Title 26B, Utah Health and Human Services Code

26B-3-1005. Insurance policies not to deny or reduce benefits of individuals eligible for state medical assistance -- Exemptions. (1) A policy of accident or sickness insurance may not contain any provision denying or reducing benefits because services are rendered to an insured …

26B-3-1006. Availability of insurance policy. If the third party does not pay the department's claim or lien within 30 days from the date the claim or lien is received, the third party shall: (1) provide a written explanation if the claim is denied; (2) specifically describe and …

26B-3-1007. Employee benefit plans. As allowed pursuant to 29 U.S.C. Sec. 1144, an employee benefit plan may not include any provision that has the effect of limiting or excluding coverage or payment for any health care for an individual who would otherwise be covered or entitled…

26B-3-1008. Statute of limitations -- Survival of right of action -- Insurance policy not to limit time allowed for recovery. (1)(a) Subject to Subsection (6), action commenced by the department under this part against a health insurance entity shall be commenced within: (i) subj…

26B-3-1009. Recovery of medical assistance from third party -- Lien -- Notice -- Action -- Compromise or waiver -- Recipient's right to action protected. (1)(a) Except as provided in Subsection (1)(c), if the department provides or becomes obligated to provide medical assistance …

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) …

26B-3-1010. Action by department -- Notice to recipient. (1)(a) Within 30 days after commencing an action under Subsection 26B-3-1009(3), the department shall give the recipient, the recipient's guardian, personal representative, trustee, estate, or survivor, whichever is appropr…

26B-3-1011. Notice of claim by recipient -- Department response -- Conditions for proceeding -- Collection agreements. (1)(a) A recipient may not file a claim, commence an action, or settle, compromise, release, or waive a claim against a third party for recovery of medical costs…

26B-3-1012. Department's right to intervene -- Department's interests protected -- Remitting funds -- Disbursements -- Liability and penalty for noncompliance. (1) The department has an unconditional right to intervene in an action commenced by a recipient against a third party f…

26B-3-1013. Estate and trust recovery. (1)(a) Except as provided in Subsection (1)(b), upon a recipient's death, the department may recover from the recipient's recovery estate and any trust, in which the recipient is the grantor and a beneficiary, medical assistance correctly pr…

26B-3-1014. Recovery from recipient of incorrectly provided medical assistance. The department may: (1) recover medical assistance incorrectly provided, whether due to administrative or factual error or fraud, from the recipient or the recipient's recovery estate; and (2) pursuan…

26B-3-1015. TEFRA liens authorized -- Grounds for TEFRA liens -- Exemptions. (1) Except as provided in Subsections (2) and (3), the department may impose a TEFRA lien on the real property of an individual for the amount of medical assistance provided for, or to, the individual wh…

26B-3-1016. Presumption of permanency. There is a rebuttable presumption that an individual who is an inpatient in a care facility cannot reasonably be expected to be discharged from a care facility and return to the individual's home, if the individual has been an inpatient in a…

26B-3-1017. Preliminary notice of intent to impose a TEFRA lien. (1) Prior to imposing a TEFRA lien on real property, the department shall serve a preliminary notice of intent to impose a TEFRA lien, on the individual described in Subsection 26B-3-1015(1), who owns the property. …

26B-3-1018. Final notice of intent to impose a TEFRA lien. (1) The department may issue a final notice of intent to impose a TEFRA lien on real property if: (a) a preliminary notice of intent relating to the property is served in accordance with Section 26B-3-1017; (b) it is at l…

26B-3-1019. Review of department decision. An individual who has been served with a final notice of intent to impose a TEFRA lien under Section 26B-3-1018 may seek agency or judicial review of that decision under Title 63G, Chapter 4, Administrative Procedures Act.

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-3-9…

26B-3-1020. Dissolution and removal of TEFRA lien. (1) A TEFRA lien shall dissolve and be removed by the department if the individual described in Subsection 26B-3-1015(1): (a)(i) is discharged from the care facility; and (ii) returns to the individual's home; or (b) provides suf…

26B-3-1021. Expenditures included in lien -- Other proceedings. (1) A TEFRA lien imposed on real property under Sections 26B-3-1015 through 26B-3-1023 includes all expenses relating to medical assistance provided or paid for under the state plan from the first day that the indivi…

26B-3-1022. Contract with another government agency. If the department contracts with another government agency to recover funds paid for medical assistance under this part, that government agency shall be the sole agency that determines whether to impose or remove a TEFRA lien u…

26B-3-1023. Precedence of the Tax Equity and Fiscal Responsibility Act of 1982. If any provision of Sections 26B-3-1015 through 26B-3-1023 conflict with the requirements of the Tax Equity and Fiscal Responsibility Act of 1982 for imposing a lien against the property of an individ…

26B-3-1024. Legal recognition of electronic claims records. Pursuant to Title 46, Chapter 4, Uniform Electronic Transactions Act: (1) a claim submitted to the department for payment may not be denied legal effect, enforceability, or admissibility as evidence in any court in any c…

26B-3-1025. Direct payment to the department by third party. (1) Any third party required to make payment to the department pursuant to this part shall make the payment directly to the department or its designee. (2) The department may negotiate a payment or payment instrument it…

26B-3-1026. Attorney general or county attorney to represent department. The attorney general or a county attorney shall represent the department in any action commenced under this part.

26B-3-1027. Department's right to attorney fees and costs. In any action brought by the department under this part in which it prevails, the department shall recover along with the principal sum and interest, a reasonable attorney fee and costs incurred.

26B-3-1028. Application of provisions contrary to federal law prohibited. In no event shall any provision contained in this part be applied contrary to existing federal law.

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 e…

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 …

26B-3-105. Medicaid drug program -- Preferred drug list. (1) As used in this section: (a) "Immunosuppressive drug" means a drug that: (i) is used in immunosuppressive therapy to inhibit or prevent activity of the immune system to aid the body in preventing the rejection of transp…

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 ren…

26B-3-107. Dental benefits. (1)(a) The division may: (i) establish a dental health care delivery system and payment reform pilot program for Medicaid dental benefits to increase access to cost effective and quality dental health care by increasing the number of dentists available…

26B-3-108. Administration of Medicaid program by department -- Reporting to the Legislature -- Disciplinary measures and sanctions -- Funds collected -- Eligibility standards -- Optional dental services costs and delivery -- Internal audits -- Health opportunity accounts. (1) The…

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 …

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 l…

26B-3-1101. Definitions. As used in this part: (1) "Benefit" means the receipt of money, goods, or any other thing of pecuniary value. (2) "Claim" means any request or demand for money or property: (a) made to any: (i) employee, officer, or agent of the state; (ii) contractor wit…

26B-3-1102. False statement or representation relating to medical benefits. (1) A person may not make or cause to be made a false statement or false representation of a material fact in an application for medical benefits. (2) A person may not make or cause to be made a false sta…

26B-3-1103. Kickbacks or bribes prohibited. (1) For purposes of this section, kickback or bribe: (a) includes rebates, compensation, or any other form of remuneration which is: (i) direct or indirect; (ii) overt or covert; or (iii) in cash or in kind; and (b) does not include a r…

26B-3-1104. False statements or false representations relating to qualification of health institution or facility prohibited -- Felony. (1) A person may not knowingly, intentionally, or recklessly make, induce, or seek to induce, the making of a false statement or false represent…

26B-3-1105. Conspiracy to defraud prohibited. A person may not enter into an agreement, combination, or conspiracy to defraud the state by obtaining or aiding another to obtain the payment or allowance of a false, fictitious, or fraudulent claim for a medical benefit.

26B-3-1106. False claims for medical benefits prohibited. (1) A person may not make or present or cause to be made or presented to an employee or officer of the state a claim for a medical benefit: (a) which is wholly or partially false, fictitious, or fraudulent; (b) for service…

26B-3-1107. Knowledge of past acts not necessary to establish fact that false statement or representation knowingly made. In prosecution under this part, it is not necessary to show that the person had knowledge of similar acts having been performed in the past on the part of per…

26B-3-1108. Criminal penalties. (1)(a) Except as provided in Subsection (1)(b) the culpable mental state required for a criminal violation of this part is knowingly, intentionally, or recklessly as defined in Section 76-2-103. (b) The culpable mental state required for a criminal…

26B-3-1109. Civil penalties. (1) The culpable mental state required for a civil violation of this part is "knowing" or "knowingly" which: (a) means that person, with respect to information: (i) has actual knowledge of the information; (ii) acts in deliberate ignorance of the trut…

26B-3-111. Income and resources from institutionalized spouses. (1) As used in this section: (a) "Community spouse" means the spouse of an institutionalized spouse. (b)(i) "Community spouse monthly income allowance" means an amount by which the minimum monthly maintenance needs a…

26B-3-1110. Revocation of license of assisted living facility -- Appointment of receiver. (1)(a) If the license of an assisted living facility is revoked for violation of this part, the county attorney may bring a petition in a court with jurisdiction under Title 78A, Judiciary a…

26B-3-1111. Presumption based on paid state warrant -- Value of medical benefits -- Repayment of benefits. (1) In any civil or criminal action brought under this part, a paid state warrant, made payable to the order of a party, creates a presumption that the party received funds …