LEGISLATIVE GENERAL COUNSEL H.B. 501
6 Approved for Filing: C. Williams 6 3rd Sub. (Cherry)
6 02-26-24 7:05 PM 6
Representative James A. Dunnigan proposes the following substitute bill:
1 HEALTH AMENDMENTS
2 2024 GENERAL SESSION
3 STATE OF UTAH
4 Chief Sponsor: James A. Dunnigan
5 Senate Sponsor: Michael S. Kennedy
6
7 LONG TITLE
8 General Description:
9 This bill updates provisions related to health assistance.
10 Highlighted Provisions:
11 This bill:
12 < amends or repeals obsolete Medicaid provisions and makes conforming changes;
13 < requires the department to apply for a Medicaid waiver or amend an existing waiver
14 application related to qualified inmates in prison or jail; and
15 < modifies provisions related to how a health insurance entity interacts with the
16 Medicaid program.
17 Money Appropriated in this Bill:
18 This bill appropriates in fiscal year 2025:
19 < to Department of Health and Human Services - Integrated Health Care Services -
20 Medicaid Other Services as an ongoing appropriation: 3rd Sub. H.B. 501
21 C from the General Fund, $701,500
22 < to Department of Health and Human Services - Integrated Health Care Services -
23 Non-Medicaid Behavioral Health Treatment and Crisis Response as an ongoing
24 appropriation:
25 C from the General Fund, $4,800,000
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26 < to Department of Health and Human Services - Integrated Health Care Services -
27 Non-Medicaid Behavioral Health Treatment and Crisis Response as a one-time
28 appropriation:
29 C from the General Fund, One-time, $800,000
30 Other Special Clauses:
31 None
32 Utah Code Sections Affected:
33 AMENDS:
34 26B-1-316, as last amended by Laws of Utah 2023, Chapter 495 and renumbered and
35 amended by Laws of Utah 2023, Chapter 305
36 26B-1-332, as renumbered and amended by Laws of Utah 2023, Chapter 305
37 26B-3-108, as last amended by Laws of Utah 2023, Chapter 466 and renumbered and
38 amended by Laws of Utah 2023, Chapter 306
39 26B-3-110, as renumbered and amended by Laws of Utah 2023, Chapter 306
40 26B-3-111, as renumbered and amended by Laws of Utah 2023, Chapter 306
41 26B-3-112, as renumbered and amended by Laws of Utah 2023, Chapter 306
42 26B-3-126, as renumbered and amended by Laws of Utah 2023, Chapter 306
43 26B-3-136, as renumbered and amended by Laws of Utah 2023, Chapter 306
44 26B-3-201, as renumbered and amended by Laws of Utah 2023, Chapter 306
45 26B-3-203, as renumbered and amended by Laws of Utah 2023, Chapter 306
46 26B-3-205, as renumbered and amended by Laws of Utah 2023, Chapter 306
47 26B-3-217, as renumbered and amended by Laws of Utah 2023, Chapter 306
48 26B-3-224, as renumbered and amended by Laws of Utah 2023, Chapter 306
49 26B-3-226, as enacted by Laws of Utah 2023, Chapter 336
50 26B-3-401, as renumbered and amended by Laws of Utah 2023, Chapter 306
51 26B-3-403, as renumbered and amended by Laws of Utah 2023, Chapter 306
52 26B-3-503, as renumbered and amended by Laws of Utah 2023, Chapter 306
53 26B-3-504, as renumbered and amended by Laws of Utah 2023, Chapter 306
54 26B-3-511, as renumbered and amended by Laws of Utah 2023, Chapter 306
55 26B-3-512, as renumbered and amended by Laws of Utah 2023, Chapter 306
56 26B-3-605, as renumbered and amended by Laws of Utah 2023, Chapter 306
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57 26B-3-607, as renumbered and amended by Laws of Utah 2023, Chapter 306
58 26B-3-610, as renumbered and amended by Laws of Utah 2023, Chapter 306
59 26B-3-705, as renumbered and amended by Laws of Utah 2023, Chapter 306
60 26B-3-707, as last amended by Laws of Utah 2023, Chapter 495 and renumbered and
61 amended by Laws of Utah 2023, Chapter 306
62 26B-3-803, as renumbered and amended by Laws of Utah 2023, Chapter 306
63 26B-3-1004, as renumbered and amended by Laws of Utah 2023, Chapter 306
64 63C-18-202, as last amended by Laws of Utah 2023, Chapters 270, 329
65 REPEALS:
66 26B-3-138, as renumbered and amended by Laws of Utah 2023, Chapter 306
67
68 Be it enacted by the Legislature of the state of Utah:
69 Section 1. Section 26B-1-316 is amended to read:
70 26B-1-316. Hospital Provider Assessment Expendable Revenue Fund.
71 (1) There is created an expendable special revenue fund known as the "Hospital
72 Provider Assessment Expendable Revenue Fund."
73 (2) The fund shall consist of:
74 (a) the assessments collected by the department under Chapter 3, Part 7, Hospital
75 Provider Assessment;
76 (b) any interest and penalties levied with the administration of Chapter 3, Part 7,
77 Hospital Provider Assessment; and
78 (c) any other funds received as donations for the fund and appropriations from other
79 sources.
80 (3) Money in the fund shall be used:
81 (a) to support capitated rates consistent with Subsection 26B-3-705(1)(d) for
82 accountable care organizations as defined in Section 26B-3-701;
83 (b) to implement the quality strategies described in Subsection 26B-3-707(2), except
84 that the amount under this Subsection (3)(b) may not exceed $211,300 in each fiscal year; and
85 (c) to reimburse money collected by the division from a hospital, as defined in Section
86 26B-3-701, through a mistake made under Chapter 3, Part 7, Hospital Provider Assessment.
87 [(4) (a) Subject to Subsection (4)(b), for the fiscal year beginning July 1, 2019, and
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88 ending July 1, 2020, any fund balance in excess of the amount necessary to pay for the costs
89 described in Subsection (3) shall be deposited into the General Fund.]
90 [(b) Subsection (4)(a) applies only to funds that were appropriated by the Legislature
91 from the General Fund to the fund and the interest and penalties deposited into the fund under
92 Subsection (2)(b).]
93 Section 2. Section 26B-1-332 is amended to read:
94 26B-1-332. Nursing Care Facilities Provider Assessment Fund -- Creation --
95 Administration -- Uses.
96 (1) There is created an expendable special revenue fund known as the "Nursing Care
97 Facilities Provider Assessment Fund" consisting of:
98 (a) [the] assessments collected by the department under Chapter 3, Part 4, Nursing
99 Care Facility Assessment;
100 (b) fines paid by nursing care facilities for excessive Medicare inpatient revenue under
101 Section 26B-2-222;
102 (c) money appropriated or otherwise made available by the Legislature;
103 (d) any interest earned on the fund; and
104 (e) penalties levied with the administration of Chapter 3, Part 4, Nursing Care Facility
105 Assessment.
106 (2) Money in the fund shall only be used by the Medicaid program:
107 (a) to the extent authorized by federal law, to obtain federal financial participation in
108 the Medicaid program;
109 (b) to provide the increased level of hospice reimbursement resulting from the nursing
110 care facilities assessment imposed under Section 26B-3-403;
111 (c) for the Medicaid program to make quality incentive payments to nursing care
112 facilities, subject to CMS approval of a Medicaid state plan amendment [to do so by the
113 Centers for Medicare and Medicaid Services within the United States Department of Health
114 and Human Services];
115 (d) to increase the rates paid before July 1, 2004, to nursing care facilities for providing
116 services pursuant to the Medicaid program; and
117 (e) for administrative expenses, if the administrative expenses for the fiscal year do not
118 exceed 3% of the money deposited into the fund during the fiscal year.
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119 (3) The department may not spend the money in the fund to replace existing state
120 expenditures paid to nursing care facilities for providing services under the Medicaid program,
121 except for increased costs due to hospice reimbursement under Subsection (2)(b).
122 Section 3. Section 26B-3-108 is amended to read:
123 26B-3-108. Administration of Medicaid program by department -- Reporting to
124 the Legislature -- Disciplinary measures and sanctions -- Funds collected -- Eligibility
125 standards -- Optional dental services costs and delivery -- Internal audits -- Health
126 opportunity accounts.
127 (1) The department shall be the single state agency responsible for the administration
128 of the Medicaid program in connection with the United States Department of Health and
129 Human Services pursuant to Title XIX of the Social Security Act.
130 (2) (a) The department shall implement the Medicaid program through administrative
131 rules in conformity with this chapter, Title 63G, Chapter 3, Utah Administrative Rulemaking
132 Act, the requirements of Title XIX, and applicable federal regulations.
133 (b) The rules adopted under Subsection (2)(a) shall include, in addition to other rules
134 necessary to implement the program:
135 (i) the standards used by the department for determining eligibility for Medicaid
136 services;
137 (ii) the services and benefits to be covered by the Medicaid program;
138 (iii) reimbursement methodologies for providers under the Medicaid program; and
139 (iv) a requirement that:
140 (A) a person receiving Medicaid services shall participate in the electronic exchange of
141 clinical health records established in accordance with Section 26B-8-411 unless the individual
142 opts out of participation;
143 (B) prior to enrollment in the electronic exchange of clinical health records the enrollee
144 shall receive notice of enrollment in the electronic exchange of clinical health records and the
145 right to opt out of participation at any time; and
146 (C) [beginning July 1, 2012, when] when the program sends enrollment or renewal
147 information to the enrollee and when the enrollee logs onto the program's website, the enrollee
148 shall receive notice of the right to opt out of the electronic exchange of clinical health records.
149 (3) (a) The department shall, in accordance with Subsection (3)(b), report to the Social
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150 Services Appropriations Subcommittee when the department:
151 (i) implements a change in the Medicaid State Plan;
152 (ii) initiates a new Medicaid waiver;
153 (iii) initiates an amendment to an existing Medicaid waiver;
154 (iv) applies for an extension of an application for a waiver or an existing Medicaid
155 waiver;
156 (v) applies for or receives approval for a change in any capitation rate within the
157 Medicaid program; or
158 (vi) initiates a rate change that requires public notice under state or federal law.
159 (b) The report required by Subsection (3)(a) shall:
160 (i) be submitted to the Social Services Appropriations Subcommittee prior to the
161 department implementing the proposed change; and
162 (ii) include:
163 (A) a description of the department's current practice or policy that the department is
164 proposing to change;
165 (B) an explanation of why the department is proposing the change;
166 (C) the proposed change in services or reimbursement, including a description of the
167 effect of the change;
168 (D) the effect of an increase or decrease in services or benefits on individuals and
169 families;
170 (E) the degree to which any proposed cut may result in cost-shifting to more expensive
171 services in health or human service programs; and
172 (F) the fiscal impact of the proposed change, including:
173 (I) the effect of the proposed change on current or future appropriations from the
174 Legislature to the department;
175 (II) the effect the proposed change may have on federal matching dollars received by
176 the state Medicaid program;
177 (III) any cost shifting or cost savings within the department's budget that may result
178 from the proposed change; and
179 (IV) identification of the funds that will be used for the proposed change, including any
180 transfer of funds within the department's budget.
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181 (4) Any rules adopted by the department under Subsection (2) are subject to review and
182 reauthorization by the Legislature in accordance with Section 63G-3-502.
183 (5) The department may, in its discretion, contract with other qualified agencies for
184 services in connection with the administration of the Medicaid program, including:
185 (a) the determination of the eligibility of individuals for the program;
186 (b) recovery of overpayments; and
187 (c) consistent with Section 26B-3-1113, and to the extent permitted by law and quality
188 control services, enforcement of fraud and abuse laws.
189 (6) The department shall provide, by rule, disciplinary measures and sanctions for
190 Medicaid providers who fail to comply with the rules and procedures of the program, provided
191 that sanctions imposed administratively may not extend beyond:
192 (a) termination from the program;
193 (b) recovery of claim reimbursements incorrectly paid; and
194 (c) those specified in Section 1919 of Title XIX of the federal Social Security Act.
195 (7) (a) Funds collected as a result of a sanction imposed under Section 1919 of Title
196 XIX of the federal Social Security Act shall be deposited [in] into the General Fund as
197 dedicated credits to be used by the division in accordance with the requirements of Section
198 1919 of Title XIX of the federal Social Security Act.
199 (b) In accordance with Section 63J-1-602.2, sanctions collected under this Subsection
200 (7) are nonlapsing.
201 (8) (a) In determining whether an applicant or recipient is eligible for a service or
202 benefit under this part or Part 9, Utah Children's Health Insurance Program, the department
203 shall, if Subsection (8)(b) is satisfied, exclude from consideration one passenger vehicle
204 designated by the applicant or recipient.
205 (b) Before Subsection (8)(a) may be applied:
206 (i) the federal government shall:
207 (A) determine that Subsection (8)(a) may be implemented within the state's existing
208 public assistance-related waivers as of January 1, 1999;
209 (B) extend a waiver to the state permitting the implementation of Subsection (8)(a); or
210 (C) determine that the state's waivers that permit dual eligibility determinations for
211 cash assistance and Medicaid are no longer valid; and
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212 (ii) the department shall determine that Subsection (8)(a) can be implemented within
213 existing funding.
214 (9) (a) As used in this Subsection (9):
215 (i) "aged, blind, or has a disability" means an aged, blind, or disabled individual, as
216 defined in 42 U.S.C. Sec. 1382c(a)(1); and
217 (ii) "spend down" means an amount of income in excess of the allowable income
218 standard that shall be paid in cash to the department or incurred through the medical services
219 not paid by Medicaid.
220 (b) In determining whether an applicant or recipient who is aged, blind, or has a
221 disability is eligible for a service or benefit under this chapter, the department shall use 100%
222 of the federal poverty level as:
223 (i) the allowable income standard for eligibility for services or benefits; and
224 (ii) the allowable income standard for eligibility as a result of spend down.
225 (10) The department shall conduct internal audits of the Medicaid program.
226 [(11) (a) The department may apply for and, if approved, implement a demonstration
227 program for health opportunity accounts, as provided for in 42 U.S.C. Sec. 1396u-8.]
228 [(b) A health opportunity account established under Subsection (11)(a) shall be an
229 alternative to the existing benefits received by an individual eligible to receive Medicaid under
230 this chapter.]
231 [(c) Subsection (11)(a) is not intended to expand the coverage of the Medicaid
232 program.]
233 [(12)] (11) (a) (i) The department shall apply for, and if approved, implement an
234 amendment to the state plan under this Subsection [(12)] (11) for benefits for:
235 (A) medically needy pregnant women;
236 (B) medically