which is renumbered from Section 26-36d-203 is 4495 renumbered and amended to read: 4496 [26-36d-203]. 26B-3-705. Calculation of assessment. 4497 (1) (a) An annual assessment is payable on a quarterly basis for each hospital in an 4498 amount calculated at a uniform assessment rate for each hospital discharge, in accordance with 4499 this section. 4500 (b) The uniform assessment rate shall be determined using the total number of hospital 4501 discharges for assessed hospitals divided into the total non-federal portion in an amount 4502 consistent with Section [26-36d-205] 26B-3-707 that is needed to support capitated rates for 4503 accountable care organizations for purposes of hospital services provided to Medicaid 4504 enrollees. 4505 (c) Any quarterly changes to the uniform assessment rate shall be applied uniformly to 4506 all assessed hospitals. 4507 (d) The annual uniform assessment rate may not generate more than: 4508 (i) $1,000,000 to offset Medicaid mandatory expenditures; and 4509 (ii) the non-federal share to seed amounts needed to support capitated rates for 4510 accountable care organizations as provided for in Subsection (1)(b). 4511 (2) (a) For each state fiscal year, discharges shall be determined using the data from 4512 each hospital's Medicare Cost Report contained in the Centers for Medicare and Medicaid 4513 Services' Healthcare Cost Report Information System file. The hospital's discharge data will be 4514 derived as follows: 4515 (i) for state fiscal year 2013, the hospital's cost report data for the hospital's fiscal year 4516 ending between July 1, 2009, and June 30, 2010; 4517 (ii) for state fiscal year 2014, the hospital's cost report data for the hospital's fiscal year 4518 ending between July 1, 2010, and June 30, 2011; 4519 (iii) for state fiscal year 2015, the hospital's cost report data for the hospital's fiscal year 4520 ending between July 1, 2011, and June 30, 2012; 4521 (iv) for state fiscal year 2016, the hospital's cost report data for the hospital's fiscal year 4522 ending between July 1, 2012, and June 30, 2013; and 02-10-23 5:41 PM S.B. 39 - 147 - 4523 (v) for each subsequent state fiscal year, the hospital's cost report data for the hospital's 4524 fiscal year that ended in the state fiscal year two years prior to the assessment fiscal year. 4525 (b) If a hospital's fiscal year Medicare Cost Report is not contained in the Centers for 4526 Medicare and Medicaid Services' Healthcare Cost Report Information System file: 4527 (i) the hospital shall submit to the division a copy of the hospital's Medicare Cost 4528 Report applicable to the assessment year; and 4529 (ii) the division shall determine the hospital's discharges. 4530 (c) If a hospital is not certified by the Medicare program and is not required to file a 4531 Medicare Cost Report: 4532 (i) the hospital shall submit to the division its applicable fiscal year discharges with 4533 supporting documentation; 4534 (ii) the division shall determine the hospital's discharges from the information 4535 submitted under Subsection (2)(c)(i); and 4536 (iii) the failure to submit discharge information shall result in an audit of the hospital's 4537 records and a penalty equal to 5% of the calculated assessment. 4538 (3) Except as provided in Subsection (4), if a hospital is owned by an organization that 4539 owns more than one hospital in the state: 4540 (a) the assessment for each hospital shall be separately calculated by the department; 4541 and 4542 (b) each separate hospital shall pay the assessment imposed by this [chapter] part. 4543 (4) Notwithstanding the requirement of Subsection (3), if multiple hospitals use the 4544 same Medicaid provider number: 4545 (a) the department shall calculate the assessment in the aggregate for the hospitals 4546 using the same Medicaid provider number; and 4547 (b) the hospitals may pay the assessment in the aggregate. 4548 Section 114. Section 26B-3-706, which is renumbered from Section 26-36d-204 is 4549 renumbered and amended to read: 4550 [26-36d-204]. 26B-3-706. Quarterly notice -- Collection. 4551 Quarterly assessments imposed by this [chapter] part shall be paid to the division within 4552 15 business days after the original invoice date that appears on the invoice issued by the 4553 division. S.B. 39 02-10-23 5:41 PM - 148 - 4554 Section 115. Section 26B-3-707, which is renumbered from Section 26-36d-205 is 4555 renumbered and amended to read: 4556 [26-36d-205]. 26B-3-707. Medicaid hospital adjustment under accountable 4557 care organization rates. 4558 To preserve and improve access to hospital services, the division shall, for accountable 4559 care organization rates effective on or after April 1, 2013, incorporate into the accountable care 4560 organization rate structure calculation consistent with the certified actuarial rate range: 4561 (1) $154,000,000 to be allocated toward the hospital inpatient directed payments for 4562 the Medicaid eligibility categories covered in Utah before January 1, 2019; and 4563 (2) an amount equal to the difference between payments made to hospitals by 4564 accountable care organizations for the Medicaid eligibility categories covered in Utah before 4565 January 1, 2019, based on submitted encounter data and the maximum amount that could be 4566 paid for those services using Medicare payment principles to be used for directed payments to 4567 hospitals for outpatient services. 4568 Section 116. Section 26B-3-708, which is renumbered from Section 26-36d-206 is 4569 renumbered and amended to read: 4570 [26-36d-206]. 26B-3-708. Penalties and interest. 4571 (1) A facility that fails to pay any assessment or file a return as required under this 4572 [chapter] part, within the time required by this [chapter] part, shall pay, in addition to the 4573 assessment, penalties and interest established by the department. 4574 (2) (a) Consistent with Subsection (2)(b), the department shall adopt rules in 4575 accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, which establish 4576 reasonable penalties and interest for the violations described in Subsection (1). 4577 (b) If a hospital fails to timely pay the full amount of a quarterly assessment, the 4578 department shall add to the assessment: 4579 (i) a penalty equal to 5% of the quarterly amount not paid on or before the due date; 4580 and 4581 (ii) on the last day of each quarter after the due date until the assessed amount and the 4582 penalty imposed under Subsection (2)(b)(i) are paid in full, an additional 5% penalty on: 4583 (A) any unpaid quarterly assessment; and 4584 (B) any unpaid penalty assessment. 02-10-23 5:41 PM S.B. 39 - 149 - 4585 (c) Upon making a record of its actions, and upon reasonable cause shown, the division 4586 may waive, reduce, or compromise any of the penalties imposed under this part. 4587 Section 117. Section 26B-3-709, which is renumbered from Section 26-36d-208 is 4588 renumbered and amended to read: 4589 [26-36d-208]. 26B-3-709. Repeal of assessment. 4590 (1) The repeal of the assessment imposed by this [chapter] part shall occur upon the 4591 certification by the executive director of the department that the sooner of the following has 4592 occurred: 4593 (a) the effective date of any action by Congress that would disqualify the assessment 4594 imposed by this [chapter] part from counting toward state Medicaid funds available to be used 4595 to determine the federal financial participation; 4596 (b) the effective date of any decision, enactment, or other determination by the 4597 Legislature or by any court, officer, department, or agency of the state, or of the federal 4598 government that has the effect of: 4599 (i) disqualifying the assessment from counting towards state Medicaid funds available 4600 to be used to determine federal financial participation for Medicaid matching funds; or 4601 (ii) creating for any reason a failure of the state to use the assessments for the Medicaid 4602 program as described in this [chapter] part; 4603 (c) the effective date of: 4604 (i) an appropriation for any state fiscal year from the General Fund for hospital 4605 payments under the state Medicaid program that is less than the amount appropriated for state 4606 fiscal year 2012; 4607 (ii) the annual revenues of the state General Fund budget return to the level that was 4608 appropriated for fiscal year 2008; 4609 (iii) a division change in rules that reduces any of the following below July 1, 2011, 4610 payments: 4611 (A) aggregate hospital inpatient payments; 4612 (B) adjustment payment rates; or 4613 (C) any cost settlement protocol; or 4614 (iv) a division change in rules that reduces the aggregate outpatient payments below 4615 July 1, 2011, payments; and S.B. 39 02-10-23 5:41 PM - 150 - 4616 (d) the sunset of this [chapter] part in accordance with Section 63I-1-226. 4617 (2) If the assessment is repealed under Subsection (1), money in the fund that was 4618 derived from assessments imposed by this [chapter] part, before the determination made under 4619 Subsection (1), shall be disbursed under Section [26-36d-205] 26B-3-707 to the extent federal 4620 matching is not reduced due to the impermissibility of the assessments. Any funds remaining in 4621 the special revenue fund shall be refunded to the hospitals in proportion to the amount paid by 4622 each hospital. 4623 Section 118. Section 26B-3-801, which is renumbered from Section 26-37a-102 is 4624 renumbered and amended to read: 4625 Part 8. Ambulance Service Provider Assessment 4626 [26-37a-102]. 26B-3-801. Definitions. 4627 As used in this [chapter] part: 4628 (1) "Ambulance service provider" means: 4629 (a) an ambulance provider as defined in Section [26-8a-102] 26B-4-101; or 4630 (b) a non-911 service provider as defined in Section [26-8a-102] 26B-4-101. 4631 (2) "Assessment" means the Medicaid ambulance service provider assessment 4632 established by this [chapter] part. 4633 (3) "Division" means the Division of Health Care Financing within the department. 4634 (4) "Non-federal portion" means the non-federal share the division needs to seed 4635 amounts that will support fee-for-service ambulance service provider rates, as described in 4636 Section [26-37a-105] 26B-3-804. 4637 (5) "Total transports" means the number of total ambulance transports applicable to a 4638 given fiscal year, as determined under Subsection [26-37a-104] 26B-3-803(5). 4639 Section 119. Section 26B-3-802, which is renumbered from Section 26-37a-103 is 4640 renumbered and amended to read: 4641 [26-37a-103]. 26B-3-802. Assessment, collection, and payment of 4642 ambulance service provider assessment. 4643 (1) An ambulance service provider shall pay an assessment to the division: 4644 (a) in the amount designated in Section [26-37a-104] 26B-3-803; 4645 (b) in accordance with this [chapter] part; 4646 (c) quarterly, on a day determined by the division by rule made under Subsection 02-10-23 5:41 PM S.B. 39 - 151 - 4647 (2)(b); and 4648 (d) no more than 15 business days after the day on which the division issues the 4649 ambulance service provider notice of the assessment. 4650 (2) The division shall: 4651 (a) collect the assessment described in Subsection (1); 4652 (b) determine, by rule made in accordance with Title 63G, Chapter 3, Utah 4653 Administrative Rulemaking Act, standards and procedures for implementing and enforcing the 4654 provisions of this [chapter] part; and 4655 (c) transfer assessment proceeds to the state treasurer for deposit into the Ambulance 4656 Service Provider Assessment Expendable Revenue Fund created in Section [26-37a-107] 4657 26B-1-317. 4658 Section 120. Section 26B-3-803, which is renumbered from Section 26-37a-104 is 4659 renumbered and amended to read: 4660 [26-37a-104]. 26B-3-803. Calculation of assessment. 4661 (1) The division shall calculate a uniform assessment per transport as described in this 4662 section. 4663 (2) The assessment due from a given ambulance service provider equals the 4664 non-federal portion divided by total transports, multiplied by the number of transports for the 4665 ambulance service provider. 4666 (3) The division shall apply any quarterly changes to the assessment rate, calculated as 4667 described in Subsection (2), uniformly to all assessed ambulance service providers. 4668 (4) The assessment may not generate more than the total of: 4669 (a) an annual amount of $20,000 to offset Medicaid administration expenses; and 4670 (b) the non-federal portion. 4671 (5) (a) For each state fiscal year, the division shall calculate total transports using data 4672 from the Emergency Medical System as follows: 4673 (i) for state fiscal year 2016, the division shall use ambulance service provider 4674 transports during the 2014 calendar year; and 4675 (ii) for a fiscal year after 2016, the division shall use ambulance service provider 4676 transports during the calendar year ending 18 months before the end of the fiscal year. 4677 (b) If an ambulance service provider fails to submit transport information to the S.B. 39 02-10-23 5:41 PM - 152 - 4678 Emergency Medical System, the division may audit the ambulance service provider to 4679 determine the ambulance service provider's transports for a given fiscal year. 4680 Section 121. Section 26B-3-804, which is renumbered from Section 26-37a-105 is 4681 renumbered and amended to read: 4682 [26-37a-105]. 26B-3-804. Medicaid ambulance service provider adjustment 4683 under fee-for-service rates. 4684 The division shall, if the assessment imposed by this [chapter] part is approved by the 4685 Centers for Medicare and Medicaid Services, for fee-for-service rates effective on or after July 4686 1, 2015, reimburse an ambulance service provider in an amount up to the Emergency Medical 4687 Services Ambulance Rates adopted annually by the department. 4688 Section 122. Section 26B-3-805, which is renumbered from Section 26-37a-106 is 4689 renumbered and amended to read: 4690 [26-37a-106]. 26B-3-805. Penalties. 4691 The division shall require an ambulance service provider that fails to pay an assessment 4692 due under this [chapter] part to pay the division, in addition to the assessment, a penalty 4693 determined by the division by rule made in accordance with Title 63G, Chapter 3, Utah 4694 Administrative Rulemaking Act. 4695 Section 123. Section 26B-3-806, which is renumbered from Section 26-37a-108 is 4696 renumbered and amended to read: 4697 [26-37a-108]. 26B-3-806. Repeal of assessment. 4698 (1) This [chapter] part is repealed when, as certified by the executive director of the 4699 department, any of the following occurs: 4700 (a) an action by Congress that disqualifies the assessment imposed by this [chapter] 4701 part from state Medicaid funds available to be used to determine the federal financial 4702 participation takes legal effect; or 4703 (b) an action, decision, enactment, or other determination by the Legislature or by any 4704 court, officer, department, or agency of the state or federal government takes effect that: 4705 (i) disqualifies the assessment from counting toward state Medicaid funds available to 4706 be used to determine federal financial participation for Medicaid matching funds; or 4707 (ii) creates for any reason a failure of the state to use the assessments for the Medicaid 4708 program as described in this [chapter] part. 02-10-23 5:41 PM S.B. 39 - 153 - 4709 (2) If this [chapter] part is repealed under Subsection (1): 4710 (a) money in the Ambulance Service Provider Assessment Expendable Revenue Fund 4711 that was derived from assessments imposed by this [chapter] part, deposited before the 4712 determination made under Subsection (1), shall be disbursed under Section [26-37a-107] 4713 26B-1-317 to the extent federal matching is not reduced due to the impermissibility of the 4714 assessments; and 4715 (b) any funds remaining in the special revenue fund shall be refunded to each 4716 ambulance service provider in proportion to the amount paid by the ambulance service 4717 provider. 4718 Section 124. Section 26B-3-901, which is renumbered from Section 26-40-102 is 4719 renumbered and amended to read: 4720 Part 9. Utah Children's Health Insurance Program 4721 [26-40-102]. 26B-3-901. Definitions. 4722 As used in this [chapter] part: 4723 (1) "Child" means [a person who is under 19 years of age] an individual who is 4724 younger than 19 years old. 4725 (2) "Eligible child" means a child who qualifies for enrollment in the program as 4726 provided in Section [26-40-105] 26B-3-903. 4727 (3) "Member" means a child enrolled in the program. 4728 (4) "Plan" means the department's plan submitted to the United States Department of 4729 Health and Human Services pursuant to 42 U.S.C. Sec. 1397ff. 4730 (5) "Program" means the Utah Children's Health Insurance Program created by this 4731 [chapter] part. 4732 Section 125. Section 26B-3-902, which is renumbered from Section 26-40-103 is 4733 renumbered and amended to read: 4734 [26-40-103]. 26B-3-902. Creation and administration of the Utah 4735 Children's Health Insurance Program. 4736 (1) There is created the Utah Children's Health Insurance Program to be administered 4737 by the department in accordance with the provisions of: 4738 (a) this [chapter] part; and 4739 (b) the State Children's Health Insurance Program, 42 U.S.C. Sec. 1397aa et seq. S.B. 39 02-10-23 5:41 PM - 154 - 4740 (2) The department shall: 4741 (a) prepare and submit the state's children's health insurance plan before May 1, 1998, 4742 and any amendments to the federal Department of Health and Human Services in accordance 4743 with 42 U.S.C. Sec. 1397ff; and 4744 (b) make rules in accordance with Title 63G, Chapter 3, Utah Administrative 4745 Rulemaking Act, regarding: 4746 (i) eligibility requirements consistent with Section [26-18-3] 26B-3-108; 4747 (ii) program benefits; 4748 (iii) the level of coverage for each program benefit; 4749 (iv) cost-sharing requirements for members, which may not: 4750 (A) exceed the guidelines set forth in 42 U.S.C. Sec. 1397ee; or 4751 (B) impose deductible, copayment, or coinsurance requirements on a member for 4752 well-child, well-baby, and immunizations; 4753 (v) the administration of the program; and 4754 (vi) a requirement that: 4755 (A) members in the program shall participate in the electronic exchange of clinical 4756 health records established in accordance with Section [26-1-37] 26B-8-411 unless the member 4757 opts out of participation; 4758 (B) prior to enrollment in the electronic exchange of clinical health records the member 4759 shall receive notice of the enrollment in the electronic exchange of clinical health records and 4760 the right to opt out of participation at any time; and 4761 (C) beginning July 1, 2012, when the program sends enrollment or renewal information 4762 to the member and when the member logs onto the program's website, the member shall 4763 receive notice of the right to opt out of the electronic exchange of clinical health records. 4764 Section 126. Section 26B-3-903, which is renumbered from Section 26-40-105 is 4765 renumbered and amended to read: 4766 [26-40-105]. 26B-3-903. Eligibility. 4767 (1) A child is eligible to enroll in the program if the child: 4768 (a) is a bona fide Utah resident; 4769 (b) is a citizen or legal resident of the United States; 4770 (c) is under 19 years of age; 02-10-23 5:41 PM S.B. 39 - 155 - 4771 (d) does not have access to or coverage under other health insurance, including any 4772 coverage available through a parent or legal guardian's employer; 4773 (e) is ineligible for Medicaid benefits; 4774 (f) resides in a household whose gross family income, as defined by rule, is at or below 4775 200% of the federal poverty level; and 4776 (g) is not an inmate of a public institution or a patient in an institution for mental 4777 diseases. 4778 (2) A child who qualifies for enrollment in the program under Subsection (1) may not 4779 be denied enrollment due to a diagnosis or pre-existing condition. 4780 (3) (a) The department shall determine eligibility and send notification of the eligibility 4781 decision within 30 days after receiving the application for coverage. 4782 (b) If the department cannot reach a decision because the applicant fails to take a 4783 required action, or because there is an administrative or other emergency beyond the 4784 department's control, the department shall: 4785 (i) document the reason for the delay in the applicant's case record; and 4786 (ii) inform the applicant of the status of the application and time frame for completion. 4787 (4) The department may not close enrollment in the program for a child who is eligible 4788 to enroll in the program under the provisions of Subsection (1). 4789 (5) The program shall: 4790 (a) apply for grants to make technology system improvements necessary to implement 4791 a simplified enrollment and renewal process in accordance with Subsection (5)(b); and 4792 (b) if funding is available, implement a simplified enrollment and renewal process. 4793 Section 127. Section 26B-3-904, which is renumbered from Section 26-40-106 is 4794 renumbered and amended to read: 4795 [26-40-106]. 26B-3-904. Program benefits. 4796 (1) Except as provided in Subsection (3), medical and dental program benefits shall be 4797 benchmarked, in accordance with 42 U.S.C. Sec. 1397cc, as follows: 4798 (a) medical program benefits, including behavioral health care benefits, shall be 4799 benchmarked effective July 1, 2019, and on July 1 every third year thereafter, to: 4800 (i) be substantially equal to a health benefit plan with the largest insured commercial 4801 enrollment offered by a health maintenance organization in the state; and S.B. 39 02-10-23 5:41 PM - 156 - 4802 (ii) comply with the Mental Health Parity and Addiction Equity Act, Pub. L. No. 4803 110-343; and 4804 (b) dental program benefits shall be benchmarked effective July 1, 2019, and on July 1 4805 every third year thereafter in accordance with the Children's Health Insurance Program 4806 Reauthorization Act of 2009, to be substantially equal to a dental benefit plan that has the 4807 largest insured, commercial, non-Medicaid enrollment of covered lives that is offered in the 4808 state, except that the utilization review mechanism for orthodontia shall be based on medical 4809 necessity. 4810 (2) On or before July 1 of each year, the department shall publish the benchmark for 4811 dental program benefits established under Subsection (1)(b). 4812 (3) The program benefits: 4813 (a) for enrollees who are at or below 100% of the federal poverty level are exempt 4814 from the benchmark requirements of Subsections (1) and (2); and 4815 (b) shall include treatment for autism spectrum disorder as defined in Section 4816 31A-22-642, which: 4817 (i) shall include coverage for applied behavioral analysis; and 4818 (ii) if the benchmark described in Subsection (1)(a) does not include the coverage 4819 described in this Subsection (3)(b), the department shall exclude from the benchmark described 4820 in Subsection (1)(a) for any purpose other than providing benefits under the program. 4821 Section 128. Section 26B-3-905, which is renumbered from Section 26-40-107 is 4822 renumbered and amended to read: 4823 [26-40-107]. 26B-3-905. Limitation of benefits. 4824 Abortion is not a covered benefit, except as provided in 42 U.S.C. Sec. 1397ee. 4825 Section 129. Section 26B-3-906, which is renumbered from Section 26-40-108 is 4826 renumbered and amended to read: 4827 [26-40-108]. 26B-3-906. Funding. 4828 (1) The program shall be funded by federal matching funds received under, together 4829 with state matching funds required by, 42 U.S.C. Sec. 1397ee. 4830 (2) Program expenditures in the following categories may not exceed 10% in the 4831 aggregate of all federal payments pursuant to 42 U.S.C. Sec. 1397ee: 4832 (a) other forms of child health assistance for children with gross family incomes below 02-10-23 5:41 PM S.B. 39 - 157 - 4833 200% of the federal poverty level; 4834 (b) other health services initiatives to improve low-income children's health; 4835 (c) outreach program expenditures; and 4836 (d) administrative costs. 4837 Section 130. Section 26B-3-907, which is renumbered from Section 26-40-109 is 4838 renumbered and amended to read: 4839 [26-40-109]. 26B-3-907. Evaluation. 4840 The department shall develop performance measures and annually evaluate the 4841 program's performance. 4842 Section 131. Section 26B-3-908, which is renumbered from Section 26-40-110 is 4843 renumbered and amended to read: 4844 [26-40-110]. 26B-3-908. Managed care -- Contracting for services. 4845 (1) Program benefits provided to a member under the program, as described in Section 4846 [26-40-106] 26B-3-904, shall be delivered by a managed care organization if the department 4847 determines that adequate services are available where the member lives or resides. 4848 (2) The department may contract with a managed care organization to provide program 4849 benefits. The department shall evaluate a potential contract with a managed care organization 4850 based on: 4851 (a) the managed care organization's: 4852 (i) ability to manage medical expenses, including mental health costs; 4853 (ii) proven ability to handle accident and health insurance; 4854 (iii) efficiency of claim paying procedures; 4855 (iv) proven ability for managed care and quality assurance; 4856 (v) provider contracting and discounts; 4857 (vi) pharmacy benefit management; 4858 (vii) estimated total charges for administering the pool; 4859 (viii) ability to administer the pool in a cost-efficient manner; 4860 (ix) ability to provide adequate providers and services in the state; and 4861 (x) ability to meet quality measures for emergency room use and access to primary care 4862 established by the department under Subsection [26-18-408] 26B-3-204(4); and 4863 (b) other factors established by the department. S.B. 39 02-10-23 5:41 PM - 158 - 4864 (3) The department may enter into separate managed care organization contracts to 4865 provide dental benefits required by Section [26-40-106] 26B-3-904. 4866 (4) The department's contract with a managed care organization for the program's 4867 benefits shall include risk sharing provisions in which the plan shall accept at least 75% of the 4868 risk for any difference between the department's premium payments per member and actual 4869 medical expenditures. 4870 (5) (a) The department may contract with the Group Insurance Division within the 4871 Utah State Retirement Office to provide services under Subsection (1) if no managed care 4872 organization is willing to contract with the department or the department determines no 4873 managed care organization meets the criteria established under Subsection (2). 4874 (b) In accordance with Section 49-20-201, a contract awarded under Subsection (5)(a) 4875 is not subject to the risk sharing required by Subsection (4). 4876 Section 132. Section 26B-3-909, which is renumbered from Section 26-40-115 is 4877 renumbered and amended to read: 4878 [26-40-115]. 26B-3-909. State contractor -- Employee and dependent 4879 health benefit plan coverage. 4880 (1) For purposes of Sections 17B-2a-818.5, 19-1-206, 63A-5b-607, 63C-9-403, 4881 72-6-107.5, and 79-2-404, "qualified health coverage" means, at the time the contract is entered 4882 into or renewed: 4883 (a) a health benefit plan and employer contribution level with a combined actuarial 4884 value at least actuarially equivalent to the combined actuarial value of: 4885 (i) the benchmark plan determined by the program under Subsection [26-40-106] 4886 26B-3-904(1)(a); and 4887 (ii) a contribution level at which the employer pays at least 50% of the premium or 4888 contribution amounts for the employee and the dependents of the employee who reside or work 4889 in the state; or 4890 (b) a federally qualified high deductible health plan that, at a minimum: 4891 (i) has a deductible that is: 4892 (A) the lowest deductible permitted for a federally qualified high deductible health 4893 plan; or 4894 (B) a deductible that is higher than the lowest deductible permitted for a federally 02-10-23 5:41 PM S.B. 39 - 159 - 4895 qualified high deductible health plan, but includes an employer contribution to a health savings 4896 account in a dollar amount at least equal to the dollar amount difference between the lowest 4897 deductible permitted for a federally qualified high deductible plan and the deductible for the 4898 employer offered federally qualified high deductible plan; 4899 (ii) has an out-of-pocket maximum that does not exceed three times the amount of the 4900 annual deductible; and 4901 (iii) provides that the employer pays 60% of the premium or contribution amounts for 4902 the employee and the dependents of the employee who work or reside in the state. 4903 (2) The department shall: 4904 (a) on or before July 1, 2016: 4905 (i) determine the commercial equivalent of the benchmark plan described in Subsection 4906 (1)(a); and 4907 (ii) post the commercially equivalent benchmark plan described in Subsection (2)(a)(i) 4908 on the department's website, noting the date posted; and 4909 (b) update the posted commercially equivalent benchmark plan annually and at the 4910 time of any change in the benchmark. 4911 Section 133. Section 26B-3-1001, which is renumbered from Section 26-19-102 is 4912 renumbered and amended to read: 4913 Part 10. Medical Benefits Recovery 4914 [26-19-102]. 26B-3-1001. Definitions. 4915 As used in this [chapter] part: 4916 (1) "Annuity" shall have the same meaning as provided in Section 31A-1-301. 4917 (2) "Care facility" means: 4918 (a) a nursing facility; 4919 (b) an intermediate care facility for an individual with an intellectual disability; or 4920 (c) any other medical institution. 4921 (3) "Claim" means: 4922 (a) a request or demand for payment; or 4923 (b) a cause of action for money or damages arising under any law. 4924 (4) "Employee welfare benefit plan" means a medical insurance plan developed by an 4925 employer under 29 U.S.C. [Section] Sec. 1001, et seq., the Employee Retirement Income S.B. 39 02-10-23 5:41 PM - 160 - 4926 Security Act of 1974 as amended. 4927 (5) "Health insurance entity" means: 4928 (a) an insurer; 4929 (b) a person who administers, manages, provides, offers, sells, carries, or underwrites 4930 health insurance, as defined in Section 31A-1-301; 4931 (c) a self-insured plan; 4932 (d) a group health plan, as defined in Subsection 607(1) of the federal Employee 4933 Retirement Income Security Act of 1974; 4934 (e) a service benefit plan; 4935 (f) a managed care organization; 4936 (g) a pharmacy benefit manager; 4937 (h) an employee welfare benefit plan; or 4938 (i) a person who is, by statute, contract, or agreement, legally responsible for payment 4939 of a claim for a health care item or service. 4940 (6) "Inpatient" means an individual who is a patient and a resident of a care facility. 4941 (7) "Insurer" includes: 4942 (a) a group health plan as defined in Subsection 607(1) of the federal Employee 4943 Retirement Income Security Act of 1974; 4944 (b) a health maintenance organization; and 4945 (c) any entity offering a health service benefit plan. 4946 (8) "Medical assistance" means: 4947 (a) all funds expended for the benefit of a recipient under Title 26, Chapter 18, Medical 4948 Assistance Act, or under Titles XVIII and XIX, federal Social Security Act; and 4949 (b) any other services provided for the benefit of a recipient by a prepaid health care 4950 delivery system under contract with the department. 4951 (9) "Office of Recovery Services" means the Office of Recovery Services within the 4952 [Department of Human Services] department. 4953 (10) "Provider" means a person or entity who provides services to a recipient. 4954 (11) "Recipient" means: 4955 (a) an individual who has applied for or received medical assistance from the state; 4956 (b) the guardian, conservator, or other personal representative of an individual under 02-10-23 5:41 PM S.B. 39 - 161 - 4957 Subsection (11)(a) if the individual is a minor or an incapacitated person; or 4958 (c) the estate and survivors of an individual under Subsection (11)(a), if the individual 4959 is deceased. 4960 (12) "Recovery estate" means, regarding a deceased recipient: 4961 (a) all real and personal property or other assets included within a decedent's estate as 4962 defined in Section 75-1-201; 4963 (b) the decedent's augmented estate as defined in Section 75-2-203; and 4964 (c) that part of other real or personal property in which the decedent had a legal interest 4965 at the time of death including assets conveyed to a survivor, heir, or assign of the decedent 4966 through joint tenancy, tenancy in common, survivorship, life estate, living trust, or other 4967 arrangement. 4968 (13) "State plan" means the state Medicaid program as enacted in accordance with Title 4969 XIX, federal Social Security Act. 4970 (14) "TEFRA lien" means a lien, authorized under the Tax Equity and Fiscal 4971 Responsibility Act of 1982, against the real property of an individual prior to the individual's 4972 death, as described in 42 U.S.C. Sec. 1396p. 4973 (15) "Third party" includes: 4974 (a) an individual, institution, corporation, public or private agency, trust, estate, 4975 insurance carrier, employee welfare benefit plan, health maintenance organization, health 4976 service organization, preferred provider organization, governmental program such as Medicare, 4977 CHAMPUS, and workers' compensation, which may be obligated to pay all or part of the 4978 medical costs of injury, disease, or disability of a recipient, unless any of these are excluded by 4979 department rule; and 4980 (b) a spouse or a parent who: 4981 (i) may be obligated to pay all or part of the medical costs of a recipient under law or 4982 by court or administrative order; or 4983 (ii) has been ordered to maintain health, dental, or accident and health insurance to 4984 cover medical expenses of a spouse or dependent child by court or administrative order. 4985 (16) "Trust" shall have the same meaning as provided in Section 75-1-201. 4986 Section 134. Section 26B-3-1002, which is renumbered from Section 26-19-103 is 4987 renumbered and amended to read: S.B. 39 02-10-23 5:41 PM - 162 - 4988 [26-19-103]. 26B-3-1002. Program established by department -- 4989 Promulgation of rules. 4990 (1) The department shall establish and maintain a program for the recoupment of 4991 medical assistance. 4992 (2) The department may promulgate rules to implement the purposes of this [chapter] 4993 part. 4994 Section 135. Section 26B-3-1003, which is renumbered from Section 26-19-201 is 4995 renumbered and amended to read: 4996 [26-19-201]. 26B-3-1003. Assignment of rights to benefits. 4997 (1) (a) Except as provided in Subsection [26-19-401] 26B-3-1009(1), to the extent that 4998 medical assistance is actually provided to a recipient, all benefits for medical services or 4999 payments from a third-party otherwise payable to or on behalf of a recipient are assigned by 5000 operation of law to the department if the department provides, or becomes obligated to provide, 5001 medical assistance, regardless of who made application for the benefits on behalf of the 5002 recipient. 5003 (b) The assignment: 5004 (i) authorizes the department to submit its claim to the third-party and authorizes 5005 payment of benefits directly to the department; and 5006 (ii) is effective for all medical assistance. 5007 (2) The department may recover the assigned benefits or payments in accordance with 5008 Section [26-19-401] 26B-3-1009 and as otherwise provided by law. 5009 (3) (a) The assignment of benefits includes medical support and third-party payments 5010 ordered, decreed, or adjudged by any court of this state or any other state or territory of the 5011 United States. 5012 (b) The assignment is not in lieu of, and does not supersede or alter any other court 5013 order, decree, or judgment. 5014 (4) When an assignment takes effect, the recipient is entitled to receive medical 5015 assistance, and the benefits paid to the department are a reimbursement to the department. 5016 Section 136. Section 26B-3-1004, which is renumbered from Section 26-19-301 is 5017 renumbered and amended to read: 5018 [26-19-301]. 26B-3-1004. Health insurance entity -- Duties related to state 02-10-23 5:41 PM S.B. 39 - 163 - 5019 claims for Medicaid payment or recovery. 5020 As a condition of doing business in the state, a health insurance entity shall: 5021 (1) with respect to an individual who is eligible for, or is provided, medical assistance 5022 under the state plan, upon the request of the [Department of Health] department, provide 5023 information to determine: 5024 (a) during what period the individual, or the spouse or dependent of the individual, may 5025 be or may have been, covered by the health insurance entity; and 5026 (b) the nature of the coverage that is or was provided by the health insurance entity 5027 described in Subsection (1)(a), including the name, address, and identifying number of the 5028 plan; 5029 (2) accept the state's right of recovery and the assignment to the state of any right of an 5030 individual to payment from a party for an item or service for which payment has been made 5031 under the state plan; 5032 (3) respond to any inquiry by the [Department of Health] department regarding a claim 5033 for payment for any health care item or service that is submitted no later than three years after 5034 the day on which the health care item or service is provided; and 5035 (4) not deny a claim submitted by the [Department of Health] department solely on the 5036 basis of the date of submission of the claim, the type or format of the claim form, or failure to 5037 present proper documentation at the point-of-sale that is the basis for the claim, if: 5038 (a) the claim is submitted no later than three years after the day on which the item or 5039 service is furnished; and 5040 (b) any action by the [Department of Health] department to enforce the rights of the 5041 state with respect to the claim is commenced no later than six years after the day on which the 5042 claim is submitted. 5043 Section 137. Section 26B-3-1005, which is renumbered from Section 26-19-302 is 5044 renumbered and amended to read: 5045 [26-19-302]. 26B-3-1005. Insurance policies not to deny or reduce benefits 5046 of individuals eligible for state medical assistance -- Exemptions. 5047 (1) A policy of accident or sickness insurance may not contain any provision denying 5048 or reducing benefits because services are rendered to an insured or dependent who is eligible 5049 for or receiving medical assistance from the state. S.B. 39 02-10-23 5:41 PM - 164 - 5050 (2) An association, corporation, or organization may not deliver, issue for delivery, or 5051 renew any subscriber's contract which contains any provisions denying or reducing benefits 5052 because services are rendered to a subscriber or dependent who is eligible for or receiving 5053 medical assistance from the state. 5054 (3) An association, corporation, business, or organization authorized to do business in 5055 this state and which provides or pays for any health care benefits may not deny or reduce 5056 benefits because services are rendered to a beneficiary who is eligible for or receiving medical 5057 assistance from the state. 5058 (4) Notwithstanding Subsection (1), (2), or (3), the Utah State Public Employees' 5059 Health Program, administered by the Utah State Retirement Board, is not required to reimburse 5060 any agency of state government for custodial care which the agency provides, through its staff 5061 or facilities, to members of the Utah State Public Employees' Health Program. 5062 Section 138. Section 26B-3-1006, which is renumbered from Section 26-19-303 is 5063 renumbered and amended to read: 5064 [26-19-303]. 26B-3-1006. Availability of insurance policy. 5065 If the third party does not pay the department's claim or lien within 30 days from the 5066 date the claim or lien is received, the third party shall: 5067 (1) provide a written explanation if the claim is denied; 5068 (2) specifically describe and request any additional information from the department 5069 that is necessary to process the claim; and 5070 (3) provide the department or its agent a copy of any relevant or applicable insurance 5071 or benefit policy. 5072 Section 139. Section 26B-3-1007, which is renumbered from Section 26-19-304 is 5073 renumbered and amended to read: 5074 [26-19-304]. 26B-3-1007. Employee benefit plans. 5075 As allowed pursuant to 29 U.S.C. [Section] Sec. 1144, an employee benefit plan may 5076 not include any provision that has the effect of limiting or excluding coverage or payment for 5077 any health care for an individual who would otherwise be covered or entitled to benefits or 5078 services under the terms of the employee benefit plan based on the fact that the individual is 5079 eligible for or is provided services under the state plan. 5080 Section 140. Section 26B-3-1008, which is renumbered from Section 26-19-305 is 02-10-23 5:41 PM S.B. 39 - 165 - 5081 renumbered and amended to read: 5082 [26-19-305]. 26B-3-1008. Statute of limitations -- Survival of right of 5083 action -- Insurance policy not to limit time allowed for recovery. 5084 (1) (a) Subject to Subsection (6), action commenced by the department under this 5085 [chapter] part against a health insurance entity shall be commenced within: 5086 (i) subject to Subsection (7), six years after the day on which the department submits 5087 the claim for recovery or payment for the health care item or service upon which the action is 5088 based; or 5089 (ii) six months after the date of the last payment for medical assistance, whichever is 5090 later. 5091 (b) An action against any other third party, the recipient, or anyone to whom the 5092 proceeds are payable shall be commenced within: 5093 (i) four years after the date of the injury or onset of the illness; or 5094 (ii) six months after the date of the last payment for medical assistance, whichever is 5095 later. 5096 (2) The death of the recipient does not abate any right of action established by this 5097 [chapter] part. 5098 (3) (a) No insurance policy issued or renewed after June 1, 1981, may contain any 5099 provision that limits the time in which the department may submit its claim to recover medical 5100 assistance benefits to a period of less than 24 months from the date the provider furnishes 5101 services or goods to the recipient. 5102 (b) No insurance policy issued or renewed after April 30, 2007, may contain any 5103 provision that limits the time in which the department may submit its claim to recover medical 5104 assistance benefits to a period of less than that described in Subsection (1)(a). 5105 (4) The provisions of this section do not apply to Section [26-19-405 or Part 5, TEFRA 5106 Liens] 26B-3-1013 or Sections 26B-3-1015 through 26B-3-1023. 5107 (5) The provisions of this section supercede any other sections regarding the time limit 5108 in which an action shall be commenced, including Section 75-7-509. 5109 (6) (a) Subsection (1)(a) extends the statute of limitations on a cause of action 5110 described in Subsection (1)(a) that was not time-barred on or before April 30, 2007. 5111 (b) Subsection (1)(a) does not revive a cause of action that was time-barred on or S.B. 39 02-10-23 5:41 PM - 166 - 5112 before April 30, 2007. 5113 (7) An action described in Subsection (1)(a) may not be commenced if the claim for 5114 recovery or payment described in Subsection (1)(a)(i) is submitted later than three years after 5115 the day on which the health care item or service upon which the claim is based was provided. 5116 Section 141. Section 26B-3-1009, which is renumbered from Section 26-19-401 is 5117 renumbered and amended to read: 5118 [26-19-401]. 26B-3-1009. Recovery of medical assistance from third party 5119 -- Lien -- Notice -- Action -- Compromise or waiver -- Recipient's right to action 5120 protected. 5121 (1) (a) Except as provided in Subsection (1)(c), if the department provides or becomes 5122 obligated to provide medical assistance to a recipient that a third-party is obligated to pay for, 5123 the department may recover the medical assistance directly from the third-party. 5124 (b) (i) A claim under Subsection (1)(a) or Section [26-19-201] 26B-3-1003 to recover 5125 medical assistance provided to a recipient is a lien against any proceeds payable to or on behalf 5126 of the recipient by the third-party. 5127 (ii) The lien described in Subsection (1)(b)(i) has priority over all other claims to the 5128 proceeds, except claims for attorney fees and costs authorized under Subsection [26-19-403] 5129 26B-3-1011(2)(c)(ii). 5130 (c) (i) The department may not recover medical assistance under Subsection (1)(a) if: 5131 (A) the third-party is obligated to pay the recipient for an injury to the recipient's child 5132 that occurred while the child was in the physical custody of the child's foster parent; 5133 (B) the child's injury is a physical or mental impairment that requires ongoing medical 5134 attention, or limits activities of daily living, for at least one year; 5135 (C) the third-party's payment to the recipient is placed in a trust, annuity, financial 5136 account, or other financial instrument for the benefit of the child; and 5137 (D) the recipient makes reasonable efforts to mitigate any other medical assistance 5138 costs for the recipient to the state. 5139 (ii) The department is responsible for any repayment to the federal government related 5140 to the medical assistance the department is prohibited from recovering under Subsection 5141 (1)(c)(i). 5142 (2) (a) The department shall mail or deliver written notice of the department's claim or 02-10-23 5:41 PM S.B. 39 - 167 - 5143 lien to the third-party at the third-party's principal place of business or last-known address. 5144 (b) The notice shall include: 5145 (i) the recipient's name; 5146 (ii) the approximate date of illness or injury; 5147 (iii) a general description of the type of illness or injury; and 5148 (iv) if applicable, the general location where the injury is alleged to have occurred. 5149 (3) The department may commence an action on the department's claim or lien in the 5150 department's name, but the claim or lien is not enforceable as to a third-party unless: 5151 (a) the third-party receives written notice of the department's claim or lien before the 5152 third-party settles with the recipient; or 5153 (b) the department has evidence that the third party had knowledge that the department 5154 provided or was obligated to provide medical assistance. 5155 (4) The department may: 5156 (a) waive a claim or lien against a third party in whole or in part; or 5157 (b) compromise, settle, or release a claim or lien. 5158 (5) An action commenced under this section does not bar an action by a recipient or a 5159 dependent of a recipient for loss or damage not included in the department's action. 5160 (6) Except as provided in Subsection (1)(c), the department's claim or lien on proceeds 5161 under this section is not affected by the transfer of the proceeds to a trust, annuity, financial 5162 account, or other financial instrument. 5163 Section 142. Section 26B-3-1010, which is renumbered from Section 26-19-402 is 5164 renumbered and amended to read: 5165 [26-19-402]. 26B-3-1010. Action by department -- Notice to recipient. 5166 (1) (a) Within 30 days after commencing an action under Subsection [26-19-401] 5167 26B-3-1009(3), the department shall give the recipient, the recipient's guardian, personal 5168 representative, trustee, estate, or survivor, whichever is appropriate, written notice of the action 5169 by: 5170 (i) personal service or certified mail to the last known address of the person receiving 5171 the notice; or 5172 (ii) if no last-known address is available, by publishing a notice: 5173 (A) once a week for three successive weeks in a newspaper of general circulation in the S.B. 39 02-10-23 5:41 PM - 168 - 5174 county where the recipient resides; and 5175 (B) in accordance with Section 45-1-101 for three weeks. 5176 (b) Proof of service shall be filed in the action. 5177 (c) The recipient may intervene in the department's action at any time before trial. 5178 (2) The notice required by Subsection (1) shall name the court in which the action is 5179 commenced and advise the recipient of: 5180 (a) the right to intervene in the proceeding; 5181 (b) the right to obtain a private attorney; and 5182 (c) the department's right to recover medical assistance directly from the third party. 5183 Section 143. Section 26B-3-1011, which is renumbered from Section 26-19-403 is 5184 renumbered and amended to read: 5185 [26-19-403]. 26B-3-1011. Notice of claim by recipient -- Department 5186 response -- Conditions for proceeding -- Collection agreements. 5187 (1) (a) A recipient may not file a claim, commence an action, or settle, compromise, 5188 release, or waive a claim against a third party for recovery of medical costs for an injury, 5189 disease, or disability for which the department has provided or has become obligated to provide 5190 medical assistance, without the department's written consent as provided in Subsection (2)(b) 5191 or (4). 5192 (b) For purposes of Subsection (1)(a), consent may be obtained if: 5193 (i) a recipient who files a claim, or commences an action against a third party notifies 5194 the department in accordance with Subsection (1)(d) within 10 days of the recipient making the 5195 claim or commencing an action; or 5196 (ii) an attorney, who has been retained by the recipient to file a claim, or commence an 5197 action against a third party, notifies the department in accordance with Subsection (1)(d) of the 5198 recipient's claim: 5199 (A) within 30 days after being retained by the recipient for that purpose; or 5200 (B) within 30 days from the date the attorney either knew or should have known that 5201 the recipient received medical assistance from the department. 5202 (c) Service of the notice of claim to the department shall be made by certified mail, 5203 personal service, or by e-mail in accordance with Rule 5 of the Utah Rules of Civil Procedure, 5204 to the director of the Office of Recovery Services. 02-10-23 5:41 PM S.B. 39 - 169 - 5205 (d) The notice of claim shall include the following information: 5206 (i) the name of the recipient; 5207 (ii) the recipient's Social Security number; 5208 (iii) the recipient's date of birth; 5209 (iv) the name of the recipient's attorney if applicable; 5210 (v) the name or names of individuals or entities against whom the recipient is making 5211 the claim, if known; 5212 (vi) the name of the third party's insurance carrier, if known; 5213 (vii) the date of the incident giving rise to the claim; and 5214 (viii) a short statement identifying the nature of the recipient's claim. 5215 (2) (a) Within 30 days of receipt of the notice of the claim required in Subsection (1), 5216 the department shall acknowledge receipt of the notice of the claim to the recipient or the 5217 recipient's attorney and shall notify the recipient or the recipient's attorney in writing of the 5218 following: 5219 (i) if the department has a claim or lien pursuant to Section [26-19-401] 26B-3-1009 or 5220 has become obligated to provide medical assistance; and 5221 (ii) whether the department is denying or granting written consent in accordance with 5222 Subsection (1)(a). 5223 (b) The department shall provide the recipient's attorney the opportunity to enter into a 5224 collection agreement with the department, with the recipient's consent, unless: 5225 (i) the department, prior to the receipt of the notice of the recipient's claim pursuant to 5226 Subsection (1), filed a written claim with the third party, the third party agreed to make 5227 payment to the department before the date the department received notice of the recipient's 5228 claim, and the agreement is documented in the department's record; or 5229 (ii) there has been a failure by the recipient's attorney to comply with any provision of 5230 this section by: 5231 (A) failing to comply with the notice provisions of this section; 5232 (B) failing or refusing to enter into a collection agreement; 5233 (C) failing to comply with the terms of a collection agreement with the department; or 5234 (D) failing to disburse funds owed to the state in accordance with this section. 5235 (c) (i) The collection agreement shall be: S.B. 39 02-10-23 5:41 PM - 170 - 5236 (A) consistent with this section and the attorney's obligation to represent the recipient 5237 and represent the state's claim; and 5238 (B) state the terms under which the interests of the department may be represented in 5239 an action commenced by the recipient. 5240 (ii) If the recipient's attorney enters into a written collection agreement with the 5241 department, or includes the department's claim in the recipient's claim or action pursuant to 5242 Subsection (4), the department shall pay attorney fees at the rate of 33.3% of the department's 5243 total recovery and shall pay a proportionate share of the litigation expenses directly related to 5244 the action. 5245 (d) The department is not required to enter into a collection agreement with the 5246 recipient's attorney for collection of personal injury protection under Subsection 5247 31A-22-302(2). 5248 (3) (a) If the department receives notice pursuant to Subsection (1), and notifies the 5249 recipient and the recipient's attorney that the department will not enter into a collection 5250 agreement with the recipient's attorney, the recipient may proceed with the recipient's claim or 5251 action against the third party if the recipient excludes from the claim: 5252 (i) any medical expenses paid by the department; or 5253 (ii) any medical costs for which the department is obligated to provide medical 5254 assistance. 5255 (b) When a recipient proceeds with a claim under Subsection (3)(a), the recipient shall 5256 provide written notice to the third party of the exclusion of the department's claim for expenses 5257 under Subsection (3)(a)(i) or (ii). 5258 (4) If the department receives notice pursuant to Subsection (1), and does not respond 5259 within 30 days to the recipient or the recipient's attorney, the recipient or the recipient's 5260 attorney: 5261 (a) may proceed with the recipient's claim or action against the third party; 5262 (b) may include the state's claim in the recipient's claim or action; and 5263 (c) may not negotiate, compromise, settle, or waive the department's claim without the 5264 department's consent. 5265 Section 144. Section 26B-3-1012, which is renumbered from Section 26-19-404 is 5266 renumbered and amended to read: 02-10-23 5:41 PM S.B. 39 - 171 - 5267 [26-19-404]. 26B-3-1012. Department's right to intervene -- Department's 5268 interests protected -- Remitting funds -- Disbursements -- Liability and penalty for 5269 noncompliance. 5270 (1) The department has an unconditional right to intervene in an action commenced by 5271 a recipient against a third party for the purpose of recovering medical costs for which the 5272 department has provided or has become obligated to provide medical assistance. 5273 (2) (a) If the recipient proceeds without complying with the provisions of Section 5274 [26-19-403] 26B-3-1011, the department is not bound by any decision, judgment, agreement, 5275 settlement, or compromise rendered or made on the claim or in the action. 5276 (b) The department: 5277 (i) may recover in full from the recipient, or any party to which the proceeds were 5278 made payable, all medical assistance that the department has provided; and 5279 (ii) retains its right to commence an independent action against the third party, subject 5280 to Subsection [26-19-401] 26B-3-1009(3). 5281 (3) Any amounts assigned to and recoverable by the department pursuant to Sections 5282 [26-19-201 and 26-19-401] 26B-3-1003 and 26B-3-1009 collected directly by the recipient 5283 shall be remitted to the Bureau of Medical Collections within the Office of Recovery Services 5284 no later than five business days after receipt. 5285 (4) (a) Any amounts assigned to and recoverable by the department pursuant to 5286 Sections [26-19-201 and 26-19-401] 26B-3-1003 and 26B-3-1009 collected directly by the 5287 recipient's attorney shall be remitted to the Bureau of Medical Collections within the Office of 5288 Recovery Services no later than 30 days after the funds are placed in the attorney's trust 5289 account. 5290 (b) The date by which the funds shall be remitted to the department may be modified 5291 based on agreement between the department and the recipient's attorney. 5292 (c) The department's consent to another date for remittance may not be unreasonably 5293 withheld. 5294 (d) If the funds are received by the recipient's attorney, no disbursements shall be made 5295 to the recipient or the recipient's attorney until the department's claim has been paid. 5296 (5) A recipient or recipient's attorney who knowingly and intentionally fails to comply 5297 with this section is liable to the department for: S.B. 39 02-10-23 5:41 PM - 172 - 5298 (a) the amount of the department's claim or lien pursuant to Subsection (1); 5299 (b) a penalty equal to 10% of the amount of the department's claim; and 5300 (c) attorney fees and litigation expenses related to recovering the department's claim. 5301 Section 145. Section 26B-3-1013, which is renumbered from Section 26-19-405 is 5302 renumbered and amended to read: 5303 [26-19-405]. 26B-3-1013. Estate and trust recovery. 5304 (1) (a) Except as provided in Subsection (1)(b), upon a recipient's death, the 5305 department may recover from the recipient's recovery estate and any trust, in which the 5306 recipient is the grantor and a beneficiary, medical assistance correctly provided for the benefit 5307 of the recipient when the recipient was 55 years of age or older. 5308 (b) The department may not make an adjustment or a recovery under Subsection (1)(a): 5309 (i) while the deceased recipient's spouse is still living; or 5310 (ii) if the deceased recipient has a surviving child who is: 5311 (A) under age 21; or 5312 (B) blind or disabled, as defined in the state plan. 5313 (2) (a) The amount of medical assistance correctly provided for the benefit of a 5314 recipient and recoverable under this section is a lien against the deceased recipient's recovery 5315 estate or any trust when the recipient is the grantor and a beneficiary. 5316 (b) The lien holds the same priority as reasonable and necessary medical expenses of 5317 the last illness as provided in Section 75-3-805. 5318 (3) (a) For a lien described in Subsection (2), the department shall provide notice in 5319 accordance with Section 38-12-102. 5320 (b) Before final distribution, the department shall perfect the lien as follows: 5321 (i) for an estate, by presenting the lien to the estate's personal representative in 5322 accordance with Section 75-3-804; and 5323 (ii) for a trust, by presenting the lien to the trustee in accordance with Section 5324 75-7-510. 5325 (c) The department may file an amended lien before the entry of the final order to close 5326 the estate or trust. 5327 (4) Claims against a deceased recipient's inter vivos trust shall be presented in 5328 accordance with Sections 75-7-509 and 75-7-510. 02-10-23 5:41 PM S.B. 39 - 173 - 5329 (5) Any trust provision that denies recovery for medical assistance is void at the time of 5330 its making. 5331 (6) Nothing in this section affects the right of the department to recover Medicaid 5332 assistance before a recipient's death under Section [26-19-201 or Section 26-19-406] 5333 26B-3-1003 or 26B-3-1014. 5334 (7) A lien imposed under this section is of indefinite duration. 5335 Section 146. Section 26B-3-1014, which is renumbered from Section 26-19-406 is 5336 renumbered and amended to read: 5337 [26-19-406]. 26B-3-1014. Recovery from recipient of incorrectly provided 5338 medical assistance. 5339 The department may: 5340 (1) recover medical assistance incorrectly provided, whether due to administrative or 5341 factual error or fraud, from the recipient or the recipient's recovery estate; and 5342 (2) pursuant to a judgment, impose a lien against real property of the recipient. 5343 Section 147. Section 26B-3-1015, which is renumbered from Section 26-19-501 is 5344 renumbered and amended to read: 5345 [26-19-501]. 26B-3-1015. TEFRA liens authorized -- Grounds for TEFRA 5346 liens -- Exemptions. 5347 (1) Except as provided in Subsections (2) and (3), the department may impose a 5348 TEFRA lien on the real property of an individual for the amount of medical assistance provided 5349 for, or to, the individual while the individual is an inpatient in a care facility, if: 5350 (a) the individual is an inpatient in a care facility; 5351 (b) the individual is required, as a condition of receiving services under the state plan, 5352 to spend for costs of medical care all but a minimal amount of the individual's income required 5353 for personal needs; and 5354 (c) the department determines that the individual cannot reasonably be expected to: 5355 (i) be discharged from the care facility; and 5356 (ii) return to the individual's home. 5357 (2) The department may not impose a lien on the home of an individual described in 5358 Subsection (1), if any of the following individuals are lawfully residing in the home: 5359 (a) the spouse of the individual; S.B. 39 02-10-23 5:41 PM - 174 - 5360 (b) a child of the individual, if the child is: 5361 (i) under 21 years of age; or 5362 (ii) blind or permanently and totally disabled, as defined in Title 42 U.S.C. Sec. 5363 1382c(a)(3)(F); or 5364 (c) a sibling of the individual, if the sibling: 5365 (i) has an equity interest in the home; and 5366 (ii) resided in the home for at least one year immediately preceding the day on which 5367 the individual was admitted to the care facility. 5368 (3) The department may not impose a TEFRA lien on the real property of an 5369 individual, unless: 5370 (a) the individual has been an inpatient in a care facility for the 180-day period 5371 immediately preceding the day on which the lien is imposed; 5372 (b) the department serves: 5373 (i) a preliminary notice of intent to impose a TEFRA lien relating to the real property, 5374 in accordance with Section [26-19-503] 26B-3-1017; and 5375 (ii) a final notice of intent to impose a TEFRA lien relating to the real property, in 5376 accordance with Section [26-19-504] 26B-3-1018; and 5377 (c) (i) the individual does not file a timely request for review of the department's 5378 decision under Title 63G, Chapter 4, Administrative Procedures Act; or 5379 (ii) the department's decision is upheld upon final review or appeal under Title 63G, 5380 Chapter 4, Administrative Procedures Act. 5381 Section 148. Section 26B-3-1016, which is renumbered from Section 26-19-502 is 5382 renumbered and amended to read: 5383 [26-19-502]. 26B-3-1016. Presumption of permanency. 5384 There is a rebuttable presumption that an individual who is an inpatient in a care facility 5385 cannot reasonably be expected to be discharged from a care facility and return to the 5386 individual's home, if the individual has been an inpatient in a care facility for a period of at 5387 least 180 consecutive days. 5388 Section 149. Section 26B-3-1017, which is renumbered from Section 26-19-503 is 5389 renumbered and amended to read: 5390 [26-19-503]. 26B-3-1017. Preliminary notice of intent to impose a TEFRA 02-10-23 5:41 PM S.B. 39 - 175 - 5391 lien. 5392 (1) Prior to imposing a TEFRA lien on real property, the department shall serve a 5393 preliminary notice of intent to impose a TEFRA lien, on the individual described in Subsection 5394 [26-19-501] 26B-3-1015(1), who owns the property. 5395 (2) The preliminary notice of intent shall: 5396 (a) be served in person, or by certified mail, on the individual described in Subsection 5397 [26-19-501] 26B-3-1015(1), and, if the department is aware that the individual has a legally 5398 authorized representative, on the representative; 5399 (b) include a statement indicating that, according to the department's records, the 5400 individual: 5401 (i) meets the criteria described in Subsections [26-19-501] 26B-3-1015(1)(a) and (b); 5402 (ii) has been an inpatient in a care facility for a period of at least 180 days immediately 5403 preceding the day on which the department provides the notice to the individual; and 5404 (iii) is legally presumed to be in a condition where it cannot reasonably be expected 5405 that the individual will be discharged from the care facility and return to the individual's home; 5406 (c) indicate that the department intends to impose a TEFRA lien on real property 5407 belonging to the individual; 5408 (d) describe the real property that the TEFRA lien will apply to; 5409 (e) describe the current amount of, and purpose of, the TEFRA lien; 5410 (f) indicate that the amount of the lien may continue to increase as the individual 5411 continues to receive medical assistance; 5412 (g) indicate that the individual may seek to prevent the TEFRA lien from being 5413 imposed on the real property by providing documentation to the department that: 5414 (i) establishes that the individual does not meet the criteria described in Subsection 5415 [26-19-501] 26B-3-1015(1)(a) or (b); 5416 (ii) establishes that the individual has not been an inpatient in a care facility for a 5417 period of at least 180 days; 5418 (iii) rebuts the presumption described in Section [26-19-502] 26B-3-1016; or 5419 (iv) establishes that the real property is exempt from imposition of a TEFRA lien under 5420 Subsection [26-19-501] 26B-3-1015(2); 5421 (h) indicate that if the owner fails to provide the documentation described in S.B. 39 02-10-23 5:41 PM - 176 - 5422 Subsection (2)(g) within 30 days after the day on which the preliminary notice of intent is 5423 served, the department will issue a final notice of intent to impose a TEFRA lien on the real 5424 property and will proceed to impose the lien; 5425 (i) identify the type of documentation that the owner may provide to comply with 5426 Subsection (2)(g); 5427 (j) describe the circumstances under which a TEFRA lien is required to be released; 5428 and 5429 (k) describe the circumstances under which the department may seek to recover the 5430 lien. 5431 Section 150. Section 26B-3-1018, which is renumbered from Section 26-19-504 is 5432 renumbered and amended to read: 5433 [26-19-504]. 26B-3-1018. Final notice of intent to impose a TEFRA lien. 5434 (1) The department may issue a final notice of intent to impose a TEFRA lien on real 5435 property if: 5436 (a) a preliminary notice of intent relating to the property is served in accordance with 5437 Section [26-19-503] 26B-3-1017; 5438 (b) it is at least 30 days after the day on which the preliminary notice of intent was 5439 served; and 5440 (c) the department has not received documentation or other evidence that adequately 5441 establishes that a TEFRA lien may not be imposed on the real property. 5442 (2) The final notice of intent to impose a TEFRA lien on real property shall: 5443 (a) be served in person, or by certified mail, on the individual described in Subsection 5444 [26-19-501] 26B-3-1015(1), who owns the property, and, if the department is aware that the 5445 individual has a legally authorized representative, on the representative; 5446 (b) indicate that the department has complied with the requirements for filing the final 5447 notice of intent under Subsection (1); 5448 (c) include a statement indicating that, according to the department's records, the 5449 individual: 5450 (i) meets the criteria described in Subsections [26-19-501] 26B-3-1015(1)(a) and (b); 5451 (ii) has been an inpatient in a care facility for a period of at least 180 days immediately 5452 preceding the day on which the department provides the notice to the individual; and 02-10-23 5:41 PM S.B. 39 - 177 - 5453 (iii) is legally presumed to be in a condition where it cannot reasonably be expected 5454 that the individual will be discharged from the care facility and return to the individual's home; 5455 (d) indicate that the department intends to impose a TEFRA lien on real property 5456 belonging to the individual; 5457 (e) describe the real property that the TEFRA lien will apply to; 5458 (f) describe the current amount of, and purpose of, the TEFRA lien; 5459 (g) indicate that the amount of the lien may continue to increase as the individual 5460 continues to receive medical assistance; 5461 (h) describe the circumstances under which a TEFRA lien is required to be released; 5462 (i) describe the circumstances under which the department may seek to recover the 5463 lien; 5464 (j) describe the right of the individual to challenge the decision of the department in an 5465 adjudicative proceeding; and 5466 (k) indicate that failure by the individual to successfully challenge the decision of the 5467 department will result in the TEFRA lien being imposed. 5468 Section 151. Section 26B-3-1019, which is renumbered from Section 26-19-505 is 5469 renumbered and amended to read: 5470 [26-19-505]. 26B-3-1019. Review of department decision. 5471 An individual who has been served with a final notice of intent to impose a TEFRA lien 5472 under Section [26-19-504] 26B-3-1018 may seek agency or judicial review of that decision 5473 under Title 63G, Chapter 4, Administrative Procedures Act. 5474 Section 152. Section 26B-3-1020, which is renumbered from Section 26-19-506 is 5475 renumbered and amended to read: 5476 [26-19-506]. 26B-3-1020. Dissolution and removal of TEFRA lien. 5477 (1) A TEFRA lien shall dissolve and be removed by the department if the individual 5478 described in Subsection [26-19-501] 26B-3-1015(1): 5479 (a) (i) is discharged from the care facility; and 5480 (ii) returns to the individual's home; or 5481 (b) provides sufficient documentation to the department that: 5482 (i) rebuts the presumption described in Section [26-19-502] 26B-3-1016; or 5483 (ii) any of the following individuals are lawfully residing in the individual's home: S.B. 39 02-10-23 5:41 PM - 178 - 5484 (A) the spouse of the individual; 5485 (B) a child of the individual, if the child is under 21 years of age or blind or 5486 permanently and totally disabled, as defined in Title 42 U.S.C. Sec. 1382c(a)(3)(F); or 5487 (C) a sibling of the individual, if the sibling has an equity interest in the home and 5488 resided in the home for at least one year immediately preceding the day on which the individual 5489 was admitted to the care facility. 5490 (2) An individual described in Subsection [26-19-501] 26B-3-1015(1)(a) may, at any 5491 time after the department has imposed a lien under [this part] Sections 26B-3-1015 through 5492 26B-3-1023, file a request for the department to remove the lien. 5493 (3) A request filed under Subsection (2) shall be considered and reviewed pursuant to 5494 Title 63G, Chapter 4, Administrative Procedures Act. 5495 Section 153. Section 26B-3-1021, which is renumbered from Section 26-19-507 is 5496 renumbered and amended to read: 5497 [26-19-507]. 26B-3-1021. Expenditures included in lien -- Other 5498 proceedings. 5499 (1) A TEFRA lien imposed on real property under [this part] Sections 26B-3-1015 5500 through 26B-3-1023 includes all expenses relating to medical assistance provided or paid for 5501 under the state plan from the first day that the individual is placed in a care facility, regardless 5502 of when the lien is imposed or filed on the property. 5503 (2) Nothing in this [part] Sections 26B-3-1015 through 26B-3-1023 affects or prevents 5504 the department from bringing or pursuing any other legally authorized action to recover 5505 medical assistance or to set aside a fraudulent or improper conveyance. 5506 Section 154. Section 26B-3-1022, which is renumbered from Section 26-19-508 is 5507 renumbered and amended to read: 5508 [26-19-508]. 26B-3-1022. Contract with another government agency. 5509 If the department contracts with another government agency to recover funds paid for 5510 medical assistance under this [chapter] part, that government agency shall be the sole agency 5511 that determines whether to impose or remove a TEFRA lien under [this part] Sections 5512 26B-3-1015 through 26B-3-1023. 5513 Section 155. Section 26B-3-1023, which is renumbered from Section 26-19-509 is 5514 renumbered and amended to read: 02-10-23 5:41 PM S.B. 39 - 179 - 5515 [26-19-509]. 26B-3-1023. Precedence of the Tax Equity and Fiscal 5516 Responsibility Act of 1982. 5517 If any provision of [this part] Sections 26B-3-1015 through 26B-3-1023 conflicts with 5518 the requirements of the Tax Equity and Fiscal Responsibility Act of 1982 for imposing a lien 5519 against the property of an individual prior to the individual's death, under 42 U.S.C. Sec. 5520 1396p, the provisions of the Tax Equity and Fiscal Responsibility Act of 1982 take precedence 5521 and shall be complied with by the department. 5522 Section 156. Section 26B-3-1024, which is renumbered from Section 26-19-601 is 5523 renumbered and amended to read: 5524 [26-19-601]. 26B-3-1024. Legal recognition of electronic claims records. 5525 Pursuant to Title 46, Chapter 4, Uniform Electronic Transactions Act: 5526 (1) a claim submitted to the department for payment may not be denied legal effect, 5527 enforceability, or admissibility as evidence in any court in any civil action because it is in 5528 electronic form; and 5529 (2) a third party shall accept an electronic record of payments by the department for 5530 medical services on behalf of a recipient as evidence in support of the department's claim. 5531 Section 157. Section 26B-3-1025, which is renumbered from Section 26-19-602 is 5532 renumbered and amended to read: 5533 [26-19-602]. 26B-3-1025. Direct payment to the department by third 5534 party. 5535 (1) Any third party required to make payment to the department pursuant to this 5536 [chapter] part shall make the payment directly to the department or its designee. 5537 (2) The department may negotiate a payment or payment instrument it receives in 5538 connection with Subsection (1) without the cosignature or other participation of the recipient or 5539 any other party. 5540 Section 158. Section 26B-3-1026, which is renumbered from Section 26-19-603 is 5541 renumbered and amended to read: 5542 [26-19-603]. 26B-3-1026. Attorney general or county attorney to 5543 represent department. 5544 The attorney general or a county attorney shall represent the department in any action 5545 commenced under this [chapter] part. S.B. 39 02-10-23 5:41 PM - 180 - 5546 Section 159. Section 26B-3-1027, which is renumbered from Section 26-19-604 is 5547 renumbered and amended to read: 5548 [26-19-604]. 26B-3-1027. Department's right to attorney fees and costs. 5549 In any action brought by the department under this [chapter] part in which it prevails, 5550 the department shall recover along with the principal sum and interest, a reasonable attorney 5551 fee and costs incurred. 5552 Section 160. Section 26B-3-1028, which is renumbered from Section 26-19-605 is 5553 renumbered and amended to read: 5554 [26-19-605]. 26B-3-1028. Application of provisions contrary to federal 5555 law prohibited. 5556 In no event shall any provision contained in this [chapter] part be applied contrary to 5557 existing federal law. 5558 Section 161. Section 26B-3-1101, which is renumbered from Section 26-20-2 is 5559 renumbered and amended to read: 5560 Part 11. Utah False Claims Act 5561 [26-20-2]. 26B-3-1101. Definitions. 5562 As used in this [chapter] part: 5563 (1) "Benefit" means the receipt of money, goods, or any other thing of pecuniary value. 5564 (2) "Claim" means any request or demand for money or property: 5565 (a) made to any: 5566 (i) employee, officer, or agent of the state; 5567 (ii) contractor with the state; or 5568 (iii) grantee or other recipient, whether or not under contract with the state; and 5569 (b) if: 5570 (i) any portion of the money or property requested or demanded was issued from or 5571 provided by the state; or 5572 (ii) the state will reimburse the contractor, grantee, or other recipient for any portion of 5573 the money or property. 5574 (3) "False statement" or "false representation" means a wholly or partially untrue 5575 statement or representation which is: 5576 (a) knowingly made; and 02-10-23 5:41 PM S.B. 39 - 181 - 5577 (b) a material fact with respect to the claim. 5578 (4) "Knowing" and "knowingly": 5579 (a) for purposes of criminal prosecutions for violations of this [chapter] part, is one of 5580 the culpable mental states described in Subsection [26-20-9] 26B-3-1108(1); and 5581 (b) for purposes of civil prosecutions for violations of this [chapter] part, is the 5582 required culpable mental state as defined in Subsection [26-20-9.5] 26B-3-1109(1). 5583 (5) "Medical benefit" means a benefit paid or payable to a recipient or a provider under 5584 a program administered by the state under: 5585 (a) Titles V and XIX of the federal Social Security Act; 5586 (b) Title X of the federal Public Health Services Act; 5587 (c) the federal Child Nutrition Act of 1966 as amended by P.L. 94-105; and 5588 (d) any programs for medical assistance of the state. 5589 (6) "Person" means an individual, corporation, unincorporated association, professional 5590 corporation, partnership, or other form of business association. 5591 Section 162. Section 26B-3-1102, which is renumbered from Section 26-20-3 is 5592 renumbered and amended to read: 5593 [26-20-3]. 26B-3-1102. False statement or representation relating to medical 5594 benefits. 5595 (1) A person may not make or cause to be made a false statement or false representation 5596 of a material fact in an application for medical benefits. 5597 (2) A person may not make or cause to be made a false statement or false 5598 representation of a material fact for use in determining rights to a medical benefit. 5599 (3) A person, who having knowledge of the occurrence of an event affecting the 5600 person's initial or continued right to receive a medical benefit or the initial or continued right of 5601 any other person on whose behalf the person has applied for or is receiving a medical benefit, 5602 may not conceal or fail to disclose that event with intent to obtain a medical benefit to which 5603 the person or any other person is not entitled or in an amount greater than that to which the 5604 person or any other person is entitled. 5605 Section 163. Section 26B-3-1103, which is renumbered from Section 26-20-4 is 5606 renumbered and amended to read: 5607 [26-20-4]. 26B-3-1103. Kickbacks or bribes prohibited. S.B. 39 02-10-23 5:41 PM - 182 - 5608 (1) For purposes of this section, kickback or bribe: 5609 (a) includes rebates, compensation, or any other form of remuneration which is: 5610 (i) direct or indirect; 5611 (ii) overt or covert; or 5612 (iii) in cash or in kind; and 5613 (b) does not include a rebate paid to the state under 42 U.S.C. Sec. 1396r-8 or any state 5614 supplemental rebates. 5615 (2) A person may not solicit, offer, pay, or receive a kickback or bribe in return for or 5616 to induce: 5617 (a) the purchasing, leasing, or ordering of any goods or services for which payment is 5618 or may be made in whole or in part pursuant to a medical benefit program; or 5619 (b) the referral of an individual to another person for the furnishing of any goods or 5620 services for which payment is or may be made in whole or in part pursuant to a medical benefit 5621 program. 5622 Section 164. Section 26B-3-1104, which is renumbered from Section 26-20-5 is 5623 renumbered and amended to read: 5624 [26-20-5]. 26B-3-1104. False statements or false representations relating to 5625 qualification of health institution or facility prohibited -- Felony. 5626 (1) A person may not knowingly, intentionally, or recklessly make, induce, or seek to 5627 induce, the making of a false statement or false representation of a material fact with respect to 5628 the conditions or operation of an institution or facility in order that the institution or facility 5629 may qualify, upon initial certification or upon recertification, as a hospital, skilled nursing 5630 facility, intermediate care facility, or home health agency. 5631 (2) A person who violates this section is guilty of a second degree felony. 5632 Section 165. Section 26B-3-1105, which is renumbered from Section 26-20-6 is 5633 renumbered and amended to read: 5634 [26-20-6]. 26B-3-1105. Conspiracy to defraud prohibited. 5635 A person may not enter into an agreement, combination, or conspiracy to defraud the 5636 state by obtaining or aiding another to obtain the payment or allowance of a false, fictitious, or 5637 fraudulent claim for a medical benefit. 5638 Section 166. Section 26B-3-1106, which is renumbered from Section 26-20-7 is 02-10-23 5:41 PM S.B. 39 - 183 - 5639 renumbered and amended to read: 5640 [26-20-7]. 26B-3-1106. False claims for medical benefits prohibited. 5641 (1) A person may not make or present or cause to be made or presented to an employee 5642 or officer of the state a claim for a medical benefit: 5643 (a) which is wholly or partially false, fictitious, or fraudulent; 5644 (b) for services which were not rendered or for items or materials which were not 5645 delivered; 5646 (c) which misrepresents the type, quality, or quantity of items or services rendered; 5647 (d) representing charges at a higher rate than those charged by the provider to the 5648 general public; 5649 (e) for items or services which the person or the provider knew were not medically 5650 necessary in accordance with professionally recognized standards; 5651 (f) which has previously been paid; 5652 (g) for services also covered by one or more private sources when the person or 5653 provider knew of the private sources without disclosing those sources on the claim; or 5654 (h) where a provider: 5655 (i) unbundles a product, procedure, or group of procedures usually and customarily 5656 provided or performed as a single billable product or procedure into artificial components or 5657 separate procedures; and 5658 (ii) bills for each component of the product, procedure, or group of procedures: 5659 (A) as if they had been provided or performed independently and at separate times; and 5660 (B) the aggregate billing for the components exceeds the amount otherwise billable for 5661 the usual and customary single product or procedure. 5662 (2) In addition to the prohibitions in Subsection (1), a person may not: 5663 (a) fail to credit the state for payments received from other sources; 5664 (b) recover or attempt to recover payment in violation of the provider agreement from: 5665 (i) a recipient under a medical benefit program; or 5666 (ii) the recipient's family; 5667 (c) falsify or alter with intent to deceive, any report or document required by state or 5668 federal law, rule, or Medicaid provider agreement; 5669 (d) retain any unauthorized payment as a result of acts described by this section; or S.B. 39 02-10-23 5:41 PM - 184 - 5670 (e) aid or abet the commission of any act prohibited by this section. 5671 Section 167. Section 26B-3-1107, which is renumbered from Section 26-20-8 is 5672 renumbered and amended to read: 5673 [26-20-8]. 26B-3-1107. Knowledge of past acts not necessary to establish fact 5674 that false statement or representation knowingly made. 5675 In prosecution under this [chapter] part, it is not necessary to show that the person had 5676 knowledge of similar acts having been performed in the past on the part of persons acting on 5677 his behalf nor to show that the person had actual notice that the acts by the persons acting on 5678 his behalf occurred to establish the fact that a false statement or representation was knowingly 5679 made. 5680 Section 168. Section 26B-3-1108, which is renumbered from Section 26-20-9 is 5681 renumbered and amended to read: 5682 [26-20-9]. 26B-3-1108. Criminal penalties. 5683 (1) (a) Except as provided in Subsection (1)(b) the culpable mental state required for a 5684 criminal violation of this [chapter] part is knowingly, intentionally, or recklessly as defined in 5685 Section 76-2-103. 5686 (b) The culpable mental state required for a criminal violation of this [chapter] part for 5687 kickbacks and bribes under Section [26-20-4] 26B-3-1103 is knowingly and intentionally as 5688 defined in Section 76-2-103. 5689 (2) The punishment for a criminal violation of any provision of this [chapter] part, 5690 except as provided under Section [26-20-5] 26B-3-1104, is determined by the cumulative value 5691 of the funds or other benefits received or claimed in the commission of all violations of a 5692 similar nature, and not by each separate violation. 5693 (3) Punishment for criminal violation of this [chapter] part, except as provided under 5694 Section [26-20-5] 26B-3-1104, is a felony of the second degree, felony of the third degree, 5695 class A misdemeanor, or class B misdemeanor based on the dollar amounts as prescribed by 5696 Subsection 76-6-412(1) for theft of property and services. 5697 Section 169. Section 26B-3-1109, which is renumbered from Section 26-20-9.5 is 5698 renumbered and amended to read: 5699 [26-20-9.5]. 26B-3-1109. Civil penalties. 5700 (1) The culpable mental state required for a civil violation of this [chapter] part is 02-10-23 5:41 PM S.B. 39 - 185 - 5701 "knowing" or "knowingly" which: 5702 (a) means that person, with respect to information: 5703 (i) has actual knowledge of the information; 5704 (ii) acts in deliberate ignorance of the truth or falsity of the information; or 5705 (iii) acts in reckless disregard of the truth or falsity of the information; and 5706 (b) does not require a specific intent to defraud. 5707 (2) Any person who violates this [chapter] part shall, in all cases, in addition to other 5708 penalties provided by law, be required to: 5709 (a) make full and complete restitution to the state of all damages that the state sustains 5710 because of the person's violation of this [chapter] part; 5711 (b) pay to the state its costs of enforcement of this [chapter] part in that case, including 5712 the cost of investigators, attorneys, and other public employees, as determined by the state; and 5713 (c) pay to the state a civil penalty equal to: 5714 (i) three times the amount of damages that the state sustains because of the person's 5715 violation of this [chapter] part; and 5716 (ii) not less than $5,000 or more than $10,000 for each claim filed or act done in 5717 violation of this [chapter] part. 5718 (3) Any civil penalties assessed under Subsection (2) shall be awarded by the court as 5719 part of its judgment in both criminal and civil actions. 5720 (4) A criminal action need not be brought against a person in order for that person to be 5721 civilly liable under this section. 5722 Section 170. Section 26B-3-1110, which is renumbered from Section 26-20-10 is 5723 renumbered and amended to read: 5724 [26-20-10]. 26B-3-1110. Revocation of license of assisted living facility -- 5725 Appointment of receiver. 5726 (1) If the license of an assisted living facility is revoked for violation of this [chapter] 5727 part, the county attorney may file a petition with the district court for the county in which the 5728 facility is located for the appointment of a receiver. 5729 (2) The district court shall issue an order to show cause why a receiver should not be 5730 appointed returnable within five days after the filing of the petition. 5731 (3) (a) If the court finds that the facts warrant the granting of the petition, the court S.B. 39 02-10-23 5:41 PM - 186 - 5732 shall appoint a receiver to take charge of the facility. 5733 (b) The court may determine fair compensation for the receiver. 5734 (4) A receiver appointed pursuant to this section shall have the powers and duties 5735 prescribed by the court. 5736 Section 171. Section 26B-3-1111, which is renumbered from Section 26-20-11 is 5737 renumbered and amended to read: 5738 [26-20-11]. 26B-3-1111. Presumption based on paid state warrant -- Value of 5739 medical benefits -- Repayment of benefits. 5740 (1) In any civil or criminal action brought under this [chapter] part, a paid state 5741 warrant, made payable to the order of a party, creates a presumption that the party received 5742 funds from the state. 5743 (2) In any civil or criminal action brought under this [chapter] part, the value of the 5744 benefits received shall be the ordinary or usual charge for similar benefits in the private sector. 5745 (3) In any criminal action under this [chapter] part, the repayment of funds or other 5746 benefits obtained in violation of the provisions of this [chapter] part does not constitute a 5747 defense to, or grounds for dismissal of that action. 5748 Section 172. Section 26B-3-1112, which is renumbered from Section 26-20-12 is 5749 renumbered and amended to read: 5750 [26-20-12]. 26B-3-1112. Violation of other laws. 5751 (1) The provisions of this [chapter] part are: 5752 (a) not exclusive, and the remedies provided for in this [chapter] part are in addition to 5753 any other remedies provided for under: 5754 (i) any other applicable law; or 5755 (ii) common law; and 5756 (b) to be liberally construed and applied to: 5757 (i) effectuate the chapter's remedial and deterrent purposes; and 5758 (ii) serve the public interest. 5759 (2) If any provision of this [chapter] part or the application of this [chapter] part to any 5760 person or circumstance is held unconstitutional: 5761 (a) the remaining provisions of this [chapter] part are not affected; and 5762 (b) the application of this [chapter] part to other persons or circumstances are not 02-10-23 5:41 PM S.B. 39 - 187 - 5763 affected. 5764 Section 173. Section 26B-3-1113, which is renumbered from Section 26-20-13 is 5765 renumbered and amended to read: 5766 [26-20-13]. 26B-3-1113. Medicaid fraud enforcement. 5767 (1) This [chapter] part shall be enforced in accordance with this section. 5768 (2) The department is responsible for: 5769 (a) (i) investigating and prosecuting suspected civil violations of this [chapter] part; or 5770 (ii) referring suspected civil violations of this [chapter] part to the attorney general for 5771 investigation and prosecution; and 5772 (b) promptly referring suspected criminal violations of this [chapter] part to the 5773 attorney general for criminal investigation and prosecution. 5774 (3) The attorney general has: 5775 (a) concurrent jurisdiction with the department for investigating and prosecuting 5776 suspected civil violations of this [chapter] part; and 5777 (b) exclusive jurisdiction to investigate and prosecute all suspected criminal violations 5778 of this [chapter] part. 5779 (4) The department and the attorney general share concurrent civil enforcement 5780 authority under this [chapter] part and may enter into an interagency agreement regarding the 5781 investigation and prosecution of violations of this [chapter] part in accordance with this 5782 section, the requirements of Title XIX of the federal Social Security Act, and applicable federal 5783 regulations. 5784 (5) (a) Any violation of this [chapter] part which comes to the attention of any state 5785 government officer or agency shall be reported to the attorney general or the department. 5786 (b) All state government officers and agencies shall cooperate with and assist in any 5787 prosecution for violation of this [chapter] part. 5788 Section 174. Section 26B-3-1114, which is renumbered from Section 26-20-14 is 5789 renumbered and amended to read: 5790 [26-20-14]. 26B-3-1114. Investigations -- Civil investigative demands. 5791 (1) The attorney general may take investigative action under Subsection (2) if the 5792 attorney general has reason to believe that: 5793 (a) a person has information or custody or control of documentary material relevant to S.B. 39 02-10-23 5:41 PM - 188 - 5794 the subject matter of an investigation of an alleged violation of this [chapter] part; 5795 (b) a person is committing, has committed, or is about to commit a violation of this 5796 [chapter] part; or 5797 (c) it is in the public interest to conduct an investigation to ascertain whether or not a 5798 person is committing, has committed, or is about to commit a violation of this [chapter] part. 5799 (2) In taking investigative action, the attorney general may: 5800 (a) require the person to file on a prescribed form a statement in writing, under oath or 5801 affirmation describing: 5802 (i) the facts and circumstances concerning the alleged violation of this [chapter] part; 5803 and 5804 (ii) other information considered necessary by the attorney general; 5805 (b) examine under oath a person in connection with the alleged violation of this 5806 [chapter] part; and 5807 (c) in accordance with Subsections (7) through (18), execute in writing, and serve on 5808 the person, a civil investigative demand requiring the person to produce the documentary 5809 material and permit inspection and copying of the material. 5810 (3) The attorney general may not release or disclose information that is obtained under 5811 Subsection (2)(a) or (b), or any documentary material or other record derived from the 5812 information obtained under Subsection (2)(a) or (b), except: 5813 (a) by court order for good cause shown; 5814 (b) with the consent of the person who provided the information; 5815 (c) to an employee of the attorney general or the department; 5816 (d) to an agency of this state, the United States, or another state; 5817 (e) to a special assistant attorney general representing the state in a civil action; 5818 (f) to a political subdivision of this state; or 5819 (g) to a person authorized by the attorney general to receive the information. 5820 (4) The attorney general may use documentary material derived from information 5821 obtained under Subsection (2)(a) or (b), or copies of that material, as the attorney general 5822 determines necessary in the enforcement of this [chapter] part, including presentation before a 5823 court. 5824 (5) (a) If a person fails to file a statement as required by Subsection (2)(a) or fails to 02-10-23 5:41 PM S.B. 39 - 189 - 5825 submit to an examination as required by Subsection (2)(b), the attorney general may file in 5826 district court a complaint for an order to compel the person to within a period stated by court 5827 order: 5828 (i) file the statement required by Subsection (2)(a); or 5829 (ii) submit to the examination required by Subsection (2)(b). 5830 (b) Failure to comply with an order entered under Subsection (5)(a) is punishable as 5831 contempt. 5832 (6) A civil investigative demand shall: 5833 (a) state the rule or statute under which the alleged violation of this [chapter] part is 5834 being investigated; 5835 (b) describe the: 5836 (i) general subject matter of the investigation; and 5837 (ii) class or classes of documentary material to be produced with reasonable specificity 5838 to fairly indicate the documentary material demanded; 5839 (c) designate a date within which the documentary material is to be produced; and 5840 (d) identify an authorized employee of the attorney general to whom the documentary 5841 material is to be made available for inspection and copying. 5842 (7) A civil investigative demand may require disclosure of any documentary material 5843 that is discoverable under the Utah Rules of Civil Procedure. 5844 (8) Service of a civil investigative demand may be made by: 5845 (a) delivering an executed copy of the demand to the person to be served or to a 5846 partner, an officer, or an agent authorized by appointment or by law to receive service of 5847 process on behalf of that person; 5848 (b) delivering an executed copy of the demand to the principal place of business in this 5849 state of the person to be served; or 5850 (c) mailing by registered or certified mail an executed copy of the demand addressed to 5851 the person to be served: 5852 (i) at the person's principal place of business in this state; or 5853 (ii) if the person has no place of business in this state, to the person's principal office or 5854 place of business. 5855 (9) Documentary material demanded in a civil investigative demand shall be produced S.B. 39 02-10-23 5:41 PM - 190 - 5856 for inspection and copying during normal business hours at the office of the attorney general or 5857 as agreed by the person served and the attorney general. 5858 (10) The attorney general may not produce for inspection or copying or otherwise 5859 disclose the contents of documentary material obtained pursuant to a civil investigative demand 5860 except: 5861 (a) by court order for good cause shown; 5862 (b) with the consent of the person who produced the information; 5863 (c) to an employee of the attorney general or the department; 5864 (d) to an agency of this state, the United States, or another state; 5865 (e) to a special assistant attorney general representing the state in a civil action; 5866 (f) to a political subdivision of this state; or 5867 (g) to a person authorized by the attorney general to receive the information. 5868 (11) (a) With respect to documentary material obtained pursuant to a civil investigative 5869 demand, the attorney general shall prescribe reasonable terms and conditions allowing such 5870 documentary material to be available for inspection and copying by the person who produced 5871 the material or by an authorized representative of that person. 5872 (b) The attorney general may use such documentary material or copies of it as the 5873 attorney general determines necessary in the enforcement of this [chapter] part, including 5874 presentation before a court. 5875 (12) (a) A person may file a complaint, stating good cause, to extend the return date for 5876 the demand or to modify or set aside the demand. 5877 (b) A complaint under this Subsection (12) shall be filed in district court before the 5878 earlier of: 5879 [(a)] (i) the return date specified in the demand; or 5880 [(b)] (ii) the 20th day after the date the demand is served. 5881 (13) Except as provided by court order, a person who has been served with a civil 5882 investigative demand shall comply with the terms of the demand. 5883 (14) (a) A person who has committed a violation of this [chapter] part in relation to the 5884 Medicaid program in this state or to any other medical benefit program administered by the 5885 state has submitted to the jurisdiction of this state. 5886 (b) Personal service of a civil investigative demand under this section may be made on 02-10-23 5:41 PM S.B. 39 - 191 - 5887 the person described in Subsection (14)(a) outside of this state. 5888 (15) This section does not limit the authority of the attorney general to conduct 5889 investigations or to access a person's documentary materials or other information under another 5890 state or federal law, the Utah Rules of Civil Procedure, or the Federal Rules of Civil Procedure. 5891 (16) The attorney general may file a complaint in district court for an order to enforce 5892 the civil investigative demand if: 5893 (a) a person fails to comply with a civil investigative demand; or 5894 (b) copying and reproduction of the documentary material demanded: 5895 (i) cannot be satisfactorily accomplished; and 5896 (ii) the person refuses to surrender the documentary material. 5897 (17) If a complaint is filed under Subsection (16), the court may determine the matter 5898 presented and may enter an order to enforce the civil investigative demand. 5899 (18) Failure to comply with a final order entered under Subsection (17) is punishable 5900 by contempt. 5901 Section 175. Section 26B-3-1115, which is renumbered from Section 26-20-15 is 5902 renumbered and amended to read: 5903 [26-20-15]. 26B-3-1115. Limitation of actions -- Civil acts antedating this 5904 section -- Civil burden of proof -- Estoppel -- Joint civil liability -- Venue. 5905 (1) An action under this [chapter] part may not be brought after the later of: 5906 (a) six years after the date on which the violation was committed; or 5907 (b) three years after the date an official of the state charged with responsibility to act in 5908 the circumstances discovers the violation, but in no event more than 10 years after the date on 5909 which the violation was committed. 5910 (2) A civil action brought under this [chapter] part may be brought for acts occurring 5911 prior to the effective date of this section if the limitations period set forth in Subsection (1) has 5912 not lapsed. 5913 (3) In any civil action brought under this [chapter] part the state shall be required to 5914 prove by a preponderance of evidence, all essential elements of the cause of action including 5915 damages. 5916 (4) Notwithstanding any other provision of law, a final judgment rendered in favor of 5917 the state in any criminal proceeding under this [chapter] part, whether upon a verdict after trial S.B. 39 02-10-23 5:41 PM - 192 - 5918 or upon a plea of guilty or nolo contendere, shall estop the defendant from denying the essential 5919 elements of the offense in any civil action under this [chapter] part which involves the same 5920 transaction. 5921 (5) Civil liability under this [chapter] part shall be joint and several for a violation 5922 committed by two or more persons. 5923 (6) Any action brought by the state under this [chapter] part shall be brought in district 5924 court in Salt Lake County or in any county where the defendant resides or does business. 5925 Section 176. Section 26B-8-101 is amended to read: 5926 CHAPTER 8. HEALTH DATA, VITAL STATISTICS AND UTAH MEDICAL 5927 EXAMINER 5928 Part 1. Vital Statistics 5929 26B-8-101. Definitions. 5930 [Reserved] 5931 As used in this part: 5932 (1) "Adoption document" means an adoption-related document filed with the office, a 5933 petition for adoption, a decree of adoption, an original birth certificate, or evidence submitted 5934 in support of a supplementary birth certificate. 5935 (2) "Certified nurse midwife" means an individual who: 5936 (a) is licensed to practice as a certified nurse midwife under Title 58, Chapter 44a, 5937 Nurse Midwife Practice Act; and 5938 (b) has completed an education program regarding the completion of a certificate of 5939 death developed by the department by rule made in accordance with Title 63G, Chapter 3, Utah 5940 Administrative Rulemaking Act. 5941 (3) "Custodial funeral service director" means a funeral service director who: 5942 (a) is employed by a licensed funeral establishment; and 5943 (b) has custody of a dead body. 5944 (4) "Dead body" means a human body or parts of the human body from the condition 5945 of which it reasonably may be concluded that death occurred. 5946 (5) "Decedent" means the same as dead body. 5947 (6) "Dead fetus" means a product of human conception, other than those circumstances 5948 described in Subsection 76-7-301(1): 02-10-23 5:41 PM S.B. 39 - 193 - 5949 (a) of 20 weeks' gestation or more, calculated from the date the last normal menstrual 5950 period began to the date of delivery; and 5951 (b) that was not born alive. 5952 (7) "Declarant father" means a male who claims to be the genetic father of a child, and, 5953 along with the biological mother, signs a voluntary declaration of paternity to establish the 5954 child's paternity. 5955 (8) "Dispositioner" means: 5956 (a) a person designated in a written instrument, under Subsection 58-9-602(1), as 5957 having the right and duty to control the disposition of the decedent, if the person voluntarily 5958 acts as the dispositioner; or 5959 (b) the next of kin of the decedent, if: 5960 (i) (A) a person has not been designated as described in Subsection (8)(a); or 5961 (B) the person described in Subsection (8)(a) is unable or unwilling to exercise the 5962 right and duty described in Subsection (8)(a); and 5963 (ii) the next of kin voluntarily acts as the dispositioner. 5964 (9) "Fetal remains" means: 5965 (a) an aborted fetus as that term is defined in Section 26B-2-232; or 5966 (b) a miscarried fetus as that term is defined in Section 26B-2-233. 5967 (10) "File" means the submission of a completed certificate or other similar document, 5968 record, or report as provided under this part for registration by the state registrar or a local 5969 registrar. 5970 (11) "Funeral service director" means the same as that term is defined in Section 5971 58-9-102. 5972 (12) "Health care facility" means the same as that term is defined in Section 5973 26B-2-201. 5974 (13) "Health care professional" means a physician, physician assistant, nurse 5975 practitioner, or certified nurse midwife. 5976 (14) "Licensed funeral establishment" means: 5977 (a) if located in Utah, a funeral service establishment, as that term is defined in Section 5978 58-9-102, that is licensed under Title 58, Chapter 9, Funeral Services Licensing Act; or 5979 (b) if located in a state, district, or territory of the United States other than Utah, a S.B. 39 02-10-23 5:41 PM - 194 - 5980 funeral service establishment that complies with the licensing laws of the jurisdiction where the 5981 establishment is located. 5982 (15) "Live birth" means the birth of a child who shows evidence of life after the child is 5983 entirely outside of the mother. 5984 (16) "Local registrar" means a person appointed under Subsection 26B-8-102(3)(b). 5985 (17) "Nurse practitioner" means an individual who: 5986 (a) is licensed to practice as an advanced practice registered nurse under Title 58, 5987 Chapter 31b, Nurse Practice Act; and 5988 (b) has completed an education program regarding the completion of a certificate of 5989 death developed by the department by administrative rule made in accordance with Title 63G, 5990 Chapter 3, Utah Administrative Rulemaking Act. 5991 (18) "Office" means the Office of Vital Records and Statistics within the department. 5992 (19) "Physician" means a person licensed to practice as a physician or osteopath in this 5993 state under Title 58, Chapter 67, Utah Medical Practice Act, or Title 58, Chapter 68, Utah 5994 Osteopathic Medical Practice Act. 5995 (20) "Physician assistant" means an individual who: 5996 (a) is licensed to practice as a physician assistant under Title 58, Chapter 70a, Utah 5997 Physician Assistant Act; and 5998 (b) has completed an education program regarding the completion of a certificate of 5999 death developed by the department by administrative rule made in accordance with Title 63G, 6000 Chapter 3, Utah Administrative Rulemaking Act. 6001 (21) "Presumed father" means the father of a child conceived or born during a marriage 6002 as defined in Section 30-1-17.2. 6003 (22) "Registration" or "register" means acceptance by the local or state registrar of a 6004 certificate and incorporation of the certificate into the permanent records of the state. 6005 (23) "State registrar" means the state registrar of vital records appointed under Section 6006 26B-8-102. 6007 (24) "Vital records" means: 6008 (a) registered certificates or reports of birth, death, fetal death, marriage, divorce, 6009 dissolution of marriage, or annulment; 6010 (b) amendments to any of the registered certificates or reports described in Subsection 02-10-23 5:41 PM S.B. 39 - 195 - 6011 (24)(a); 6012 (c) an adoption document; and 6013 (d) other similar documents. 6014 (25) "Vital statistics" means the data derived from registered certificates and reports of 6015 birth, death, fetal death, induced termination of pregnancy, marriage, divorce, dissolution of 6016 marriage, or annulment. 6017 Section 177. Section 26B-8-102, which is renumbered from Section 26-2-3 is 6018 renumbered and amended to read: 6019 [26-2-3]. 26B-8-102. Department duties and authority. 6020 (1) As used in this section: 6021 (a) "Compact" means the Compact for Interstate Sharing of Putative Father Registry 6022 Information created in Section 78B-6-121.5, effective on May 10, 2016. 6023 (b) "Putative father": 6024 (i) means the same as that term is as defined in Section 78B-6-121.5; and 6025 (ii) includes an unmarried biological father. 6026 (c) "State registrar" means the state registrar of vital records appointed under 6027 Subsection (2)(e). 6028 (d) "Unmarried biological father" means the same as that term is defined in Section 6029 78B-6-103. 6030 (2) The department shall: 6031 (a) provide offices properly equipped for the preservation of vital records made or 6032 received under this [chapter] part; 6033 (b) establish a statewide vital records system for the registration, collection, 6034 preservation, amendment, and certification of vital records and other similar documents 6035 required by this [chapter] part and activities related to them, including the tabulation, analysis, 6036 and publication of vital statistics; 6037 (c) prescribe forms for certificates, certification, reports, and other documents and 6038 records necessary to establish and maintain a statewide system of vital records; 6039 (d) prepare an annual compilation, analysis, and publication of statistics derived from 6040 vital records; and 6041 (e) appoint a state registrar to direct the statewide system of vital records. S.B. 39 02-10-23 5:41 PM - 196 - 6042 (3) The department may: 6043 (a) divide the state from time to time into registration districts; and 6044 (b) appoint local registrars for registration districts who under the direction and 6045 supervision of the state registrar shall perform all duties required of them by this [chapter] part 6046 and department rules. 6047 (4) The state registrar appointed under Subsection (2)(e) shall, with the input of Utah 6048 stakeholders and the Uniform Law Commission, study the following items for the state's 6049 implementation of the compact: 6050 (a) the feasibility of using systems developed by the National Association for Public 6051 Health Statistics and Information Systems, including the State and Territorial Exchange of 6052 Vital Events (STEVE) system and the Electronic Verification of Vital Events (EVVE) system, 6053 or similar systems, to exchange putative father registry information with states that are parties 6054 to the compact; 6055 (b) procedures necessary to share putative father information, located in the 6056 confidential registry maintained by the state registrar, upon request from the state registrar of 6057 another state that is a party to the compact; 6058 (c) procedures necessary for the state registrar to access putative father information 6059 located in a state that is a party to the compact, and share that information with persons who 6060 request a certificate from the state registrar; 6061 (d) procedures necessary to ensure that the name of the mother of the child who is the 6062 subject of a putative father's notice of commencement, filed pursuant to Section 78B-6-121, is 6063 kept confidential when a state that is a party to the compact accesses this state's confidential 6064 registry through the state registrar; and 6065 (e) procedures necessary to ensure that a putative father's registration with a state that 6066 is a party to the compact is given the same effect as a putative father's notice of commencement 6067 filed pursuant to Section 78B-6-121. 6068 Section 178. Section 26B-8-103, which is renumbered from Section 26-2-4 is 6069 renumbered and amended to read: 6070 [26-2-4]. 26B-8-103. Content and form of certificates and reports. 6071 (1) As used in this section: 6072 (a) "Additional information" means information that is beyond the information 02-10-23 5:41 PM S.B. 39 - 197 - 6073 necessary to comply with federal standards or state law for registering a birth. 6074 (b) "Diacritical mark" means a mark on a letter from the ISO basic Latin alphabet used 6075 to indicate a special pronunciation. 6076 (c) "Diacritical mark" includes accents, tildes, graves, umlauts, and cedillas. 6077 (2) Except as provided in Subsection (8), to promote and maintain nationwide 6078 uniformity in the vital records system, the forms of certificates, certification, reports, and other 6079 documents and records required by this [chapter] part or the rules implementing this [chapter] 6080 part shall include as a minimum the items recommended by the federal agency responsible for 6081 national vital statistics, subject to approval, additions, and modifications by the department. 6082 (3) Certificates, certifications, forms, reports, other documents and records, and the 6083 form of communications between persons required by this [chapter] part shall be prepared in 6084 the format prescribed by department rule. 6085 (4) All vital records shall include the date of filing. 6086 (5) Certificates, certifications, forms, reports, other documents and records, and 6087 communications between persons required by this [chapter] part may be signed, filed, verified, 6088 registered, and stored by photographic, electronic, or other means as prescribed by department 6089 rule. 6090 (6) (a) An individual may use a diacritical mark in an application for a vital record. 6091 (b) The office shall record a diacritical mark on a vital record as indicated on the 6092 application for the vital record. 6093 (7) The absence of a diacritical mark on a vital record does not render the document 6094 invalid or affect any constructive notice imparted by proper recordation of the document. 6095 (8) (a) The state: 6096 (i) may collect the Social Security number of a deceased individual; and 6097 (ii) may not include the Social Security number of an individual on a certificate of 6098 death. 6099 (b) For registering a birth, the department may not require an individual to provide 6100 additional information. 6101 (c) The department may request additional information if the department provides a 6102 written statement that: 6103 (i) discloses that providing the additional information is voluntary; S.B. 39 02-10-23 5:41 PM - 198 - 6104 (ii) discloses how the additional information will be used and the duration of use; 6105 (iii) describes how the department prevents the additional information from being used 6106 in a manner different from the disclosure given under Subsection (6)(c)(ii); and 6107 (iv) includes a notice that the individual is consenting to the department's use of the 6108 additional information by providing the additional information. 6109 (d) (i) Beginning July 1, 2022, an individual may submit a written request to the 6110 department to de-identify the individual's additional information contained in the department's 6111 databases. 6112 (ii) Upon receiving the written request, the department shall de-identify the additional 6113 information. 6114 (e) The department shall de-identify additional information contained in the 6115 department's databases before the additional information is held by the department for longer 6116 than six years. 6117 Section 179. Section 26B-8-104, which is renumbered from Section 26-2-5 is 6118 renumbered and amended to read: 6119 [26-2-5]. 26B-8-104. Birth certificates -- Execution and registration 6120 requirements. 6121 (1) As used in this section, "birthing facility" means a general acute hospital or birthing 6122 center as defined in Section [26-21-2] 26B-2-201. 6123 (2) For each live birth occurring in the state, a certificate shall be filed with the local 6124 registrar for the district in which the birth occurred within 10 days following the birth. The 6125 certificate shall be registered if it is completed and filed in accordance with this [chapter] part. 6126 (3) (a) For each live birth that occurs in a birthing facility, the administrator of the 6127 birthing facility, or his designee, shall obtain and enter the information required under this 6128 [chapter] part on the certificate, securing the required signatures, and filing the certificate. 6129 (b) (i) The date, time, place of birth, and required medical information shall be certified 6130 by the birthing facility administrator or his designee. 6131 (ii) The attending physician or nurse midwife may sign the certificate, but if the 6132 attending physician or nurse midwife has not signed the certificate within seven days of the 6133 date of birth, the birthing facility administrator or his designee shall enter the attending 6134 physician's or nurse midwife's name and transmit the certificate to the local registrar. 02-10-23 5:41 PM S.B. 39 - 199 - 6135 (iii) The information on the certificate about the parents shall be provided and certified 6136 by the mother or father or, in their incapacity or absence, by a person with knowledge of the 6137 facts. 6138 (4) (a) For live births that occur outside a birthing facility, the birth certificate shall be 6139 completed and filed by the physician, physician assistant, nurse, midwife, or other person 6140 primarily responsible for providing assistance to the mother at the birth. If there is no such 6141 person, either the presumed or declarant father shall complete and file the certificate. In his 6142 absence, the mother shall complete and file the certificate, and in the event of her death or 6143 disability, the owner or operator of the premises where the birth occurred shall do so. 6144 (b) The certificate shall be completed as fully as possible and shall include the date, 6145 time, and place of birth, the mother's name, and the signature of the person completing the 6146 certificate. 6147 (5) (a) For each live birth to an unmarried mother that occurs in a birthing facility, the 6148 administrator or director of that facility, or his designee, shall: 6149 (i) provide the birth mother and declarant father, if present, with: 6150 (A) a voluntary declaration of paternity form published by the state registrar; 6151 (B) oral and written notice to the birth mother and declarant father of the alternatives 6152 to, the legal consequences of, and the rights and responsibilities that arise from signing the 6153 declaration; and 6154 (C) the opportunity to sign the declaration; 6155 (ii) witness the signature of a birth mother or declarant father in accordance with 6156 Section 78B-15-302 if the signature occurs at the facility; 6157 (iii) enter the declarant father's information on the original birth certificate, but only if 6158 the mother and declarant father have signed a voluntary declaration of paternity or a court or 6159 administrative agency has issued an adjudication of paternity; and 6160 (iv) file the completed declaration with the original birth certificate. 6161 (b) If there is a presumed father, the voluntary declaration will only be valid if the 6162 presumed father also signs the voluntary declaration. 6163 (c) The state registrar shall file the information provided on the voluntary declaration 6164 of paternity form with the original birth certificate and may provide certified copies of the 6165 declaration of paternity as otherwise provided under Title 78B, Chapter 15, Utah Uniform S.B. 39 02-10-23 5:41 PM - 200 - 6166 Parentage Act. 6167 (6) (a) The state registrar shall publish a form for the voluntary declaration of paternity, 6168 a description of the process for filing a voluntary declaration of paternity, and of the rights and 6169 responsibilities established or effected by that filing, in accordance with Title 78B, Chapter 15, 6170 Utah Uniform Parentage Act. 6171 (b) Information regarding the form and services related to voluntary paternity 6172 establishment shall be made available to birthing facilities and to any other entity or individual 6173 upon request. 6174 (7) The name of a declarant father may only be included on the birth certificate of a 6175 child of unmarried parents if: 6176 (a) the mother and declarant father have signed a voluntary declaration of paternity; or 6177 (b) a court or administrative agency has issued an adjudication of paternity. 6178 (8) Voluntary declarations of paternity, adjudications of paternity by judicial or 6179 administrative agencies, and voluntary rescissions of paternity shall be filed with and 6180 maintained by the state registrar for the purpose of comparing information with the state case 6181 registry maintained by the Office of Recovery Services pursuant to Section [62A-11-104] 6182 26B-9-104. 6183 Section 180. Section 26B-8-105, which is renumbered from Section 26-2-5.5 is 6184 renumbered and amended to read: 6185 [26-2-5.5]. 26B-8-105. Requirement to obtain parents' social security numbers. 6186 (1) For each live birth that occurs in this state, the administrator of the birthing facility, 6187 as defined in Section [26-2-5] 26B-8-104, or other person responsible for completing and filing 6188 the birth certificate under Section [26-2-5] 26B-8-104 shall obtain the social security numbers 6189 of each parent and provide those numbers to the state registrar. 6190 (2) Each parent shall furnish his or her social security number to the person authorized 6191 to obtain the numbers under Subsection (1) unless a court or administrative agency has 6192 determined there is good cause for not furnishing a number under Subsection (1). 6193 (3) The state registrar shall, as soon as practicable, supply those social security 6194 numbers to the Office of Recovery Services within the [Department of Human Services] 6195 department. 6196 (4) The social security numbers obtained under this section may not be recorded on the 02-10-23 5:41 PM S.B. 39 - 201 - 6197 child's birth certificate. 6198 (5) The state may not use any social security number obtained under this section for 6199 any reason other than enforcement of child support orders in accordance with the federal 6200 Family Support Act of 1988, [Public Law] Pub. L. No. 100-485. 6201 Section 181. Section 26B-8-106, which is renumbered from Section 26-2-6 is 6202 renumbered and amended to read: 6203 [26-2-6]. 26B-8-106. Foundling certificates. 6204 (1) A foundling certificate shall be filed for each infant of unknown parentage found in 6205 the state. The certificate shall be prepared and filed with the local registrar of the district in 6206 which the infant was found by the person assuming custody. 6207 (2) The certificate shall be filed within 10 days after the infant is found and is 6208 acceptable for all purposes in lieu of a certificate of birth. 6209 Section 182. Section 26B-8-107, which is renumbered from Section 26-2-7 is 6210 renumbered and amended to read: 6211 [26-2-7]. 26B-8-107. Correction of errors or omissions in vital records -- 6212 Conflicting birth and foundling certificates -- Rulemaking. 6213 In accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, the 6214 department may make rules: 6215 (1) governing applications to correct alleged errors or omissions on any vital record; 6216 (2) establishing procedures to resolve conflicting birth and foundling certificates; and 6217 (3) allowing for the correction and reissuance of a vital record that was originally 6218 created omitting a diacritical mark. 6219 Section 183. Section 26B-8-108, which is renumbered from Section 26-2-8 is 6220 renumbered and amended to read: 6221 [26-2-8]. 26B-8-108. Birth certificates -- Delayed registration. 6222 (1) When a certificate of birth of a person born in this state has not been filed within 6223 the time provided in Subsection [26-2-5] 26B-8-104(2), a certificate of birth may be filed in 6224 accordance with department rules and subject to this section. 6225 (2) (a) The registrar shall mark a certificate of birth as "delayed" and show the date of 6226 registration if the certificate is registered one year or more after the date of birth. 6227 (b) The registrar shall abstract a summary statement of the evidence submitted in S.B. 39 02-10-23 5:41 PM - 202 - 6228 support of delayed registration onto the certificate. 6229 (3) When the minimum evidence required for delayed registration is not submitted or 6230 when the state registrar has reasonable cause to question the validity or adequacy of the 6231 evidence supporting the application, and the deficiencies are not corrected, the state registrar: 6232 (a) may not register the certificate; and 6233 (b) shall provide the applicant with a written statement indicating the reasons for denial 6234 of registration. 6235 (4) The state registrar has no duty to take further action regarding an application which 6236 is not actively pursued. 6237 Section 184. Section 26B-8-109, which is renumbered from Section 26-2-9 is 6238 renumbered and amended to read: 6239 [26-2-9]. 26B-8-109. Birth certificates -- Petition for issuance of delayed 6240 certificate -- Court procedure. 6241 (1) (a) If registration of a certificate of birth under Section [26-2-8] 26B-8-108 is 6242 denied, the person seeking registration may bring an action by a verified petition in the Utah 6243 [district] court encompassing where the petitioner resides or in the district encompassing Salt 6244 Lake City. 6245 (b) The petition shall request an order establishing a record of the date and place of the 6246 birth and the parentage of the person whose birth is to be registered. 6247 (2) The petition shall be on a form furnished by the state registrar and shall allege: 6248 (a) the person for whom registration of a delayed certificate is sought was born in this 6249 state and is still living; 6250 (b) no registered certificate of birth of the person can be found in the state office of 6251 vital statistics or the office of any local registrar; 6252 (c) diligent efforts by the petitioner have failed to obtain the evidence required by 6253 department rule; and 6254 (d) the state registrar has denied the petitioner's request to register a delayed certificate 6255 of birth. 6256 (3) The petition shall be accompanied by a written statement of the state registrar 6257 indicating the reasons for denial of registration and all documentary evidence which was 6258 submitted in support of registration. 02-10-23 5:41 PM S.B. 39 - 203 - 6259 (4) The court shall fix a time and place for hearing the petition and shall give the state 6260 registrar 15 days notice of the hearing. The state registrar or his authorized representative may 6261 appear and testify at the hearing. 6262 (5) (a) If the court finds the person for whom registration of a certificate of birth is 6263 sought under Section [26-2-8] 26B-8-108 was born in this state, it shall make findings as to the 6264 place and date of birth, parentage, and other findings as may be required and shall issue an 6265 order, on a form prescribed and furnished by the state registrar, to establish a court-ordered 6266 delayed certificate of birth. 6267 (b) The order shall include the birth data to be registered, a description of the evidence 6268 presented, and the date of the court's action. 6269 [(b)] (c) The clerk of the court shall forward each order to the state registrar not later 6270 than the tenth day of the calendar month following the month in which the order was entered. 6271 (d) The order described in Subsection (5)(a) shall be registered by the state registrar 6272 and constitutes the certificate of birth. 6273 Section 185. Section 26B-8-110, which is renumbered from Section 26-2-10 is 6274 renumbered and amended to read: 6275 [26-2-10]. 26B-8-110. Supplementary certificate of birth. 6276 (1) An individual born in this state may request the state registrar to register a 6277 supplementary birth certificate for the individual if: 6278 (a) the individual is legally recognized as a child of the individual's natural parents 6279 when the individual's natural parents are subsequently married; 6280 (b) the individual's parentage has been determined by a state court of the United States 6281 or a Canadian provincial court with jurisdiction; or 6282 (c) the individual has been legally adopted, as a child or as an adult, under the law of 6283 this state, any other state, or any province of Canada. 6284 (2) The application for registration of a supplementary birth certificate may be made 6285 by: 6286 (a) the individual requesting registration under Subsection (1) if the individual is of 6287 legal age; 6288 (b) a legal representative; or 6289 (c) any agency authorized to receive children for placement or adoption under the laws S.B. 39 02-10-23 5:41 PM - 204 - 6290 of this or any other state. 6291 (3) (a) The state registrar shall require that an applicant submit identification and proof 6292 according to department rules. 6293 (b) In the case of an adopted individual, that proof may be established by order of the 6294 court in which the adoption proceedings were held. 6295 (4) (a) After the supplementary birth certificate is registered, any information disclosed 6296 from the record shall be from the supplementary birth certificate. 6297 (b) Access to the original birth certificate and to the evidence submitted in support of 6298 the supplementary birth certificate are not open to inspection except upon the order of a Utah 6299 district court or as described in Section 78B-6-141 or Section 78B-6-144. 6300 Section 186. Section 26B-8-111, which is renumbered from Section 26-2-11 is 6301 renumbered and amended to read: 6302 [26-2-11]. 26B-8-111. Name or sex change -- Registration of court order and 6303 amendment of birth certificate. 6304 (1) When a person born in this state has a name change or sex change approved by an 6305 order of a Utah [district] court or a court of competent jurisdiction of another state or a 6306 province of Canada, a certified copy of the order may be filed with the state registrar with an 6307 application form provided by the registrar. 6308 (2) (a) Upon receipt of the application, a certified copy of the order, and payment of the 6309 required fee, the state registrar shall review the application, and if complete, register it and note 6310 the fact of the amendment on the otherwise unaltered original certificate. 6311 (b) The amendment shall be registered with and become a part of the original 6312 certificate and a certified copy shall be issued to the applicant without additional cost. 6313 Section 187. Section 26B-8-112, which is renumbered from Section 26-2-12.5 is 6314 renumbered and amended to read: 6315 [26-2-12.5]. 26B-8-112. Certified copies of birth certificates -- Fees credited to 6316 Children's Account. 6317 (1) In addition to the fees provided for in Section 26B-1-209, the department and local 6318 registrars authorized to issue certified copies shall charge an additional $3 fee for each certified 6319 copy of a birth certificate, including certified copies of supplementary and amended birth 6320 certificates, under Sections [26-2-8 through 26-2-11] 26B-8-108 through 26B-8-111. [This] 02-10-23 5:41 PM S.B. 39 - 205 - 6321 (2) The additional fee described in Subsection (1) may be charged only for the first 6322 copy requested at any one time. 6323 [(2)] (3) The fee shall be transmitted monthly to the state treasurer and credited to the 6324 Children's Account [established] created in Section 80-2-501. 6325 Section 188. Section 26B-8-113, which is renumbered from Section 26-2-12.6 is 6326 renumbered and amended to read: 6327 [26-2-12.6]. 26B-8-113. Fee waived for certified copy of birth certificate. 6328 (1) Notwithstanding [Section] Sections 26B-1-209 and [Section 26-2-12.5] 26B-6-112, 6329 the department shall waive a fee that would otherwise be charged for a certified copy of a birth 6330 certificate, if the individual whose birth is confirmed by the birth certificate is: 6331 (a) the individual requesting the certified copy of the birth certificate; and 6332 (b) (i) homeless, as defined in Section [26-18-411] 26B-3-207; 6333 (ii) a person who is homeless, as defined in Section 35A-5-302; 6334 (iii) an individual whose primary nighttime residence is a location that is not designed 6335 for or ordinarily used as a sleeping accommodation for an individual; 6336 (iv) a homeless service provider as verified by the Department of Workforce Services; 6337 or 6338 (v) a homeless child or youth, as defined in 42 U.S.C. Sec. 11434a. 6339 (2) To satisfy the requirement in Subsection (1)(b), the department shall accept written 6340 verification that the individual is homeless or a person, child, or youth who is homeless from: 6341 (a) a homeless shelter; 6342 (b) a permanent housing, permanent, supportive, or transitional facility, as defined in 6343 Section 35A-5-302; 6344 (c) the Department of Workforce Services; 6345 (d) a homeless service provider as verified by the Department of Workforce Services; 6346 or 6347 (e) a local educational agency liaison for homeless children and youth designated under 6348 42 U.S.C. Sec. 11432(g)(1)(J)(ii). 6349 Section 189. Section 26B-8-114, which is renumbered from Section 26-2-13 is 6350 renumbered and amended to read: 6351 [26-2-13]. 26B-8-114. Certificate of death -- Execution and registration S.B. 39 02-10-23 5:41 PM - 206 - 6352 requirements -- Information provided to lieutenant governor. 6353 (1) (a) A certificate of death for each death that occurs in this state shall be filed with 6354 the local registrar of the district in which the death occurs, or as otherwise directed by the state 6355 registrar, within five days after death and prior to the decedent's interment, any other disposal, 6356 or removal from the registration district where the death occurred. 6357 (b) A certificate of death shall be registered if the certificate of death is completed and 6358 filed in accordance with this [chapter] part. 6359 (2) (a) If the place of death is unknown but the dead body is found in this state: 6360 (i) the certificate of death shall be completed and filed in accordance with this section; 6361 and 6362 (ii) the place where the dead body is found shall be shown as the place of death. 6363 (b) If the date of death is unknown, the date shall be determined by approximation. 6364 (3) (a) When death occurs in a moving conveyance in the United States and the 6365 decedent is first removed from the conveyance in this state: 6366 (i) the certificate of death shall be filed with: 6367 (A) the local registrar of the district where the decedent is removed; or 6368 (B) a person designated by the state registrar; and 6369 (ii) the place where the decedent is removed shall be considered the place of death. 6370 (b) When a death occurs on a moving conveyance outside the United States and the 6371 decedent is first removed from the conveyance in this state: 6372 (i) the certificate of death shall be filed with: 6373 (A) the local registrar of the district where the decedent is removed; or 6374 (B) a person designated by the state registrar; and 6375 (ii) the certificate of death shall show the actual place of death to the extent it can be 6376 determined. 6377 (4) (a) Subject to Subsections (4)(d) and (10), a custodial funeral service director or, if a 6378 funeral service director is not retained, a dispositioner shall sign the certificate of death. 6379 (b) The custodial funeral service director, an agent of the custodial funeral service 6380 director, or, if a funeral service director is not retained, a dispositioner shall: 6381 (i) file the certificate of death prior to any disposition of a dead body or fetus; and 6382 (ii) obtain the decedent's personal data from the next of kin or the best qualified person 02-10-23 5:41 PM S.B. 39 - 207 - 6383 or source available, including the decedent's social security number, if known. 6384 (c) The certificate of death may not include the decedent's social security number. 6385 (d) A dispositioner may not sign a certificate of death, unless the signature is witnessed 6386 by the state registrar or a local registrar. 6387 (5) (a) Except as provided in Section [26-2-14] 26B-8-115, fetal death certificates, the 6388 medical section of the certificate of death shall be completed, signed, and returned to the 6389 funeral service director, or, if a funeral service director is not retained, a dispositioner, within 6390 72 hours after death by the health care professional who was in charge of the decedent's care 6391 for the illness or condition which resulted in death, except when inquiry is required by [Title 6392 26, Chapter 4, Utah Medical Examiner Act] Chapter X, Part X, Utah Medical Examiner. 6393 (b) In the absence of the health care professional or with the health care professional's 6394 approval, the certificate of death may be completed and signed by an associate physician, the 6395 chief medical officer of the institution in which death occurred, or a physician who performed 6396 an autopsy upon the decedent, if: 6397 (i) the person has access to the medical history of the case; 6398 (ii) the person views the decedent at or after death; and 6399 (iii) the death is not due to causes required to be investigated by the medical examiner. 6400 (6) When death occurs more than 365 days after the day on which the decedent was last 6401 treated by a health care professional, the case shall be referred to the medical examiner for 6402 investigation to determine and certify the cause, date, and place of death. 6403 (7) When inquiry is required by [Title 26, Chapter 4, Utah Medical Examiner Act] Part 6404 2, Utah Medical Examiner, the medical examiner shall make an investigation and complete and 6405 sign the medical section of the certificate of death within 72 hours after taking charge of the 6406 case. 6407 (8) If the cause of death cannot be determined within 72 hours after death: 6408 (a) the medical section of the certificate of death shall be completed as provided by 6409 department rule; 6410 (b) the attending health care professional or medical examiner shall give the funeral 6411 service director, or, if a funeral service director is not retained, a dispositioner, notice of the 6412 reason for the delay; and 6413 (c) final disposition of the decedent may not be made until authorized by the attending S.B. 39 02-10-23 5:41 PM - 208 - 6414 health care professional or medical examiner. 6415 (9) (a) When a death is presumed to have occurred within this state but the dead body 6416 cannot be located, a certificate of death may be prepared by the state registrar upon receipt of 6417 an order of a Utah [district] court. 6418 (b) The order described in Subsection (9)(a) shall include a finding of fact stating the 6419 name of the decedent, the date of death, and the place of death. 6420 (c) A certificate of death prepared under Subsection (9)(a) shall: 6421 (i) show the date of registration; and 6422 (ii) identify the court and the date of the order. 6423 (10) It is unlawful for a dispositioner to charge for or accept any remuneration for: 6424 (a) signing a certificate of death; or 6425 (b) performing any other duty of a dispositioner, as described in this section. 6426 (11) The state registrar shall, within five business days after the day on which the state 6427 registrar or local registrar registers a certificate of death for a Utah resident, inform the 6428 lieutenant governor of: 6429 (a) the decedent's name, last known residential address, date of birth, and date of death; 6430 and 6431 (b) any other information requested by the lieutenant governor to assist the county 6432 clerk in identifying the decedent for the purpose of removing the decedent from the official 6433 register of voters. 6434 (12) The lieutenant governor shall, within one business day after the day on which the 6435 lieutenant governor receives the information described in Subsection (11), provide the 6436 information to the county clerks. 6437 Section 190. Section 26B-8-115, which is renumbered from Section 26-2-14 is 6438 renumbered and amended to read: 6439 [26-2-14]. 26B-8-115. Fetal death certificate -- Filing and registration 6440 requirements. 6441 (1) A fetal death certificate shall be filed for each fetal death which occurs in this state. 6442 The certificate shall be filed within five days after delivery with the local registrar or as 6443 otherwise directed by the state registrar. The certificate shall be registered if it is completed and 6444 filed in accordance with this [chapter] part. 02-10-23 5:41 PM S.B. 39 - 209 - 6445 (2) When a dead fetus is delivered in an institution, the institution administrator or his 6446 designated representative shall prepare and file the fetal death certificate. The attending 6447 physician shall state in the certificate the cause of death and sign the certificate. 6448 (3) When a dead fetus is delivered outside an institution, the physician in attendance at 6449 or immediately after delivery shall complete, sign, and file the fetal death certificate. 6450 (4) When a fetal death occurs without medical attendance at or immediately after the 6451 delivery or when inquiry is required by [Title 26, Chapter 4, Utah Medical Examiner Act] Part 6452 2, Utah Medical Examiner, the medical examiner shall investigate the cause of death and 6453 prepare and file the certificate of fetal death within five days after taking charge of the case. 6454 (5) When a fetal death occurs in a moving conveyance and the dead fetus is first 6455 removed from the conveyance in this state or when a dead fetus is found in this state and the 6456 place of death is unknown, the death shall be registered in this state. The place where the dead 6457 fetus was first removed from the conveyance or found shall be considered the place of death. 6458 (6) Final disposition of the dead fetus may not be made until the fetal death certificate 6459 has been registered. 6460 Section 191. Section 26B-8-116, which is renumbered from Section 26-2-14.1 is 6461 renumbered and amended to read: 6462 [26-2-14.1]. 26B-8-116. Certificate of birth resulting in stillbirth. 6463 (1) [For purposes of this section and Section 26-2-14.2] As used in this section, 6464 "stillbirth" and "stillborn child" [shall have the same meaning] mean the same as "dead fetus" 6465 as defined in Section [26-2-2] 26B-8-101. 6466 (2) (a) In addition to the requirements of Section [26-2-14] 26B-8-115, the state 6467 registrar shall establish a certificate of birth resulting in stillbirth on a form approved by the 6468 state registrar for each stillbirth occurring in this state. 6469 (b) This certificate shall be offered to the parent or parents of a stillborn child. 6470 (3) The certificate of birth resulting in stillbirth shall meet all of the format and filing 6471 requirements of Sections [26-2-4 and 26-2-5] 26B-8-103 and 26B-8-104, relating to a live 6472 birth. 6473 (4) The person who prepares a certificate pursuant to this section shall leave blank any 6474 references to the stillborn child's name if the stillborn child's parent or parents do not wish to 6475 provide a name for the stillborn child. S.B. 39 02-10-23 5:41 PM - 210 - 6476 (5) Notwithstanding Subsections (2) and (3), the certificate of birth resulting in 6477 stillbirth shall be filed with the designated registrar within 10 days following the delivery and 6478 prior to cremation or removal of the fetus from the registration district. 6479 Section 192. Section 26B-8-117, which is renumbered from Section 26-2-14.2 is 6480 renumbered and amended to read: 6481 [26-2-14.2]. 26B-8-117. Delayed registration of birth resulting in stillbirth. 6482 When a birth resulting in stillbirth occurring in this state has not been registered within 6483 one year after the date of delivery, a certificate marked "delayed" may be filed and registered in 6484 accordance with department rule relating to evidentiary and other requirements sufficient to 6485 substantiate the alleged facts of birth resulting in stillbirth. 6486 Section 193. Section 26B-8-118, which is renumbered from Section 26-2-14.3 is 6487 renumbered and amended to read: 6488 [26-2-14.3]. 26B-8-118. Certificate of early term stillbirth. 6489 (1) As used in this section, "early term stillborn child" means a product of human 6490 conception, other than in the circumstances described in Subsection 76-7-301(1), that: 6491 (a) is of at least 16 weeks' gestation but less than 20 weeks' gestation, calculated from 6492 the day on which the mother's last normal menstrual period began to the day of delivery; and 6493 (b) is not born alive. 6494 (2) The state registrar shall issue a certificate of early term stillbirth to a parent of an 6495 early term stillborn child if: 6496 (a) the parent requests, on a form created by the state registrar, that the state registrar 6497 register and issue a certificate of early term stillbirth for the early term stillborn child; and 6498 (b) the parent files with the state registrar: 6499 (i) (A) a signed statement from a physician confirming the delivery of the early term 6500 stillborn child; or 6501 (B) an accurate copy of the parent's medical records related to the early term stillborn 6502 child; and 6503 (ii) any other record the state registrar determines, by rule made in accordance with 6504 Title 63G, Chapter 3, Utah Administrative Rulemaking Act, is necessary for accurate 6505 recordkeeping. 6506 (3) The certificate of early term stillbirth described in Subsection (2) shall meet all of 02-10-23 5:41 PM S.B. 39 - 211 - 6507 the format and filing requirements of Section [26-2-4] 26B-8-103. 6508 (4) A person who prepares a certificate of early term stillbirth under this section shall 6509 leave blank any references to an early term stillborn child's name if the early term stillborn 6510 child's parent does not wish to provide a name for the early term stillborn child. 6511 Section 194. Section 26B-8-119, which is renumbered from Section 26-2-15 is 6512 renumbered and amended to read: 6513 [26-2-15]. 26B-8-119. Petition for establishment of unregistered birth or death 6514 -- Court procedure. 6515 (1) A person holding a direct, tangible, and legitimate interest as described in 6516 Subsection [26-2-22] 26B-8-125(3)(a) or (b) may petition for a court order establishing the 6517 fact, time, and place of a birth or death that is not registered or for which a certified copy of the 6518 registered birth or death certificate is not obtainable. The person shall verify the petition and 6519 file the petition in the Utah [district] court for the county where: 6520 (a) the birth or death is alleged to have occurred; 6521 (b) the person resides whose birth is to be established; or 6522 (c) the decedent named in the petition resided at the date of death. 6523 (2) In order for the court to have jurisdiction, the petition shall: 6524 (a) allege the date, time, and place of the birth or death; and 6525 (b) state either that no certificate of birth or death has been registered or that a copy of 6526 the registered certificate cannot be obtained. 6527 (3) The court shall set a hearing for five to 10 days after the day on which the petition 6528 is filed. 6529 (4) (a) If the time and place of birth or death are in question, the court shall hear 6530 available evidence and determine the time and place of the birth or death. 6531 (b) If the time and place of birth or death are not in question, the court shall determine 6532 the time and place of birth or death to be those alleged in the petition. 6533 (5) A court order under this section shall be made on a form prescribed and furnished 6534 by the department and is effective upon the filing of a certified copy of the order with the state 6535 registrar. 6536 (6) (a) For purposes of this section, the birth certificate of an adopted alien child, as 6537 defined in Section 78B-6-108, is considered to be unobtainable if the child was born in a S.B. 39 02-10-23 5:41 PM - 212 - 6538 country that is not recognized by department rule as having an established vital records 6539 registration system. 6540 (b) If the adopted child was born in a country recognized by department rule, but a 6541 person described in Subsection (1) is unable to obtain a certified copy of the birth certificate, 6542 the state registrar shall authorize the preparation of a birth certificate if the state registrar 6543 receives a written statement signed by the registrar of the child's birth country stating a certified 6544 copy of the birth certificate is not available. 6545 Section 195. Section 26B-8-120, which is renumbered from Section 26-2-16 is 6546 renumbered and amended to read: 6547 [26-2-16]. 26B-8-120. Certificate of death -- Duties of a custodial funeral 6548 service director, an agent of a funeral service director, or a dispositioner -- Medical 6549 certification -- Records of funeral service director or dispositioner -- Information filed 6550 with local registrar -- Unlawful signing of certificate of death. 6551 (1) The custodial funeral service director or, if a funeral service director is not retained, 6552 a dispositioner shall sign the certificate of death prior to any disposition of a dead body or dead 6553 fetus. 6554 (2) The custodial funeral service director, an agent of the custodial funeral service 6555 director, or, if a funeral service director is not retained, a dispositioner shall: 6556 (a) obtain personal and statistical information regarding the decedent from the 6557 available persons best qualified to provide the information; 6558 (b) present the certificate of death to the attending health care professional, if any, or to 6559 the medical examiner who shall certify the cause of death and other information required on the 6560 certificate of death; 6561 (c) provide the address of the custodial funeral service director or, if a funeral service 6562 director is not retained, a dispositioner; 6563 (d) certify the date and place of burial; and 6564 (e) file the certificate of death with the state or local registrar. 6565 (3) A funeral service director, dispositioner, embalmer, or other person who removes a 6566 dead body or dead fetus from the place of death or transports or is in charge of final disposal of 6567 a dead body or dead fetus, shall keep a record identifying the dead body or dead fetus, and 6568 containing information pertaining to receipt, removal, and delivery of the dead body or dead 02-10-23 5:41 PM S.B. 39 - 213 - 6569 fetus as prescribed by department rule. 6570 (4) (a) Not later than the tenth day of each month, every licensed funeral service 6571 establishment shall send to the local registrar and the department a list of the information 6572 required in Subsection (3) for each casket furnished and for funerals performed when no casket 6573 was furnished, during the preceding month. 6574 (b) The list described in Subsection (4)(a) shall be in the form prescribed by the state 6575 registrar. 6576 (5) Any person who intentionally signs the portion of a certificate of death that is 6577 required to be signed by a funeral service director or a dispositioner under Subsection (1) is 6578 guilty of a class B misdemeanor, unless the person: 6579 (a) (i) is a funeral service director; and 6580 (ii) is employed by a licensed funeral establishment; or 6581 (b) is a dispositioner, if a funeral service director is not retained. 6582 (6) The state registrar shall post information on the state registrar's website, providing 6583 instructions to a dispositioner for complying with the requirements of law relating to the 6584 dispositioner's responsibilities for: 6585 (a) completing and filing a certificate of death; and 6586 (b) possessing, transporting, and disposing of a dead body or dead fetus. 6587 (7) The provisions of this [chapter] part shall be construed to avoid interference, to the 6588 fullest extent possible, with the ceremonies, customs, rites, or beliefs of the decedent and the 6589 decedent's next of kin for disposing of a dead body or dead fetus. 6590 Section 196. Section 26B-8-121, which is renumbered from Section 26-2-17 is 6591 renumbered and amended to read: 6592 [26-2-17]. 26B-8-121. Certificate of death -- Registration prerequisite to 6593 interment -- Burial-transit permits -- Procedure where body donated under anatomical 6594 gift law -- Permit for disinterment. 6595 (1) (a) A dead body or dead fetus may not be interred or otherwise disposed of or 6596 removed from the registration district in which death or fetal death occurred or the remains are 6597 found until a certificate of death is registered. 6598 (b) Subsection (1)(a) does not apply to fetal remains for a fetus that is less than 20 6599 weeks in gestational age. S.B. 39 02-10-23 5:41 PM - 214 - 6600 (2) (a) For deaths or fetal deaths which occur in this state, no burial-transit permit is 6601 required for final disposition of the remains if: 6602 (i) disposition occurs in the state and is performed by a funeral service director; or 6603 (ii) the disposition takes place with authorization of the next of kin and in: 6604 (A) a general acute hospital as [that term is] defined in Section [26-21-2] 26B-2-201, 6605 that is licensed by the department; or 6606 (B) in a pathology laboratory operated under contract with a general acute hospital 6607 licensed by the department. 6608 (b) For an abortion or miscarriage that occurs at a health care facility, no burial-transit 6609 permit is required for final disposition of the fetal remains if: 6610 (i) disposition occurs in the state and is performed by a funeral service director; or 6611 (ii) the disposition takes place: 6612 (A) with authorization of the parent of a miscarried fetus or the pregnant woman for an 6613 aborted fetus; and 6614 (B) in a general acute hospital as [that term is] defined in Section [26-21-2] 26B-2-201, 6615 or a pathology laboratory operated under contract with a general acute hospital. 6616 (3) (a) A burial-transit permit shall be issued by the local registrar of the district where 6617 the certificate of death or fetal death is registered: 6618 (i) for a dead body or a dead fetus to be transported out of the state for final 6619 disposition; or 6620 (ii) when disposition of the dead body or dead fetus is made by a person other than a 6621 funeral service director. 6622 (b) For fetal remains that are less than 20 weeks in gestational age, a burial-transit 6623 permit shall be issued by the local registrar of the district where the health care facility that is in 6624 possession of the fetal remains is located: 6625 (i) for the fetal remains to be transported out of the state for final disposition; or 6626 (ii) when disposition of the fetal remains is made by a person other than a funeral 6627 service director. 6628 (c) A local registrar issuing a burial-transit permit issued under Subsection (3)(b): 6629 (i) may not require an individual to designate a name for the fetal remains; and 6630 (ii) may leave the space for a name on the burial-transit permit blank; and 02-10-23 5:41 PM S.B. 39 - 215 - 6631 (d) shall redact from any public records maintained under this [chapter] part any 6632 information: 6633 (i) that is submitted under Subsection (3)(c); and 6634 (ii) that may be used to identify the parent or pregnant woman. 6635 (4) A burial-transit permit issued under the law of another state which accompanies a 6636 dead body, dead fetus, or fetal remains brought into this state is authority for final disposition 6637 of the dead body, dead fetus, or fetal remains in this state. 6638 (5) When a dead body or dead fetus or any part of the dead body or dead fetus has been 6639 donated under [the] Part 3, Revised Uniform Anatomical Gift Act, or similar laws of another 6640 state and the preservation of the gift requires the immediate transportation of the dead body, 6641 dead fetus, or any part of the body or fetus outside of the registration district in which death 6642 occurs or the remains are found, or into this state from another state, the dead body or dead 6643 fetus or any part of the body or fetus may be transported and the burial-transit permit required 6644 by this section obtained within a reasonable time after transportation. 6645 (6) A permit for disinterment and reinterment is required prior to disinterment of a 6646 dead body, dead fetus, or fetal remains, except as otherwise provided by statute or department 6647 rule. 6648 Section 197. Section 26B-8-122, which is renumbered from Section 26-2-18 is 6649 renumbered and amended to read: 6650 [26-2-18]. 26B-8-122. Interments -- Duties of sexton or person in charge -- 6651 Record of interments -- Information filed with local registrar. 6652 (1) (a) A sexton or person in charge of any premises in which interments are made may 6653 not inter or permit the interment of any dead body, dead fetus, or fetal remains unless the 6654 interment is made by a funeral service director or by a person holding a burial-transit permit. 6655 (b) The right and duty to control the disposition of a deceased person shall be governed 6656 by Sections 58-9-601 through 58-9-604. 6657 (2) (a) The sexton or the person in charge of any premises where interments are made 6658 shall keep a record of all interments made in the premises under their charge, stating the name 6659 of the decedent, place of death, date of burial, and name and address of the funeral service 6660 director or other person making the interment. 6661 (b) The record described in this Subsection (2) shall be open to public inspection. S.B. 39 02-10-23 5:41 PM - 216 - 6662 (c) A city or county clerk may, at the clerk's option, maintain the interment records 6663 described in this Subsection (2) on behalf of the sexton or person in charge of any premises in 6664 which interments are made. 6665 (3) (a) Not later than the tenth day of each month, the sexton, person in charge of the 6666 premises, or city or county clerk who maintains the interment records shall send to the local 6667 registrar and the department a list of all interments made in the premises during the preceding 6668 month. 6669 (b) The list described in Subsection (3)(a) shall be in the form prescribed by the state 6670 registrar. 6671 Section 198. Section 26B-8-123, which is renumbered from Section 26-2-19 is 6672 renumbered and amended to read: 6673 [26-2-19]. 26B-8-123. Rules of department for transmittal of certificates and 6674 keeping of records by local registrar. 6675 Each local registrar shall transmit all records registered by him to the department in 6676 accordance with department rules. The manner of keeping local copies of vital records and the 6677 uses of them shall be prescribed by department rules. 6678 Section 199. Section 26B-8-124, which is renumbered from Section 26-2-21 is 6679 renumbered and amended to read: 6680 [26-2-21]. 26B-8-124. Local registrars authorized to issue certified copies of 6681 records. 6682 The state registrar may authorize local registrars to issue certified copies of vital 6683 records. 6684 Section 200. Section 26B-8-125, which is renumbered from Section 26-2-22 is 6685 renumbered and amended to read: 6686 [26-2-22]. 26B-8-125. Inspection of vital records. 6687 (1) As used in this section: 6688 (a) "Designated legal representative" means an attorney, physician, funeral service 6689 director, genealogist, or other agent of the subject, or an immediate family member of the 6690 subject, who has been delegated the authority to access vital records. 6691 (b) "Drug use intervention or suicide prevention effort" means a program that studies 6692 or promotes the prevention of drug overdose deaths or suicides in the state. 02-10-23 5:41 PM S.B. 39 - 217 - 6693 (c) "Immediate family member" means a spouse, child, parent, sibling, grandparent, or 6694 grandchild. 6695 (2) (a) The vital records shall be open to inspection, but only in compliance with the 6696 provisions of this [chapter] part, department rules, and Sections 78B-6-141 and 78B-6-144. 6697 (b) It is unlawful for any state or local officer or employee to disclose data contained in 6698 vital records contrary to this [chapter] part, department rule, Section 78B-6-141, or Section 6699 78B-6-144. 6700 (c) (i) An adoption document is open to inspection as provided in Section 78B-6-141 6701 or Section 78B-6-144. 6702 (ii) A birth parent may not access an adoption document under Subsection 6703 78B-6-141(3). 6704 (d) A custodian of vital records may permit inspection of a vital record or issue a 6705 certified copy of a record or a part of a record when the custodian is satisfied that the applicant 6706 has demonstrated a direct, tangible, and legitimate interest. 6707 (3) Except as provided in Subsection (4), a direct, tangible, and legitimate interest in a 6708 vital record is present only if: 6709 (a) the request is from: 6710 (i) the subject; 6711 (ii) an immediate family member of the subject; 6712 (iii) the guardian of the subject; 6713 (iv) a designated legal representative of the subject; or 6714 (v) a person, including a child-placing agency as defined in Section 78B-6-103, with 6715 whom a child has been placed pending finalization of an adoption of the child; 6716 (b) the request involves a personal or property right of the subject of the record; 6717 (c) the request is for official purposes of a public health authority or a state, local, or 6718 federal governmental agency; 6719 (d) the request is for a drug use intervention or suicide prevention effort or a statistical 6720 or medical research program and prior consent has been obtained from the state registrar; or 6721 (e) the request is a certified copy of an order of a court of record specifying the record 6722 to be examined or copied. 6723 (4) (a) Except as provided in Title 78B, Chapter 6, Part 1, Utah Adoption Act, a parent, S.B. 39 02-10-23 5:41 PM - 218 - 6724 or an immediate family member of a parent, who does not have legal or physical custody of or 6725 visitation or parent-time rights for a child because of the termination of parental rights under 6726 Title 80, Chapter 4, Termination and Restoration of Parental Rights, or by virtue of consenting 6727 to or relinquishing a child for adoption pursuant to Title 78B, Chapter 6, Part 1, Utah Adoption 6728 Act, may not be considered as having a direct, tangible, and legitimate interest under this 6729 section. 6730 (b) Except as provided in Subsection (2)(d), a commercial firm or agency requesting 6731 names, addresses, or similar information may not be considered as having a direct, tangible, 6732 and legitimate interest under this section. 6733 (5) Upon payment of a fee established in accordance with Section 63J-1-504, the office 6734 shall make the following records available to the public: 6735 (a) except as provided in Subsection [26-2-10] 26B-8-110(4)(b), a birth record, 6736 excluding confidential information collected for medical and health use, if 100 years or more 6737 have passed since the date of birth; 6738 (b) a death record if 50 years or more have passed since the date of death; and 6739 (c) a vital record not subject to Subsection (5)(a) or (b) if 75 years or more have passed 6740 since the date of the event upon which the record is based. 6741 (6) Upon payment of a fee established in accordance with Section 63J-1-504, the office 6742 shall make an adoption document available as provided in Sections 78B-6-141 and 78B-6-144. 6743 (7) The office shall make rules in accordance with Title 63G, Chapter 3, Utah 6744 Administrative Rulemaking Act, establishing procedures and the content of forms as follows: 6745 (a) for the inspection of adoption documents under Subsection 78B-6-141(4); 6746 (b) for a birth parent's election to permit identifying information about the birth parent 6747 to be made available, under Section 78B-6-141; 6748 (c) for the release of information by the mutual-consent, voluntary adoption registry, 6749 under Section 78B-6-144; 6750 (d) for collecting fees and donations under Section 78B-6-144.5; and 6751 (e) for the review and approval of a request described in Subsection (3)(d). 6752 Section 201. Section 26B-8-126, which is renumbered from Section 26-2-23 is 6753 renumbered and amended to read: 6754 [26-2-23]. 26B-8-126. Records required to be kept by health care institutions 02-10-23 5:41 PM S.B. 39 - 219 - 6755 -- Information filed with local registrar and department. 6756 (1) (a) All administrators or other persons in charge of hospitals, nursing homes, or 6757 other institutions, public or private, to which persons resort for treatment of diseases, 6758 confinements, or are committed by law, shall record all the personal and statistical information 6759 about patients of their institutions as required in certificates prescribed by this [chapter] part. 6760 (b) The information described in Subsection (1)(a) shall: 6761 (i) be recorded for collection at the time of admission of a patient; 6762 (ii) be obtained from the patient, if possible; and 6763 (iii) if the information cannot be obtained from the patient, the information shall be 6764 secured in as complete a manner as possible from other persons acquainted with the facts. 6765 (2) (a) When a dead body or dead fetus is released or disposed of by an institution, the 6766 person in charge of the institution shall keep a record showing: 6767 (i) the name of the deceased; 6768 (ii) the date of death of the deceased; 6769 (iii) the name and address of the person to whom the dead body or dead fetus is 6770 released; and 6771 (iv) the date that the dead body or dead fetus is removed from the institution. 6772 (b) If final disposal is by the institution, the date, place, manner of disposition, and the 6773 name of the person authorizing disposition shall be recorded by the person in charge of the 6774 institution. 6775 (3) Not later than the tenth day of each month, the administrator of each institution 6776 shall cause to be sent to the local registrar and the department a list of all births, deaths, fetal 6777 deaths, and induced abortions occurring in the institution during the preceding month. The list 6778 shall be in the form prescribed by the state registrar. 6779 (4) A person or institution who, in good faith, releases a dead body or dead fetus, under 6780 this section, to a funeral service director or a dispositioner is immune from civil liability 6781 connected, directly or indirectly, with release of the dead body or dead fetus. 6782 Section 202. Section 26B-8-127, which is renumbered from Section 26-2-24 is 6783 renumbered and amended to read: 6784 [26-2-24]. 26B-8-127. Marriage licenses -- Execution and filing requirements. 6785 (1) The state registrar shall supply county clerks with application forms for marriage S.B. 39 02-10-23 5:41 PM - 220 - 6786 licenses. 6787 (2) Completed applications shall be transmitted by the clerks to the state registrar 6788 monthly. 6789 (3) The personal identification information contained on each application for a 6790 marriage license filed with the county clerk shall be entered on a form supplied by the state 6791 registrar. 6792 (4) The person performing the marriage shall furnish the date and place of marriage 6793 and his name and address. 6794 (5) The form described in Subsection (1) shall be completed and certified by the county 6795 clerk before it is filed with the state registrar. 6796 Section 203. Section 26B-8-128, which is renumbered from Section 26-2-25 is 6797 renumbered and amended to read: 6798 [26-2-25]. 26B-8-128. Divorce or adoption -- Duty of court clerk to file 6799 certificates or reports. 6800 (1) For each adoption, annulment of adoption, divorce, and annulment of marriage 6801 ordered or decreed in this state, the clerk of the court shall prepare a divorce certificate or 6802 report of adoption on a form furnished by the state registrar. 6803 (2) The petitioner shall provide the information necessary to prepare the certificate or 6804 report under Subsection (1). 6805 (3) The clerk shall: 6806 (a) prepare the certificate or report under Subsection (1); and 6807 (b) complete the remaining entries for the certificate or report immediately after the 6808 decree or order becomes final. 6809 (4) On or before the 15th day of each month, the clerk shall forward the divorce 6810 certificates and reports of adoption under Subsection (1) completed by the clerk during the 6811 preceding month to the state registrar. 6812 (5) (a) A report of adoption under Subsection (1) may be provided to the attorney who 6813 is providing representation of a party to the adoption or the child-placing agency, as defined in 6814 Section 78B-6-103, that is placing the child. 6815 (b) If a report of adoption is provided to the attorney or the child-placing agency, as 6816 defined in Section 78B-6-103, the attorney or the child-placing agency shall immediately 02-10-23 5:41 PM S.B. 39 - 221 - 6817 provide the report of adoption to the state registrar. 6818 Section 204. Section 26B-8-129, which is renumbered from Section 26-2-26 is 6819 renumbered and amended to read: 6820 [26-2-26]. 26B-8-129. Certified copies of vital records -- Preparation by state 6821 and local registrars -- Evidentiary value. 6822 (1) The state registrar and local registrars authorized by the department under Section 6823 [26-2-21] 26B-8-124 may prepare typewritten, photographic, electronic, or other reproductions 6824 of vital records and certify their correctness. 6825 (2) Certified copies of the vital record, or authorized reproductions of the original, 6826 issued by either the state registrar or a designated local registrar are prima facie evidence in all 6827 courts of the state with like effect as the vital record. 6828 Section 205. Section 26B-8-130, which is renumbered from Section 26-2-27 is 6829 renumbered and amended to read: 6830 [26-2-27]. 26B-8-130. Identifying birth certificates of missing persons -- 6831 Procedures. 6832 (1) As used in this section: 6833 (a) "Division" means the Criminal Investigations and Technical Services Division, 6834 Department of Public Safety, in Title 53, Chapter 10, Criminal Investigations and Technical 6835 Services Act. 6836 (b) "Missing child" means a person younger than 18 years of age who is missing from 6837 the person's home environment or a temporary placement facility for any reason, and whose 6838 whereabouts cannot be determined by the person responsible for the child's care. 6839 (c) "Missing person" means a person who: 6840 (i) is missing from the person's home environment; and 6841 (ii) (A) has a physical or mental disability; 6842 (B) is missing under circumstances that indicate that the person is endangered, missing 6843 involuntarily, or a victim of a catastrophe; or 6844 (C) is a missing child. 6845 (2) (a) In accordance with Section 53-10-203, upon the state registrar's notification by 6846 the division that a person who was born in this state is missing, the state and local registrars 6847 shall flag the registered birth certificate of that person so that when a copy of the registered S.B. 39 02-10-23 5:41 PM - 222 - 6848 birth certificate or information regarding the birth record is requested, the state and local 6849 registrars are alerted to the fact the registered birth certificate is that of a missing person. 6850 (b) Upon notification by the division the missing person has been recovered, the state 6851 and local registrars shall remove the flag from that person's registered birth certificate. 6852 (3) The state and local registrars may not provide a copy of a registered birth certificate 6853 of any person whose record is flagged under Subsection (2), except as approved by the 6854 division. 6855 (4) (a) When a copy of the registered birth certificate of a person whose record has 6856 been flagged is requested in person, the state or local registrar shall require that person to 6857 complete a form supplying that person's name, address, telephone number, and relationship to 6858 the missing person, and the name and birth date of the missing person. 6859 (b) The state or local registrar shall inform the requester that a copy of the registered 6860 birth certificate will be mailed to the requester. 6861 (c) The state or local registrar shall note the physical description of the person making 6862 the request, and shall immediately notify the division of the request and the information 6863 obtained pursuant to this Subsection (4). 6864 (5) When a copy of the registered birth certificate of a person whose record has been 6865 flagged is requested in writing, the state or local registrar or personnel of the state or local 6866 registrar shall immediately notify the division, and provide it with a copy of the written request. 6867 Section 206. Section 26B-8-131, which is renumbered from Section 26-2-28 is 6868 renumbered and amended to read: 6869 [26-2-28]. 26B-8-131. Birth certificate for foreign adoptees. 6870 Upon presentation of a court order of adoption and an order establishing the fact, time, 6871 and place of birth under Section [26-2-15] 26B-6-119, the department shall prepare a birth 6872 certificate for an individual who: 6873 (1) was adopted under the laws of this state; and 6874 (2) was at the time of adoption, as a child or as an adult, considered an alien child or 6875 adult for whom the court received documentary evidence of lawful admission under Section 6876 78B-6-108. 6877 Section 207. Section 26B-8-132, which is renumbered from Section 26-34-4 is 6878 renumbered and amended to read: 02-10-23 5:41 PM S.B. 39 - 223 - 6879 [26-34-4]. 26B-8-132. Determination of death made by registered nurse. 6880 (1) As used in this section[: (a) "Health care facility" means the same as that term is 6881 defined in Section 26-21-2. (b) "Physician" means a physician licensed under: (i) Title 58, 6882 Chapter 67, Utah Medical Practice Act; or (ii) Title 58, Chapter 68, Utah Osteopathic Medical 6883 Practice Act. (c) "Registered], "registered nurse" means a registered nurse licensed under Title 6884 58, Chapter 31b, Nurse Practice Act. 6885 (2) (a) An individual is dead if the individual has sustained either: 6886 (i) irreversible cessation of circulatory and respiratory functions; or 6887 (ii) irreversible cessation of all functions of the entire brain, including the brain stem. 6888 (b) A determination of death shall be made in accordance with this part and accepted 6889 medical standards. 6890 [(2)] (3) A registered nurse may make a determination of death of an individual if: 6891 (a) an attending physician has: 6892 (i) documented in the individual's medical or clinical record that the individual's death 6893 is anticipated due to illness, infirmity, or disease no later than 180 days after the day on which 6894 the physician makes the documentation; and 6895 (ii) established clear assessment procedures for determining death; 6896 (b) the death actually occurs within the 180-day period described in Subsection [(2)] 6897 (3)(a); and 6898 (c) at the time of the documentation described in Subsection [(2)] (3)(a), the physician 6899 authorized the following, in writing, to make the determination of death: 6900 (i) one or more specific registered nurses; or 6901 (ii) if the individual is in a health care facility that has complied with Subsection [(5)] 6902 (6), all registered nurses that the facility employs. 6903 [(3)] (4) A registered nurse who has determined death under this section shall: 6904 (a) document the clinical criteria for the determination in the individual's medical or 6905 clinical record; 6906 (b) notify the physician described in Subsection [(2)] (3); and 6907 (c) ensure that the death certificate includes: 6908 (i) the name of the deceased; 6909 (ii) the presence of a contagious disease, if known; and S.B. 39 02-10-23 5:41 PM - 224 - 6910 (iii) the date and time of death. 6911 [(4)] (5) Except as otherwise provided by law or rule, a physician [licensed under Title 6912 58, Chapter 67, Utah Medical Practice Act, or Title 58, Chapter 68, Utah Osteopathic Medical 6913 Practice Act,] shall certify a determination of death described in Subsection [(3)] (4) within 24 6914 hours after the registered nurse makes the determination of death. 6915 [(5)] (6) (a) For a health care facility to be eligible for a general authorization described 6916 in Subsection [(2)] (3)(c), the facility shall adopt written policies and procedures that provide 6917 for the determination of death by a registered nurse under this section. 6918 (b) A registered nurse that a health care facility employs may not make a determination 6919 of death under this section unless the facility has adopted the written policies and procedures 6920 described in Subsection [(5)] (6)(a). 6921 [(6)] (7) The department may make rules, in accordance with Title 63G, Chapter 3, 6922 Utah Administrative Rulemaking Act, to ensure the appropriate determination of death under 6923 this section. 6924 Section 208. Section 26B-8-133, which is renumbered from Section 26-23-5 is 6925 renumbered and amended to read: 6926 [26-23-5]. 26B-8-133. Unlawful acts concerning certificates, records, and 6927 reports -- Unlawful transportation or acceptance of dead human body. 6928 It is unlawful for any person, association, or corporation and the officers of any of them: 6929 (1) to willfully and knowingly make any false statement in a certificate, record, or 6930 report required to be filed with the department, or in an application for a certified copy of a 6931 vital record, or to willfully and knowingly supply false information intending that the 6932 information be used in the preparation of any report, record, or certificate, or an amendment to 6933 any of these; 6934 (2) to make, counterfeit, alter, amend, or mutilate any certificate, record, or report 6935 required to be filed under this code or a certified copy of the certificate, record, or report 6936 without lawful authority and with the intent to deceive; 6937 (3) to willfully and knowingly obtain, possess, use, sell, furnish, or attempt to obtain, 6938 possess, use, sell, or furnish to another, for any purpose of deception, any certificate, record, 6939 report, or certified copy of any of them, including any that are counterfeited, altered, amended, 6940 or mutilated; 02-10-23 5:41 PM S.B. 39 - 225 - 6941 (4) without lawful authority, to possess any certificate, record, or report, required by 6942 the department or a copy or certified copy of the certificate, record, or report, knowing it to 6943 have been stolen or otherwise unlawfully obtained; or 6944 (5) to willfully and knowingly transport or accept for transportation, interment, or other 6945 disposition a dead human body without a permit required by law. 6946 Section 209. Section 26B-8-134, which is renumbered from Section 26-23-5.5 is 6947 renumbered and amended to read: 6948 [26-23-5.5]. 26B-8-134. Illegal use of birth certificate -- Penalties. 6949 (1) It is a third degree felony for any person to willfully and knowingly: 6950 (a) and with the intent to deceive, obtain, possess, use, sell, furnish, or attempt to 6951 obtain, possess, use, sell, or furnish to another any certificate of birth or certified copy of a 6952 certificate of birth knowing that the certificate or certified copy was issued upon information 6953 which is false in whole or in part or which relates to the birth of another person, whether living 6954 or deceased; or 6955 (b) furnish or process a certificate of birth or certified copy of a certificate of birth with 6956 the knowledge or intention that it be used for the purpose of deception by a person other than 6957 the person to whom the certificate of birth relates. 6958 (2) The specific criminal violations and the criminal penalty under this section take 6959 precedence over any more general criminal offense as described in Section [26-23-5] 6960 26B-8-133. 6961 Section 210. Section 26B-8-201, which is renumbered from Section 26-4-2 is 6962 renumbered and amended to read: 6963 Part 2. Utah Medical Examiner 6964 [26-4-2]. 26B-8-201. Definitions. 6965 As used in this [chapter] part: 6966 (1) "Dead body" means the same as that term is defined in Section [26-2-2] 26B-8-101. 6967 (2) (a) "Death by violence" means death that resulted by the decedent's exposure to 6968 physical, mechanical, or chemical forces. 6969 (b) "Death by violence" includes death that appears to have been due to homicide, 6970 death that occurred during or in an attempt to commit rape, mayhem, kidnapping, robbery, 6971 burglary, housebreaking, extortion, or blackmail accompanied by threats of violence, assault S.B. 39 02-10-23 5:41 PM - 226 - 6972 with a dangerous weapon, assault with intent to commit any offense punishable by 6973 imprisonment for more than one year, arson punishable by imprisonment for more than one 6974 year, or any attempt to commit any of the foregoing offenses. 6975 (3) "Immediate relative" means an individual's spouse, child, parent, sibling, 6976 grandparent, or grandchild. 6977 (4) "Health care professional" means any of the following while acting in a 6978 professional capacity: 6979 (a) a physician licensed under Title 58, Chapter 67, Utah Medical Practice Act, or Title 6980 58, Chapter 68, Utah Osteopathic Medical Practice Act; 6981 (b) a physician assistant licensed under Title 58, Chapter 70a, Utah Physician Assistant 6982 Act; or 6983 (c) an advance practice registered nurse licensed under Subsection 58-31b-301(2)(e). 6984 (5) "Medical examiner" means the state medical examiner appointed pursuant to 6985 Section [26-4-4] 26B-8-202 or a deputy appointed by the medical examiner. 6986 (6) "Medical examiner record" means: 6987 (a) all information that the medical examiner obtains regarding a decedent; and 6988 (b) reports that the medical examiner makes regarding a decedent. 6989 (7) "Regional pathologist" means a trained pathologist licensed to practice medicine 6990 and surgery in the state, appointed by the medical examiner pursuant to Subsection [26-4-4] 6991 26B-8-202(3). 6992 (8) "Sudden death while in apparent good health" means apparently instantaneous 6993 death without obvious natural cause, death during or following an unexplained syncope or 6994 coma, or death during an acute or unexplained rapidly fatal illness. 6995 (9) "Sudden infant death syndrome" means the death of a child who was thought to be 6996 in good health or whose terminal illness appeared to be so mild that the possibility of a fatal 6997 outcome was not anticipated. 6998 (10) "Suicide" means death caused by an intentional and voluntary act of an individual 6999 who understands the physical nature of the act and intends by such act to accomplish 7000 self-destruction. 7001 (11) "Unattended death" means a death that occurs more than 365 days after the day on 7002 which a health care professional examined or treated the deceased individual for any purpose, 02-10-23 5:41 PM S.B. 39 - 227 - 7003 including writing a prescription. 7004 (12) (a) "Unavailable for postmortem investigation" means that a dead body is: 7005 (i) transported out of state; 7006 (ii) buried at sea; 7007 (iii) cremated; 7008 (iv) processed by alkaline hydrolysis; or 7009 (v) otherwise made unavailable to the medical examiner for postmortem investigation 7010 or autopsy. 7011 (b) "Unavailable for postmortem investigation" does not include embalming or burial 7012 of a dead body pursuant to the requirements of law. 7013 (13) "Within the scope of the decedent's employment" means all acts reasonably 7014 necessary or incident to the performance of work, including matters of personal convenience 7015 and comfort not in conflict with specific instructions. 7016 Section 211. Section 26B-8-202, which is renumbered from Section 26-4-4 is 7017 renumbered and amended to read: 7018 [26-4-4]. 26B-8-202. Chief medical examiner -- Appointment -- Qualifications 7019 -- Authority. 7020 (1) The executive director, with the advice of an advisory board consisting of the 7021 chairman of the Department of Pathology at the University of Utah medical school and the 7022 dean of the law school at the University of Utah, shall appoint a chief medical examiner who 7023 shall be licensed to practice medicine in the state and shall meet the qualifications of a forensic 7024 pathologist, certified by the American Board of Pathologists. 7025 (2) (a) The medical examiner shall serve at the will of the executive director. 7026 (b) The medical examiner has authority to: 7027 (i) employ medical, technical and clerical personnel as may be required to effectively 7028 administer this chapter, subject to the rules of the department and the state merit system; 7029 (ii) conduct investigations and pathological examinations; 7030 (iii) perform autopsies authorized in this title; 7031 (iv) conduct or authorize necessary examinations on dead bodies; and 7032 (v) notwithstanding the provisions of Subsection [26-28-122] 26B-8-321(3), retain 7033 tissues and biological samples: S.B. 39 02-10-23 5:41 PM - 228 - 7034 (A) for scientific purposes; 7035 (B) where necessary to accurately certify the cause and manner of death; or 7036 (C) for tissue from an unclaimed body, subject to Section [26-4-25] 26B-8-225, in 7037 order to donate the tissue or biological sample to an individual who is affiliated with an 7038 established search and rescue dog organization, for the purpose of training a dog to search for 7039 human remains. 7040 (c) In the case of an unidentified body, the medical examiner shall authorize or conduct 7041 investigations, tests and processes in order to determine its identity as well as the cause of 7042 death. 7043 (3) The medical examiner may appoint regional pathologists, each of whom shall be 7044 approved by the executive director. 7045 Section 212. Section 26B-8-203, which is renumbered from Section 26-4-5 is 7046 renumbered and amended to read: 7047 [26-4-5]. 26B-8-203. County medical examiners. 7048 The county executive, with the advice and consent of the county legislative body, may 7049 appoint medical examiners for their respective counties. 7050 Section 213. Section 26B-8-204, which is renumbered from Section 26-4-6 is 7051 renumbered and amended to read: 7052 [26-4-6]. 26B-8-204. Investigation of deaths -- Requests for autopsies. 7053 (1) The following have authority to investigate a death described in Section [26-4-7] 7054 26B-8-205 and any other case which may be within their jurisdiction: 7055 (a) the attorney general or an assistant attorney general; 7056 (b) the district attorney or county attorney who has criminal jurisdiction over the death 7057 or case; 7058 (c) a deputy of the district attorney or county attorney described in Subsection (1)(b); 7059 or 7060 (d) a peace officer within the jurisdiction described in Subsection (1)(b). 7061 (2) If, in the opinion of the medical examiner, an autopsy should be performed or if an 7062 autopsy is requested by the district attorney or county attorney having criminal jurisdiction, or 7063 by the attorney general, the autopsy shall be performed by the medical examiner or a regional 7064 pathologist. 02-10-23 5:41 PM S.B. 39 - 229 - 7065 Section 214. Section 26B-8-205, which is renumbered from Section 26-4-7 is 7066 renumbered and amended to read: 7067 [26-4-7]. 26B-8-205. Custody by medical examiner. 7068 Upon notification under Section [26-4-8] 26B-8-206 or investigation by the medical 7069 examiner's office, the medical examiner shall assume custody of a deceased body if it appears 7070 that death: 7071 (1) was by violence, gunshot, suicide, or accident; 7072 (2) was sudden death while in apparent good health; 7073 (3) occurred unattended, except that an autopsy may only be performed in accordance 7074 with the provisions of Subsection [26-4-9] 26B-8-207(3); 7075 (4) occurred under suspicious or unusual circumstances; 7076 (5) resulted from poisoning or overdose of drugs; 7077 (6) resulted from a disease that may constitute a threat to the public health; 7078 (7) resulted from disease, injury, toxic effect, or unusual exertion incurred within the 7079 scope of the decedent's employment; 7080 (8) was due to sudden infant death syndrome; 7081 (9) occurred while the decedent was in prison, jail, police custody, the state hospital, or 7082 in a detention or medical facility operated for the treatment of persons with a mental illness, 7083 persons who are emotionally disturbed, or delinquent persons; 7084 (10) resulted directly from the actions of a law enforcement officer, as defined in 7085 Section 53-13-103; 7086 (11) was associated with diagnostic or therapeutic procedures; or 7087 (12) was described in this section when request is made to assume custody by a county 7088 or district attorney or law enforcement agency in connection with a potential homicide 7089 investigation or prosecution. 7090 Section 215. Section 26B-8-206, which is renumbered from Section 26-4-8 is 7091 renumbered and amended to read: 7092 [26-4-8]. 26B-8-206. Discovery of dead body -- Notice requirements -- 7093 Procedure. 7094 (1) When death occurs under circumstances listed in Section [26-4-7] 26B-8-205, the 7095 person or persons finding or having custody of the body shall immediately notify the nearest S.B. 39 02-10-23 5:41 PM - 230 - 7096 law enforcement agency. The law enforcement agency having jurisdiction over the case shall 7097 then proceed to the place where the body is and conduct an investigation concerning the cause 7098 and circumstances of death for the purpose of determining whether there exists any criminal 7099 responsibility for the death. 7100 (2) On a determination by the law enforcement agency that death may have occurred in 7101 any of the ways described in Section [26-4-7] 26B-8-205, the death shall be reported to the 7102 district attorney or county attorney having criminal jurisdiction and to the medical examiner by 7103 the law enforcement agency having jurisdiction over the investigation. 7104 (3) The report shall be made by the most expeditious means available. Failure to give 7105 notification or report to the district attorney or county attorney having criminal jurisdiction and 7106 medical examiner is a class B misdemeanor. 7107 Section 216. Section 26B-8-207, which is renumbered from Section 26-4-9 is 7108 renumbered and amended to read: 7109 [26-4-9]. 26B-8-207. Custody of dead body and personal effects -- 7110 Examination of scene of death -- Preservation of body -- Autopsies. 7111 (1) (a) Upon notification of a death under Section [26-4-8] 26B-8-206, the medical 7112 examiner shall assume custody of the deceased body, clothing on the body, biological samples 7113 taken, and any article on or near the body which may aid the medical examiner in determining 7114 the cause of death except those articles which will assist the investigative agency to proceed 7115 without delay with the investigation. 7116 (b) In all cases the scene of the event may not be disturbed until authorization is given 7117 by the senior ranking peace officer from the law enforcement agency having jurisdiction of the 7118 case and conducting the investigation. 7119 (c) Where death appears to have occurred under circumstances listed in Section 7120 [26-4-7] 26B-8-205, the person or persons finding or having custody of the body, or 7121 jurisdiction over the investigation of the death, shall take reasonable precautions to preserve the 7122 body and body fluids so that minimum deterioration takes place. 7123 (d) A person may not move a body in the custody of the medical examiner unless: 7124 (i) the medical examiner, or district attorney or county attorney that has criminal 7125 jurisdiction, authorizes the person to move the body; 7126 (ii) a designee of an individual listed in Subsection (1)(d) authorizes the person to 02-10-23 5:41 PM S.B. 39 - 231 - 7127 move the body; 7128 (iii) not moving the body would be an affront to public decency or impractical; or 7129 (iv) the medical examiner determines the cause of death is likely due to natural causes. 7130 (e) The body can under direction of the medical examiner or the medical examiner's 7131 designee be moved to a place specified by the medical examiner or the medical examiner's 7132 designee. 7133 (2) (a) If the medical examiner has custody of a body, a person may not clean or 7134 embalm the body without first obtaining the medical examiner's permission. 7135 (b) An intentional or knowing violation of Subsection (2)(a) is a class B misdemeanor. 7136 (3) (a) When the medical examiner assumes lawful custody of a body under Subsection 7137 [26-4-7] 26B-8-205(3) solely because the death was unattended, an autopsy may not be 7138 performed unless requested by the district attorney, county attorney having criminal 7139 jurisdiction, or law enforcement agency having jurisdiction of the place where the body is 7140 found. 7141 (b) The county attorney or district attorney and law enforcement agency having 7142 jurisdiction shall consult with the medical examiner to determine the need for an autopsy. 7143 (c) If the deceased chose not to be seen or treated by a health care professional for a 7144 spiritual or religious reason, a district attorney, county attorney, or law enforcement agency, 7145 may not request an autopsy or inquest under Subsection (3)(a) solely because of the deceased's 7146 choice. 7147 (d) The medical examiner or medical examiner's designee may not conduct a requested 7148 autopsy described in Subsection (3)(a) if the medical examiner or medical examiner's designee 7149 determines: 7150 (i) the request violates Subsection (3)(c); or 7151 (ii) the cause of death can be determined without performing an autopsy. 7152 Section 217. Section 26B-8-208, which is renumbered from Section 26-2-18.5 is 7153 renumbered and amended to read: 7154 [26-2-18.5]. 26B-8-208. Rendering a dead body unavailable for postmortem 7155 investigation. 7156 (1) As used in this section: 7157 (a) "Medical examiner" means the same as that term is defined in Section [26-4-2] S.B. 39 02-10-23 5:41 PM - 232 - 7158 26B-8-201. 7159 (b) "Unavailable for postmortem investigation" means the same as that term is defined 7160 in Section [26-4-2] 26B-8-201. 7161 (2) It is unlawful for a person to engage in any conduct that makes a dead body 7162 unavailable for postmortem investigation, unless, before engaging in that conduct, the person 7163 obtains a permit from the medical examiner to render the dead body unavailable for 7164 postmortem investigation, under Section [26-4-29] 26B-8-230, if the person intends to make 7165 the body unavailable for postmortem investigation. 7166 (3) A person who violates Subsection (2) is guilty of a third degree felony. 7167 (4) If a person engages in conduct that constitutes both a violation of this section and a 7168 violation of Section 76-9-704, the provisions and penalties of Section 76-9-704 supersede the 7169 provisions and penalties of this section. 7170 Section 218. Section 26B-8-209, which is renumbered from Section 26-4-10 is 7171 renumbered and amended to read: 7172 [26-4-10]. 26B-8-209. Certification of cause of death. 7173 (1) (a) For a death under any of the circumstances described in Section [26-4-7] 7174 26B-8-205, only the medical examiner or the medical examiner's designee may certify the 7175 cause of death. 7176 (b) An individual who knowingly certifies the cause of death in violation of Subsection 7177 (1)(a) is guilty of a class B misdemeanor. 7178 (2) (a) For a death described in Section [26-4-7] 26B-8-205, an individual may not 7179 knowingly give false information, with the intent to mislead, to the medical examiner or the 7180 medical examiner's designee. 7181 (b) A violation of Subsection (2)(a) is a class B misdemeanor. 7182 Section 219. Section 26B-8-210, which is renumbered from Section 26-4-10.5 is 7183 renumbered and amended to read: 7184 [26-4-10.5]. 26B-8-210. Medical examiner to report death caused by prescribed 7185 controlled substance poisoning or overdose. 7186 (1) If a medical examiner determines that the death of a person who is 12 years old or 7187 older at the time of death resulted from poisoning or overdose involving a prescribed controlled 7188 substance, the medical examiner shall, within three business days after the day on which the 02-10-23 5:41 PM S.B. 39 - 233 - 7189 medical examiner determines the cause of death, send a written report to the Division of 7190 Professional Licensing, created in Section 58-1-103, that includes: 7191 (a) the decedent's name; 7192 (b) each drug or other substance found in the decedent's system that may have 7193 contributed to the poisoning or overdose, if known; and 7194 (c) the name of each person the medical examiner has reason to believe may have 7195 prescribed a controlled substance described in Subsection (1)(b) to the decedent. 7196 (2) This section does not create a new cause of action. 7197 Section 220. Section 26B-8-211, which is renumbered from Section 26-4-11 is 7198 renumbered and amended to read: 7199 [26-4-11]. 26B-8-211. Records and reports of investigations. 7200 (1) A complete copy of all written records and reports of investigations and facts 7201 resulting from medical care treatment, autopsies conducted by any person on the body of the 7202 deceased who died in any manner listed in Section [26-4-7] 26B-8-205 and the written reports 7203 of any investigative agency making inquiry into the incident shall be promptly made and filed 7204 with the medical examiner. 7205 (2) The judiciary or a state or local government entity that retains a record, other than a 7206 document described in Subsection (1), of the decedent shall provide a copy of the record to the 7207 medical examiner: 7208 (a) in accordance with federal law; and 7209 (b) upon receipt of the medical examiner's written request for the record. 7210 (3) Failure to submit reports or records described in Subsection (1) or (2), other than 7211 reports of a county attorney, district attorney, or law enforcement agency, within 10 days after 7212 the day on which the person in possession of the report or record receives the medical 7213 examiner's written request for the report or record is a class B misdemeanor. 7214 Section 221. Section 26B-8-212, which is renumbered from Section 26-4-12 is 7215 renumbered and amended to read: 7216 [26-4-12]. 26B-8-212. Order to exhume body -- Procedure. 7217 (1) In case of any death described in Section [26-4-7] 26B-8-205, when a body is 7218 buried without an investigation by the medical examiner as to the cause and manner of death, it 7219 shall be the duty of the medical examiner, upon being advised of the fact, to notify the district S.B. 39 02-10-23 5:41 PM - 234 - 7220 attorney or county attorney having criminal jurisdiction where the body is buried or death 7221 occurred. Upon notification, the district attorney or county attorney having criminal 7222 jurisdiction may file an action in the district court to obtain an order to exhume the body. A 7223 district judge may order the body exhumed upon an ex parte hearing. 7224 (2) (a) A body may not be exhumed until notice of the order has been served upon the 7225 executor or administrator of the deceased's estate, or if no executor or administrator has been 7226 appointed, upon the nearest heir of the deceased, determined as if the deceased had died 7227 intestate. If the nearest heir of the deceased cannot be located within the jurisdiction, then the 7228 next heir in succession within the jurisdiction may be served. 7229 (b) The executor, administrator, or heir shall have 24 hours to notify the issuing court 7230 of any objection to the order prior to the time the body is exhumed. If no heirs can be located 7231 within the jurisdiction within 24 hours, the facts shall be reported to the issuing court which 7232 may order that the body be exhumed forthwith. 7233 (c) Notification to the executor, administrator, or heir shall specifically state the nature 7234 of the action and the fact that any objection shall be filed with the issuing court within 24 hours 7235 of the time of service. 7236 (d) In the event an heir files an objection, the court shall set hearing on the matter at the 7237 earliest possible time and issue an order on the matter immediately at the conclusion of the 7238 hearing. Upon the receipt of notice of objection, the court shall immediately notify the county 7239 attorney who requested the order, so that the interest of the state may be represented at the 7240 hearing. 7241 (e) When there is reason to believe that death occurred in a manner described in 7242 Section [26-4-7] 26B-8-205, the district attorney or county attorney having criminal 7243 jurisdiction may make a motion that the court, upon ex parte hearing, order the body exhumed 7244 forthwith and without notice. Upon a showing of exigent circumstances the court may order 7245 the body exhumed forthwith and without notice. In any event, upon motion of the district 7246 attorney or county attorney having criminal jurisdiction and upon the personal appearance of 7247 the medical examiner, the court for good cause may order the body exhumed forthwith and 7248 without notice. 7249 (3) An order to exhume a body shall be directed to the medical examiner, commanding 7250 the medical examiner to cause the body to be exhumed, perform the required autopsy, and 02-10-23 5:41 PM S.B. 39 - 235 - 7251 properly cause the body to be reburied upon completion of the examination. 7252 (4) The examination shall be completed and the complete autopsy report shall be made 7253 to the district attorney or county attorney having criminal jurisdiction for any action the 7254 attorney considers appropriate. The district attorney or county attorney shall submit the return 7255 of the order to exhume within 10 days in the manner prescribed by the issuing court. 7256 Section 222. Section 26B-8-213, which is renumbered from Section 26-4-13 is 7257 renumbered and amended to read: 7258 [26-4-13]. 26B-8-213. Autopsies -- When authorized. 7259 (1) The medical examiner shall perform an autopsy to: 7260 (a) aid in the discovery and prosecution of a crime; 7261 (b) protect an innocent person accused of a crime; and 7262 (c) disclose hazards to public health. 7263 (2) The medical examiner may perform an autopsy: 7264 (a) to aid in the administration of civil justice in life and accident insurance problems 7265 in accordance with Title 34A, Chapter 2, Workers' Compensation Act; 7266 (b) in other cases involving questions of civil liability. 7267 Section 223. Section 26B-8-214, which is renumbered from Section 26-4-14 is 7268 renumbered and amended to read: 7269 [26-4-14]. 26B-8-214. Certification of death by attending health care 7270 professional -- Deaths without medical attendance -- Cause of death uncertain -- Notice 7271 requirements. 7272 (1) (a) A health care professional who treats or examines an individual within 365 days 7273 from the day on which the individual dies, shall certify the individual's cause of death to the 7274 best of the health care professional's knowledge and belief unless the health care professional 7275 determines the individual may have died in a manner described in Section [26-4-7] 26B-8-205. 7276 (b) If a health care professional is unable to determine an individual's cause of death in 7277 accordance with Subsection (1)(a), the health care professional shall notify the medical 7278 examiner. 7279 (2) For an unattended death, the person with custody of the body shall notify the 7280 medical examiner of the death. 7281 (3) If the medical examiner determines there may be criminal responsibility for a death, S.B. 39 02-10-23 5:41 PM - 236 - 7282 the medical examiner shall notify: 7283 (a) the district attorney or county attorney that has criminal jurisdiction; or 7284 (b) the head of the law enforcement agency that has jurisdiction to investigate the 7285 death. 7286 Section 224. Section 26B-8-215, which is renumbered from Section 26-4-15 is 7287 renumbered and amended to read: 7288 [26-4-15]. 26B-8-215. Deaths in medical centers and federal facilities. 7289 All death certificates of any decedent who died in a teaching medical center or a federal 7290 medical facility unattended or in the care of an unlicensed physician or other medical personnel 7291 shall be signed by the licensed supervisory physician, attending physician or licensed resident 7292 physician of the medical center or facility. 7293 Section 225. Section 26B-8-216, which is renumbered from Section 26-4-16 is 7294 renumbered and amended to read: 7295 [26-4-16]. 26B-8-216. Release of body for funeral preparations. 7296 (1) (a) Where a body is held for investigation or autopsy under this chapter or for a 7297 medical investigation permitted by law, the body shall, if requested by the person given priority 7298 under Section 58-9-602, be released for funeral preparations no later than 24 hours after the 7299 arrival at the office of the medical examiner or regional medical facility. 7300 (b) An extension may be ordered only by a district court. 7301 (2) The right and duty to control the disposition of a deceased person is governed by 7302 Sections 58-9-601 through 58-9-606. 7303 Section 226. Section 26B-8-217, which is renumbered from Section 26-4-17 is 7304 renumbered and amended to read: 7305 [26-4-17]. 26B-8-217. Records of medical examiner -- Confidentiality. 7306 (1) The medical examiner shall maintain complete, original records for the medical 7307 examiner record, which shall: 7308 (a) be properly indexed, giving the name, if known, or otherwise identifying every 7309 individual whose death is investigated; 7310 (b) indicate the place where the body was found; 7311 (c) indicate the date of death; 7312 (d) indicate the cause and manner of death; 02-10-23 5:41 PM S.B. 39 - 237 - 7313 (e) indicate the occupation of the decedent, if available; 7314 (f) include all other relevant information concerning the death; and 7315 (g) include a full report and detailed findings of the autopsy or report of the 7316 investigation. 7317 (2) (a) Upon written request from an individual described in Subsections (2)(a)(i) 7318 through (iv), the medical examiner shall provide a copy of the medical examiner's final report 7319 of examination for the decedent, including the autopsy report, toxicology report, lab reports, 7320 and investigative reports to any of the following: 7321 (i) a decedent's immediate relative; 7322 (ii) a decedent's legal representative; 7323 (iii) a physician or physician assistant who attended the decedent during the year before 7324 the decedent's death; or 7325 (iv) a county attorney, a district attorney, a criminal defense attorney, or other law 7326 enforcement official with jurisdiction, as necessary for the performance of the attorney or 7327 official's professional duties. 7328 (b) Upon written request from the director or a designee of the director of an entity 7329 described in Subsections (2)(b)(i) through (iv), the medical examiner may provide a copy of the 7330 of the medical examiner's final report of examination for the decedent, including any other 7331 reports described in Subsection (2)(a), to any of the following entities as necessary for 7332 performance of the entity's official purposes: 7333 (i) a local health department; 7334 (ii) a local mental health authority; 7335 (iii) a public health authority; or 7336 (iv) another state or federal governmental agency. 7337 (c) The medical examiner may provide a copy of the medical examiner's final report of 7338 examination, including any other reports described in Subsection (2)(a), if the final report 7339 relates to an issue of public health or safety, as further defined by rule made by the department 7340 in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act. 7341 (3) Reports provided under Subsection (2) may not include records that the medical 7342 examiner obtains from a third party in the course of investigating the decedent's death. 7343 (4) The medical examiner may provide a medical examiner record to a researcher who: S.B. 39 02-10-23 5:41 PM - 238 - 7344 (a) has an advanced degree; 7345 (b) (i) is affiliated with an accredited college or university, a hospital, or another 7346 system of care, including an emergency medical response or a local health agency; or 7347 (ii) is part of a research firm contracted with an accredited college or university, a 7348 hospital, or another system of care; 7349 (c) requests a medical examiner record for a research project or a quality improvement 7350 initiative that will have a public health benefit, as determined by the department; and 7351 (d) provides to the medical examiner an approval from: 7352 (i) the researcher's sponsoring organization; and 7353 (ii) the Utah Department of Health and Human Services Institutional Review Board. 7354 (5) Records provided under Subsection (4) may not include a third party record, unless: 7355 (a) a court has ordered disclosure of the third party record; and 7356 (b) disclosure is conducted in compliance with state and federal law. 7357 (6) A person who obtains a medical examiner record under Subsection (4) shall: 7358 (a) maintain the confidentiality of the medical examiner record by removing personally 7359 identifying information about a decedent or the decedent's family and any other information 7360 that may be used to identify a decedent before using the medical examiner record in research; 7361 (b) conduct any research within and under the supervision of the Office of the Medical 7362 Examiner, if the medical examiner record contains a third party record with personally 7363 identifiable information; 7364 (c) limit the use of a medical examiner record to the purpose for which the person 7365 requested the medical examiner record; 7366 (d) destroy a medical examiner record and the data abstracted from the medical 7367 examiner record at the conclusion of the research for which the person requested the medical 7368 examiner record; 7369 (e) reimburse the medical examiner, as provided in Section 26B-1-209, for any costs 7370 incurred by the medical examiner in providing a medical examiner record; 7371 (f) allow the medical examiner to review, before public release, a publication in which 7372 data from a medical examiner record is referenced or analyzed; and 7373 (g) provide the medical examiner access to the researcher's database containing data 7374 from a medical examiner record, until the day on which the researcher permanently destroys 02-10-23 5:41 PM S.B. 39 - 239 - 7375 the medical examiner record and all data obtained from the medical examiner record. 7376 (7) The department may make rules, in accordance with Title 63G, Chapter 3, Utah 7377 Administrative Rulemaking Act, and in consideration of applicable state and federal law, to 7378 establish permissible uses and disclosures of a medical examiner record or other record 7379 obtained under this section. 7380 (8) Except as provided in this chapter or ordered by a court, the medical examiner may 7381 not disclose any part of a medical examiner record. 7382 (9) A person who obtains a medical examiner record under Subsection (4) is guilty of a 7383 class B misdemeanor, if the person fails to comply with the requirements of Subsections (6)(a) 7384 through (d). 7385 Section 227. Section 26B-8-218, which is renumbered from Section 26-4-18 is 7386 renumbered and amended to read: 7387 [26-4-18]. 26B-8-218. Records of medical examiner -- Admissibility as 7388 evidence -- Subpoena of person who prepared record. 7389 The records of the medical examiner or transcripts thereof certified by the medical 7390 examiner are admissible as evidence in any civil action in any court in this state except that 7391 statements by witnesses or other persons, unless taken pursuant to Section [26-4-21] 7392 26B-8-221, as conclusions upon extraneous matters are not hereby made admissible. The 7393 person who prepared a report or record offered in evidence hereunder may be subpoenaed as a 7394 witness in the case by any party. 7395 Section 228. Section 26B-8-219, which is renumbered from Section 26-4-19 is 7396 renumbered and amended to read: 7397 [26-4-19]. 26B-8-219. Personal property of deceased -- Disposition. 7398 (1) Personal property of the deceased not held as evidence shall be turned over to the 7399 legal representative of the deceased within 30 days after completion of the investigation of the 7400 death of the deceased. If no legal representative is known, the county attorney, district attorney, 7401 or the medical examiner shall, within 30 days after the investigation, turn the personal property 7402 over to the county treasurer to be handled pursuant to the escheat laws. 7403 (2) An affidavit shall be filed with the county treasurer by the county attorney, district 7404 attorney, or the medical examiner within 30 days after investigation of the death of the 7405 deceased showing the money or other property belonging to the estate of the deceased person S.B. 39 02-10-23 5:41 PM - 240 - 7406 which has come into his possession and the disposition made of the property. 7407 (3) Property required to be turned over to the legal representative of the deceased may 7408 be held longer than 30 days if, in the opinion of the county attorney, district attorney, or 7409 attorney general, the property is necessary evidence in a court proceeding. Upon conclusion of 7410 the court proceedings, the personal property shall be turned over as described in this section 7411 and in accordance with the rules of the court. 7412 Section 229. Section 26B-8-220, which is renumbered from Section 26-4-20 is 7413 renumbered and amended to read: 7414 [26-4-20]. 26B-8-220. Officials not liable for authorized acts. 7415 Except as provided in this [chapter] part, a criminal or civil action may not arise against 7416 the county attorney, district attorney, or his deputies, the medical examiner or his deputies, or 7417 regional pathologists for authorizing or performing autopsies authorized by this [chapter] part 7418 or for any other act authorized by this [chapter] part. 7419 Section 230. Section 26B-8-221, which is renumbered from Section 26-4-21 is 7420 renumbered and amended to read: 7421 [26-4-21]. 26B-8-221. Authority of county attorney or district attorney to 7422 subpoena witnesses and compel testimony -- Determination if decedent died by unlawful 7423 means. 7424 (1) The district attorney or county attorney having criminal jurisdiction may subpoena 7425 witnesses and compel testimony concerning the death of any person and have such testimony 7426 reduced to writing under his direction and may employ a shorthand reporter for that purpose at 7427 the same compensation as is allowed to reporters in the district courts. When the testimony has 7428 been taken down by the shorthand reporter, a transcript thereof, duly certified, shall constitute 7429 the deposition of the witness. 7430 (2) Upon review of all facts and testimony taken concerning the death of a person, the 7431 district attorney or county attorney having criminal jurisdiction shall determine if the decedent 7432 died by unlawful means and shall also determine if criminal prosecution shall be instituted. 7433 Section 231. Section 26B-8-222, which is renumbered from Section 26-4-22 is 7434 renumbered and amended to read: 7435 [26-4-22]. 26B-8-222. Additional powers and duties of department. 7436 The department may: 02-10-23 5:41 PM S.B. 39 - 241 - 7437 (1) establish rules to carry out the provisions of this [chapter] part; 7438 (2) arrange for the state health laboratory to perform toxicologic analysis for public or 7439 private institutions and fix fees for the services; 7440 (3) cooperate and train law enforcement personnel in the techniques of criminal 7441 investigation as related to medical and pathological matters; and 7442 (4) pay to private parties, institutions or funeral directors the reasonable value of 7443 services performed for the medical examiner's office. 7444 Section 232. Section 26B-8-223, which is renumbered from Section 26-4-23 is 7445 renumbered and amended to read: 7446 [26-4-23]. 26B-8-223. Authority of examiner to provide organ or other tissue 7447 for transplant purposes. 7448 (1) When requested by the licensed physician of a patient who is in need of an organ or 7449 other tissue for transplant purpose, by a legally created Utah eye bank, organ bank or medical 7450 facility, the medical examiner may provide an organ or other tissue if: 7451 (a) a decedent who may provide a suitable organ or other tissue for the transplant is in 7452 the custody of the medical examiner; 7453 (b) the medical examiner is assured that the requesting party has made reasonable 7454 search for and inquiry of next of kin of the decedent and that no objection by the next of kin is 7455 known by the requesting party; and 7456 (c) the removal of the organ or other tissue will not interfere with the investigation or 7457 autopsy or alter the post-mortem facial appearance. 7458 (2) When the medical examiner is in custody of a decedent who may provide a suitable 7459 organ or other tissue for transplant purposes, he may contact the appropriate eye bank, organ 7460 bank or medical facility and notify them concerning the suitability of the organ or other tissue. 7461 In such contact the medical examiner may disclose the name of the decedent so that necessary 7462 clearances can be obtained. 7463 (3) No person shall be held civilly or criminally liable for any acts performed pursuant 7464 to this section. 7465 Section 233. Section 26B-8-224, which is renumbered from Section 26-4-24 is 7466 renumbered and amended to read: 7467 [26-4-24]. 26B-8-224. Autopsies -- Persons eligible to authorize. S.B. 39 02-10-23 5:41 PM - 242 - 7468 (1) Autopsies may be authorized: 7469 (a) by the commissioner of the Labor Commission or the commissioner's designee as 7470 provided in Section 34A-2-603; 7471 (b) by individuals by will or other written document; 7472 (c) upon a decedent by the next of kin in the following order and as known: surviving 7473 spouse, child, if 18 years or older, otherwise the legal guardian of the child, parent, sibling, 7474 uncle or aunt, nephew or niece, cousin, others charged by law with the duty of burial, or friend 7475 assuming the obligation of burial; 7476 (d) by the county attorney, district attorney, or the district attorney's deputy, or a district 7477 judge; and 7478 (e) by the medical examiner as provided in this [chapter] part. 7479 (2) Autopsies authorized under Subsections (1)(a) and (1)(d) shall be performed by a 7480 certified pathologist. 7481 (3) No criminal or civil action arises against a pathologist or a physician who proceeds 7482 in good faith and performs an autopsy authorized by this section. 7483 Section 234. Section 26B-8-225, which is renumbered from Section 26-4-25 is 7484 renumbered and amended to read: 7485 [26-4-25]. 26B-8-225. Burial of an unclaimed body -- Request by the school of 7486 medicine at the University of Utah -- Medical examiner may retain tissue for dog 7487 training. 7488 (1) Except as described in Subsection (2) or (3), a county shall provide, at the county's 7489 expense, decent burial for an unclaimed body found in the county. 7490 (2) A county is not responsible for decent burial of an unclaimed body found in the 7491 county if the body is requested by the dean of the school of medicine at the University of Utah 7492 under Section 53B-17-301. 7493 (3) For an unclaimed body that is temporarily in the medical examiner's custody before 7494 burial under Subsection (1), the medical examiner may retain tissue from the unclaimed body 7495 in order to donate the tissue to an individual who is affiliated with an established search and 7496 rescue dog organization, for the purpose of training a dog to search for human remains. 7497 Section 235. Section 26B-8-226, which is renumbered from Section 26-4-26 is 7498 renumbered and amended to read: 02-10-23 5:41 PM S.B. 39 - 243 - 7499 [26-4-26]. 26B-8-226. Social security number in certification of death. 7500 A certification of death shall include, if known, the social security number of the 7501 deceased person, and a copy of the certification shall be sent to the Office of Recovery Services 7502 within the [Department of Human Services] department upon request. 7503 Section 236. Section 26B-8-227, which is renumbered from Section 26-4-27 is 7504 renumbered and amended to read: 7505 [26-4-27]. 26B-8-227. Registry of unidentified deceased persons. 7506 (1) If the identity of a deceased person over which the medical examiner has 7507 jurisdiction under Section [26-4-7] 26B-8-205 is unknown, the medical examiner shall do the 7508 following before releasing the body to the county in which the body was found as provided in 7509 Section [26-4-25] 26B-8-225: 7510 (a) assign a unique identifying number to the body; 7511 (b) create and maintain a file under the assigned number; 7512 (c) examine the body, take samples, and perform other related tasks for the purpose of 7513 deriving information that may be useful in ascertaining the identity of the deceased person; 7514 (d) use the identifying number in all records created by the medical examiner that 7515 pertains to the body; 7516 (e) record all information pertaining to the body in the file created and maintained 7517 under Subsection (1)(b); 7518 (f) communicate the unique identifying number to the county in which the body was 7519 found; and 7520 (g) access information from available government sources and databases in an attempt 7521 to ascertain the identity of the deceased person. 7522 (2) A county which has received a body to which Subsection (1) applies: 7523 (a) shall adopt and use the same identifying number assigned by Subsection (1) in all 7524 records created by the county that pertain to the body; 7525 (b) require any funeral director or sexton who is involved in the disposition of the body 7526 to adopt and use the same identifying number assigned by Subsection (1) in all records created 7527 by the funeral director or sexton pertaining to the body; and 7528 (c) shall provide a decent burial for the body. 7529 (3) Within 30 days of receiving a body to which Subsection (1) applies, the county S.B. 39 02-10-23 5:41 PM - 244 - 7530 shall inform the medical examiner of the disposition of the body including the burial plot. The 7531 medical examiner shall record this information in the file created and maintained under 7532 Subsection (1)(b). 7533 (4) The requirements of Subsections (1) and (6) apply to a county examiner appointed 7534 under Section [26-4-5] 26B-8-203, with the additional requirements that the county examiner: 7535 (a) obtain a unique identifying number from the medical examiner for the body; and 7536 (b) send to the medical examiner a copy of the file created and maintained in 7537 accordance with Subsection (1)(b), including the disposition of the body and burial plot, within 7538 30 days of releasing the body. 7539 (5) The medical examiner shall maintain a file received under Subsection (4) in the 7540 same way that it maintains a file created and maintained by the medical examiner in accordance 7541 with Subsection (1)(b). 7542 (6) The medical examiner shall cooperate and share information generated and 7543 maintained under this section with a person who demonstrates: 7544 (a) a legitimate personal or governmental interest in determining the identity of a 7545 deceased person; and 7546 (b) a reasonable belief that the body of that deceased person may have come into the 7547 custody of the medical examiner. 7548 Section 237. Section 26B-8-228, which is renumbered from Section 26-4-28 is 7549 renumbered and amended to read: 7550 [26-4-28]. 26B-8-228. Testing for suspected suicides -- Maintaining 7551 information -- Compensation to deputy medical examiners. 7552 (1) In all cases where it is suspected that a death resulted from suicide, including 7553 assisted suicide, the medical examiner shall endeavor to have the following tests conducted 7554 upon samples taken from the body of the deceased: 7555 (a) a test that detects all of the substances included in the volatiles panel of the Bureau 7556 of Forensic Toxicology within the [Department of Health] department; 7557 (b) a test that detects all of the substances included in the drugs of abuse panel of the 7558 Bureau of Forensic Toxicology within the [Department of Health] department; and 7559 (c) a test that detects all of the substances included in the prescription drug panel of the 7560 Bureau of Forensic Toxicology within the [Department of Health] department. 02-10-23 5:41 PM S.B. 39 - 245 - 7561 (2) The medical examiner shall maintain information regarding the types of substances 7562 found present in the samples taken from the body of a person who is suspected to have died as 7563 a result of suicide or assisted suicide. 7564 (3) Within funds appropriated by the Legislature for this purpose, the medical 7565 examiner shall provide compensation, at a standard rate determined by the medical examiner, 7566 to a deputy medical examiner who collects samples for the purposes described in Subsection 7567 (1). 7568 Section 238. Section 26B-8-229, which is renumbered from Section 26-4-28.5 is 7569 renumbered and amended to read: 7570 [26-4-28.5]. 26B-8-229. Psychological autopsy examiner. 7571 (1) With funds appropriated by the Legislature for this purpose, the department shall 7572 provide compensation, at a standard rate determined by the department, to a psychological 7573 autopsy examiner. 7574 (2) The psychological autopsy examiner shall: 7575 (a) work with the medical examiner to compile data regarding suicide related deaths; 7576 (b) as relatives of the deceased are willing, gather information from relatives of the 7577 deceased regarding the psychological reasons for the decedent's death; 7578 (c) maintain a database of information described in Subsections (2)(a) and (b); 7579 (d) in accordance with all applicable privacy laws subject to approval by the 7580 department, share the database described in Subsection (2)(c) with the University of Utah 7581 Department of Psychiatry or other university-based departments conducting research on 7582 suicide; 7583 (e) coordinate no less than monthly with the suicide prevention coordinator described 7584 in Subsection [62A-15-1101] 26B-5-611(2); and 7585 (f) coordinate no less than quarterly with the state suicide prevention coalition. 7586 Section 239. Section 26B-8-230, which is renumbered from Section 26-4-29 is 7587 renumbered and amended to read: 7588 [26-4-29]. 26B-8-230. Application for permit to render a dead body 7589 unavailable for postmortem examination -- Fees. 7590 (1) Upon receiving an application by a person for a permit to render a dead body 7591 unavailable for postmortem investigation, the medical examiner shall review the application to S.B. 39 02-10-23 5:41 PM - 246 - 7592 determine whether: 7593 (a) the person is authorized by law to render the dead body unavailable for postmortem 7594 investigation in the manner specified in the application; and 7595 (b) there is a need to delay any action that will render the dead body unavailable for 7596 postmortem investigation until a postmortem investigation or an autopsy of the dead body is 7597 performed by the medical examiner. 7598 (2) Except as provided in Subsection (4), within three days after receiving an 7599 application described in Subsection (1), the medical examiner shall: 7600 (a) make the determinations described in Subsection (1); and 7601 (b) (i) issue a permit to render the dead body unavailable for postmortem investigation 7602 in the manner specified in the application; or 7603 (ii) deny the permit. 7604 (3) The medical examiner may deny a permit to render a dead body unavailable for 7605 postmortem investigation only if: 7606 (a) the applicant is not authorized by law to render the dead body unavailable for 7607 postmortem investigation in the manner specified in the application; 7608 (b) the medical examiner determines that there is a need to delay any action that will 7609 render the dead body unavailable for postmortem investigation; or 7610 (c) the applicant fails to pay the fee described in Subsection (5). 7611 (4) If the medical examiner cannot in good faith make the determinations described in 7612 Subsection (1) within three days after receiving an application described in Subsection (1), the 7613 medical examiner shall notify the applicant: 7614 (a) that more time is needed to make the determinations described in Subsection (1); 7615 and 7616 (b) of the estimated amount of time needed before the determinations described in 7617 Subsection (1) can be made. 7618 (5) The medical examiner may charge a fee, pursuant to Section 63J-1-504, to recover 7619 the costs of fulfilling the duties of the medical examiner described in this section. 7620 Section 240. Section 26B-8-231, which is renumbered from Section 26-4-30 is 7621 renumbered and amended to read: 7622 [26-4-30]. 26B-8-231. Overdose fatality examiner. 02-10-23 5:41 PM S.B. 39 - 247 - 7623 (1) Within funds appropriated by the Legislature, the department shall provide 7624 compensation, at a standard rate determined by the department, to an overdose fatality 7625 examiner. 7626 (2) The overdose fatality examiner shall: 7627 (a) work with the medical examiner to compile data regarding overdose and opioid 7628 related deaths, including: 7629 (i) toxicology information; 7630 (ii) demographics; and 7631 (iii) the source of opioids or drugs; 7632 (b) as relatives of the deceased are willing, gather information from relatives of the 7633 deceased regarding the circumstances of the decedent's death; 7634 (c) maintain a database of information described in Subsections (2)(a) and (b); 7635 (d) coordinate no less than monthly with the suicide prevention coordinator described 7636 in Section [62A-15-1101] 26B-5-611; and 7637 (e) coordinate no less than quarterly with the Opioid and Overdose Fatality Review 7638 Committee created in Section 26-7-13. 7639 Section 241. Section 26B-8-301, which is renumbered from Section 26-28-102 is 7640 renumbered and amended to read: 7641 Part 3. Revised Uniform Anatomical Gift Act 7642 [26-28-102]. 26B-8-301. Definitions. 7643 As used in this [chapter] part: 7644 (1) "Adult" means an individual who is at least 18 years of age. 7645 (2) "Agent" means an individual: 7646 (a) authorized to make health care decisions on the principal's behalf by a power of 7647 attorney for health care; or 7648 (b) expressly authorized to make an anatomical gift on the principal's behalf by any 7649 other record signed by the principal. 7650 (3) "Anatomical gift" means a donation of all or part of a human body to take effect 7651 after the donor's death for the purpose of transplantation, therapy, research, or education. 7652 (4) "Decedent" means: 7653 (a) a deceased individual whose body or part is or may be the source of an anatomical S.B. 39 02-10-23 5:41 PM - 248 - 7654 gift; and 7655 (b) includes: 7656 (i) a stillborn infant; and 7657 (ii) subject to restrictions imposed by law other than this [chapter] part, a fetus. 7658 (5) (a) "Disinterested witness" means: 7659 (i) a witness other than the spouse, child, parent, sibling, grandchild, grandparent, or 7660 guardian of the individual who makes, amends, revokes, or refuses to make an anatomical gift; 7661 or 7662 (ii) another adult who exhibited special care and concern for the individual. 7663 (b) "Disinterested witness" does not include a person to which an anatomical gift could 7664 pass under Section [26-28-111] 26B-8-310. 7665 (6) "Document of gift" means a donor card or other record used to make an anatomical 7666 gift. The term includes a statement or symbol on a driver license, identification card, or donor 7667 registry. 7668 (7) "Donor" means an individual whose body or part is the subject of an anatomical 7669 gift. 7670 (8) "Donor registry" means a database that contains records of anatomical gifts and 7671 amendments to or revocations of anatomical gifts. 7672 (9) "Driver license" means a license or permit issued by the Driver License Division of 7673 the Department of Public Safety, to operate a vehicle, whether or not conditions are attached to 7674 the license or permit. 7675 (10) "Eye bank" means a person that is licensed, accredited, or regulated under federal 7676 or state law to engage in the recovery, screening, testing, processing, storage, or distribution of 7677 human eyes or portions of human eyes. 7678 (11) "Guardian": 7679 (a) means a person appointed by a court to make decisions regarding the support, care, 7680 education, health, or welfare of an individual; and 7681 (b) does not include a guardian ad litem. 7682 (12) "Hospital" means a facility licensed as a hospital under the law of any state or a 7683 facility operated as a hospital by the United States, a state, or a subdivision of a state. 7684 (13) "Identification card" means an identification card issued by the Driver License 02-10-23 5:41 PM S.B. 39 - 249 - 7685 Division of the Department of Public Safety. 7686 (14) "Know" means to have actual knowledge. 7687 (15) "Minor" means an individual who is under 18 years of age. 7688 (16) "Organ procurement organization" means a person designated by the Secretary of 7689 the United States Department of Health and Human Services as an organ procurement 7690 organization. 7691 (17) "Parent" means a parent whose parental rights have not been terminated. 7692 (18) "Part" means an organ, an eye, or tissue of a human being. The term does not 7693 include the whole body. 7694 (19) "Person" means an individual, corporation, business trust, estate, trust, 7695 partnership, limited liability company, association, joint venture, public corporation, 7696 government or governmental subdivision, agency, or instrumentality, or any other legal or 7697 commercial entity. 7698 (20) "Physician" means an individual authorized to practice medicine or osteopathy 7699 under the law of any state. 7700 (21) "Procurement organization" means an eye bank, organ procurement organization, 7701 or tissue bank. 7702 (22) "Prospective donor": 7703 (a) means an individual who is dead or near death and has been determined by a 7704 procurement organization to have a part that could be medically suitable for transplantation, 7705 therapy, research, or education; and 7706 (b) does not include an individual who has made a refusal. 7707 (23) "Reasonably available" means able to be contacted by a procurement organization 7708 without undue effort and willing and able to act in a timely manner consistent with existing 7709 medical criteria necessary for the making of an anatomical gift. 7710 (24) "Recipient" means an individual into whose body a decedent's part has been or is 7711 intended to be transplanted. 7712 (25) "Record" means information that is inscribed on a tangible medium or that is 7713 stored in an electronic or other medium and is retrievable in perceivable form. 7714 (26) "Refusal" means a record created under Section [26-28-107] 26B-8-306 that 7715 expressly states an intent to bar other persons from making an anatomical gift of an individual's S.B. 39 02-10-23 5:41 PM - 250 - 7716 body or part. 7717 (27) "Sign" means, with the present intent to authenticate or adopt a record: 7718 (a) to execute or adopt a tangible symbol; or 7719 (b) to attach to or logically associate with the record an electronic symbol, sound, or 7720 process. 7721 (28) "State" means a state of the United States, the District of Columbia, Puerto Rico, 7722 the United States Virgin Islands, or any territory or insular possession subject to the jurisdiction 7723 of the United States. 7724 (29) "Technician": 7725 (a) means an individual determined to be qualified to remove or process parts by an 7726 appropriate organization that is licensed, accredited, or regulated under federal or state law; and 7727 (b) includes an enucleator. 7728 (30) "Tissue" means a portion of the human body other than an organ or an eye. The 7729 term does not include blood unless the blood is donated for the purpose of research or 7730 education. 7731 (31) "Tissue bank" means a person that is licensed, accredited, or regulated under 7732 federal or state law to engage in the recovery, screening, testing, processing, storage, or 7733 distribution of tissue. 7734 (32) "Transplant hospital" means a hospital that furnishes organ transplants and other 7735 medical and surgical specialty services required for the care of transplant patients. 7736 Section 242. Section 26B-8-302, which is renumbered from Section 26-28-103 is 7737 renumbered and amended to read: 7738 [26-28-103]. 26B-8-302. Applicability. 7739 This [chapter] part applies to an anatomical gift or amendment to, revocation of, or 7740 refusal to make an anatomical gift, whenever made. 7741 Section 243. Section 26B-8-303, which is renumbered from Section 26-28-104 is 7742 renumbered and amended to read: 7743 [26-28-104]. 26B-8-303. Who may make anatomical gift before donor's 7744 death. 7745 Subject to Section [26-28-108] 26B-8-307, an anatomical gift of a donor's body or part 7746 may be made during the life of the donor for the purpose of transplantation, therapy, research, 02-10-23 5:41 PM S.B. 39 - 251 - 7747 or education in the manner provided in Section [26-28-105] 26B-8-304 by: 7748 (1) the donor, if the donor is an adult or if the donor is a minor and is: 7749 (a) emancipated; or 7750 (b) authorized under state law to apply for a driver license because the donor is at least 7751 15 years of age; 7752 (2) an agent of the donor, unless the power of attorney for health care or other record 7753 prohibits the agent from making an anatomical gift; 7754 (3) a parent of the donor, if the donor is an unemancipated minor; or 7755 (4) the donor's guardian. 7756 Section 244. Section 26B-8-304, which is renumbered from Section 26-28-105 is 7757 renumbered and amended to read: 7758 [26-28-105]. 26B-8-304. Manner of making anatomical gift before donor's 7759 death. 7760 (1) A donor may make an anatomical gift: 7761 (a) by authorizing a statement or symbol indicating that the donor has made an 7762 anatomical gift to be imprinted on the donor's driver license or identification card; 7763 (b) in a will; 7764 (c) during a terminal illness or injury of the donor, by any form of communication 7765 addressed to at least two adults, at least one of whom is a disinterested witness; or 7766 (d) as provided in Subsection (2). 7767 (2) A donor or other person authorized to make an anatomical gift under Section 7768 [26-28-104] 26B-8-303 may make a gift by a donor card or other record signed by the donor or 7769 other person making the gift or by authorizing that a statement or symbol indicating that the 7770 donor has made an anatomical gift be included on a donor registry. If the donor or other person 7771 is physically unable to sign a record, the record may be signed by another individual at the 7772 direction of the donor or other person and shall: 7773 (a) be witnessed by at least two adults, at least one of whom is a disinterested witness, 7774 who have signed at the request of the donor or the other person; and 7775 (b) state that it has been signed and witnessed as provided in Subsection (2)(a). 7776 (3) Revocation, suspension, expiration, or cancellation of a driver license or 7777 identification card upon which an anatomical gift is indicated does not invalidate the gift. S.B. 39 02-10-23 5:41 PM - 252 - 7778 (4) An anatomical gift made by will takes effect upon the donor's death whether or not 7779 the will is probated. Invalidation of the will after the donor's death does not invalidate the gift. 7780 Section 245. Section 26B-8-305, which is renumbered from Section 26-28-106 is 7781 renumbered and amended to read: 7782 [26-28-106]. 26B-8-305. Amending or revoking anatomical gift before 7783 donor's death. 7784 (1) Subject to Section [26-28-108] 26B-8-307, a donor or other person authorized to 7785 make an anatomical gift under Section [26-28-104] 26B-8-303 may amend or revoke an 7786 anatomical gift by: 7787 (a) a record signed by: 7788 (i) the donor; 7789 (ii) the other person; or 7790 (iii) subject to Subsection (2), another individual acting at the direction of the donor or 7791 the other person if the donor or other person is physically unable to sign; or 7792 (b) a later-executed document of gift that amends or revokes a previous anatomical gift 7793 or portion of an anatomical gift, either expressly or by inconsistency. 7794 (2) A record signed pursuant to Subsection (1)(a)(iii) shall: 7795 (a) be witnessed by at least two adults, at least one of whom is a disinterested witness, 7796 who have signed at the request of the donor or the other person; and 7797 (b) state that it has been signed and witnessed as provided in Subsection (1)(a). 7798 (3) Subject to Section [26-28-108] 26B-8-307, a donor or other person authorized to 7799 make an anatomical gift under Section [26-28-104] 26B-8-303 may revoke an anatomical gift 7800 by the destruction or cancellation of the document of gift, or the portion of the document of gift 7801 used to make the gift, with the intent to revoke the gift. 7802 (4) A donor may amend or revoke an anatomical gift that was not made in a will by any 7803 form of communication during a terminal illness or injury addressed to at least two adults, at 7804 least one of whom is a disinterested witness. 7805 (5) A donor who makes an anatomical gift in a will may amend or revoke the gift in the 7806 manner provided for amendment or revocation of wills or as provided in Subsection (1). 7807 Section 246. Section 26B-8-306, which is renumbered from Section 26-28-107 is 7808 renumbered and amended to read: 02-10-23 5:41 PM S.B. 39 - 253 - 7809 [26-28-107]. 26B-8-306. Refusal to make anatomical gift -- Effect of 7810 refusal. 7811 (1) An individual may refuse to make an anatomical gift of the individual's body or part 7812 by: 7813 (a) a record signed by: 7814 (i) the individual; or 7815 (ii) subject to Subsection (2), another individual acting at the direction of the individual 7816 if the individual is physically unable to sign; 7817 (b) the individual's will, whether or not the will is admitted to probate or invalidated 7818 after the individual's death; or 7819 (c) any form of communication made by the individual during the individual's terminal 7820 illness or injury addressed to at least two adults, at least one of whom is a disinterested witness. 7821 (2) A record signed pursuant to Subsection (1)(a)(ii) shall: 7822 (a) be witnessed by at least two adults, at least one of whom is a disinterested witness, 7823 who have signed at the request of the individual; and 7824 (b) state that it has been signed and witnessed as provided in Subsection (1)(a). 7825 (3) An individual who has made a refusal may amend or revoke the refusal: 7826 (a) in the manner provided in Subsection (1) for making a refusal; 7827 (b) by subsequently making an anatomical gift pursuant to Section [26-28-105] 7828 26B-8-304 that is inconsistent with the refusal; or 7829 (c) by destroying or canceling the record evidencing the refusal, or the portion of the 7830 record used to make the refusal, with the intent to revoke the refusal. 7831 (4) Except as otherwise provided in Subsection [26-28-108] 26B-8-307(8), in the 7832 absence of an express, contrary indication by the individual set forth in the refusal, an 7833 individual's unrevoked refusal to make an anatomical gift of the individual's body or part bars 7834 all other persons from making an anatomical gift of the individual's body or part. 7835 Section 247. Section 26B-8-307, which is renumbered from Section 26-28-108 is 7836 renumbered and amended to read: 7837 [26-28-108]. 26B-8-307. Preclusive effect of anatomical gift, amendment, 7838 or revocation. 7839 (1) Except as otherwise provided in Subsection (7) and subject to Subsection (6), in the S.B. 39 02-10-23 5:41 PM - 254 - 7840 absence of an express, contrary indication by the donor, a person other than the donor is barred 7841 from making, amending, or revoking an anatomical gift of a donor's body or part if the donor 7842 made an anatomical gift of the donor's body or part under Section [26-28-105] 26B-8-304 or an 7843 amendment to an anatomical gift of the donor's body or part under Section [26-28-106] 7844 26B-8-305. 7845 (2) A donor's revocation of an anatomical gift of the donor's body or part under Section 7846 [26-28-106] 26B-8-305 is not a refusal and does not bar another person specified in Section 7847 [26-28-104 or 26-28-109] 26B-8-303 or 26B-8-308 from making an anatomical gift of the 7848 donor's body or part under Section [26-28-105 or 26-28-110] 26B-8-304 or 26B-8-309. 7849 (3) If a person other than the donor makes an unrevoked anatomical gift of the donor's 7850 body or part under Section [26-28-105] 26B-8-304 or an amendment to an anatomical gift of 7851 the donor's body or part under Section [26-28-106] 26B-8-305, another person may not make, 7852 amend, or revoke the gift of the donor's body or part under Section [26-28-110] 26B-8-309. 7853 (4) A revocation of an anatomical gift of a donor's body or part under Section 7854 26-28-106 by a person other than the donor does not bar another person from making an 7855 anatomical gift of the body or part under Section [26-28-105 or 26-28-110] 26B-8-304 or 7856 26B-8-309. 7857 (5) In the absence of an express, contrary indication by the donor or other person 7858 authorized to make an anatomical gift under Section [26-28-104] 26B-8-303, an anatomical 7859 gift of a part is neither a refusal to give another part nor a limitation on the making of an 7860 anatomical gift of another part at a later time by the donor or another person. 7861 (6) In the absence of an express, contrary indication by the donor or other person 7862 authorized to make an anatomical gift under Section [26-28-104] 26B-8-303, an anatomical 7863 gift of a part for one or more of the purposes set forth in Section [26-28-104] 26B-8-303 is not 7864 a limitation on the making of an anatomical gift of the part for any of the other purposes by the 7865 donor or any other person under Section [26-28-105 or 26-28-110] 26B-8-304 or 26B-8-309. 7866 (7) If a donor who is an unemancipated minor dies, a parent of the donor who is 7867 reasonably available may revoke or amend an anatomical gift of the donor's body or part. 7868 (8) If an unemancipated minor who signed a refusal dies, a parent of the minor who is 7869 reasonably available may revoke the minor's refusal. 7870 Section 248. Section 26B-8-308, which is renumbered from Section 26-28-109 is 02-10-23 5:41 PM S.B. 39 - 255 - 7871 renumbered and amended to read: 7872 [26-28-109]. 26B-8-308. Who may make anatomical gift of decedent's 7873 body or part. 7874 (1) Subject to Subsections (2) and (3) and unless barred by Section [26-28-107 or 7875 26-28-108] 26B-8-306 or 26B-8-307, an anatomical gift of a decedent's body or part for 7876 purpose of transplantation, therapy, research, or education may be made by any member of the 7877 following classes of persons who is reasonably available, in the order of priority listed: 7878 (a) an agent of the decedent at the time of death who could have made an anatomical 7879 gift under Subsection [26-28-104] 26B-8-303(2) immediately before the decedent's death; 7880 (b) the spouse of the decedent; 7881 (c) adult children of the decedent; 7882 (d) parents of the decedent; 7883 (e) adult siblings of the decedent; 7884 (f) adult grandchildren of the decedent; 7885 (g) grandparents of the decedent; 7886 (h) the persons who were acting as the guardians of the person of the decedent at the 7887 time of death; 7888 (i) an adult who exhibited special care and concern for the decedent; and 7889 (j) any other person having the authority to dispose of the decedent's body. 7890 (2) If there is more than one member of a class listed in Subsection (1)(a), (c), (d), (e), 7891 (f), (g), or (j) entitled to make an anatomical gift, an anatomical gift may be made by a member 7892 of the class unless that member or a person to which the gift may pass under Section 7893 [26-28-111] 26B-8-310 knows of an objection by another member of the class. If an objection 7894 is known, the gift may be made only by a majority of the members of the class who are 7895 reasonably available. 7896 (3) A person may not make an anatomical gift if, at the time of the decedent's death, a 7897 person in a prior class under Subsection (1) is reasonably available to make or to object to the 7898 making of an anatomical gift. 7899 Section 249. Section 26B-8-309, which is renumbered from Section 26-28-110 is 7900 renumbered and amended to read: 7901 [26-28-110]. 26B-8-309. Manner of making, amending, or revoking S.B. 39 02-10-23 5:41 PM - 256 - 7902 anatomical gift of decedent's body or part. 7903 (1) A person authorized to make an anatomical gift under Section [26-28-109] 7904 26B-8-308 may make an anatomical gift by a document of gift signed by the person making the 7905 gift or by that person's oral communication that is electronically recorded or is 7906 contemporaneously reduced to a record and signed by the individual receiving the oral 7907 communication. 7908 (2) Subject to Subsection (3), an anatomical gift by a person authorized under Section 7909 [26-28-109] 26B-8-308 may be amended or revoked orally or in a record by any member of a 7910 prior class who is reasonably available. If more than one member of the prior class is 7911 reasonably available, the gift made by a person authorized under Section [26-28-109] 7912 26B-8-308 may be: 7913 (a) amended only if a majority of the reasonably available members agree to the 7914 amending of the gift; or 7915 (b) revoked only if a majority of the reasonably available members agree to the 7916 revoking of the gift or if they are equally divided as to whether to revoke the gift. 7917 (3) A revocation under Subsection (2) is effective only if, before an incision has been 7918 made to remove a part from the donor's body or before invasive procedures have begun to 7919 prepare the recipient, the procurement organization, transplant hospital, or physician or 7920 technician knows of the revocation. 7921 Section 250. Section 26B-8-310, which is renumbered from Section 26-28-111 is 7922 renumbered and amended to read: 7923 [26-28-111]. 26B-8-310. Persons that may receive anatomical gift -- 7924 Purpose of anatomical gift. 7925 (1) An anatomical gift may be made to the following persons named in the document 7926 of gift: 7927 (a) a hospital, accredited medical school, dental school, college, university, organ 7928 procurement organization, or other appropriate person, for research or education; 7929 (b) subject to Subsection (2), an individual designated by the person making the 7930 anatomical gift if the individual is the recipient of the part; or 7931 (c) an eye bank or tissue bank. 7932 (2) If an anatomical gift to an individual under Subsection (1)(b) cannot be 02-10-23 5:41 PM S.B. 39 - 257 - 7933 transplanted into the individual, the part passes in accordance with Subsection (7) in the 7934 absence of an express, contrary indication by the person making the anatomical gift. 7935 (3) If an anatomical gift of one or more specific parts or of all parts is made in a 7936 document of gift that does not name a person described in Subsection (1) but identifies the 7937 purpose for which an anatomical gift may be used, the following rules apply: 7938 (a) If the part is an eye and the gift is for the purpose of transplantation or therapy, the 7939 gift passes to the appropriate eye bank. 7940 (b) If the part is tissue and the gift is for the purpose of transplantation or therapy, the 7941 gift passes to the appropriate tissue bank. 7942 (c) If the part is an organ and the gift is for the purpose of transplantation or therapy, 7943 the gift passes to the appropriate organ procurement organization as custodian of the organ. 7944 (d) If the part is an organ, an eye, or tissue and the gift is for the purpose of research or 7945 education, the gift passes to the appropriate procurement organization. 7946 (4) For the purpose of Subsection (3), if there is more than one purpose of an 7947 anatomical gift set forth in the document of gift but the purposes are not set forth in any 7948 priority, the gift shall be used for transplantation or therapy, if suitable. If the gift cannot be 7949 used for transplantation or therapy, the gift may be used for research or education. 7950 (5) If an anatomical gift of one or more specific parts is made in a document of gift that 7951 does not name a person described in Subsection (1) and does not identify the purpose of the 7952 gift, the gift may be used only for transplantation or therapy, and the gift passes in accordance 7953 with Subsection (7). 7954 (6) If a document of gift specifies only a general intent to make an anatomical gift by 7955 words such as "donor," "organ donor," or "body donor," or by a symbol or statement of similar 7956 import, the gift may be used only for transplantation or therapy, and the gift passes in 7957 accordance with Subsection (7). 7958 (7) For purposes of Subsections (2), (5), and (7) the following rules apply: 7959 (a) If the part is an eye, the gift passes to the appropriate eye bank. 7960 (b) If the part is tissue, the gift passes to the appropriate tissue bank. 7961 (c) If the part is an organ, the gift passes to the appropriate organ procurement 7962 organization as custodian of the organ. 7963 (8) An anatomical gift of an organ for transplantation or therapy, other than an S.B. 39 02-10-23 5:41 PM - 258 - 7964 anatomical gift under Subsection (1)(b), passes to the organ procurement organization as 7965 custodian of the organ. 7966 (9) If an anatomical gift does not pass pursuant to Subsections (2) through (8) or the 7967 decedent's body or part is not used for transplantation, therapy, research, or education, custody 7968 of the body or part passes to the person under obligation to dispose of the body or part. 7969 (10) A person may not accept an anatomical gift if the person knows that the gift was 7970 not effectively made under Section [26-28-105 or 26-28-110] 26B-8-304 or 26B-8-309 or if the 7971 person knows that the decedent made a refusal under Section [26-28-107] 26B-8-306 that was 7972 not revoked. For purposes of this Subsection (10), if a person knows that an anatomical gift 7973 was made on a document of gift, the person is considered to know of any amendment or 7974 revocation of the gift or any refusal to make an anatomical gift on the same document of gift. 7975 (11) Except as otherwise provided in Subsection (1)(b), nothing in this [chapter] part 7976 affects the allocation of organs for transplantation or therapy. 7977 Section 251. Section 26B-8-311, which is renumbered from Section 26-28-112 is 7978 renumbered and amended to read: 7979 [26-28-112]. 26B-8-311. Search and notification. 7980 (1) The following persons shall make a reasonable search of an individual who the 7981 person reasonably believes is dead or near death for a document of gift or other information 7982 identifying the individual as a donor or as an individual who made a refusal: 7983 (a) a law enforcement officer, firefighter, paramedic, or other emergency rescuer 7984 finding the individual; 7985 (b) if no other source of the information is immediately available, a hospital, as soon as 7986 practical after the individual's arrival at the hospital; and 7987 (c) a law enforcement officer, firefighter, emergency medical services provider, or 7988 other emergency rescuer who finds an individual who is deceased at the scene of a motor 7989 vehicle accident, when the deceased individual is transported from the scene of the accident to 7990 a funeral establishment licensed under Title 58, Chapter 9, Funeral Services Licensing Act: 7991 (i) the law enforcement officer, firefighter, emergency medical services provider, or 7992 other emergency rescuer shall as soon as reasonably possible, notify the appropriate organ 7993 procurement organization, tissue bank, or eye bank of: 7994 (A) the identity of the deceased individual, if known; 02-10-23 5:41 PM S.B. 39 - 259 - 7995 (B) information, if known, pertaining to the deceased individual's legal next-of-kin in 7996 accordance with Section [26-28-109] 26B-8-308; and 7997 (C) the name and location of the funeral establishment which received custody of and 7998 transported the deceased individual; and 7999 (ii) the funeral establishment receiving custody of the deceased individual under this 8000 Subsection (1)(c) may not embalm the body of the deceased individual until: 8001 (A) the funeral establishment receives notice from the organ procurement organization, 8002 tissue bank, or eye bank that the readily available persons listed as having priority in Section 8003 [26-28-109] 26B-8-308 have been informed by the organ procurement organization of the 8004 option to make or refuse to make an anatomical gift in accordance with Section [26-28-104] 8005 26B-8-303, with reasonable discretion and sensitivity appropriate to the circumstances of the 8006 family; 8007 (B) in accordance with federal law, prior approval for embalming has been obtained 8008 from a family member or other authorized person; and 8009 (C) the period of time in which embalming is prohibited under Subsection (1)(c)(ii) 8010 may not exceed 24 hours after death. 8011 (2) If a document of gift or a refusal to make an anatomical gift is located by the search 8012 required by Subsection (1)(a) and the individual or deceased individual to whom it relates is 8013 taken to a hospital, the person responsible for conducting the search shall send the document of 8014 gift or refusal to the hospital. 8015 (3) A person is not subject to criminal or civil liability for failing to discharge the 8016 duties imposed by this section but may be subject to administrative sanctions. 8017 Section 252. Section 26B-8-312, which is renumbered from Section 26-28-113 is 8018 renumbered and amended to read: 8019 [26-28-113]. 26B-8-312. Delivery of document of gift not required -- Right 8020 to examine. 8021 (1) A document of gift need not be delivered during the donor's lifetime to be effective. 8022 (2) Upon or after an individual's death, a person in possession of a document of gift or 8023 a refusal to make an anatomical gift with respect to the individual shall allow examination and 8024 copying of the document of gift or refusal by a person authorized to make or object to the 8025 making of an anatomical gift with respect to the individual or by a person to which the gift S.B. 39 02-10-23 5:41 PM - 260 - 8026 could pass under Section [26-28-111] 26B-8-310. 8027 Section 253. Section 26B-8-313, which is renumbered from Section 26-28-114 is 8028 renumbered and amended to read: 8029 [26-28-114]. 26B-8-313. Rights and duties of procurement organization 8030 and others. 8031 (1) When a hospital refers an individual at or near death to a procurement organization, 8032 the organization shall make a reasonable search of the records of the Department of Public 8033 Safety and any donor registry that it knows exists for the geographical area in which the 8034 individual resides to ascertain whether the individual has made an anatomical gift. 8035 (2) A procurement organization shall be allowed reasonable access to information in 8036 the records of the Department of Public Safety to ascertain whether an individual at or near 8037 death is a donor. 8038 (3) When a hospital refers an individual at or near death to a procurement organization, 8039 the organization may conduct any reasonable examination necessary to ensure the medical 8040 suitability of a part that is or could be the subject of an anatomical gift for transplantation, 8041 therapy, research, or education from a donor or a prospective donor. During the examination 8042 period, measures necessary to ensure the medical suitability of the part may not be withdrawn 8043 unless the hospital or procurement organization knows that the individual expressed a contrary 8044 intent. 8045 (4) Unless prohibited by law other than this [chapter] part, at any time after a donor's 8046 death, the person to which a part passes under Section [26-28-111] 26B-8-310 may conduct 8047 any reasonable examination necessary to ensure the medical suitability of the body or part for 8048 its intended purpose. 8049 (5) Unless prohibited by law other than this [chapter] part, an examination under 8050 Subsection (3) or (4) may include an examination of all medical and dental records of the 8051 donor or prospective donor. 8052 (6) Upon the death of a minor who was a donor or had signed a refusal, unless a 8053 procurement organization knows the minor is emancipated, the procurement organization shall 8054 conduct a reasonable search for the parents of the minor and provide the parents with an 8055 opportunity to revoke or amend the anatomical gift or revoke the refusal. 8056 (7) Upon referral by a hospital under Subsection (1), a procurement organization shall 02-10-23 5:41 PM S.B. 39 - 261 - 8057 make a reasonable search for any person listed in Section 26-28-109 having priority to make an 8058 anatomical gift on behalf of a prospective donor. If a procurement organization receives 8059 information that an anatomical gift to any other person was made, amended, or revoked, it shall 8060 promptly advise the other person of all relevant information. 8061 (8) Subject to Subsection 26-28-111(9) and Section 26-28-123, the rights of the person 8062 to which a part passes under Section 26-28-111 are superior to the rights of all others with 8063 respect to the part. The person may accept or reject an anatomical gift in whole or in part. 8064 Subject to the terms of the document of gift and this [chapter] part, a person that accepts an 8065 anatomical gift of an entire body may allow embalming, burial or cremation, and use of 8066 remains in a funeral service. If the gift is of a part, the person to which the part passes under 8067 Section 26-28-111, upon the death of the donor and before embalming, burial, or cremation, 8068 shall cause the part to be removed without unnecessary mutilation. 8069 (9) Neither the physician or physician assistant who attends the decedent at death nor 8070 the physician or physician assistant who determines the time of the decedent's death may 8071 participate in the procedures for removing or transplanting a part from the decedent. 8072 (10) A physician, physician assistant, or technician may remove a donated part from 8073 the body of a donor that the physician, physician assistant, or technician is qualified to remove. 8074 Section 254. Section 26B-8-314, which is renumbered from Section 26-28-115 is 8075 renumbered and amended to read: 8076 [26-28-115]. 26B-8-314. Coordination of procurement and use. 8077 Each hospital in this state shall enter into agreements or affiliations with procurement 8078 organizations for coordination of procurement and use of anatomical gifts. 8079 Section 255. Section 26B-8-315, which is renumbered from Section 26-28-116 is 8080 renumbered and amended to read: 8081 [26-28-116]. 26B-8-315. Sale or purchase of parts prohibited. 8082 (1) Except as otherwise provided in Subsection (2), a person that for valuable 8083 consideration, knowingly purchases or sells a part for transplantation or therapy if removal of a 8084 part from an individual is intended to occur after the individual's death commits a third degree 8085 felony. 8086 (2) A person may charge a reasonable amount for the removal, processing, 8087 preservation, quality control, storage, transportation, implantation, or disposal of a part. S.B. 39 02-10-23 5:41 PM - 262 - 8088 Section 256. Section 26B-8-316, which is renumbered from Section 26-28-117 is 8089 renumbered and amended to read: 8090 [26-28-117]. 26B-8-316. Other prohibited acts. 8091 A person that, in order to obtain a financial gain, intentionally falsifies, forges, 8092 conceals, defaces, or obliterates a document of gift, an amendment, or revocation of a 8093 document of gift, or a refusal commits a third degree felony. 8094 Section 257. Section 26B-8-317, which is renumbered from Section 26-28-118 is 8095 renumbered and amended to read: 8096 [26-28-118]. 26B-8-317. Immunity. 8097 (1) A person that acts in accordance with this [chapter] part or with the applicable 8098 anatomical gift law of another state, or attempts in good faith to do so, is not liable for the act 8099 in a civil action, criminal prosecution, or administrative proceeding. 8100 (2) Neither the person making an anatomical gift nor the donor's estate is liable for any 8101 injury or damage that results from the making or use of the gift. 8102 (3) In determining whether an anatomical gift has been made, amended, or revoked 8103 under this [chapter] part, a person may rely upon representations of an individual listed in 8104 Subsection 26-28-109(1)(b), (c), (d), (e), (f), (g), (h), (i), or (j) relating to the individual's 8105 relationship to the donor or prospective donor unless the person knows that the representation 8106 is untrue. 8107 Section 258. Section 26B-8-318, which is renumbered from Section 26-28-119 is 8108 renumbered and amended to read: 8109 [26-28-119]. 26B-8-318. Law governing validity -- Choice of law as to 8110 execution of document of gift -- Presumption of validity. 8111 (1) A document of gift is valid if executed in accordance with: 8112 (a) this [chapter] part; 8113 (b) the laws of the state or country where it was executed; or 8114 (c) the laws of the state or country where the person making the anatomical gift was 8115 domiciled, has a place of residence, or was a national at the time the document of gift was 8116 executed. 8117 (2) If a document of gift is valid under this section, the law of this state governs the 8118 interpretation of the document of gift. 02-10-23 5:41 PM S.B. 39 - 263 - 8119 (3) A person may presume that a document of gift or amendment of an anatomical gift 8120 is valid unless that person knows that it was not validly executed or was revoked. 8121 Section 259. Section 26B-8-319, which is renumbered from Section 26-28-120 is 8122 renumbered and amended to read: 8123 [26-28-120]. 26B-8-319. Donor registry. 8124 (1) The Department of Public Safety may establish or contract for the establishment of 8125 a donor registry. 8126 (2) The Driver License Division of the Department of Public Safety shall cooperate 8127 with a person that administers any donor registry that this state establishes, contracts for, or 8128 recognizes for the purpose of transferring to the donor registry all relevant information 8129 regarding a donor's making, amendment to, or revocation of an anatomical gift. 8130 (3) A donor registry shall: 8131 (a) allow a donor or other person authorized under Section [26-28-104] 26B-8-303 to 8132 include on the donor registry a statement or symbol that the donor has made, amended, or 8133 revoked an anatomical gift; 8134 (b) be accessible to a procurement organization to allow it to obtain relevant 8135 information on the donor registry to determine, at or near death of the donor or a prospective 8136 donor, whether the donor or prospective donor has made, amended, or revoked an anatomical 8137 gift; and 8138 (c) be accessible for purposes of Subsections (3)(a) and (b) seven days a week on a 8139 24-hour basis. 8140 (4) Personally identifiable information on a donor registry about a donor or prospective 8141 donor may not be used or disclosed without the express consent of the donor, prospective 8142 donor, or person that made the anatomical gift for any purpose other than to determine, at or 8143 near death of the donor or prospective donor, whether the donor or prospective donor has 8144 made, amended, or revoked an anatomical gift. 8145 (5) This section does not prohibit any person from creating or maintaining a donor 8146 registry that is not established by or under contract with the state. Any such registry shall 8147 comply with Subsections (3) and (4). 8148 Section 260. Section 26B-8-320, which is renumbered from Section 26-28-121 is 8149 renumbered and amended to read: S.B. 39 02-10-23 5:41 PM - 264 - 8150 [26-28-121]. 26B-8-320. Effect of anatomical gift on advance health care 8151 directive. 8152 (1) As used in this section: 8153 (a) "Advance health care directive" means a power of attorney for health care or a 8154 record signed or authorized by a prospective donor containing the prospective donor's direction 8155 concerning a health care decision for the prospective donor. 8156 (b) "Declaration" means a record signed by a prospective donor specifying the 8157 circumstances under which a life support system may be withheld or withdrawn from the 8158 prospective donor. 8159 (c) "Health care decision" means any decision regarding the health care of the 8160 prospective donor. 8161 (2) If a prospective donor has a declaration or advance health care directive and the 8162 terms of the declaration or directive and the express or implied terms of a potential anatomical 8163 gift are in conflict with regard to the administration of measures necessary to ensure the 8164 medical suitability of a part for transplantation or therapy, the prospective donor's attending 8165 physician and prospective donor shall confer to resolve the conflict. If the prospective donor is 8166 incapable of resolving the conflict, an agent acting under the prospective donor's declaration or 8167 directive, or if no declaration or directive exists or the agent is not reasonably available, 8168 another person authorized by a law other than this [chapter] part to make a health care decision 8169 on behalf of the prospective donor, shall act for the donor to resolve the conflict. The conflict 8170 shall be resolved as expeditiously as possible. Information relevant to the resolution of the 8171 conflict may be obtained from the appropriate procurement organization and any other person 8172 authorized to make an anatomical gift for the prospective donor under Section [26-28-109] 8173 26B-8-308. Before resolution of the conflict, measures necessary to ensure the medical 8174 suitability of the part may not be withheld or withdrawn from the prospective donor if 8175 withholding or withdrawing the measures is not contraindicated by appropriate end of life care. 8176 Section 261. Section 26B-8-321, which is renumbered from Section 26-28-122 is 8177 renumbered and amended to read: 8178 [26-28-122]. 26B-8-321. Cooperation between medical examiner and 8179 procurement organization. 8180 (1) A medical examiner shall cooperate with procurement organizations to maximize 02-10-23 5:41 PM S.B. 39 - 265 - 8181 the opportunity to recover anatomical gifts for the purpose of transplantation, therapy, research, 8182 or education. 8183 (2) If a medical examiner receives notice from a procurement organization that an 8184 anatomical gift might be available or was made with respect to a decedent whose body is under 8185 the jurisdiction of the medical examiner and a postmortem examination is going to be 8186 performed, unless the medical examiner denies recovery in accordance with Section 8187 [26-28-123] 26B-8-322, the medical examiner or designee shall conduct a postmortem 8188 examination of the body or the part in a manner and within a period compatible with its 8189 preservation for the purposes of the gift. 8190 (3) A part may not be removed from the body of a decedent under the jurisdiction of a 8191 medical examiner for transplantation, therapy, research, or education unless the part is the 8192 subject of an anatomical gift. The body of a decedent under the jurisdiction of the medical 8193 examiner may not be delivered to a person for research or education unless the body is the 8194 subject of an anatomical gift. This Subsection (3) does not preclude a medical examiner from 8195 performing the medicolegal investigation upon the body or parts of a decedent under the 8196 jurisdiction of the medical examiner. 8197 Section 262. Section 26B-8-322, which is renumbered from Section 26-28-123 is 8198 renumbered and amended to read: 8199 [26-28-123]. 26B-8-322. Facilitation of anatomical gift from decedent 8200 whose body is under jurisdiction of medical examiner. 8201 (1) Upon request of a procurement organization, a medical examiner shall release to 8202 the procurement organization the name, contact information, and available medical and social 8203 history of a decedent whose body is under the jurisdiction of the medical examiner. If the 8204 decedent's body or part is medically suitable for transplantation, therapy, research, or education, 8205 the medical examiner shall release postmortem examination results to the procurement 8206 organization. The procurement organization may make a subsequent disclosure of the 8207 postmortem examination results or other information received from the medical examiner only 8208 if relevant to transplantation or therapy. 8209 (2) The medical examiner may conduct a medicolegal examination by reviewing all 8210 medical records, laboratory test results, x-rays, other diagnostic results, and other information 8211 that any person possesses about a donor or prospective donor whose body is under the S.B. 39 02-10-23 5:41 PM - 266 - 8212 jurisdiction of the medical examiner which the medical examiner determines may be relevant 8213 to the investigation. 8214 (3) A person that has any information requested by a medical examiner pursuant to 8215 Subsection (2) shall provide that information as expeditiously as possible to allow the medical 8216 examiner to conduct the medicolegal investigation within a period compatible with the 8217 preservation of parts for the purpose of transplantation, therapy, research, or education. 8218 (4) If an anatomical gift has been or might be made of a part of a decedent whose body 8219 is under the jurisdiction of the medical examiner and a postmortem examination is not 8220 required, or the medical examiner determines that a postmortem examination is required but 8221 that the recovery of the part that is the subject of an anatomical gift will not interfere with the 8222 examination, the medical examiner and procurement organization shall cooperate in the timely 8223 removal of the part from the decedent for the purpose of transplantation, therapy, research, or 8224 education. 8225 (5) If an anatomical gift of a part from the decedent under the jurisdiction of the 8226 medical examiner has been or might be made, but the medical examiner initially believes that 8227 the recovery of the part could interfere with the postmortem investigation into the decedent's 8228 cause or manner of death, the medical examiner shall consult with the procurement 8229 organization or physician or technician designated by the procurement organization about the 8230 proposed recovery. After consultation, the medical examiner may allow the recovery. 8231 (6) Following the consultation under Subsection (5), in the absence of mutually agreed 8232 upon protocols to resolve conflict between the medical examiner and the procurement 8233 organization, if the medical examiner intends to deny recovery, the medical examiner or 8234 designee, at the request of the procurement organization, may attend the removal procedure for 8235 the part before making a final determination not to allow the procurement organization to 8236 recover the part. During the removal procedure, the medical examiner or designee may allow 8237 recovery by the procurement organization to proceed, or, if the medical examiner or designee 8238 reasonably believes that the part may be involved in determining the decedent's cause or 8239 manner of death, deny recovery by the procurement organization. 8240 (7) If the medical examiner or designee denies recovery under Subsection (6), the 8241 medical examiner or designee shall: 8242 (a) explain in a record the specific reasons for not allowing recovery of the part; 02-10-23 5:41 PM S.B. 39 - 267 - 8243 (b) include the specific reasons in the records of the medical examiner; and 8244 (c) provide a record with the specific reasons to the procurement organization. 8245 (8) If the medical examiner or designee allows recovery of a part under Subsection (4), 8246 (5), or (6), the procurement organization, upon request, shall cause the physician or technician 8247 who removes the part to provide the medical examiner with a record describing the condition 8248 of the part, a biopsy, a photograph, and any other information and observations that would 8249 assist in the postmortem examination. 8250 (9) If a medical examiner or designee is required to be present at a removal procedure 8251 under Subsection (6), upon request the procurement organization requesting the recovery of the 8252 part shall reimburse the medical examiner or designee for the additional costs incurred in 8253 complying with Subsection (6). 8254 Section 263. Section 26B-8-323, which is renumbered from Section 26-28-124 is 8255 renumbered and amended to read: 8256 [26-28-124]. 26B-8-323. Uniformity of application and construction. 8257 In applying and construing [this] the uniform act in this part, consideration shall be 8258 given to the need to promote uniformity of the law with respect to its subject matter among 8259 states that enact it. 8260 Section 264. Section 26B-8-324, which is renumbered from Section 26-28-125 is 8261 renumbered and amended to read: 8262 [26-28-125]. 26B-8-324. Relation to Electronic Signatures in Global and 8263 National Commerce Act. 8264 This act modifies, limits, and supersedes the Electronic Signatures in Global and 8265 National Commerce Act, 15 U.S.C. [Section] Sec. 7001 et seq., but does not modify, limit or 8266 supersede Section 101(a) of that act, 15 U.S.C. [Section] Sec. 7001, or authorize electronic 8267 delivery of any of the notices described in Section 103(b) of that act, 15 U.S.C. [Section] Sec. 8268 7003(b). 8269 Section 265. Section 26B-8-401, which is renumbered from Section 26-3-1 is 8270 renumbered and amended to read: 8271 Part 4. Health Statistics 8272 [26-3-1]. 26B-8-401. Definitions. 8273 As used in this [chapter] part: S.B. 39 02-10-23 5:41 PM - 268 - 8274 (1) "Disclosure" or "disclose" means the communication of health data to any 8275 individual or organization outside the department. 8276 (2) "Health data" means any information, except vital records as defined in Section 8277 [26-2-2] 26B-8-101, relating to the health status of individuals, the availability of health 8278 resources and services, and the use and cost of these resources and services. 8279 (3) "Identifiable health data" means any item, collection, or grouping of health data 8280 which makes the individual supplying it or described in it identifiable. 8281 (4) "Individual" means a natural person. 8282 (5) "Organization" means any corporation, association, partnership, agency, 8283 department, unit, or other legally constituted institution or entity, or part of any of these. 8284 (6) "Research and statistical purposes" means the performance of activities relating to 8285 health data, including: 8286 (a) describing the group characteristics of individuals or organizations; 8287 (b) analyzing the interrelationships among the various characteristics of individuals or 8288 organizations; 8289 (c) the conduct of statistical procedures or studies to improve the quality of health data; 8290 (d) the design of sample surveys and the selection of samples of individuals or 8291 organizations; 8292 (e) the preparation and publication of reports describing these matters; and 8293 (f) other related functions. 8294 Section 266. Section 26B-8-402, which is renumbered from Section 26-3-2 is 8295 renumbered and amended to read: 8296 [26-3-2]. 26B-8-402. Powers of department to collect and maintain health 8297 data. 8298 The department may on a voluntary basis, except when there is specific legal authority 8299 to compel reporting of health data: 8300 (1) collect and maintain health data on: 8301 (a) the extent, nature, and impact of illness and disability on the population of the state; 8302 (b) the determinants of health and health hazards; 8303 (c) health resources, including the extent of available manpower and resources; 8304 (d) utilization of health care; 02-10-23 5:41 PM S.B. 39 - 269 - 8305 (e) health care costs and financing; or 8306 (f) other health or health-related matters; 8307 (2) undertake and support research, demonstrations, and evaluations respecting new or 8308 improved methods for obtaining current data on the matters referred to in Subsection (1) of this 8309 section; 8310 (3) collect health data under other authorities and on behalf of other governmental or 8311 not-for-profit organizations. 8312 Section 267. Section 26B-8-403, which is renumbered from Section 26-3-4 is 8313 renumbered and amended to read: 8314 [26-3-4]. 26B-8-403. Quality and publication of statistics. 8315 The department shall: 8316 (1) take such actions as may be necessary to assure that statistics developed under this 8317 [chapter] part are of high quality, timely, and comprehensive, as well as specific, standardized, 8318 and adequately analyzed and indexed; and 8319 (2) publish, make available, and disseminate such statistics on as wide a basis as 8320 practicable. 8321 Section 268. Section 26B-8-404, which is renumbered from Section 26-3-5 is 8322 renumbered and amended to read: 8323 [26-3-5]. 26B-8-404. Coordination of health data collection activities. 8324 (1) The department shall coordinate health data activities within the state to eliminate 8325 unnecessary duplication of data collection and maximize the usefulness of data collected. 8326 (2) Except as specifically provided, this [chapter] part does not independently provide 8327 authority for the department to compel the reporting of information. 8328 Section 269. Section 26B-8-405, which is renumbered from Section 26-3-6 is 8329 renumbered and amended to read: 8330 [26-3-6]. 26B-8-405. Uniform standards -- Powers of department. 8331 The department may: 8332 (1) participate and cooperate with state, local, and federal agencies and other 8333 organizations in the design and implementation of uniform standards for the management of 8334 health information at the federal, state, and local levels; and 8335 (2) undertake and support research, development, demonstrations, and evaluations that S.B. 39 02-10-23 5:41 PM - 270 - 8336 support uniform health information standards. 8337 Section 270. Section 26B-8-406, which is renumbered from Section 26-3-7 is 8338 renumbered and amended to read: 8339 [26-3-7]. 26B-8-406. Disclosure of health data -- Limitations. 8340 The department may not [disclose] make a disclosure of any identifiable health data 8341 unless: 8342 (1) one of the following persons has consented to the disclosure: 8343 (a) the individual; 8344 (b) the next-of-kin if the individual is deceased; 8345 (c) the parent or legal guardian if the individual is a minor or mentally incompetent; or 8346 (d) a person holding a power of attorney covering such matters on behalf of the 8347 individual; 8348 (2) the disclosure is to a governmental entity in this or another state or the federal 8349 government, provided that: 8350 (a) the data will be used for a purpose for which they were collected by the department; 8351 and 8352 (b) the recipient enters into a written agreement satisfactory to the department agreeing 8353 to protect such data in accordance with the requirements of this [chapter] part and department 8354 rule and not permit further disclosure without prior approval of the department; 8355 (3) the disclosure is to an individual or organization, for a specified period, solely for 8356 bona fide research and statistical purposes, determined in accordance with department rules, 8357 and the department determines that the data are required for the research and statistical 8358 purposes proposed and the requesting individual or organization enters into a written 8359 agreement satisfactory to the department to protect the data in accordance with this [chapter] 8360 part and department rule and not permit further disclosure without prior approval of the 8361 department; 8362 (4) the disclosure is to a governmental entity for the purpose of conducting an audit, 8363 evaluation, or investigation of the department and such governmental entity agrees not to use 8364 those data for making any determination affecting the rights, benefits, or entitlements of any 8365 individual to whom the health data relates; 8366 (5) the disclosure is of specific medical or epidemiological information to authorized 02-10-23 5:41 PM S.B. 39 - 271 - 8367 personnel within the department, local health departments, public health authorities, official 8368 health agencies in other states, the United States Public Health Service, the Centers for Disease 8369 Control and Prevention (CDC), or agencies responsible to enforce quarantine, when necessary 8370 to continue patient services or to undertake public health efforts to control communicable, 8371 infectious, acute, chronic, or any other disease or health hazard that the department considers to 8372 be dangerous or important or that may affect the public health; 8373 (6) (a) the disclosure is of specific medical or epidemiological information to a "health 8374 care provider" as defined in Section 78B-3-403, health care personnel, or public health 8375 personnel who has a legitimate need to have access to the information in order to assist the 8376 patient or to protect the health of others closely associated with the patient; and 8377 (b) this Subsection (6) does not create a duty to warn third parties; 8378 (7) the disclosure is necessary to obtain payment from an insurer or other third-party 8379 payor in order for the department to obtain payment or to coordinate benefits for a patient; or 8380 (8) the disclosure is to the subject of the identifiable health data. 8381 Section 271. Section 26B-8-407, which is renumbered from Section 26-3-8 is 8382 renumbered and amended to read: 8383 [26-3-8]. 26B-8-407. Disclosure of health data -- Discretion of department. 8384 (1) Any disclosure provided for in Section 26-3-7 shall be made at the discretion of the 8385 department[, except that the]. 8386 (2) Notwithstanding Subsection (1), the disclosure provided for in Subsection [26-3-7] 8387 26B-8-406(4) shall be made when the requirements of that paragraph are met. 8388 Section 272. Section 26B-8-408, which is renumbered from Section 26-3-9 is 8389 renumbered and amended to read: 8390 [26-3-9]. 26B-8-408. Health data not subject to subpoena or compulsory 8391 process -- Exception. 8392 Identifiable health data obtained in the course of activities undertaken or supported 8393 under this [chapter] part may not be subject to discovery, subpoena, or similar compulsory 8394 process in any civil or criminal, judicial, administrative, or legislative proceeding, nor shall any 8395 individual or organization with lawful access to identifiable health data under the provisions of 8396 this [chapter] part be compelled to testify with regard to such health data, except that data 8397 pertaining to a party in litigation may be subject to subpoena or similar compulsory process in S.B. 39 02-10-23 5:41 PM - 272 - 8398 an action brought by or on behalf of such individual to enforce any liability arising under this 8399 [chapter] part. 8400 Section 273. Section 26B-8-409, which is renumbered from Section 26-3-10 is 8401 renumbered and amended to read: 8402 [26-3-10]. 26B-8-409. Department measures to protect security of health data. 8403 The department shall protect the security of identifiable health data by use of the 8404 following measures and any other measures adopted by rule: 8405 (1) limit access to identifiable health data to authorized individuals who have received 8406 training in the handling of such data; 8407 (2) designate a person to be responsible for physical security; 8408 (3) develop and implement a system for monitoring security; and 8409 (4) review periodically all identifiable health data to determine whether identifying 8410 characteristics should be removed from the data. 8411 Section 274. Section 26B-8-410, which is renumbered from Section 26-3-11 is 8412 renumbered and amended to read: 8413 [26-3-11]. 26B-8-410. Relation to other provisions. 8414 Because [Chapter 2, Utah Vital Statistics Act, Chapter 4, Utah Medical Examiner Act, 8415 Chapter 6, Utah Communicable Disease Control Act, and Chapter 33a, Utah Health Data 8416 Authority Act] the following parts contain specific provisions regarding collection and 8417 disclosure of data, the provisions of this [chapter] part do not apply to data subject to those 8418 [chapters.] parts: 8419 (1) Part 1, Vital Statistics; 8420 (2) Part 2, Utah Medical Examiner; and 8421 (3) Part 5, Utah Health Data Authority. 8422 Section 275. Section 26B-8-411, which is renumbered from Section 26-1-37 is 8423 renumbered and amended to read: 8424 [26-1-37]. 26B-8-411. Duty to establish standards for the electronic exchange 8425 of clinical health information -- Immunity. 8426 (1) [For purposes of] As used in this section: 8427 (a) "Affiliate" means an organization that directly or indirectly through one or more 8428 intermediaries controls, is controlled by, or is under common control with another 02-10-23 5:41 PM S.B. 39 - 273 - 8429 organization. 8430 (b) "Clinical health information" shall be defined by the department by administrative 8431 rule adopted in accordance with Subsection (2). 8432 (c) "Electronic exchange": 8433 (i) includes: 8434 (A) the electronic transmission of clinical health data via Internet or extranet; and 8435 (B) physically moving clinical health information from one location to another using 8436 magnetic tape, disk, or compact disc media; and 8437 (ii) does not include exchange of information by telephone or fax. 8438 (d) "Health care provider" means a licensing classification that is either: 8439 (i) licensed under Title 58, Occupations and Professions, to provide health care; or 8440 (ii) licensed under [Chapter 21] Chapter 2, Part 2, Health Care Facility Licensing and 8441 Inspection [Act]. 8442 (e) "Health care system" shall include: 8443 (i) affiliated health care providers; 8444 (ii) affiliated third party payers; and 8445 (iii) other arrangement between organizations or providers as described by the 8446 department by administrative rule. 8447 (f) "Qualified network" means an entity that: 8448 (i) is a non-profit organization; 8449 (ii) is accredited by the Electronic Healthcare Network Accreditation Commission, or 8450 another national accrediting organization recognized by the department; and 8451 (iii) performs the electronic exchange of clinical health information among multiple 8452 health care providers not under common control, multiple third party payers not under common 8453 control, the department, and local health departments. 8454 (g) "Third party payer" means: 8455 (i) all insurers offering health insurance who are subject to Section 31A-22-614.5; and 8456 (ii) the state Medicaid program. 8457 (2) (a) [In addition to the duties listed in Section 26-1-30, the] The department shall, 8458 make rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to: 8459 (i) define: S.B. 39 02-10-23 5:41 PM - 274 - 8460 (A) "clinical health information" subject to this section; and 8461 (B) "health system arrangements between providers or organizations" as described in 8462 Subsection (1)(e)(iii); and 8463 (ii) adopt standards for the electronic exchange of clinical health information between 8464 health care providers and third party payers that are for treatment, payment, health care 8465 operations, or public health reporting, as provided for in 45 C.F.R. Parts 160, 162, and 164, 8466 Health Insurance Reform: Security Standards. 8467 (b) The department shall coordinate its rule making authority under the provisions of 8468 this section with the rule making authority of the Insurance Department under Section 8469 31A-22-614.5. 8470 (c) The department shall establish procedures for developing the rules adopted under 8471 this section, which ensure that the Insurance Department is given the opportunity to comment 8472 on proposed rules. 8473 (3) (a) Except as provided in Subsection (3)(e), a health care provider or third party 8474 payer in Utah is required to use the standards adopted by the department under the provisions 8475 of Subsection (2) if the health care provider or third party payer elects to engage in an 8476 electronic exchange of clinical health information with another health care provider or third 8477 party payer. 8478 (b) A health care provider or third party payer may [disclose] make a disclosure of 8479 information to the department or a local health department, by electronic exchange of clinical 8480 health information, as permitted by Subsection 45 C.F.R. Sec. 164.512(b). 8481 (c) When functioning in its capacity as a health care provider or payer, the department 8482 or a local health department may [disclose] make a disclosure of clinical health information by 8483 electronic exchange to another health care provider or third party payer. 8484 (d) An electronic exchange of clinical health information by a health care provider, a 8485 third party payer, the department, a local health department, or a qualified network is a 8486 disclosure for treatment, payment, or health care operations if it complies with Subsection 8487 (3)(a) or (c) and is for treatment, payment, or health care operations, as those terms are defined 8488 in 45 C.F.R. Parts 160, 162, and 164. 8489 (e) A health care provider or third party payer is not required to use the standards 8490 adopted by the department under the provisions of Subsection (2) if the health care provider or 02-10-23 5:41 PM S.B. 39 - 275 - 8491 third party payer engage in the electronic exchange of clinical health information within a 8492 particular health care system. 8493 (4) Nothing in this section shall limit the number of networks eligible to engage in the 8494 electronic data interchange of clinical health information using the standards adopted by the 8495 department under Subsection (2)(a)(ii). 8496 (5) (a) The department, a local health department, a health care provider, a third party 8497 payer, or a qualified network is not subject to civil liability for a disclosure of clinical health 8498 information if the disclosure is in accordance with: 8499 (i) Subsection (3)(a); and 8500 (ii) Subsection (3)(b), (c), or (d). 8501 (b) The department, a local health department, a health care provider, a third party 8502 payer, or a qualified network that accesses or reviews clinical health information from or 8503 through the electronic exchange in accordance with the requirements in this section is not 8504 subject to civil liability for the access or review. 8505 (6) Within a qualified network, information generated or [disclosed] for which a 8506 disclosure is made in the electronic exchange of clinical health information is not subject to 8507 discovery, use, or receipt in evidence in any legal proceeding of any kind or character. 8508 Section 276. Section 26B-8-501, which is renumbered from Section 26-33a-102 is 8509 renumbered and amended to read: 8510 Part 5. Utah Health Data Authority 8511 [26-33a-102]. 26B-8-501. Definitions. 8512 As used in this [chapter] part: 8513 (1) "Committee" means the Health Data Committee created [by Section 26B-1-204] in 8514 Section 26B-1-413. 8515 (2) "Control number" means a number assigned by the committee to an individual's 8516 health data as an identifier so that the health data can be disclosed or used in research and 8517 statistical analysis without readily identifying the individual. 8518 (3) "Data supplier" means a health care facility, health care provider, self-funded 8519 employer, third-party payor, health maintenance organization, or government department which 8520 could reasonably be expected to provide health data under this [chapter] part. 8521 (4) "Disclosure" or "disclose" means the communication of health care data to any S.B. 39 02-10-23 5:41 PM - 276 - 8522 individual or organization outside the committee, its staff, and contracting agencies. 8523 (5) (a) "Health care facility" means a facility that is licensed by the department under 8524 [Title 26, Chapter 21] Chapter 2, Part 2, Health Care Facility Licensing and Inspection [Act]. 8525 (b) In accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, the 8526 committee, with the concurrence of the department, may by rule add, delete, or modify the list 8527 of facilities that come within this definition for purposes of this [chapter] part. 8528 (6) "Health care provider" means [any person, partnership, association, corporation, or 8529 other facility or institution that renders or causes to be rendered health care or professional 8530 services as a physician, physician assistant, registered nurse, licensed practical nurse, 8531 nurse-midwife, dentist, dental hygienist, optometrist, clinical laboratory technologist, 8532 pharmacist, physical therapist, podiatric physician, psychologist, chiropractic physician, 8533 naturopathic physician, osteopathic physician, osteopathic physician and surgeon, audiologist, 8534 speech pathologist, certified social worker, social service worker, social service aide, marriage 8535 and family counselor, or practitioner of obstetrics, and others rendering similar care and 8536 services relating to or arising out of the health needs of persons or groups of persons, and 8537 officers, employees, or agents of any of the above acting in the course and scope of their 8538 employment] the same as that term is defined in Section 78B-3-403. 8539 (7) "Health data" means information relating to the health status of individuals, health 8540 services delivered, the availability of health manpower and facilities, and the use and costs of 8541 resources and services to the consumer, except vital records as defined in Section [26-2-2] 8542 26B-8-101 shall be excluded. 8543 (8) "Health maintenance organization" [has the meaning set forth] means the same as 8544 that term is defined in Section 31A-8-101. 8545 (9) "Identifiable health data" means any item, collection, or grouping of health data that 8546 makes the individual supplying or described in the health data identifiable. 8547 (10) "Organization" means any corporation, association, partnership, agency, 8548 department, unit, or other legally constituted institution or entity, or part thereof. 8549 (11) "Research and statistical analysis" means activities using health data analysis 8550 including: 8551 (a) describing the group characteristics of individuals or organizations; 8552 (b) analyzing the noncompliance among the various characteristics of individuals or 02-10-23 5:41 PM S.B. 39 - 277 - 8553 organizations; 8554 (c) conducting statistical procedures or studies to improve the quality of health data; 8555 (d) designing sample surveys and selecting samples of individuals or organizations; 8556 and 8557 (e) preparing and publishing reports describing these matters. 8558 (12) "Self-funded employer" means an employer who provides for the payment of 8559 health care services for employees directly from the employer's funds, thereby assuming the 8560 financial risks rather than passing them on to an outside insurer through premium payments. 8561 (13) "Plan" means the plan developed and adopted by the Health Data Committee 8562 under Section [26-33a-104] 26B-1-413. 8563 (14) "Third party payor" means: 8564 (a) an insurer offering a health benefit plan, as defined by Section 31A-1-301, to at 8565 least 2,500 enrollees in the state; 8566 (b) a nonprofit health service insurance corporation licensed under Title 31A, Chapter 8567 7, Nonprofit Health Service Insurance Corporations; 8568 (c) a program funded or administered by Utah for the provision of health care services, 8569 including the Medicaid and medical assistance programs described in [Chapter 18] Chapter3, 8570 Part 1, Medical Assistance Act; and 8571 (d) a corporation, organization, association, entity, or person: 8572 (i) which administers or offers a health benefit plan to at least 2,500 enrollees in the 8573 state; and 8574 (ii) which is required by administrative rule adopted by the department in accordance 8575 with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to supply health data to the 8576 committee. 8577 Section 277. Section 26B-8-502, which is renumbered from Section 26-33a-105 is 8578 renumbered and amended to read: 8579 [26-33a-105]. 26B-8-502. Executive secretary -- Appointment -- Powers. 8580 (1) An executive secretary shall be appointed by the executive director, with the 8581 approval of the committee, and shall serve under the administrative direction of the executive 8582 director. 8583 (2) The executive secretary shall: S.B. 39 02-10-23 5:41 PM - 278 - 8584 (a) employ full-time employees necessary to carry out this [chapter] part; 8585 (b) supervise the development of a draft health data plan for the committee's review, 8586 modification, and approval; and 8587 (c) supervise and conduct the staff functions of the committee in order to assist the 8588 committee in meeting its responsibilities under this [chapter] part. 8589 Section 278. Section 26B-8-503, which is renumbered from Section 26-33a-106 is 8590 renumbered and amended to read: 8591 [26-33a-106]. 26B-8-503. Limitations on use of health data. 8592 The committee may not use the health data provided to it by third-party payors, health 8593 care providers, or health care facilities to make recommendations with regard to a single health 8594 care provider or health care facility, or a group of health care providers or health care facilities. 8595 Section 279. Section 26B-8-504, which is renumbered from Section 26-33a-106.1 is 8596 renumbered and amended to read: 8597 [26-33a-106.1]. 26B-8-504. Health care cost and reimbursement data. 8598 (1) The committee shall, as funding is available: 8599 (a) establish a plan for collecting data from data suppliers to determine measurements 8600 of cost and reimbursements for risk-adjusted episodes of health care; 8601 (b) share data regarding insurance claims and an individual's and small employer 8602 group's health risk factor and characteristics of insurance arrangements that affect claims and 8603 usage with the Insurance Department, only to the extent necessary for: 8604 (i) risk adjusting; and 8605 (ii) the review and analysis of health insurers' premiums and rate filings; and 8606 (c) assist the Legislature and the public with awareness of, and the promotion of, 8607 transparency in the health care market by reporting on: 8608 (i) geographic variances in medical care and costs as demonstrated by data available to 8609 the committee; and 8610 (ii) rate and price increases by health care providers: 8611 (A) that exceed the Consumer Price Index - Medical as provided by the United States 8612 Bureau of Labor Statistics; 8613 (B) as calculated yearly from June to June; and 8614 (C) as demonstrated by data available to the committee; 02-10-23 5:41 PM S.B. 39 - 279 - 8615 (d) provide on at least a monthly basis, enrollment data collected by the committee to a 8616 not-for-profit, broad-based coalition of state health care insurers and health care providers that 8617 are involved in the standardized electronic exchange of health data as described in Section 8618 31A-22-614.5, to the extent necessary: 8619 (i) for the department or the Medicaid Office of the Inspector General to determine 8620 insurance enrollment of an individual for the purpose of determining Medicaid third party 8621 liability; 8622 (ii) for an insurer that is a data supplier, to determine insurance enrollment of an 8623 individual for the purpose of coordination of health care benefits; and 8624 (iii) for a health care provider, to determine insurance enrollment for a patient for the 8625 purpose of claims submission by the health care provider; 8626 (e) coordinate with the State Emergency Medical Services Committee to publish data 8627 regarding air ambulance charges under Section [26-8a-203] 26B-4-106; 8628 (f) share data collected under this [chapter] part with the state auditor for use in the 8629 health care price transparency tool described in Section 67-3-11; and 8630 (g) publish annually a report on primary care spending within Utah. 8631 (2) A data supplier is not liable for a breach of or unlawful disclosure of the data 8632 caused by an entity that obtains data in accordance with Subsection (1). 8633 (3) The plan adopted under Subsection (1) shall include: 8634 (a) the type of data that will be collected; 8635 (b) how the data will be evaluated; 8636 (c) how the data will be used; 8637 (d) the extent to which, and how the data will be protected; and 8638 (e) who will have access to the data. 8639 Section 280. Section 26B-8-505, which is renumbered from Section 26-33a-106.5 is 8640 renumbered and amended to read: 8641 [26-33a-106.5]. 26B-8-505. Comparative analyses. 8642 (1) The committee may publish compilations or reports that compare and identify 8643 health care providers or data suppliers from the data it collects under this [chapter] part or from 8644 any other source. 8645 (2) (a) Except as provided in Subsection (7)(c), the committee shall publish S.B. 39 02-10-23 5:41 PM - 280 - 8646 compilations or reports from the data it collects under this [chapter] part or from any other 8647 source which: 8648 (i) contain the information described in Subsection (2)(b); and 8649 (ii) compare and identify by name at least a majority of the health care facilities, health 8650 care plans, and institutions in the state. 8651 (b) Except as provided in Subsection (7)(c), the report required by this Subsection (2) 8652 shall: 8653 (i) be published at least annually; 8654 (ii) list, as determined by the committee, the median paid amount for at least the top 50 8655 medical procedures performed in the state by volume; 8656 (iii) describe the methodology approved by the committee to determine the amounts 8657 described in Subsection (2)(b)(ii); and 8658 (iv) contain comparisons based on at least the following factors: 8659 (A) nationally or other generally recognized quality standards; 8660 (B) charges; and 8661 (C) nationally recognized patient safety standards. 8662 (3) (a) The committee may contract with a private, independent analyst to evaluate the 8663 standard comparative reports of the committee that identify, compare, or rank the performance 8664 of data suppliers by name. 8665 (b) The evaluation described in this Subsection (3) shall include a validation of 8666 statistical methodologies, limitations, appropriateness of use, and comparisons using standard 8667 health services research practice. 8668 (c) The independent analyst described in Subsection (3)(a) shall be experienced in 8669 analyzing large databases from multiple data suppliers and in evaluating health care issues of 8670 cost, quality, and access. 8671 (d) The results of the analyst's evaluation shall be released to the public before the 8672 standard comparative analysis upon which it is based may be published by the committee. 8673 (4) [In] The committee, with the concurrence of the department, shall make rules in 8674 accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, [the committee, 8675 with the concurrence of the department, shall adopt by rule] to adopt a timetable for the 8676 collection and analysis of data from multiple types of data suppliers. 02-10-23 5:41 PM S.B. 39 - 281 - 8677 (5) The comparative analysis required under Subsection (2) shall be available free of 8678 charge and easily accessible to the public. 8679 (6) (a) The department shall include in the report required by Subsection (2)(b), or 8680 include in a separate report, comparative information on commonly recognized or generally 8681 agreed upon measures of cost and quality identified in accordance with Subsection (7), for: 8682 (i) routine and preventive care; and 8683 (ii) the treatment of diabetes, heart disease, and other illnesses or conditions as 8684 determined by the committee. 8685 (b) The comparative information required by Subsection (6)(a) shall be based on data 8686 collected under Subsection (2) and clinical data that may be available to the committee, and 8687 shall compare: 8688 (i) results for health care facilities or institutions; 8689 (ii) results for health care providers by geographic regions of the state; 8690 (iii) a clinic's aggregate results for a physician who practices at a clinic with five or 8691 more physicians; and 8692 (iv) a geographic region's aggregate results for a physician who practices at a clinic 8693 with less than five physicians, unless the physician requests physician-level data to be 8694 published on a clinic level. 8695 (c) The department: 8696 (i) may publish information required by this Subsection (6) directly or through one or 8697 more nonprofit, community-based health data organizations; and 8698 (ii) may use a private, independent analyst under Subsection (3)(a) in preparing the 8699 report required by this section. 8700 (d) A report published by the department under this Subsection (6): 8701 (i) is subject to the requirements of Section [26-33a-107] 26B-8-506; and 8702 (ii) shall, prior to being published by the department, be submitted to a neutral, 8703 non-biased entity with a broad base of support from health care payers and health care 8704 providers in accordance with Subsection (7) for the purpose of validating the report. 8705 (7) (a) The Health Data Committee shall, through the department, for purposes of 8706 Subsection (6)(a), use the quality measures that are developed and agreed upon by a neutral, 8707 non-biased entity with a broad base of support from health care payers and health care S.B. 39 02-10-23 5:41 PM - 282 - 8708 providers. 8709 (b) If the entity described in Subsection (7)(a) does not submit the quality measures, 8710 the department may select the appropriate number of quality measures for purposes of the 8711 report required by Subsection (6). 8712 (c) (i) For purposes of the reports published on or after July 1, 2014, the department 8713 may not compare individual facilities or clinics as described in Subsections (6)(b)(i) through 8714 (iv) if the department determines that the data available to the department can not be 8715 appropriately validated, does not represent nationally recognized measures, does not reflect the 8716 mix of cases seen at a clinic or facility, or is not sufficient for the purposes of comparing 8717 providers. 8718 (ii) The department shall report to the Legislature's Health and Human Services Interim 8719 Committee prior to making a determination not to publish a report under Subsection (7)(c)(i). 8720 Section 281. Section 26B-8-506, which is renumbered from Section 26-33a-107 is 8721 renumbered and amended to read: 8722 [26-33a-107]. 26B-8-506. Limitations on release of reports. 8723 The committee may not release a compilation or report that compares and identifies 8724 health care providers or data suppliers unless it: 8725 (1) allows the data supplier and the health care provider to verify the accuracy of the 8726 information submitted to the committee and submit to the committee any corrections of errors 8727 with supporting evidence and comments within a reasonable period of time to be established by 8728 rule, with the concurrence of the department, made in accordance with Title 63G, Chapter 3, 8729 Utah Administrative Rulemaking Act; 8730 (2) corrects data found to be in error; and 8731 (3) allows the data supplier a reasonable amount of time prior to publication to review 8732 the committee's interpretation of the data and prepare a response. 8733 Section 282. Section 26B-8-507, which is renumbered from Section 26-33a-108 is 8734 renumbered and amended to read: 8735 [26-33a-108]. 26B-8-507. Disclosure of identifiable health data prohibited. 8736 (1) (a) All information, reports, statements, memoranda, or other data received by the 8737 committee are strictly confidential. 8738 (b) Any use, release, or publication of the information shall be done in such a way that 02-10-23 5:41 PM S.B. 39 - 283 - 8739 no person is identifiable except as provided in Sections [26-33a-107] 26B-6-506 and 8740 [26-33a-109] 26B-8-508. 8741 (2) No member of the committee may be held civilly liable by reason of having 8742 released or published reports or compilations of data supplied to the committee, so long as the 8743 publication or release is in accordance with the requirements of Subsection (1). 8744 (3) No person, corporation, or entity may be held civilly liable for having provided data 8745 to the committee in accordance with this [chapter] part. 8746 Section 283. Section 26B-8-508, which is renumbered from Section 26-33a-109 is 8747 renumbered and amended to read: 8748 [26-33a-109]. 26B-8-508. Exceptions to prohibition on disclosure of 8749 identifiable health data. 8750 (1) The committee may not disclose any identifiable health data unless: 8751 (a) the individual has authorized the disclosure; 8752 (b) the disclosure is to the department or a public health authority in accordance with 8753 Subsection (2); or 8754 (c) the disclosure complies with the provisions of: 8755 (i) Subsection (3); 8756 (ii) insurance enrollment and coordination of benefits under Subsection [26-33a-106.1] 8757 26B-8-504(1)(d); or 8758 (iii) risk adjusting under Subsection [26-33a-106.1] 26B-8-504(1)(b). 8759 (2) The committee may disclose identifiable health data to the department or a public 8760 health authority under Subsection (1)(b) if: 8761 (a) the department or the public health authority has clear statutory authority to possess 8762 the identifiable health data; and 8763 (b) the disclosure is solely for use: 8764 (i) in the Utah Statewide Immunization Information System operated by the 8765 department; 8766 (ii) in the Utah Cancer Registry operated by the University of Utah, in collaboration 8767 with the department; or 8768 (iii) by the medical examiner, as defined in Section [26-4-2] 26B-8-201, or the medical 8769 examiner's designee. S.B. 39 02-10-23 5:41 PM - 284 - 8770 (3) The committee shall consider the following when responding to a request for 8771 disclosure of information that may include identifiable health data: 8772 (a) whether the request comes from a person after that person has received approval to 8773 do the specific research or statistical work from an institutional review board; and 8774 (b) whether the requesting entity complies with the provisions of Subsection (4). 8775 (4) A request for disclosure of information that may include identifiable health data 8776 shall: 8777 (a) be for a specified period; or 8778 (b) be solely for bona fide research or statistical purposes as determined in accordance 8779 with administrative rules adopted by the department in accordance with Title 63G, Chapter 3, 8780 Utah Administrative Rulemaking Act, which shall require: 8781 (i) the requesting entity to demonstrate to the department that the data is required for 8782 the research or statistical purposes proposed by the requesting entity; and 8783 (ii) the requesting entity to enter into a written agreement satisfactory to the department 8784 to protect the data in accordance with this [chapter] part or other applicable law. 8785 (5) A person accessing identifiable health data pursuant to Subsection (4) may not 8786 further disclose the identifiable health data: 8787 (a) without prior approval of the department; and 8788 (b) unless the identifiable health data is disclosed or identified by control number only. 8789 (6) Identifiable health data that has been designated by a data supplier as being subject 8790 to regulation under 42 C.F.R. Part 2, Confidentiality of Substance Use Disorder Patient 8791 Records, may only be used or disclosed in accordance with applicable federal regulations. 8792 Section 284. Section 26B-8-509, which is renumbered from Section 26-33a-110 is 8793 renumbered and amended to read: 8794 [26-33a-110]. 26B-8-509. Penalties. 8795 (1) Any use, release, or publication of health care data contrary to the provisions of 8796 Sections [26-33a-108 and 26-33a-109] 26B-8-507 and 26B-8-508 is a class A misdemeanor. 8797 (2) Subsection (1) does not relieve the person or organization responsible for that use, 8798 release, or publication from civil liability. 8799 Section 285. Section 26B-8-510, which is renumbered from Section 26-33a-111 is 8800 renumbered and amended to read: 02-10-23 5:41 PM S.B. 39 - 285 - 8801 [26-33a-111]. 26B-8-510. Health data not subject to subpoena or 8802 compulsory process -- Exception. 8803 Identifiable health data obtained in the course of activities undertaken or supported 8804 under this [chapter] part are not subject to subpoena or similar compulsory process in any civil 8805 or criminal, judicial, administrative, or legislative proceeding, nor shall any individual or 8806 organization with lawful access to identifiable health data under the provisions of this [chapter] 8807 part be compelled to testify with regard to such health data, except that data pertaining to a 8808 party in litigation may be subject to subpoena or similar compulsory process in an action 8809 brought by or on behalf of such individual to enforce any liability arising under this [chapter] 8810 part. 8811 Section 286. Section 26B-8-511, which is renumbered from Section 26-33a-115 is 8812 renumbered and amended to read: 8813 [26-33a-115]. 26B-8-511. Consumer-focused health care delivery and 8814 payment reform demonstration project. 8815 (1) The Legislature finds that: 8816 (a) current health care delivery and payment systems do not provide system wide 8817 incentives for the competitive delivery and pricing of health care services to consumers; 8818 (b) there is a compelling state interest to encourage consumers to seek high quality, low 8819 cost care and educate themselves about health care options; 8820 (c) some health care providers and health care payers have developed 8821 consumer-focused ideas for health care delivery and payment system reform, but lack the 8822 critical number of patient lives and payer involvement to accomplish system-wide 8823 consumer-focused reform; and 8824 (d) there is a compelling state interest to encourage as many health care providers and 8825 health care payers to join together and coordinate efforts at consumer-focused health care 8826 delivery and payment reform that would provide to consumers enrolled in a high-deductible 8827 health plan: 8828 (i) greater choice in health care options; 8829 (ii) improved services through competition; and 8830 (iii) more affordable options for care. 8831 (2) (a) The department shall meet with health care providers and health care payers for S.B. 39 02-10-23 5:41 PM - 286 - 8832 the purpose of coordinating a demonstration project for consumer-based health care delivery 8833 and payment reform. 8834 (b) Participation in the coordination efforts is voluntary, but encouraged. 8835 (3) The department, in order to facilitate the coordination of a demonstration project 8836 for consumer-based health care delivery and payment reform, shall convene and consult with 8837 pertinent entities including: 8838 (a) the Utah Insurance Department; 8839 (b) the Office of Consumer Health Services; 8840 (c) the Utah Medical Association; 8841 (d) the Utah Hospital Association; and 8842 (e) neutral, non-biased third parties with an established record for broad based, 8843 multi-provider and multi-payer quality assurance efforts and data collection. 8844 (4) The department shall supervise the efforts by entities under Subsection (3) 8845 regarding: 8846 (a) applying for and obtaining grant funding and other financial assistance that may be 8847 available for demonstrating consumer-based improvements to health care delivery and 8848 payment; 8849 (b) obtaining and analyzing information and data related to current health system 8850 utilization and costs to consumers; and 8851 (c) consulting with those health care providers and health care payers who elect to 8852 participate in the consumer-based health delivery and payment demonstration project. 8853 [(5) The executive director shall report to the Health System Reform Task Force by 8854 January 1, 2015, regarding the progress toward coordination of consumer-focused health care 8855 system payment and delivery reform.] 8856 Section 287. Section 26B-8-512, which is renumbered from Section 26-33a-116 is 8857 renumbered and amended to read: 8858 [26-33a-116]. 26B-8-512. Health care billing data. 8859 (1) Subject to Subsection (2), the department shall make aggregate data produced 8860 under this [chapter] part available to the public through a standardized application program 8861 interface format. 8862 (2) (a) The department shall ensure that data made available to the public under 02-10-23 5:41 PM S.B. 39 - 287 - 8863 Subsection (1): 8864 (i) does not contain identifiable health data of a patient; and 8865 (ii) meets state and federal data privacy requirements, including the requirements of 8866 Section [26-33a-107] 26B-8-506. 8867 (b) The department may not release any data under Subsection (1) that may be 8868 identifiable health data of a patient. 8869 Section 288. Section 26B-8-513, which is renumbered from Section 26-33a-117 is 8870 renumbered and amended to read: 8871 [26-33a-117]. 26B-8-513. Identifying potential overuse of 8872 non-evidence-based health care. 8873 (1) The department shall, in accordance with Title 63G, Chapter 6a, Utah Procurement 8874 Code, contract with an entity to provide a nationally-recognized health waste calculator that: 8875 (a) uses principles such as the principles of the Choosing Wisely initiative of the 8876 American Board of Internal Medicine Foundation; and 8877 (b) is approved by the committee. 8878 (2) The department shall use the calculator described in Subsection (1) to: 8879 (a) analyze the data in the state's All Payer Claims Database; and 8880 (b) flag data entries that the calculator identifies as potential overuse of non- 8881 evidence-based health care. 8882 (3) The department, or a third party organization that the department contracts with in 8883 accordance with Title 63G, Chapter 6a, Utah Procurement Code, shall: 8884 (a) analyze the data described in Subsection (2)(b); 8885 (b) review current scientific literature about medical services that are best practice; 8886 (c) review current scientific literature about eliminating duplication in health care; 8887 (d) solicit input from Utah health care providers, health systems, insurers, and other 8888 stakeholders regarding duplicative health care quality initiatives and instances of 8889 non-alignment in metrics used to measure health care quality that are required by different 8890 health systems; 8891 (e) solicit input from Utah health care providers, health systems, insurers, and other 8892 stakeholders on methods to avoid overuse of non-evidence-based health care; and 8893 (f) present the results of the analysis, research, and input described in Subsections S.B. 39 02-10-23 5:41 PM - 288 - 8894 (3)(a) through (e) to the committee. 8895 (4) The committee shall: 8896 (a) make recommendations for action and opportunities for improvement based on the 8897 results described in Subsection (3)(f); 8898 (b) make recommendations on methods to bring into alignment the various health care 8899 quality metrics different entities in the state use; and 8900 (c) identify priority issues and recommendations to include in an annual report. 8901 (5) The department, or the third party organization described in Subsection (3) shall: 8902 (a) compile the report described in Subsection (4)(c); and 8903 (b) submit the report to the committee for approval. 8904 (6) Beginning in 2021, on or before November 1 each year, the department shall 8905 submit the report approved in Subsection (5)(b) to the Health and Human Services Interim 8906 Committee. 8907 Section 289. Section 26B-8-514, which is renumbered from Section 26-70-102 is 8908 renumbered and amended to read: 8909 [26-70-102]. 26B-8-514. Standard health record access form. 8910 (1) As used in this section: 8911 (a) "HIPAA" means the Health Insurance Portability and Accountability Act of 1996, 8912 Pub. L. No. 104-191, 110 Stat. 1936, as amended. 8913 (b) "Patient" means the individual whose information is being requested. 8914 (c) "Personal representative" means an individual described in 45 C.F.R. Sec. 8915 164.502(g). 8916 [(1)] (2) Before December 31, 2022, the department shall create a standard form that: 8917 (a) is compliant with HIPAA and 42 C.F.R. Part 2; and 8918 (b) a patient or a patient's personal representative may use to request that a copy of the 8919 patient's health records be sent to any of the following: 8920 (i) the patient; 8921 (ii) the patient's personal representative; 8922 (iii) the patient's attorney; or 8923 (iv) a third party authorized by the patient. 8924 [(2)] (3) The form described in Subsection (2) shall include fields for: 02-10-23 5:41 PM S.B. 39 - 289 - 8925 (a) the patient's name; 8926 (b) the patient's date of birth; 8927 (c) the patient's phone number; 8928 (d) the patient's address; 8929 (e) (i) the patient's signature and date of signature, which may not require notarization; 8930 or 8931 (ii) the signature of the patient's personal representative and date of signature, which 8932 may not require notarization; 8933 (f) the name, address, and phone number of the person to which the information will be 8934 disclosed; 8935 (g) the records requested, including whether the patient is requesting paper or 8936 electronic records; 8937 (h) the duration of time the authorization is valid; and 8938 (i) the dates of service requested. 8939 [(3)] (4) The form described in Subsection (2) shall include the following options for 8940 the field described in Subsection [(2)] (3)(g): 8941 (a) history and physical examination records; 8942 (b) treatment plans; 8943 (c) emergency room records; 8944 (d) radiology and lab reports; 8945 (e) operative reports; 8946 (f) pathology reports; 8947 (g) consultations; 8948 (h) discharge summary; 8949 (i) outpatient clinic records and progress notes; 8950 (j) behavioral health evaluation; 8951 (k) behavioral health discharge summary; 8952 (l) mental health therapy records; 8953 (m) financial information including an itemized billing statement; 8954 (n) health insurance claim form; 8955 (o) billing form; and S.B. 39 02-10-23 5:41 PM - 290 - 8956 (p) other. 8957 Section 290. Revisor instructions. 8958 The Legislature intends that the Office of Legislative Research and General Counsel, in 8959 preparing the Utah Code database for publication: 8960 (1) not enroll this bill if any of the following bills do not pass: 8961 (a) S.B. 38, Health and Human Services Recodification - Administration, Licensing, 8962 and Recovery Services; 8963 (b) S.B. 40, Health and Human Services Recodification - Health Care Assistance and 8964 Data; or 8965 (c) S.B. 41, Health and Human Services Recodification - Health Care Delivery and 8966 Repeals; and 8967 (2) in any new language added to the Utah Code by legislation passed during the 2023 8968 General Session, replace any references to Titles 26 or 62A with the renumbered reference as it 8969 is renumbered in this bill.

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 C health care administration and assistance; and 15 C 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) S.B. 39 Enrolled Copy - 2 - 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 Enrolled Copy S.B. 39 - 3 - 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) S.B. 39 Enrolled Copy - 4 - 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, Enrolled Copy S.B. 39 - 5 - 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) S.B. 39 Enrolled Copy - 6 - 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, Enrolled Copy S.B. 39 - 7 - 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) S.B. 39 Enrolled Copy - 8 - 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, Enrolled Copy S.B. 39 - 9 - 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) S.B. 39 Enrolled Copy - 10 - 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, Enrolled Copy S.B. 39 - 11 - 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) S.B. 39 Enrolled Copy - 12 - 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 Enrolled Copy S.B. 39 - 13 - 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) S.B. 39 Enrolled Copy - 14 - 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 Enrolled Copy S.B. 39 - 15 - 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) S.B. 39 Enrolled Copy - 16 - 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, Enrolled Copy S.B. 39 - 17 - 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) S.B. 39 Enrolled Copy - 18 - 461 26B-8-211, (Renumbered from 26-4-11, as last amended by Laws of Utah 2018, 462 Chapter 414) 463 26B-8-212, (Renumbered from 26-4-12, as last amended by Laws of Utah 2011, 464 Chapter 297) 465 26B-8-213, (Renumbered from 26-4-13, as last amended by Laws of Utah 2001, 466 Chapter 278) 467 26B-8-214, (Renumbered from 26-4-14, as last amended by Laws of Utah 2021, 468 Chapter 297) 469 26B-8-215, (Renumbered from 26-4-15, as enacted by Laws of Utah 1981, Chapter 470 126) 471 26B-8-216, (Renumbered from 26-4-16, as last amended by Laws of Utah 2007, 472 Chapter 144) 473 26B-8-217, (Renumbered from 26-4-17, as last amended by Laws of Utah 2022, 474 Chapter 255) 475 26B-8-218, (Renumbered from 26-4-18, as enacted by Laws of Utah 1981, Chapter 476 126) 477 26B-8-219, (Renumbered from 26-4-19, as last amended by Laws of Utah 1993, 478 Chapter 38) 479 26B-8-220, (Renumbered from 26-4-20, as last amended by Laws of Utah 2011, 480 Chapter 297) 481 26B-8-221, (Renumbered from 26-4-21, as last amended by Laws of Utah 1997, 482 Chapter 372) 483 26B-8-222, (Renumbered from 26-4-22, as enacted by Laws of Utah 1981, Chapter 484 126) 485 26B-8-223, (Renumbered from 26-4-23, as enacted by Laws of Utah 1981, Chapter 486 126) 487 26B-8-224, (Renumbered from 26-4-24, as last amended by Laws of Utah 1997, Enrolled Copy S.B. 39 - 19 - 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) S.B. 39 Enrolled Copy - 20 - 515 26B-8-306, (Renumbered from 26-28-107, as last amended by Laws of Utah 2011, 516 Chapter 297) 517 26B-8-307, (Renumbered from 26-28-108, as enacted by Laws of Utah 2007, Chapter 518 60) 519 26B-8-308, (Renumbered from 26-28-109, as last amended by Laws of Utah 2018, 520 Chapter 48) 521 26B-8-309, (Renumbered from 26-28-110, as enacted by Laws of Utah 2007, Chapter 522 60) 523 26B-8-310, (Renumbered from 26-28-111, as last amended by Laws of Utah 2011, 524 Chapter 297) 525 26B-8-311, (Renumbered from 26-28-112, as last amended by Laws of Utah 2014, 526 Chapter 189) 527 26B-8-312, (Renumbered from 26-28-113, as enacted by Laws of Utah 2007, Chapter 528 60) 529 26B-8-313, (Renumbered from 26-28-114, as last amended by Laws of Utah 2019, 530 Chapter 349) 531 26B-8-314, (Renumbered from 26-28-115, as enacted by Laws of Utah 2007, Chapter 532 60) 533 26B-8-315, (Renumbered from 26-28-116, as enacted by Laws of Utah 2007, Chapter 534 60) 535 26B-8-316, (Renumbered from 26-28-117, as enacted by Laws of Utah 2007, Chapter 536 60) 537 26B-8-317, (Renumbered from 26-28-118, as last amended by Laws of Utah 2018, 538 Chapter 48) 539 26B-8-318, (Renumbered from 26-28-119, as enacted by Laws of Utah 2007, Chapter 540 60) 541 26B-8-319, (Renumbered from 26-28-120, as last amended by Laws of Utah 2011, Enrolled Copy S.B. 39 - 21 - 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) S.B. 39 Enrolled Copy - 22 - 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 Enrolled Copy S.B. 39 - 23 - 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 S.B. 39 Enrolled Copy - 24 - 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 -- Enrolled Copy S.B. 39 - 25 - 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; S.B. 39 Enrolled Copy - 26 - 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; Enrolled Copy S.B. 39 - 27 - 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): S.B. 39 Enrolled Copy - 28 - 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: Enrolled Copy S.B. 39 - 29 - 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 S.B. 39 Enrolled Copy - 30 - 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. Enrolled Copy S.B. 39 - 31 - 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. S.B. 39 Enrolled Copy - 32 - 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 Enrolled Copy S.B. 39 - 33 - 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 S.B. 39 Enrolled Copy - 34 - 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; Enrolled Copy S.B. 39 - 35 - 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; S.B. 39 Enrolled Copy - 36 - 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 Enrolled Copy S.B. 39 - 37 - 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: S.B. 39 Enrolled Copy - 38 - 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. Enrolled Copy S.B. 39 - 39 - 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 S.B. 39 Enrolled Copy - 40 - 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; Enrolled Copy S.B. 39 - 41 - 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 S.B. 39 Enrolled Copy - 42 - 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 Enrolled Copy S.B. 39 - 43 - 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: S.B. 39 Enrolled Copy - 44 - 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 Enrolled Copy S.B. 39 - 45 - 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. S.B. 39 Enrolled Copy - 46 - 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: Enrolled Copy S.B. 39 - 47 - 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); S.B. 39 Enrolled Copy - 48 - 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 Enrolled Copy S.B. 39 - 49 - 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) S.B. 39 Enrolled Copy - 50 - 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] Enrolled Copy S.B. 39 - 51 - 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, S.B. 39 Enrolled Copy - 52 - 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] Enrolled Copy S.B. 39 - 53 - 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 S.B. 39 Enrolled Copy - 54 - 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 Enrolled Copy S.B. 39 - 55 - 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 S.B. 39 Enrolled Copy - 56 - 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 Enrolled Copy S.B. 39 - 57 - 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. S.B. 39 Enrolled Copy - 58 - 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: Enrolled Copy S.B. 39 - 59 - 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 S.B. 39 Enrolled Copy - 60 - 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 Enrolled Copy S.B. 39 - 61 - 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 S.B. 39 Enrolled Copy - 62 - 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 Enrolled Copy S.B. 39 - 63 - 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. S.B. 39 Enrolled Copy - 64 - 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 Enrolled Copy S.B. 39 - 65 - 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 S.B. 39 Enrolled Copy - 66 - 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 Enrolled Copy S.B. 39 - 67 - 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: S.B. 39 Enrolled Copy - 68 - 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. Enrolled Copy S.B. 39 - 69 - 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: S.B. 39 Enrolled Copy - 70 - 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 Enrolled Copy S.B. 39 - 71 - 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; S.B. 39 Enrolled Copy - 72 - 1919 (iv) the total cost incurred by the state to implement this section; and 1920 (v) any conclusions that can be drawn regarding the impact of the DPP on the rate of 1921 type 2 diabetes for enrollees. 1922 Section 38. Section 26B-3-138, which is renumbered from Section 26-18-427 is 1923 renumbered and amended to read: 1924 [26-18-427]. 26B-3-138. Behavioral health delivery working group. 1925 (1) As used in this section, "targeted adult Medicaid program" means the same as that 1926 term is defined in Section [26-18-411] 26B-3-207. 1927 (2) On or before May 31, 2022, the department shall convene a working group to 1928 collaborate with the department on: 1929 (a) establishing specific and measurable metrics regarding: 1930 (i) compliance of managed care organizations in the state with federal Medicaid 1931 managed care requirements; 1932 (ii) timeliness and accuracy of authorization and claims processing in accordance with 1933 Medicaid policy and contract requirements; 1934 (iii) reimbursement by managed care organizations in the state to providers to maintain 1935 adequacy of access to care; 1936 (iv) availability of care management services to meet the needs of Medicaid-eligible 1937 individuals enrolled in the plans of managed care organizations in the state; and 1938 (v) timeliness of resolution for disputes between a managed care organization and the 1939 managed care organization's providers and enrollees; 1940 (b) improving the delivery of behavioral health services in the Medicaid program; 1941 (c) proposals to implement the delivery system adjustments authorized under 1942 Subsection [26-18-428] 26B-3-223(3); and 1943 (d) issues that are identified by managed care organizations, behavioral health service 1944 providers, and the department. 1945 (3) The working group convened under Subsection (2) shall: Enrolled Copy S.B. 39 - 73 - 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 S.B. 39 Enrolled Copy - 74 - 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 Enrolled Copy S.B. 39 - 75 - 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 S.B. 39 Enrolled Copy - 76 - 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 Enrolled Copy S.B. 39 - 77 - 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 S.B. 39 Enrolled Copy - 78 - 2081 section that the person knows is false, misleading, or fraudulent. 2082 (b) A violation of Subsection [(3)] (4)(a) is a third degree felony. 2083 (5) The division and the Department of Workforce Services shall: 2084 (a) cooperate with the Division of Child and Family Services in regard to an adoption 2085 assistance interstate compact; and 2086 (b) comply with an adoption assistance interstate compact. 2087 Section 42. Section 26B-3-201, which is renumbered from Section 26-18-403 is 2088 renumbered and amended to read: 2089 Part 2. Medicaid Waivers 2090 [26-18-403]. 26B-3-201. Medicaid waiver for independent foster care 2091 adolescents. 2092 (1) [For purposes of] As used in this section, an "independent foster care adolescent" 2093 includes any individual who reached 18 years [of age] old while in the custody of the[ Division 2094 of Child and Family Services, or the Department of Human Services] department if the 2095 [Division of Child and Family Services] department was the primary case manager, or a 2096 federally recognized Indian tribe. 2097 (2) An independent foster care adolescent is eligible, when funds are available, for 2098 Medicaid coverage until the individual reaches 21 years [of age] old. 2099 (3) Before July 1, 2006, the division shall submit a state Medicaid Plan amendment to 2100 [the Center For Medicaid Services] CMS to provide medical coverage for independent foster 2101 care adolescents effective fiscal year 2006-07. 2102 Section 43. Section 26B-3-202, which is renumbered from Section 26-18-405 is 2103 renumbered and amended to read: 2104 [26-18-405]. 26B-3-202. Waivers to maximize replacement of 2105 fee-for-service delivery model -- Cost of mandated program changes. 2106 (1) The department shall develop a waiver program in the Medicaid program to replace 2107 the fee-for-service delivery model with one or more risk-based delivery models. Enrolled Copy S.B. 39 - 79 - 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 S.B. 39 Enrolled Copy - 80 - 2135 determined by the department in consultation with the Medicaid accountable care 2136 organizations, and may include a change to the state Medicaid program that is required by state 2137 or federal law, state or federal guidance, policy, or the state Medicaid plan. 2138 (b) A mandated program change shall be included in the base budget for the Medicaid 2139 program for the fiscal year in which the Medicaid program adopted the mandated program 2140 change. 2141 (c) The mandated program change is not subject to the limit on the rate of growth in 2142 per-patient-per-month General Fund expenditures for the program established in Subsection 2143 (2)(e), until the fiscal year following the fiscal year in which the Medicaid program adopted the 2144 mandated program change. 2145 (5) A managed care organization or a pharmacy benefit manager that provides a 2146 pharmacy benefit to an enrollee shall establish a unique group number, payment classification 2147 number, or bank identification number for each Medicaid managed care organization plan for 2148 which the managed care organization or pharmacy benefit manager provides a pharmacy 2149 benefit. 2150 Section 44. Section 26B-3-203, which is renumbered from Section 26-18-405.5 is 2151 renumbered and amended to read: 2152 [26-18-405.5]. 26B-3-203. Base budget appropriations for Medicaid 2153 accountable care organizations and behavioral health plans -- Forecast of behavioral 2154 health services cost. 2155 (1) As used in this section: 2156 (a) "ACO" means an accountable care organization that contracts with the state's 2157 Medicaid program for: 2158 (i) physical health services; or 2159 (ii) integrated physical and behavioral health services. 2160 (b) "Base budget" means the same as that term is defined in legislative rule. 2161 (c) "Behavioral health plan" means a managed care or fee for service delivery system Enrolled Copy S.B. 39 - 81 - 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 S.B. 39 Enrolled Copy - 82 - 2189 ACOs and behavioral health plans multiplied by the General Fund growth factor. 2190 (5) The appropriations provided to the department for behavioral health plans under 2191 this section shall be reduced by the amount contributed by counties in the current fiscal year for 2192 behavioral health plans in accordance with Subsections 17-43-201(5)(k) and 2193 17-43-301(6)(a)(x). 2194 (6) In order for the department to estimate the impact of Subsections (2) through (4) 2195 before identification of the next fiscal year ongoing General Fund revenue estimate, the 2196 Governor's Office of Planning and Budget shall, in cooperation with the Office of the 2197 Legislative Fiscal Analyst, develop an estimate of ongoing General Fund revenue for the next 2198 fiscal year and provide the estimate to the department no later than November 1 of each year. 2199 (7) The Office of the Legislative Fiscal Analyst shall include an estimate of the cost of 2200 behavioral health services in any state Medicaid funding or savings forecast that is completed 2201 in coordination with the department and the Governor's Office of Planning and Budget. 2202 Section 45. Section 26B-3-204, which is renumbered from Section 26-18-408 is 2203 renumbered and amended to read: 2204 [26-18-408]. 26B-3-204. Incentives to appropriately use emergency 2205 department services. 2206 (1) (a) This section applies to the Medicaid program and to the Utah Children's Health 2207 Insurance Program created in [Chapter 40, Utah Children's Health Insurance Act] Section 2208 26B-3-902. 2209 (b) As used in this section: 2210 (i) "Managed care organization" means a comprehensive full risk managed care 2211 delivery system that contracts with the Medicaid program or the Children's Health Insurance 2212 Program to deliver health care through a managed care plan. 2213 (ii) "Managed care plan" means a risk-based delivery service model authorized by 2214 Section [26-18-405] 26B-3-202 and administered by a managed care organization. 2215 (iii) "Non-emergent care": Enrolled Copy S.B. 39 - 83 - 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. S.B. 39 Enrolled Copy - 84 - 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 Enrolled Copy S.B. 39 - 85 - 2270 renumbered and amended to read: 2271 [26-18-409]. 26B-3-205. Long-term care insurance partnership. 2272 (1) As used in this section: 2273 (a) "Qualified long-term care insurance contract" is as defined in 26 U.S.C. Sec. 2274 7702B(b). 2275 (b) "Qualified long-term care insurance partnership" is as defined in 42 U.S.C. Sec. 2276 1396p(b)(1)(C)(iii). 2277 (c) "State plan amendment" means an amendment to the state Medicaid plan drafted by 2278 the department in compliance with this section. 2279 (2) No later than July 1, 2014, the department shall seek federal approval of a state plan 2280 amendment that creates a qualified long-term care insurance partnership. 2281 (3) The department may make rules to comply with federal laws and regulations 2282 relating to qualified long-term care insurance partnerships and qualified long-term care 2283 insurance contracts. 2284 Section 47. Section 26B-3-206, which is renumbered from Section 26-18-410 is 2285 renumbered and amended to read: 2286 [26-18-410]. 26B-3-206. Medicaid waiver for children with disabilities 2287 and complex medical needs. 2288 (1) As used in this section: 2289 (a) "Additional eligibility criteria" means the additional eligibility criteria set by the 2290 department under Subsection (4)(e). 2291 (b) "Complex medical condition" means a physical condition of an individual that: 2292 (i) results in severe functional limitations for the individual; and 2293 (ii) is likely to: 2294 (A) last at least 12 months; or 2295 (B) result in death. 2296 (c) "Program" means the program for children with complex medical conditions S.B. 39 Enrolled Copy - 86 - 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; Enrolled Copy S.B. 39 - 87 - 2324 (b) convene a public process to determine the benefits and services to offer a qualified 2325 child under the program; 2326 (c) evaluate, on an ongoing basis, the cost and effectiveness of the program; 2327 (d) if funding for the program is reduced, develop an evaluation process to reduce the 2328 number of children served based on the participation criteria established under Subsection 2329 (4)(a); and 2330 (e) establish, by rule made in accordance with Title 63G, Chapter 3, Utah 2331 Administrative Rulemaking Act, additional eligibility criteria based on the factors described in 2332 Subsections (4)(a)(i) and (ii). 2333 Section 48. Section 26B-3-207, which is renumbered from Section 26-18-411 is 2334 renumbered and amended to read: 2335 [26-18-411]. 26B-3-207. Health coverage improvement program -- 2336 Eligibility -- Annual report -- Expansion of eligibility for adults with dependent children. 2337 (1) As used in this section: 2338 (a) "Adult in the expansion population" means an individual who: 2339 (i) is described in 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII); and 2340 (ii) is not otherwise eligible for Medicaid as a mandatory categorically needy 2341 individual. 2342 (b) "Enhancement waiver program" means the Primary Care Network enhancement 2343 waiver program described in Section [26-18-416] 26B-3-211. 2344 (c) "Federal poverty level" means the poverty guidelines established by the Secretary of 2345 the United States Department of Health and Human Services under 42 U.S.C. Sec. 9909(2). 2346 (d) "Health coverage improvement program" means the health coverage improvement 2347 program described in Subsections (3) through [(10)] (9). 2348 (e) "Homeless": 2349 (i) means an individual who is chronically homeless, as determined by the department; 2350 and S.B. 39 Enrolled Copy - 88 - 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 Enrolled Copy S.B. 39 - 89 - 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 S.B. 39 Enrolled Copy - 90 - 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 Enrolled Copy S.B. 39 - 91 - 2432 program while the health coverage improvement program is suspended under Subsection [(11)] 2433 (10)(c). 2434 (11) If, after the enhancement waiver program takes effect, the enhancement waiver 2435 program is repealed or suspended by either the state or federal government, the department 2436 shall reinstate the health coverage improvement program and continue to accept new enrollees 2437 into the health coverage improvement program in accordance with the provisions of this 2438 section. 2439 Section 49. Section 26B-3-208, which is renumbered from Section 26-18-413 is 2440 renumbered and amended to read: 2441 [26-18-413]. 26B-3-208. Medicaid waiver for delivery of adult dental 2442 services. 2443 (1) (a) Before June 30, 2016, the department shall ask CMS to grant waivers from 2444 federal statutory and regulatory law necessary for the Medicaid program to provide dental 2445 services in the manner described in Subsection (2)(a). 2446 (b) Before June 30, 2018, the department shall submit to CMS a request for waivers, or 2447 an amendment of existing waivers, from federal law necessary for the state to provide dental 2448 services, in accordance with Subsections (2)(b)(i) and (d) through (g), to an individual 2449 described in Subsection (2)(b)(i). 2450 (c) Before June 30, 2019, the department shall submit to the Centers for Medicare and 2451 Medicaid Services a request for waivers, or an amendment to existing waivers, from federal 2452 law necessary for the state to: 2453 (i) provide dental services, in accordance with Subsections (2)(b)(ii) and (d) through 2454 (g) to an individual described in Subsection (2)(b)(ii); and 2455 (ii) provide the services described in Subsection (2)(h). 2456 (2) (a) To the extent funded, the department shall provide services to only blind or 2457 disabled individuals, as defined in 42 U.S.C. Sec. 1382c(a)(1), who are 18 years old or older 2458 and eligible for the program. S.B. 39 Enrolled Copy - 92 - 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. Enrolled Copy S.B. 39 - 93 - 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 S.B. 39 Enrolled Copy - 94 - 2513 program shall begin providing dental services to the population described in Subsection 2514 (2)(b)(ii) within 90 days after the day on which the waivers are granted. 2515 (4) If the federal share of the cost of providing dental services under this section will be 2516 less than 65% during any portion of the next fiscal year, the Medicaid program shall cease 2517 providing dental services under this section no later than the end of the current fiscal year. 2518 Section 50. Section 26B-3-209, which is renumbered from Section 26-18-414 is 2519 renumbered and amended to read: 2520 [26-18-414]. 26B-3-209. Medicaid long-term support services housing 2521 coordinator. 2522 (1) There is created within the Medicaid program a full-time-equivalent position of 2523 Medicaid long-term support services housing coordinator. 2524 (2) The coordinator shall help Medicaid recipients receive long-term support services 2525 in a home or other community-based setting rather than in a nursing home or other institutional 2526 setting by: 2527 (a) working with municipalities, counties, the Housing and Community Development 2528 Division within the Department of Workforce Services, and others to identify 2529 community-based settings available to recipients; 2530 (b) working with the same entities to promote the development, construction, and 2531 availability of additional community-based settings; 2532 (c) training Medicaid case managers and support coordinators on how to help Medicaid 2533 recipients move from an institutional setting to a community-based setting; and 2534 (d) performing other related duties. 2535 Section 51. Section 26B-3-210, which is renumbered from Section 26-18-415 is 2536 renumbered and amended to read: 2537 [26-18-415]. 26B-3-210. Medicaid waiver expansion. 2538 (1) As used in this section: 2539 (a) "Federal poverty level" means the same as that term is defined in Section Enrolled Copy S.B. 39 - 95 - 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 S.B. 39 Enrolled Copy - 96 - 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. Enrolled Copy S.B. 39 - 97 - 2594 (6) If the Medicaid waiver expansion is approved by CMS, the department shall report 2595 to the Social Services Appropriations Subcommittee on or before November 1 of each year that 2596 the Medicaid waiver expansion is operational: 2597 (a) the number of individuals who enrolled in the Medicaid waiver program; 2598 (b) costs to the state for the Medicaid waiver program; 2599 (c) estimated costs for the current and following state fiscal year; and 2600 (d) recommendations to control costs of the Medicaid waiver expansion. 2601 Section 52. Section 26B-3-211, which is renumbered from Section 26-18-416 is 2602 renumbered and amended to read: 2603 [26-18-416]. 26B-3-211. Primary Care Network enhancement waiver 2604 program. 2605 (1) As used in this section: 2606 (a) "Enhancement waiver program" means the Primary Care Network enhancement 2607 waiver program described in this section. 2608 (b) "Federal poverty level" means the poverty guidelines established by the secretary of 2609 the United States Department of Health and Human Services under 42 U.S.C. Sec. 9902(2). 2610 (c) "Health coverage improvement program" means the same as that term is defined in 2611 Section [26-18-411] 26B-3-207. 2612 (d) "Income eligibility ceiling" means the percentage of federal poverty level: 2613 (i) established by the Legislature in an appropriations act adopted pursuant to Title 63J, 2614 Chapter 1, Budgetary Procedures Act; and 2615 (ii) under which an individual may qualify for coverage in the enhancement waiver 2616 program in accordance with this section. 2617 (e) "Optional population" means the optional expansion population under PPACA if 2618 the expansion provides coverage for individuals at or above 95% of the federal poverty level. 2619 (f) "Primary Care Network" means the state Primary Care Network program created by 2620 the Medicaid primary care network demonstration waiver obtained under Section [26-18-3] S.B. 39 Enrolled Copy - 98 - 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. Enrolled Copy S.B. 39 - 99 - 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 S.B. 39 Enrolled Copy - 100 - 2675 to the state, and the state budget. 2676 (8) The department may implement the enhancement waiver program by contracting 2677 with Medicaid accountable care organizations to administer the enhancement waiver program. 2678 (9) In accordance with Subsections [26-18-411(11) and (12)] 26B-3-207(10) and (11), 2679 the department may use funds that have been appropriated for the health coverage 2680 improvement program to implement the enhancement waiver program. 2681 (10) If the department expands the state Medicaid program to the optional population, 2682 the department: 2683 (a) except as provided in Subsection (11), may not accept any new enrollees into the 2684 enhancement waiver program after the day on which the expansion to the optional population 2685 is effective; 2686 (b) shall suspend the enhancement waiver program within one year after the day on 2687 which the expansion to the optional population is effective; and 2688 (c) shall work with CMS to maintain the waiver for the enhancement waiver program 2689 submitted under Subsection (3) while the enhancement waiver program is suspended under 2690 Subsection (10)(b). 2691 (11) If, after the expansion to the optional population described in Subsection (10) 2692 takes effect, the expansion to the optional population is repealed by either the state or the 2693 federal government, the department shall reinstate the enhancement waiver program and 2694 continue to accept new enrollees into the enhancement waiver program in accordance with the 2695 provisions of this section. 2696 Section 53. Section 26B-3-212, which is renumbered from Section 26-18-417 is 2697 renumbered and amended to read: 2698 [26-18-417]. 26B-3-212. Limited family planning services for low-income 2699 individuals. 2700 (1) As used in this section: 2701 (a) (i) "Family planning services" means family planning services that are provided Enrolled Copy S.B. 39 - 101 - 2702 under the state Medicaid program, including: 2703 (A) sexual health education and family planning counseling; and 2704 (B) other medical diagnosis, treatment, or preventative care routinely provided as part 2705 of a family planning service visit. 2706 (ii) "Family planning services" do not include an abortion, as that term is defined in 2707 Section 76-7-301. 2708 (b) "Low-income individual" means an individual who: 2709 (i) has an income level that is equal to or below 95% of the federal poverty level; and 2710 (ii) does not qualify for full coverage under the Medicaid program. 2711 (2) Before July 1, 2018, the division shall apply for a Medicaid waiver or a state plan 2712 amendment with CMS to: 2713 (a) offer a program that provides family planning services to low-income individuals; 2714 and 2715 (b) receive a federal match rate of 90% of state expenditures for family planning 2716 services provided under the waiver or state plan amendment. 2717 Section 54. Section 26B-3-213, which is renumbered from Section 26-18-418 is 2718 renumbered and amended to read: 2719 [26-18-418]. 26B-3-213. Medicaid waiver for mental health crisis lines 2720 and mobile crisis outreach teams. 2721 (1) As used in this section: 2722 (a) "Local mental health crisis line" means the same as that term is defined in Section 2723 [62A-15-1301] 26B-5-610. 2724 (b) "Mental health crisis" means: 2725 (i) a mental health condition that manifests itself in an individual by symptoms of 2726 sufficient severity that a prudent layperson who possesses an average knowledge of mental 2727 health issues could reasonably expect the absence of immediate attention or intervention to 2728 result in: S.B. 39 Enrolled Copy - 102 - 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). Enrolled Copy S.B. 39 - 103 - 2756 Section 55. Section 26B-3-214, which is renumbered from Section 26-18-419 is 2757 renumbered and amended to read: 2758 [26-18-419]. 26B-3-214. Medicaid waiver for coverage of mental health 2759 services in schools. 2760 (1) As used in this section, "local education agency" means: 2761 (a) a school district; 2762 (b) a charter school; or 2763 (c) the Utah Schools for the Deaf and the Blind. 2764 (2) In consultation with [the Department of Human Services and] the State Board of 2765 Education, the department shall develop a proposal to allow the state Medicaid program to 2766 reimburse a local education agency, a local mental health authority, or a private provider for 2767 covered mental health services provided: 2768 (a) in accordance with Section 53E-9-203; and 2769 (b) (i) at a local education agency building or facility; or 2770 (ii) by an employee or contractor of a local education agency. 2771 (3) Before January 1, 2020, the department shall apply to CMS for a state plan 2772 amendment to implement the coverage described in Subsection (2). 2773 Section 56. Section 26B-3-215, which is renumbered from Section 26-18-420 is 2774 renumbered and amended to read: 2775 [26-18-420]. 26B-3-215. Coverage for in vitro fertilization and genetic 2776 testing. 2777 (1) As used in this section: 2778 (a) "Qualified condition" means: 2779 (i) cystic fibrosis; 2780 (ii) spinal muscular atrophy; 2781 (iii) Morquio Syndrome; 2782 (iv) myotonic dystrophy; or S.B. 39 Enrolled Copy - 104 - 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 Enrolled Copy S.B. 39 - 105 - 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). S.B. 39 Enrolled Copy - 106 - 2837 (3) If the waiver or state plan amendment described in Subsection (2) is approved, the 2838 Medicaid program shall provide coverage to a qualified enrollee for standard fertility 2839 preservation services. 2840 (4) The Medicaid program may not provide the coverage described in Subsection (3) 2841 before the later of: 2842 (a) the day on which the waiver described in Subsection (2) is approved; and 2843 (b) January 1, 2023. 2844 (5) Before November 1, 2023, and before November 1 of each third year after 2023, 2845 the department shall: 2846 (a) calculate the change in state spending attributable to the coverage described in this 2847 section; and 2848 (b) report the amount described in Subsection (5)(a) to the Health and Human Services 2849 Interim Committee and the Social Services Appropriations Subcommittee. 2850 Section 58. Section 26B-3-217, which is renumbered from Section 26-18-421 is 2851 renumbered and amended to read: 2852 [26-18-421]. 26B-3-217. Medicaid waiver for coverage of qualified 2853 inmates leaving prison or jail. 2854 (1) As used in this section: 2855 (a) "Correctional facility" means: 2856 (i) a county jail; 2857 (ii) the Department of Corrections, created in Section 64-13-2; or 2858 (iii) a prison, penitentiary, or other institution operated by or under contract with the 2859 Department of Corrections for the confinement of an offender, as defined in Section 64-13-1. 2860 (b) "Qualified inmate" means an individual who: 2861 (i) is incarcerated in a correctional facility; and 2862 (ii) has: 2863 (A) a chronic physical or behavioral health condition; Enrolled Copy S.B. 39 - 107 - 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). S.B. 39 Enrolled Copy - 108 - 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 Enrolled Copy S.B. 39 - 109 - 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 S.B. 39 Enrolled Copy - 110 - 2945 department shall consult with accountable care organizations and counties in the state. 2946 Section 61. Section 26B-3-220, which is renumbered from Section 26-18-424 is 2947 renumbered and amended to read: 2948 [26-18-424]. 26B-3-220. Crisis services -- Reimbursement. 2949 The [Department] department shall submit a waiver or state plan amendment to allow 2950 for reimbursement for 988 services provided to an individual who is eligible and enrolled in 2951 Medicaid at the time this service is provided. 2952 Section 62. Section 26B-3-221, which is renumbered from Section 26-18-425 is 2953 renumbered and amended to read: 2954 [26-18-425]. 26B-3-221. Medicaid waiver for respite care facility that 2955 provides services to homeless individuals. 2956 (1) As used in this section: 2957 (a) "Adult in the expansion population" means an adult: 2958 (i) described in 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII); and 2959 (ii) not otherwise eligible for Medicaid as a mandatory categorically needy individual. 2960 (b) "Homeless" means the same as that term is defined in Section [26-18-411] 2961 26B-3-207. 2962 (c) "Medical respite care" means short-term housing with supportive medical services. 2963 (d) "Medical respite facility" means a residential facility that provides medical respite 2964 care to homeless individuals. 2965 (2) Before January 1, 2022, the department shall apply for a Medicaid waiver or state 2966 plan amendment with CMS to choose a single medical respite facility to reimburse for services 2967 provided to an individual who is: 2968 (a) homeless; and 2969 (b) an adult in the expansion population. 2970 (3) The department shall choose a medical respite facility best able to serve homeless 2971 individuals who are adults in the expansion population. Enrolled Copy S.B. 39 - 111 - 2972 (4) If the waiver or state plan amendment described in Subsection (2) is approved, 2973 while the waiver or state plan amendment is in effect, the department shall submit a report to 2974 the Health and Human Services Interim Committee each year before November 30 detailing: 2975 (a) the number of homeless individuals served at the facility; 2976 (b) the cost of the program; and 2977 (c) the reduction of health care costs due to the program's implementation. 2978 (5) Through administrative rule made in accordance with Title 63G, Chapter 3, Utah 2979 Administrative Rulemaking Act, the department shall further define and limit the services, 2980 described in this section, provided to a homeless individual. 2981 Section 63. Section 26B-3-222, which is renumbered from Section 26-18-426 is 2982 renumbered and amended to read: 2983 [26-18-426]. 26B-3-222. Medicaid waiver expansion for extraordinary 2984 care reimbursement. 2985 (1) As used in this section: 2986 (a) "Existing home and community-based services waiver" means an existing home 2987 and community-based services waiver in the state that serves an individual: 2988 (i) with an acquired brain injury; 2989 (ii) with an intellectual or physical disability; or 2990 (iii) who is 65 years old or older. 2991 (b) "Personal care services" means a service that: 2992 (i) is furnished to an individual who is not an inpatient nor a resident of a hospital, 2993 nursing facility, intermediate care facility, or institution for mental diseases; 2994 (ii) is authorized for an individual described in Subsection (1)(b)(i) in accordance with 2995 a plan of treatment; 2996 (iii) is provided by an individual who is qualified to provide the services; and 2997 (iv) is furnished in a home or another community-based setting. 2998 (c) "Waiver enrollee" means an individual who is enrolled in an existing home and S.B. 39 Enrolled Copy - 112 - 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) Enrolled Copy S.B. 39 - 113 - 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: S.B. 39 Enrolled Copy - 114 - 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, Enrolled Copy S.B. 39 - 115 - 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 S.B. 39 Enrolled Copy - 116 - 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 Enrolled Copy S.B. 39 - 117 - 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, S.B. 39 Enrolled Copy - 118 - 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. Enrolled Copy S.B. 39 - 119 - 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 S.B. 39 Enrolled Copy - 120 - 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 Enrolled Copy S.B. 39 - 121 - 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 S.B. 39 Enrolled Copy - 122 - 3269 pharmacists to record information to be collected under this part. The recorded information 3270 shall include: 3271 (a) the name, address, age, and gender of the recipient; 3272 (b) individual history of the recipient where significant, including disease state, known 3273 allergies and drug reactions, and a comprehensive list of medications and relevant devices; 3274 (c) the pharmacist's comments on the individual's drug therapy; 3275 (d) name of prescriber; and 3276 (e) name of drug, dose, duration of therapy, and directions for use. 3277 Section 69. Section 26B-3-304, which is renumbered from Section 26-18-104 is 3278 renumbered and amended to read: 3279 [26-18-104]. 26B-3-304. Confidentiality of records. 3280 (1) Information obtained under this part shall be treated as confidential or controlled 3281 information under Title 63G, Chapter 2, Government Records Access and Management Act. 3282 (2) The board shall establish procedures [insuring] ensuring that the information 3283 described in Subsection [26-18-103] 26B-3-304(16) is held confidential by the pharmacist, 3284 being provided to the physician only upon request. 3285 (3) The board shall adopt and implement procedures designed to ensure the 3286 confidentiality of all information collected, stored, retrieved, assessed, or analyzed by the 3287 board, staff to the board, or contractors to the DUR program, that identifies individual 3288 physicians, pharmacists, or recipients. The board may have access to identifying information 3289 for purposes of carrying out intervention activities, but that identifying information may not be 3290 released to anyone other than a member of the board. The board may release cumulative 3291 nonidentifying information for research purposes. 3292 Section 70. Section 26B-3-305, which is renumbered from Section 26-18-105 is 3293 renumbered and amended to read: 3294 [26-18-105]. 26B-3-305. Drug prior approval program. 3295 (1) A drug prior approval program approved or implemented by the board shall meet Enrolled Copy S.B. 39 - 123 - 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 S.B. 39 Enrolled Copy - 124 - 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). Enrolled Copy S.B. 39 - 125 - 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 S.B. 39 Enrolled Copy - 126 - 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 Enrolled Copy S.B. 39 - 127 - 3404 the provisions of Subsections [26-18-503] 26B-3-311(5) and (7). 3405 (3) The division may not: 3406 (a) except as authorized by Section [26-18-503] 26B-3-311: 3407 (i) process initial applications for Medicaid certification or execute provider 3408 agreements with nursing care facility programs; or 3409 (ii) reinstate Medicaid certification for a nursing care facility whose certification 3410 expired or was terminated by action of the federal or state government; or 3411 (b) execute a Medicaid provider agreement with a certified program that moves to a 3412 different physical facility, except as authorized by Subsection [26-18-503] 26B-3-311(3). 3413 (4) Notwithstanding Section [26-18-503] 26B-3-311, beginning May 4, 2021, the 3414 division may not approve a new or additional bed in an intermediate care facility for 3415 individuals with an intellectual disability for Medicaid certification, unless certification of the 3416 bed by the division does not increase the total number in the state of Medicaid-certified beds in 3417 intermediate care facilities for individuals with an intellectual disability. 3418 Section 76. Section 26B-3-311, which is renumbered from Section 26-18-503 is 3419 renumbered and amended to read: 3420 [26-18-503]. 26B-3-311. Authorization to renew, transfer, or increase 3421 Medicaid certified programs -- Reimbursement methodology. 3422 (1) (a) The division may renew Medicaid certification of a certified program if the 3423 program, without lapse in service to Medicaid recipients, has its nursing care facility program 3424 certified by the division at the same physical facility as long as the licensed and certified bed 3425 capacity at the facility has not been expanded, unless the director has approved additional beds 3426 in accordance with Subsection (5). 3427 (b) The division may renew Medicaid certification of a nursing care facility program 3428 that is not currently certified if: 3429 (i) since the day on which the program last operated with Medicaid certification: 3430 (A) the physical facility where the program operated has functioned solely and S.B. 39 Enrolled Copy - 128 - 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 Enrolled Copy S.B. 39 - 129 - 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: S.B. 39 Enrolled Copy - 130 - 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 Enrolled Copy S.B. 39 - 131 - 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: S.B. 39 Enrolled Copy - 132 - 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. Enrolled Copy S.B. 39 - 133 - 3566 (9) (a) If the director makes an initial determination that quality standards under 3567 Subsection (5)(d)(v) have not been met in a rural county or group of rural counties over the 3568 previous three-year period, the director shall, before approving certification of additional 3569 Medicaid beds in the rural county or group of counties: 3570 (i) notify the certified program that has not met the quality standards in Subsection 3571 (5)(d)(v) that the director intends to certify additional Medicaid beds under the provisions of 3572 Subsection (5)(d)(v); and 3573 (ii) consider additional information submitted to the director by the certified program 3574 in a rural county that has not met the quality standards under Subsection (5)(d)(v). 3575 (b) The notice under Subsection (9)(a) does not give the certified program that has not 3576 met the quality standards under Subsection (5)(d)(v), the right to legally challenge or appeal the 3577 director's decision to certify additional Medicaid beds under Subsection (5)(d)(v). 3578 Section 77. Section 26B-3-312, which is renumbered from Section 26-18-504 is 3579 renumbered and amended to read: 3580 [26-18-504]. 26B-3-312. Appeals of division decision -- Rulemaking 3581 authority -- Application of act. 3582 (1) A decision by the director under this part to deny Medicaid certification for a 3583 nursing care facility program or to deny additional bed capacity for an existing certified 3584 program is subject to review under the procedures and requirements of Title 63G, Chapter 4, 3585 Administrative Procedures Act. 3586 (2) The department shall make rules to administer and enforce [this part] Sections 3587 26B-3-310 through 26B-3-313 in accordance with Title 63G, Chapter 3, Utah Administrative 3588 Rulemaking Act. 3589 (3) (a) In the event the department is at risk for a federal disallowance with regard to a 3590 Medicaid recipient being served in a nursing care facility program that is not Medicaid 3591 certified, the department may grant temporary Medicaid certification to that facility for up to 24 3592 months. S.B. 39 Enrolled Copy - 134 - 3593 (b) (i) The department may extend a temporary Medicaid certification granted to a 3594 facility under Subsection (3)(a): 3595 (A) for the number of beds in the nursing care facility occupied by a Medicaid 3596 recipient; and 3597 (B) for the period of time during which the Medicaid recipient resides at the facility. 3598 (ii) A temporary Medicaid certification granted under this Subsection (3) is revoked 3599 upon: 3600 (A) the discharge of the patient from the facility; or 3601 (B) the patient no longer residing at the facility for any reason. 3602 (c) The department may place conditions on the temporary certification granted under 3603 Subsections (3)(a) and (b), such as: 3604 (i) not allowing additional admissions of Medicaid recipients to the program; and 3605 (ii) not paying for the care of the patient after October 1, 2008, with state only dollars. 3606 Section 78. Section 26B-3-313, which is renumbered from Section 26-18-505 is 3607 renumbered and amended to read: 3608 [26-18-505]. 26B-3-313. Authorization to sell or transfer licensed 3609 Medicaid beds -- Duties of transferor -- Duties of transferee -- Duties of division. 3610 (1) This section provides a method to transfer or sell the license for a Medicaid bed 3611 from a nursing care facility program to another entity that is in addition to the authorization to 3612 transfer under Section [26-18-503] 26B-3-311. 3613 (2) (a) A nursing care facility program may transfer or sell one or more of its licenses 3614 for Medicaid beds in accordance with Subsection (2)(b) if: 3615 (i) at the time of the transfer, and with respect to the license for the Medicaid bed that 3616 will be transferred, the nursing care facility program that will transfer the Medicaid license 3617 meets all applicable regulations for Medicaid certification; 3618 (ii) the nursing care facility program gives a written assurance, which is postmarked or 3619 has proof of delivery 30 days before the transfer, to the director and to the transferee in Enrolled Copy S.B. 39 - 135 - 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 S.B. 39 Enrolled Copy - 136 - 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 Enrolled Copy S.B. 39 - 137 - 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; S.B. 39 Enrolled Copy - 138 - 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 Enrolled Copy S.B. 39 - 139 - 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; S.B. 39 Enrolled Copy - 140 - 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, Enrolled Copy S.B. 39 - 141 - 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 S.B. 39 Enrolled Copy - 142 - 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. Enrolled Copy S.B. 39 - 143 - 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 S.B. 39 Enrolled Copy - 144 - 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. Enrolled Copy S.B. 39 - 145 - 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 S.B. 39 Enrolled Copy - 146 - 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 Enrolled Copy S.B. 39 - 147 - 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 S.B. 39 Enrolled Copy - 148 - 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 Enrolled Copy S.B. 39 - 149 - 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: S.B. 39 Enrolled Copy - 150 - 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 Enrolled Copy S.B. 39 - 151 - 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, S.B. 39 Enrolled Copy - 152 - 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. Enrolled Copy S.B. 39 - 153 - 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 S.B. 39 Enrolled Copy - 154 - 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 Enrolled Copy S.B. 39 - 155 - 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 S.B. 39 Enrolled Copy - 156 - 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: Enrolled Copy S.B. 39 - 157 - 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: S.B. 39 Enrolled Copy - 158 - 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 Enrolled Copy S.B. 39 - 159 - 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 S.B. 39 Enrolled Copy - 160 - 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. Enrolled Copy S.B. 39 - 161 - 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; S.B. 39 Enrolled Copy - 162 - 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 Enrolled Copy S.B. 39 - 163 - 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. S.B. 39 Enrolled Copy - 164 - 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. Enrolled Copy S.B. 39 - 165 - 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. S.B. 39 Enrolled Copy - 166 - 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 Enrolled Copy S.B. 39 - 167 - 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. S.B. 39 Enrolled Copy - 168 - 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: Enrolled Copy S.B. 39 - 169 - 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. S.B. 39 Enrolled Copy - 170 - 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 Enrolled Copy S.B. 39 - 171 - 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 S.B. 39 Enrolled Copy - 172 - 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. Enrolled Copy S.B. 39 - 173 - 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. S.B. 39 Enrolled Copy - 174 - 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. Enrolled Copy S.B. 39 - 175 - 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 S.B. 39 Enrolled Copy - 176 - 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, Enrolled Copy S.B. 39 - 177 - 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; S.B. 39 Enrolled Copy - 178 - 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. Enrolled Copy S.B. 39 - 179 - 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: S.B. 39 Enrolled Copy - 180 - 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 Enrolled Copy S.B. 39 - 181 - 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 S.B. 39 Enrolled Copy - 182 - 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: Enrolled Copy S.B. 39 - 183 - 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; S.B. 39 Enrolled Copy - 184 - 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 Enrolled Copy S.B. 39 - 185 - 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 S.B. 39 Enrolled Copy - 186 - 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 Enrolled Copy S.B. 39 - 187 - 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: S.B. 39 Enrolled Copy - 188 - 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. Enrolled Copy S.B. 39 - 189 - 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 S.B. 39 Enrolled Copy - 190 - 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 Enrolled Copy S.B. 39 - 191 - 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; S.B. 39 Enrolled Copy - 192 - 5159 (ii) the approximate date of illness or injury; 5160 (iii) a general description of the type of illness or injury; and 5161 (iv) if applicable, the general location where the injury is alleged to have occurred. 5162 (3) The department may commence an action on the department's claim or lien in the 5163 department's name, but the claim or lien is not enforceable as to a third-party unless: 5164 (a) the third-party receives written notice of the department's claim or lien before the 5165 third-party settles with the recipient; or 5166 (b) the department has evidence that the third party had knowledge that the department 5167 provided or was obligated to provide medical assistance. 5168 (4) The department may: 5169 (a) waive a claim or lien against a third party in whole or in part; or 5170 (b) compromise, settle, or release a claim or lien. 5171 (5) An action commenced under this section does not bar an action by a recipient or a 5172 dependent of a recipient for loss or damage not included in the department's action. 5173 (6) Except as provided in Subsection (1)(c), the department's claim or lien on proceeds 5174 under this section is not affected by the transfer of the proceeds to a trust, annuity, financial 5175 account, or other financial instrument. 5176 Section 142. Section 26B-3-1010, which is renumbered from Section 26-19-402 is 5177 renumbered and amended to read: 5178 [26-19-402]. 26B-3-1010. Action by department -- Notice to recipient. 5179 (1) (a) Within 30 days after commencing an action under Subsection [26-19-401] 5180 26B-3-1009(3), the department shall give the recipient, the recipient's guardian, personal 5181 representative, trustee, estate, or survivor, whichever is appropriate, written notice of the action 5182 by: 5183 (i) personal service or certified mail to the last known address of the person receiving 5184 the notice; or 5185 (ii) if no last-known address is available, by publishing a notice: Enrolled Copy S.B. 39 - 193 - 5186 (A) once a week for three successive weeks in a newspaper of general circulation in the 5187 county where the recipient resides; and 5188 (B) in accordance with Section 45-1-101 for three weeks. 5189 (b) Proof of service shall be filed in the action. 5190 (c) The recipient may intervene in the department's action at any time before trial. 5191 (2) The notice required by Subsection (1) shall name the court in which the action is 5192 commenced and advise the recipient of: 5193 (a) the right to intervene in the proceeding; 5194 (b) the right to obtain a private attorney; and 5195 (c) the department's right to recover medical assistance directly from the third party. 5196 Section 143. Section 26B-3-1011, which is renumbered from Section 26-19-403 is 5197 renumbered and amended to read: 5198 [26-19-403]. 26B-3-1011. Notice of claim by recipient -- Department 5199 response -- Conditions for proceeding -- Collection agreements. 5200 (1) (a) A recipient may not file a claim, commence an action, or settle, compromise, 5201 release, or waive a claim against a third party for recovery of medical costs for an injury, 5202 disease, or disability for which the department has provided or has become obligated to provide 5203 medical assistance, without the department's written consent as provided in Subsection (2)(b) 5204 or (4). 5205 (b) For purposes of Subsection (1)(a), consent may be obtained if: 5206 (i) a recipient who files a claim, or commences an action against a third party notifies 5207 the department in accordance with Subsection (1)(d) within 10 days of the recipient making the 5208 claim or commencing an action; or 5209 (ii) an attorney, who has been retained by the recipient to file a claim, or commence an 5210 action against a third party, notifies the department in accordance with Subsection (1)(d) of the 5211 recipient's claim: 5212 (A) within 30 days after being retained by the recipient for that purpose; or S.B. 39 Enrolled Copy - 194 - 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 Enrolled Copy S.B. 39 - 195 - 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 S.B. 39 Enrolled Copy - 196 - 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). Enrolled Copy S.B. 39 - 197 - 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. S.B. 39 Enrolled Copy - 198 - 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. Enrolled Copy S.B. 39 - 199 - 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 S.B. 39 Enrolled Copy - 200 - 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 Enrolled Copy S.B. 39 - 201 - 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); S.B. 39 Enrolled Copy - 202 - 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: Enrolled Copy S.B. 39 - 203 - 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: S.B. 39 Enrolled Copy - 204 - 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: Enrolled Copy S.B. 39 - 205 - 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: S.B. 39 Enrolled Copy - 206 - 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 Enrolled Copy S.B. 39 - 207 - 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. S.B. 39 Enrolled Copy - 208 - 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 Enrolled Copy S.B. 39 - 209 - 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. S.B. 39 Enrolled Copy - 210 - 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 Enrolled Copy S.B. 39 - 211 - 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 S.B. 39 Enrolled Copy - 212 - 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 Enrolled Copy S.B. 39 - 213 - 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 S.B. 39 Enrolled Copy - 214 - 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: Enrolled Copy S.B. 39 - 215 - 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: S.B. 39 Enrolled Copy - 216 - 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. Enrolled Copy S.B. 39 - 217 - 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 S.B. 39 Enrolled Copy - 218 - 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 Enrolled Copy S.B. 39 - 219 - 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. S.B. 39 Enrolled Copy - 220 - 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 Enrolled Copy S.B. 39 - 221 - 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. S.B. 39 Enrolled Copy - 222 - 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. Enrolled Copy S.B. 39 - 223 - 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, S.B. 39 Enrolled Copy - 224 - 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, Enrolled Copy S.B. 39 - 225 - 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 S.B. 39 Enrolled Copy - 226 - 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. Enrolled Copy S.B. 39 - 227 - 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. S.B. 39 Enrolled Copy - 228 - 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. Enrolled Copy S.B. 39 - 229 - 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. S.B. 39 Enrolled Copy - 230 - 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. Enrolled Copy S.B. 39 - 231 - 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. S.B. 39 Enrolled Copy - 232 - 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; Enrolled Copy S.B. 39 - 233 - 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 S.B. 39 Enrolled Copy - 234 - 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 Enrolled Copy S.B. 39 - 235 - 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; S.B. 39 Enrolled Copy - 236 - 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: Enrolled Copy S.B. 39 - 237 - 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. S.B. 39 Enrolled Copy - 238 - 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 Enrolled Copy S.B. 39 - 239 - 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. S.B. 39 Enrolled Copy - 240 - 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 Enrolled Copy S.B. 39 - 241 - 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 S.B. 39 Enrolled Copy - 242 - 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 Enrolled Copy S.B. 39 - 243 - 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 S.B. 39 Enrolled Copy - 244 - 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. Enrolled Copy S.B. 39 - 245 - 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 S.B. 39 Enrolled Copy - 246 - 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 Enrolled Copy S.B. 39 - 247 - 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. S.B. 39 Enrolled Copy - 248 - 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. Enrolled Copy S.B. 39 - 249 - 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; S.B. 39 Enrolled Copy - 250 - 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; Enrolled Copy S.B. 39 - 251 - 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. S.B. 39 Enrolled Copy - 252 - 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. Enrolled Copy S.B. 39 - 253 - 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 S.B. 39 Enrolled Copy - 254 - 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 Enrolled Copy S.B. 39 - 255 - 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: S.B. 39 Enrolled Copy - 256 - 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: Enrolled Copy S.B. 39 - 257 - 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 S.B. 39 Enrolled Copy - 258 - 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 Enrolled Copy S.B. 39 - 259 - 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; S.B. 39 Enrolled Copy - 260 - 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; Enrolled Copy S.B. 39 - 261 - 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; S.B. 39 Enrolled Copy - 262 - 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 Enrolled Copy S.B. 39 - 263 - 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 S.B. 39 Enrolled Copy - 264 - 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. Enrolled Copy S.B. 39 - 265 - 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. S.B. 39 Enrolled Copy - 266 - 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. Enrolled Copy S.B. 39 - 267 - 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. S.B. 39 Enrolled Copy - 268 - 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. Enrolled Copy S.B. 39 - 269 - 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 S.B. 39 Enrolled Copy - 270 - 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 Enrolled Copy S.B. 39 - 271 - 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: S.B. 39 Enrolled Copy - 272 - 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 Enrolled Copy S.B. 39 - 273 - 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 S.B. 39 Enrolled Copy - 274 - 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 Enrolled Copy S.B. 39 - 275 - 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 S.B. 39 Enrolled Copy - 276 - 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; Enrolled Copy S.B. 39 - 277 - 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: S.B. 39 Enrolled Copy - 278 - 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 Enrolled Copy S.B. 39 - 279 - 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 S.B. 39 Enrolled Copy - 280 - 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. Enrolled Copy S.B. 39 - 281 - 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: S.B. 39 Enrolled Copy - 282 - 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 Enrolled Copy S.B. 39 - 283 - 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: S.B. 39 Enrolled Copy - 284 - 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. Enrolled Copy S.B. 39 - 285 - 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. S.B. 39 Enrolled Copy - 286 - 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. Enrolled Copy S.B. 39 - 287 - 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 S.B. 39 Enrolled Copy - 288 - 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 Enrolled Copy S.B. 39 - 289 - 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 S.B. 39 Enrolled Copy - 290 - 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. Enrolled Copy S.B. 39 - 291 - 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). S.B. 39 Enrolled Copy - 292 - 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 Enrolled Copy S.B. 39 - 293 - 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. S.B. 39 Enrolled Copy - 294 - 7913 (6) In the absence of an express, contrary indication by the donor or other person 7914 authorized to make an anatomical gift under Section [26-28-104] 26B-8-303, an anatomical 7915 gift of a part for one or more of the purposes set forth in Section [26-28-104] 26B-8-303 is not 7916 a limitation on the making of an anatomical gift of the part for any of the other purposes by the 7917 donor or any other person under Section [26-28-105 or 26-28-110] 26B-8-304 or 26B-8-309. 7918 (7) If a donor who is an unemancipated minor dies, a parent of the donor who is 7919 reasonably available may revoke or amend an anatomical gift of the donor's body or part. 7920 (8) If an unemancipated minor who signed a refusal dies, a parent of the minor who is 7921 reasonably available may revoke the minor's refusal. 7922 Section 249. Section 26B-8-308, which is renumbered from Section 26-28-109 is 7923 renumbered and amended to read: 7924 [26-28-109]. 26B-8-308. Who may make anatomical gift of decedent's 7925 body or part. 7926 (1) Subject to Subsections (2) and (3) and unless barred by Section [26-28-107 or 7927 26-28-108] 26B-8-306 or 26B-8-307, an anatomical gift of a decedent's body or part for 7928 purpose of transplantation, therapy, research, or education may be made by any member of the 7929 following classes of persons who is reasonably available, in the order of priority listed: 7930 (a) an agent of the decedent at the time of death who could have made an anatomical 7931 gift under Subsection [26-28-104] 26B-8-303(2) immediately before the decedent's death; 7932 (b) the spouse of the decedent; 7933 (c) adult children of the decedent; 7934 (d) parents of the decedent; 7935 (e) adult siblings of the decedent; 7936 (f) adult grandchildren of the decedent; 7937 (g) grandparents of the decedent; 7938 (h) the persons who were acting as the guardians of the person of the decedent at the 7939 time of death; Enrolled Copy S.B. 39 - 295 - 7940 (i) an adult who exhibited special care and concern for the decedent; and 7941 (j) any other person having the authority to dispose of the decedent's body. 7942 (2) If there is more than one member of a class listed in Subsection (1)(a), (c), (d), (e), 7943 (f), (g), or (j) entitled to make an anatomical gift, an anatomical gift may be made by a member 7944 of the class unless that member or a person to which the gift may pass under Section 7945 [26-28-111] 26B-8-310 knows of an objection by another member of the class. If an objection 7946 is known, the gift may be made only by a majority of the members of the class who are 7947 reasonably available. 7948 (3) A person may not make an anatomical gift if, at the time of the decedent's death, a 7949 person in a prior class under Subsection (1) is reasonably available to make or to object to the 7950 making of an anatomical gift. 7951 Section 250. Section 26B-8-309, which is renumbered from Section 26-28-110 is 7952 renumbered and amended to read: 7953 [26-28-110]. 26B-8-309. Manner of making, amending, or revoking 7954 anatomical gift of decedent's body or part. 7955 (1) A person authorized to make an anatomical gift under Section [26-28-109] 7956 26B-8-308 may make an anatomical gift by a document of gift signed by the person making the 7957 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 S.B. 39 Enrolled Copy - 296 - 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. Enrolled Copy S.B. 39 - 297 - 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 S.B. 39 Enrolled Copy - 298 - 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; Enrolled Copy S.B. 39 - 299 - 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. S.B. 39 Enrolled Copy - 300 - 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 renumbered and amended to read: 8082 [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. Enrolled Copy S.B. 39 - 301 - 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 S.B. 39 Enrolled Copy - 302 - 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. Enrolled Copy S.B. 39 - 303 - 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 S.B. 39 Enrolled Copy - 304 - 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 renumbered and amended to read: 8204 [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. Enrolled Copy S.B. 39 - 305 - 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. S.B. 39 Enrolled Copy - 306 - 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 renumbered and amended to read: 8253 [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 Enrolled Copy S.B. 39 - 307 - 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 S.B. 39 Enrolled Copy - 308 - 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 renumbered and amended to read: 8310 [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. Enrolled Copy S.B. 39 - 309 - 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 S.B. 39 Enrolled Copy - 310 - 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, Enrolled Copy S.B. 39 - 311 - 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; S.B. 39 Enrolled Copy - 312 - 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 Enrolled Copy S.B. 39 - 313 - 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 S.B. 39 Enrolled Copy - 314 - 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. Enrolled Copy S.B. 39 - 315 - 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 S.B. 39 Enrolled Copy - 316 - 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 Enrolled Copy S.B. 39 - 317 - 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 S.B. 39 Enrolled Copy - 318 - 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, Enrolled Copy S.B. 39 - 319 - 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. S.B. 39 Enrolled Copy - 320 - 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 Enrolled Copy S.B. 39 - 321 - 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; S.B. 39 Enrolled Copy - 322 - 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. Enrolled Copy S.B. 39 - 323 - 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 S.B. 39 Enrolled Copy - 324 - 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: Enrolled Copy S.B. 39 - 325 - 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. S.B. 39 Enrolled Copy - 326 - 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. Enrolled Copy S.B. 39 - 327 - 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: S.B. 39 Enrolled Copy - 328 - 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 Enrolled Copy S.B. 39 - 329 - 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. S.B. 39 Enrolled Copy - 330 - 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: Enrolled Copy S.B. 39 - 331 - 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); S.B. 39 Enrolled Copy - 332 - 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, Enrolled Copy S.B. 39 - 333 - 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. S.B. 39 Enrolled Copy - 334 - 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, Enrolled Copy S.B. 39 - 335 - 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 S.B. 39 Enrolled Copy - 336 - 9047 General Session, replace any references to Title 26 or 62A with the renumbered reference as it 9048 is renumbered in this bill.