Title 26B, Title 26B: Utah Health and Human Services Code

26B-3-212. Limited family planning services for low-income individuals. (1) As used in this section: "Family planning services" means family planning services that are provided under the state Medicaid program, including: sexual health education and family planning counseling; an…

26B-3-213. Medicaid waiver for mental health crisis lines and mobile crisis outreach teams. (1) As used in this section: "Local mental health crisis line" means the same as that term is defined in Section. 26B-5-610 "Mental health crisis" means: a mental health condition that man…

26B-3-214. Medicaid waiver for coverage of mental health services in schools. (1) As used in this section, "local education agency" means: a school district; a charter school; or the Utah Schools for the Deaf and the Blind. (2) In consultation with the State Board of Education, t…

26B-3-215. Coverage for in vitro fertilization and genetic testing. (1) As used in this section: "Qualified condition" means: cystic fibrosis; spinal muscular atrophy; Morquio Syndrome; myotonic dystrophy; or sickle cell anemia. "Qualified enrollee" means an individual who: is en…

26B-3-216. Medicaid waiver for fertility preservation services. (1) As used in this section: "Iatrogenic infertility" means an impairment of fertility or reproductive functioning caused by surgery, chemotherapy, radiation, or other medical treatment. "Physician" means an individu…

26B-3-217. Medicaid waiver for coverage of qualified inmates leaving prison or jail. (1) As used in this section: "Certified community health worker" means an individual who has obtained the certification described in Section. 26B-2-504 "Correctional facility" means: a county jai…

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 Medicai…

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: "Accountable care organization" means the same as that term is defined in Section. 26B-3-2…

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.

26B-3-221. Medicaid waiver for respite care facility that provides services to homeless individuals. (1) As used in this section: "Adult in the expansion population" means an adult: described in 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII); and not otherwise eligible for Medicaid as a…

26B-3-222. Medicaid waiver expansion for extraordinary care reimbursement. (1) As used in this section: "Existing home and community-based services waiver" means an existing home and community-based services waiver in the state that serves an individual: with an acquired brain in…

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 …

26B-3-224. Medicaid waiver for increased integrated health care reimbursement. (1) As used in this section: "Integrated health care setting" means a health care or behavioral health care setting that provides integrated physical and behavioral health care services. "Local mental …

26B-3-225. Coverage for autism spectrum disorder. (1) As used in this section: "Applied behavior analysis" means the design, implementation, and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in hu…

26B-3-226. Medicaid waiver for rural healthcare for chronic conditions. (1) As used in this section: "Qualified condition" means: diabetes; high blood pressure; congestive heart failure; asthma; obesity; chronic obstructive pulmonary disease; or chronic kidney disease. "Qualified…

26B-3-227. Recreational therapy -- Reimbursement. (1) As used in this section: "Assisted living facility" means the same as that term is defined in Section. 26B-2-201 "Behavioral health program" means a behavioral health program described in Title 26B, Chapter 5, Health Care - Su…

26B-3-228. Medicaid coverage for certain postpartum women. (1) As used in this section: "Extended postpartum period" means the period after a woman's pregnancy ends: beginning the day after the initial postpartum period; and ending on the last day of the month that is 12 months a…

26B-3-229. Doula services. (1) As used in this section, "doula services" means non-medical advice, information, emotional support, and physical comfort provided to an individual during the individual's pregnancy, childbirth, and postpartum period. (2) Before October 1, 2025, the …

26B-3-230. Traditional healing services waiver. (1) As used in this section: "Eligible facility" means any of the following: an Indian Health Service facility; a tribal health program designated under the Indian Self-Determination and Education Assistance Act, Pub. L. No. 93-638;…

26B-3-231. Medicaid waiver for minor beneficiaries. (1) As used in this section: "ABLE account" means the same as that term is defined in Section. 80-2-504 "Federal benefit" means the same as that term is defined in Section. 80-2-504 "Minor beneficiary" means the same as that ter…

26B-3-232. Wraparound services for qualified individuals with a disability. (1) As used in this section: "Federal poverty level" means the United States poverty level as defined by the most recently revised poverty income guidelines published by the United States Department of He…

26B-3-301. Definitions. As used in this part: (1) "Appropriate and medically necessary" means, regarding drug prescribing, dispensing, and patient usage, that it is in conformity with the criteria and standards developed in accordance with this part. (2) "Board" means the Drug Ut…

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) Except as required by Subsection, as terms of current board members expir…

26B-3-303. DUR Board -- Responsibilities. The board shall: (1) develop rules necessary to carry out its responsibilities as defined in this part; (2) oversee the implementation of a Medicaid retrospective and prospective DUR program in accordance with this part, including respons…

26B-3-304. Confidentiality of records. (1) Information obtained under this part shall be treated as confidential or controlled information under. Title 63G, Chapter 2, Government Records Access and Management Act (2) The board shall establish procedures ensuring that the informat…

26B-3-305. Drug prior approval program. (1) A drug prior approval program approved or implemented by the board shall meet the following conditions: except as provided in Subsection, a drug may not be placed on prior approval for other than medical reasons; (2) the board shall hol…

26B-3-306. Advisory committees. The board may establish advisory committees to assist it in carrying out its duties under Sectionsthrough.

26B-3-307. Retrospective and prospective DUR. (1) The board, in cooperation with the division, shall include in its state plan the creation and implementation of a retrospective and prospective DUR program for Medicaid outpatient drugs to ensure that prescriptions are appropriate…

26B-3-308. Penalties. Any person who violates the confidentiality provisions of Sectionsthroughis guilty of a class B misdemeanor.

26B-3-309. Immunity. There is no liability on the part of, and no cause of action of any nature arises against any member of the board, its agents, or employees for any action or omission by them in effecting the provisions of Sectionsthrough.

26B-3-310. Purpose -- Medicaid certification of nursing care facilities. (1) The Legislature finds: that an oversupply of nursing care facilities in the state adversely affects the state Medicaid program and the health of the people in the state; it is in the best interest of the…

26B-3-311. Authorization to renew, transfer, or increase Medicaid certified programs -- Reimbursement methodology. (1) The division may renew Medicaid certification of a certified program if the program, without lapse in service to Medicaid recipients, has its nursing care facili…

26B-3-312. Appeals of division decision -- Rulemaking authority -- Application of act. (1) A decision by the director under this part to deny Medicaid certification for a nursing care facility program or to deny additional bed capacity for an existing certified program is subject…

26B-3-313. Authorization to sell or transfer licensed Medicaid beds -- Duties of transferor -- Duties of transferee -- Duties of division. (1) This section provides a method to transfer or sell the license for a Medicaid bed from a nursing care facility program to another entity …

26B-3-401. Definitions. As used in this part: (1) "Nursing care facility" means: a nursing care facility as defined in Section; 26B-2-201 a designated swing bed in: a general acute hospital as defined in Section; and 26B-2-201 a critical access hospital which meets the criteria o…

26B-3-402. Legislative findings. (1) The Legislature finds that there is an important state purpose to improve the quality of care given to persons who are elderly and to people who have a disability, in long-term care nursing facilities. (2) The Legislature finds that in order t…

26B-3-403. Collection, remittance, and payment of nursing care facilities assessment. (1) An assessment is imposed upon each nursing care facility in the amount designated in Subsection (1)(c). The department shall establish by rule, a uniform rate per non-Medicare patient day th…

26B-3-404. Penalties . (1) The division shall require a nursing care facility that fails to pay an assessment due under this part to pay to the division, in addition to the assessment, a penalty determined by the division. (2) The department may waive the imposition of a penalty …

26B-3-405. Adjustment to nursing care facility Medicaid reimbursement rates. If federal law or regulation prohibits the money in the Nursing Care Facilities Provider Assessment Fund from being used in the manner set forth in Subsection, the rates paid to nursing care facilities f…

26B-3-406. Intermediate care facility for people with an intellectual disability -- Uniform rate. An intermediate care facility for people with an intellectual disability is subject to all the provisions of this part, except that the department shall establish a uniform rate for …

26B-3-501. Definitions. As used in this part: (1) "Assessment" means the inpatient hospital assessment established by this part. (2) "CMS" means the Centers for Medicare and Medicaid Services within the United States Department of Health and Human Services. (3) "Discharges" means…

26B-3-502. Application. (1) Other than for the imposition of the assessment described in this part, nothing in this part shall affect the nonprofit or tax exempt status of any nonprofit charitable, religious, or educational health care provider under any: state law; ad valorem pr…

26B-3-503. Assessment. (1) An assessment is imposed on each private hospital: in the amount designated in Sectionsand; and 26B-3-506 26B-3-507 in accordance with Section. 26B-3-504 (2) Subject to Section, the assessment imposed by this part is due and payable on a quarterly basis…

26B-3-504. Collection of assessment -- Deposit of revenue -- Rulemaking. (1) The collecting agent for the assessment imposed under Sectionis the department. 26B-3-503 (2) The department is vested with the administration and enforcement of this part, and may make rules in accordan…

26B-3-505. Quarterly notice. (1) Quarterly assessments imposed by this part shall be paid to the division within 15 business days after the original invoice date that appears on the invoice issued by the division. (2) The department may, by rule, extend the time for paying the as…

26B-3-506. Hospital financing of health coverage improvement program Medicaid waiver expansion -- Hospital share. (1) The hospital share is: 45% of the state's net cost of the health coverage improvement program, including Medicaid coverage for individuals with dependent children…