reglab/housing_qa huggingface dataset:
UT Code § 26-18-602 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 18 - Medical Assistance Act|Part 6 - Medical Assistance Accountability|Section 602 - Definitions.

 Effective 5/12/2015  26-18-602. Definitions.  As used in this part:  (1) "Abuse" means:   (a) an action or practice that:   (i) is inconsistent with sound fiscal, business, or medical practices; and     (ii) results, or may result, in unnecessary Medicaid related costs or other medical or hospital assistance costs; or       (b) reckless or negligent upcoding.       (2) "Auditor's Office" means the Office of Internal Audit, within the department.     (3) "Fraud" means intentional or knowing:   (a) deception, misrepresentation, or upcoding in relation to Medicaid funds, costs, claims, reimbursement, or practice; or     (b) deception or misrepresentation in relation to medical or hospital assistance funds, costs, claims, reimbursement, or practice.       (4) "Medical or hospital assistance" is as defined in Section 26-18-2.     (5) "Upcoding" means assigning an inaccurate billing code for a service that is payable or reimbursable by Medicaid funds, if the correct billing code for the service, taking into account reasonable opinions derived from official published coding definitions, would result in a lower Medicaid payment or reimbursement.     (6) "Waste" means overutilization of resources or inappropriate payment.    Amended by Chapter 135, 2015 General Session
UT Code § 26-18-603 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 18 - Medical Assistance Act|Part 6 - Medical Assistance Accountability|Section 603 - Adjudicative proceedings related to Medicaid funds.

 Effective 5/12/2015  26-18-603. Adjudicative proceedings related to Medicaid funds.    (1) If a proceeding of the department, under Title 63G, Chapter 4, Administrative Procedures Act, relates in any way to recovery of Medicaid funds:   (a) the presiding officer shall be designated by the executive director of the department and report directly to the executive director or, in the discretion of the executive director, report directly to the director of the Office of Internal Audit; and     (b) the decision of the presiding officer is the recommended decision to the executive director of the department or a designee of the executive director who is not in the division.       (2) Subsection (1) does not apply to hearings conducted by the Department of Workforce Services relating to medical assistance eligibility determinations.     (3) If a proceeding of the department, under Title 63G, Chapter 4, Administrative Procedures Act, relates in any way to Medicaid or Medicaid funds, the following may attend and present evidence or testimony at the proceeding:   (a) the director of the Office of Internal Audit, or the director's designee; and     (b) the inspector general of Medicaid services or the inspector general's designee.       (4) In relation to a proceeding of the department under Title 63G, Chapter 4, Administrative Procedures Act, a person may not, outside of the actual proceeding, attempt to influence the decision of the presiding officer.    Amended by Chapter 135, 2015 General Session
UT Code § 26-18-604 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 18 - Medical Assistance Act|Part 6 - Medical Assistance Accountability|Section 604 - Division duties -- Reporting.

 Effective 1/1/2020  26-18-604. Division duties -- Reporting.  The division shall:   (1) develop and implement procedures relating to Medicaid funds and medical or hospital assistance funds to ensure that providers do not receive:   (a) duplicate payments for the same goods or services;     (b) payment for goods or services by resubmitting a claim for which:   (i) payment has been disallowed on the grounds that payment would be a violation of federal or state law, administrative rule, or the state plan; and     (ii) the decision to disallow the payment has become final;       (c) payment for goods or services provided after a recipient's death, including payment for pharmaceuticals or long-term care; or     (d) payment for transporting an unborn infant;       (2) consult with the Centers for Medicaid and Medicare Services, other states, and the Office of Inspector General of Medicaid Services to determine and implement best practices for discovering and eliminating fraud, waste, and abuse of Medicaid funds and medical or hospital assistance funds;     (3) actively seek repayment from providers for improperly used or paid:   (a) Medicaid funds; and     (b) medical or hospital assistance funds;       (4) coordinate, track, and keep records of all division efforts to obtain repayment of the funds described in Subsection (3), and the results of those efforts;     (5) keep Medicaid pharmaceutical costs as low as possible by actively seeking to obtain pharmaceuticals at the lowest price possible, including, on a quarterly basis for the pharmaceuticals that represent the highest 45% of state Medicaid expenditures for pharmaceuticals and on an annual basis for the remaining pharmaceuticals:   (a) tracking changes in the price of pharmaceuticals;     (b) checking the availability and price of generic drugs;     (c) reviewing and updating the state's maximum allowable cost list; and     (d) comparing pharmaceutical costs of the state Medicaid program to available pharmacy price lists; and       (6) provide training, on an annual basis, to the employees of the division who make decisions on billing codes, or who are in the best position to observe and identify upcoding, in order to avoid and detect upcoding.    Amended by Chapter 135, 2015 General Session
UT Code § 26-18-605 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 18 - Medical Assistance Act|Part 6 - Medical Assistance Accountability|Section 605 - Utah Office of Internal Audit.

 Effective 5/12/2015  26-18-605. Utah Office of Internal Audit.  The Utah Office of Internal Audit:  (1) may not be placed within the division;     (2) shall be placed directly under, and report directly to, the executive director of the Department of Health; and     (3) shall have full access to all records of the division.    Amended by Chapter 135, 2015 General Session
UT Code § 26-19-101 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 19 - Medical Benefits Recovery Act|Part 1 - General Provisions|Section 101 - Title.

 Effective 5/8/2018  26-19-101. Title.  This chapter is known as the "Medical Benefits Recovery Act." Renumbered and Amended by Chapter 443, 2018 General Session
UT Code § 26-19-103 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 19 - Medical Benefits Recovery Act|Part 1 - General Provisions|Section 103 - Program established by department -- Promulgation of rules.

 Effective 5/8/2018  26-19-103. Program established by department -- Promulgation of rules.    (1) The department shall establish and maintain a program for the recoupment of medical assistance.     (2) The department may promulgate rules to implement the purposes of this chapter.    Renumbered and Amended by Chapter 443, 2018 General Session
UT Code § 26-19-201 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 19 - Medical Benefits Recovery Act|Part 2 - Assignment of Rights|Section 201 - Assignment of rights to benefits.

 Effective 5/5/2021  26-19-201. Assignment of rights to benefits.    (1)   (a) Except as provided in Subsection 26-19-401(1), to the extent that medical assistance is actually provided to a recipient, all benefits for medical services or payments from a third-party otherwise payable to or on behalf of a recipient are assigned by operation of law to the department if the department provides, or becomes obligated to provide, medical assistance, regardless of who made application for the benefits on behalf of the recipient.     (b) The assignment:   (i) authorizes the department to submit its claim to the third-party and authorizes payment of benefits directly to the department; and     (ii) is effective for all medical assistance.         (2) The department may recover the assigned benefits or payments in accordance with Section 26-19-401 and as otherwise provided by law.     (3)   (a) The assignment of benefits includes medical support and third-party payments ordered, decreed, or adjudged by any court of this state or any other state or territory of the United States.     (b) The assignment is not in lieu of, and does not supersede or alter any other court order, decree, or judgment.       (4) When an assignment takes effect, the recipient is entitled to receive medical assistance, and the benefits paid to the department are a reimbursement to the department.    Amended by Chapter 300, 2021 General Session
UT Code § 26-19-301 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 19 - Medical Benefits Recovery Act|Part 3 - Insurance Provisions|Section 301 - Health insurance entity -- Duties related to state claims for Medicaid payment or recovery.

 Effective 5/8/2018  26-19-301. Health insurance entity -- Duties related to state claims for Medicaid payment or recovery.  As a condition of doing business in the state, a health insurance entity shall:  (1) with respect to an individual who is eligible for, or is provided, medical assistance under the state plan, upon the request of the Department of Health, provide information to determine:   (a) during what period the individual, or the spouse or dependent of the individual, may be or may have been, covered by the health insurance entity; and     (b) the nature of the coverage that is or was provided by the health insurance entity described in Subsection (1)(a), including the name, address, and identifying number of the plan;       (2) accept the state's right of recovery and the assignment to the state of any right of an individual to payment from a party for an item or service for which payment has been made under the state plan;     (3) respond to any inquiry by the Department of Health regarding a claim for payment for any health care item or service that is submitted no later than three years after the day on which the health care item or service is provided; and     (4) not deny a claim submitted by the Department of Health solely on the basis of the date of submission of the claim, the type or format of the claim form, or failure to present proper documentation at the point-of-sale that is the basis for the claim, if:   (a) the claim is submitted no later than three years after the day on which the item or service is furnished; and     (b) any action by the Department of Health to enforce the rights of the state with respect to the claim is commenced no later than six years after the day on which the claim is submitted.      Renumbered and Amended by Chapter 443, 2018 General Session
UT Code § 26-19-302 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 19 - Medical Benefits Recovery Act|Part 3 - Insurance Provisions|Section 302 - Insurance policies not to deny or reduce benefits of individuals eligible for state medical assistance -- Exemptions.

 Effective 5/12/2020  26-19-302. Insurance policies not to deny or reduce benefits of individuals eligible for state medical assistance -- Exemptions.    (1) A policy of accident or sickness insurance may not contain any provision denying or reducing benefits because services are rendered to an insured or dependent who is eligible for or receiving medical assistance from the state.     (2) An association, corporation, or organization may not deliver, issue for delivery, or renew any subscriber's contract which contains any provisions denying or reducing benefits because services are rendered to a subscriber or dependent who is eligible for or receiving medical assistance from the state.     (3) An association, corporation, business, or organization authorized to do business in this state and which provides or pays for any health care benefits may not deny or reduce benefits because services are rendered to a beneficiary who is eligible for or receiving medical assistance from the state.     (4) Notwithstanding Subsection (1), (2), or (3), the Utah State Public Employees' Health Program, administered by the Utah State Retirement Board, is not required to reimburse any agency of state government for custodial care which the agency provides, through its staff or facilities, to members of the Utah State Public Employees' Health Program.    Amended by Chapter 354, 2020 General Session
UT Code § 26-19-303 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 19 - Medical Benefits Recovery Act|Part 3 - Insurance Provisions|Section 303 - Availability of insurance policy.

 Effective 5/8/2018  26-19-303. Availability of insurance policy.  If the third party does not pay the department's claim or lien within 30 days from the date the claim or lien is received, the third party shall:  (1) provide a written explanation if the claim is denied;     (2) specifically describe and request any additional information from the department that is necessary to process the claim; and     (3) provide the department or its agent a copy of any relevant or applicable insurance or benefit policy.    Renumbered and Amended by Chapter 443, 2018 General Session
UT Code § 26-19-304 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 19 - Medical Benefits Recovery Act|Part 3 - Insurance Provisions|Section 304 - Employee benefit plans.

 Effective 5/8/2018  26-19-304. Employee benefit plans.  As allowed pursuant to 29 U.S.C. Section 1144, an employee benefit plan may not include any provision that has the effect of limiting or excluding coverage or payment for any health care for an individual who would otherwise be covered or entitled to benefits or services under the terms of the employee benefit plan based on the fact that the individual is eligible for or is provided services under the state plan. Renumbered and Amended by Chapter 443, 2018 General Session
UT Code § 26-19-305 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 19 - Medical Benefits Recovery Act|Part 3 - Insurance Provisions|Section 305 - Statute of limitations -- Survival of right of action -- Insurance policy not to limit time allowed for recovery.

 Effective 5/8/2018  26-19-305. Statute of limitations -- Survival of right of action -- Insurance policy not to limit time allowed for recovery.    (1)   (a) Subject to Subsection (6), action commenced by the department under this chapter against a health insurance entity shall be commenced within:   (i) subject to Subsection (7), six years after the day on which the department submits the claim for recovery or payment for the health care item or service upon which the action is based; or     (ii) six months after the date of the last payment for medical assistance, whichever is later.       (b) An action against any other third party, the recipient, or anyone to whom the proceeds are payable shall be commenced within:   (i) four years after the date of the injury or onset of the illness; or     (ii) six months after the date of the last payment for medical assistance, whichever is later.         (2) The death of the recipient does not abate any right of action established by this chapter.     (3)   (a) No insurance policy issued or renewed after June 1, 1981, may contain any provision that limits the time in which the department may submit its claim to recover medical assistance benefits to a period of less than 24 months from the date the provider furnishes services or goods to the recipient.     (b) No insurance policy issued or renewed after April 30, 2007, may contain any provision that limits the time in which the department may submit its claim to recover medical assistance benefits to a period of less than that described in Subsection (1)(a).       (4) The provisions of this section do not apply to Section 26-19-405 or Part 5, TEFRA Liens.     (5) The provisions of this section supercede any other sections regarding the time limit in which an action shall be commenced, including Section 75-7-509.     (6)   (a) Subsection (1)(a) extends the statute of limitations on a cause of action described in Subsection (1)(a) that was not time-barred on or before April 30, 2007.     (b) Subsection (1)(a) does not revive a cause of action that was time-barred on or before April 30, 2007.       (7) An action described in Subsection (1)(a) may not be commenced if the claim for recovery or payment described in Subsection (1)(a)(i) is submitted later than three years after the day on which the health care item or service upon which the claim is based was provided.    Renumbered and Amended by Chapter 443, 2018 General Session
UT Code § 26-19-402 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 19 - Medical Benefits Recovery Act|Part 4 - General Recovery Provisions|Section 402 - Action by department -- Notice to recipient.

 Effective 5/8/2018  26-19-402. Action by department -- Notice to recipient.    (1)   (a) Within 30 days after commencing an action under Subsection 26-19-401(3), the department shall give the recipient, the recipient's guardian, personal representative, trustee, estate, or survivor, whichever is appropriate, written notice of the action by:   (i) personal service or certified mail to the last known address of the person receiving the notice; or     (ii) if no last-known address is available, by publishing a notice:   (A) once a week for three successive weeks in a newspaper of general circulation in the county where the recipient resides; and     (B) in accordance with Section 45-1-101 for three weeks.         (b) Proof of service shall be filed in the action.     (c) The recipient may intervene in the department's action at any time before trial.       (2) The notice required by Subsection (1) shall name the court in which the action is commenced and advise the recipient of:   (a) the right to intervene in the proceeding;     (b) the right to obtain a private attorney; and     (c) the department's right to recover medical assistance directly from the third party.      Renumbered and Amended by Chapter 443, 2018 General Session
UT Code § 26-19-404 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 19 - Medical Benefits Recovery Act|Part 4 - General Recovery Provisions|Section 404 - Department's right to intervene -- Department's interests protected -- Remitting funds -- Disbursements -- Liability and penalty for noncompliance.

 Effective 5/8/2018  26-19-404. Department's right to intervene -- Department's interests protected -- Remitting funds -- Disbursements -- Liability and penalty for noncompliance.    (1) The department has an unconditional right to intervene in an action commenced by a recipient against a third party for the purpose of recovering medical costs for which the department has provided or has become obligated to provide medical assistance.     (2)   (a) If the recipient proceeds without complying with the provisions of Section 26-19-403, the department is not bound by any decision, judgment, agreement, settlement, or compromise rendered or made on the claim or in the action.     (b) The department:   (i) may recover in full from the recipient, or any party to which the proceeds were made payable, all medical assistance that the department has provided; and     (ii) retains its right to commence an independent action against the third party, subject to Subsection 26-19-401(3).         (3) Any amounts assigned to and recoverable by the department pursuant to Sections 26-19-201 and 26-19-401 collected directly by the recipient shall be remitted to the Bureau of Medical Collections within the Office of Recovery Services no later than five business days after receipt.     (4)   (a) Any amounts assigned to and recoverable by the department pursuant to Sections 26-19-201 and 26-19-401 collected directly by the recipient's attorney shall be remitted to the Bureau of Medical Collections within the Office of Recovery Services no later than 30 days after the funds are placed in the attorney's trust account.     (b) The date by which the funds shall be remitted to the department may be modified based on agreement between the department and the recipient's attorney.     (c) The department's consent to another date for remittance may not be unreasonably withheld.     (d) If the funds are received by the recipient's attorney, no disbursements shall be made to the recipient or the recipient's attorney until the department's claim has been paid.       (5) A recipient or recipient's attorney who knowingly and intentionally fails to comply with this section is liable to the department for:   (a) the amount of the department's claim or lien pursuant to Subsection (1);     (b) a penalty equal to 10% of the amount of the department's claim; and     (c) attorney fees and litigation expenses related to recovering the department's claim.      Enacted by Chapter 443, 2018 General Session
UT Code § 26-19-405 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 19 - Medical Benefits Recovery Act|Part 4 - General Recovery Provisions|Section 405 - Estate and trust recovery.

 Effective 5/8/2018  26-19-405. Estate and trust recovery.    (1)   (a) Except as provided in Subsection (1)(b), upon a recipient's death, the department may recover from the recipient's recovery estate and any trust, in which the recipient is the grantor and a beneficiary, medical assistance correctly provided for the benefit of the recipient when the recipient was 55 years of age or older.     (b) The department may not make an adjustment or a recovery under Subsection (1)(a):   (i) while the deceased recipient's spouse is still living; or     (ii) if the deceased recipient has a surviving child who is:   (A) under age 21; or     (B) blind or disabled, as defined in the state plan.           (2)   (a) The amount of medical assistance correctly provided for the benefit of a recipient and recoverable under this section is a lien against the deceased recipient's recovery estate or any trust when the recipient is the grantor and a beneficiary.     (b) The lien holds the same priority as reasonable and necessary medical expenses of the last illness as provided in Section 75-3-805.       (3)   (a) For a lien described in Subsection (2), the department shall provide notice in accordance with Section 38-12-102.     (b) Before final distribution, the department shall perfect the lien as follows:   (i) for an estate, by presenting the lien to the estate's personal representative in accordance with Section 75-3-804; and     (ii) for a trust, by presenting the lien to the trustee in accordance with Section 75-7-510.       (c) The department may file an amended lien before the entry of the final order to close the estate or trust.       (4) Claims against a deceased recipient's inter vivos trust shall be presented in accordance with Sections 75-7-509 and 75-7-510.     (5) Any trust provision that denies recovery for medical assistance is void at the time of its making.     (6) Nothing in this section affects the right of the department to recover Medicaid assistance before a recipient's death under Section 26-19-201 or Section 26-19-406.     (7) A lien imposed under this section is of indefinite duration.     Renumbered and Amended by Chapter 443, 2018 General Session
UT Code § 26-19-406 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 19 - Medical Benefits Recovery Act|Part 4 - General Recovery Provisions|Section 406 - Recovery from recipient of incorrectly provided medical assistance.

 Effective 5/8/2018  26-19-406. Recovery from recipient of incorrectly provided medical assistance.  The department may:  (1) recover medical assistance incorrectly provided, whether due to administrative or factual error or fraud, from the recipient or the recipient's recovery estate; and     (2) pursuant to a judgment, impose a lien against real property of the recipient.    Renumbered and Amended by Chapter 443, 2018 General Session