Title 26B, Utah Health and Human Services Code

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 c…

26B-3-113. Expanding the Medicaid program. (1) As used in this section: (a) "Federal poverty level" means the same as that term is defined in Section 26B-3-207. (b) "Medicaid ACA Fund" means the Medicaid ACA Fund created in Section 26B-1-315. (c) "Medicaid expansion" means an exp…

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 if the standards and policies comply with Section 26B-3-108. (b) An applic…

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 pro…

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 …

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 di…

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…

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 …

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 eac…

26B-3-1201. Definitions. As used in this part: (1) "Agent" means a person that has express or implied authority to obligate or act on behalf of another person. (2) "Affiliated person" means: (a) a subcontractor, subsidiary, or parent organization of a risk contractor; or (b) a pa…

26B-3-1202. Medicaid managed care quality data -- Dashboard-- Reporting requirements -- Rulemaking authority. (1)(a) By December 31, 2026, the division shall establish and maintain a dashboard to report the data described in this Subsection (1) that is: (i) online on the division…

26B-3-1203. Identifying improper payments -- Repayment -- Prevention. (1) Each risk contractor and subcontractor shall quarterly: (a) identify and document all improper payments; (b) conduct a root cause analysis for each type of improper payment; (c) repay all improper payments …

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 discrimin…

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 telemedi…

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 2…

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 …

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 month…

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 i…

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…

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 descr…

26B-3-129. Review of claims -- Audit and investigation procedures. (1)(a) The department shall adopt administrative rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, and in consultation with providers and health care professionals subject to audit…

26B-3-130. Medicaid intergovernmental transfer report -- Approval requirements. (1) As used in this section: (a)(i) "Intergovernmental transfer" means the transfer of public funds from: (A) a local government entity to another nonfederal governmental entity; or (B) from a nonfede…

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 58-37-303, who: (i) has a record of having co…

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 prog…

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 intrauteri…

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 enrol…

26B-3-135. Reimbursement for nonemergency secured behavioral health transport providers. (1) As used in this section, "nonemergency secured behavioral health transport" means the same as that term is defined in Section 53-2d-101. (2) The department may reimburse a nonemergency se…

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 …

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 direct…

26B-3-140. Medical assistance accountability -- Division duties -- Reporting. (1) As used in this section: (a) "Abuse" means: (i) an action or practice that: (A) is inconsistent with sound fiscal, business, or medical practices; and (B) results, or may result, in unnecessary Medi…

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…

26B-3-142.1. Medicaid work requirements. (1) As used in this section: (a) "Applicable individual" means an individual who: (i) is eligible to enroll in Medicaid under 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII); or (ii)(A) is eligible to enroll under a waiver that provides coverage t…

26B-3-142.2. Verification of eligibility. (1) Except as required under federal law, the department may not accept self-attestation of any of the following in the administration of the Medicaid program without verification before enrollment: (a) income; (b) residency; (c) identity…

26B-3-142.3. Citizenship requirements. (1) As used in this section, "qualified citizen" means a resident of the United States and meets at least one of the following criteria: (a) a citizen or national of the United States; (b) an alien lawfully admitted for permanent residence a…

26B-3-142.4. Multi-state enrollment. (1)(a) The department shall: (i) receive and review address change information from returned mail by the United States Postal Service, the National Change of Address database, and accountable care organizations; (ii) conduct cross-checks regar…

26B-3-142.5. Remove deceased enrollees. (1) As used in this section, "death master file" means the database maintained by the Social Security Administration that contains reported deaths. (2) The department shall: (a) receive and review information from the death master file; (b)…

26B-3-142.6. Retroactive eligibility. (1) As used in this section: (a) "Expansion population" means the population who is enrolled in the Medicaid program under 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII). (b) "Traditional population" means the population who is enrolled in Medicaid …

26B-3-143. Medicaid provider quality measures -- Reporting -- Eligibility for incentive payments. (1) As used in this section: (a) "Incentive payment" means a one-time fee-for-services payment to a participating Medicaid provider, including a managed care entity or a Medicaid pro…

26B-3-144. Closed loop referral system. (1) As used in this section: (a) "Authorized user" means a social needs care provider authorized by rules the department makes to use a closed loop referral system. (b) "Closed loop referral system" means a system that enables efficient out…

26B-3-201. 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 I…

26B-3-202. Waivers to maximize replacement of fee-for-service delivery model -- Cost of mandated program changes. (1) The department shall develop a waiver program in the Medicaid program to replace the fee-for-service delivery model with one or more risk-based delivery models. (…

26B-3-203. Base budget appropriations for Medicaid accountable care organizations and behavioral health plans -- Forecast of behavioral health services cost, behavioral health plans, and ABA services -- Forecast of behavioral health services cost. (1) As used in this section: (a)…

26B-3-204. Incentives to appropriately use emergency department services. (1)(a) This section applies to the Medicaid program and to the Utah Children's Health Insurance Program created in Section 26B-3-902. (b) As used in this section: (i) "Managed care organization" means a com…

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) …

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…

26B-3-207. Health coverage improvement program -- Eligibility -- Annual report -- Expansion of eligibility for adults with dependent children. (1) As used in this section: (a) "Adult in the expansion population" means an individual who: (i) is described in 42 U.S.C. Sec. 1396a(a)…