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

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) Except as provided in Subsectionthe culpable mental state required for a criminal violation of this part is knowingly, intentionally, or recklessly as defined in Section. (1)(b) 76-2-103 The culpable mental state required for a criminal violati…

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

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

26B-3-1110. Revocation of license of assisted living facility -- Appointment of receiver. (1) 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 and …

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 …

26B-3-1112. Violation of other laws. (1) The provisions of this part are: not exclusive, and the remedies provided for in this part are in addition to any other remedies provided for under: any other applicable law; or common law; and to be liberally construed and applied to: eff…

26B-3-1113. Medicaid fraud enforcement. (1) This part shall be enforced in accordance with this section. (2) The department is responsible for: investigating and prosecuting suspected civil violations of this part; or referring suspected civil violations of this part to the attor…

26B-3-1114. Investigations -- Civil investigative demands. (1) The attorney general may take investigative action under Subsection (2) if the attorney general has reason to believe that: a person has information or custody or control of documentary material relevant to the subjec…

26B-3-1115. Limitation of actions -- Civil acts antedating this section -- Civil burden of proof -- Estoppel -- Joint civil liability -- Venue. (1) An action under this part may not be brought after the later of: six years after the date on which the violation was committed; or t…

26B-3-112. Maximizing use of premium assistance programs -- Utah's Premium Partnership for Health Insurance. (1) 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 cove…

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

26B-3-114. Department standards for eligibility under Medicaid -- Funds for abortions. (1) 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 An applicant rec…

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, 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 (2) an amo…

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,,,,, andto the extent that these sections pertain to benefits conferred or administered by the division under this chapter, to the extent allowed und…

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 subcontractor, subsidiary, or parent organization of a risk contractor; or a party with…

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

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

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) 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: the communication by telemedicine me…

26B-3-123. Reimbursement of telemedicine services and telepsychiatric consultations. (1) As used in this section: "Telehealth services" means the same as that term is defined in Section. 26B-4-704 "Telemedicine services" means the same as that term is defined in Section. 26B-4-70…

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: the chil…

26B-3-125. Medicaid -- Continuous eligibility -- Promoting payment and delivery reform. (1) In accordance with Subsection, and within appropriations from the Legislature, the department may amend the state Medicaid plan to: (2) create continuous eligibility for up to 12 months fo…

26B-3-126. Patient notice of health care provider privacy practices. (1) For purposes of this section: "Health care provider" means a health care provider as defined in Sectionwho: 78B-3-403 receives payment for medical services from the Medicaid program established in this chapt…

26B-3-127. Optional Medicaid expansion. (1) The department and the governor may not expand the state's Medicaid program under PPACA unless: the department expands Medicaid in accordance with Section; or 26B-3-210 the governor or the governor's designee has reported the intention …

26B-3-128. Medicaid vision services -- Request for proposals. The department may select one or more contractors, in accordance with, to provide vision services to the Medicaid populations that are eligible for vision services, as described in department rules, without restricting…

26B-3-129. Review of claims -- Audit and investigation procedures. (1) 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 an…

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

26B-3-131. Screening, Brief Intervention, and Referral to Treatment Medicaid reimbursement. (1) As used in this section: "Controlled substance prescriber" means a controlled substance prescriber, as that term is defined in Section, who: 58-37-303 has a record of having completed …

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: an intrauterine d…

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: for an enrollee …

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, relates in any way to recovery of Medicaid funds: Title 63G, Chapter 4, Administrative Procedures Act the presiding officer shall be designated by the executive director o…

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

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: "Adoption assistance" means the same as that term is defined in Section. 80-2-…

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

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: income; residency; identity; and citize…

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 citizen or national of the United States; an alien lawfully admitted for permanent residence as an imm…

26B-3-142.4. Multi-state enrollment. (1) The department shall: 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; conduct cross-checks regarding all add…

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: receive and review information from the death master file; conduct…