reglab/statecodes huggingface dataset:
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 1 - Health Care Assistance › Section 137 - Reimbursement for diabetes prevention program.

Affected by 63I-1-226 on 6/30/2027
Effective 5/3/2023
26B-3-137.
Reimbursement for diabetes prevention program.
(1) As used in this section, "DPP" means the National Diabetes Prevention Program developed by the United States Centers for Disease Control and Prevention.
(2) Beginning July 1, 2022, the Medicaid program shall reimburse a provider for an enrollee's participation in the DPP if the enrollee:
(a) meets the DPP's eligibility requirements; and
(b) has not previously participated in the DPP after July 1, 2022, while enrolled in the Medicaid program.
(3) Subject to appropriation, the Medicaid program may set the rate for reimbursement.
(4) The department may apply for a state plan amendment if necessary to implement this section.
(5)
(a) On or after July 1, 2025, but before October 1, 2025, the department shall provide a written report regarding the efficacy of the DPP and reimbursement under this section to the Health and Human Services Interim Committee.
(b) The report described in Subsection (5)(a) shall include:
(i) the total number of enrollees with a prediabetic condition as of July 1, 2022;
(ii) the total number of enrollees as of July 1, 2022, with a diagnosis of type 2 diabetes;
(iii) the total number of enrollees who participated in the DPP;
(iv) the total cost incurred by the state to implement this section; and
(v) any conclusions that can be drawn regarding the impact of the DPP on the rate of type 2 diabetes for enrollees.
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 139 - Adjudicative proceedings related to Medicaid funds.

Effective 5/3/2023
26B-3-139.
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.
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 141 - Medical assistance from division or Department of Workforce Services and compliance under adoption assistance interstate compact -- Penalty for fraudulent claim.

Effective 5/3/2023
26B-3-141.
Medical assistance from division or Department of Workforce Services and compliance under adoption assistance interstate compact -- Penalty for fraudulent claim.
(1) As used in this section:
(a) "Adoption assistance" means the same as that term is defined in Section 80-2-809.
(b) "Adoption assistance agreement" means the same as that term is defined in Section 80-2-809.
(c) "Adoption assistance interstate compact" means an agreement executed by the Division of Child and Family Services with any other state in accordance with Section 80-2-809.
(2)
(a) A child who is a resident of this state and is the subject of an adoption assistance interstate compact is entitled to receive medical assistance from the division and the Department of Workforce Services by filing a certified copy of the child's adoption assistance agreement with the division or the Department of Workforce Services.
(b) The adoptive parent of the child described in Subsection (2)(a) shall annually provide the division or the Department of Workforce Services with evidence verifying that the adoption assistance agreement is still effective.
(3) The Department of Workforce Services shall consider the recipient of medical assistance under this section as the Department of Workforce Services does any other recipient of medical assistance under an adoption assistance agreement executed by the Division of Child and Family Services.
(4)
(a) A person may not submit a claim for payment or reimbursement under this section that the person knows is false, misleading, or fraudulent.
(b) A violation of Subsection (4)(a) is a third degree felony.
(5) The division and the Department of Workforce Services shall:
(a) cooperate with the Division of Child and Family Services in regard to an adoption assistance interstate compact; and
(b) comply with an adoption assistance interstate compact.
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 142 - Long-acting injectables.

Affected by 63I-2-226 on 7/1/2024
Effective 5/3/2023
26B-3-142.
Long-acting injectables.
(1) With respect to payments by the Medicaid program for long-acting injectable typical and atypical antipsychotics, the department shall report on the following to the Health and Human Services Interim Committee before November 1, 2023:
(a) options for payment, including the benefits and cost of each option; and
(b) whether payment should be included in a bundled payment made to a hospital.
(2) The department shall prepare the report with input from health care providers.
Enacted by Chapter 295, 2023 General Session
Technical renumber of section for proper placement in Title and Chapter, according to Coordniation Clause and Revisor Instructions.
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 2 - Medicaid Waivers › Section 201 - Medicaid waiver for independent foster care adolescents.

Effective 5/3/2023
26B-3-201.
Medicaid waiver for independent foster care adolescents.
(1) As used in this section, an "independent foster care adolescent" includes any individual who reached 18 years old while in the custody of the department if the department 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 old.
(3) Before July 1, 2006, the division shall submit a state Medicaid Plan amendment to CMS to provide medical coverage for independent foster care adolescents effective fiscal year 2006-07.
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 2 - Medicaid Waivers › Section 205 - Long-term care insurance partnership.

Effective 5/3/2023
26B-3-205.
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.
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 2 - Medicaid Waivers › Section 206 - Medicaid waiver for children with disabilities and complex medical needs.

Effective 7/1/2023
26B-3-206.
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 on an ongoing basis;
(c) requires periodic reevaluations of an enrolled child's eligibility and other applicants or eligible children waiting for services in the program based on the additional eligibility criteria; and
(d) at the time of reevaluation, allows the department to disenroll a child if the child is no longer a qualified child.
(4) The department shall:
(a) establish by rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, criteria to prioritize qualified children's participation in the program based on the following factors, in the following priority order:
(i) the complexity of a qualified child's medical condition; and
(ii) the financial needs of the qualified child and the qualified child's family;
(b) convene a public process to determine the benefits and services to offer a qualified child under the program;
(c) evaluate, on an ongoing basis, the cost and effectiveness of the program;
(d) if funding for the program is reduced, develop an evaluation process to reduce the number of children served based on the participation criteria established under Subsection (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 286, 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 2 - Medicaid Waivers › Section 209 - Medicaid long-term support services housing coordinator.

Effective 5/3/2023
26B-3-209.
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.
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 2 - Medicaid Waivers › Section 212 - Limited family planning services for low-income individuals.

Effective 5/3/2023
26B-3-212.
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 185% of the federal poverty level; and
(ii) does not qualify for full coverage under the Medicaid program.
(2) Before January 1, 2024, 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.
Renumbered and Amended by Chapter 306, 2023 General Session
Amended by Chapter 316, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 2 - Medicaid Waivers › Section 213 - Medicaid waiver for mental health crisis lines and mobile crisis outreach teams.

Affected by 63I-1-226 on 12/31/2026
Effective 5/3/2023
26B-3-213.
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 26B-5-610.
(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 26B-5-610.
(2) In consultation with 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).
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 2 - Medicaid Waivers › Section 214 - Medicaid waiver for coverage of mental health services in schools.

Effective 5/3/2023
26B-3-214.
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 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).
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 2 - Medicaid Waivers › Section 215 - Coverage for in vitro fertilization and genetic testing.

Affected by 63I-2-226 on 7/1/2030
Effective 5/3/2023
26B-3-215.
Coverage for in vitro fertilization and genetic testing.
(1) As used in this section:
(a) "Qualified condition" means:
(i) cystic fibrosis;
(ii) spinal muscular atrophy;
(iii) Morquio Syndrome;
(iv) myotonic dystrophy; or
(v) sickle cell anemia.
(b) "Qualified enrollee" means an individual who:
(i) is enrolled in the Medicaid program;
(ii) has been diagnosed by a physician as having a genetic trait associated with a qualified condition; and
(iii) intends to get pregnant with a partner who is diagnosed by a physician as having a genetic trait associated with the same qualified condition as the individual.
(2) Before January 1, 2021, the department shall apply for a Medicaid waiver or a state plan amendment with the Centers for Medicare and Medicaid Services within the United States Department of Health and Human Services to implement the coverage described in Subsection (3).
(3) If the waiver described in Subsection (2) is approved, the Medicaid program shall provide coverage to a qualified enrollee for:
(a) in vitro fertilization services; and
(b) genetic testing of a qualified enrollee who receives in vitro fertilization services under Subsection (3)(a).
(4) The Medicaid program may not provide the coverage described in Subsection (3) before the later of:
(a) the day on which the waiver described in Subsection (2) is approved; and
(b) January 1, 2021.
(5) Before November 1, 2022, and before November 1 of every third year thereafter, the department shall:
(a) calculate the change in state spending attributable to the coverage under this section; and
(b) report the amount described in Subsection (5)(a) to the Health and Human Services Interim Committee and the Social Services Appropriations Subcommittee.
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 2 - Medicaid Waivers › Section 216 - Medicaid waiver for fertility preservation services.

Effective 5/3/2023
26B-3-216.
Medicaid waiver for fertility preservation services.
(1) As used in this section:
(a) "Iatrogenic infertility" means an impairment of fertility or reproductive functioning caused by surgery, chemotherapy, radiation, or other medical treatment.
(b) "Physician" means an individual licensed to practice under Title 58, Chapter 67, Utah Medical Practice Act, or Title 58, Chapter 68, Utah Osteopathic Medical Practice Act.
(c) "Qualified enrollee" means an individual who:
(i) is enrolled in the Medicaid program;
(ii) has been diagnosed with a form of cancer by a physician; and
(iii) needs treatment for that cancer that may cause a substantial risk of sterility or iatrogenic infertility, including surgery, radiation, or chemotherapy.
(d) "Standard fertility preservation service" means a fertility preservation procedure and service that:
(i) is not considered experimental or investigational by the American Society for Reproductive Medicine or the American Society of Clinical Oncology; and
(ii) is consistent with established medical practices or professional guidelines published by the American Society for Reproductive Medicine or the American Society of Clinical Oncology, including:
(A) sperm banking;
(B) oocyte banking;
(C) embryo banking;
(D) banking of reproductive tissues; and
(E) storage of reproductive cells and tissues.
(2) Before January 1, 2022, the department shall apply for a Medicaid waiver or a state plan amendment with CMS to implement the coverage described in Subsection (3).
(3) If the waiver or state plan amendment described in Subsection (2) is approved, the Medicaid program shall provide coverage to a qualified enrollee for standard fertility preservation services.
(4) The Medicaid program may not provide the coverage described in Subsection (3) before the later of:
(a) the day on which the waiver described in Subsection (2) is approved; and
(b) January 1, 2023.
(5) Before November 1, 2023, and before November 1 of each third year after 2023, the department shall:
(a) calculate the change in state spending attributable to the coverage described in this section; and
(b) report the amount described in Subsection (5)(a) to the Health and Human Services Interim Committee and the Social Services Appropriations Subcommittee.
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 2 - Medicaid Waivers › Section 217 - Medicaid waiver for coverage of qualified inmates leaving prison or jail.

Effective 5/3/2023
26B-3-217.
Medicaid waiver for coverage of qualified inmates leaving prison or jail.
(1) As used in this section:
(a) "Correctional facility" means:
(i) a county jail;
(ii) the Department of Corrections, created in Section 64-13-2; or
(iii) a prison, penitentiary, or other institution operated by or under contract with the Department of Corrections for the confinement of an offender, as defined in Section 64-13-1.
(b) "Qualified inmate" means an individual who:
(i) is incarcerated in a correctional facility; and
(ii) has:
(A) a chronic physical or behavioral health condition;
(B) a mental illness, as defined in Section 26B-5-301; or
(C) an opioid use disorder.
(2) Before July 1, 2020, the division shall apply for a Medicaid waiver or a state plan amendment with CMS to offer a program to provide Medicaid coverage to a qualified inmate for up to 30 days immediately before the day on which the qualified inmate is released from a correctional facility.
(3) If the waiver or state plan amendment described in Subsection (2) is approved, the department shall report to the Health and Human Services Interim Committee each year before November 30 while the waiver or state plan amendment is in effect regarding:
(a) the number of qualified inmates served under the program;
(b) the cost of the program; and
(c) the effectiveness of the program, including:
(i) any reduction in the number of emergency room visits or hospitalizations by inmates after release from a correctional facility;
(ii) any reduction in the number of inmates undergoing inpatient treatment after release from a correctional facility;
(iii) any reduction in overdose rates and deaths of inmates after release from a correctional facility; and
(iv) any other costs or benefits as a result of the program.
(4) If the waiver or state plan amendment described in Subsection (2) is approved, a county that is responsible for the cost of a qualified inmate's medical care shall provide the required matching funds to the state for:
(a) any costs to enroll the qualified inmate for the Medicaid coverage described in Subsection (2);
(b) any administrative fees for the Medicaid coverage described in Subsection (2); and
(c) the Medicaid coverage that is provided to the qualified inmate 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 2 - Medicaid Waivers › Section 218 - Medicaid waiver for inpatient care in an institution for mental diseases.

Effective 5/3/2023
26B-3-218.
Medicaid waiver for inpatient care in an institution for mental diseases.
(1) As used in this section, "institution for mental diseases" means the same as that term is defined in 42 C.F.R. Sec. 435.1010.
(2) Before August 1, 2020, the division shall apply for a Medicaid waiver or a state plan amendment with CMS to offer a program that provides reimbursement for mental health services that are provided:
(a) in an institution for mental diseases that includes more than 16 beds; and
(b) to an individual who receives mental health services in an institution for mental diseases for a period of more than 15 days in a calendar month.
(3) If the waiver or state plan amendment described in Subsection (2) is approved, the department shall:
(a) develop and offer the program described in Subsection (2); and
(b) submit to the Health and Human Services Interim Committee and the Social Services Appropriations Subcommittee any report that the department submits to CMS that relates to the budget neutrality, independent waiver evaluation, or performance metrics of the program described in Subsection (2), within 15 days after the day on which the report is submitted to CMS.
(4) Notwithstanding Sections 17-43-201 and 17-43-301, if the waiver or state plan amendment described in Subsection (2) is approved, a county does not have to provide matching funds to the state for the mental health services described in Subsection (2) that are provided to an individual who qualifies for Medicaid coverage under Section 26B-3-113 or 26B-3-207.
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 2 - Medicaid Waivers › Section 219 - Reimbursement for crisis management services provided in a behavioral health receiving center -- Integration of payment for physical health services.

Effective 5/3/2023
26B-3-219.
Reimbursement for crisis management services provided in a behavioral health receiving center -- Integration of payment for physical health services.
(1) As used in this section:
(a) "Accountable care organization" means the same as that term is defined in Section 26B-3-204.
(b) "Behavioral health receiving center" means the same as that term is defined in Section 26B-4-114.
(c) "Crisis management services" means behavioral health services provided to an individual who is experiencing a mental health crisis.
(d) "Managed care organization" means the same as that term is defined in 42 C.F.R. Sec. 438.2.
(2) Before July 1, 2020, the division shall apply for a Medicaid waiver or state plan amendment with CMS to offer a program that provides reimbursement through a bundled daily rate for crisis management services that are delivered to an individual during the individual's stay at a behavioral health receiving center.
(3) If the waiver or state plan amendment described in Subsection (2) is approved, the department shall:
(a) implement the program described in Subsection (2); and
(b) require a managed care organization that contracts with the state's Medicaid program for behavioral health services or integrated health services to provide coverage for crisis management services that are delivered to an individual during the individual's stay at a behavioral health receiving center.
(4)
(a) The department may elect to integrate payment for physical health services provided in a behavioral health receiving center.
(b) In determining whether to integrate payment under Subsection (4)(a), the department shall consult with accountable care organizations and counties in the state.
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 2 - Medicaid Waivers › Section 220 - Crisis services -- Reimbursement.

Effective 5/3/2023
26B-3-220.
Crisis services -- Reimbursement.
The department shall submit a waiver or state plan amendment to allow for reimbursement for 988 services provided to an individual who is eligible and enrolled in Medicaid at the time this service is provided.
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 2 - Medicaid Waivers › Section 221 - Medicaid waiver for respite care facility that provides services to homeless individuals.

Effective 5/3/2023
26B-3-221.
Medicaid waiver for respite care facility that provides services to homeless individuals.
(1) As used in this section:
(a) "Adult in the expansion population" means an adult:
(i) described in 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII); and
(ii) not otherwise eligible for Medicaid as a mandatory categorically needy individual.
(b) "Homeless" means the same as that term is defined in Section 26B-3-207.
(c) "Medical respite care" means short-term housing with supportive medical services.
(d) "Medical respite facility" means a residential facility that provides medical respite care to homeless individuals.
(2) Before January 1, 2022, the department shall apply for a Medicaid waiver or state plan amendment with CMS to choose a single medical respite facility to reimburse for services provided to an individual who is:
(a) homeless; and
(b) an adult in the expansion population.
(3) The department shall choose a medical respite facility best able to serve homeless individuals who are adults in the expansion population.
(4) If the waiver or state plan amendment described in Subsection (2) is approved, while the waiver or state plan amendment is in effect, the department shall submit a report to the Health and Human Services Interim Committee each year before November 30 detailing:
(a) the number of homeless individuals served at the facility;
(b) the cost of the program; and
(c) the reduction of health care costs due to the program's implementation.
(5) Through administrative rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, the department shall further define and limit the services, described in this section, provided to a homeless individual.
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 2 - Medicaid Waivers › Section 222 - Medicaid waiver expansion for extraordinary care reimbursement.

Effective 5/3/2023
26B-3-222.
Medicaid waiver expansion for extraordinary care reimbursement.
(1) As used in this section:
(a) "Existing home and community-based services waiver" means an existing home and community-based services waiver in the state that serves an individual:
(i) with an acquired brain injury;
(ii) with an intellectual or physical disability; or
(iii) who is 65 years old or older.
(b) "Guardian" means a person appointed by a court to manage the affairs of a living individual.
(c) "Parent" means a biological or adoptive parent of an individual."
(d) "Personal care services" means a service that:
(i) is furnished to an individual who is not an inpatient nor a resident of a hospital, nursing facility, intermediate care facility, or institution for mental diseases;
(ii) is authorized for an individual described in Subsection (1)(d)(i) in accordance with a plan of treatment;
(iii) is provided by an individual who is qualified to provide the services; and
(iv) is furnished in a home or another community-based setting.
(e) "Waiver enrollee" means an individual who is enrolled in an existing home and community-based services waiver.
(2) Before July 1, 2021, the department shall apply with CMS for an amendment to an existing home and community-based services waiver to implement a program to offer reimbursement to an individual who provides personal care services that constitute extraordinary care to a waiver enrollee who is the individual's spouse.
(3) If CMS approves the amendment described in Subsection (2), the department shall implement the program described in Subsection (2).
(4) The department shall by rule, made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, define "extraordinary care" for purposes of Subsection (2).
(5) Before July 1, 2023, the department shall apply with CMS for an amendment to an existing home and community-based services waiver to implement a program to offer reimbursement to an individual who provides personal care services that constitute extraordinary care to a waiver enrollee to whom the individual is a parent or guardian.
(6) If CMS approves the amendment described in Subsection (5), the department shall implement the program described in Subsection (5).
(7) The department shall by rule, made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, define "extraordinary care" for purposes of Subsection (5).
Renumbered and Amended by Chapter 306, 2023 General Session
Amended by Chapter 315, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 2 - Medicaid Waivers › Section 223 - Delivery system adjustments for the targeted adult Medicaid program.

Effective 5/3/2023
26B-3-223.
Delivery system adjustments for the targeted adult Medicaid program.
(1) As used in this section, "targeted adult Medicaid program" means the same as that term is defined in Section 26B-3-207.
(2) The department may implement the delivery system adjustments authorized under Subsection (3) only on the later of:
(a) July 1, 2023; and
(b) the department determining that the Medicaid program, including providers and managed care organizations, are satisfying the metrics established in collaboration with the working group convened under Subsection 26B-3-138(2).
(3) The department may, for individuals who are enrolled in the targeted adult Medicaid program:
(a) integrate the delivery of behavioral and physical health in certain counties; and
(b) deliver behavioral health services through an accountable care organization where implemented.
(4) Before implementing the delivery system adjustments described in Subsection (3) in a county, the department shall, at a minimum, seek input from:
(a) individuals who qualify for the targeted adult Medicaid program who reside in the county;
(b) the county's executive officer, legislative body, and other county officials who are involved in the delivery of behavioral health services;
(c) the local mental health authority and local substance abuse authority that serves the county;
(d) Medicaid managed care organizations operating in the state, including Medicaid accountable care organizations;
(e) providers of physical or behavioral health services in the county who provide services to enrollees in the targeted adult Medicaid program in the county; and
(f) other individuals that the department deems necessary.
(5) If the department provides Medicaid coverage through a managed care delivery system under this section, the department shall include language in the department's managed care contracts that require the managed care plan to:
(a) be in compliance with federal Medicaid managed care requirements;
(b) timely and accurately process authorizations and claims in accordance with Medicaid policy and contract requirements;
(c) adequately reimburse providers to maintain adequacy of access to care;
(d) provide care management services sufficient to meet the needs of Medicaid eligible individuals enrolled in the managed care plan's plan; and
(e) timely resolve any disputes between a provider or enrollee with the managed care plan.
(6) The department may take corrective action if the managed care organization fails to comply with the terms of the managed care organization's contract.
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 2 - Medicaid Waivers › Section 224 - Medicaid waiver for increased integrated health care reimbursement.

Effective 5/3/2023
26B-3-224.
Medicaid waiver for increased integrated health care reimbursement.
(1) As used in this section:
(a) "Integrated health care setting" means a health care or behavioral health care setting that provides integrated physical and behavioral health care services.
(b) "Local mental health authority" means a local mental health authority described in Section 17-43-301.
(2) The department shall develop a proposal to allow the state Medicaid program to reimburse a local mental health authority for covered physical health care services provided in an integrated health care setting to Medicaid eligible individuals.
(3) Before December 31, 2022, the department shall apply for a Medicaid waiver or a state plan amendment with CMS to implement the proposal described in Subsection (2).
(4) If the waiver or state plan amendment described in Subsection (3) is approved, the department shall:
(a) implement the proposal described in Subsection (2); and
(b) while the waiver or state plan amendment is in effect, submit a report to the Health and Human Services Interim Committee each year before November 30 detailing:
(i) the number of patients served under the waiver or state plan amendment;
(ii) the cost of the waiver or state plan amendment; and
(iii) any benefits of the waiver or state plan amendment.
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 2 - Medicaid Waivers › Section 226 - Medicaid waiver for rural healthcare for chronic conditions.

Effective 5/3/2023
26B-3-226.
Medicaid waiver for rural healthcare for chronic conditions.
(1) As used in this section:
(a) "Qualified condition" means:
(i) diabetes;
(ii) high blood pressure;
(iii) congestive heart failure;
(iv) asthma;
(v) obesity;
(vi) chronic obstructive pulmonary disease; or
(vii) chronic kidney disease.
(b) "Qualified enrollee" means an individual who:
(i) is enrolled in the Medicaid program;
(ii) has been diagnosed as having a qualified condition; and
(iii) is not enrolled in an accountable care organization.
(2) Before January 1, 2024, the department shall apply for a Medicaid waiver with the Centers for Medicare and Medicaid Services to implement the coverage described in Subsection (3) for a three-year pilot program.
(3) If the waiver described in Subsection (2) is approved, the Medicaid program shall contract with a single entity to provide coordinated care for the following services to each qualified enrollee:
(a) a telemedicine platform for the qualified enrollee to use;
(b) an in-home initial visit to the qualified enrollee;
(c) daily remote monitoring of the qualified enrollee's qualified condition;
(d) all services in the qualified enrollee's language of choice;
(e) individual peer monitoring and coaching for the qualified enrollee;
(f) available access for the qualified enrollee to video-enabled consults and voice-enabled consults 24 hours a day, seven days a week;
(g) in-home biometric monitoring devices to monitor the qualified enrollee's qualified condition; and
(h) at-home medication delivery to the qualified enrollee.
(4) The Medicaid program may not provide the coverage described in Subsection (3) until the waiver is approved.
(5) Each year the waiver is active, the department shall submit a report to the Health and Human Services Interim Committee before November 30 detailing:
(a) the number of patients served under the waiver;
(b) the cost of the waiver; and
(c) any benefits of the waiver, including an estimate of:
(i) the reductions in emergency room visits or hospitalizations;
(ii) the reductions in 30-day hospital readmissions for the same diagnosis;
(iii) the reductions in complications related to qualified conditions; and
(iv) any improvements in health outcomes from baseline assessments.
Enacted by Chapter 336, 2023 General Session
Technical renumber of section for proper placement in Title and Chapter.
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 2 - Medicaid Waivers › Section 227 - Recreational therapy -- Reimbursement.

Effective 5/3/2023
26B-3-227.
Recreational therapy -- Reimbursement.
(1) As used in this section:
(a) "Assisted living facility" means the same as that term is defined in Section 26B-2-201.
(b) "Behavioral health program" means a behavioral health program described in Title 62A, Chapter 15, Substance Abuse and Mental Health Act.
(c) "General acute hospital" means the same as that term is defined in Section 26B-2-201.
(d) "Intermediate care facility" means the same as that term is defined in Section 58-15-101.
(e) "Mental health therapist" means the same as that term is defined in Section 58-60-102.
(f) "Qualified enrollee" means an individual who:
(i) is enrolled in the Medicaid program; and
(ii) has been referred for recreational therapy services by a mental health therapist.
(g) "Recreational therapy services" means the same as that term is defined in Section 58-40-102.
(h) "Skilled nursing facility" means the same as that term is defined in Section 58-15-101.
(i) "Youth residential treatment facility" means a facility that provides a 24-hour group living environment for four or more individuals who are under 18 years old and who are unrelated to the owner or provider of the facility.
(2) Before January 1, 2024, the department shall apply for a Medicaid waiver or a state plan with CMS to allow for reimbursement for recreational therapy services provided:
(a) to a qualified enrollee;
(b) by an individual authorized to engage in the practice of recreational therapy under Title 58, Chapter 40, Recreational Therapy Practice Act; and
(c) at a:
(i) general acute hospital;
(ii) youth residential treatment facility;
(iii) behavioral health program;
(iv) intermediate care facility;
(v) assisted living facility;
(vi) skilled nursing facility;
(vii) psychiatric hospital; or
(viii) mental health agency.
(3) If the waiver or state plan amendment described in Subsection (2) is approved, the Medicaid program shall provide coverage to a qualified enrollee for recreational therapy services.
Enacted by Chapter 288, 2023 General Session
Technical renumber of section for proper placement in Title and Chapter.
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 2 - Medicaid Waivers › Section 228 - Medicaid coverage for certain postpartum women.

Effective 5/3/2023
26B-3-228.
Medicaid coverage for certain postpartum women.
(1) As used in this section:
(a) "Extended postpartum period" means the period after a woman's pregnancy ends:
(i) beginning the day after the initial postpartum period; and
(ii) ending on the last day of the month that is 12 months after the day on which the woman's pregnancy ends.
(b) "Initial postpartum period" means the period:
(i) beginning on the day on which a woman's pregnancy ends; and
(ii) ending on the last day of the month that is 60 days after the day on which the woman's pregnancy ends.
(c) "Miscarriage" means the spontaneous or accidental loss of a fetus, regardless of gestational age or the duration of the pregnancy.
(2) Before July 1, 2023, the division shall request a waiver or state plan amendment to, in accordance with 42 U.S.C. Sec. 1396a(e)(16), provide continuous Medicaid coverage during the woman's extended postpartum period if:
(a) the woman is eligible for Medicaid during the woman's pregnancy; and
(b) the woman's pregnancy ended by way of:
(i) birth;
(ii) miscarriage;
(iii) stillbirth; or
(iv) an abortion that is permitted under Section 76-7a-201.
(3) If the request described in Subsection (2) is denied or is not approved by January 1, 2024, the division shall request a waiver or state plan amendment to, in accordance with 42 U.S.C. Sec. 1396a(e)(16), provide continuous Medicaid coverage during the woman's extended postpartum period if the woman is eligible for Medicaid during the woman's pregnancy.
Enacted by Chapter 316, 2023 General Session
Technically renumbered to avoid duplication of newly enacted Chapter also in SB 39, Chapter 306.
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 3 - Administration of Medicaid Programs: Drug Utilization Review and Long Term Care Facility Certification › Section 302 - DUR Board -- Creation and membership -- Expenses.

Affected by 63I-1-226 on 7/1/2027
Effective 5/3/2023
26B-3-302.
DUR Board -- Creation and membership -- Expenses.
(1) There is created a 12-member Drug Utilization Review Board responsible for implementation of a retrospective and prospective DUR program.
(2)
(a) Except as required by Subsection (2)(b), as terms of current board members expire, the executive director shall appoint each new member or reappointed member to a four-year term.
(b) Notwithstanding the requirements of Subsection (2)(a), the executive director shall, at the time of appointment or reappointment, adjust the length of terms to ensure that the terms of board members are staggered so that approximately half of the board is appointed every two years.
(c) Persons appointed to the board may be reappointed upon completion of their terms, but may not serve more than two consecutive terms.
(d) The executive director shall provide for geographic balance in representation on the board.
(3) When a vacancy occurs in the membership for any reason, the replacement shall be appointed for the unexpired term.
(4) The membership shall be comprised of the following:
(a) four physicians who are actively engaged in the practice of medicine or osteopathic medicine in this state, to be selected from a list of nominees provided by the Utah Medical Association;
(b) one physician in this state who is actively engaged in academic medicine;
(c) three pharmacists who are actively practicing in retail pharmacy in this state, to be selected from a list of nominees provided by the Utah Pharmaceutical Association;
(d) one pharmacist who is actively engaged in academic pharmacy;
(e) one person who shall represent consumers;
(f) one person who shall represent pharmaceutical manufacturers, to be recommended by the Pharmaceutical Manufacturers Association; and
(g) one dentist licensed to practice in this state under Title 58, Chapter 69, Dentist and Dental Hygienist Practice Act, who is actively engaged in the practice of dentistry, nominated by the Utah Dental Association.
(5) Physician and pharmacist members of the board shall have expertise in clinically appropriate prescribing and dispensing of outpatient drugs.
(6) The board shall elect a chair from among its members who shall serve a one-year term, and may serve consecutive terms.
(7) A member may not receive compensation or benefits for the member's service, but may receive per diem and travel expenses in accordance with:
(a) Section 63A-3-106;
(b) Section 63A-3-107; and
(c) rules made by the Division of Finance pursuant to Sections 63A-3-106 and 63A-3-107.
Renumbered and Amended by Chapter 306, 2023 General Session