Rep. Norm Thurston — Voting Record

Bill

Number

H.B. 172 (2017GS)

Sponsor

Rep. Cutler, B. R.

Final action

Governor Signed 3/17/2017

Outcome

Became law — signed by Gov. Gary R. Herbert

Summary

What it does

• This bill:
• instructs the state Medicaid program to:
• seek a plan amendment to disregard resources held by an applicant in a Utah Educational Savings Plan account when determining eligibility for certain benefits in the Medicaid program; and
• implement the plan amendment for benefit determinations made on or after the date of the approval of the state plan amendment; and
• makes technical amendments.

Every vote on this bill

Bill text

UTAH EDUCATIONAL SAVINGS PLAN MEDICAID
EXEMPTIONS
GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Bruce R. Cutler
Senate Sponsor: 
 Brian E. Shiozawa
LONG TITLE
General Description:
This bill amends the Medical Assistance Act in the Utah Health Code.
Highlighted Provisions:
This bill:
▸ instructs the state Medicaid program to:
• seek a plan amendment to disregard resources held by an applicant in a Utah
Educational Savings Plan account when determining eligibility for certain
benefits in the Medicaid program; and
• implement the plan amendment for benefit determinations made on or after the
date of the approval of the state plan amendment; and
▸ makes technical amendments.
Money Appropriated in this Bill:
None
Other Special Clauses:
None
Utah Code Sections Affected:
AMENDS:
26-18-3
, as last amended by Laws of Utah 2016, Chapter 168
26-18-10
, as last amended by Laws of Utah 2013, Chapter 167
26-40-103
, as last amended by Laws of Utah 2013, Chapter 167
Be it enacted by the Legislature of the state of Utah:
Section 1. Section 
26-18-3
 is amended to read:
26-18-3.
Administration of Medicaid program by department -- Reporting to the
Legislature -- Disciplinary measures and sanctions -- Funds collected -- Eligibility
standards -- Internal audits -- Health opportunity accounts.
(1) The department shall be the single state agency responsible for the administration
of the Medicaid program in connection with the United States Department of Health and
Human Services pursuant to Title XIX of the Social Security Act.
(2) (a) The department shall implement the Medicaid program through administrative
rules in conformity with this chapter, Title 63G, Chapter 3, Utah Administrative Rulemaking
Act, the requirements of Title XIX, and applicable federal regulations.
(b) The rules adopted under Subsection (2)(a) shall include, in addition to other rules
necessary to implement the program:
(i) the standards used by the department for determining eligibility for Medicaid
services;
(ii) the services and benefits to be covered by the Medicaid program;
(iii) reimbursement methodologies for providers under the Medicaid program; and
(iv) a requirement that:
(A) a person receiving Medicaid services shall participate in the electronic exchange of
clinical health records established in accordance with Section 
26-1-37
 unless the individual
opts out of participation;
(B) prior to enrollment in the electronic exchange of clinical health records the enrollee
shall receive notice of enrollment in the electronic exchange of clinical health records and the
right to opt out of participation at any time; and
(C) beginning July 1, 2012, when the program sends enrollment or renewal information
to the enrollee and when the enrollee logs onto the program's website, the enrollee shall receive
notice of the right to opt out of the electronic exchange of clinical health records.
(3) (a) The department shall, in accordance with Subsection (3)(b), report to the Social
Services Appropriations Subcommittee when the department:
(i) implements a change in the Medicaid State Plan;
(ii) initiates a new Medicaid waiver;
(iii) initiates an amendment to an existing Medicaid waiver;
(iv) applies for an extension of an application for a waiver or an existing Medicaid
waiver; or
(v) initiates a rate change that requires public notice under state or federal law.
(b) The report required by Subsection (3)(a) shall:
(i) be submitted to the Social Services Appropriations Subcommittee prior to the
department implementing the proposed change; and
(ii) include:
(A) a description of the department's current practice or policy that the department is
proposing to change;
(B) an explanation of why the department is proposing the change;
(C) the proposed change in services or reimbursement, including a description of the
effect of the change;
(D) the effect of an increase or decrease in services or benefits on individuals and
families;
(E) the degree to which any proposed cut may result in cost-shifting to more expensive
services in health or human service programs; and
(F) the fiscal impact of the proposed change, including:
(I) the effect of the proposed change on current or future appropriations from the
Legislature to the department;
(II) the effect the proposed change may have on federal matching dollars received by
the state Medicaid program;
(III) any cost shifting or cost savings within the department's budget that may result
from the proposed change; and
(IV) identification of the funds that will be used for the proposed change, including any
transfer of funds within the department's budget.
(4) Any rules adopted by the department under Subsection (2) are subject to review and
reauthorization by the Legislature in accordance with Section 
63G-3-502
.
(5) The department may, in its discretion, contract with the Department of Human
Services or other qualified agencies for services in connection with the administration of the
Medicaid program, including:
(a) the determination of the eligibility of individuals for the program;
(b) recovery of overpayments; and
(c) consistent with Section 
26-20-13
, and to the extent permitted by law and quality
control services, enforcement of fraud and abuse laws.
(6) The department shall provide, by rule, disciplinary measures and sanctions for
Medicaid providers who fail to comply with the rules and procedures of the program, provided
that sanctions imposed administratively may not extend beyond:
(a) termination from the program;
(b) recovery of claim reimbursements incorrectly paid; and
(c) those specified in Section 1919 of Title XIX of the federal Social Security Act.
(7) Funds collected as a result of a sanction imposed under Section 1919 of Title XIX
of the federal Social Security Act shall be deposited in the General Fund as dedicated credits to
be used by the division in accordance with the requirements of Section 1919 of Title XIX of
the federal Social Security Act.
(8) (a) In determining whether an applicant or recipient is eligible for a service or
benefit under this part or Chapter 40, Utah Children's Health Insurance Act, the department
shall, if Subsection (8)(b) is satisfied, exclude from consideration one passenger vehicle
designated by the applicant or recipient.
(b) Before Subsection (8)(a) may be applied:
(i) the federal government shall:
(A) determine that Subsection (8)(a) may be implemented within the state's existing
public assistance-related waivers as of January 1, 1999;
(B) extend a waiver to the state permitting the implementation of Subsection (8)(a); or
(C) determine that the state's waivers that permit dual eligibility determinations for
cash assistance and Medicaid are no longer valid; and
(ii) the department shall determine that Subsection (8)(a) can be implemented within
existing funding.
(9) (a) For purposes of this Subsection (9):
(i) "aged, blind, or has a disability" means an aged, blind, or disabled individual, as
defined in 42 U.S.C. Sec. 1382c(a)(1); and
(ii) "spend down" means an amount of income in excess of the allowable income
standard that shall be paid in cash to the department or incurred through the medical services
not paid by Medicaid.
(b) In determining whether an applicant or recipient who is aged, blind, or has a
disability is eligible for a service or benefit under this chapter, the department shall use 100%
of the federal poverty level as:
(i) the allowable income standard for eligibility for services or benefits; and
(ii) the allowable income standard for eligibility as a result of spend down.
(10) The department shall conduct internal audits of the Medicaid program.
(11) (a) The department may apply for and, if approved, implement a demonstration
program for health opportunity accounts, as provided for in 42 U.S.C. Sec. 1396u-8.
(b) A health opportunity account established under Subsection (11)(a) shall be an
alternative to the existing benefits received by an individual eligible to receive Medicaid under
this chapter.
(c) Subsection (11)(a) is not intended to expand the coverage of the Medicaid program.
(12) (a) (i) The department shall apply for, and if approved, implement an amendment
to the state plan under this Subsection (12) for benefits for:
(A) medically needy pregnant women;
(B) medically needy children; and
(C) medically needy parents and caretaker relatives.
(ii) The department may implement the eligibility standards of Subsection (12)(b) for
eligibility determinations made on or after the date of the approval of the amendment to the
state plan.
(b) In determining whether an applicant is eligible for benefits described in Subsection
(12)(a)(i), the department shall:
(i) disregard resources held in an account in the savings plan created under Title 53B,
Chapter 8a, Utah Educational Savings Plan, if the beneficiary of the account is:
(A) under the age of 26; and
(B) living with the account owner, as that term is defined in Section 
53B-8a-102
, or
temporarily absent from the residence of the account owner; and
(ii) include the withdrawals from an account in the Utah Educational Savings Plan as
resources for a benefit determination, if the withdrawal was not used for qualified higher
education costs as that term is defined in Section 
53B-8a-102
.
Section 2. Section 
26-18-10
 is amended to read:
26-18-10.
Utah Medical Assistance Program -- Policies and standards.
(1) The division shall develop a medical assistance program, which shall be known as
the Utah Medical Assistance Program, for low income persons who are not eligible under the
state plan for Medicaid under Title XIX of the Social Security Act or Medicare under Title
XVIII of that act.
(2) Persons in the custody of prisons, jails, halfway houses, and other nonmedical
government institutions are not eligible for services provided under this section.
(3) The department shall develop standards and administer policies relating to
eligibility requirements, consistent with [
Subsection
] 
Section
26-18-3
[
(8)
], for participation in
the program, and for payment of medical claims for eligible persons.
(4) The program shall be a payor of last resort. Before assistance is rendered the
division shall investigate the availability of the resources of the spouse, father, mother, and
adult children of the person making application.
(5) The department shall determine what medically necessary care or services are
covered under the program, including duration of care, and method of payment, which may be
partial or in full.
(6) The department may not provide public assistance for medical, hospital, or other
medical expenditures or medical services to otherwise eligible persons where the purpose of
the assistance is for the performance of an abortion, unless the life of the mother would be
endangered if an abortion were not performed.
(7) The department may establish rules to carry out the provisions of this section.
Section 3. Section 
26-40-103
 is amended to read:
26-40-103.
Creation and administration of the Utah Children's Health Insurance
Program.
(1) There is created the Utah Children's Health Insurance Program to be administered
by the department in accordance with the provisions of:
(a) this chapter; and
(b) the State Children's Health Insurance Program, 42 U.S.C. Sec. 1397aa et seq.
(2) The department shall:
(a) prepare and submit the state's children's health insurance plan before May 1, 1998,
and any amendments to the federal Department of Health and Human Services in accordance
with 42 U.S.C. Sec. 1397ff; and
(b) make rules in accordance with Title 63G, Chapter 3, Utah Administrative
Rulemaking Act regarding:
(i) eligibility requirements consistent with [
Subsection
] 
Section
26-18-3
[
(8)
];
(ii) program benefits;
(iii) the level of coverage for each program benefit;
(iv) cost-sharing requirements for enrollees, which may not:
(A) exceed the guidelines set forth in 42 U.S.C. Sec. 1397ee; or
(B) impose deductible, copayment, or coinsurance requirements on an enrollee for
well-child, well-baby, and immunizations;
(v) the administration of the program; and
(vi) a requirement that:
(A) enrollees in the program shall participate in the electronic exchange of clinical
health records established in accordance with Section 
26-1-37
 unless the enrollee opts out of
participation;
(B) prior to enrollment in the electronic exchange of clinical health records the enrollee
shall receive notice of the enrollment in the electronic exchange of clinical health records and
the right to opt out of participation at any time; and
(C) beginning July 1, 2012, when the program sends enrollment or renewal information
to the enrollee and when the enrollee logs onto the program's website, the enrollee shall receive
notice of the right to opt out of the electronic exchange of clinical health records.
Legislative Review Note
Office of Legislative Research and General Counsel