reglab/housing_qa huggingface dataset:
UT Code § 26-18-105 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 18 - Medical Assistance Act|Part 2 - Drug Utilization Review Board|Section 105 - Drug prior approval program.

 Affected by 63I-1-226 on 7/1/2027 26-18-105. Drug prior approval program.    (1) A drug prior approval program approved or implemented by the board shall meet the following conditions:   (a) except as provided in Subsection (2), a drug may not be placed on prior approval for other than medical reasons;     (b) the board shall hold a public hearing at least 30 days prior to placing a drug on prior approval;     (c) notwithstanding the provisions of Section 52-4-202, the board shall provide not less than 14 days' notice to the public before holding a public hearing under Subsection (1)(b);     (d) the board shall consider written and oral comments submitted by interested parties prior to or during the hearing held in accordance with Subsection (1)(b);     (e) the board shall provide evidence that placing a drug class on prior approval:   (i) will not impede quality of recipient care; and     (ii) that the drug class is subject to clinical abuse or misuse;       (f) the board shall reconsider its decision to place a drug on prior approval:   (i) no later than nine months after any drug class is placed on prior approval; and     (ii) at a public hearing with notice as provided in Subsection (1)(b);       (g) the program shall provide an approval or denial of a request for prior approval:   (i) by either:   (A) fax;     (B) telephone; or     (C) electronic transmission;       (ii) at least Monday through Friday, except for state holidays; and     (iii) within 24 hours after receipt of the prior approval request;       (h) the program shall provide for the dispensing of at least a 72-hour supply of the drug on the prior approval program:   (i) in an emergency situation; or     (ii) on weekends or state holidays;       (i) the program may be applied to allow acceptable medical use of a drug on prior approval for appropriate off-label indications; and     (j) before placing a drug class on the prior approval program, the board shall:   (i) determine that the requirements of Subsections (1)(a) through (i) have been met; and     (ii) by majority vote, place the drug class on prior approval.         (2) The board may, only after complying with Subsections (1)(b) through (j), consider the cost:   (a) of a drug when placing a drug on the prior approval program; and     (b) associated with including, or excluding a drug from the prior approval process, including:   (i) potential side effects associated with a drug; or     (ii) potential hospitalizations or other complications that may occur as a result of a drug's inclusion on the prior approval process.        Amended by Chapter 205, 2010 General Session
UT Code § 26-18-106 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 18 - Medical Assistance Act|Part 2 - Drug Utilization Review Board|Section 106 - Advisory committees.

 Affected by 63I-1-226 on 7/1/2027 26-18-106. Advisory committees.  The board may establish advisory committees to assist it in carrying out its duties under this part.  Enacted by Chapter 273, 1992 General Session
UT Code § 26-18-107 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 18 - Medical Assistance Act|Part 2 - Drug Utilization Review Board|Section 107 - Retrospective and prospective DUR.

 Affected by 63I-1-226 on 7/1/2027  Effective 5/14/2019  26-18-107. Retrospective and prospective DUR.    (1) The board, in cooperation with the division, shall include in its state plan the creation and implementation of a retrospective and prospective DUR program for Medicaid outpatient drugs to ensure that prescriptions are appropriate, medically necessary, and not likely to result in adverse medical outcomes.     (2) The retrospective and prospective DUR program shall be operated under guidelines established by the board under Subsections (3) and (4).     (3) The retrospective DUR program shall be based on guidelines established by the board, using the mechanized drug claims processing and information retrieval system to analyze claims data in order to:   (a) identify patterns of fraud, abuse, gross overuse, and inappropriate or medically unnecessary care; and     (b) assess data on drug use against explicit predetermined standards that are based on the compendia and other sources for the purpose of monitoring:   (i) therapeutic appropriateness;     (ii) overutilization or underutilization;     (iii) therapeutic duplication;     (iv) drug-disease contraindications;     (v) drug-drug interactions;     (vi) incorrect drug dosage or duration of drug treatment; and     (vii) clinical abuse and misuse.         (4) The prospective DUR program shall be based on guidelines established by the board and shall provide that, before a prescription is filled or delivered, a review will be conducted by the pharmacist at the point of sale to screen for potential drug therapy problems resulting from:   (a) therapeutic duplication;     (b) drug-drug interactions;     (c) incorrect dosage or duration of treatment;     (d) drug-allergy interactions; and     (e) clinical abuse or misuse.       (5) In conducting the prospective DUR, a pharmacist may not alter the prescribed outpatient drug therapy without the consent of the prescribing physician or physician assistant. This section does not effect the ability of a pharmacist to substitute a generic equivalent.    Amended by Chapter 349, 2019 General Session
UT Code § 26-18-108 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 18 - Medical Assistance Act|Part 2 - Drug Utilization Review Board|Section 108 - Penalties.

 Affected by 63I-1-226 on 7/1/2027 26-18-108. Penalties.  Any person who violates the confidentiality provisions of this part is guilty of a class B misdemeanor.  Enacted by Chapter 273, 1992 General Session
UT Code § 26-18-109 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 18 - Medical Assistance Act|Part 2 - Drug Utilization Review Board|Section 109 - Immunity.

 Affected by 63I-1-226 on 7/1/2027 26-18-109. Immunity.  There is no liability on the part of, and no cause of action of any nature arises against any member of the board, its agents, or employees for any action or omission by them in effecting the provisions of this part.  Enacted by Chapter 273, 1992 General Session
UT Code § 26-18-402 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 18 - Medical Assistance Act|Part 4 - Medicaid Waiver|Section 402 - Medicaid Restricted Account.

 Effective 5/12/2020  26-18-402. Medicaid Restricted Account.    (1) There is created a restricted account in the General Fund known as the Medicaid Restricted Account.     (2)   (a) Except as provided in Subsection (3), the following shall be deposited into the Medicaid Restricted Account:   (i) any general funds appropriated to the department for the state plan for medical assistance or for the Division of Health Care Financing that are not expended by the department in the fiscal year for which the general funds were appropriated and which are not otherwise designated as nonlapsing shall lapse into the Medicaid Restricted Account;     (ii) any unused state funds that are associated with the Medicaid program, as defined in Section 26-18-2, from the Department of Workforce Services and the Department of Human Services; and     (iii) any penalties imposed and collected under:   (A) Section 17B-2a-818.5;     (B) Section 19-1-206;     (C) Section 63A-5b-607;     (D) Section 63C-9-403;     (E) Section 72-6-107.5; or     (F) Section 79-2-404.         (b) The account shall earn interest and all interest earned shall be deposited into the account.     (c) The Legislature may appropriate money in the restricted account to fund programs that expand medical assistance coverage and private health insurance plans to low income persons who have not traditionally been served by Medicaid, including the Utah Children's Health Insurance Program created in Chapter 40, Utah Children's Health Insurance Act.       (3) For fiscal years 2008-09, 2009-10, 2010-11, 2011-12, and 2012-13 the following funds are nonlapsing:   (a) any general funds appropriated to the department for the state plan for medical assistance, or for the Division of Health Care Financing that are not expended by the department in the fiscal year in which the general funds were appropriated; and     (b) funds described in Subsection (2)(a)(ii).      Amended by Chapter 152, 2020 General Session
UT Code § 26-18-402.5 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 18 - Medical Assistance Act|Part 4 - Medicaid Waiver|Section 402.5 - Nonlapsing Medicaid funds.

 Effective 4/22/2020  26-18-402.5. Nonlapsing Medicaid funds.    (1) Notwithstanding Subsection 26-18-402(3), for fiscal years 2019-20 and 2020-21 the funds described in Subsections 26-18-402(3)(a) and 26-18-402(2)(a)(ii) are nonlapsing.     (2) This section supersedes any conflicting provisions of Utah law.    Enacted by Chapter 3, 2020 Special Session 3
UT Code § 26-18-403 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 18 - Medical Assistance Act|Part 4 - Medicaid Waiver|Section 403 - Medicaid waiver for independent foster care adolescents.

26-18-403. Medicaid waiver for independent foster care adolescents.    (1) For purposes of this section, an "independent foster care adolescent" includes any individual who reached 18 years of age while in the custody of the Division of Child and Family Services, or the Department of Human Services if the Division of Child and Family Services was the primary case manager, or a federally recognized Indian tribe.     (2) An independent foster care adolescent is eligible, when funds are available, for Medicaid coverage until the individual reaches 21 years of age.     (3) Before July 1, 2006, the division shall submit a state Medicaid Plan amendment to the Center For Medicaid Services to provide medical coverage for independent foster care adolescents effective fiscal year 2006-07.    Enacted by Chapter 110, 2006 General Session
UT Code § 26-18-405.5 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 18 - Medical Assistance Act|Part 4 - Medicaid Waiver|Section 405.5 - Base budget appropriations for Medicaid accountable care organizations.

 Effective 7/1/2021  Superseded 7/1/2022  26-18-405.5. Base budget appropriations for Medicaid accountable care organizations.    (1) For purposes of this section:   (a) "ACOs" means accountable care organizations.     (b) "Base budget" means the same as that term is defined in legislative rule.     (c) "Current fiscal year PMPM" means per-member-per-month funding for Medicaid accountable care organizations under the Department of Health in the current fiscal year.     (d) "General Fund growth factor" means the amount determined by dividing the next fiscal year ongoing General Fund revenue estimate by current fiscal year ongoing appropriations from the General Fund.     (e) "Next fiscal year ongoing General Fund revenue estimate" means the next fiscal year ongoing General Fund revenue estimate identified by the Executive Appropriations Subcommittee, in accordance with legislative rule, for use by the Office of the Legislative Fiscal Analyst in preparing budget recommendations.     (f) "Next fiscal year PMPM" means per-member-per-month funding for Medicaid accountable care organizations under the Department of Health for the next fiscal year.       (2) If the General Fund growth factor is less than 100%, the next fiscal year base budget shall include an appropriation to the Department of Health for Medicaid ACOs in an amount necessary to ensure that next fiscal year PMPM equals current fiscal year PMPM multiplied by 100%.     (3) If the General Fund growth factor is greater than or equal to 100%, but less than 102%, the next fiscal year base budget shall include an appropriation to the Department of Health for Medicaid ACOs in an amount necessary to ensure that next fiscal year PMPM equals current fiscal year PMPM multiplied by the General Fund growth factor.     (4) If the General Fund growth factor is greater than or equal to 102%, the next fiscal year base budget shall include an appropriation to the Department of Health for Medicaid ACOs in an amount necessary to ensure that next fiscal year PMPM is greater than or equal to PMPM multiplied by 102% and less than or equal to current fiscal year PMPM multiplied by the General Fund growth factor.     (5) In order for the department to estimate the impact of Subsections (2) through (4) prior to identification of the next fiscal year ongoing General Fund revenue estimate under Subsection (1)(e), the Governor's Office of Planning and Budget shall, in cooperation with the Office of the Legislative Fiscal Analyst, develop an estimate of ongoing General Fund revenue for the next fiscal year and provide it to the department no later than November 1 of each year.    Amended by Chapter 382, 2021 General Session
UT Code § 26-18-409 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 18 - Medical Assistance Act|Part 4 - Medicaid Waiver|Section 409 - Long-term care insurance partnership.

 Effective 5/13/2014  26-18-409. Long-term care insurance partnership.    (1) As used in this section:   (a) "Qualified long-term care insurance contract" is as defined in 26 U.S.C. Sec. 7702B(b).     (b) "Qualified long-term care insurance partnership" is as defined in 42 U.S.C. Sec. 1396p(b)(1)(C)(iii).     (c) "State plan amendment" means an amendment to the state Medicaid plan drafted by the department in compliance with this section.       (2) No later than July 1, 2014, the department shall seek federal approval of a state plan amendment that creates a qualified long-term care insurance partnership.     (3) The department may make rules to comply with federal laws and regulations relating to qualified long-term care insurance partnerships and qualified long-term care insurance contracts.    Enacted by Chapter 174, 2014 General Session
UT Code § 26-18-410 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 18 - Medical Assistance Act|Part 4 - Medicaid Waiver|Section 410 - Medicaid waiver for children with disabilities and complex medical needs.

 Effective 5/14/2019  26-18-410. Medicaid waiver for children with disabilities and complex medical needs.    (1) As used in this section:   (a) "Additional eligibility criteria" means the additional eligibility criteria set by the department under Subsection (4)(e).     (b) "Complex medical condition" means a physical condition of an individual that:   (i) results in severe functional limitations for the individual; and     (ii) is likely to:   (A) last at least 12 months; or     (B) result in death.         (c) "Program" means the program for children with complex medical conditions created in Subsection (3).     (d) "Qualified child" means a child who:   (i) is less than 19 years old;     (ii) is diagnosed with a complex medical condition;     (iii) has a condition that meets the definition of disability in 42 U.S.C. Sec. 12102; and     (iv) meets the additional eligibility criteria.         (2) The department shall apply for a Medicaid home and community-based waiver with CMS to implement, within the state Medicaid program, the program described in Subsection (3).     (3) If the waiver described in Subsection (2) is approved, the department shall offer a program that:   (a) as funding permits, provides treatment for qualified children;     (b) accepts applications for the program during periods of open enrollment; and     (c) if approved by CMS:   (i) requires periodic reevaluations of an enrolled child's eligibility based on the additional eligibility criteria; and     (ii) at the time of reevaluation, allows the department to disenroll a child who does not meet the additional eligibility criteria.         (4) The department shall:   (a) seek to prioritize, in the waiver described in Subsection (2), entrance into the program based on the:   (i) complexity of a qualified child's medical condition; and     (ii) financial needs of a qualified child and the qualified child's family;       (b) convene a public process to determine:   (i) the benefits and services to offer a qualified child under the program; and     (ii) additional eligibility criteria for a qualified child;       (c) evaluate, on an ongoing basis, the cost and effectiveness of the program;     (d) if funding for the program is reduced, develop an evaluation process to reduce the number of children served based on the criteria in Subsection (4)(a); and     (e) establish, by rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, additional eligibility criteria based on the factors described in Subsections (4)(a)(i) and (ii).      Amended by Chapter 393, 2019 General Session
UT Code § 26-18-414 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 18 - Medical Assistance Act|Part 4 - Medicaid Waiver|Section 414 - Medicaid long-term support services housing coordinator.

 Effective 5/9/2017  26-18-414. Medicaid long-term support services housing coordinator.    (1) There is created within the Medicaid program a full-time-equivalent position of Medicaid long-term support services housing coordinator.     (2) The coordinator shall help Medicaid recipients receive long-term support services in a home or other community-based setting rather than in a nursing home or other institutional setting by:   (a) working with municipalities, counties, the Housing and Community Development Division within the Department of Workforce Services, and others to identify community-based settings available to recipients;     (b) working with the same entities to promote the development, construction, and availability of additional community-based settings;     (c) training Medicaid case managers and support coordinators on how to help Medicaid recipients move from an institutional setting to a community-based setting; and     (d) performing other related duties.      Enacted by Chapter 307, 2017 General Session
UT Code § 26-18-417 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 18 - Medical Assistance Act|Part 4 - Medicaid Waiver|Section 417 - Limited family planning services for low-income individuals.

 Effective 7/1/2020  26-18-417. Limited family planning services for low-income individuals.    (1) As used in this section:   (a)   (i) "Family planning services" means family planning services that are provided under the state Medicaid program, including:   (A) sexual health education and family planning counseling; and     (B) other medical diagnosis, treatment, or preventative care routinely provided as part of a family planning service visit.       (ii) "Family planning services" do not include an abortion, as that term is defined in Section 76-7-301.       (b) "Low-income individual" means an individual who:   (i) has an income level that is equal to or below 95% of the federal poverty level; and     (ii) does not qualify for full coverage under the Medicaid program.         (2) Before July 1, 2018, the division shall apply for a Medicaid waiver or a state plan amendment with CMS to:   (a) offer a program that provides family planning services to low-income individuals; and     (b) receive a federal match rate of 90% of state expenditures for family planning services provided under the waiver or state plan amendment.      Amended by Chapter 393, 2019 General Session
UT Code § 26-18-418 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 18 - Medical Assistance Act|Part 4 - Medicaid Waiver|Section 418 - Medicaid waiver for mental health crisis lines and mobile crisis outreach teams.

 Affected by 63I-1-226 on 7/1/2023  Effective 5/12/2020  26-18-418. Medicaid waiver for mental health crisis lines and mobile crisis outreach teams.    (1) As used in this section:   (a) "Local mental health crisis line" means the same as that term is defined in Section 62A-15-1301.     (b) "Mental health crisis" means:   (i) a mental health condition that manifests itself in an individual by symptoms of sufficient severity that a prudent layperson who possesses an average knowledge of mental health issues could reasonably expect the absence of immediate attention or intervention to result in:   (A) serious danger to the individual's health or well-being; or     (B) a danger to the health or well-being of others; or       (ii) a mental health condition that, in the opinion of a mental health therapist or the therapist's designee, requires direct professional observation or the intervention of a mental health therapist.       (c)   (i) "Mental health crisis services" means direct mental health services and on-site intervention that a mobile crisis outreach team provides to an individual suffering from a mental health crisis, including the provision of safety and care plans, prolonged mental health services for up to 90 days, and referrals to other community resources.     (ii) "Mental health crisis services" includes:   (A) local mental health crisis lines; and     (B) the statewide mental health crisis line.         (d) "Mental health therapist" means the same as that term is defined in Section 58-60-102.     (e) "Mobile crisis outreach team" or "MCOT" means a mobile team of medical and mental health professionals that, in coordination with local law enforcement and emergency medical service personnel, provides mental health crisis services.     (f) "Statewide mental health crisis line" means the same as that term is defined in Section 62A-15-1301.       (2) In consultation with the Department of Human Services and the Behavioral Health Crisis Response Commission created in Section 63C-18-202, the department shall develop a proposal to amend the state Medicaid plan to include mental health crisis services, including the statewide mental health crisis line, local mental health crisis lines, and mobile crisis outreach teams.     (3) By January 1, 2019, the department shall apply for a Medicaid waiver with CMS, if necessary to implement, within the state Medicaid program, the mental health crisis services described in Subsection (2).    Amended by Chapter 303, 2020 General Session
UT Code § 26-18-419 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 18 - Medical Assistance Act|Part 4 - Medicaid Waiver|Section 419 - Medicaid waiver for coverage of mental health services in schools.

 Effective 5/14/2019  26-18-419. Medicaid waiver for coverage of mental health services in schools.    (1) As used in this section, "local education agency" means:   (a) a school district;     (b) a charter school; or     (c) the Utah Schools for the Deaf and the Blind.       (2) In consultation with the Department of Human Services and the State Board of Education, the department shall develop a proposal to allow the state Medicaid program to reimburse a local education agency, a local mental health authority, or a private provider for covered mental health services provided:   (a) in accordance with Section 53E-9-203; and     (b)   (i) at a local education agency building or facility; or     (ii) by an employee or contractor of a local education agency.         (3) Before January 1, 2020, the department shall apply to CMS for a state plan amendment to implement the coverage described in Subsection (2).    Enacted by Chapter 172, 2019 General Session