Title 31A, Insurance Code

31A-44-405. Continuing care facilities not exempt from property tax. Notwithstanding any tax-exempt status of a provider or facility, a provider or facility is liable for property tax due under Title 59, Chapter 2, Property Tax Act.

31A-44-501.1. Receivership. (1) The department may, by petition or motion, request that a court appoint the commissioner as receiver for a provider. (2) The court may appoint the commissioner as receiver if, as determined by the commissioner, the provider: (a) is insolvent or at …

31A-44-502. Relief available. (1) In a judicial proceeding, including under Sections 31A-44-501 and 31A-44-501.1, a court may: (a) direct a receiver to take possession of the provider's property in order to conduct the provider's business, including employing any manager or agent…

31A-44-504. Bond. A court may refuse to make or vacate an order to rehabilitate a provider's facility under this part if the provider posts a bond that is: (1) in an amount that the court determines is equal to the reserve funding the provider needs to fulfill the provider's obli…

31A-44-505. Termination of receivership. (1) A court may terminate a receivership of a provider's facility and order the return of the facility and the facility's assets to the provider if the court determines: (a) the objectives of the receivership orders have been accomplished;…

31A-44-506. Payment of receiver. A receiver's and any deputy receiver's reasonable costs, expenses, and fees are payable from a provider's or facility's assets.

31A-44-601. Lien held by the commissioner in favor of a resident or a group of residents. (1) To secure the obligations of the provider to a resident or a group of residents under a continuing care contract, the commissioner holds a lien in favor of the resident or group of resid…

31A-44-602. Enforcement by department -- Rulemaking. (1) Subject to the requirements of Title 63G, Chapter 4, Administrative Procedures Act, the department may: (a) receive and act on a complaint from a resident about a provider or a facility; (b) take action designed to obtain v…

31A-44-603. Examinations. (1) The department may conduct periodic on-site examinations of a provider. (2) In conducting an examination, the department or the department's staff: (a) shall have full and free access to all the provider's records; and (b) may summon and qualify as a…

31A-44-604. Criminal and civil penalties. (1) A person who knowingly violates this chapter or files materially false information with a registration application or renewal under this chapter is: (a) guilty of a class B misdemeanor; and (b) subject to revocation of the person's re…

31A-44-605. Civil liability. (1) A provider who enters into a continuing care contract with an individual without complying with the disclosure statement requirement described in this chapter, or who makes a continuing care contract with an individual who relies on a disclosure s…

31A-45-101. Title. This chapter is known as "Managed Care Organizations."

31A-45-102. Definitions. As used in this chapter: (1) "Covered benefit" or "benefit" means the health care services to which a covered person is entitled under the terms of a health care insurance plan offered by a managed care organization. (2) "Managed care organization" means:…

31A-45-103. Managed care contract standards. The commissioner shall adopt rules relating to standards for the manner and content of policy provisions, and disclosures to be made in connection with the sale of policies covered by this chapter, dealing with at least the following m…

31A-45-201. Applicability to other provisions of law -- Commissioner discretion. (1) Except for exemptions specifically granted under this title, a managed care organization is subject to regulation under all of the provisions of this title. (2) The commissioner may by rule waive…

31A-45-301. Written contracts -- Limited liability of enrollee -- Provider claim disputes -- Leased networks. (1) A managed care organization may not contract with a health care provider for treatment of illness or injury unless the health care provider is licensed to perform tha…

31A-45-302. Provider payment information -- Notice of admissions. (1)(a) A managed care organization shall provide the managed care organization's network providers access to current information necessary for the network provider to determine: (i) the effect of procedure codes on…

31A-45-303. Network provider contract provisions. (1) Managed care organizations may provide for enrollees to receive services or reimbursement in accordance with this section. (2)(a) Subject to restrictions under this section, a managed care organization may enter into contracts…

31A-45-304. Objective criteria for adding or terminating network providers -- Termination of contracts -- Review process. (1)(a) A managed care organization shall establish criteria for adding health care providers to a new or existing network provider panel. (b) Criteria under S…

31A-45-305. Prohibition on certain age-based physician testing. A managed care organization or other third party may not require for purposes of reimbursement that a physician, as defined in Section 58-67-102, take a cognitive test when the physician reaches a specified age, unle…

31A-45-401. Court ordered coverage for minor children who reside outside the service area. (1)(a) The requirements of Subsection (2) apply to a managed care organization if the managed care organization: (i) restricts coverage for nonemergency services to services provided by con…

31A-45-402. Alcohol and drug dependency treatment. (1) A managed care organization offering a health benefit plan providing coverage for alcohol or drug dependency treatment may require an inpatient facility to be licensed by: (a)(i) the Department of Health and Human Services, u…

31A-45-403. Essential health benefits. (1) The state designates the state's own essential health benefits benchmark plan and does not accept a federal determination of the essential health benefits benchmark plan under the PPACA. (2) The commissioner shall make rules in accordanc…

31A-45-501. Access to health care providers. (1) As used in this section: (a) "Class of health care provider" means a health care provider or a health care facility regulated by the state within the same professional, trade, occupational, or certification category established und…

31A-46-101. Title. This chapter is known as "Pharmacy Benefits Act."

31A-46-102. Definitions. As used in this chapter: (1) "340B drug" means a drug purchased through the 340B drug discount program by a 340B entity. (2) "340B drug discount program" means the 340B drug discount program described in 42 U.S.C. Sec. 256b. (3) "340B entity" means: (a) a…

31A-46-103. Rulemaking. In accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, the department may make rules to implement this chapter.

31A-46-201. License required. (1) A person may not perform, offer to perform, or advertise any pharmacy benefits management service in the state unless the person is licensed as a pharmacy benefit manager under this chapter. (2) A person may not utilize the services of another pe…

31A-46-202. Application for licensure. (1) To obtain or renew a license as a pharmacy benefit manager, a person shall: (a) submit an application to the commissioner on forms and in a manner established by the commissioner by rule made in accordance with Title 63G, Chapter 3, Utah…

31A-46-301. Reporting requirements. (1) Before April 1 of each year, a pharmacy benefit manager operating in the state shall report to the department, for the previous calendar year: (a) any insurer, pharmacy, or pharmacist in the state with which the pharmacy benefit manager had…

31A-46-302. Direct or indirect remuneration by pharmacy benefit managers -- Disclosure of customer costs -- Limit on customer payment for prescription drugs. (1) If a pharmacy service entity engages in direct or indirect remuneration with a pharmacy, the pharmacy service entity s…

31A-46-303. Insurer and pharmacy benefit management services -- Registration -- Maximum allowable cost -- Audit restrictions. (1) An insurer and an insurer's pharmacy benefit manager is subject to the pharmacy audit provisions of Section 58-17b-622. (2) A pharmacy benefit manager…

31A-46-304. Claims practices. (1) A pharmacy benefit manager shall permit a pharmacy to collect the amount of a customer's cost share from any source. (2) A pharmacy benefit manager may not deny or reduce a reimbursement to a pharmacy or a pharmacist after the adjudication of the…

31A-46-305. Pharmacy reimbursement. A pharmacy benefit manager shall reimburse a network pharmacy, in the aggregate, in an amount no less than the amount that the pharmacy benefit manager reimburses an affiliate of the pharmacy benefit manager in the same network, in the aggregat…

31A-46-306. Mailing or delivering prescription drugs. A pharmacy benefit manager or an insurer may not, directly or indirectly: (1) prohibit an in-network retail pharmacy from: (a) mailing or delivering a prescription drug to an enrollee as an ancillary service of the in-network …

31A-46-307. Pharmacy benefit manager reporting. (1) A pharmacy benefit manager may not enter into or renew a contract with an insurer on or after January 1, 2021, to administer or manage rebate contracting or rebate administration unless the pharmacy benefit manager agrees to reg…

31A-46-308. Out-of-state mail service pharmacies -- Drugs not readily available in all pharmacies. (1) As used in this section, "out-of-state mail service pharmacy" means the same as that term is defined in Section 58-17b-102. (2) Except as provided in Subsection (3), a third par…

31A-46-309. Reimbursement -- Prohibitions. (1) This section applies to a contract entered into or renewed on or after January 1, 2021, between a pharmacy benefit manager and a pharmacy. (2) A pharmacy benefit manager may not vary the amount it reimburses a pharmacy for a drug on …

31A-46-310. Prohibited actions with respect to a federally qualified health center. (1) As used in this section, "federally qualified health center": (a) means the same as that term is defined in 42 U.S.C. Sec. 1395x(aa)(4); and (b) includes the pharmacy or pharmacies that are op…

31A-46-311. Prohibited actions with respect to the 340B drug discount program. (1) As used in this section: (a) "340B covered entity" means the same as the term "covered entity" is defined in 42 U.S.C. Sec. 256b(a)(4). (b) "340B eligible drug" means a drug purchased through the 3…

31A-46-312. Options for self-funded health benefit plans. A pharmacy benefit manager shall offer to a self-funded health benefit plan, as an option for the self-funded health benefit plan's design, pharmacy benefit management services that: (1) comply with the provisions of Subse…

31A-46-401. Penalties. (1) The commissioner may order a pharmacy benefit manager who violates this chapter to forfeit to the state not more than $2,500 for each violation. (2) Each day the violation continues is a separate violation.

31A-46-402. Severability. If any provision of this chapter or the application of any provision of this chapter is found invalid, the remainder of this chapter shall be given effect without the invalid provision or application.

31A-48-101. Title. This chapter is known as "Prescription Drug Price Transparency Act."

31A-48-102. Definitions. As used in this chapter: (1)(a) "Drug" means a substance that is: (i)(A) intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in humans; and (B) recognized in or in a supplement to the official United States Pharmacopoe…

31A-48-103. Manufacturer reports -- Insurer report -- Publication by department. (1)(a) A manufacturer of a drug shall, beginning January 1, 2022, report to the department the information described in Subsection (1)(b) no more than 30 days after the day on which an increase to th…