Title 31A, Title 31A: Insurance Code

31A-44-310. Annual disclosure statement revision. (1) A provider shall file a revised disclosure statement with the department before 120 days after the day on which the provider's fiscal year ends. (2) The revised disclosure statement shall revise, as of the end of the provider'…

31A-44-311. Advertisement in conflict with disclosures. A provider may not engage in any type of advertisement for a continuing care contract or facility if the advertisement contains a statement or representation in conflict with the disclosures required under this part.

31A-44-312. Rescission of contract -- Required language. (1) An individual who executes a continuing care contract with a provider may rescind the contract at any time before the later of: midnight on the day seven days after the day on which the individual executes the continuin…

31A-44-313. Cancellation of contract -- Death or incapacity before occupancy. (1) A continuing care contract to provide continuing care in a living unit in a facility is cancelled if the resident: dies before occupying a living unit in the facility; or is precluded under the term…

31A-44-314. Disclosure statement fees. A provider that files a disclosure statement under this chapter shall pay to the department a fee established by the department in accordance with Section.

31A-44-315. Financial assessment. (1) The department shall assess the financial condition of a provider no less than once per year. (2) The department may consider any relevant documents and information in performing an assessment. (3) A provider shall prepare and timely provide …

31A-44-401. Continuing care contract requirements -- No waiver. (1) A continuing care contract shall: provide that the provider shall refund the portion of a departing resident's entrance fee that the provider has agreed to refund, if any, no later than the earlier of: if the dep…

31A-44-402. Actuarial reserve -- Priority of entrance fee refunds. (1) The department may require a provider that the department determines has actuarial liability under Sectionto create an additional reserve fund to offset the actuarial liability. 31A-44-204 (2) The department m…

31A-44-403. Resident advisory committee. (1) A provider shall maintain, beginning no later than two years after the day on which a facility is operational, a resident advisory committee for the facility that meets the requirements of this section. (2) A resident advisory committe…

31A-44-404. Nondisturbance of residents. (1) A person may not directly or indirectly disturb the rights of a resident or third party beneficiary under a continuing care contract and this chapter if the resident has substantially performed the resident's obligations under the cont…

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.

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: is insolvent or at mate…

31A-44-502. Relief available. (1) In a judicial proceeding, including under Sectionsand, a court may: 31A-44-501 31A-44-501.1 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 that…

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: the objectives of the receivership orders have been accomplished; and…

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, the department may: Title 63G, Chapter 4, Administrative Procedures Act receive and act on a complaint from a resident about a provider or a facility; take action designed to obtain voluntary…

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: shall have full and free access to all the provider's records; and may summon and qualify as a witness…

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: guilty of a class B misdemeanor; and subject to revocation of the person's registrati…

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 managed care organization shall provide the managed care organization's network providers access to current information necessary for the network provider to determine: the effect of procedure codes on paymen…

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) Subject to restrictions under this section, a managed care organization may enter into contracts wi…

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

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, take a cognitive test when the physician reaches a specified age, unless the tes…

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

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: the Department of Health and Human Services, under; o…

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: "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 under, …

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: an en…

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: submit an application to the commissioner on forms and in a manner established by the commissioner by rule made in accordance with; and Title 63G, Chapter 3, Uta…

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: any insurer, pharmacy, or pharmacist in the state with which the pharmacy benefit manager had a c…

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: mailing or delivering a prescription drug to an enrollee as an ancillary service of the in-network reta…

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…