reglab/statecodes huggingface dataset:
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 2 - Licensing and Certifications › Part 5 - Certifications › Section 504 - Certification -- Unlawful conduct.

Effective 5/3/2023
26B-2-504.
Certification -- Unlawful conduct.
(1) The department shall issue to an individual who qualifies under Section 26B-2-505 a certification as a state certified community health worker.
(2) An individual may not use the term "state certified" in conjunction with the individual's work as a community health worker if the individual is not state certified.
(3) The department may fine an individual who violates Subsection (2) in an amount up to $100.
Renumbered and Amended by Chapter 305, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 2 - Licensing and Certifications › Part 5 - Certifications › Section 505 - Qualifications for certification.

Effective 5/3/2023
26B-2-505.
Qualifications for certification.
(1) The department shall issue a certification described in Section 26B-2-504 to a community health worker if the community health worker has:
(a) completed core-skill training administered by:
(i) the department;
(ii) a state professional association that:
(A) is associated with the community health worker profession; and
(B) is aligned with a national community health worker professional association; or
(iii) an entity designated by a state professional association described in Subsection (1)(a)(ii);
(b) completed training regarding basic medical confidentiality requirements, including the confidentiality requirements of HIPAA as defined in Section 26B-8-514;
(c) completed an application as designed by the department with a signed statement agreeing to abide by national standards of practice and ethics for community health workers; and
(d) paid a fee established by the department under Section 63J-1-504.
(2) A community health worker with at least 4,000 hours of experience as a community health worker is exempt from the core-skill training requirement described in Subsection (1)(a).
Renumbered and Amended by Chapter 305, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 2 - Licensing and Certifications › Part 5 - Certifications › Section 506 - Certification is voluntary.

Effective 5/3/2023
26B-2-506.
Certification is voluntary.
This part does not prohibit an individual from acting as a community health worker if the individual does not have a certificate described in this part.
Renumbered and Amended by Chapter 305, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 2 - Licensing and Certifications › Part 5 - Certifications › Section 507 - Term of certification - Expiration - Renewal.

Effective 5/3/2023
26B-2-507.
Term of certification - Expiration - Renewal.
(1) Subject to Subsection (2), the department shall issue each certification under Section 26B-2-504 in accordance with a two-year renewal cycle.
(2) The department may by rule extend or shorten a renewal cycle by as much as one year to stagger the renewal cycles that the department administers.
(3)
(a) The department shall print the expiration date on the certification.
(b) Each certification automatically expires on the date shown on the certificate.
(c) The department shall establish procedures through rule to notify each state certified community health worker when the certification is due for renewal.
(4)
(a) The department shall renew a certification if the individual has:
(i) met each renewal requirement established by the department through rule; and
(ii) paid a certification renewal fee established by the department.
(b) A rule created by the department under Subsection (4)(a)(i) shall include a requirement regarding:
(i) continuing education; and
(ii) maintaining professional conduct.
Renumbered and Amended by Chapter 305, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 2 - Licensing and Certifications › Part 6 - Mammography Quality Assurance › Section 601 - Definitions.

Effective 5/3/2023
26B-2-601.
Definitions.
As used in this part:
(1) "Diagnostic mammography" means mammography performed on a woman having suspected breast cancer.
(2) "Facility" means a facility that provides screening or diagnostic breast mammography services.
Renumbered and Amended by Chapter 305, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 2 - Licensing and Certifications › Part 6 - Mammography Quality Assurance › Section 602 - Department rulemaking authority.

Effective 5/3/2023
26B-2-602.
Department rulemaking authority.
The department shall make rules under Title 63G, Chapter 3, Utah Administrative Rulemaking Act:
(1) establishing quality assurance standards for all facilities performing screening or diagnostic mammography and developing mammogram x-ray films, including notification and procedures for clinical follow-up of abnormal mammograms;
(2) providing for:
(a) collection and periodic reporting of mammography examinations and clinical follow-up data to the department;
(b) certification and revocation of certification of mammogram facilities;
(c) inspection of mammogram facilities, including entry of agents of the department into the facilities for inspections;
(d) setting fees for certification; and
(e) an appeal process regarding department certification decisions; and
(3) requiring a facility that is certified under Section 26B-2-603 to comply with the notification requirement described in Section 26B-2-605.
Renumbered and Amended by Chapter 305, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 2 - Licensing and Certifications › Part 6 - Mammography Quality Assurance › Section 603 - Mammogram provider certification.

Effective 5/3/2023
26B-2-603.
Mammogram provider certification.
(1) A mammogram may only be performed in a facility the department certifies as meeting:
(a) the qualifications and standards under Section 26B-2-602; and
(b) the registration, licensing, and inspection requirements for radiation sources under Section 19-3-104.
(2) Facilities desiring to perform mammograms shall request certification as a mammogram provider by the department under procedures established by department rule.
Renumbered and Amended by Chapter 305, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 2 - Licensing and Certifications › Part 6 - Mammography Quality Assurance › Section 604 - Department duties.

Effective 5/3/2023
26B-2-604.
Department duties.
The department shall:
(1) enforce rules established under this part;
(2) implement and enforce the notice requirement in Section 26B-2-605;
(3) authorize qualified department agents to conduct inspections of mammogram facilities under department rules;
(4) collect and credit fees for certification established by the department in accordance with Section 63J-1-504; and
(5) provide necessary administrative and staff support to the committee.
Renumbered and Amended by Chapter 305, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 2 - Licensing and Certifications › Part 6 - Mammography Quality Assurance › Section 605 - Women's cancer screening notification requirement.

Effective 5/3/2023
26B-2-605.
Women's cancer screening notification requirement.
(1) As used in this section, "dense breast tissue" means heterogeneously dense tissue or extremely dense tissue as defined in the Breast Imaging and Reporting Data System established by the American College of Radiology.
(2) A facility that is certified under Section 26B-2-603 shall include the following notification and information with a mammography result provided to a patient with dense breast tissue:
"Your mammogram indicates that you have dense breast tissue. Dense breast tissue is common and is found in as many as half of all women. However, dense breast tissue can make it more difficult to fully and accurately evaluate your mammogram and detect early signs of possible cancer in the breast. This information is being provided to inform and encourage you to discuss your dense breast tissue and other breast cancer risk factors with your health care provider. Together, you can decide what may be best for you. A copy of your mammography report has been sent to your health care provider. Please contact them if you have any questions or concerns about this notice."
Renumbered and Amended by Chapter 305, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 2 - Licensing and Certifications › Part 6 - Mammography Quality Assurance › Section 606 - Breast cancer mortality reduction program.

Effective 5/3/2023
26B-2-606.
Breast cancer mortality reduction program.
The department shall create a breast cancer mortality reduction program. The program shall include:
(1) education programs for health professionals regarding skills in cancer screening, diagnosis, referral, treatment, and rehabilitation based on current scientific knowledge;
(2) education programs to assist the public in understanding:
(a) the benefits of regular breast cancer screening;
(b) resources available in the medical care system for cancer screening, diagnosis, referral, treatment, and rehabilitation; and
(c) available options for treatment of breast cancer and the ramifications of each approach; and
(3) subsidized screening mammography for low-income women as determined by the department standards.
Renumbered and Amended by Chapter 305, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 101 - Definitions.

Effective 5/3/2023
26B-3-101.
Definitions.
As used in this chapter:
(1) "Applicant" means any person who requests assistance under the medical programs of the state.
(2) "CMS" means the Centers for Medicare and Medicaid Services within the United States Department of Health and Human Services.
(3) "Division" means the Division of Integrated Healthcare within the department, established under Section 26B-3-102.
(4) "Enrollee" or "member" means an individual whom the department has determined to be eligible for assistance under the Medicaid program.
(5) "Medicaid program" means the state program for medical assistance for persons who are eligible under the state plan adopted pursuant to Title XIX of the federal Social Security Act.
(6) "Medical assistance" means services furnished or payments made to or on behalf of a member.
(7)
(a) "Passenger vehicle" means a self-propelled, two-axle vehicle intended primarily for operation on highways and used by an applicant or recipient to meet basic transportation needs and has a fair market value below 40% of the applicable amount of the federal luxury passenger automobile tax established in 26 U.S.C. Sec. 4001 and adjusted annually for inflation.
(b) "Passenger vehicle" does not include:
(i) a commercial vehicle, as defined in Section 41-1a-102;
(ii) an off-highway vehicle, as defined in Section 41-1a-102; or
(iii) a motor home, as defined in Section 13-14-102.
(8) "PPACA" means the same as that term is defined in Section 31A-1-301.
(9) "Recipient" means a person who has received medical assistance under the Medicaid program.
Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 102 - Division -- Creation.

Effective 5/3/2023
26B-3-102.
Division -- Creation.
There is created, within the department, the Division of Integrated Healthcare which shall be responsible for implementing, organizing, and maintaining the Medicaid program and the Children's Health Insurance Program established in Section 26B-3-902, in accordance with the provisions of this chapter and applicable federal law.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 103 - State Medicaid director -- Appointment -- Responsibilities.

Effective 5/3/2023
26B-3-103.
State Medicaid director -- Appointment -- Responsibilities.
(1) The state Medicaid director shall be appointed by the governor, after consultation with the executive director, with the advice and consent of the Senate.
(2) The state Medicaid director may employ other employees as necessary to implement the provisions of this chapter, and shall:
(a) administer the responsibilities of the division as set forth in this chapter;
(b) administer the division's budget; and
(c) establish and maintain a state plan for the Medicaid program in compliance with federal law and regulations.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 104 - Division responsibilities -- Emphasis -- Periodic assessment.

Effective 5/3/2023
26B-3-104.
Division responsibilities -- Emphasis -- Periodic assessment.
(1) In accordance with the requirements of Title XIX of the Social Security Act and applicable federal regulations, the division is responsible for the effective and impartial administration of this chapter in an efficient, economical manner. The division shall:
(a) establish, on a statewide basis, a program to safeguard against unnecessary or inappropriate use of Medicaid services, excessive payments, and unnecessary or inappropriate hospital admissions or lengths of stay;
(b) deny any provider claim for services that fail to meet criteria established by the division concerning medical necessity or appropriateness; and
(c) place its emphasis on high quality care to recipients in the most economical and cost-effective manner possible, with regard to both publicly and privately provided services.
(2) The division shall implement and utilize cost-containment methods, where possible, which may include:
(a) prepayment and postpayment review systems to determine if utilization is reasonable and necessary;
(b) preadmission certification of nonemergency admissions;
(c) mandatory outpatient, rather than inpatient, surgery in appropriate cases;
(d) second surgical opinions;
(e) procedures for encouraging the use of outpatient services;
(f) consistent with Sections 26B-3-105 and 58-17b-606, a Medicaid drug program;
(g) coordination of benefits; and
(h) review and exclusion of providers who are not cost effective or who have abused the Medicaid program, in accordance with the procedures and provisions of federal law and regulation.
(3) The state Medicaid director shall periodically assess the cost effectiveness and health implications of the existing Medicaid program, and consider alternative approaches to the provision of covered health and medical services through the Medicaid program, in order to reduce unnecessary or unreasonable utilization.
(4)
(a) The department shall ensure Medicaid program integrity by conducting internal audits of the Medicaid program for efficiencies, best practices, and cost avoidance.
(b) The department shall coordinate with the Office of the Inspector General for Medicaid Services created in Section 63A-13-201 to implement Subsection (2) and to address Medicaid fraud, waste, or abuse as described in Section 63A-13-202.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 106 - Simplified enrollment and renewal process for Medicaid and other state medical programs -- Financial institutions.

Effective 5/3/2023
26B-3-106.
Simplified enrollment and renewal process for Medicaid and other state medical programs -- Financial institutions.
(1) The department may apply for grants and accept donations to make technology system improvements necessary to implement a simplified enrollment and renewal process for the Medicaid program, Utah Premium Partnership, and Primary Care Network Demonstration Project programs.
(2)
(a) The department may enter into an agreement with a financial institution doing business in the state to develop and operate a data match system to identify an applicant's or enrollee's assets that:
(i) uses automated data exchanges to the maximum extent feasible; and
(ii) requires a financial institution each month to provide the name, record address, Social Security number, other taxpayer identification number, or other identifying information for each applicant or enrollee who maintains an account at the financial institution.
(b) The department may pay a reasonable fee to a financial institution for compliance with this Subsection (2), as provided in Section 7-1-1006.
(c) A financial institution may not be liable under any federal or state law to any person for any disclosure of information or action taken in good faith under this Subsection (2).
(d) The department may disclose a financial record obtained from a financial institution under this section only for the purpose of, and to the extent necessary in, verifying eligibility as provided in this section and Section 26B-3-903.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 109 - Medicaid expansion.

Effective 5/3/2023
26B-3-109.
Medicaid expansion.
(1) The purpose of this section is to expand the coverage of the Medicaid program to persons who are in categories traditionally not served by that program.
(2) Within appropriations from the Legislature, the department may amend the state plan for medical assistance to provide for eligibility for Medicaid:
(a) on or after July 1, 1994, for children 12 to 17 years old who live in households below the federal poverty income guideline; and
(b) on or after July 1, 1995, for persons who have incomes below the federal poverty income guideline and who are aged, blind, or have a disability.
(3)
(a) Within appropriations from the Legislature, on or after July 1, 1996, the Medicaid program may provide for eligibility for persons who have incomes below the federal poverty income guideline.
(b) In order to meet the provisions of this subsection, the department may seek approval for a demonstration project under 42 U.S.C. Sec. 1315 from the secretary of the United States Department of Health and Human Services.
(4) The Medicaid program shall provide for eligibility for persons as required by Subsection 26B-3-113(2).
(5) Services available for persons described in this section shall include required Medicaid services and may include one or more optional Medicaid services if those services are funded by the Legislature. The department may also require persons described in Subsections (1) through (3) to meet an asset test.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 110 - Copayments by recipients -- Employer sponsored plans.

Effective 5/3/2023
26B-3-110.
Copayments by recipients -- Employer sponsored plans.
(1) The department shall selectively provide for enrollment fees, premiums, deductions, cost sharing or other similar charges to be paid by recipients, their spouses, and parents, within the limitations of federal law and regulation.
(2) Beginning May 1, 2006, within appropriations by the Legislature and as a means to increase health care coverage among the uninsured, the department shall take steps to promote increased participation in employer sponsored health insurance, including:
(a) maximizing the health insurance premium subsidy provided under the state's 1115 demonstration waiver by:
(i) ensuring that state funds are matched by federal funds to the greatest extent allowable; and
(ii) as the department determines appropriate, seeking federal approval to do one or more of the following:
(A) eliminate or otherwise modify the annual enrollment fee;
(B) eliminate or otherwise modify the schedule used to determine the level of subsidy provided to an enrollee each year;
(C) reduce the maximum number of participants allowable under the subsidy program; or
(D) otherwise modify the program in a manner that promotes enrollment in employer sponsored health insurance; and
(b) exploring the use of other options, including the development of a waiver under the Medicaid Health Insurance Flexibility Demonstration Initiative or other federal authority.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 112 - Maximizing use of premium assistance programs -- Utah's Premium Partnership for Health Insurance.

Effective 5/3/2023
26B-3-112.
Maximizing use of premium assistance programs -- Utah's Premium Partnership for Health Insurance.
(1)
(a) The department shall seek to maximize the use of Medicaid and Children's Health Insurance Program funds for assistance in the purchase of private health insurance coverage for Medicaid-eligible and non-Medicaid-eligible individuals.
(b) The department's efforts to expand the use of premium assistance shall:
(i) include, as necessary, seeking federal approval under all Medicaid and Children's Health Insurance Program premium assistance provisions of federal law, including provisions of PPACA;
(ii) give priority to, but not be limited to, expanding the state's Utah Premium Partnership for Health Insurance Program, including as required under Subsection (2); and
(iii) encourage the enrollment of all individuals within a household in the same plan, where possible, including enrollment in a plan that allows individuals within the household transitioning out of Medicaid to retain the same network and benefits they had while enrolled in Medicaid.
(2) The department shall seek federal approval of an amendment to the state's Utah Premium Partnership for Health Insurance program to adjust the eligibility determination for single adults and parents who have an offer of employer sponsored insurance. The amendment shall:
(a) be within existing appropriations for the Utah Premium Partnership for Health Insurance program; and
(b) provide that adults who are up to 200% of the federal poverty level are eligible for premium subsidies in the Utah Premium Partnership for Health Insurance program.
(3) For the fiscal year 2020-21, the department shall seek authority to increase the maximum premium subsidy per month for adults under the Utah Premium Partnership for Health Insurance program to $300.
(4) Beginning with the fiscal year 2021-22, and in each subsequent fiscal year, the department may increase premium subsidies for single adults and parents who have an offer of employer-sponsored insurance to keep pace with the increase in insurance premium costs, subject to appropriation of additional funding.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 114 - Department standards for eligibility under Medicaid -- Funds for abortions.

Effective 5/3/2023
26B-3-114.
Department standards for eligibility under Medicaid -- Funds for abortions.
(1)
(a) The department may develop standards and administer policies relating to eligibility under the Medicaid program as long as they are consistent with Subsection 26B-4-704(8).
(b) An applicant receiving Medicaid assistance may be limited to particular types of care or services or to payment of part or all costs of care determined to be medically necessary.
(2) The department may not provide any funds for medical, hospital, or other medical expenditures or medical services to otherwise eligible persons where the purpose of the assistance is to perform an abortion, unless the life of the mother would be endangered if an abortion were not performed.
(3) Any employee of the department who authorizes payment for an abortion contrary to the provisions of this section is guilty of a class B misdemeanor and subject to forfeiture of office.
(4) Any person or organization that, under the guise of other medical treatment, provides an abortion under auspices of the Medicaid program is guilty of a third degree felony and subject to forfeiture of license to practice medicine or authority to provide medical services and treatment.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 115 - Contracts for provision of medical services -- Federal provisions modifying department rules -- Compliance with Social Security Act.

Effective 5/3/2023
26B-3-115.
Contracts for provision of medical services -- Federal provisions modifying department rules -- Compliance with Social Security Act.
(1) The department may contract with other public or private agencies to purchase or provide medical services in connection with the programs of the division. Where these programs are used by other government entities, contracts shall provide that other government entities, in compliance with state and federal law regarding intergovernmental transfers, transfer the state matching funds to the department in amounts sufficient to satisfy needs of the specified program.
(2) Contract terms shall include provisions for maintenance, administration, and service costs.
(3) If a federal legislative or executive provision requires modifications or revisions in an eligibility factor established under this chapter as a condition for participation in medical assistance, the department may modify or change its rules as necessary to qualify for participation.
(4) The provisions of this section do not apply to department rules governing abortion.
(5) The department shall comply with all pertinent requirements of the Social Security Act and all orders, rules, and regulations adopted thereunder when required as a condition of participation in benefits under the Social Security Act.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 116 - Liability insurance required.

Effective 5/3/2023
26B-3-116.
Liability insurance required.
The Medicaid program may not reimburse a home health agency, as defined in Section 26B-2-201, for home health services provided to an enrollee unless the home health agency has liability coverage of:
(1) at least $500,000 per incident; or
(2) an amount established by department rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 117 - Federal aid -- Authority of executive director.

Effective 5/3/2023
26B-3-117.
Federal aid -- Authority of executive director.
(1) The executive director, with the approval of the governor, may bind the state to any executive or legislative provisions promulgated or enacted by the federal government which invite the state to participate in the distribution, disbursement or administration of any fund or service advanced, offered or contributed in whole or in part by the federal government for purposes consistent with the powers and duties of the department.
(2) Such funds shall be used as provided in this chapter and be administered by the department for purposes related to medical assistance programs.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 118 - Medical vendor rates.

Effective 5/3/2023
26B-3-118.
Medical vendor rates.
(1) Medical vendor payments made to providers of services for and in behalf of recipient households shall be based upon predetermined rates from standards developed by the division in cooperation with providers of services for each type of service purchased by the division.
(2) As far as possible, the rates paid for services shall be established in advance of the fiscal year for which funds are to be requested.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 119 - Enforcement of public assistance statutes.

Effective 5/3/2023
26B-3-119.
Enforcement of public assistance statutes.
(1) The department shall enforce or contract for the enforcement of Sections 35A-1-503, 35A-3-108, 35A-3-110, 35A-3-111, 35A-3-112, and 35A-3-603 to the extent that these sections pertain to benefits conferred or administered by the division under this chapter, to the extent allowed under federal law or regulation.
(2) The department may contract for services covered in Section 35A-3-111 insofar as that section pertains to benefits conferred or administered by the division under this chapter.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 120 - Prohibited acts of state or local employees of Medicaid program -- Violation a misdemeanor.

Effective 5/3/2023
26B-3-120.
Prohibited acts of state or local employees of Medicaid program -- Violation a misdemeanor.
(1) Each state or local employee responsible for the expenditure of funds under the state Medicaid program, each individual who formerly was such an officer or employee, and each partner of such an officer or employee is prohibited for a period of one year after termination of such responsibility from committing any act, the commission of which by an officer or employee of the United States Government, an individual who was such an officer or employee, or a partner of such an officer or employee is prohibited by Section 207 or Section 208 of Title 18, United States Code.
(2) Violation of this section is a class A misdemeanor.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 121 - Rural hospitals.

Effective 5/3/2023
26B-3-121.
Rural hospitals.
(1) As used in this section "rural hospital" means a hospital located outside of a standard metropolitan statistical area, as designated by the United States Bureau of the Census.
(2) For purposes of the Medicaid program, the division may not discriminate among rural hospitals on the basis of size.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 122 - Telemedicine -- Reimbursement -- Rulemaking.

Effective 5/3/2023
26B-3-122.
Telemedicine -- Reimbursement -- Rulemaking.
(1)
(a) As used in this section, communication by telemedicine is considered face-to-face contact between a health care provider and a patient under the state's medical assistance program if:
(i) the communication by telemedicine meets the requirements of administrative rules adopted in accordance with Subsection (3); and
(ii) the health care services are eligible for reimbursement under the state's medical assistance program.
(b) This Subsection (1) applies to any managed care organization that contracts with the state's medical assistance program.
(2) The reimbursement rate for telemedicine services approved under this section:
(a) shall be subject to reimbursement policies set by the state plan; and
(b) may be based on:
(i) a monthly reimbursement rate;
(ii) a daily reimbursement rate; or
(iii) an encounter rate.
(3) The department shall adopt administrative rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, which establish:
(a) the particular telemedicine services that are considered face-to-face encounters for reimbursement purposes under the state's medical assistance program; and
(b) the reimbursement methodology for the telemedicine services designated under Subsection (3)(a).
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 123 - Reimbursement of telemedicine services and telepsychiatric consultations.

Effective 5/3/2023
26B-3-123.
Reimbursement of telemedicine services and telepsychiatric consultations.
(1) As used in this section:
(a) "Telehealth services" means the same as that term is defined in Section 26B-4-704.
(b) "Telemedicine services" means the same as that term is defined in Section 26B-4-704.
(c) "Telepsychiatric consultation" means a consultation between a physician and a board certified psychiatrist, both of whom are licensed to engage in the practice of medicine in the state, that utilizes:
(i) the health records of the patient, provided from the patient or the referring physician;
(ii) a written, evidence-based patient questionnaire; and
(iii) telehealth services that meet industry security and privacy standards, including compliance with the:
(A) Health Insurance Portability and Accountability Act; and
(B) Health Information Technology for Economic and Clinical Health Act, Pub. L. No. 111-5, 123 Stat. 226, 467, as amended.
(2) This section applies to:
(a) a managed care organization that contracts with the Medicaid program; and
(b) a provider who is reimbursed for health care services under the Medicaid program.
(3) The Medicaid program shall reimburse for telemedicine services at the same rate that the Medicaid program reimburses for other health care services.
(4) The Medicaid program shall reimburse for audio-only telehealth services as specified by division rule.
(5) The Medicaid program shall reimburse for telepsychiatric consultations at a rate set by the Medicaid program.
Amended by Chapter 295, 2023 General Session
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 124 - Process to promote health insurance coverage for children.

Effective 5/3/2023
26B-3-124.
Process to promote health insurance coverage for children.
(1) The department, in collaboration with the Department of Workforce Services and the State Board of Education, shall develop a process to promote health insurance coverage for a child in school when:
(a) the child applies for free or reduced price school lunch;
(b) a child enrolls in or registers in school; and
(c) other appropriate school related opportunities.
(2) The department, in collaboration with the Department of Workforce Services, shall promote and facilitate the enrollment of children identified under Subsection (1) without health insurance in the Utah Children's Health Insurance Program, the Medicaid program, or the Utah Premium Partnership for Health Insurance Program.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 125 - Medicaid -- Continuous eligibility -- Promoting payment and delivery reform.

Effective 5/3/2023
26B-3-125.
Medicaid -- Continuous eligibility -- Promoting payment and delivery reform.
(1) In accordance with Subsection (2), and within appropriations from the Legislature, the department may amend the state Medicaid plan to:
(a) create continuous eligibility for up to 12 months for an individual who has qualified for the state Medicaid program;
(b) provide incentives in managed care contracts for an individual to obtain appropriate care in appropriate settings; and
(c) require the managed care system to accept the risk of managing the Medicaid population assigned to the plan amendment in return for receiving the benefits of providing quality and cost effective care.
(2) If the department amends the state Medicaid plan under Subsection (1)(a) or (b), the department:
(a) shall ensure that the plan amendment:
(i) is cost effective for the state Medicaid program;
(ii) increases the quality and continuity of care for recipients; and
(iii) calculates and transfers administrative savings from continuous enrollment from the Department of Workforce Services to the department; and
(b) may limit the plan amendment under Subsection (1)(a) or (b) to select geographic areas or specific Medicaid populations.
(3) The department may seek approval for a state plan amendment, waiver, or a demonstration project from the Secretary of the United States Department of Health and Human Services if necessary to implement a plan amendment under Subsection (1)(a) or (b).
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 126 - Patient notice of health care provider privacy practices.

Effective 5/3/2023
26B-3-126.
Patient notice of health care provider privacy practices.
(1)
(a) For purposes of this section:
(i) "Health care provider" means a health care provider as defined in Section 78B-3-403 who:
(A) receives payment for medical services from the Medicaid program established in this chapter, or the Children's Health Insurance Program established in Section 26B-3-902; and
(B) submits a patient's personally identifiable information to the Medicaid eligibility database or the Children's Health Insurance Program eligibility database.
(ii) "HIPAA" means 45 C.F.R. Parts 160, 162, and 164, Health Insurance Portability and Accountability Act of 1996, as amended.
(b) Beginning July 1, 2013, this section applies to the Medicaid program, the Children's Health Insurance Program created in Section 26B-3-902, and a health care provider.
(2) A health care provider shall, as part of the notice of privacy practices required by HIPAA, provide notice to the patient or the patient's personal representative that the health care provider either has, or may submit, personally identifiable information about the patient to the Medicaid eligibility database and the Children's Health Insurance Program eligibility database.
(3) The Medicaid program and the Children's Health Insurance Program may not give a health care provider access to the Medicaid eligibility database or the Children's Health Insurance Program eligibility database unless the health care provider's notice of privacy practices complies with Subsection (2).
(4) The department may adopt an administrative rule to establish uniform language for the state requirement regarding notice of privacy practices to patients required under Subsection (2).
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 127 - Optional Medicaid expansion.

Effective 5/3/2023
26B-3-127.
Optional Medicaid expansion.
(1) The department and the governor may not expand the state's Medicaid program under PPACA unless:
(a) the department expands Medicaid in accordance with Section 26B-3-210; or
(b)
(i) the governor or the governor's designee has reported the intention to expand the state Medicaid program under PPACA to the Legislature in compliance with the legislative review process in Section 26B-3-108; and
(ii) the governor submits the request for expansion of the Medicaid program for optional populations to the Legislature under the high impact federal funds request process required by Section 63J-5-204.
(2)
(a) The department shall request approval from CMS for waivers from federal statutory and regulatory law necessary to implement the health coverage improvement program under Section 26B-3-207.
(b) The health coverage improvement program under Section 26B-3-207 is not subject to the requirements in Subsection (1).
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 128 - Medicaid vision services -- Request for proposals.

Effective 5/3/2023
26B-3-128.
Medicaid vision services -- Request for proposals.
The department may select one or more contractors, in accordance with Title 63G, Chapter 6a, Utah Procurement Code, to provide vision services to the Medicaid populations that are eligible for vision services, as described in department rules, without restricting provider participation, and within existing appropriations from the Legislature.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 131 - Screening, Brief Intervention, and Referral to Treatment Medicaid reimbursement.

Effective 5/3/2023
26B-3-131.
Screening, Brief Intervention, and Referral to Treatment Medicaid reimbursement.
(1) As used in this section:
(a) "Controlled substance prescriber" means a controlled substance prescriber, as that term is defined in Section 58-37-6.5, who:
(i) has a record of having completed SBIRT training, in accordance with Subsection 58-37-6.5(2), before providing the SBIRT services; and
(ii) is a Medicaid enrolled health care provider.
(b) "SBIRT" means the same as that term is defined in Section 58-37-6.5.
(2) The department shall reimburse a controlled substance prescriber who provides SBIRT services to a Medicaid enrollee who is 13 years old or older for the SBIRT services.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 132 - Prescribing policies for opioid prescriptions.

Effective 5/3/2023
26B-3-132.
Prescribing policies for opioid prescriptions.
(1) The department may implement a prescribing policy for certain opioid prescriptions that is substantially similar to the prescribing policies required in Section 31A-22-615.5.
(2) The department may amend the state program and apply for waivers for the state program, if necessary, to implement Subsection (1).
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 133 - Reimbursement for long-acting reversible contraception immediately following childbirth.

Effective 5/3/2023
26B-3-133.
Reimbursement for long-acting reversible contraception immediately following childbirth.
(1) As used in this section, "long-acting reversible contraception" means a contraception method that requires administration less than once per month, including:
(a) an intrauterine device; and
(b) a contraceptive implant.
(2) The division shall separately identify and reimburse, from other labor and delivery services within the Medicaid program, the provision and insertion of long-acting reversible contraception immediately after childbirth.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 134 - Coverage of exome sequence testing.

Effective 5/3/2023
26B-3-134.
Coverage of exome sequence testing.
(1) As used in this section, "exome sequence testing" means a genomic technique for sequencing the genome of an individual for diagnostic purposes.
(2) The Medicaid program shall reimburse for exome sequence testing:
(a) for an enrollee who:
(i) is younger than 21 years old; and
(ii) who remains undiagnosed after exhausting all other appropriate diagnostic-related tests;
(b) performed by a nationally recognized provider with significant experience in exome sequence testing;
(c) that is medically necessary; and
(d) at a rate set by the Medicaid program.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 135 - Reimbursement for nonemergency secured behavioral health transport providers.

Effective 5/3/2023
Superseded 7/1/2024
26B-3-135.
Reimbursement for nonemergency secured behavioral health transport providers.
The department may not reimburse a nonemergency secured behavioral health transport provider that is designated under Section 26B-4-117.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 135 - Reimbursement for nonemergency secured behavioral health transport providers.

Effective 7/1/2024
26B-3-135.
Reimbursement for nonemergency secured behavioral health transport providers.
The department may not reimburse a nonemergency secured behavioral health transport provider that is designated under Section 53-2d-403.
Renumbered and Amended by Chapter 306, 2023 General Session
Amended by Chapter 310, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 136 - Children's Health Care Coverage Program.

Affected by 63I-1-226 on 7/1/2025
Effective 5/3/2023
26B-3-136.
Children's Health Care Coverage Program.
(1) As used in this section:
(a) "CHIP" means the Children's Health Insurance Program created in Section 26B-3-902.
(b) "Program" means the Children's Health Care Coverage Program created in Subsection (2).
(2)
(a) There is created the Children's Health Care Coverage Program within the department.
(b) The purpose of the program is to:
(i) promote health insurance coverage for children in accordance with Section 26B-3-124;
(ii) conduct research regarding families who are eligible for Medicaid and CHIP to determine awareness and understanding of available coverage;
(iii) analyze trends in disenrollment and identify reasons that families may not be renewing enrollment, including any barriers in the process of renewing enrollment;
(iv) administer surveys to recently enrolled CHIP and children's Medicaid enrollees to identify:
(A) how the enrollees learned about coverage; and
(B) any barriers during the application process;
(v) develop promotional material regarding CHIP and children's Medicaid eligibility, including outreach through social media, video production, and other media platforms;
(vi) identify ways that the eligibility website for enrollment in CHIP and children's Medicaid can be redesigned to increase accessibility and enhance the user experience;
(vii) identify outreach opportunities, including partnerships with community organizations including:
(A) schools;
(B) small businesses;
(C) unemployment centers;
(D) parent-teacher associations; and
(E) youth athlete clubs and associations; and
(viii) develop messaging to increase awareness of coverage options that are available through the department.
(3)
(a) The department may not delegate implementation of the program to a private entity.
(b) Notwithstanding Subsection (3)(a), the department may contract with a media agency to conduct the activities described in Subsection (2)(b)(iv) and (vii).
Renumbered and Amended by Chapter 306, 2023 General Session